March 2014 Sombrero

8/12/2019 March 2014 Sombrero

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SOMBREROP i m a C o u n t y M e d i c a l S o c i e t y

Home Medical Society of the 17th United States Surgeon General

M A R C H 2 0 1 4

Medical marijuana

mysteries revealed

Monitoring pertussis

In Memoriam:

Dr. Vernor Lovett


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3/28SOMBRERO March 2014 3

Ofcial Publication of the Pima County Medical Society Vol. 47 No. 3

PrintingCommercial Printers, Inc.Phone: 623-4775

E-mail: [email protected]

PublisherPima County Medical Society5199 E. Farness Dr., Tucson, AZ 85712Phone: (520) 795-7985Fax: (520) 323-9559

Website: pimamedicalsociety.org

EditorStuart FaxonPhone: 883-0408

E-mail: [email protected] do not submit PDFs as editorial copy.

Art Director

Alene Randklev, Commerc ial Printers, Inc.Phone: 623-4775

Fax: 622-8321

E-mail: [email protected]

Pima County MedicalSociety Officers

PresidentTimothy Marshall, MD

President-ElectMelissa Levine, MD

Vice PresidentSteve Cohen, MD

Secretary-TreasurerGuruprasad Raju, MD

Past-PresidentCharles Katzenberg, MD

PCMS Board of DirectorsEric Barrett, MD

Diana Benenati, MD

Neil Clements, MD

Michael Connolly, DO

Michael Dean, MD

Howard Eisenberg, MD

Afshin Emami, MD

Randall Fehr, MD

Alton Hallum, MD

Evan Kligman, MDKevin Moynahan, MD

Soheila Nouri, MD

Wayne Peate, MD

Scott Weiss, MD

Leslie Willingham, MD

Gustavo Ortega, MD (Resident)

Snehal Patel, DO (Resident)

Joanna Holstein, DO (Resident)

Jeffrey Brown (Student)

Jamie Fleming (Student)

Members at Large

Donald Green, MD

Veronica Pimienta, MD

Board of Mediation

Timothy Fagan, MD

Thomas Grifn, MDGeorge Makol, MD

Mark Mecikalski, MD

Edward Schwager, MD

Arizona MedicalAssociation OfficersThomas Rothe, MD

president

Michael F. Hamant, MDsecretary

At Large ArMA BoardR. Screven Farmer, MD

Pima Directorsto ArMATimothy C. Fagan, MD

Charles Katzenberg, MD

Delegates to AMAWilliam J. Mangold, MD

Thomas H. Hicks, MD

Gary Figge, MD (alternate)

SOMBRERO (ISSN 0279-909X) is published monthlyexcept bimonthly June/July and August/September by thePima County Medical Society, 5199 E. Farness, Tucson,

Ariz. 85712. Annual subscription price is $30. Periodicalspaid at Tucson, AZ. POSTMASTER: Send address

changes to Pima County Medical Society, 5199 E. FarnessDrive, Tucson, Arizona 85712-2134. Opinions expressedare those of the individuals and do not necessarily repre-sent the opinions or policies of the publisher or the PCMSBoard of Directors, Executive Officers or the members atlarge, nor does any product or service advertised carry theendorsement of the society unless expressly stated. Paidadvertisements are accepted subject to the approval of theBoard of Directors, which retains the right to reject anyadvertising submitted. Copyright 2014, Pima CountyMedical Society. All rights reserved. Reproduction inwhole or in part without permission is prohibited.

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On the Cover

Eleven-mile-long Aravaipa Canyon, in Graham and Pinal counes,

part of the 19,000-acre Aravaipa Canyon Wilderness, usually has

a spectacular display of poppies, but this year theyve been scanty

due to lack of Spring rains, so these may be the only poppies well

see(Dr. Hal Tretbar photo).

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5 Milestones:Center for Neurosciences welcomesDr. Daniel Wee. Dr. Mateja de Leonni-Stanonik

chairs Tucson Heart and Stroke Walk.

9 PCMS News: Please send us your e-mail address if

you have not yet.13 In Memoriam: Dr. Vernor F. Love dies at 84.

16 Medical Marijuana: Dr. Suzanne Sisley explainswhat the Arizona Medical Marijuana Acts means to

physicians.

18 Public Health: County health department updateon pertussis.

19 Valley Fever: Dr. John Galgiani helps The NewYorkerexplain our disease to Easterners.

23 Makols Call: Sll like medicine despite it all?Reasons to cheer up.

24 Perspectve:Our editor holds forth on Arizonasnew judicial decisions basis law.

26 Mayo CME: Coming events from Mayo ClinicScosdale.

Inside



Milestones

Dr. de Leonni-Stanonikchairs heart/stroke walkMateja de Leonni-Stanonik,

M.D., M.A., Ph.D.of the Center

for Neurosciences, former

surgeon-general of the Republic

of Slovenia, has been appointed

to chair the 2014 Tucson Heart

and Stroke Walk, Sunday April 6

at Reid Park, the American

Heart Associaon reported.

As chairman, Dr. de Leonni-

Stanonik will lead the charge

of bringing the Tucson

community together in the

ght against heart diseases

and stroke, they said.

We are pleased that Dr. de Leonni-Stanonik has acceptedthe challenge to lead our 2014 Heart and Stroke Walk, saidBriany Starace, heart walk director for AHA and American Stroke

Associaon. Her wealth of experience and inuence as a former

surgeon-general, her knowledge of heart diseases and stroke, as

well as her passion for the cause, will help elevate our lifesaving

message and mission of building healthier lives free of

cardiovascular diseases and stroke.

Staraces news release said that AHA-funded research has yielded

or contributed to innovaons such as CPR, life-extending drugs

(including clot-busters), pacemakers, bypass surgery, the heart-

lung machine, and surgical techniques to repair heart defects.

People dont understand how heart disease and stroke compare toother heath causes, Dr. de Leonni-Stanonik said. Its a more

signicant health threat than anything else faced by our community.

Dr. de Leonni-Stanonik said she hopes to raise signicant funds to

meet the event goal of $175,000, which will assist in research andeducaonal programs. Its all about bringing the support in from

the community. Plus, its a wonderful way to spend me with

friends, family, and co-workers and do something wonderful at

the same me.

This years Heart and Stroke Walk will include a Kids Zone, Heart

& Stroke Pavilion, CPP training, food and entertainment, music

and interacve acvies. For informaon about the Tucson Heart

and Stroke Walk or to register, visit tucsonheartwalk.org or call520.917.7522.

Dr. de Leonni-Stanonik is originally from the rural mountains of

Slovenia close to the border of Austria and Italy. She moved to

the U.S. where she graduated with a dual degree in biology/

psychology, and German/polical science. She received hermasters degree in cognive psychology in 1999 and her

doctorate in cognive neuroscience in 2002 from the University

of Tennessee. She completed medical school at Saba University

School of Medicine in 2007 in the Netherlands, and moved toVirginia where in 2008 where she nished her internship at UVA/

Carillion Clinic in medicine/psychiatry. She completed her

neurology residency at George Washington University. She also

trained in vascular neurology at the Medical University of South

Carolina before moving to Tucson in summer 2012.

Although staying very busy in the world of academia, Dr. de

Leonni-Stanonik has also taken me to serve her home and

adopted countries, the AHA release said. She started in 2003,

becoming vice-president of the Slovene World Congress, and in

2004 Consul from Slovenia to the United States.

In 2009 she was appointed to be the scienc and organizing

chair for the Global Health Forum for the Embassy of Slovenia in

Washington, D.C. She has led numerous projects in medical andscienc diplomacy as well as cared for several policians

including the late Sen. Ted Kennedy.

