December 2020 Issue
Volume 48, Number 11
Volume 48, Number 11
Thanksgiving has always been my favorite holiday. It is uniquely American, instituted by Abraham Lincoln. It belongs to, and is celebrated by, all Americans regardless of religion, race, or creed. It is a non-commercial holiday without the pressure for gifts or great expense. But most of all, it is a day of introspection. A day where despite the stress and turmoil swirling around us out of our control, we pause to reflect on the positive aspects of each of our lives that are present there for all of us. A day to pause to re-establish perspective, cherish what gives us most meaning, and to truly give thanks. After this terrible 10 months of pandemic and one of the most divisive elections in US history this is very much needed. I truly hope that you all had a blessed and safe Thanksgiving!
I hope that this message finds all CANS members safe and healthy. The recent news that several Covid vaccines have been found to be safe and effective and that their doses are being fast-tracked is certainly welcome news for a “light at the end of this pandemic tunnel”. It cannot come soon enough.
I want to remind everyone to please “save the date” for our CANS virtual Special Session to be held Sunday January 17, 2021. We plan to have informative and excellent presentations from the residents from all our California training programs. You will be able to see and hear some of our future colleagues in California neurosurgery, and learn about their interests and projects. Just as importantly, there will be updates on the policies and pending legislation and propositions that might affect California neurosurgery at a state level, as well as an update on the implications of our current election results on neurosurgery and healthcare at the national federal level. These updates promise to be both important and timely. You won’t want to miss them.
By now I am sure that most CANS members have heard the sad news that we lost our friend and colleague Phil Lippe on 11/05/2020. A founding member of CANS who at one time or another, held every single officer position in our organization, and who continued to advise the CANS Board as our longest serving Consultant through this year when he stepped down for health reasons, Phil will be deeply missed. Our deepest condolences go out to his wife, Gail, and their whole family.
I continue to hope that all of our members continue to remain healthy and safe during this trying time with Covid-19. CANS has yet to hear of any member who has been sick with Covid-19, but we very much want to know and keep track of any such event(s) to measure and document the direct personal impact of the pandemic among individual California Neurosurgeons. Anyone who knows of a CANS member, or any California neurosurgeon, for that matter, who has been sick with Covid-19, please contact our executive secretary Emily Schile with the particulars at email@example.com .
Please stay safe everyone. Please support CANS and the CMA, they are fighting for you. Please save the date for our virtual CANS Special Session to be held Sunday January 17, 2021. All the best!
The fabric of California neurosurgery was torn on November 5th when our good friend Phil Lippe died. A most thoughtful obituary by Don Prolo, who knew Phil better than most everyone else, is included elsewhere in the newsletter.
I, like most of Phil’s colleagues, knew him as a staunch worker for CANS as it dealt with the Medicare intermediary and the CMA. I knew he was involved in pain medicine but was unaware of the details. Back in the day, pain medicine was me and my prescription pad. When I retired, pretty well-trained pain specialists abounded. What follows is how that happened as memorialized in an article in the journal Pain Medicine, a publication of the American Academy of Pain Medicine, published in 2011. The article is entitled, Encomium: Philipp Maria Lippe, MD, FACS, DABPM which we obtained via Stanford where Phil was on the clinical faculty since 1963. An encomium, unlike an obituary, can be published while the subject is still very much alive and usually admired.
The neurological surgeon in him was challenged by the fundamental aspects of pain management, but he recognized deficits in traditional knowledge and teaching. He also felt that patients deserved better access to competent pain physicians and better delivery of effective pain care. This required that his nonclinical efforts be spent concurrently in three major policy areas: training, certification, and public education. He had then, as a young neurological surgeon, and still has, as an emeritus professor, the vision, energy, and dedication to pursue all these goals.
His conviction that persistent pain is actually a distinct non-nociceptive disease was far ahead of its time. When the International Association for the Study of Pain (IASP) was still defining “chronic pain” as pain persisting more than 3 months, Phil was developing the concepts of “eudynia” and “maldynia.” Eudynia (normal pain) is the protective nociceptive process common to all organisms, while maldynia is a maladaptive disease state in humans. Maldynia is now being shown both in the laboratory and at the bedside to have structural and functional changes in both central and peripheral neurologic systems. These changes are being documented with functional MRI and other imaging. Long-term pain that becomes maldynia produces abnormal biopsychosocial changes that have enormous costs to the individual, family, society, and the health care system. The concept of maldynia has now been accepted by the American Medical Association (AMA) Council on Science and Public Health and is a searchable keyword in Medline.
