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RE: Bruce Frankel, DPM
From: Multiple Respondents
Joy and I were truly saddened by the news of Bruce Frankel's death. Bruce was a real gentleman and represented our profession with dignity and class. He was a quiet leader who earned the respect and admiration of his peers. We pray for Bobbi and her family.
Glenn B. Gastwirth, DPM, Executive Director, APMA
I am shocked and saddened at Dr. Bruce Frankel's passing. His love of podiatry, sense of humor and base of knowledge are what made him the man he was. He helped me in a lot of ways, and in fact, interviewed me for admission to NYCPM in 1987. He liked me and accepted me right then and there. So I do owe some of my success to him. Rest in peace, my friend.
John Spina, DPM, Brooklyn, NY
I would add my condolences--Bruce Frankel was truly a giver--he had a special pleasant manner to stimulate and motivate his students. It was not unusual for his students to recall his "pearls." My experience with residents who had been his students was that he made a lasting impression that they not "give up" and that they would succeed. We lost a true educator
Joe Addante , DPM, Fitchburg, MA
Just a short addition to the myriad condolences coming in for Bruce, who I considered a close friend and all around super-podiatrist for the over 30 years I was privileged to know him....and of course his alter ego Bobbi. His funeral was an amazing tribute to an amazing person....a great outpouring of love and affection. The eulogies by his rabbi (a close family friend), Terri Spilken, and one of his daughters were touching, with lots of humor thrown in, as Bruce would've expected and much appreciated. Services lasted close to an hour, but we were all riveted to the many family and podiatric stories that were offered. There were almost 200 attendees....standing room only. It was a both a sad, but uplifting experience. Bruce will be sorely missed, but his goodness, humor and deeds will leave a legacy we'll all remember with admiration and love.
Arthur Gudeon, DPM, Rego Park, NY
RE: DMERC A Update
From: Paul Kesselman, DPM
1) Claims sent between 6/29 - 7/5 claims have still not gotten through to National Heritage Insurance Company (NHIC). NHIC (the new DMERC A carrier) is attempting to get these through on 7 24 06. This issue is tied to the original issue experienced with all electronic claims sent to this carrier. There is currently no need to resubmit these claims. I would urge you to have your staffs watch the validation reports they receive from NHIC.
2) NHIC has increased its staff significantly and call waiting times are decreasing and approaching what they were for Health Now (the previous contractor for DMERC A).
3) NHIC is paying out the same amount per day now as Health Now did prior to the transition to NHIC.
4) Some EOB’s issued on 7 11 06 are missing from the NHIC’s computer bulletin board. NHIC is looking into this matter.
5) Some claims are being improperly rejected because they belong in another DMERC jurisdiction (i.e., DMERC B C or D). Claims which are noted as misdirected (sent to the wrong DMERC carrier) and simply sent back to NHIC will be rejected as duplicates. Anyone who thinks these claims are being improperly rejected is urged to call NHIC immediately.
6) Some suppliers are receiving duplicate payments on the same EOB’s. This is not just a duplicate EOB, but actually the claim is processed twice and paid twice on the same claim. Obviously NHIC is looking into this and will of course be sending suppliers affected by this w/nice letters requesting repayment with interest if not paid back within a certain amount of time.
Paul Kesselman, DPM, Woodside, NY, pkesselman@pol.net
RE: 3 + 4 Programs For Podiatry Not Unique
From: Roger Greene
An item in the July 22nd issue of PM News discusses a new, joint seven-year program for undergraduates who plan on attending a college of podiatric medicine and claims that “Allopathic and osteopathic schools have utilized the 3 + 4 program model before, but it is unique to podiatric medicine.” This is not correct.
The New York College of Podiatric Medicine (NYCPM) has “3+4” articulation agreements with thirty-three undergraduate institutions, running the gamut from City College, Brooklyn College and John Jay College, three colleges which are part of the City University of New York; to Dillard University in New Orleans; Sacred Heart University in Fairfield, CT; Grand Canyon University in Phoenix, AZ; Quinnipiac University in Hamden, CT; Washington and Jefferson College in Washington, PA; and Yeshiva University in New York City.
The earliest of these agreements was signed in 1993. All of them enable students to enter NYCPM as first-year students after their junior year of college. The undergraduate institution accepts NYCPM’s first-year curriculum in lieu of the student’s senior year, and then awards the student his or her undergraduate degree at the completion of the first year at NYCPM. NYCPM’s Office of Admissions works with the pre-med advisors at each college to ensure that the student’s first three years of study include the proper mix of courses prior to the student’s matriculation at NYCPM.
