Commentary

Sixty-six years after George Orwell penned his prophetic vision of 1984, many physicians are encountering tangible evidence that “Big Brother” is alive and well: Meaningful use audits are here, and we’ve heard from a lot of our readers that they are time consuming and disconcerting, if not a bit scary. We, too, have encountered Stage II audits and have helped physicians navigate audit mysteries, so we thought it would be a good idea to offer our insight into the process.

First, a disclaimer: The best advice for passing an audit should come from a consultant familiar with your unique situation and audit request. There are, however, a few general principles that everyone should adopt to make the process as smooth as possible. We will highlight them here, beginning with the following axiom:

Prepare, but don’t panic

The most important piece of advice we can offer to providers attesting for meaningful use is to plan carefully for an audit, even if an audit request never comes. The best way to do this is to maintain attestation documentation so it is readily available when needed. This might mean screenshots, “dashboard” reports, letters of intent from collaborating registries, or records of successful data transmission. If you are not sure what to prepare, your EHR vendor should be able to provide you with guidance; every EHR product needs to be certified for meaningful use, so vendors must have documentation on how you can prove you’ve achieved it.

It’s also worth pointing out that audits may encompass a multistep process. Once you respond to the request, the auditor may require additional documentation. This may become a two-way conversation and allow you to clarify what is needed, but preparation will make the process go much more smoothly. Thus, if an audit request materializes, you’ll have already done all of the hard work and will need only to provide it to the third-party auditor. A word of caution, though: Don’t believe that once you’ve received your meaningful use payment that you are completely out of the woods, because ...

Audits may come before or after payment

There are several types of audit requests. Auditors may simply ask you to prove you are using a certified EHR, or they may ask for a whole lot more. Furthermore, they may perform “prepayment” or “postpayment” audits. In the case of a prepayment audit, they will hold any incentive payments until after the audit requests are satisfied. Audits after payment is issued can be a bit trickier; if you don’t “pass” a postpayment audit, the Centers for Medicare & Medicaid Services will ask for the money back and typically won’t be too friendly about it. The appeal process isn’t easy and may involve lawyers and other complications, so make sure to take the audit request quite seriously, and cover yourself by remembering that when it comes to a Meaningful Use audit …

There is no such thing as TMI (too much information)

When submitting supporting documentation to an auditor, try to be as exhaustive as possible to avoid making the process lengthier than it needs to be. It is critical to make your case clear, and screenshots depicting the measure, source, and date can be one great way to do this.

For example, if you are sending attainment numbers from scored measures (e.g., ePrescribing, CPOE, or Clinical Summaries), be sure to include some evidence that the numbers were obtained from your certified EHR’s scorecard or dashboard (such as the software’s logo, etc.). If sending evidence of compliance for a yes/no measure (e.g., patient lists by condition or clinical support rule activation), be sure the date you generated it is clear so you can prove it was active during the reporting period. Finally, be sure to provide clear documentation that you are actively submitting data to immunization and disease registries (or at least have done your due diligence to set it up), and whatever you do ...

Don’t neglect the security risk analysis

This is one area that seems to become a focus point in every audit. It’s also something that may be taken for granted by providers, as it is a yes/no measure that can be easily overlooked. Don’t fall into this trap; the CMS takes data security very seriously and so should you. If you receive an audit request from them, they will want to know not only that the analysis was performed but also what potential risks were identified, what type of data was collected, and what your practice is doing to improve upon any deficiencies. If you need guidance on how to do this, you’ll find help here.

This leads us to one final important piece of advice:

Make sure you follow up

It is not uncommon for providers to submit information to auditors and then wait a little while for a response, but we have also heard of communications being lost to spam filters and misspelled email addresses. It’s therefore critical to follow up carefully on any audit request, as there are deadlines attached and financial incentives at risk. In our experience, auditors are not offended by providers “checking in” on the status of their audit, nor are they opposed to clarifying questions. So even though “Big Brother” may be watching, in this case he (or she) has a name and an e-mail address and is willing to answer your questions, should any arise. In summary, audits will happen, but with some preparation as described above, the process will be less intimidating and (hopefully) a lot less work.

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

Sixty-six years after George Orwell penned his prophetic vision of 1984, many physicians are encountering tangible evidence that “Big Brother” is alive and well: Meaningful use audits are here, and we’ve heard from a lot of our readers that they are time consuming and disconcerting, if not a bit scary. We, too, have encountered Stage II audits and have helped physicians navigate audit mysteries, so we thought it would be a good idea to offer our insight into the process.

First, a disclaimer: The best advice for passing an audit should come from a consultant familiar with your unique situation and audit request. There are, however, a few general principles that everyone should adopt to make the process as smooth as possible. We will highlight them here, beginning with the following axiom:

Prepare, but don’t panic

The most important piece of advice we can offer to providers attesting for meaningful use is to plan carefully for an audit, even if an audit request never comes. The best way to do this is to maintain attestation documentation so it is readily available when needed. This might mean screenshots, “dashboard” reports, letters of intent from collaborating registries, or records of successful data transmission. If you are not sure what to prepare, your EHR vendor should be able to provide you with guidance; every EHR product needs to be certified for meaningful use, so vendors must have documentation on how you can prove you’ve achieved it.

It’s also worth pointing out that audits may encompass a multistep process. Once you respond to the request, the auditor may require additional documentation. This may become a two-way conversation and allow you to clarify what is needed, but preparation will make the process go much more smoothly. Thus, if an audit request materializes, you’ll have already done all of the hard work and will need only to provide it to the third-party auditor. A word of caution, though: Don’t believe that once you’ve received your meaningful use payment that you are completely out of the woods, because ...

Audits may come before or after payment

There are several types of audit requests. Auditors may simply ask you to prove you are using a certified EHR, or they may ask for a whole lot more. Furthermore, they may perform “prepayment” or “postpayment” audits. In the case of a prepayment audit, they will hold any incentive payments until after the audit requests are satisfied. Audits after payment is issued can be a bit trickier; if you don’t “pass” a postpayment audit, the Centers for Medicare & Medicaid Services will ask for the money back and typically won’t be too friendly about it. The appeal process isn’t easy and may involve lawyers and other complications, so make sure to take the audit request quite seriously, and cover yourself by remembering that when it comes to a Meaningful Use audit …

There is no such thing as TMI (too much information)

When submitting supporting documentation to an auditor, try to be as exhaustive as possible to avoid making the process lengthier than it needs to be. It is critical to make your case clear, and screenshots depicting the measure, source, and date can be one great way to do this.

For example, if you are sending attainment numbers from scored measures (e.g., ePrescribing, CPOE, or Clinical Summaries), be sure to include some evidence that the numbers were obtained from your certified EHR’s scorecard or dashboard (such as the software’s logo, etc.). If sending evidence of compliance for a yes/no measure (e.g., patient lists by condition or clinical support rule activation), be sure the date you generated it is clear so you can prove it was active during the reporting period. Finally, be sure to provide clear documentation that you are actively submitting data to immunization and disease registries (or at least have done your due diligence to set it up), and whatever you do ...

Don’t neglect the security risk analysis

This is one area that seems to become a focus point in every audit. It’s also something that may be taken for granted by providers, as it is a yes/no measure that can be easily overlooked. Don’t fall into this trap; the CMS takes data security very seriously and so should you. If you receive an audit request from them, they will want to know not only that the analysis was performed but also what potential risks were identified, what type of data was collected, and what your practice is doing to improve upon any deficiencies. If you need guidance on how to do this, you’ll find help here.

This leads us to one final important piece of advice:

Make sure you follow up

It is not uncommon for providers to submit information to auditors and then wait a little while for a response, but we have also heard of communications being lost to spam filters and misspelled email addresses. It’s therefore critical to follow up carefully on any audit request, as there are deadlines attached and financial incentives at risk. In our experience, auditors are not offended by providers “checking in” on the status of their audit, nor are they opposed to clarifying questions. So even though “Big Brother” may be watching, in this case he (or she) has a name and an e-mail address and is willing to answer your questions, should any arise. In summary, audits will happen, but with some preparation as described above, the process will be less intimidating and (hopefully) a lot less work.