In 2010 she returned home and served as surgeon-general forthe Republic of Slovenia and the chief execuve for the e-Health

and Telemedicine Program of Slovenia, at its Ministry of Health.

She has also been involved in various execuve leadership

posions of the Slovene World Congress which unites all at the

Slovenes in the diaspora.

Providing medical support to rural areas around the world

through the use of Telemedicine programs is close to Dr. de

Leonni-Stanoniks heart. In 2006, she served as team physician

and co-director of the Amazon Virtual Medical Team, making atrip along the Amazon River to introduce telemedicine to the

remotest areas of the Amazon and provide telemedicine

equipment and medical supplies to villages.

From 2007 to 2010 she also served on the Board of Directors for

the Internaonal Virtual e-Hospital Foundaon where she wasinvolved in seng up telemedicine systems in the Balkans and

around the world.

She joined the Center for Neurosciences in December of 2013 as

an Adult Neurologist with subspecialty in vascular/stroke

neurology, headaches, and pain disorders, as well as neuro-

degenerave diseases such as Alzheimers and Parkinsons.

She said she is extremely excited to be in Southern Arizona, is trulyhonored to be serving the community, and especially appreciave of

the wonderful weather and scenery we all enjoy in here in Tucson.

Dr. Wee joins Cornea AssociatesDaniel Wee, M.D. has joined

Cornea Associates, the pracce

announced, and he is now

accepng appointments.

Dr. Wee, who is uent in

Korean and Spanish, earned

his undergraduate degree in

biology at Northwestern

University, and earned his M.D

at Washington University in St.

Louis. Mo.

He completed his internship at

St. Francis Hospital in

Evanston, Ill., and his

ophthalmology residency at the University of South Carolina

where he served as chief resident.

Dr. Wee then completed a cornea fellowship at Tus New

England Eye Center and Ophthalmic Consultants of Boston,

where he served as a clinical instructor to the residents.



Dr. Fain honored withendowed chair in medicine

Mindy Fain, M.D, a widelyrecognized leader ingerontology, has beenhonored with the University ofArizona College of MedicineTucsons Anne and Alden Hart

Endowed Chair in Medicine,the university reported.

Dr. Fains many responsibilieswith the UA College of Medicineaest to her achievements inadvancing healthcare for olderadults, they said.

Dr. Fain is professor ofmedicine and chief of the Division of Geriatrics, General InternalMedicine and Palliave Medicine in the UA Department ofMedicine. She is co-director of the University of Arizona Center onAging and Arizona Geriatric Educaon Center. She also is theArizona Health Sciences Center s execuve director of pracceinnovaon, working with the faculty of the AHSC colleges ofmedicine, nursing, pharmacy and public health to develop newways to provide high-quality care at lower costs.

She recently was appointed to the Health Disparies AdvisoryCouncil, one of four councils formed by Joe G.N. Skip Garcia,M.D., UA senior vice-president for Health Sciences, to advanceareas of excellence in health sciences research.

Mindy Fain truly is one of our superstars, said Steve Goldschmid,M.D., dean of the UA College of MedicineTucson. Her creavevision, her clinical skills, and her commitment to improvinggeriatric care at all levels are recognized by her colleagues hereand across the country.

Dr. Fain said she is humbled and delighted by this new honor. Itshows such wonderful support for the work I do. And its notwhat I do, its what we dobecause I am fortunate to work withso many people who are so outstanding in their work.

Dr. Fain also is working with an interdisciplinary team to establishan ACEacute care of eldersunit at UAMCSouth Campus, theuniversity reported. A paents care team could include, forexample, a geriatrician, a nurse praconer, a pharmacist, a socialworker and a physical therapist, all specially trained in geriatriccare. She also hopes to create a virtual ACE unit at UAMCUniversity Campus. Paents would be treated in more than oneunit of the hospital, but with a similarly integrated care team.

The Anne and Alden Hart Endowed Chair in Medicine was madepossible by a gi of real estate to the UA by Anne Hart in memory ofher husband, who died in 1967, the year the College of Medicineadmied its rst students, the university reported. Alden Hart beganworking in the telephone industry in 1906 and worked his way upunl in 1940 he became president of Kansas-based United Ulies.That company evolved into United Telecommunicaons and, in the1980s, became Sprint. Hart rered in 1958 and the couple moved toTucson in 1959. Before her passing, Anne made the gi, specifyingthat it be used to benet the College of Medicine.

Dr. Fain and her husband, infecous disease specialist RichardMandel, M.D., moved to Tucson from Boston in 1984. Fain signedon for a year with a local HMO before accepng a UA Department

of Medicine posion with the Veterans Administraon Hospital,now part of the Southern Arizona VA Health Care System.

Her job was to provide home-based primary carehousecallsto elders. I rapidly fell in love with geriatrics, Dr. Fain said. Thesynergies between geriatrics and palliave care and the Centeron Aging and the other programs are what make it so excing.

CofM Dean Steve Goldschmid

accepts new clinical pracceSteve Goldschmid, M.D., whohas served as dean of theUniversity of Arizona College ofMedicineTucson since July2009, has been appointedassociate vice- president forclinical aairs at the ArizonaHealth Sciences Center, theuniversity reported.

Dr. Goldschmid will begin hisnew dues March 3 and willreport to Joe G.N. Skip

Garcia, M.D., UA senior vice-president for health sciences,who now also will serve as interim dean of the UA College ofMedicine Tucson.

In a parallel appointment, Dr. Goldschmid also will serve as vice-president of physician services for The University of ArizonaHealth Network, they said.

In his new role Dr. Goldschmid will provide senior leadership indeveloping clinical pracce strategies and opportunies for theUAs health colleges. He will collaborate with AHSC deans,clinical department heads, instute and center directors and TheUniversity of Arizona Health Network execuve team, providingleadership in AHSC-UAHN eorts to advance clinical pracce

programs and services. He also will oversee development ofclinical aliaon and pracce opportunies and manage exisngstrategic relaonships with aliates, such as the SouthernArizona VA Health Care System.

In his UAHN role Dr. Goldschmid will serve as a key member ofthe UAHN execuve team, with involvement in health systemstrategic planning, clinical quality and paent safety, monitoringand accreditaon of programs and nancial management andoversight. As UAHNs vice-president of physician services, he willmaintain and improve relaonships among clinical departmentsand hospital-based operang units, contribung to the building ofmul-disciplinary clinical programs and teams, and will promoteprofessionalism standards among clinical providers and sta.

Board cered in internal medicine and gastroenterology, Dr.Goldschmid joined the UA College of MedicineTucson in 2000,when he was recruited to establish a state-of-the-artgastroenterology service/endoscopy lab. He chaired the UADepartment of Medicine from 2006 unl July 2008, when heaccepted the role of interim dean of the UA College ofMedicineTucson. Before joining the UA, he served as directorof clinical services in gastroenterology at Emory University Schoolof Medicine in Atlanta, Ga.

In serving as dean for the past ve-and-a-half years, Dr.Goldschmid said, I gained a deep understanding of just howimportant the success of the UA Health Network is to the vitality



of the College of Medicine. Im extremely excited to take on thisnew role, focusing on eorts to strengthen the performance ofour clinical pracce in full support of our academic mission.

Campus honorsNaonal Solidarity DayOn Feb. 14 The University ofArizona College of Medicine

honored the Fourth AnnualNaonal Day of Solidarity forCompassionate Paent Care,the university reported.

Naonal Solidarity Daymemorializes the Tucsonmurders of Jan. 8, 2011. AcrossNorth America and Canada,medical schools and otherhealth care instuonsincluding The University ofArizona College of Medicine,stand in solidarity andundertake projects to pay tribute to all compassionate, paent-centered caregivers, they said.

