Health Care Report Card Compendium

From the press release:

With rising interest in information about the quality of care delivered by health care providers, HHS' Agency for Healthcare Research and Quality has developed a new Web tool demonstrating a variety of approaches for health quality report cards.

The new Health Care Report Card Compendium is a searchable directory of over 200 samples of report cards produced by a variety of organizations. The samples show formats and approaches for providing comparative information on the quality of health plans, hospitals, medical groups, individual physicians, nursing homes, and other providers of care. The Health Care Report Card Compendium can be found at http://www.talkingquality.gov/compendium/.

"Consumers and providers alike need better information if we're to get the highest quality and value from our health care system," said HHS Secretary Mike Leavitt. "We're still learning how to gather and present that information in the best ways, and we can learn from one another. The new AHRQ Web site will help with that learning."

Click here to access the press release.

DTC advertising

Check out the latest issue of the New England Journal of Medicine for the free full-text article "Drug Risks and Free Speech — Can Congress Ban Consumer Drug Ads?" From the article:

Spending on direct-to-consumer advertising increased by 296.4% from 1997 to 2005, during which time spending on promotion to physicians increased by 86.0% and spending on pharmaceutical research and development increased by 103.3%. Data are from the Government Accountability Office (report no. GAO-07-54, December 14, 2006).

Click here to read the article (registration required).

"Musings of a Dinosaur"

I came across this entertaining blog written by a family physician in solo practice ("dinosaur")! An excerpt from the physician's "Laws of the Dinosaur":

First Law: The Art of Medicine consists of amusing the patient while nature takes its course.

Second Law: It is impossible to make an asymptomatic patient feel better.

Third Law: The urgency of the test is inversely proportional to the IQ of the insurance company preauthorization clerk.

Fourth Law: No good deed goes unpunished.

I especially like the 12th Law:

Twelfth Law: A bad idea held by many people for a long time is still a bad idea.

Click here to access this blog.

Continuing Education Alliance Wins Award from California Medical Association

From the press release:

After only three years as a continuing medical educational (CME) non-profit, Continuing Education Alliance has received the California Medical Association’s first Cultural and Linguistic Competency Award for Excellence in a CME Activity. The award was presented at the annual CME provider conference in San Francisco on Friday, May 11, attended by over 260 accredited providers from throughout California.
Continuing Education Alliance received this award for the original concept and development of a CME activity, “Cross Cultural Considerations at End of Life” presented by Dr. Stephen Oppenheim, medical director of San Diego Hospice. This CME is an interactive discussion of multiple case studies showing effective end-of-life treatment, pain management, and communication strategies for patients of diverse religious, linguistic and/or cultural backgrounds.

Following the initial presentation of this activity at Continuing Education Alliance’s monthly meeting in September 2006, the course was offered to area hospitals. Two hospitals in San Diego, Scripps Memorial Hospital La Jolla and Sharp Grossmont Hospital, presented this activity to their staff physicians in 2006 and other hospitals in San Diego have asked for more information about including “Cross Cultural Considerations in End of Life Care” in their 2007 schedule.

Kudos to CEA! Jenell Hollett, President of CEA, is a collaborator extraordinaire; CME Providers interested in learning more about this CME activity or CEA can contact her at:

Continuing Education Alliance
4403 Manchester Ave, Ste 103
Encinitas CA 92024
Telephone# 760.633.4160

Disclosure: I have provided consulting services to CEA on accreditation issues.

Malpractice insurance price gouging?

According to a new report issued by the American Association for Justice the answer is "yes": from the press release:

Written by former Missouri Insurance Commissioner Jay Angoff, the study is based on recent annual reports from the top 15 medical malpractice insurers as rated by A.M. Best. The report shows that these insurers artificially raised doctors’ premiums and misled the public about the nature of malpractice claims – asserting that a so-called “malpractice crisis” exists. The report puts the lie to that claim.

