The 5th Annual Academic Surgical Congress will be held on February 3-5, 2010 at
San Antonio Marriott River Center, San Antonio, Texas

DEADLINE August 24, 2009

I suspect that access is a more complex notion than we give it credit for. There are very intricate reasons why some Americans are denied access - some of which were predictably engineered in the 1940s by established custodians of American social and urban planning. Now we have some races who live in complete isolation, living only among themselves in over 500 of the total 3200 plus counties in the country. I examined access as a function of opportunity and utilization and found that geography DOES matter. We  reported this in two articles this month in The Journal of the American College of Surgeons and Archives of Surgery.

Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: a county-level data analysis. Hayanga AJ, Waljee AK, Kaiser HE, Chang DC, Morris AM. Arch Surg. 2009 Jun;144(6):532-5

Residential segregation and access to surgical care by minority populations in US counties.  Hayanga AJ, Kaiser HE, Sinha R, Berenholtz SM, Makary M, Chang D. J Am Coll Surg. 2009 Jun;208(6):1017-22

If you are distrustful of the health system and you have no exposure to the system except through distant strangers, you will be less likely to wish to use those services until too late. This has important preventive health implications. These populations do not get screened, get diagnosed late and die earlier.  This has received a certain amount of attention.

http://www.thedoctorschannel.com/video/2071.html

http://www.healthfinder.gov/news/newsstory.aspx?docid=628090
http://www.redorbit.com/news/health/1704005/research_finds_segregation_reduces_access_to_surgical_care

http://cancer.med.upenn.edu/resources/article.cfm?c=3&s=8&ss=23&Year=2009&Month=06&id=16305

http://www.eurekalert.org/pub_releases/2009-06/jaaj-ucw061109.php

http://www.physorg.com/news164302548.html

http://esciencenews.com/articles/2009/06/11/study.finds.segregation.decreases.access.surgical.care.minorities

http://www.sciencecentric.com/news/article.php?q=09061606-us-counties-with-more-african-american-patients-may-have-fewer-colorectal-cancer-specialists

http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Racial-Clustering-Linked-With-Access-to-Colon-Canc/ArticleNewsFeed/Article/detail/604058?contextCategoryId=46736

America has significant health challenges but without addressing the effect of racial clustering and geography, there is little to believe that health disparities in access in  the US will be resolved before 2010 like the federal government promised many years ago.

The 50th Annual Meeting at Digestive Disease Week, May 30 to June 3, 2009, Chicago, Illinois.

AND

The 5th Annual ASC/AAS/SUS from February 3- 5, 2010 at the Marriott River Center in San Antonio, Texas.

In order to expand coverage to the estimated 40 million Americans
without healthcare, the Obama healthcare plan is likely to require the
assistance of all Americans. The mere availability of an increased
budget beyond the current 640 billion dollars will likely be
insufficient and instead require a more judicious approach in how care
is rendered without merely relying on increasing capacity in monetary
terms. One can envisage a triage system that would use algorithimic
modelling to identify patients with multiple organ dysfunction,
increased age, lethal comorbidities and poor predictive survival and,
from the outset, make the recommendation for a less aggressive
approach. This is likely to constitute a revolution in medical
decision making in healthcare in the US, affecting both patient and
provide alike. Might we actually have to lower our expectations about just how aggressive care can be in futile situations? Unseeming though it may sound, the judicious use of healthcare resources has been a trademark of all other OECD countries that have offered universal healthcare and if the US is finally ready to join Asian and European counterparts of similar economic stature, she may be best advised to rethink how the resources we have available are used.

After what seems a lifetime of tight glycemic control and a seeming fixation of the adequacy of a glucose of 110 mg/dl, new evidence has emerged that tight glycemic control may increase mortality. The results, published by the NICE-SUGAR Study Investigators from a large international randomized trial was published in this week’s New England Journal of Medicine and may change the way we view glycemic control for a long time to come.