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

Sixty-six years after George Orwell penned his prophetic vision of 1984, many physicians are encountering tangible evidence that “Big Brother” is alive and well: Meaningful use audits are here, and we’ve heard from a lot of our readers that they are time consuming and disconcerting, if not a bit scary. We, too, have encountered Stage II audits and have helped physicians navigate audit mysteries, so we thought it would be a good idea to offer our insight into the process.

First, a disclaimer: The best advice for passing an audit should come from a consultant familiar with your unique situation and audit request. There are, however, a few general principles that everyone should adopt to make the process as smooth as possible. We will highlight them here, beginning with the following axiom:

Prepare, but don’t panic

The most important piece of advice we can offer to providers attesting for meaningful use is to plan carefully for an audit, even if an audit request never comes. The best way to do this is to maintain attestation documentation so it is readily available when needed. This might mean screenshots, “dashboard” reports, letters of intent from collaborating registries, or records of successful data transmission. If you are not sure what to prepare, your EHR vendor should be able to provide you with guidance; every EHR product needs to be certified for meaningful use, so vendors must have documentation on how you can prove you’ve achieved it.

It’s also worth pointing out that audits may encompass a multistep process. Once you respond to the request, the auditor may require additional documentation. This may become a two-way conversation and allow you to clarify what is needed, but preparation will make the process go much more smoothly. Thus, if an audit request materializes, you’ll have already done all of the hard work and will need only to provide it to the third-party auditor. A word of caution, though: Don’t believe that once you’ve received your meaningful use payment that you are completely out of the woods, because ...

Audits may come before or after payment

There are several types of audit requests. Auditors may simply ask you to prove you are using a certified EHR, or they may ask for a whole lot more. Furthermore, they may perform “prepayment” or “postpayment” audits. In the case of a prepayment audit, they will hold any incentive payments until after the audit requests are satisfied. Audits after payment is issued can be a bit trickier; if you don’t “pass” a postpayment audit, the Centers for Medicare & Medicaid Services will ask for the money back and typically won’t be too friendly about it. The appeal process isn’t easy and may involve lawyers and other complications, so make sure to take the audit request quite seriously, and cover yourself by remembering that when it comes to a Meaningful Use audit …

There is no such thing as TMI (too much information)

When submitting supporting documentation to an auditor, try to be as exhaustive as possible to avoid making the process lengthier than it needs to be. It is critical to make your case clear, and screenshots depicting the measure, source, and date can be one great way to do this.

For example, if you are sending attainment numbers from scored measures (e.g., ePrescribing, CPOE, or Clinical Summaries), be sure to include some evidence that the numbers were obtained from your certified EHR’s scorecard or dashboard (such as the software’s logo, etc.). If sending evidence of compliance for a yes/no measure (e.g., patient lists by condition or clinical support rule activation), be sure the date you generated it is clear so you can prove it was active during the reporting period. Finally, be sure to provide clear documentation that you are actively submitting data to immunization and disease registries (or at least have done your due diligence to set it up), and whatever you do ...

Don’t neglect the security risk analysis

This is one area that seems to become a focus point in every audit. It’s also something that may be taken for granted by providers, as it is a yes/no measure that can be easily overlooked. Don’t fall into this trap; the CMS takes data security very seriously and so should you. If you receive an audit request from them, they will want to know not only that the analysis was performed but also what potential risks were identified, what type of data was collected, and what your practice is doing to improve upon any deficiencies. If you need guidance on how to do this, you’ll find help here.

This leads us to one final important piece of advice:

Make sure you follow up

It is not uncommon for providers to submit information to auditors and then wait a little while for a response, but we have also heard of communications being lost to spam filters and misspelled email addresses. It’s therefore critical to follow up carefully on any audit request, as there are deadlines attached and financial incentives at risk. In our experience, auditors are not offended by providers “checking in” on the status of their audit, nor are they opposed to clarifying questions. So even though “Big Brother” may be watching, in this case he (or she) has a name and an e-mail address and is willing to answer your questions, should any arise. In summary, audits will happen, but with some preparation as described above, the process will be less intimidating and (hopefully) a lot less work.

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

The practice of medicine is a sacred event between a doctor and a patient – two individuals who have met each other in the flesh. This is the sentiment of many, and soon to be the law in the great state of Texas. It was also a popular topic of conversation at the American Telemedicine Association meeting in Los Angeles.

As a physician, I’m passionate about the profession of medicine, and as a soon-to-be MBA, I’m passionate about the practice of medicine. In this case, these ideals are pulling in opposite directions. I’m writing this dialectic as much to help me form my opinion as to help you with yours.

Should the practice of medicine be reserved only for those patients whom you have met in person? This is, after all, our history. All of us who practice medicine know the laying on of hands heals. It is a core human interaction that conveys care and concern, warmth and protection. It is the most powerful tool we have as clinicians to diagnose and heal. Touching patients can only be done in the flesh, and any interaction between a doctor and a patient that lacks this is, in one way, inferior. Not only does seeing a patient in person ensure that we won’t miss the obvious melanoma not visualized in the photo or video, but it also enables us to better connect this visit with every other visit and with the entirety of the patient’s record.

Having access to a patient’s medical record improves the quality and efficiency of care, a value conspicuously missing from one-off-dial-a-doc interactions from an online doctor who cares nothing of patient history or future.

Dr. Jack Resneck, a plenary presenter at ATA this year, told a cautionary tale of an acne patient who was treated online with an antibiotic that caused him to develop Stevens-Johnson syndrome, a life-threatening condition requiring extreme medicine and extraordinary costs. Clearly, digital medicine has shortcomings.

On the other hand, should we yield to the demands of our patients who want convenient care? Leaving work (or family) to endure traffic, to find a parking space, to sit in your waiting room, then your exam room, to have a chance to touch you once and see you for 10 minutes is not convenient. Given the option to receive care by the phone, online, or in person, patients increasingly are choosing the more convenient channels. And if you wrote a prescription for trimethoprim-sulfamethoxazole for an acne patient with no history of medication allergy and he developed Stevens-Johnson syndrome, would seeing him in person have helped? Perhaps, but probably not.

We are reluctant to call our patients “customers” for good reasons. I respect that, and I caution us to consider the truth that the trade of service for a fee is a business transaction. No matter how much patients love and respect us as doctors, if the price of our services grew exorbitantly high, or if it became impossible to see us, then they would abandon us. They would do so with remorse, yet they would do so.

Ideally, a person with a rash makes an appointment to see a dermatologist. In reality, patients turn to many services and products for this need. They choose primary care doctors, physician assistants, nurses, naturopaths, moisturizers, coconut oil, pharmacists, Dr. Oz, WebMD, customer care agents at WalMart, Google, and even God (see Book of Job). Our patients have many choices, and they choose us because we are the best value for their money. This could change.

I’m concerned that in a digital world where customers can book a trip to Italy, buy a house, and even get married without ever having to leave their phone, (yes, the last is legal in some states, but not in Texas), we risk irrelevance. By forcing our patients to use an inconvenient channel, we risk losing our one and only customer, our patient.

Dr. William Osler said, “In seeking the truth, we aim at the unattainable, and must be content with finding broken portions.” Telemedicine may not offer the warmth of our hand, but it does offer the service our modern patients desire. The question is not whether or not we practice medicine digitally, but rather how we will maintain the quality, trust and convenience that our patients ask of us.

Please discuss.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

The practice of medicine is a sacred event between a doctor and a patient – two individuals who have met each other in the flesh. This is the sentiment of many, and soon to be the law in the great state of Texas. It was also a popular topic of conversation at the American Telemedicine Association meeting in Los Angeles.