According to the study:

The medical malpractice insurers saw losses and projected losses plummet by 48% over the period 2003-2006.
These incurred losses have declined every year for the past five years. These insurers’ 2006 surplus is 43% greater than their surplus in 2003 – five times the state-minimum surplus for insurer stability.
Only three of the 15 leading insurers issued dividends to doctors in 2006.

“Medical malpractice insurance companies have been price-gouging doctors, padding their pockets with excessive premiums and driving up the cost of healthcare,” said Jon Haber, AAJ Chief Executive Officer. “Cynically, these same insurance companies have been blaming high premiums on a so-called ‘malpractice crisis’ that doesn’t exist. We have an insurance crisis, not a medical malpractice crisis.”

Click here to read the entire press release. Click here to access the AAJ report (that graph on page 3 says it all).

hospitalcompare.hhs.gov

As reported in the USA Today article, beginning in June, "the Centers for Medicare and Medicaid Services (CMS) plans to post the first broad comparison of the death rates for heart attack and heart failure on its website, Hospital Compare." From the article:

The federal initiative marks a bold departure for an agency that has long been the repository of private information on Medicare patients. More than a dozen top hospitals provided USA TODAY with an exclusive look at the government's initiative by sharing their confidential Medicare death-rate report cards. The reports are drawn from death rates of heart attack and heart failure patients who died between July 2005 and June 2006, of any cause, within a month of entering the hospital.

The analysis reveals just 17 of 4,477 hospitals had heart attack death rates that were better than the national rate. Thirty-eight of 4,804 hospitals had heart failure death rates that were better than the national rate.

There was cause for alarm, too. The analysis reveals 42 hospitals where patients are more likely to die from heart attacks and heart failure than patients who go elsewhere, including at least one whose 24% heart attack death rate topped the national rate by nearly 10 percentage points.

Click here to read the entire article.

Data sources on health facts

Ever wonder how many U.S. states have firearm laws designed to protect children? Then check out statehealthfacts.org.

Did you know that, globally, in 2005 there were 8,810,805 new cases of TB? Do you know which three countries led the world in new cases of TB? Check out globalhealthfacts.org.

AMA Therapeutic Insights released (eCME activity)

From the PRNewswire press release:

The AMA is collaborating with recognized disease experts, national data providers and medical specialty groups to incorporate unique drug therapy information, disease prevalence and practice guidelines into an educational delivery format. The prescribing data included in AMA Therapeutic Insights are provided by IMS Health. The data are fully compliant with federal privacy standards and do not contain any patient identifiable information.

Physicians interested in continuing medical education can access AMA Therapeutic Insights to earn AMA PRA Category 1 Credit(TM) that can be applied toward the Physician Recognition Award (PRA).

Click here to read the press release. Click here to access AMA Therapeutic Insights.

Loose lips...

From the theheart.org article:

The American College of Cardiology (ACC) is formally penalizing Dr Martin Leon (Columbia University, New York, NY) for remarks about the COURAGE trial, made openly at an industry-sponsored symposium, that the organization says were in violation of an embargo on public disclosure of the trial's outcomes. The sanctions will include public censure and restrictions on his participation in the group's scientific sessions next year, the ACC announced today.

Click here to read the entire article (registration required).

The Nissen "Net" that caught Avandia

That'd be Cleveland Clinic's cardiology chief, Dr. Steven Nissen, who is also the immediate past president of the American College of Cardiology. From the Houston Chronicle article:

...review of dozens of studies showed the drug, taken by millions of diabetics, significantly raises the risk of heart attack. Six days later, he submitted the paper to the New England Journal of Medicine, which moved "at lightning speed" to get it out on Monday.

"I felt I had an ethical and a moral obligation to work as fast as I could," Nissen said.

He previously warned of heart risks from the painkiller Vioxx, which was pulled off the market in 2004, and three other drugs that nearly won approval: the diabetes drug Pargluva, the anticoagulant Exanta and the blood pressure drug Vanlev. He was the only FDA adviser to vote against Natrecor, a heart failure drug that some research has tied to a risk of death.