Roger Greene, Director, Public Relations/Marketing, NYCPM
RE: Long-Term Studies on Efficacy of Orthotics (Tip Sullivan, DPM)
From: Multiple Respondents
How can we possibly do a true “double-blind study” with custom foot orthoses without the patient discovering somewhere along the way of the multi-year study, that they have either a custom orthosis or a placebo orthosis inside of their shoe? In addition, what does one use for a “placebo orthosis” in a study where we want to compare the custom orthoses to a placebo? Do we use a custom-molded, flexible insole that is shaped to the patient’s foot that then loses its shape rapidly, or do we use a prefabricated foot orthosis? And can we assume that this “placebo orthosis” truly has an insignificant mechanical and therapeutic effect on the patient’s foot unless we do material tests on that insert to see what mechanical effect it may indeed have on the foot? The technical problems are so numerous with attempting to perform “double-blind” foot orthosis research that I doubt that a double-blind foot orthosis study can be realistically or practically performed, especially over a long time period.
I believe that the way forward in foot orthosis research is doing “single-case experimental study design” where each patient is treated with a truly customized orthoses by a practitioner, and then the treatment is withdrawn and then reintroduced to study the symptomatic effects of that foot orthoses on the patient over time. An Australian podiatrist, Angela Evans, PhD, published a wonderful paper using this type of experimental design in studying growing pains in children a few years ago (Evans A: Relationship between ‘Growing Pains’ and Foot Posture in Children? Single case experimental designs in clinical practice. JAPMA, 93: 111-117, 2003). I believe that the most fair and accurate picture of the true therapeutic effectiveness of foot orthoses in the future will come from single-case experimental design.
Kevin A. Kirby, DPM, kevinakirby@comcast.net
Other responders have discussed the difficulties of doing the research on CFO’s. I would like to comment about our profession’s support for CFO research.
The need, the researchers, and the protocols are out there, but the support is not. These past three years alone have produced significant research that is evidence-based and peer-reviewed. The published research relates orthotics and biomechanics to tarsal tunnel syndrome (3 articles), rheumatoid arthritic feet (3 articles) pediatric symptoms (1 article) effect on shock (2 articles) plantar fasciitis (2 articles) injured runners (1 article) muscle activity (1 article) kinematics (2 articles). None of these papers were produced or supported by our profession.
What original papers will be presented at our August “Scientific Meeting” – “Are athletic shoes worth $200?” ; “Why do my orthoses cost more than my shoes?” Must we always follow?
Paul R. Scherer, DPM, Chair, Department of Applied Biomechanics at Samuel Merritt College, HPOC@aol.com
There are several labs and non-profit associations like PFOLA, who are devoted to promoting foot orthotic therapy education and supporting custom foot orthotic research through research grants. The former is not “self-serving” but for the better of all who are involved including the labs, the podiatrist and, most importantly, the Patient. Improved prescription-writing and trouble-shooting skills are essential so that patients receive the best level of care possible.
With regards to research, and I can speak to this directly from firsthand experience, this is an exciting time. Research groups (university- and podiatric college-centered biomechanics labs) in Europe, Australia and North America have a renewed interest in answering questions about custom foot orthoses. The reason for the renewed interest is twofold: 1) technological advances in 3-D motion analysis now allow for better analysis of the foot dynamics, and 2) because there are now grants available from individual labs and lab associations (i.e., PFOLA). The PFOLA grants, for instance, are chosen by a select group of external reviewers including leaders in the DPM community and academic biomechanists. These reviewers are instructed to select the best studies and those who are selected are awarded the funds. The results are unknown until the investigation is complete and the process, therefore, is completely unbiased.
Several research studies involving custom foot orthoses have been funded by the Lab industry, carried out by investigators who are not involved with the Lab industry (nonbiased researchers) and who have published their findings in high quality journals such as Clinical Biomechanics, Journal of Applied Biomechanics and Gait & Posture. Journals with editorial boards that are in no way involved with the lab business.
There is an “incentive” for labs to support research. The Lab industry recognizes that the findings of some these studies may conflict with the current paradigms. That’s the whole point, reconfirm that what we think we know is true or, if not, find a new solution. We need to get more researchers interested in podiatry and orthotic therapy so that we can build on the knowledge and ideas that Dr. Root has inspired and many of his students have further evolved.
Christopher MacLean, Ph.D. (Candidate), Paris Orthotics Lab, Vancouver, Canada cmaclean@parisorthotics.com
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Editor-Barry Block, DPM, JD