Editorials from the Executive Medical Director
Last Sunday, I went to an open-air shopping center in an affluent suburb of Atlanta to buy a new iPad at the Apple Store. The Apple Stores in Georgia are still open, and they are doing a great job at requiring masks and social distancing inside. But all around me were people walking about the shopping center, and almost no one was wearing a mask - families with children, young adults, and even the elderly. I felt like a visitor from another planet wearing my mask. Did the pandemic go away and I did not get the memo? Earlier that morning, I watched the news and saw that the numbers of infected were growing. It was worse in the southern and western United States, with hospitalizations and ICU admissions increasing. With over 125,000 Americans dead from COVID-19, what am I missing? This is not a Republican vs.
As I stay sheltered in place, I have had plenty of time to think about the “new normal.” In my last Insider column, I mentioned two things that I thought the COVID-19 pandemic would change in allergy practice. One was the use of telemedicine on a regular basis. I have heard that it has worked for many allergists during these unprecedented times, though some patients prefer the “old time,” in-person visit. If payment for telemedicine visits stays on par with office visits, I do think it will continue to be used by allergists after the pandemic. With the ability to have inexpensive home spirometers, patients with asthma can be followed as well at home as in the office. Do you really need to see the allergic rhinitis patient on immunotherapy back in the office for a checkup?
When I wrote my editorial on COVID-19 for the College Insider on March 2nd, I was hopefully optimistic that we would not be seeing what we are unfortunately seeing now. Due to this pandemic, we all know the meaning of social distancing, PPE (Personal Protective Equipment), shelter in place, and flattening the curve. Who would have thought that a Board-certified allergist/immunologist would be the rock star of the COVID-19 crisis? All over the internet, we read praises for “Saint Tony” and “Fauci for President.” How does he do it at 79 years of age? He is the beacon of truth for all of us in this emergency. Someone we can count on to not play politics in a life-and-death situation. Please stay safe, Dr. Fauci. We are all pulling for you.
During a recent haircut, my barber, who knows I’m a physician, wanted to know about the coronavirus and what she should do. She was hoping that the extra vitamin C she took that morning would help prevent infection. She wanted to know what she could do to boost her immune system. Should she be wearing a mask? I bet you have had patients asking you about this probable pandemic, too. There are lots of rumors spreading out there about COVID-19, which raises alarm in the community. Of course, I am not an infectious disease specialist, but as an allergist, I should still be able to answer some basic questions and help patients by giving reasonable, scientific answers.
One of the most common emails that the College receives from members is “Why can’t the College do something about the remote practice of allergy?” We are hearing more and more about physicians who are not fellowship-trained or board-certified allergists doing allergy testing and even placing patients on immunotherapy. It is not uncommon to hear about non-medical doctors such as chiropractors and naturopaths treating allergy and asthma patients. You may have seen ads on TV and social media hawking blood tests for “food sensitivities,” which measure IgG in the blood to different foods.
This December, a draft of the Expert Panel Report 4 (EPR 4) from the National Asthma Education and Prevention Program (NAEPP) was posted for public comment. The deadline to submit your comments is Jan. 6.
Since the publication in 2007 of the EPR 3 from the NAEPP of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, there has been a flood of new data on asthma management. EPR 3 quickly became the bible of the diagnosis and management of asthma in the United States. Numerous new therapies have been approved for our patients suffering with this condition.
It is not uncommon to hear physicians saying they would not want their children to become physicians. Of course, there are many reasons mentioned such as loss of autonomy, high cost that can lead to high debt, time commitment and decreasing incomes. Even with these concerns, there is no shortage of applicants to U.S. medical schools. In 2018 - 2019, 21,622 applicants were accepted to allopathic (MD) medical schools out of the 52,777 who applied, for an overall acceptance rate of 41%. According to the Association of American Medical Colleges, this is the highest number of applications ever. So even with all the negative concerns about the future of medicine in the U.S., it is not affecting the number of young men and women wanting to become doctors.
There are many ways to get allergy education. You can go to national meetings, like the one this week in Houston hosted by the College. There are great regional and state meetings with terrific speakers. Of course, you have the allergy journals like Annals. Webinars on educational topics in allergy and practice management, both live and on demand, are available on the College Learning Connection. But this column is not about all the different ways you can keep up with allergy education from the College. I want to talk about my favorite way to get medical education and, for that matter, all types of education and entertainment. That’s podcasts.
One of the buzzwords in medicine today is diversity. I really like the definition of diversity on the Queensborough Community College site. Diversity means understanding that each individual is unique and recognizing our individual differences. These can be along the dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies. Medicine is going through changes with a major emphasis on diversity, and with that, so is allergy. Gone are the days when medicine was thought of as a profession of white males, with nurses being all female. In 2018, for the first time, more than half of the applicants and enrollees in U.S.