"I didn't really ask for this role," Nissen said. "I would rather spend my time doing studies that develop medications. But what happened was the FDA seems to have lost its way, and seems to be incapable of monitoring drug safety adequately. So it's fallen upon individuals to do independent analyses. I would love for that to change."

Click here to read the entire article.

Let's all take a deep breath...

From the Wall Street Journal article on Avandia "What Diabetes Patients Need to Know":

In a joint statement, the American Heart Association, American College of Cardiology and American Diabetes Association said the study "deserves serious thought and follow up" though the overall level of risk associated with the drug "appears to be small." The groups said patients should not stop taking any prescribed drugs without talking with their health-care providers.

Dr. Kirkman of the American Diabetes Association noted that diabetics are at a high risk for cardiovascular problems. However, she said, "We don't feel that this is an emergency or a panic situation, and we certainly don't advise that people go off medication without talking to their health-care provider about alternatives," she says.

Richard Hellman, president of the American Association of Clinical Endocrinologists, said Dr. Nissen's study raises the possibility that certain patients, such as those who have heart disease, may be at especially high risk. He said, the association isn't recommending that doctors stop prescribing Avandia altogether.

Click here to access the WSJ article (subscription required).

Too much, too soon?

Looks like states are backing away from making the cervical cancer vaccination mandatory. From the courant.com article:

Combine national wariness with a vaccine that costs more than any other in U.S. history; skimpy or non-existent insurance payments to doctors; and concern from social conservatives that a vaccine to prevent a sexually transmitted disease might promote promiscuity, and efforts to mandate the HPV vaccine ended up on the legislative back burner.

On top of all that, while cervical cancer remains a serious disease, it is not a public health crisis in the United States.

However, the article makes an important point:

Last week, a newly published study linked the HPV virus to certain types of throat cancer among people infected through oral sex. The incidence of oral cancer has not dropped in the United States, despite a decline in the major risk factor, smoking, leading researchers to suspect that HPV might be a culprit.

Given the reported popularity of oral sex among teens (Centers for Disease Control), there may be a public health crisis brewing; I offer that research on the etiology of these types of throat cancer is needed quickly. Click here to read the courant.com article.

Good health for SiCKO?

Michael Moore's new film, SiCKO, was shown at the Cannes Film Festival over the weekend; from a review:

Pic's tone alternates between comedy, poignancy and outrage as it compares the U.S system of care to other countries. Given Moore's celebrity and fan base, plus heightened awareness of the pic resulting from the heated battle that's already begun between left and right, returns look to be extremely healthy.

Pic should also play well internationally, providing an eye-opening lesson for foreigners who may be inclined (like Moore's Canadian cousins) to take out insurance from their homeland before visiting the States.

Chief criticism of the film is that it paints too rosy a picture of the national health care of the countries he compares America to, including Canada, England, France -- and Cuba.

Click here to read the entire review.

Another reasonable voice

Scott Lassman, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, sounded off in the Boston Globe this past Friday:

The information exchange also goes both ways. Doctors learn firsthand the trends in medicine safety before anyone else in the medical community. It's the kind of experiential knowledge that can't be taught in the university or even learned in a lab, and they share their experiences with a given medicine with these representatives.

This debate is really about trust. The industry values the relationship its representatives have built with the nation's healthcare professionals, and it is critical to the mission of helping patients that these interactions be maintained at the highest ethical standards. Just as patients trust their physician, it is equally important that physicians trust their pharmaceutical representatives.

Click here to read the entire article.

A reasonable voice

This essay didn't make it into one of the big newspapers; however, it deserves a wider forum, from the Daily News Tribune:

Current medical journals and the popular press carry numerous articles about the relationships between the drug manufacturing industry and physicians. Newspapers and computer screens roar with disturbing headlines: ``Doctors reap millions for anemia drugs;'' ``Pills for Patients, Payday for Docs;'' ``Posing as pals, drug reps sway doctors' choices.''

The perception of physicians created by these stories raises many questions. It often appears that physicians and pharmaceutical companies are engaged in an unholy alliance where greed and money rule. Some reports would have you believe most doctors are checking patients with one hand and looking for a hand-out with the other.