The day is held in honor of the humanisc acons of surgeonRandall Friese, M.D., the rst physician to treat Rep. GabrielleGiords aer she was shot, and other members of The Universityof Arizona Medical CenterUniversity Campus team in Tucson,who cared for the wounded and dying.

The event was led by the Gold Humanism Honor Society (GHHS)

chapter at the University of Arizona College of Medicine, Programin Medical HumaniesTucson, with weeklong acviesbeforehand. AHSC and UA Medical Center faculty and sta wereinvited to meet on Feb. 14, 11:45 a.m. to 1 p.m., on the AHSC Plaza

just south of the medical school.

Prepatory events included students delivering baskets withinformaon about GHHS Solidarity Day, as well as ribbons,candies and cards to units throughout The University of ArizonaMedical CenterUniversity and South Campuses, and readingsof poetry and cards from display boards at Java City.

At the Feb. 14 event medical and other health sciences students,faculty and sta, formed a human chain joining hands in a circleto demonstrate standing in solidarity for compassionate paentcare. This was followed by speakers from GHHS and others.Banners with the seven aributes of humanism in medicineintegrity, excellence, compassion, altruism, respect, empathy andservicewere arranged in a circle and aendees asked to standnear the aribute they most exemplify.

The event concluded with a choral performance by Doc-Apella, amusical group of UA medical students who sing together to helpconnect with paents and to relieve stress.

Dr. Friese struck a chord in the internaonal medical community

when he toldThe New York Times that his most important aconsthat terrible day were holding her hand, speaking to her, andreassuring her that she was in the hospital and would be caredfor, the university reported.

Dr. Friese took part in the rst Tucson observance. It is a disncthonor to have my small acons contribute to the organizaon of thisevent, he said. I am pleased that a message of humanism inmedicine is being communicated across the state and country. n

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PCMS News

Members must send PCMStheir e-mail addressesAs of this month, the Society transions to e-mail,

a speedier,low-cost means of distribung ourbullen, legislave news and alerts, social

announcements, and educaonal opportunies

for physicians and sta.

Other than mailings required by Society bylaws,

including Sombreromagazine, ballots, bylaws

changes, etc., we are going strictly electronic.

For our physician e-community to work, each

member must provide the Society an e-mail

address to add to our membership e-distribuon

list. So, please email your address to AssistantDirector Dennis Carey at [email protected].

Once weve veried or added your address, youll

start to receive all our announcements and news

via your iPhone, iPad, laptop, or desktop computer.

What do they want, blood? YesIn mid-February United Blood Services of Arizona announced

public blood drives through March 31 due to rising needs.

Arizona hospital paents require more transfusions January

through March than during any other me of the year, they said.While donors of all blood types are needed, O-negave, the

universal blood type, is always in greatest demand. Premature

babies, trauma vicms, as well as paents suering from cancer,

leukemia and heart disease all receive lifesaving blood transfusions.

To make an appointment to Find the Hero in You, call 1-877-UBS-

HERO (1877.827.4376) or visit www.BloodHero.com and enter

your city or ZIP code.

Blood drives remaining on the schedule as of Sombreropublicaon

were Monday March 10, 10 a.m.-2 p.m., Bloodmobile at Intuit,

2800 Commerce Center Place; and Tuesday March 11, 8 a.m.-12

p.m., UofA Campus Rec, 1400 E. 6thSt. second oor Room 203.

PCMF CME dinnermeetsPima County Medical Foundaon has scheduled these CME

events for its Tuesday Evening Speaker series. Dinner is served at

6:30 p.m. and the presentaon is at 7.

March 11:Treatments of Obesity presented by Jerey Monash, M.D.

April 8:Alzheimers and Other Degenerave Brain Diseases

presented by Georey Ahern, M.D. Also at this meeng, Timothy

Fagan, M.D., Hector L. Garcia, M.D., and Jane Orient, M.D. will

receive the Foundaon Award for Lifeme Achievement in the

Furtherance of Medical Educaon.

May 13:Healthcare Update 2014presented by Timothy Fagan, M.D

Other likely speakers are Marc Leib, M.D. and Bill Mangold, M.D.

June 10:Rheumatoid Arthrispresented by Michael Maricic, M.D.

Sept. 9:Dermal llers and Fat Stem Cells in Plasc Surgery

presented by plasc surgeon Dr. John Pierce.

Oct. 14:New Medical and Surgical Treatments for Prostate

Cancer presented by Rick Ahmano, M.D.

Nov. 11:Newer Ancoagulants and Their Role in A-Fib, DVT, andPulmonary Embolism presented by Tmothy Fagan, M.D.

TMC rae reduxJust before Sombrerowent to composion, the full-color folder

for TMC Mega Rae in support of Tucson Medical Center hit

Tucson mailboxes for the second year.

Calling it the only large-scale rae in Southern Arizona, Michae

Duran, VP and chief development ocer of TMC Foundaon, said

that once again, each cket purchased gives parcipants a one

in 20 chance of winning one of the more than 2,800 spectacular

prizes, including a luxury home package, a variety of new cars,

amazing dream vacaons, and an array of the latest in electronics,jewelry, and home accessories.

Tickets are $100, with limited mul-packs available at three for $250.

For informaon see TMCmegarae.org or call 1800.395.8805.

Society hosts Walk With a Doc

Physicians and paents can benet from the Just Walk/Walk With

A Doc program sponsored by PCMS.

Walk With A Doc is a naonal non-prot organizaon, founded by

Dr. Dave Sabgir, a board-cered cardiologist in Columbus, Ohio,

designed to encourage paents to get more exercise. The Society

has hosted Just Walk events since February 2012. It is the only

Walk With A Doc program in Arizona.

I endorse it, SombreroEditor Stuart Faxon said. I dont take

part directly in the program, but when I was heading for 300

pounds as a Type 2 paentnot even for the rst meI had to

Leo Roop registers for the February Walk With A Doc 2.4-mileevent at Rillito Park. T-shirts are available for rst-time walkers.



do something. So I tried walking one hour per day and talked to

my physician about it at the same me. In the last year Ive lost 28

pounds, and with his approval no longer taking glyburide. He is

sll working on it, Faxon said.

Each event begins with a brief presentaon from a physician on

various healthcare topics. The Arizona Chapter of the American

College of Physicians provides physicians who lead the walk and

presentaon.

Walks are at Rillito Park on the south bank, just east of the Swan

Road Bridge. The easy hike covers a 1.2- or 2.4-mile course that

includes trails and paved pathways. Walkers are encouraged to

interact with the physicians during the walk. The presentaon

begins at 8 a.m. on the second Saturday of the month. There is a

summer break from May through August.

According to the American Heart Associaon, walking has the

lowest dropout rate of any physical acvity. The Walk With A Doc

program is designed to get people of all ages acve and reverse

the consequences of a sedentary lifestyle. Walking as lile as 30

minutes each day can provide the following benets:

Reduce risk of coronary heart disease.

Improve blood pressure and blood sugar levels.

Maintain body weight and lower risk of obesity.

Enhance mental well-being. Improve blood lipid prole.

Reduce risk of osteoporosis.

Reduce risk of breast and colon cancer.

Reduce risk of Type 2 diabetes

Walking is low-impact, and easier on the joints than running. It is

safewith a physicians approvalfor people with orthopedic

ailments, heart condions, and those who are more than 20

percent overweight.

Just Walk/Walk With A Doc is free and open to anyone who wants

to parcipate. Walkers are encouraged to arrive a few minutes

before the event starts to register.