As a physician, I’m passionate about the profession of medicine, and as a soon-to-be MBA, I’m passionate about the practice of medicine. In this case, these ideals are pulling in opposite directions. I’m writing this dialectic as much to help me form my opinion as to help you with yours.

Should the practice of medicine be reserved only for those patients whom you have met in person? This is, after all, our history. All of us who practice medicine know the laying on of hands heals. It is a core human interaction that conveys care and concern, warmth and protection. It is the most powerful tool we have as clinicians to diagnose and heal. Touching patients can only be done in the flesh, and any interaction between a doctor and a patient that lacks this is, in one way, inferior. Not only does seeing a patient in person ensure that we won’t miss the obvious melanoma not visualized in the photo or video, but it also enables us to better connect this visit with every other visit and with the entirety of the patient’s record.

Having access to a patient’s medical record improves the quality and efficiency of care, a value conspicuously missing from one-off-dial-a-doc interactions from an online doctor who cares nothing of patient history or future.

Dr. Jack Resneck, a plenary presenter at ATA this year, told a cautionary tale of an acne patient who was treated online with an antibiotic that caused him to develop Stevens-Johnson syndrome, a life-threatening condition requiring extreme medicine and extraordinary costs. Clearly, digital medicine has shortcomings.

On the other hand, should we yield to the demands of our patients who want convenient care? Leaving work (or family) to endure traffic, to find a parking space, to sit in your waiting room, then your exam room, to have a chance to touch you once and see you for 10 minutes is not convenient. Given the option to receive care by the phone, online, or in person, patients increasingly are choosing the more convenient channels. And if you wrote a prescription for trimethoprim-sulfamethoxazole for an acne patient with no history of medication allergy and he developed Stevens-Johnson syndrome, would seeing him in person have helped? Perhaps, but probably not.

We are reluctant to call our patients “customers” for good reasons. I respect that, and I caution us to consider the truth that the trade of service for a fee is a business transaction. No matter how much patients love and respect us as doctors, if the price of our services grew exorbitantly high, or if it became impossible to see us, then they would abandon us. They would do so with remorse, yet they would do so.

Ideally, a person with a rash makes an appointment to see a dermatologist. In reality, patients turn to many services and products for this need. They choose primary care doctors, physician assistants, nurses, naturopaths, moisturizers, coconut oil, pharmacists, Dr. Oz, WebMD, customer care agents at WalMart, Google, and even God (see Book of Job). Our patients have many choices, and they choose us because we are the best value for their money. This could change.

I’m concerned that in a digital world where customers can book a trip to Italy, buy a house, and even get married without ever having to leave their phone, (yes, the last is legal in some states, but not in Texas), we risk irrelevance. By forcing our patients to use an inconvenient channel, we risk losing our one and only customer, our patient.

Dr. William Osler said, “In seeking the truth, we aim at the unattainable, and must be content with finding broken portions.” Telemedicine may not offer the warmth of our hand, but it does offer the service our modern patients desire. The question is not whether or not we practice medicine digitally, but rather how we will maintain the quality, trust and convenience that our patients ask of us.

Please discuss.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

The practice of medicine is a sacred event between a doctor and a patient – two individuals who have met each other in the flesh. This is the sentiment of many, and soon to be the law in the great state of Texas. It was also a popular topic of conversation at the American Telemedicine Association meeting in Los Angeles.

As a physician, I’m passionate about the profession of medicine, and as a soon-to-be MBA, I’m passionate about the practice of medicine. In this case, these ideals are pulling in opposite directions. I’m writing this dialectic as much to help me form my opinion as to help you with yours.

Should the practice of medicine be reserved only for those patients whom you have met in person? This is, after all, our history. All of us who practice medicine know the laying on of hands heals. It is a core human interaction that conveys care and concern, warmth and protection. It is the most powerful tool we have as clinicians to diagnose and heal. Touching patients can only be done in the flesh, and any interaction between a doctor and a patient that lacks this is, in one way, inferior. Not only does seeing a patient in person ensure that we won’t miss the obvious melanoma not visualized in the photo or video, but it also enables us to better connect this visit with every other visit and with the entirety of the patient’s record.

Having access to a patient’s medical record improves the quality and efficiency of care, a value conspicuously missing from one-off-dial-a-doc interactions from an online doctor who cares nothing of patient history or future.

Dr. Jack Resneck, a plenary presenter at ATA this year, told a cautionary tale of an acne patient who was treated online with an antibiotic that caused him to develop Stevens-Johnson syndrome, a life-threatening condition requiring extreme medicine and extraordinary costs. Clearly, digital medicine has shortcomings.

On the other hand, should we yield to the demands of our patients who want convenient care? Leaving work (or family) to endure traffic, to find a parking space, to sit in your waiting room, then your exam room, to have a chance to touch you once and see you for 10 minutes is not convenient. Given the option to receive care by the phone, online, or in person, patients increasingly are choosing the more convenient channels. And if you wrote a prescription for trimethoprim-sulfamethoxazole for an acne patient with no history of medication allergy and he developed Stevens-Johnson syndrome, would seeing him in person have helped? Perhaps, but probably not.

We are reluctant to call our patients “customers” for good reasons. I respect that, and I caution us to consider the truth that the trade of service for a fee is a business transaction. No matter how much patients love and respect us as doctors, if the price of our services grew exorbitantly high, or if it became impossible to see us, then they would abandon us. They would do so with remorse, yet they would do so.

Ideally, a person with a rash makes an appointment to see a dermatologist. In reality, patients turn to many services and products for this need. They choose primary care doctors, physician assistants, nurses, naturopaths, moisturizers, coconut oil, pharmacists, Dr. Oz, WebMD, customer care agents at WalMart, Google, and even God (see Book of Job). Our patients have many choices, and they choose us because we are the best value for their money. This could change.

I’m concerned that in a digital world where customers can book a trip to Italy, buy a house, and even get married without ever having to leave their phone, (yes, the last is legal in some states, but not in Texas), we risk irrelevance. By forcing our patients to use an inconvenient channel, we risk losing our one and only customer, our patient.

Dr. William Osler said, “In seeking the truth, we aim at the unattainable, and must be content with finding broken portions.” Telemedicine may not offer the warmth of our hand, but it does offer the service our modern patients desire. The question is not whether or not we practice medicine digitally, but rather how we will maintain the quality, trust and convenience that our patients ask of us.

Please discuss.

Dr. Benabio is a partner physician in the department of dermatology of the Southern California Permanente Group in San Diego, and a volunteer clinical assistant professor at the University of California, San Diego. Dr. Benabio is @dermdoc on Twitter.

It’s an extremely common scenario. A patient’s screening tests return, showing a significant elevation of the calculated low-density lipoprotein cholesterol (LDL-C), known to the lay public as bad cholesterol. To a physician like myself, someone who prides himself on a modest bit of expertise in lipids, it’s an absolute no-brainer. The patient should be placed on statin therapy pronto to reduce the major risks of heart attack, stroke, and other vascular misfortunes that are clearly associated with an elevated LDL-C level.

The tremendous ability of statins to reduce cardiovascular risk is among the best-demonstrated therapeutic effects of any class of medication in any branch of medical practice. The first major trial to show definitive benefits with the use of statins was the Scandinavian Simvastatin Survival Study, which came out in 1994 and showed a 30% relative reduction in cardiovascular events in a high-risk secondary prevention population, meaning that the subjects already had documented vascular disease before entering the trial.

Related: Did Niacin Get a Bum Rap?

Similar results were reported soon after in primary prevention populations in the WOSCOPS study in the United Kingdom (UK), and from the AFCAPS/TexCAPS studies in the U.S. Then the large UK-based Heart Protection Study showed that statins reduce cardiovascular risk regardless of the initial LDL-C level. Some experts suspected that many of the protective effects of statins were due not only to the LDL-C reduction per se, but also the so-called pleiotropic benefits, which included vasodilation, antithrombotic effects, and improved function of the endothelial cells that line the walls of blood vessels.