It's true some physicians (as well as drug company representatives) may lose their ethical compass from time to time. Thankfully, the overwhelming percentage of my profession is populated with good, honest, decent and wonderfully caring people.

Click here to read this essay written by Leonard J. Morse, M.D.

Advances in medical technology

On the theme of new medical technology and its associated monetary costs, here are a couple of other news items y'all might want to check out:

The Baltimore Sun article "Medical Scans Zapping Insurers":

The upshot: Imaging has nudged out drugs as the fastest growing component of rising medical costs, increasing as much as 20 percent a year.

The overall cost of diagnostic imaging is estimated at well over $100 billion annually in the United States. That's about a nickel of each health spending dollar.

That's gotten the attention of insurers, who have put up more hurdles and imposed more controls, creating hassles for doctors and patients alike. Sometimes they refuse to pay at all.

The courant.com article "Doctors Balk At Small Fee For Injecting Costly Vaccine":

Doctors report a brisk demand for the vaccine, which blocks strains of the ubiquitous human papillomavirus (HPV) that cause 70 percent of cervical cancers.

But some doctors, especially pediatricians and gynecologists, who are most likely to be asked for the vaccine, are refusing to buy it or restricting who receives the shots.

Discontent over the price of the vaccine - the most expensive ever - highlights a long-simmering dispute over reimbursement for immunizations, traditionally regarded as bedrock medicine. It is a dispute, experts say, with significant public health implications that has accelerated as the number of costly new vaccines has proliferated.

No doctor in the OR!

From the Tennessean.com article:

Imagine going to the hospital for surgery, but there's no doctor in the operating room.

Instead, there's a robot, controlled by a doctor in some other city.

The breakthrough that makes that possible is among the technology on display at the 12th annual meeting of the American Telemedicine Association. The meet, which began Sunday, ends today at the Gaylord Opryland Resort & Convention Center.

The event drew about 120 exhibitors, including the makers of a robot that lets doctors interact with patients from miles away, and of machines that can be used to check on patients in their homes and record their blood pressure and other vital signs.

The article points out that insurance (lack of reimbursement) can be a barrier to telemedicine. Click here to read the entire article.

"Engaging" sales reps result in more scripts

From the PRNewswire press release:

The puzzle of why physicians make different prescribing decisions is a complex one. Many companies invest solely in research that assesses sales representative performance from the physician perspective. Such research often examines only the functional aspects of the detail process. PeopleMetrics research finds that the engagement level of the representative and their passion for the company is an overlooked but critical piece to this puzzle. Pharmaceutical companies that measure and improve sales representative engagement thereby position their sales force to build stronger relationships with physicians.

Gosh, what a surprise! Click here to read the entire press release.

Walkin' and workin'...

This is so cool! A physician at the Mayo Clinic just finished a small study (n=15) in which obese folks worked on a special computer-treadmill station:

Levine didn't measure actual weight loss. This is a theoretical study, but he calculates that burning an extra 100 or more calories an hour for two or three hours each working day would cause many obese people to lose between 20 and 30 kilograms a year.

The "walk and work" device is no ordinary treadmill.

It's built on a steel frame with four wheels, so that workers can steer it around the office.

There's room for a computer, books, pens, a phone, a flower vase, coffee cup and paper tray. The whole thing slides over a standard treadmill, or slides away when the user wants to stand on a solid floor.

It can also slide over to a chair so that the user doesn't have to stand for the entire day. Mr. Levine says it costs about $1,600 US, not including the treadmill - a bargain, he suggests, since obesity costs the U.S. $100-billion to $200-billion a year in health costs and lost productivity.

Click here to read the entire article.

