Gift registry?

From the New York Times article:

In the midst of a Senate hearing about the money and gifts that drug makers routinely provide to doctors, Senator Claire McCaskill mentioned that she had a brother who runs a restaurant.

“And he said that the most lucrative part of his business was the private room that is used mostly by drug companies” to entertain doctors, said Ms. McCaskill, Democrat of Missouri. “He said that you wouldn’t believe how much expensive wine these guys buy.” The tab often totals thousands of dollars, she said later.

Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, assured Ms. McCaskill that major drug makers no longer offer doctors expensive dinners. The industry’s code of ethics mandates that free meals be modest — pizza, for instance, Ms. Powell said.

Click here to access the article.

G'day mate?

From the Sydney Morning Herald article:

The pharmaceutical industry was dealt a bitter blow this week when a three-member panel headed by Justice Robert French ruled that Medicines Australia, the industry body covering more than 90 per cent of drug companies in Australia, could only continue to self-regulate its code of conduct if all drug companies twice a year forwarded complete information on hospitality: the venues, the number and types of professionals invited, the total cost of food, travel, accommodation and entertainment. This information would be published on a freely accessible internet database.

Click here to access the article; interesting reading.

And now, the Senate Special Committee on Aging

From the Washington Post article:

For doctors, though, drug company funding "makes it very difficult to know what research to believe," said J. Gregory Rosenthal, an Ohio retinal surgeon and a founder of Physicians for Clinical Responsibility, a group pushing for tighter controls on conflicts of interest in medicine. "Even at the [specialty] academy level, you can't go onto a Web site without being confronted by sponsorship logos."

Rosenthal will testify today in a hearing before the Senate Special Committee on Aging, which is looking into physician links with the drug industry. Sen. Herb Kohl (D-Wis.), the chairman, said the commercial sponsorship of courses creates a conflict of interest.

"It appears that everyone profits from this pervasive system of gifts and payments, except the consumer," Kohl said.

The hearing marks the second time this year that the Senate has examined the independence of industry-sponsored continuing education. In April, a Senate Finance Committee study found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, does not scrutinize course materials for accuracy or evidence of bias toward sponsors' products. At times, sponsors have been able to select topics, and presenters have discussed off-label uses for drugs, the report found.

The article goes on to quote Murray Kopelow, ACCME CEO. Click here to access the article.

Injuries and surgeons in training

From the New York Times article:

Nearly all surgeons accidentally stick themselves with needles and sharp instruments while in training. But most fail to report the injuries, risking their health and that of their families and patients to the threat of diseases including AIDS, hepatitis and many other blood-borne illnesses, according to a survey being published today.

Their being rushed was the chief reason the surgical residents cited for the injuries, which were mostly self-inflicted. Among the reasons they cited for not reporting the potentially fatal injuries was that doing so would take too much time, could jeopardize career opportunities and might cause a loss of face among peers.

In addition, there was a false belief that getting even timely medical attention would not prevent infection. In fact, immediate treatment with antiviral drugs can prevent infection among those stuck with needles while caring for patients with the viruses that cause AIDS and hepatitis B. Immediate treatment can also prevent chronic infection among those infected with hepatitis C virus.

Click here to access the article. Click here to access the New England Journal of Medicine source article.

Shrinks and pharma dollars

From the New York Times article:

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Click here to read the entire article.

Teletrauma

From an interesting article in the Arizona Daily Star:

A new live two-way video link between University Medical Center and the city's 17 paramedic units is expected to put Tucson at the cutting edge of medical technology when it goes online in August.
The system allows real-time videoconferencing over the city's public safety and public works wireless Internet system — a wireless mesh that links the city's traffic signals and other public safety wireless functions.
Dr. Rifat Latifi, interim medical director of UMC's Level 1 trauma center, said the video link will be the first of its kind in the country and the world.
"We think it's an incredible thing," Latifi said. "Wherever a patient is, we're there."

Click here to access the article.

The Joint Commission 2008 National Patient Safety Goals

From the Joint Commission's press release:

Major changes in this sixth annual issuance of National Patient Safety Goals include a new Requirement to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy, and a new Goal and Requirement that address the recognition of, and response to unexpected deterioration in a patient’s condition. The new anticoagulant therapy Requirement addresses a widely-acknowledged patient safety problem and becomes a key element of the Goal: Improve the safety of using medications. It is applicable to hospitals, critical access hospitals, ambulatory care and office-based surgery settings, and home care and long term care organizations. The new Goal and Requirement respecting the deteriorating patient will ask hospitals and critical access hospitals to select a suitable method for enabling care-givers to directly request and obtain assistance from a specially-trained individual(s) if and when a patient’s condition worsens. Each of the foregoing new Requirements has a one-year phase-in period that includes defined milestones. Full implementation is targeted for January 2009.