He was instrumental in the concept and passage of Public Law 106–386 signed by President Clinton. This declared the years 2001–2010 as the Decade of Pain Control and Research . It required a heroic effort on his part, but the gains have been immeasurable. Both basic and clinical sciences benefited directly and indirectly from the increased public and political awareness (and funding) of the issues. This could have been equally correctly termed Lippe’s Decade. He was influential in organizing the Pain Care Coalition (PCC) of concerned professional associations. This group retains Washington counsel and monitors activities relevant to Pain Medicine, patient access to treatment and pain treatment education and research.
Phil managed to have the State of California mandate proper pain medicine training in its medical schools. There had been no formal pain fellowships in this country “before Phil.” The American Board of Pain Medicine (ABPM) (http://www.abpm.org), formerly the American College of Pain Medicine, held the first certifying examination ever in the new specialty under his guidance. This was years before any other specialty body thought of doing so.
He has steered the Academy and Board through perilous legal waters as a member (and President) of both boards, former Executive Medical Director of AAPM, and in his continued role as Executive Vice President of the ABPM. Courtroom issues could have arisen from disgruntled applicants, candidates, and other organizations, but they have been avoided by impartially applying the AAPM’s and the ABPM’s guidelines with a generous dose of his own diplomacy.
Pain Medicine has become accepted as a distinct medical specialty largely because of his efforts in venues such as American Medical Association’s House of Delegates and various State medical licensing boards, notably California, Texas, and Florida. Phil spent years talking, educating, and influencing these entities. The AMA accepted the AAPM as a specialty society in 1988. This has raised the profile of the specialty and has made it easier for other legitimate specialty groups to be accepted under the AMA umbrella. He has been indefatigable in his role as AAPM Delegate to the AMA House. He organized and conducted the first National Pain Summit for 32 pain interested specialty societies in 2009.
His unvarying position is that the patients’ interests come first; turf be damned! For example, he believes that pain physicians should only be engaging in clinical activities for which they have been thoroughly trained in a formal educational setting. It is this belief that underpins his undying devotion to residency training in pain medicine, so that every trained pain physician will possess the requisite knowledge and skill sets to undertake the comprehensive care of the person in pain in a safe, effective, compassionate, and competent manner.
Phil has been recognized for his work in many other ways. Most significantly, the AAPM instituted the Philipp M. Lippe, MD award for the person who contributed the most in that year to the social and political aspects of Pain Medicine. He has been the recipient of the highest awards from the AAPM, California Medical Association, and California Association of Neurological Surgeons, etc. and this year from the AMA for his career of work and has received numerous eponymous awards from other organizations.
Phil, luckily for people in pain and the specialty of Pain Medicine, has always been (with apologies to Eric Bogle) . . . marching to a distant, different drum, Banging his poor head against brick walls, Trying to catch the flag every time it falls.
I didn’t know when I was with Phil that I was in the presence of a true prophet and giant!
PHILIPP MARIA LIPPE, MD
(May 17, 1929 – November 5, 2020)
Riddle: Why did an Emu select a Cushing Lineage Neurosurgeon as a Patron-Protector?
Vienna, Austria, birthplace of Phil Lippe, was suffering the chaotic 1930’s, the interregnum between World Wars I and II. Hitler’s Germany had invaded and occupied Austria in 1938, and that nation subsequently suffered the ravages of Kristallnacht November 9-10. It was that year at age 9 the Lippe family escaped Austria via the Adriatic and Mediterranean Seas and Atlantic Ocean to reach America and Chicago, Illinois. To that city family members previously had immigrated. Phil Lippe’s parents, father (violinist) and mother (pianist), both had graduated from the prestigious Vienna Conservatory of Music. In Chicago Phil’s father became Concert Master for the Chicago Symphony Orchestra.
Phil attended Loyola University College of Arts and Science, Pre-Med Program, Evanston IL 1947-1950 and University of Illinois College of Medicine, Chicago, IL, 1950-1954. He earned a B.S. degree in Medicine, 1952 and MD with High Honors, 1954 [magna cum laude, first in class].
From 1956-1958 Phil served as a Captain U.S.A.F. (M.C.) and Chief, Department, Department of Surgery, Walker AFB (SAC), Roswell, New Mexico.
Phil then became a neurosurgeon under the guidance of Professor Eric Oldberg (1959-1962) at the Neuropsychiatric Institute, Research & Education Hospitals, University of Illinois, Chicago IL. Doctor Oldberg was a neurosurgeon trained by the historic “Father of Neurosurgery” Doctor Harvey Cushing, in Boston MA.
In 1963 he began his very active neurosurgical private practice in San Jose, CA, was certified by the American Board of Neurological Surgery (1965) and American Board of Pain Medicine (1992). After a disruptive myocardial infarction in 1993 he transferred his entire professional attention and exceptional service to multifarious medical organizations, local, state and national.
