Genetic Links to Prevention

The movement towards personalized
medicine and prevention in health care

According to the Office of the Surgeon General, seven of ten Americans die each year from a preventable chronic disease such as heart disease, diabetes and many forms of cancer. In addition to the high morbidity of chronic disease, there is an associated high economic cost. For instance, health care spending in the United States reached $2.3 trillion last year, which is 16 percent of the country's gross domestic product. As much of this cost is due to treating chronic disease, the Office of the Surgeon General has declared that disease prevention is its number one priority. Advances in medicine have made it possible for each person to identify his/her genetic predisposition for many of these common conditions and empower physicians to personalize health plans to a degree never before possible.

It’s the field of personalized genetics. You may already have heard of it.

Personalized genetics is based on medicine’s newly developed ability to look past your chromosomes, through your genes and into the secrets of your DNA. The results help you understand what your genetic code has to say about the future of your health and act on that knowledge now.

These tests do not define your destiny, but rather provide you with insight that allows you to know your genetic chance of developing a variety of conditions – common and uncommon. Your physician will then have the ability to make earlier diagnoses, delay the onset of conditions or prevent them altogether.

These tests are able to look for genetic markers associated with a risk for heart disease, cancers, immune system disorders, digestive problems, diabetes and many other conditions.

Some patients assume that they have tapped all such information when they tell their doctors about the diseases that run in their families or when their doctor has taken a complete history.

This information is only part of the story. Family histories often have gaps, and most common conditions are triggered by a complex mix of genetic and lifestyle factors that don’t affect every generation. Furthermore, some genes are associated with a level of risk that exceeds the common risks that we all know about, such as being overweight or smoking. Thus, there are silent genetic risks that many of us may carry that could be helpful if known by our doctors.

In summary, doctors are able to better understand your health future, and act on it, if they are aware of which specific genetic risks you have actually inherited.

For instance:

• After one young woman learned of her elevated risk of colon cancer, she received her first colonoscopy years before the standard age of 50 and discovered a sizable polyp.
  
• A man whose scan showed he was at risk of macular degeneration, an eye disease leading to blindness, had his eyes tested years earlier than the usual screening test and learned he already had signs of the disease, which led to his physician starting early aggressive therapy.
  
• A woman who learned she had an elevated risk of celiac disease realized the reason behind decades of digestive problems and changed her diet accordingly with a cessation of symptoms.
  
  This type of personal insight means people are able to focus their health efforts on what really matters to them.
  
  Personalized genetic testing is appealing for several other reasons.
  
• It’s simple. You just provide a saliva sample. A genetics laboratory returns the results a few weeks later.
  
• It’s broad. Unlike single tests for individual diseases, it is a scan that simultaneously checks more than a million points in your genetic code.
  
• It stays up-to-date. New genetic discoveries are made all the time, but once your DNA scan has been completed, your record can be compared against the newest research and provide you with ongoing insight enabling you to optimize your health.

This field and its potential in personalized medicine are advancing rapidly. Given the promise of the field to fundamentally change patient care from reactive medicine to predictive medicine, certain physicians in the U.S. are leading the way to usher in this exciting era.

Is genetic testing for you? Your MDVIP-affiliated physician is the most knowledgeable about your health matters and family history, so he or she can provide the best insight. You can then decide if having information on your genetics will be useful. Call or email your MDVIP-affiliated physician today.

Uninsured Receive VIP Treatment Through Project Access

MDVIP is proud to acknowledge the following MDVIP-affiliated physicians for volunteering their time and expertise to Palm Beach County Project Access in South Florida: Robert Collins, MD; Earl Lysaker, Jr., MD; Brian Kaplan, MD; Charles Metzger, Jr., MD; Charles Metzger, Sr., MD; Richard Raborn, MD; Andrew Schlein, MD; Stacey Shinder, MD; and Donald Watren, MD.

Project Access, established in 2005 by the Palm Beach County Medical Society, is designed to provide uninsured people whose annual income is below 200 percent of the federal poverty level with access to primary care physicians, specialists, diagnostic facilities and hospitals.

“We are pleased to be working with MDVIP physicians who are donating their time and experience to give back to the community through this new program,” stated Jose F. Arrascue, MD, President Palm Beach County Medical Society Services.

Dr. Edward Goldman, CEO of MDVIP, says, “We believe preventive medicine is not only good for the patients because it reduces health risks, but also because it relieves stress on the entire medical system by reducing hospital visits and expensive emergency care.”