Dietary supplements...what residents don't know

Interesting study just published in the Archives of Internal Medicine on physician knowledge of dietary supplements and FDA regulation (or lack thereof):

Baseline knowledge of dietary supplement regulatory issues was poor. The total average pretest score was only 59% (986/1675). The average score rose to 91% (1526/1675) after completion of the curriculum (P<.001). With regard to specific content areas, about one third of physicians were unaware that dietary supplements did not require FDA approval or submission of safety and efficacy data before being marketed. Similar percentages believed that there are regulations in place to ensure supplement quality. Most physicians were unaware that serious adverse events due to the use of supplements should be reported through the FDA MedWatch system.

Click here to access the abstract.

New TIA diagnostic protocol

From the ACEP News Release:

A new emergency department diagnostic protocol shows potential for saving money and time, as well as for dramatically reducing the number of hospital admissions for patients diagnosed with transient ischemic attack (TIA), or stroke. The study appears online in the Annals of Emergency Medicine ("An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial").

"Because TIAs tend to be so predictive of future, more serious strokes, many within a couple of days, emergency physicians hospitalize most TIA patients," said lead study author Michael A. Ross, MD, of William Beaumont Hospital in Royal Oak, Michigan. "By managing TIA patients using an accelerated diagnostic protocol in the emergency department, we were able to cut most patients' length of stays and costs in half without compromising their 90-day clinical outcomes. Besides freeing up inpatient beds, this should lead to greater patient satisfaction."

Click here to read the entire news release.

Atypical psychiatrists?

From the New York Times article:

The psychiatrist receiving the most from drug companies was Dr. Annette M. Smick, who lives outside Rochester, Minn., and was paid more than $689,000 by drug makers from 1998 to 2004. At one point Dr. Smick was doing so many sponsored talks that “it was hard for me to find time to see patients in my clinical practice,” she said.

Dr. Steven S. Sharfstein, immediate past president of the American Psychiatric Association, said psychiatrists have become too cozy with drug makers. One example of this, he said, involves Lexapro, made by Forest Laboratories, which is now the most widely used antidepressant in the country even though there are cheaper alternatives, including generic versions of Prozac.

Click here to read the entire article.

Purdue pain

From the New York Times article:

The company that makes the narcotic painkiller OxyContin and three current and former executives pleaded guilty today in federal court here to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.

To resolve criminal and civil charges related to the drug’s “misbranding”, the parent of Purdue Pharma, the company that markets OxyContin, agreed to pay more than $600 million in fines. That is the third-highest amount ever paid by a drug company in such a case.

Also, in a rare move, three executives of Purdue Pharma, including its president and it top lawyer, pleaded guilty today as individuals to misbranding charges, a criminal violation. They agreed to pay a total of $34.5 million in fines.

Click here to read the entire article.

More on anemia drugs

From the Wall Street Journal:

A Food and Drug Administration advisory committee said that cancer patients' use of popular anemia drugs made by Amgen Inc. and Johnson & Johnson should be limited further, and the companies should be required to complete studies to answer lingering safety questions.

The votes were a blow to the class of medications that the FDA calls erythropoiesis-stimulating agents, sometimes known as ESAs or EPO drugs, which are sold as Epogen and Aranesp by Amgen and Procrit by J&J. The medications are prescribed for anemia, which is a deficiency of red blood cells that can occur as a side effect of cancer chemotherapy and kidney disease.

Click here to read the WSJ article (subscription required).

Earlier in the week, the New York Times published an article on rebates to oncologists on these anemia drugs:

Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.
...
Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment.

Click here to read the NYT article.

Gender gap in health care

Make a note, ladies, now we not only make less than men for doing the same job but we don't receive the same level of health care. That's the finding according to a study done by the Health and Human Services' Agency for Healthcare Research and Quality (using 2004 data). From the United Press International article:

Women were 47 percent more likely than men to be hospitalized for high blood pressure, an event that can usually be avoided with good primary care, the study said, and 50 percent of women receive recommended colorectal cancer screening, compared to 54 percent of men.

Click here to read this short article (and don't be shocked by that photo of Imus; methinks someone has a sense of humor).

More power to the FDA?