Academic Appointments over his career have been at the University of Illinois, Chicago (1962-1963), and Stanford University Department of Neurological Surgery (1965-2006), concluding as a Clinical Professor of Neurosurgery.
His active membership and leadership roles in professional organizations are legion over his career. They include major Medical Associations and Societies (7), Pain Medicine Associations and Societies (6), Neurosurgery Associations and Societies (4), Associations and Societies in Surgery (3), Physician Executives (1), Neurology (1) and Neuroimaging (1). Amazing total: #23 major medical organizations!!! In all these organizations he served in many executive roles, including most as Director and President among other positions.
Philipp Lippe, MD is regarded as Father of Pain Medicine, establishing this discipline as a medical specialty in the United States with full representation in all medical associations. He established and led a pain center associated with O’Connor Hospital in San Jose, CA. He developed the branding terminology “Eudynia,” “Maldynia” and Algiatry. He was instrumental in creating and establishing the Decade of Pain, 2001-2010, signed into law by President Clinton.
In support of all his organizational activities he maintained an active role in the Santa Clara County Medical Association, the California Medical Association and American Medical Association, the American Association of Neurological Surgeons and was founding member of the California Association of Neurological Surgeons (1973) and American Academy of Pain Medicine. In each national, state and local organization he advanced his historic quest of establishing pain medicine as an important medical specialty. At his local Good Samaritan Hospital he provided continuing wise counsel on a monthly basis to the medical staff until his ultimate demise.
As years passed Phil became less ambulatory, but he continued his organizational contributions in administrative and consultive roles. He accomplished these feats late in his storied career only with the enormous logistic support of his truly inspirational, supportive, saintly wife Gail, who enabled and extended his continued service beyond his late-onset physical locomotor impairments.
Phil Lippe confided with me his personal awe and gratitude that his mental acuity and perspicacity remained intact forever, despite the gradual failure over the last decade of his other human physical endowments. Throughout his life and career as a neurosurgeon he has directed his bountiful human capacities to improving his medical profession under the duress and entanglements of countless efforts to obstruct his goals.
His last request of me shortly before his passing was “Don, please help me.” This request defied potential for fulfillment. His time on earth had elapsed. He had suffered a major complication during cardiac valve surgery.
Philipp Lippe’s lifetime corpus of accomplishments reflected the consummate, rightful role of professionalism and concern in the care of patients. His experience of dismissive, terminal mismanagement reveals the major, ultimate challenge lying ahead in the evolution of federalized healthcare in America.
Hats off, my good friend, for your struggles, your historic accomplishments, your friendship, paternalism and pervasive joy and optimism in combating the battles of our profession.
All neurosurgeons and their families who have had the honor of knowing Philipp Maria Lippe, MD remain in awe of his talents, his immense contributions and are eternally grateful for his friendship and inspirational career as the ultimate physician and inspirational professional.
Answer: Emus are super birds that cannot fly and depend for a future on adoption by super humans, who soar.
Gail remains in charge of the herd of emus she and Phil have adopted and guardian of eternal memories.
-Donald J. Prolo, MD
Gifts in memory of Dr. Lippe and to support “The Lippe Heritage Pain Management Collection” can be made online or by sending a check payable to the “UCSF Foundation” to UCSF Foundation, PO Box 45339, San Francisco, CA 94145 (please indicate “in memory of Dr. Lippe, Archives” in the memo line).
‘Twas the year 2020, when all through the world
A tiny new virus had just begun to unfurl.
It jumped to our species, perhaps from pangolin
Though it could have been bat who was its next kin.
First spotted in Wuhan in the province of Hubei
It moved quickly about, without much delay.
Was Seattle or San Francisco its first US stop?
Nonetheless, the US was late to get atop
Of any planning at all except for perhaps,
A massive quarantine in March, two weeks to elapse.
The shut-down immense, the nation in a dither
As we all hoped this virus would just go away and wither.
But not to the CDC’s big surprise
It would just infect more and in July a big rise.
Politicians debated mask or no mask to wear
Letting governors decide, and the consequences they’d bear.
At a Rose Garden event, wearing no mask did he learn
That even as President, it could now be his turn.
Infected with COVID to Walter Reed he does go
Gets special treatment and puts on a show.
Thanksgiving comes and three weeks later
All the travel gives way to more hospital labor.
As ICUs fill and staff is overworked
There are still people around going berserk
Over whether the virus is a reality
Until it infects them and becomes a finality.
A vaccine arrives but is in short supply
The hospital personnel first as on them we rely.
Hopefully, it won’t be long to get all the rest
For many do hope that they now can be next.
As 2021 arrives, my wish for us all
Is we get herd immunity, hopefully by fall.