Physicians and walkers enjoyed the Tucson scenery andweather as part of the benets of Walk With A Doc. Taking partwere Andrew Kovoor, M.D., a resident at the University ofArizona, who led the presentation on causes and the prevention

of strokes. Neurologist Nancy Bello, M.D. and SanthoshGheevarghese-John, M.D., assisted in answering questions.

MRC Nursing Task Force at workThe Medical Rsrserve Corps of Southern Arizonas Nursing Task

Force is at work on creang a realisc disaster scenario for

Arizona, reports MRC Secretary-Treasurer Steve Nash.

It takes work, he said, but a statewide exercise last November

posed a resource stumper: aer an unusually heavy monsoon

right in the middle of summermost of the Western power grid

goes down. And it stays down for weeks. Not only do the lightsnot work, but ATMs are down, backup generators in hospitals run

out of fuel, and there is no electricity to pump replacement fuel.

While stakeholders wrestled with this scenario in the Pima

County Emergency Operaons Center, the Nursing Task Force of

the MRC teamed up with nurses from the Pima County Health

Department to address the funconal and access needs of

community members who use durable medical equipment, who

are at huge risk when the power goes out. A framework for a plan

was developed and tasks assigned.

In January the nurses met again, Nash said. The group decided to

organize a community forum to have more comprehensive input

and collaboraon that would result in a more workable plan. Details

about the forum will be shared with Sombrerowhen they emerge.

Study: Aggressive brain-woundmanagement increasessurvival signicantlyNine out of 10 people with gunshot wounds to the brain usually

die. University of Arizona trauma surgeons, using a new

aggressive resuscitaon protocol for paents with gunshot head

injuries, have increased survival to nearly ve out of 10 vicms,

according to a recent study published in The American Journal of

Surgery, The University of Arizona reported.

Gunshot wounds to the brain are the most lethal of rearm

injuries, with survival rates of 10 percent to 15 percent. Because

of the high mortality rate, aggressive management oen is

withheld from the most severely injured paents with low

outcome scores, said Bellal Joseph, M.D., UA assistant professor

of surgery and the studys lead author.

However, military reports on the use of aggressive operave

procedures for gunshot wounds to the brain have shown higher

survival rates, Dr. Joseph said. Peter M. Rhee, M.D., professor

and chief of the UA Division of Trauma, Crical Care, Burn and

Emergency Surgery, and the studys senior author, used this

aggressive management protocol while serving as a military

trauma surgeon in Iraq and Afghanistan. Drawing from these

reports and Dr. Rhees experience, UA researchers at The

University of Arizona Medical Center Level I Trauma Center began

aggressively resuscitang all paents with gunshot wounds to the

brain in 2008.

Irrespecve of how they scored on the Glasgow Coma Scale (a

neurological scale used to measure levels of consciousness in a



person following a brain injury), 132 paents with gunshot

wounds to the brain received an aggressive management

protocol. The protocol included blood products and

hyperosmolar therapy to reduce intercranial pressure, thereby

promong long-term survival and recovery.

Aer starng the new resuscitaon methods, the survival rates

started to improve immediately. There was an increase year aer

year and during the last year of the study 46 percent of those

paents survived, Dr. Joseph said.

Results of the ve-year, single-site study also showed the

adopon of aggressive management of gunshot wounds to the

brain aided in the preservaon of organs in non-survivors,

increasing the number of organs procured per donor from 1.3

percent to 2.8 percent.

Dr. Rhee said, Aggressive management is associated with signicant

improvement in survival and organ procurement in paents with

gunshot wounds to the brain. Low outcome scores and the bias of

resource use can no longer be used to preclude trauma surgeons

from abandoning aggressive aempts to save these paents.

Study authors acknowledged that an increase in survival andorgan donaon poses some ethical issues. While some paents

had good neurologic outcomes, some were discharged in a

vegetave state or in comas. Without long-term funconal

results, it is dicult to know long-term outcomes of survivors.

This study, funded by the UA Department of Surgery, is one of a

number of research eorts by trauma surgeons at the UA

Department of Surgery Division of Trauma, Crical Care, Burn and

Emergency Surgery. Faculty, fellows and residents in the trauma

division have published more than 35 peer-reviewed arcles and

book chapters this year alone, surpassing any previous year at the

UA. Most level I trauma instuons have three or four research

arcles published annually.

Trauma research is really important, Dr. Rhee said. The

successful recovery of Rep. Giords is an example of the benet

of evidence-based treatments for the management of paents

with gunshot wounds to the brain. We can impact one person at

a me in the hospital, but trauma research impacts millions.

TMC collaborates for healthinsurance info

By Tucson Medical CenterHealthcare I can aord? Where can I sign up?

Southern Arizona residents looking for informaon on health

insurance are geng guidance from major local health care

providers and other concerned organizaons.

An awareness campaign should make it easier for folks to get

connected with their insurance opons, in light of the

reinstatement of AHCCCS in Arizona, and the deadline

approaching for the federal healthcare marketplace on March 31.

TMC is supporng the collaborave eort, along with other

sponsors including University of Arizona Medical Center,

Carondelet Health Network, Northwest Healthcare, Sinfonia

HealthCare Corporaon, Blue Cross Blue Shield of Arizona, and

Tucson Regional Economic Opportunies, Inc. (TREO).

This is the rst me the major healthcare systems have come

together for the common good and health of our cizens, said

Fletcher McCusker, CEO of Sinfonia HealthCare Corp. and

Chairman of the TREO Blueprint Update Healthcare Commiee.

We have many assets to posion us to be a healthier region in

the long run.

Our cered applicaon counselors have been helping individuals

navigate insurance enrollment since November, said Judy Rich,

TMC president & CEO. We have seen the appreciaon and

gratude expressed when they have secured insurance coverage

for their familysomemes for the rst me in years. Our

opportunity with this eort is to expand the understanding even

further about the advantages provided by medical insurance.

Thanks to this group of regional collaborators, those without

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Dr. Vernor F. Lovett1929-2013

In Memoriam

By Stuart Faxon

Vernor F. Love, M.D., F.A.C.S., general and vascular surgeonwho joined PCMS in 1966, died peacefully Jan. 20 at hishome in Tucson. He was 84. He had been an Associate Member

since his rerement in 1990.

He really was one of the good guys, recalled Dr. Dick Dale. He

was loved by all.

Dr. Robert Hasngs, 1978 PCMS president, recalled Vern from

both Tucson High School and Northwestern University Medical

School. He was a star on the [Tucson High] football team and on

other teams, Dr. Hasngs said. He was a great man, and a goodfriend. He noted that as medical oce manager of Southwestern

Surgery Associates, Dr. Love guided all the pracces economic

decisions.

From 1922 to 1960 Dr. Loves family ran Hillcrest, a TB

sanatorium at North Third Avenue and Adams Street in Tucson,

and he and Sarah Love Chatlos described that history in these

pages in December 2004. It accommodated up to 28 paents,

most of whom had tuberculosis. Many of Tucsons physicians

came here in the 1920s and 30s because they had acve TB, the

authors said. They noted that at various points between 1900 and

1927, Tucson had up to nine sanatoria.

2450 E. River Road, Tucson, AZ 85718

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Learn more about our physiciansand services at

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Center for Neurosciences

Welcomes

Vernor Floyd Love was born April 5, 1929 in Tucson and was

proud to be a nave of Tucson, his family told theArizona Daily

Star. He graduated from Tucson High School in 1947.

He earned his undergraduate degree at the University of Arizona

in 1951 and was a member of Kappa Sigma Fraternity. He went on

to Northwestern University (Evanston, Ill.) Medical School,

earning his M.D. in 1955. He interned at the U.S. Army Medical

Services Leerman Army Hospital in San Francisco, and did his

GS residency at Baylor University Medical Center, Dallas, Texas.