If the bill reauthorizing FDA user fees passes Congress, as expected, then it most likely will bring "sidecar" regulations for Pharma. From the Wall Street Journal:

If it becomes law, the Senate bill, called the Food and Drug Administration Revitalization Act, could shift the balance of power between regulators and the pharmaceutical industry. It requires the FDA to monitor drugs after they go on the market and provides new funding for that job. The bill would also require companies to make public the results from many of their studies.

The measure would grant the FDA authority to take major actions, including requiring new studies, limiting distribution or ordering label changes if the agency thought they were necessary. Currently, the FDA's authority in that area isn't clearly delineated, so the agency often has to negotiate with companies, using its leverage before it grants approval for a new drug or the indirect threat of its bully-pulpit power to get the concessions it seeks.

Click here to access the article (subscription required).

"150 consecutive daily entries on innovation"

Be certain to check out Doctor Reece's blog on medical innovations! Wednesday, May 9, 2007 marks 150 entries -- maybe you will read something you will want to put into practice. Click here to access his blog.

Influenza-Associated Pediatric Mortality and the Increase of Staphylococcus aureus co-infection

Click here to read this CDC Health Advisory.

Just say "no" to cancer prevention?

I have to admit that when I think of the issue of HPV vaccination from a public health perspective, it's a slam dunk! However, if I had a young daughter, would I race her into the doctor's office to be vaccinated? Professor R. Alta Charo discusses the issues surrounding HPV vaccination in the latest issue of the New England Journal of Medicine:

Cancer prevention has fallen victim to the culture wars. Throughout the United States, state legislatures are scrambling to respond to the availability of Merck's human papillomavirus (HPV) vaccine, Gardasil, and to the likely introduction of GlaxoSmithKline's not-yet-approved HPV vaccine, Cervarix, which have been shown to be effective in preventing infection with HPV strains that cause about 70% of cases of cervical cancer. At the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP) has voted unanimously to recommend that girls 11 and 12 years of age receive the vaccine, and the CDC has added Gardasil to its Vaccines for Children Program, which provides free immunizations to impoverished or underserved children.

Yet despite this federal imprimatur, access to these vaccines has already become more a political than a public health question. Though the more important focus might be on the high cost of the vaccines — a cost that poses a genuine obstacle to patients, physicians, and insurers — concern has focused instead on a purported interference in family life and sexual mores.

Click here to read the entire full free-text article (registration required).

The hip joint's connected to the pocketbook?

From The Star Ledger article:

For two years, federal prosecutors in New Jersey have been building a case that the nation's largest makers of artificial hips and knees defrauded the government and taxpayers by paying surgeons to use and promote their products, according to sources close to the probe.

The evidence includes statements from prominent doctors around the country who allegedly accepted lavish vacations, gifts and "consulting fees" as high as $200,000 a year from the implant makers for little or no work, said four attorneys who have been briefed on aspects of the case.

There is no allegation that the practice jeopardized patients or subjected them to substandard products or treatment. But the sources say prosecutors contend that the money had a sole purpose -- to buy surgeons' loyalty to specific products -- and that doctors often failed to reveal such a conflict to their patients. If true, such payments would violate the federal anti-kickback statutes that govern hospitals and health professionals who participate in Medicare.

Click here to read the entire article.

Chronic Obstructive Pulmonary Disease

From the Wall Street Journal article:

Former smokers may believe they are out of the woods because they quit, but nearly half of COPD patients are former smokers rather than current smokers, according to Amy Pianalto, project director of the NHBLI's "Learn More, Breathe Better" awareness campaign (www.learnaboutCOPD.org), which is sponsoring radio and print ads and offers materials for both doctors and patients.

Second-hand smoke, air pollution and workplace exposure to pollutants like chemicals, dust and fumes can also trigger the disease. An estimated 100,000 Americans also have a genetic disorder known as alpha-1 antitrypsin, or AAT, deficiency that makes them susceptible even without any kind of exposure.

"There are 12 million people in this country who are coughing and can't breathe who don't know they have COPD," says Molly McGuire, administrator of the nonprofit COPD Foundation (COPDFoundation.org). "It has been a slow process getting everyone connected to resources."