A number of additional studies have since markedly expanded the role of statins. The CARDS study showed that patients with diabetes had fewer events on statins. The ASCOT study suggested that statins reduce risk in patients with hypertension. And the SPARCL study revealed fewer recurrent events in patients on statins who had experienced a stroke or transient ischemic attack. Perhaps an even greater advance came with the JUPITER study, which showed that patients with elevated C-reactive protein levels—a marker of systemic inflammation—had fewer cardiovascular events when treated with statins than with placebo.

As you can imagine, there are plenty of times when I reach for my prescription pad (actually, my mouse) with the intention of ordering a statin to reduce a patient’s cardiovascular risk. But unfortunately, many times the patient catches me up short by objecting to such a plan. I can’t tell you how many times a patient responds by asking rather pointedly about the adverse effects (AEs) of statins. Now, I’ll readily admit that a small number of patients ask about AEs with any medication, but I would submit that the question comes up far more commonly with statins than it does with almost any other class of medication. Why?

I firmly believe that a huge driver of my patients’ irrational suspicions of statins is the drivel that is found on countless unreliable and unscientific websites. Antistatin nonsense is readily available, and many patients have thoroughly marinated themselves in a toxic slurry of misinformation and medical fantasy. Most of these sites emphasize known statin AEs, such as myalgias and myopathies, liver damage, and rhabdomyolysis, but then grossly exaggerate the severity and frequency. Other sites hammer on the modest number of patients who are nudged from prediabetes to full-fledged diabetes by the statins or rant about medically unsubstantiated AEs of statins, such as worsened mentation and depression.

Related: Are Statins Safe to Use in Pregnancy? (Clinical Edge)

That’s all bad enough, but what’s even worse is when patients attack the very medical foundation for prescribing statins, claiming that their online “research” causes them to doubt the reported association between LDL-C levels and cardiovascular risk. They also hint darkly at a vast medical-industrial conspiracy to inflate the true importance of LDL-C, thus allowing for more sales of the highly questionable statins and increased drug company profits. No patient has directly accused me of personally benefitting financially by overprescribing statins, but some have certainly hinted at it.

Another large group of patients declines to take the proffered statins by insisting that they would much rather pursue diet and exercise to bring down their high levels of LDL-C. They are invariably surprised when I tell them that even the most aggressive approaches are unlikely to reduce LDL-C by more than a negligible amount. I suspect that they think that their tired old doctor has bought into a reflexive pills-cure-all mentality and does not appreciate the wondrous benefits of a holistic approach.

Related: ASCVD Risk Estimator

The most annoying patients tell me they will instead take red yeast rice to bring down their LDL-C, because they prefer a “natural” remedy to some monstrous artificial chemical produced in a pharmaceutical company laboratory. When I try to tell them that red yeast rice contains a varying but unknown amount of a natural inhibitor of hMG-coA reductase, the same enzyme targeted with precisely dosed statins, they gape at me with unhidden disgust for completely missing the point: The naturally occurring remedy is inherently superior, precisely because it is naturally occurring!

Of course, I have to remind myself that a good number of patients simply do not want to take statins because it is a reminder of their vulnerability, status as a cardiac patient, or as a potential future victim of a heart attack or stroke. Some patients find that concept so upsetting that they would rather ignore it altogether.

Reluctantly, I admit that statins are not perfect drugs. But I would still submit that they’re the closest things we have to wonder drugs today. Yes, a fair number of patients do develop myalgias, but these are often mild and transient and can be managed. Very infrequently, patients may manifest some degree of hepatotoxicity, and very rarely rhabdomyolysis can rear its ugly head. Statins can sometimes nudge prediabetes into diabetes, just as thiazide diuretics and beta-blockers will sometimes do. However, on balance, the risk-benefit analysis of taking statins in both primary and secondary prevention settings is very much in favor of taking the drugs. 

So my message to my patients (and to your patients as well) is a very simple one. Take advantage of the phenomenal life-saving benefits of these near-wonder drugs, ignore the unscientific online nonsense authored by individuals practicing medicine without a license, and do what your tired but well-meaning doctor urges: take your statins, for Heaven’s sake!

Author disclosures
The author reports no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

It’s an extremely common scenario. A patient’s screening tests return, showing a significant elevation of the calculated low-density lipoprotein cholesterol (LDL-C), known to the lay public as bad cholesterol. To a physician like myself, someone who prides himself on a modest bit of expertise in lipids, it’s an absolute no-brainer. The patient should be placed on statin therapy pronto to reduce the major risks of heart attack, stroke, and other vascular misfortunes that are clearly associated with an elevated LDL-C level.

The tremendous ability of statins to reduce cardiovascular risk is among the best-demonstrated therapeutic effects of any class of medication in any branch of medical practice. The first major trial to show definitive benefits with the use of statins was the Scandinavian Simvastatin Survival Study, which came out in 1994 and showed a 30% relative reduction in cardiovascular events in a high-risk secondary prevention population, meaning that the subjects already had documented vascular disease before entering the trial.

Related: Did Niacin Get a Bum Rap?

Similar results were reported soon after in primary prevention populations in the WOSCOPS study in the United Kingdom (UK), and from the AFCAPS/TexCAPS studies in the U.S. Then the large UK-based Heart Protection Study showed that statins reduce cardiovascular risk regardless of the initial LDL-C level. Some experts suspected that many of the protective effects of statins were due not only to the LDL-C reduction per se, but also the so-called pleiotropic benefits, which included vasodilation, antithrombotic effects, and improved function of the endothelial cells that line the walls of blood vessels.

A number of additional studies have since markedly expanded the role of statins. The CARDS study showed that patients with diabetes had fewer events on statins. The ASCOT study suggested that statins reduce risk in patients with hypertension. And the SPARCL study revealed fewer recurrent events in patients on statins who had experienced a stroke or transient ischemic attack. Perhaps an even greater advance came with the JUPITER study, which showed that patients with elevated C-reactive protein levels—a marker of systemic inflammation—had fewer cardiovascular events when treated with statins than with placebo.

As you can imagine, there are plenty of times when I reach for my prescription pad (actually, my mouse) with the intention of ordering a statin to reduce a patient’s cardiovascular risk. But unfortunately, many times the patient catches me up short by objecting to such a plan. I can’t tell you how many times a patient responds by asking rather pointedly about the adverse effects (AEs) of statins. Now, I’ll readily admit that a small number of patients ask about AEs with any medication, but I would submit that the question comes up far more commonly with statins than it does with almost any other class of medication. Why?

I firmly believe that a huge driver of my patients’ irrational suspicions of statins is the drivel that is found on countless unreliable and unscientific websites. Antistatin nonsense is readily available, and many patients have thoroughly marinated themselves in a toxic slurry of misinformation and medical fantasy. Most of these sites emphasize known statin AEs, such as myalgias and myopathies, liver damage, and rhabdomyolysis, but then grossly exaggerate the severity and frequency. Other sites hammer on the modest number of patients who are nudged from prediabetes to full-fledged diabetes by the statins or rant about medically unsubstantiated AEs of statins, such as worsened mentation and depression.

Related: Are Statins Safe to Use in Pregnancy? (Clinical Edge)

That’s all bad enough, but what’s even worse is when patients attack the very medical foundation for prescribing statins, claiming that their online “research” causes them to doubt the reported association between LDL-C levels and cardiovascular risk. They also hint darkly at a vast medical-industrial conspiracy to inflate the true importance of LDL-C, thus allowing for more sales of the highly questionable statins and increased drug company profits. No patient has directly accused me of personally benefitting financially by overprescribing statins, but some have certainly hinted at it.

Another large group of patients declines to take the proffered statins by insisting that they would much rather pursue diet and exercise to bring down their high levels of LDL-C. They are invariably surprised when I tell them that even the most aggressive approaches are unlikely to reduce LDL-C by more than a negligible amount. I suspect that they think that their tired old doctor has bought into a reflexive pills-cure-all mentality and does not appreciate the wondrous benefits of a holistic approach.