Dr. Love served in the U.S. Air Force for 11 years as a surgeon: as

chief of general surgery at USAF Hospital Travis 1960-63, and chief

of surgery and deupty commander of Evereux AFB Hospital 1963-

66. He held the rank of major when he received an honorable

discharge and in 1966 returned to Tucson, where he opened his

GS pracce oce on North Country Club Road. By 1968 he had

sub-specialized in vascular surgery and moved his oce to North

Wilmot Road. That year he associated with doctors Duncan

Campbell, Donald Ewing and Mark Kartchner in Southwestern

Surgery Associates, Ltd.

Dr. Love was acve in various communies, serving as

president of the Rocky Mountain Vascular Society, and CEO of his

medical group, the family said. He served as a foundingmember of MICA, as president of Sunrise Ridge Homeowners

Associaon, and on the board of the White Mountain Summer

Homes. Vernor loved traveling, shing, skiing, family gatherings,

and researching genealogy. He was known as Reunion Man by

his wife for the Tucson High Reunion class of 1947.

Dr. Love taught in THMEP and at the UofA College of Medicine.



The Faces of Casa are the

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and Chief Clinical Officer

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He was a member of the AMA and the

Arizona Medical Associaon, a Fellow of

the American College of Surgeons, and a

member of the Society of Air Force Clinical

Surgeons. He was a member of St. Marks

Presbyterian Church. He was cered by

the American Board of Surgery.

In 1970 he began a three-year term as

PCMS delegate to ArMA. He also served as

an ArMA Southern District director 1972-77. He parcipated in PCMSs radio

program Prescripon for Health. In

rerement he served on the board of

P.C.M.S. Foundaon, Inc., now known as

Pima Medical Foundaon.

His wife of 60 years, Barbara Lent Love;

sons Jim and Richard; daughters Patricia

and Susan; and grandchildren Mahew

Dyer, Sarah Dyer, Jim Love Jr., Brian, and

Marissa Love survive him.

A memorial Service was given Feb. 8 at

Northminster Presbyterian Church on East

Fort Lowell Road. The family requests that

memorial donaons be made in his name

to Gospel Rescue Mission, 707 W. Miracle

Mile, Tucson 85705, or to a charity of the

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The cannabis conundrumBy Stuart Faxon

Medical Marijuana

Its illegal. Or is it? It s recreaonal. Its medicinal. Or is it?

All marijuana areas seem to have become gray since legal,

medical, and polical climate change over the drug was over us

like, well, smoke. Even smoke is not the only queson in

marijuana as medicine, but at least we can say no brownies were

served on Feb. 11 at PCMS.

Quesons abounded among the physicians aending Pima

County Medical Foundaons CME presentaon by Suzanne A.

Sisley, M.D., a Scosdale IM and psychiatry physician who is

assistant director of interprofessional educaon with the Arizona

Telemedicine Program.

For this CME, she presented the Arizona Medical Marijuana

Physicians Educaon Program, meant to educate physicians

about the tenets of Arizona medical marijuana law. The program

is supported through a contract with the Arizona Department of

Health Services Medical Marijuana Program.

Dr. Sisley herself illustrates the changing climate, because while

she is principal invesgator for a couple of research projects, she

said shes sll waing for those to kick in because the government

agency has not supplied the actual material. Could this be

because the federal agency in queson is dealing with a drug sll

considered illegal by the federal government itself? So as not to

waste me as eciently as the feds do, Dr. Sisley has used it to

become expert in Arizona medical marijuana law.

Only two states, Colorado and Washington,

have legalized marijuana. About 20 states

now allow medicinal use of the drug. In

Arizona, Dr. Sisley said, ADHS wants to make

it as medical as possible. Our law: Requires registry idencaon cards.

Limits the number of dispensaries.

Has the support of varous medical boards.

Includes several requirements for

physicians who may provide qualifying

paents with wrien cercaons.

Requires dispensaries to appoint an

individual who is a physician to fucon as

medical director.

Requires dispensaries to develop,

document, and implement policies and

procedures for inventory control.

Our law limits the number of dispensaries to

120 statewide, Dr. Sisley said. Currently we

have 77.

Even AMA ethics guidelines conict about

prescribing majijuana. So what paents qualify?

In Arizona the qualifying condions are:

Cancer

ALSAmyotrophic Lateral Sclerosis

HIV

AIDS

Glaucoma

At PCMS Feb. 11, Dr. Suzanne Sisley explained the ArizonaMedical Marijuana Act in a CME presentation for Pima County

Medical Foundation.


17/28



Public Health

Help deal with pertussis increaseBy Anissa Taylor

In the past year Pima County experienced a signicant increase

in pertussis cases. There were 97 cases of conrmed andprobable pertussis reported in Pima County for 2013, compared

to 46 conrmed and probable cases in 2012.

Year-to-date cases for January 2014 show there are seven

conrmed and probable cases. The 2013 case invesgaons

revealed that the majority of cases have occurred in those

younger than 19 years old.

Our invesgaons at

the Pima County Health

Department

determined the cases

that had history of

pertussis containingvaccine tended to have

a shorter duraon of

cough. These cases also

experienced a less

severe course of illness

than those without a

history of pertussis

containing vaccines.

The steady increase in

reported cases over the

years parallels the

increases seen inArizona and across the

naon. This may be due

to a combinaon of

increased vaccine

refusal, lower

vaccinaon rates, and a

less-than-desired

length of post-

vaccinaon immunity.

PCHDs epidemiologists

connue to track and

characterize the

changing incidence ofpertussis in the

community.

We encourage nocaon to our epidemiology oce, and

tesng and treatment when pertussis is suspected.

Recommended tesng includes a Polymerase Chain Reacon test

(PCR) or culture. These are the only tests acceptable for

conrming a case of pertussis.

The specimen should be obtained either by aspiraon or with

Dacron swabs (coon, rayon or calcium alginate swabs should

not be used), collected within three weeks of the onset of

symptoms, and prior to anbioc use. Tesng should not be done

if symptoms are not present. It is unlikely that the organism willbe recovered through tesng if no symptoms are present.

Specimens must be placed into universal transport media for PCR

and Regan-Lowe media for culture. Clinicians should consult with

their contracted laboratory for the media. If culture or PCR is not

available through your contracted lab, the Arizona State

Laboratory may be able to assist in tesng on a case-by-case

basis. Do not delay

either treatment or

reporng to the

health department

while waing for

laboratory results.For treatment or

chemoprophylaxis,

the anmicrobial

agents of choice are

azithromycin,

clarithromycin and

erythromycin.

Exposed household

members are

considered close

contacts and should

be oered

chemoprophylaxis.

Administer a course of

chemoprophylaxis to

close contacts within

three weeks of

exposure. Close

contacts are

administered the

same doses as in the

treatment schedule.

Please remind cases

to remain home unl

treatment completed.Clinicians should

consider cocooning newborns by boosng all adults and

adolescents in your pracce who may come into contact them.

We also recommend that you take steps to assure your sta

received a booster for pertussis, parcularly if there are infants in

your pracce.

Please do your part to assure that levels of circulang pertussis

remain as low as possible in our community.

Anissa Taylor is an epidemiologist with the Pima County Health

Department. n

Algorithm for Pertussis Laboratory Tesng(Cough Illnesses)

Typical characteriscs of pertussis include a worsening cough

in a non-toxic and afebrile paent.

In addion to cough, does the paent reporthaving any paroysms, whoop, or episodes of

post-tussive voming?