The preventive medicine pilot program will ultimately serve about 200 Palm Beach County low-income, uninsured patients, paid for by volunteer labor and subsidies from the medical society. The focus of this pilot is to show that close doctor-patient relationships, with an emphasis on wellness and good management of chronic disease, can work for the low-income and sick, not just the financially stable and healthy. Additionally, MDVIP plans to develop essential data that shows how this model can reduce costs to the system and improve health care for the uninsured, as it has in MDVIP-affiliated practices nationally.

Susan Freedman, MD Runs Boston Marathon


If anyone knows a little about practicing what she preaches, it’s MDVIP-affiliated physician Dr. Susan Freedman of Boston, MA. Despite multiple hurdles, Dr. Freedman trained for and completed the Boston Marathon. She said, “It was energizing…inspiring to hear individuals’ stories about why they were running this race. I don’t have one of these major stories.” We beg to differ.

Dr. Freedman considered running the marathon the biggest challenge of her life. To her, it loomed larger than her personal battles with both breast cancer and melanoma. There is no question that Dr. Freedman could have easily found many reasons to quit her training. She developed plantar fasciitis on one heel early on, as well as tendonitis in her knee. Then, two months before the race, she developed plantar fasciitis on her other heel. This forced Dr. Freedman to stop running through the streets of Boston and instead to cross-train inside on the elliptical machine and stationary bike for upwards of five hours a day. Of the last few months of vigorous cross-training, she said wryly, “I watched a lot of CNN.”

It was finally race day and Dr. Freedman was at the starting line. The first few miles went well with a rush of people and crowds all around, but by mile three the pain in her thighs started. She kept going with the thoughts that she couldn’t stop; how else would she make it to Boston? The good news was that just down the road her daughter sidled up to her at the 13-mile mark and they ran together for the next eight miles to Boston College. At mile marker 21, the “baton” was passed to Josh, Dr. Freedman’s son, to run the next five miles where he left his mom to run the final stretch down Boylston Street.

Dr. Freedman crossed the finish line for the Boston Marathon that day and joined others whom she described in admiration as being able to “overcome adversity in the most adverse conditions imaginable.”

A unique feature of the Boston Marathon is its charity program which allows selected charitable organizations to raise money for worthwhile causes. In 2007, approximately 1,200 participants, representing 21 charities, raised more than $10 million. Dr. Freedman and her husband raised a little over $5,000 toward the Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, the only independent school of nutrition in the United States.

Enhanced HRA Now Online
MDVIP’s Health Risk Assessment (HRA) has been updated with an enhanced format. More detailed questions are asked about your exercise, sleep and nutritional habits; emotional and mental status; and lifestyle factors and family history. The answers give your MDVIP-affiliated physician essential information to use in identifying current health problems and future health risks.

You should take the HRA each year, prior to your annual physical, so your MDVIP-affiliated physician can review the results before meeting with you. The assessment can be accessed by logging in to your personal website at www.MDVIP.com and clicking on the blinking red “Take Assessment” link. We recommend that you schedule approximately 20 minutes to complete the HRA when you’ll have few interruptions, since the assessment will time out after a period of inactivity and information will not be saved. If this happens, the assessment can be taken again but will start at the beginning.

For assistance logging in to your personal website, email MemberCare@mdvip.com or call toll-free 1-877-886-1411.

MDVIP Adds #1 Hospital for Orthopedics to MCE

Hospital for Special Surgery in New York City

MDVIP is proud to announce a new addition to the Medical Centers of Excellence (MCE) program, Hospital for Special Surgery (HSS) in New York. HSS is one of the most prominent facilities on the East Coast, is nationally ranked #1 in orthopedics and #4 in rheumatology by U.S. News & World Report (2008), and enjoys an international reputation that attracts patients from all over the world.

“Through this affiliation with Hospital for Special Surgery and other top medical institutions in the country, MDVIP continues to provide exceptional care for patients through all stages of their health,” stated Edward Goldman, MD, CEO and Co-Founder of MDVIP, Inc. “HSS is the nation’s leading hospital for musculoskeletal medicine, and we are proud to be able to provide our members with their high quality care for the best possible outcomes.”

“Demand is growing for highly skilled treatment of orthopedic and rheumatological conditions, including joint replacement,” said Louis A. Shapiro, President and CEO, Hospital for Special Surgery. “We support MDVIP’s commitment to offer their members exceptional care in our areas of expertise.”