Related: ASCVD Risk Estimator

The most annoying patients tell me they will instead take red yeast rice to bring down their LDL-C, because they prefer a “natural” remedy to some monstrous artificial chemical produced in a pharmaceutical company laboratory. When I try to tell them that red yeast rice contains a varying but unknown amount of a natural inhibitor of hMG-coA reductase, the same enzyme targeted with precisely dosed statins, they gape at me with unhidden disgust for completely missing the point: The naturally occurring remedy is inherently superior, precisely because it is naturally occurring!

Of course, I have to remind myself that a good number of patients simply do not want to take statins because it is a reminder of their vulnerability, status as a cardiac patient, or as a potential future victim of a heart attack or stroke. Some patients find that concept so upsetting that they would rather ignore it altogether.

Reluctantly, I admit that statins are not perfect drugs. But I would still submit that they’re the closest things we have to wonder drugs today. Yes, a fair number of patients do develop myalgias, but these are often mild and transient and can be managed. Very infrequently, patients may manifest some degree of hepatotoxicity, and very rarely rhabdomyolysis can rear its ugly head. Statins can sometimes nudge prediabetes into diabetes, just as thiazide diuretics and beta-blockers will sometimes do. However, on balance, the risk-benefit analysis of taking statins in both primary and secondary prevention settings is very much in favor of taking the drugs. 

So my message to my patients (and to your patients as well) is a very simple one. Take advantage of the phenomenal life-saving benefits of these near-wonder drugs, ignore the unscientific online nonsense authored by individuals practicing medicine without a license, and do what your tired but well-meaning doctor urges: take your statins, for Heaven’s sake!

Author disclosures
The author reports no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

It’s an extremely common scenario. A patient’s screening tests return, showing a significant elevation of the calculated low-density lipoprotein cholesterol (LDL-C), known to the lay public as bad cholesterol. To a physician like myself, someone who prides himself on a modest bit of expertise in lipids, it’s an absolute no-brainer. The patient should be placed on statin therapy pronto to reduce the major risks of heart attack, stroke, and other vascular misfortunes that are clearly associated with an elevated LDL-C level.

The tremendous ability of statins to reduce cardiovascular risk is among the best-demonstrated therapeutic effects of any class of medication in any branch of medical practice. The first major trial to show definitive benefits with the use of statins was the Scandinavian Simvastatin Survival Study, which came out in 1994 and showed a 30% relative reduction in cardiovascular events in a high-risk secondary prevention population, meaning that the subjects already had documented vascular disease before entering the trial.

Related: Did Niacin Get a Bum Rap?

Similar results were reported soon after in primary prevention populations in the WOSCOPS study in the United Kingdom (UK), and from the AFCAPS/TexCAPS studies in the U.S. Then the large UK-based Heart Protection Study showed that statins reduce cardiovascular risk regardless of the initial LDL-C level. Some experts suspected that many of the protective effects of statins were due not only to the LDL-C reduction per se, but also the so-called pleiotropic benefits, which included vasodilation, antithrombotic effects, and improved function of the endothelial cells that line the walls of blood vessels.

A number of additional studies have since markedly expanded the role of statins. The CARDS study showed that patients with diabetes had fewer events on statins. The ASCOT study suggested that statins reduce risk in patients with hypertension. And the SPARCL study revealed fewer recurrent events in patients on statins who had experienced a stroke or transient ischemic attack. Perhaps an even greater advance came with the JUPITER study, which showed that patients with elevated C-reactive protein levels—a marker of systemic inflammation—had fewer cardiovascular events when treated with statins than with placebo.

As you can imagine, there are plenty of times when I reach for my prescription pad (actually, my mouse) with the intention of ordering a statin to reduce a patient’s cardiovascular risk. But unfortunately, many times the patient catches me up short by objecting to such a plan. I can’t tell you how many times a patient responds by asking rather pointedly about the adverse effects (AEs) of statins. Now, I’ll readily admit that a small number of patients ask about AEs with any medication, but I would submit that the question comes up far more commonly with statins than it does with almost any other class of medication. Why?

I firmly believe that a huge driver of my patients’ irrational suspicions of statins is the drivel that is found on countless unreliable and unscientific websites. Antistatin nonsense is readily available, and many patients have thoroughly marinated themselves in a toxic slurry of misinformation and medical fantasy. Most of these sites emphasize known statin AEs, such as myalgias and myopathies, liver damage, and rhabdomyolysis, but then grossly exaggerate the severity and frequency. Other sites hammer on the modest number of patients who are nudged from prediabetes to full-fledged diabetes by the statins or rant about medically unsubstantiated AEs of statins, such as worsened mentation and depression.

Related: Are Statins Safe to Use in Pregnancy? (Clinical Edge)

That’s all bad enough, but what’s even worse is when patients attack the very medical foundation for prescribing statins, claiming that their online “research” causes them to doubt the reported association between LDL-C levels and cardiovascular risk. They also hint darkly at a vast medical-industrial conspiracy to inflate the true importance of LDL-C, thus allowing for more sales of the highly questionable statins and increased drug company profits. No patient has directly accused me of personally benefitting financially by overprescribing statins, but some have certainly hinted at it.

Another large group of patients declines to take the proffered statins by insisting that they would much rather pursue diet and exercise to bring down their high levels of LDL-C. They are invariably surprised when I tell them that even the most aggressive approaches are unlikely to reduce LDL-C by more than a negligible amount. I suspect that they think that their tired old doctor has bought into a reflexive pills-cure-all mentality and does not appreciate the wondrous benefits of a holistic approach.

Related: ASCVD Risk Estimator

The most annoying patients tell me they will instead take red yeast rice to bring down their LDL-C, because they prefer a “natural” remedy to some monstrous artificial chemical produced in a pharmaceutical company laboratory. When I try to tell them that red yeast rice contains a varying but unknown amount of a natural inhibitor of hMG-coA reductase, the same enzyme targeted with precisely dosed statins, they gape at me with unhidden disgust for completely missing the point: The naturally occurring remedy is inherently superior, precisely because it is naturally occurring!

Of course, I have to remind myself that a good number of patients simply do not want to take statins because it is a reminder of their vulnerability, status as a cardiac patient, or as a potential future victim of a heart attack or stroke. Some patients find that concept so upsetting that they would rather ignore it altogether.

Reluctantly, I admit that statins are not perfect drugs. But I would still submit that they’re the closest things we have to wonder drugs today. Yes, a fair number of patients do develop myalgias, but these are often mild and transient and can be managed. Very infrequently, patients may manifest some degree of hepatotoxicity, and very rarely rhabdomyolysis can rear its ugly head. Statins can sometimes nudge prediabetes into diabetes, just as thiazide diuretics and beta-blockers will sometimes do. However, on balance, the risk-benefit analysis of taking statins in both primary and secondary prevention settings is very much in favor of taking the drugs. 

So my message to my patients (and to your patients as well) is a very simple one. Take advantage of the phenomenal life-saving benefits of these near-wonder drugs, ignore the unscientific online nonsense authored by individuals practicing medicine without a license, and do what your tired but well-meaning doctor urges: take your statins, for Heaven’s sake!

Author disclosures
The author reports no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Below is an edited and condensed version of the Federal Practitioner interview with Jeffrey W. Sherman, DO, chief medical officer of the Department of Homeland Security’s Transportation Security Administration. Dr. Sherman recently received the Outstanding Service Medal from PHS. To hear the complete interview, visit: http://www.fedprac.com/multimedia/multimedia-library.html.

The Transportation Security Administration

Jeffrey W. Sherman, DO. I’m primarily responsible for providing expert opinion to the senior leadership of the Transportation Security Administration (TSA) as it relates to occupational health, preventive medicine, and other medical topics. The position of chief medical officer at the TSA has been on the books for quite a while. However, it hasn’t been filled on a permanent basis until the time that I came over from the Office of Health Affairs…. For the most part, the marching orders that I was given from the senior leadership was to take a fairly neutral look at the agency’s ability to manage the health and wellness of its workforce and find both positive areas and areas for improvement where the TSA could impact the welfare of the TSA population.