Nofy the local health departmentimmediately. Pertussis should be suspected.

Please add a nasopharyngeal swab for

pertussis tesng* (Culture and/or PCR) inaddion to other clinically indicated tests.Negave lab results should not rule out adiagnosis of pertussis.

Nofy the local health departmentimmediately. Pertussis should be suspected.

Please add a nasopharyngeal swab for

pertussis tesng* (Culture and/or PCR) inaddion to other clinically indicated tests.

Was the paent a close contact to anothercase of pertussis?

Connue to monitor paent. Clinicaljudgment should be used to determine

appropriate tesng* and intervenons.If pertussis is suspected, nofy the localhealth department immediately.

Yes

Yes

No

No

*Serologic tesng is not the preferred method of tesng for pertussis.

Updated 3/1/2011



Valley Fever

Dr. Galgiani, cocci go-toBy Stuart Faxon

When Dana Goodyear, sta writer for The New Yorker,

wanted to become familiar with valley fever, she was

quickly pointed to Tucson, Dr. John Galgiani, and the Valley Fever

Center for Excellence at the University of Arizona, of which he

is director.

Its our disease, Dr. Galgiani has said.

Two-thirds of the naons cases happen

here, and it was the second-most reported

Arizona disease in 2012. This Sombrero

department is usually authored by Dr.

Galgiani. But New Yorkerreaders pay lile

aenon to Arizona once the highway

leads away from Scosdale. Say

California, however, and they look up

from their laes. Hyper-populaon makes

New York and California the bread of the

American geographical sandwich, and the

rest of us the meat.

So in the Jan. 20 New Yorker, the storys

hyperbolic headline was Death DustThe

Valley Fever Menace, and began with

Central California in 1977, when a 5,000-

foot dust cloud bloed out the sun as it

blew from the Great Basin through the

Tehachapi Mountains, Goodyear wrote.

Coccidioidomycosiscocci to docs and

valley fever to lay folksis hardly about to

come stalking Manhaanites, but the 1977

incident was deadly to the extent of six

deaths and more than 100 cases in

Sacramento County, Goodyear reported.

In the previous 20 years there had never

been more than half a dozen cases a year.

But mainly the story was a report to

readers who have never heard of our

disease, that has no prevenve vaccine,

and in its worst cases, no cure. The

populaon of Phoenix has grown by 10

percent in the past decade and newcomer

have no acquired immunity, Goodyear

reported. The elderly and the immune-

compromised, including pregnant

women, are most suscepble and for

reasons unkonwn otherwise healthy

African-Americans and Filipinos are

disproporonately vulnerable to severe

and life-threatening forms of the disease,

she reported. But she added that one specialist told her that if

you breathe, and youre warm-blooded, you can get this.

Microscopic Coccidioides immis spores live in soil and break up

easily when disturbed, such as by housing and business

development. When we breathe the spores in, we cant breath

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them out, Goodyear was told, as they are small enough to reach

the bronchioles at the boom of our lungs.

Once in the lung, the spore circles up into a spherule, dened by

a chinous cell wall and lled with a hundred or so baby

endospores. When the spherule is suciently full, it ruptures,

releasing the endospores and smulang an acute inammatory

response that disrupts blood ow to the ssue and can lead to

necrosis. The endospores, each of which will become a new

spherule, travel through the blood and lymph systems, allowing

the cocci to spread anywhere.

Cocci is notorious for being sneaky. In a typical scenario, an

Eastern person will return home from the desert Southwest

and go to his or her physician complaining of fever, cough,

and exhauson as if it were u. The unsuspecng Eastern

physician will proceed to miss the true diagnosis, and thats

just in paents with symptoms, because 60 percent of cocci

vicms are asymptomac.

In recent years, Goodyear reported, cocci infecons have

risen dramacally. According to the CDC, from 1998 to 2011

there was a tenfold increase in reported cases. Ocials there

call it a silent epidemic that is far more destrucve than had

been previously recognized.

Its circumscribed range has made it easy for policymakers to

ignore. Thogh it sickens many more people than West Nile virus,

which aects much of the countryand is closely monitored by

the Pima and Maricopa county health departmentsit has

received only a small fracon of the funding for research.

The impact of Valley Fever on its endemic populaons is equal

to the impact of polio or chickenpox before the vaccines, Dr.

Galgiani told Goodyear. But chickenpox and polio were

worldwide.

Fluconazole, the medicine most commonly prescribed to cocci

paents, can cost up to $3,000 a month, and doesnt destroy the

fungus but mnerely keeps it in check, Goodyear reported. At

the University of Arizona in Tucson, John Galgiani is aempng to

develop a drug that will actually kill it. Trim and avida

youngster, at 67Galgiani is a partner in a company that is trying

to ready a molecular byproduct of the bacteria streptomyces,

called nikkomycin Z, for the marketplace. It works by destroying

the spherules ability to make chin, which forms the protecve

wall without which the disease stalls.

Nikkomycin Z was discovered in the 1970s and is sll several

years and millions of dollars away from being available,

Goodyear reported. A corporate partner could accelerate it,

but as long as VF is perceived as a regional disease, the market

will likely seem too small for aenon of Big Pharma.

We somemes talk about wishing a President or former

President would get cocci, Dr. Galgiani told Goodyear, who noted

that for now, the most likely source of a celebrity case is Major

League Baseball, in which thousands of players annually Spring-

train in Arizona.

Unfortunately, cocci is another consideraon that has come with

internaonal jihadist and other terrorism. Unl last year,

Goodyear reported, C. immitswas listed as a Select Agent. Aer

culturing it, lab technicians had seven days to report to the

Department of Homeland Security that it had been destroyed.

Dr. Galgiani led Goodyear on a visit to the UofAs Bio Safety 3 lab,

where he and others deal with hazardous pathogens such as

cocci. In the 1950s, he said, both the U.S. and the Russians hadbio-warfare programs using cocci. Generals cant control agents

that rely on air current to disperse them, and it was dicult to

use the vector precisely, so it fell out of favor. But terrorists dont

care about that stuall they care about is percepon. A single

call can cause disease, and you can genecally modify it to make

it more powerful.

Back in daily medical pracce world, several studies have

indicated that 15-30 percent of community-acquired pneumonia

in the hyper-endemic populaon centers of Southern Arizona

is caused by cocci. In 2007 the Arizona Department of Health

Services recommended that all paents presenng with

community-acquired pneumonia in these areas be tested

for cocci.

The University of Arizona Valley Fever Center for Excellence

provides free connuing medical educaon (CME) on cocci. The

CME is available online at the VFCE website. A CME event is given

each year, usually in Fall, in Tucson or Phoenix. This event is held

in conjuncon with the annual Valley Fever Awareness Week.

Please check the centers webpage for updated informaon.

A recorded version of the CME is also available in Spanish. n

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Makols Call

Type A-PositiveBy Dr. George J. Makol

Is it just my impression, orare doctors becomingpessimisc?

It would be hard to blame any

medical doctor who feels that

way, considering the changes in

insurance, lowered

reimbursement for more work,

and interference in paent

management by medically

uneducated bureaucrats.

On the contrary, my feelings

about the pracce of medicine,

having parcipated in it for

about 35 years, are sll amazingly posive. We doctors are sllaorded great respect, and looking back, I have enjoyed many a

moment taking care of paents and some moments not directly

related to paent care.

During my med school and postgrad training in the 1970s, I

volunteered with a group called Switchboard of Miami. We

were a group of doctors, nurses, and paramedics that served at

all Orange Bowl games, including at that me games played by

the World Champion Miami Dolphins, who at one point had 17

wins and no losses. I was able to see quite a bit of each game,

except when predictably, one of the 50,000 cheering fans would

have a heart aack right in the middle of the third quarter or so

(perhaps they just realized how much they had paid for a playogame cket). Then we were called into acon.