Click here to read the article (subscription required). Speaker resources on this topic are available here.

ACCME post re: Senate Finance Committee letter

From the ACCME's website:

The Senate Committee on Finance has provided the ACCME and the CME system with many face- and content-valid observations where enhancements could be implemented that would make the independence of CME from commercial interests more distinct. Since the development of the first version of the ACCME Standards for Commercial Support in the late 1980s, the ACCME has taken seriously its roles and responsibilities to set expectations about this independence of CME and to measure CME providers’ compliance with those expectations, especially in the presence of funds from commercial interests.

In this same spirit, the ACCME will reflect on the Senate Committee on Finance’s observations. The timing and process for this consideration matches well with the ACCME’s current process of review and assessment of the implementation of the 2004 ACCME Standards for Commercial Support: Standards to Ensure Independence. As these updated Standards are now in place across the CME system, the ACCME looks forward to determining where and how improvements to the accreditation policies and processes might strengthen the validity and independence of CME.

Click here to access.

FDA Proposes New Warnings About Suicidal Thinking, Behavior in Young Adults Who Take Antidepressant Medications

Click here to read the FDA's statement.

Lilly lifting the veil

Eli Lilly & Co. announced that it will be publicly disclosing which organizations receive grant funding from the company. From the Wall Street Journal article:

Lilly's decision to disclose its grants was prompted in part by an investigation into drug company donations by the Senate Finance Committee. The committee's report last week said while there is separation between grants and sales and marketing, potential for abuse remains. Some Eli Lilly executives had worried revealing the company's grants could expose recipients to criticism and bring more scrutiny. But ultimately, Lilly decided to disclose the details after an internal analysis showed the marketing department wasn't influencing the grant office's decisions, says Michael Bigelow, Lilly's assistant general counsel. Lilly shouldn't have to feel "apologetic" about the grants, he adds.

Click here to read the article (subscription required).

Fasten your seatbelts

The Senate Finance Committe just sent a letter to the ACCME urging "greater oversight by the council" per the press release. An excerpt from the letter:

Based on our analysis of the information you provided, we find it interesting that, even though ACCME's reaccreditation process relies almost exclusively on information supplied by the CME providers under review, ACCME still detects a significant number of incidences of noncompliance. It also appears that compliance with ACCME standards still allows CME providers to accommodate the business interests of their commercial sponsors and affords drug companies the ability to target their grant funding at programs likely to support sales of their products. The full extent to which drug companies influence the content of putatively independent CME programs cannot be estimated from the information we currently have.

Click here to read the press release and letter. And don't forget to participate in the Medical Meetings magazine survey on this topic -- click here to access.

Free prescription drug samples - good idea or bad idea?

From today's New York Times article:

The crackdown on free samples comes amid growing concern about the close ties between physicians and drug companies. Critics like Dr. Rothman say physicians don’t realize the extent to which their medical judgment is influenced by their acceptance of the samples. They point to studies like a 2002 paper in the journal Annals of Family Medicine finding that the number of doctors who treated high blood pressure with the “first line” drugs recommended by national guidelines was low, but increased sharply when free samples were removed.

So far, the University of Michigan Health System has banned free samples altogether, and the University of Pennsylvania and Stanford University medical schools have prohibited staff members from accepting them (though samples can be given to Stanford’s pharmacy for use in free clinics).
...
But there’s an upside to the samples. Using samples, a doctor can see if a patient can tolerate a new medication before the patient goes out and buys a 30-day supply. Physicians who treat poor people like to have samples on hand for them, and for uninsured patients.

Click here to read the entire article.

NH prescription data law interrupted...

A U.S. District Court judge on Monday overturned a New Hampshire law that was the first in the nation to ban the commercial use of information on what drugs physicians prescribe.

Judge Paul Barbadoro of the U.S. District Court in Concord ruled in favor of IMS Health Inc. (RX.N: Quote, Profile, Research and Verispan, two companies that collect prescription data from pharmacies and sell it to drug makers, researchers and investment firms.

Click here to read the Reuters news article.