Related: Committed to Showing Results at the VA

Programs that we were able to identify that were already in existence and working really well for the TSA were in abundance. However, there were a number of programs that I found would probably enhance the TSA’ s ability to manage its workforce better and to provide a more comfortable, safe workplace. The main one was an ability to measure the transportation security officers’ medical capability and aptitude over a period of time, so more or less to manage them periodically and allow us to review the requirements and assessments for that particular workforce from an occupational health standpoint.

Having a Career in the PHS

Dr. Sherman. My previous work with the PHS included being a director for a number of different medical programs in other government agencies, including Immigration and Customs Enforcement (ICE), where I was acting director of the Division of Immigration Health Services for a period of time. I moved on to be the senior medical advisor to the principal legal advisor at ICE; and again, working with the attorneys on various medical issues allowed me to build greater confidence in my ability to manage the interface between what’s appropriate legally from the medical standpoint and what’s appropriate from the clinical practice of medicine in occupational health. So that was very vital and important.

Just prior to coming to the TSA, I was the medical director for a number of programs for the U.S. Marshals Services. Working alongside law enforcement in their unique roles and managing programs that are variously clinical and nonclinical gives good insight as to how to come into a large organization such as the TSA, with more than 48,000 transportation security officers, and put in place programs in a preexisting organization. To retrofit programs into an organization of that size requires some tact and ability. So all that time previously spent has allowed me to gain those skills.

Joining the PHS

Dr. Sherman. We are a group of dedicated professionals; we have a very close connection and a close network of collegial interactions. I was the Professional Advisory Committee (PAC) chair for the Physicians PAC for a year and vice chair before that. Meeting all the individuals and working with them on various cross-agency public health and professional projects has absolutely brought a lot of their wealth into what I do here at the TSA specifically. No man is an island; and certainly, in the PHS, you never feel that way…

Related: Pharmacist Management of Adult Asthma at an Indian Health Service Facility

I was in private practice in rural upstate New York in 2005 when Hurricane Katrina and Hurricane Rita came ashore, and I was part of the National Health Service Corps at that time. Part of my response as a National Health Service Corps Scholar was to join colleagues—some of whom were PHS officers—down in the recovery area in Louisiana; that is where I met my first uniformed Commissioned Corps officer, 2 of them, in fact. I worked with them for several weeks and was so incredibly impressed with the work of the PHS that while I was there, I applied for my commission. So I was hit pretty hard and pretty heavy, and I haven’t looked back…

It’s, of course, very satisfying to hear your uniformed service spoken highly of in a public forum and especially by elected officials such as the president. I mean it’s difficult not to smile when you hear that. I will say, as one of the 7 uniformed services of the U.S., we do take a lot of knuckling under from our sister services that are more well known. But frankly, at the end of the day, we work beside them regardless of the notoriety or note that we get from them or from anyone else.

I’ve served alongside the Navy on the USNS Mercy, and I’ve been out with Air Force and Coast Guard on their vessels as well. So I’m very comfortable, and I think most of the PHS officers are comfortable working with our sister uniformed services. It is nice to hear the recognition.

The PHS Outstanding Service Medal

Dr. Sherman. It’s a real honor and a privilege to have received that medal…. There are things you do in your professional career that you do not do for notoriety; you do it because it’s the right thing to do, and you know it’s in the greater service to your profession.

In this case, our profession is also a uniformed service. And so for the uniformed service itself to take note and to give recognition for what I would do anyway and the manner in which I do it, it’s again, very satisfying; and it’s very humbling.

Mentoring Junior Officers

Dr. Sherman. The PHS has a very robust program of mentoring junior officers; and I think one of the things that has been most satisfying in my time in uniform, outside of the obvious professional things, has really been mentoring junior officers on their way up through the ranks and as they find their pathway forward in a career as a Commissioned Corps officer. And if I can say one thing to any new officer coming into the organization, it’s make sure that you reach out to your senior officers, and make sure you learn from both their successes and their errors so that by the time you finish your career, you can look back and say you’ve done everything you’ve wanted to.

Related: Acting Surgeon General Confident in the Battle Against Tobacco, Ebola, and Preventable Diseases

I still maintain relationships with [my] mentors. I don’t think you’re ever too old or ever too experienced to have a mentor. There’s always something you can learn from another individual. So you know, you never stop learning, and you never stop appreciating the people who you’re working beside who come before you and who are coming behind you. And please don’t ask me to state names, because there are too many.

Below is an edited and condensed version of the Federal Practitioner interview with Jeffrey W. Sherman, DO, chief medical officer of the Department of Homeland Security’s Transportation Security Administration. Dr. Sherman recently received the Outstanding Service Medal from PHS. To hear the complete interview, visit: http://www.fedprac.com/multimedia/multimedia-library.html.

The Transportation Security Administration

Jeffrey W. Sherman, DO. I’m primarily responsible for providing expert opinion to the senior leadership of the Transportation Security Administration (TSA) as it relates to occupational health, preventive medicine, and other medical topics. The position of chief medical officer at the TSA has been on the books for quite a while. However, it hasn’t been filled on a permanent basis until the time that I came over from the Office of Health Affairs…. For the most part, the marching orders that I was given from the senior leadership was to take a fairly neutral look at the agency’s ability to manage the health and wellness of its workforce and find both positive areas and areas for improvement where the TSA could impact the welfare of the TSA population.

Related: Committed to Showing Results at the VA

Programs that we were able to identify that were already in existence and working really well for the TSA were in abundance. However, there were a number of programs that I found would probably enhance the TSA’ s ability to manage its workforce better and to provide a more comfortable, safe workplace. The main one was an ability to measure the transportation security officers’ medical capability and aptitude over a period of time, so more or less to manage them periodically and allow us to review the requirements and assessments for that particular workforce from an occupational health standpoint.

Having a Career in the PHS

Dr. Sherman. My previous work with the PHS included being a director for a number of different medical programs in other government agencies, including Immigration and Customs Enforcement (ICE), where I was acting director of the Division of Immigration Health Services for a period of time. I moved on to be the senior medical advisor to the principal legal advisor at ICE; and again, working with the attorneys on various medical issues allowed me to build greater confidence in my ability to manage the interface between what’s appropriate legally from the medical standpoint and what’s appropriate from the clinical practice of medicine in occupational health. So that was very vital and important.

Just prior to coming to the TSA, I was the medical director for a number of programs for the U.S. Marshals Services. Working alongside law enforcement in their unique roles and managing programs that are variously clinical and nonclinical gives good insight as to how to come into a large organization such as the TSA, with more than 48,000 transportation security officers, and put in place programs in a preexisting organization. To retrofit programs into an organization of that size requires some tact and ability. So all that time previously spent has allowed me to gain those skills.

Joining the PHS

Dr. Sherman. We are a group of dedicated professionals; we have a very close connection and a close network of collegial interactions. I was the Professional Advisory Committee (PAC) chair for the Physicians PAC for a year and vice chair before that. Meeting all the individuals and working with them on various cross-agency public health and professional projects has absolutely brought a lot of their wealth into what I do here at the TSA specifically. No man is an island; and certainly, in the PHS, you never feel that way…

Related: Pharmacist Management of Adult Asthma at an Indian Health Service Facility

I was in private practice in rural upstate New York in 2005 when Hurricane Katrina and Hurricane Rita came ashore, and I was part of the National Health Service Corps at that time. Part of my response as a National Health Service Corps Scholar was to join colleagues—some of whom were PHS officers—down in the recovery area in Louisiana; that is where I met my first uniformed Commissioned Corps officer, 2 of them, in fact. I worked with them for several weeks and was so incredibly impressed with the work of the PHS that while I was there, I applied for my commission. So I was hit pretty hard and pretty heavy, and I haven’t looked back…

It’s, of course, very satisfying to hear your uniformed service spoken highly of in a public forum and especially by elected officials such as the president. I mean it’s difficult not to smile when you hear that. I will say, as one of the 7 uniformed services of the U.S., we do take a lot of knuckling under from our sister services that are more well known. But frankly, at the end of the day, we work beside them regardless of the notoriety or note that we get from them or from anyone else.