Click here to read the press release; click here to access the 2008 National Patient Safety Goals.

A squirt of hope

Why should we care about the environment and all those species of flora and fauna upon the earth? Well, one reason is that one of them might save your life someday. From a science blog:

A toxin derived from a humble sea squirt, Ecteinascidia turbinata (pictured, right), shows great promise as an anti-cancer drug. This toxin, known as trabectedin (ecteinascidinin-743), shrinks and even completely removes cancerous tumors in more than half of the patients treated with it, according to a new study. The patients treated with this drug suffered from a specific type of liposarcoma cancer, which is associated with chromosomal mutations. Liposarcomas are a rare but malignant tumor that grow in the fat cells in deep soft tissue, such as inside the thigh or within the abdominal cavity.

Dr Federica Grosso, from the Sarcoma Unit of the Instituto Nazionale Tumori in Milan, Italy, and her colleagues from sarcoma centers in Boston, London, Lyon and Paris, conducted this study. Out of 51 patients with myxoid liposarcomas that were treated only with trabectedin, they found that two had their tumors disappear completely (complete response) while another 24 experienced at least a 30% shrinkage of their tumor (partial response), representing an overall response rate of 51%.

Click here to read the blog entry. This study will be published in the July issue of The Lancet Oncology.

Six innovations

Check out Doctor Richard L. Reece's essay "Six Innovations to Increase Productivity, Cut Costs and Extend Coverage." Briefly, they are:

1. Facilitating patient-physician information exchange as a key of productivity.
2. Introducing new, more focused and more productive medical specialties.
3. Lessons from retailers: Hidden in plain sight and DIG (Demand-First Innovation and Growth).
4. Demand for transparency with bundled services and bundled billing arrangements.
5. Chief innovation officers will become common.
6. Tax deductible insurance for everyone to extend coverage--with strings attached.

Click here to read more about these innovations; I especially like the Chief Innovation Officer concept (CIO has a nice ring to it).
:)

AHRQ State Snapshots

From the AHRQ website:

The State Snapshots provide State-specific health care quality information including strengths, weaknesses, and opportunities for improvement. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State.

State-level information used to create the State Snapshots is based on data collected for the National Healthcare Quality Report (NHQR).

Pretty interesting stuff! Look up your state and see how it's doing. Thanks to the SACME listserve for this information. Click here to access State Snapshots.

ACGME work rules

Yale-New Haven Hospital researchers studied the impact of the new work rules on length of stay, 30-day readmission rates and medication errors at their hospital. What did they find? An excerpt from the New York Times article:

The teaching services saw a decrease in transfers to the intensive care unit, a decrease in medication errors and an increase in discharges to home or rehabilitation. After adjusting for other variables, there was also a significant decrease in deaths. While drug interaction errors increased, they also increased on the nonteaching service, probably because of the addition of new interaction rules to the database.

Click here to read the NYT article. Click here to access the Annals of Internal Medicine abstract.

$1.3 TRILLION in pharma sales?

That's what PricewaterhouseCoopers predicts in worldwide prescription drug sales by the year 2020. But it looks like Big Pharma might need to change how they do business. From the San Francisco Chronicle article:

Pharmaceutical giants that stick with that blockbuster model will be edged out by nimble, innovative companies that tailor their drugs to specific patient populations and advance the standard of care, the report says.

If the current global drug market of $520 billion more than doubles by 2020, the rise will not necessarily make health costs unaffordable, Farino said. New drugs could be cost-effective if they work better, help patients avoid more expensive treatments or hospitalization, and save health insurance payers money in the long term, Farino said.

In the United States, prescription products accounted for 10.1 percent of the nearly $2 trillion spent on health care in 2005. Hospital spending claimed 33 percent of all expenditures, according to government figures cited by PricewaterhouseCoopers.

Do your CME activities routinely address pharmacoeconomics? Click here to read the entire article.

Army Medical Action Plan

From the U.S. Army's press release:

"As we've said before, the Army takes Soldier inpatient and outpatient care very seriously," said Army Chief of Staff Gen. George W. Casey Jr., "and remains firmly committed to returning our Soldiers to productive careers and lives. We have made improvements, but realize there is still work to be done - including work with the complex Medical Evaluation Board and Physical Evaluation Board processes. By no means is everything 'fixed' - but we are aggressively acting on what we can fix now."

Click here to access the press release (ten examples of immediate improvements are delineated).

Batter up?