The switchboard also served at most of the big concerts, so I was

backstage at some of the most historic 70s rock concerts. On

Aug. 4, 1974, I worked the Eric Clapton concert at the West Palm

Beach Raceway. We had a huge medical tent behind the stage,

and we treated about 160 fans for various drug-related

symptomssome obviously believed it was sll the 1960sand

evacuated by air one pregnant fan who went into labor. She was

not about to miss this concert for anything! Near the end of the

prepared set, my fellow docs, knowing I was a rocknroll fan, told

me to climb up on stage and watch the show with the roadies,

hidden behind the stages side curtains.

I was perhaps 20 feet from Eric Clapton, and I asked the roadie

next to me who were the funny looking guys backing him up. He

replied, Are you kidding? That is Peter Townshend of the Who on

guitar, and Keith Moon of the Who on drums. Needless to say, I

was in rocknroll heaven for the next 45 minutes while they

jammed Layla, a song wrien by Clapton for George Harrisons

wife Pay, who he later married.

Then the roadie sing right next to me asked me to pass him

the Fender Stratocaster in the stand behind me. He ran onstage,

plugged into Eric Claptons amplier, and began to jam. I turned

again to the guy on my right, who by now thought I was from

some other planet, and he replied before I could ask Thats Joe

Walsh from the Eagles! For those of you from another

generaon, this was like being in the orchestra pit while FrankSinatra sang with the Tommy Dorsey band.

I later moved to Tucson for my allergy/immunology fellowship,

much to the dismay of my family who were sll in Miami. I used

to commute back and forth for the Christmas holiday, and in my

rst year away, I showed up at TIA around Dec. 20 to y to Miami.

The disnguished older gentleman at the counter checked me in,

and asked if I was Dr. Makol the allergy specialist. I replied that I

was, and he asked me if I had ever own First Class. I had once sat

just behind the driver on a Greyhound bus, but on a training

salary ying First Class was not an opon. He commented that I

took care of his granddaughter, and that I had her previously

uncontrolled asthma under control, and she no longer had to goto the ER. Next thing I knew, I was in a comfy leather seat, being

aended by a lovely stewardess (now to gender-specic a term)

and eang o real china.

I for years have consulted with the University of Arizona athlec

medical sta, and have worked with some incredible and

movated athletes. Hence, a few weeks ago my wife and I were

invited to a private showing and cocktails at the new $75 million

Lowell-Stevens football training facility. I found myself rubbing

elbows with major donors and discussing their thoroughbred

horse purchases and private workouts with the team. Luckily, no

one asked me about my end-zone seats!

Years before I had worked with a UofA basketball player withasthma. He was playing about ve minutes a game, and then raising

his hand so Coach Lute Olson could pull him out. He came in to see

me with a trainer and in a couple of visits we had him ready to play

in a big interconference game. Famed sportscaster Dick Vitale was

giving his usual colorful comments during the naonally televised

contest, and I was watching TV with my extended family as my

paent played for 25 minutes and scored 25 points.

Vitale commented aer our player scored a spectacular dunk,

Hey baby, I heard this guy has a new doctor, and wow, can he

play now! Thanks, Doc. Everyone in the room cheered,

although no one else in the country had the faintest idea what

Dick Vitale was talking about. But it did not maer to me. I hadjust done my job like each of you does every day.

So maybe reimbursements could be beer, and insurance

companies temporarily rule the roost, but we are sll aorded

respect by our fellow cizens, and somemes get special

treatment, even if it is just geng a great table and service in a

restaurant owned by one of our paents.

Cheer up!and let us know your stories.

Sombrerocolumnist George J. Makol, M.D. pracces with Alvernon

Allergy and Asthma, 2902 E. Grant Rd., and has been a PCMS

member since 1980. n



Perspecve

Is fear really our protection?By Stuart Faxon

The essenally silly idea among some hard-Le locals to create

the 51st

American state, called Baja Arizona, by seceding from therest of the 49thstate, is sll the plainest example of the historicdivide between the Arizona polical Le and Right, between PimaCounty and Maricopa County, between Tucson and Phoenix.

Baja Arizona is sll on bumpersckers around here. I saw

another that said, Id rather live in denial than live in Phoenix.

I always tell non-Arizonans that Tucson is to Arizona as Ausn is to

Texas, or Madison is to other parts of Wisconsin. I also tell them

that Phoenix/Mesa/Maricopa is so big at this pointalmost four

mes the populaon of Tucson/Pima Countythat the

Democrats we send up there just dont have the numbers to

mean anything in opposing the Republican juggernaut.

Im no Democrat, but certainly no Republican. Im anindependent, the fastest-growing electorate in our age of

American cynical polical alienaon. I consider myself aconservave at 65, but no one else would who includes a

religious test for conservasm. As an atheist since my 20s, I have

that foot in the liberal camp from which I evolved.

When one is raised in or near New York City, it would be hard not

to become a standard-issue Roosevelt Democrat. My rstpresidenal vote was for George McGovern, and next me Jimmy

Carter. I voted for John Anderson, not Ronald Reagan.

I could not bring myself to endorse such snake-oil vendors as

Clinton, Gore, Kerry, and Obama, all of whom are sll at it

because we buy our policians emoonally the same way we buyour cars. I vote against Rep. Raul Grijalva (D-7-Ariz.) every two

years like clockwork. I used to vote for Sen. John McCain, but I

fear the ancient mariner is losing his mind. Calls for congressional

term limits have no beer current example.

Both my sides come together in my hatred for the focus of evil in

mymodern world: jihadism, murder/suicide in the name of faith,

in this case faith in some imaginary guy called Allah and his

sword-wielding prophet. Since 2001 most Americans have at leasta noon of what makes up this deadly retrograde phenomenon.

Most of our planets wars and rebellions now consist of Islamists

who cant get along with their neighbors. Yet its sll a subtle

disncon for many that Islamist means jihadism or polical

Islam, as opposed to merely Islam itself and Muslims. The samepeople probably dont know Arabs from Persians, or Sunni from

Shiite from Su.

The American Le naturally hates jihadism, but tempers it with

concern for polical correctness, usually when issue front-people

present a guise of civil rights. Terrorism apologists CAIR love to

take advantage of this American gullibility.

The American Right also hates jihadism, but with a Chrisan edge

to its hatred. Of course nobody likes murder and suicide, any

more than they like airliners as missiles. Yet its sll Chrisanitythat drives much American an-jihadism.

Similar religious fervor drives the Arizona Legislature not to

murder, but to forever try to get their Bible into everyones publicschools, and their law into womens bedrooms to restrict

womens reproducve rights because they cant do anything

about federal law set forth in Roe v. Wade.So much for small,

unobtrusive government when they get their God involved. Our

capitol building even says God Rules (Ditat Deus, the state

moo). Do most of our state legislators think Arizona is a

theocracy? There would certainly be a First Amendment issuethere if state moos caused ligaon.

Islamists say they know what their god wants. Most oen they

yell it. Similarly, polical Chrisans say they know what their god

wants, and since God-fearing people exalt fear, fear is their great

movator. Fear is not a great legislator.

Since 2010 Arizona and ve other statesKansas, Louisiana,Oklahoma, South Dakota and Tennesseehave enacted legislaon

barring judges from considering foreign law in their decisions,

including Sharia (Islamic) law, which is the nub of the maer. At

least 25 states have introduced such measures, according to the

Pew Research Centers Religion and Public Life Project, as reported

by Janet Loehrke and Kimberly Railey in USA Today.