And from a world and me much beleaguered,
A nod to Clement Clarke Moore for providing the meter.
In the Vth Century, Saint Augustine the influential Christian philosopher, coined his famous saying, “Ex Malo Bonum.” He wrote this in response to the prevailing notion, advanced by Seneca that Good cannot come from Evil “Bonum Ex Malo Non Fit.” Saint Augustine’s was a much more hopeful approach.
The year 2020 has generally brought “Evil” upon the World and particularly our beloved Country and beautiful State.
We now know that as early as January of this year, seemingly ages ago, it was clear to the people in charge that COVID-19 was a serious threat. But for many reasons, mostly political, we were not informed, and … we did not take it as seriously as we should have. Consequently, the resulting pandemic has gone completely out of control. More than a quarter million Americans died and did not celebrate Thanksgiving with their families. And almost thirteen million family members, friends and neighbors have been infected. Some are still suffering from debilitating chronic manifestations; they fall in a group that is referred to as the “Long Haulers.”
For the families who lost a loved one or more than one of their members, and for the families whose breadwinner(s) lost their job(s); and for the millions of our fellow citizens who don’t have rent money or even what it takes to feed their families, it must be devastating to celebrate Thanksgiving … It is heartbreaking to me to even think about them: how are they coping?
Even though my family and I are blessed on many levels, we have had to modify our traditional Thanksgiving family celebration drastically; we did not travel to be with our family and the celebration within our “Bubble” was very small. Like many, we had to “zoom.”
Politically, 2020 has been an “Evil” year as well. Our Country is more divided and polarized than ever. We simply lost the ability to talk openly to one another in a peaceful and civil manner. Unfortunately, the present administration has encouraged such a division. Its approach to dealing with the pandemic has been non-scientific, incoherent, politically motivated, and frankly, inept. The results of our presidential election are being challenged by the present occupant of the White House, and as a result it is being questioned by many of the 73 million citizens who voted for him, and virtually the entire Republican Party. However, the fact of the matter is more than 80 million citizens voted for his challenger who also won 306 electoral votes. So, we do have a President-Elect who will move in the White House on January 20, 2021, but the transition of power has not been smooth nor civil.
The good news about the election was the turnout. It was the highest in our history despite the pandemic. To me a higher turnout reflects a healthier Democracy; we should do our utmost to safeguard it. Also, of interests is the fact that the entire World was watching with bated breath the results of our election. This confirms the importance of the role our Country plays in maintaining a world order. In fact, you may be intrigued to know that one of my high school friends who now lives in Paris, France, and teaches literature at the Sorbonne, told me: “I think that the entire world should be able to vote in the American Presidential election, since the person who occupies this office influences every corner of the World and the lives of everyone.”
In California, we suffered devastating Wildfires that resulted in the loss of hundreds of lives and thousands of homes and businesses. And we lived through few weeks of terrible air quality. Meanwhile, the present administration refuses to acknowledge the devastating effects of climate change.
But despite all this we still have many, many things for which to be thankful.
On a personal note, my immediate family remained healthy. And six months ago, we were blessed with the birth of our tenth grandchild Chafik, named after my father. And less than a month ago our extended family was blessed by the birth of another boy, a grandnephew. And although my brother, two nephews, two nieces, two nieces in law, a grandniece and grandnephew were infected by the COVID-19 virus, they all recovered. One of my nieces who is in her thirties is now a “long hauler” and is experiencing frustrating symptoms of chronic myocarditis. I pray that she will soon recover completely.
On a pandemic note, there is hope that if we all adhered to the common-sense public health measures of wearing masks in public, gathering mostly outdoors while keeping social distance, and otherwise avoiding un-necessary gatherings, testing as needed while paying attention to contact tracing, we might be able to slow down this pandemic significantly until enough vaccines become available to all Americans.
The good news is we now have three promising vaccines that are about to be released.
On a National note, for the past four years, the present occupant of the White House considered himself only president of the red states in our Country.
However, fortunately we are going to have a President who considers himself a president for all US citizens even those who did not vote for him. This includes all of us in our deep blue state, the Golden State. And our Vice President Elect is a woman from California whose parents were immigrants. She will present at the National level, a sorely needed female as well as immigrant perspective with a California light.
So, Saint Augustine was right: Good out of Evil. Ex Malo Bonum!
“Zoom Thanksgiving beats an ICU Christmas!”
Any CANS member who is looking for a new associate/partner/PA/NP or who is looking for a position (all California neurosurgery residents are CANS members and get this newsletter) is free to submit a 150 word summary of a position available or of one’s qualifications for a two month posting in this newsletter. Submit your text to the CANS office by E-mail (firstname.lastname@example.org).
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