This exciting announcement is at the heels of MDVIP’s 600th MCE referral. Since the MCE program launched, patients have obtained exceptional specialist care at:

Hospital for Special Surgery

• Internationally recognized as a leader in the diagnosis, treatment and investigation of musculoskeletal and rheumatologic conditions
  
• Received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center
  
• Recipient of the HealthGrades Joint Replacement Excellence Award
  
• Performed more than 20,000 surgical procedures last year and over 5,000 joint replacements
  
• Research is supported substantially by the National Institutes of Health
  
• Affiliated with the NewYork-Presbyterian Healthcare System
  
• All medical staff hold faculty appointments at Weill Medical College of Cornell University
  
• Overall surgical site infection rate in 2007 of less than 0.5 percent, substantially lower than the national average for similar procedures
  
• Pioneered the first total knee replacement - the forbearer of virtually all knee implants on the market today

Whatever Moves You, Helps You


Americans simply aren’t getting enough physical activity to meet the minimum threshold required for good health. Gradually increasing the frequency and the duration of your workouts will help reduce your risk of chronic disease and weight gain. Adding as little as 30 minutes of moderately intense physical activity to your day may help you avoid a host of serious ailments, including heart disease, diabetes, depression, and several types of cancer, in particular breast and colon cancers. Additionally, regular exercise can help you sleep better, reduce stress, control your weight, brighten your mood, and sharpen your mental functioning. It is hard to stay seated with these types of benefits.

Some of our MDVIP-affiliated physicians shared patient success stories that just might motivate you to start moving.

Three months ago, a 50-year-old male patient of Dr. Brian Jorgensen (Phoenix, AZ) was frustrated with his dependence on diabetes medication. He began walking and biking at least 30 minutes a day, five days a week. In three months, the patient was able to eliminate his diabetes medications and now controls his glucose levels with diet and exercise alone.

Dr. Lee Kagan (Sherman Oaks, CA) has a patient, a very successful businessman, who shows the same amount of drive in his exercise routine as he does in his business. He is in his late 60s and currently holds the record for the longest time anyone has lasted on Dr. Kagan’s stress test - 18 minutes on a treadmill with progressively increasing speed and inclination. He has built his endurance through an exercise regimen that includes running through the hilly streets of his neighborhood several times a week and working out at his local gym.

It’s never too late to get started.
Dr. Larry Snyder (Laguna Nigel, CA) often recommends water aerobics for patients with osteoarthritis to improve mobility and flexibility. Patients who cannot walk, bike or swim can often do water aerobics with great benefit. One of his patients, an 85-year-old World War II veteran who injured his back during his call to duty, questioned this activity. Despite his doubt, he agreed to participate in water exercise classes to “prove Dr. Snyder wrong.” After two weeks in the pool, Dr. Snyder’s patient was happy to report that he was wrong. In fact, he has never felt better, and he and his wife now participate on a regular basis.

According to an article written by Harvard Health Publications, a well-rounded exercise program has four components: aerobic activity, strength training, flexibility and balance exercises. Each component benefits your body in a different way. Moderate or vigorous aerobic (endurance) exercise is described as any activity that noticeably accelerates your heart rate for at least ten minutes at a time. Endurance exercises may include a brisk walk, jog, dance, bike or swim. Some patients in MDVIP-affiliated practices have even more creative ways to get their heart rates up.

Dr. Brian Turrisi (Washington, DC) shared a story of an 83-year-old man who trains dogs and found a unique form of exercise to help with his shortness of breath. He began dancing with the dogs he trains and swears by the difference it has made in his health and breathing.

Get motivated.
Dr. Paul Block (Thousand Oaks, CA) is proud to say that almost every patient in his practice is on an exercise program. He uses the annual physical to define where people are with their current health and fitness levels and helps them set attainable goals. He also gives them the resources to achieve their goals. One resource he uses is a book entitled Younger Next Year or Younger Next Year for Women. Dr. Block feels so strongly that this is the best book published to date on fitness that he has given out over 250 copies to his patients.

Dr. Block acknowledges that since every patient is different and has a different fitness goal, he does not give them a “road map” to an exercise regimen, but instead gives them a “compass” to guide them in the right direction.

Reward yourself.
Dr. Lewis Weiner (Providence, RI) has a patient with a colorful reward system in place when he attains a fitness goal, whether it is weight loss, loss of inches or lowering his cholesterol. This patient is fortunate to have some connections in Los Angeles and rewards himself by attending various events, such as the Grammy Awards.

Customize an activity plan.
Before beginning an exercise program, it’s important to take into account many factors, including age, current health conditions, risks, current activity level, and therapeutic needs. Working with your MDVIP-affiliated physician on an activity plan will help you get the most out of the exercises you can do safely.

Questions about your membership? Need help on your myMDVIP website? If there is anything we can do for you, call Member Care toll-free at 877-886-1411.