Then about three months ago, according to the Right-wing source

Naonal Report, the Dearborn (Mich.) City Council voted 4-3 to

become the rst U.S. city to ocially implement all aspects of

Sharia law. The tough new law addresses secular law including

crime, polics, and economics as well as personal maers such as

sexual intercourse, fasng, prayer, diet and hygiene.The same source claims Dearborn is a well-known and safe

haven for Muslims and Muslim sympathizers. With a populaonof around 98,000 people, roughly 30 percent of its residence

[sic] are Muslims, making them the largest concentraon of

Muslims in the U.S.

I never trust a source that cant write and edit properly forpublicaon. But if this Dearborn informaon is correct, its small

wonder that the six states enacted the laws they did.

But it was only six.

I also recalled the 2004 controversy in Hamtramck, Mich.

(pronounced ham TRAM ik), the city of 23,000 surrounded by

Detroit, in which a local mosque requested permission to air two-minute Arabic calls to prayer by loudspeakers ve mes per day.

According to a CBS News report, Hamtramck Muslims said it was

no dierent from Chrisans ringing church bells. Many local

Chrisans objected to the loud message that Allah is the one and

only God, which makes sense when each religion has its own god

I have always thought the phenomenon of sects in monotheism

was just more proof that gods are man-made, culture by human

culture. Anyway, I suspect the monotonous noise alone would

grate on me, and I dont even have a god, just a conscience.

This conict had to happen somewhere as America becomes a



greater percentage Muslim, and given that, a greater

percentage jihadi. Hamtramck used to be about Poles, pierogi

and polka, but all the newer residents are Bosnian, Yemeni,

and Bangladeshi, all with their corresponding mosques.

Like any other conservave reaconism, the state law

reacons are mainly about fear. Does Islamic law, Sharia,

have a place in American courts? asks UPI Senior Legal Aairs

Writer Michael Kirkland. A lot of state legislatures dont thinkso, and there is a movement to ban its applicaon in domesc

courts, state and federal. Its one of those naonal issues thatfor now is not before the Supreme Court, but almost inevitablywill be before the Jusces somewwhere down the line, even if

just in the peon stage.

The Pew Forum notes that the laws enacted in Arizona,

Kansas, Louisiana, South Dakota, and Tennessee are more

neutral than the Oklahoma law, and do not cite Sharia or other

religious laws in parcular. But last summer an Oklahomafederal judge struck down that states lawa constuonal

amendment approved by 70 percent of Oklahoma voters in

2010on the basis that it discriminated among religions. You

can guess who opposed it: the ACLU on behalf of the execuve

director of the state chapter of CAIR, the Council on American-

Isamic Relaons. No one is more clever than CAIR at usingAmerican courts against gullible America. Expect them in

every such case.

According to the UPI report, the appeals court said supporters

of the Oklahoma law do not idenfy any actual problem the

challenged amendment sought to solve. Indeed, they

admied at the preliminary injuncon hearing [that] they did

not know of even a single instance where an Oklahoma court

had applied Sharia law or used the legal precepts of other

naons or cultures, let alone that such applicaons or uses

had resulted in concrete problems in Oklahoma.

So whats the big deal with Sharia? asks Omar Sacirbey of

Religion News Service. Many Americans think of Sharia as anIslamic legal system characterized by misogyny, intolerance,

and harsh punishments. Some an-Semic acvists warn that

Muslims are trying to sneak Sharia into the American legal

system in ways that do not reect U.S. legal principles and

beliefs while many Muslim Americans counter that Sharia is

essenal to belief, and that any harsh punishments or

unconstuonal aspects associated with Islamic law have

either been exaggerated, abrogated, or are superseded by

American law.

Sacirbey notes that some naons, such as Saudi Arabia,

Pakistan, Malaysia, Nigeria, and Egypt, have Sharia systems

with a high degree of inuence on the legal system in family

law, criminal law, and in some places personal beliefs,including penales for apostasy, blasphemy, and not praying.

There are even Muslim-majority naons in which Sharia plays

no role, such as Mali, Niger, Tunisia, the stans of Kazak,

Kyrgyz, Tajiki, Turkmeni and Uzbeki, and Turkey. In Turkey,those engaged in recent unrest and calls for new elecons

charged popular, thrice-elected Prime Minister Recep Tayyip

Erdowan with imposing an Islamic agenda against Turkeys 90-

year rule of secularism.

Mixed systems such as in Algeria, Morocco, Somalia,

Bangladesh, Jordan, Kuwait, and Syria generally cover family

law, while secular courts cover everything else.

Of course in the U.S. there are no Islamic courts, but Sacirbey notes

that judges somemes have to consider Islamic law in their

decisions, such as a judge recognizing the validity of an Islamic

marriage contract from a Muslim country in order to grant a divorce

in America. Im sure this is common, as we do not consider women

as chael here. In Tucson Atheists, the local group I aend, there are

several women who have experienced what by American standardsis the female prison that is Islam. Sequestraon by gender is bad

enough, but when a woman steps out of line it s far worse.

The upshot here is, Sharia law is so intently unAmerican that it is notlikely to take root here. But how solid are our tradions among a

historically ignorant populace? Jamilah King, wring for the Le-

wingColor Lines News For Aconcalls the state bills useless and

asks, Are you ever afraid the fundamentalist Muslim extremists will

take over your state courthouse? Thats the idea behind the radical

Rights peddling of the myth that Sharia law will somehow make

its way to the United States.

Ah but it has, snoy Ley! The point is to what degree. Another Le

source, Think Progress, characterizes Arizonas law, HB2582, the

Arizona Foreign Decisions Act, as banning the implementaon of

Sharia law and also canon law, halacha, and karma.

In its denions secon our bill actually says, Religious sectarian

law means any statute, tenet, or body of law evolving within and

binding a specic religious sect or tribe including Sharia law, canon

law, halacha and karma, but does not include any law of the United

States or the individual states based on Anglo-American legal

tradion and principles on which the United States was founded.

Wouldnt it be funny if a judge, cing karma, told you that you get

what comes around because it goes around?

Halacha was new to me as a member of the Long Island Goyim. With

all the Hebrew and Yiddish familiar to me, I went 65 years without

hearing of halacha, or halakhah. I had to look upJudaism 101to nd

that it refers to Judaisms set of beliefs about rules and pracces that

aect every aspect of a comprehensive way of life, including food,

clothing, grooming, conducng business, whom you can marry, howto treat other people, and how to observe the holidays.

So were afraid of Jews as well as the other Semites? Thats hardly

useful, nor is the feared event likely. Heck, if a jihadi became a Jew

hed certainly be beer o, rather than needing mental health

treatment. This alleged issue about the basis for judicialdeterminaons is fear for the fearful and nothing else. Tucsonans

like to think theyre smarter and less fearful than Phoenicians. The

Le says this is paranoia on the radical-Right. The Right says wait

unl it confronts you and then see what you do.

What I fear is the Supreme Court. These unaccountable nine, eachowned by one of the two ruling pares, have done Americans dirty

in several ways in recent years: Cizens United. A corporaon is aperson. A penalty is a tax. Medicine is interstate commerce. Money

is speech. Where is money in the First Amendment? This set ofJusces turns the joint upside down in every session, yet we turn to

them because we apparently cannot unite legislavely as Americans

giving the Court unwarranted power. And dont get me started on

the Imperial Presidency.

I sure hope the Court makes the right decision about foreign law

under American lawif by that me the Jusces overpowering

party loyalty allows allow them to remember what American law is.

Stuart Faxon is Sombreroeditor. n



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