I’ve served alongside the Navy on the USNS Mercy, and I’ve been out with Air Force and Coast Guard on their vessels as well. So I’m very comfortable, and I think most of the PHS officers are comfortable working with our sister uniformed services. It is nice to hear the recognition.

The PHS Outstanding Service Medal

Dr. Sherman. It’s a real honor and a privilege to have received that medal…. There are things you do in your professional career that you do not do for notoriety; you do it because it’s the right thing to do, and you know it’s in the greater service to your profession.

In this case, our profession is also a uniformed service. And so for the uniformed service itself to take note and to give recognition for what I would do anyway and the manner in which I do it, it’s again, very satisfying; and it’s very humbling.

Mentoring Junior Officers

Dr. Sherman. The PHS has a very robust program of mentoring junior officers; and I think one of the things that has been most satisfying in my time in uniform, outside of the obvious professional things, has really been mentoring junior officers on their way up through the ranks and as they find their pathway forward in a career as a Commissioned Corps officer. And if I can say one thing to any new officer coming into the organization, it’s make sure that you reach out to your senior officers, and make sure you learn from both their successes and their errors so that by the time you finish your career, you can look back and say you’ve done everything you’ve wanted to.

Related: Acting Surgeon General Confident in the Battle Against Tobacco, Ebola, and Preventable Diseases

I still maintain relationships with [my] mentors. I don’t think you’re ever too old or ever too experienced to have a mentor. There’s always something you can learn from another individual. So you know, you never stop learning, and you never stop appreciating the people who you’re working beside who come before you and who are coming behind you. And please don’t ask me to state names, because there are too many.

Below is an edited and condensed version of the Federal Practitioner interview with Jeffrey W. Sherman, DO, chief medical officer of the Department of Homeland Security’s Transportation Security Administration. Dr. Sherman recently received the Outstanding Service Medal from PHS. To hear the complete interview, visit: http://www.fedprac.com/multimedia/multimedia-library.html.

The Transportation Security Administration

Jeffrey W. Sherman, DO. I’m primarily responsible for providing expert opinion to the senior leadership of the Transportation Security Administration (TSA) as it relates to occupational health, preventive medicine, and other medical topics. The position of chief medical officer at the TSA has been on the books for quite a while. However, it hasn’t been filled on a permanent basis until the time that I came over from the Office of Health Affairs…. For the most part, the marching orders that I was given from the senior leadership was to take a fairly neutral look at the agency’s ability to manage the health and wellness of its workforce and find both positive areas and areas for improvement where the TSA could impact the welfare of the TSA population.

Related: Committed to Showing Results at the VA

Programs that we were able to identify that were already in existence and working really well for the TSA were in abundance. However, there were a number of programs that I found would probably enhance the TSA’ s ability to manage its workforce better and to provide a more comfortable, safe workplace. The main one was an ability to measure the transportation security officers’ medical capability and aptitude over a period of time, so more or less to manage them periodically and allow us to review the requirements and assessments for that particular workforce from an occupational health standpoint.

Having a Career in the PHS

Dr. Sherman. My previous work with the PHS included being a director for a number of different medical programs in other government agencies, including Immigration and Customs Enforcement (ICE), where I was acting director of the Division of Immigration Health Services for a period of time. I moved on to be the senior medical advisor to the principal legal advisor at ICE; and again, working with the attorneys on various medical issues allowed me to build greater confidence in my ability to manage the interface between what’s appropriate legally from the medical standpoint and what’s appropriate from the clinical practice of medicine in occupational health. So that was very vital and important.

Just prior to coming to the TSA, I was the medical director for a number of programs for the U.S. Marshals Services. Working alongside law enforcement in their unique roles and managing programs that are variously clinical and nonclinical gives good insight as to how to come into a large organization such as the TSA, with more than 48,000 transportation security officers, and put in place programs in a preexisting organization. To retrofit programs into an organization of that size requires some tact and ability. So all that time previously spent has allowed me to gain those skills.

Joining the PHS

Dr. Sherman. We are a group of dedicated professionals; we have a very close connection and a close network of collegial interactions. I was the Professional Advisory Committee (PAC) chair for the Physicians PAC for a year and vice chair before that. Meeting all the individuals and working with them on various cross-agency public health and professional projects has absolutely brought a lot of their wealth into what I do here at the TSA specifically. No man is an island; and certainly, in the PHS, you never feel that way…

Related: Pharmacist Management of Adult Asthma at an Indian Health Service Facility

I was in private practice in rural upstate New York in 2005 when Hurricane Katrina and Hurricane Rita came ashore, and I was part of the National Health Service Corps at that time. Part of my response as a National Health Service Corps Scholar was to join colleagues—some of whom were PHS officers—down in the recovery area in Louisiana; that is where I met my first uniformed Commissioned Corps officer, 2 of them, in fact. I worked with them for several weeks and was so incredibly impressed with the work of the PHS that while I was there, I applied for my commission. So I was hit pretty hard and pretty heavy, and I haven’t looked back…

It’s, of course, very satisfying to hear your uniformed service spoken highly of in a public forum and especially by elected officials such as the president. I mean it’s difficult not to smile when you hear that. I will say, as one of the 7 uniformed services of the U.S., we do take a lot of knuckling under from our sister services that are more well known. But frankly, at the end of the day, we work beside them regardless of the notoriety or note that we get from them or from anyone else.

I’ve served alongside the Navy on the USNS Mercy, and I’ve been out with Air Force and Coast Guard on their vessels as well. So I’m very comfortable, and I think most of the PHS officers are comfortable working with our sister uniformed services. It is nice to hear the recognition.

The PHS Outstanding Service Medal

Dr. Sherman. It’s a real honor and a privilege to have received that medal…. There are things you do in your professional career that you do not do for notoriety; you do it because it’s the right thing to do, and you know it’s in the greater service to your profession.

In this case, our profession is also a uniformed service. And so for the uniformed service itself to take note and to give recognition for what I would do anyway and the manner in which I do it, it’s again, very satisfying; and it’s very humbling.

Mentoring Junior Officers

Dr. Sherman. The PHS has a very robust program of mentoring junior officers; and I think one of the things that has been most satisfying in my time in uniform, outside of the obvious professional things, has really been mentoring junior officers on their way up through the ranks and as they find their pathway forward in a career as a Commissioned Corps officer. And if I can say one thing to any new officer coming into the organization, it’s make sure that you reach out to your senior officers, and make sure you learn from both their successes and their errors so that by the time you finish your career, you can look back and say you’ve done everything you’ve wanted to.

Related: Acting Surgeon General Confident in the Battle Against Tobacco, Ebola, and Preventable Diseases

I still maintain relationships with [my] mentors. I don’t think you’re ever too old or ever too experienced to have a mentor. There’s always something you can learn from another individual. So you know, you never stop learning, and you never stop appreciating the people who you’re working beside who come before you and who are coming behind you. And please don’t ask me to state names, because there are too many.