The folks over the Commonwealth Fund have published a report on states relative to their health system performance ("access, quality, avoidable hospital use and costs, equity, and healthy lives"). From the Executive Summary of The State Scorecard:

The rich geographical diversity of the United States is part of its appeal. The diverse performance of the health care system across the U.S., however, is not. People in the United States, regardless of where they live, deserve the best of American health care. The State Scorecard is intended to assist states in identifying opportunities to better meet their residents current and future health needs and enable them to live long and healthy lives. With rising health costs squeezing the budgets of businesses, families, and public programs, there is a pressing need to improve performance and reap greater value from the health system.

The State Scorecard offers a framework through which policymakers and other stakeholders can gauge efforts to ensure affordable access to high quality, efficient, and equitable care. With a goal of focusing on opportunities to improve, the analysis assesses performance relative to what is achievable, based on benchmarks drawn from the range of state health system performance.

Click here to access the report.

Black and white?

Startling statistics from a study just published in JAMA; an excerpt from the www.cnn.com article:

Black people were 22 percent less likely to be transferred from a hospital that did not do such procedures to one that did, it found. And when they were, black people were 23 percent less likely to get these operations than white people, the researchers said.

In the first month after a heart attack, black people were 9 percent less likely to die than white people, the researchers said, perhaps because whites were more likely to undergo specialized procedures that sometimes can be fatal.

But in the period from a month to a year after the heart attack, blacks were up to 26 percent more likely to die than whites, the study found.

"I wished we knew what's going on," lead researcher Dr. Ioana Popescu of the University of Iowa Carver College of Medicine and the VA Medical Center in Iowa City said in a telephone interview.

The study was not designed to find the reasons for the disparities.

Click here to access the article.

The Carlat Report

Daniel Carlat, a professor at Tufts Medical School and the editor in chief of The Carlat Psychiatry Report sounds off in the New York Times:

The revelation that the diabetes drug Avandia can potentially cause heart disease is the latest in a string of pharmaceutical disappointments. Vioxx was pulled from the market in 2004 because it doubled the risks for heart attacks and strokes. Eli Lilly recently paid $750 million to settle lawsuits alleging that Zyprexa causes diabetes. Many have criticized the Food and Drug Administration as being too lax about monitoring drug safety.

While those criticisms have merit, there is another culprit: the transformation of continuing medical education into an enterprise for drug marketing. The chore of teaching doctors how to practice medicine has been handed to the pharmaceutical industry. As a result, dangerous side effects are rarely on the curriculum.

Always important to know what is being published in the lay press. Click here to access the article.

A new villain in healthcare?

The Pacific Research Institute (PRI), a think tank in San Francisco, conducted a study on health care regulation. An excerpt from the San Francisco Examiner article:

In other PRI examples: A group of surgeons is ready to invest in a clinic where they will perform only operations they specialize in, but the local acute-care hospital invokes state regulations blocking the competition. A privately insured individual wants to buy a low-premium catastrophic coverage policy while also starting a tax-exempt health savings account, but this option is unavailable under state insurance rules.

Click here to access the article.

Cap malpractice lawsuit awards and they will come

According to an article in the San Antonio Express-News, physicians are flocking to Texas:

The lower cost of being a doctor in Texas has helped trigger a stampede of applications for physician licenses, with the waiting line now up to 12 months.

Rates have fallen an average of 21.3 percent, and up to 41 percent at one insurance company, says former state Rep. Joe Nixon, a Houston trial lawyer who helped sponsor passage of Proposition 12.

An internal medicine doctor in Houston paid $18,507 for malpractice insurance in 2003 but only $13,272 in 2007, or $10,403 with a 20 percent renewal dividend, according to figures given to Nixon by the state's largest insurer, Texas Medical Liability Trust.

Apparently insurance companies are also moving to Texas since they can now "...put a numeric value on the risk of doing business in Texas, something that was not possible when the sky was the limit for juries." Click here to read this article.

New Chief Learning Officer at the American College of Cardiology

Congratulations to Joe Green, my mentor and colleague!! From the American College of Cardiology's website:

The ACC has selected Joseph S. Green, Ph.D., to serve as its chief learning officer. As the ACC’s newest vice president, Dr. Green will be responsible for shaping the College’s continuing medical education (CME) curriculum and directing the implementation of the ACC’s educational mission. Dr. Green was most recently founder and president of Professional Resource Network, Inc., a CME consulting firm. He has over 34 years of experience in medical education. He served as the associate dean of CME and associate clinical professor in the Duke University School of Medicine, and he was director of CME and vice president of educational affairs for Sharp HealthCare, an integrated health care system in San Diego. Dr. Green will begin his tenure at the ACC on Sept. 17.

"Just living is not enough... One must have sunshine, freedom, and a little flower."

So said Hans Christian Anderson. Click here to see some lovely photographs (I have no financial interest in these products and do not know this photographer, just sharing).