Herpes zoster (HZ) infection occurs when the varicella-zoster virus (VZV) is reactivated due to waning cellular immunity associated with age or immunosuppression. It results in a painful blistering cutaneous eruption.¹ The incidence and rate of complications from HZ infection increase with age.² The most common complication of HZ infection is postherpetic neuralgia (PHN), which can be extremely debilitating.¹

In 2006 the US Food and Drug Administration approved a live attenuated HZ vaccine that boosts VZV cell-mediated immunity and largely reduces HZ disease burden. The HZ vaccine contains the same strain of VZV as the varicella vaccine but contains 14 times more virus particles.³ In a study of the efficacy and safety of the HZ vaccine, HZ vaccination was associated with a 51% reduction in HZ incidence, a 61% reduction in HZ disease burden, and a 67% reduction in PHN incidence at 3-year follow-up.⁴ In adults aged 60 to 69 years, the benefit of the HZ vaccine resulted from the reduction in HZ incidence.⁵ However, in adults 70 years and older, the benefit resulted from the reduction in PHN incidence and severity. Overall, the absolute benefit of the HZ vaccine was greatest in the older age group, as the severity and incidence of HZ and PHN are highest in these patients.⁵ Although efficacy declines with time, a long-term persistence substudy demonstrated that the HZ vaccine still reduced the incidence and severity of HZ.⁶

The HZ vaccine currently is approved for adults aged 50 years or older.³ Antivirals that are active against VZV (eg, acyclovir, valacyclovir, famciclovir) should not be administered 24 hours before or 14 days after vaccination.¹ Concurrent administration of the HZ vaccine and the pneumococcal vaccine is not recommended due to risk for reduced immunogenicity of the zoster vaccine.⁵ Because it is a live vaccine, the HZ vaccine is not recommended in immunocompromised patients. However, the HZ vaccine can be safely given to moderately immunosuppressed patients. The HZ vaccine also is well tolerated and stimulates a strong cell-mediated immune response in adults who have had prior HZ infections. Herpes zoster vaccination is recommended in patients with a history of shingles, though there are no published data showing that it reduces the already low rate of recurrent HZ infections.⁷

Despite strong efficacy data and established guidelines, a low vaccination rate has been reported⁸ due to doubts about its long-term efficacy, failure of both physicians and patients to recognize the burden of disease imposed by HZ infection and PHN, and concerns about reimbursement and out-of-pocket costs for the patient.⁵ Furthermore, many patients who are eligible to receive the HZ vaccine may not do so because they do not remember having chickenpox and therefore do not feel they are at risk for developing shingles.

The HZ vaccine is an important factor in public health prevention strategy, as HZ infection and PHN are common, incurable, and incapacitating. The HZ vaccine is the most efficacious agent currently available on the market for prevention. It is important for dermatologists to educate our patients and encourage them to receive the HZ vaccine to safeguard their long-term health.

Herpes zoster (HZ) infection occurs when the varicella-zoster virus (VZV) is reactivated due to waning cellular immunity associated with age or immunosuppression. It results in a painful blistering cutaneous eruption.¹ The incidence and rate of complications from HZ infection increase with age.² The most common complication of HZ infection is postherpetic neuralgia (PHN), which can be extremely debilitating.¹

In 2006 the US Food and Drug Administration approved a live attenuated HZ vaccine that boosts VZV cell-mediated immunity and largely reduces HZ disease burden. The HZ vaccine contains the same strain of VZV as the varicella vaccine but contains 14 times more virus particles.³ In a study of the efficacy and safety of the HZ vaccine, HZ vaccination was associated with a 51% reduction in HZ incidence, a 61% reduction in HZ disease burden, and a 67% reduction in PHN incidence at 3-year follow-up.⁴ In adults aged 60 to 69 years, the benefit of the HZ vaccine resulted from the reduction in HZ incidence.⁵ However, in adults 70 years and older, the benefit resulted from the reduction in PHN incidence and severity. Overall, the absolute benefit of the HZ vaccine was greatest in the older age group, as the severity and incidence of HZ and PHN are highest in these patients.⁵ Although efficacy declines with time, a long-term persistence substudy demonstrated that the HZ vaccine still reduced the incidence and severity of HZ.⁶

The HZ vaccine currently is approved for adults aged 50 years or older.³ Antivirals that are active against VZV (eg, acyclovir, valacyclovir, famciclovir) should not be administered 24 hours before or 14 days after vaccination.¹ Concurrent administration of the HZ vaccine and the pneumococcal vaccine is not recommended due to risk for reduced immunogenicity of the zoster vaccine.⁵ Because it is a live vaccine, the HZ vaccine is not recommended in immunocompromised patients. However, the HZ vaccine can be safely given to moderately immunosuppressed patients. The HZ vaccine also is well tolerated and stimulates a strong cell-mediated immune response in adults who have had prior HZ infections. Herpes zoster vaccination is recommended in patients with a history of shingles, though there are no published data showing that it reduces the already low rate of recurrent HZ infections.⁷

Despite strong efficacy data and established guidelines, a low vaccination rate has been reported⁸ due to doubts about its long-term efficacy, failure of both physicians and patients to recognize the burden of disease imposed by HZ infection and PHN, and concerns about reimbursement and out-of-pocket costs for the patient.⁵ Furthermore, many patients who are eligible to receive the HZ vaccine may not do so because they do not remember having chickenpox and therefore do not feel they are at risk for developing shingles.

The HZ vaccine is an important factor in public health prevention strategy, as HZ infection and PHN are common, incurable, and incapacitating. The HZ vaccine is the most efficacious agent currently available on the market for prevention. It is important for dermatologists to educate our patients and encourage them to receive the HZ vaccine to safeguard their long-term health.

Herpes zoster (HZ) infection occurs when the varicella-zoster virus (VZV) is reactivated due to waning cellular immunity associated with age or immunosuppression. It results in a painful blistering cutaneous eruption.¹ The incidence and rate of complications from HZ infection increase with age.² The most common complication of HZ infection is postherpetic neuralgia (PHN), which can be extremely debilitating.¹

In 2006 the US Food and Drug Administration approved a live attenuated HZ vaccine that boosts VZV cell-mediated immunity and largely reduces HZ disease burden. The HZ vaccine contains the same strain of VZV as the varicella vaccine but contains 14 times more virus particles.³ In a study of the efficacy and safety of the HZ vaccine, HZ vaccination was associated with a 51% reduction in HZ incidence, a 61% reduction in HZ disease burden, and a 67% reduction in PHN incidence at 3-year follow-up.⁴ In adults aged 60 to 69 years, the benefit of the HZ vaccine resulted from the reduction in HZ incidence.⁵ However, in adults 70 years and older, the benefit resulted from the reduction in PHN incidence and severity. Overall, the absolute benefit of the HZ vaccine was greatest in the older age group, as the severity and incidence of HZ and PHN are highest in these patients.⁵ Although efficacy declines with time, a long-term persistence substudy demonstrated that the HZ vaccine still reduced the incidence and severity of HZ.⁶

The HZ vaccine currently is approved for adults aged 50 years or older.³ Antivirals that are active against VZV (eg, acyclovir, valacyclovir, famciclovir) should not be administered 24 hours before or 14 days after vaccination.¹ Concurrent administration of the HZ vaccine and the pneumococcal vaccine is not recommended due to risk for reduced immunogenicity of the zoster vaccine.⁵ Because it is a live vaccine, the HZ vaccine is not recommended in immunocompromised patients. However, the HZ vaccine can be safely given to moderately immunosuppressed patients. The HZ vaccine also is well tolerated and stimulates a strong cell-mediated immune response in adults who have had prior HZ infections. Herpes zoster vaccination is recommended in patients with a history of shingles, though there are no published data showing that it reduces the already low rate of recurrent HZ infections.⁷

Despite strong efficacy data and established guidelines, a low vaccination rate has been reported⁸ due to doubts about its long-term efficacy, failure of both physicians and patients to recognize the burden of disease imposed by HZ infection and PHN, and concerns about reimbursement and out-of-pocket costs for the patient.⁵ Furthermore, many patients who are eligible to receive the HZ vaccine may not do so because they do not remember having chickenpox and therefore do not feel they are at risk for developing shingles.

The HZ vaccine is an important factor in public health prevention strategy, as HZ infection and PHN are common, incurable, and incapacitating. The HZ vaccine is the most efficacious agent currently available on the market for prevention. It is important for dermatologists to educate our patients and encourage them to receive the HZ vaccine to safeguard their long-term health.