"Uniform Format for Disclosure of Competing Interests in ICMJE Journals"

Click here to see the new form; click here to see an example completed form (gosh, there ARE other people out there with my sense of humor). Click here to access the JAMA editorial on this new form.

New report from IOM: Redesigning Continuing Education in the Health Professions

From the AAFP News Now article:

According to a new report from the Institute of Medicine, or IOM, there are a number of deficiencies with the current continuing education, or CE, system for health professionals in the United States. The report is calling for the creation of a national, interprofessional CE institute to achieve a new vision of continuing professional development for health professionals, with the goal of improving patient care and health care delivery.

...According to the report,

* there are major flaws in the way CE currently is conducted, financed, regulated and evaluated;
* the science behind CE for health professionals is fragmented and underdeveloped;
* continuing education efforts need to bring health professionals from various disciplines together in tailored learning environments;
* a new vision of professional development for health care professionals is needed to replace the current culture; and
* establishing a national, interprofessional public-private institute to foster improvements in CE may help improve the overall system.

Click here to access the AAFP News Now article. Click here to access the IOM report in brief.

Yet another health care disparity

From the Business Week article:

Doctors are diagnosing more white people with the deadly skin cancer known as melanoma, and while Hispanics and blacks are much less likely to be diagnosed with the malignancy, they often have advanced forms of the cancer when it is found, new research suggests.

Click here to access the BW article. Click here to access the Archives of Dermatology article (sub. req.).

December issue of the ACCME newsletter now online

Click here to access.

Grading patient safety efforts

From the New York Times article:

Ten years ago, a national panel of health care experts released a landmark report on medical errors in the American health care system. Published by the Institute of Medicine, “To Err is Human: Building a Safer Health System” estimated that as many as 98,000 people died in hospitals each year as a result of preventable mistakes. Being hospitalized, it turned out, was far riskier than riding a jumbo jet.

While the report offered comprehensive strategies to improve safety, its main conclusion was that medical errors were primarily a result of “faulty systems, processes and conditions that lead people to make mistakes or fail to prevent them.”

Spurred on by this finding, health care leaders across the country began addressing errors believed to be a result of systemic flaws.
...
Dr. Robert M. Wachter, a professor of medicine at the University of California, San Francisco, and a national leader in patient safety, recently published two critiques of the safety movement, one in Health Affairs and one in The New England Journal of Medicine.

Click here to access the NYT article. Click here to access the Health Affairs article (sub. req.). Click here to access the NEJM article (sub. req.).

Hospital audit finds some interesting expenditures on CME

From the Silicon Valley Mercury News article:

When physicians at Santa Clara County's cash-strapped public hospital seek professional development, they often indulge in "luxurious accommodations" on tropical islands and bill taxpayers for large cars to bring spouses, children and even parents along for conferences-turned-family-vacations, according to a scathing new county audit.

The audit, which analyzed a three-year period, blasts Valley Medical Center — Santa Clara County's hospital of last resort — for what it called "abusive and noncompliant" travel expenses at a time when the county is slashing budgets and cutting social services. Physicians traveled to Canada, Mexico, Switzerland, Italy, South Africa, Puerto Rico, Spain, China, Aruba, Thailand, the West Indies and the Bahamas, with costs averaging $3,085 per trip. Each year, county doctors spent $650,000 on educational travel.

Continuing education units were pursued inside California just 8 percent of the time during the period analyzed.

Please read the entire article by clicking here.

The costs and benefits of CME regulation

Check out the latest issue of JCEHP and read the editorial "It Is Time to Study the Costs and Benefits of Regulating Continuing Medical Education in the United States" by Paul E. Mazmanian, Ph.D. Click here to access the abstract.

Med students and residents under report needle sticks

From the New York Times article:

Surgical students are frequently stuck by needles, but many students don’t bother reporting the injuries, a new study found.

Researchers from Johns Hopkins University surveyed 699 recent medical school graduates who had trained to become surgeons at 17 medical centers in the United States. The survey found that 59 percent had been stuck by a needle at some point during medical school, according to the study, in the December issue of Academic Medicine.
...
In the Johns Hopkins survey, about half the victims of a needle stick didn’t report the injury to hospital officials. The most common reason cited for not reporting a needle stick was the amount of time and paperwork required to make a report.

Click here to access the NYT article. Click here to access the Academic Medicine article.

December issue of Medical Meetings magazine now online

Click here to access.

Canadian Medical Association criticized for accepting pharma funding

From the Globe and Mail article

The Canadian Medical Association is facing criticism over its decision to team up with a major pharmaceutical company to create an education program for physicians across the country.

Some members of the medical community say the CMA is heading down a dangerous road and warn that partnering with Pfizer Canada Inc. may cross a serious ethical line that could negatively influence doctors' treatment decisions.
...
Under the new CMA initiative, Pfizer Canada said it will provide $780,000 to fund the new “continuing medical education” or CME program, designed to inform physicians of new developments in medicine and help maintain their skills. Two Pfizer staff members will also sit on an administrative board, responsible for overseeing, implementing and evaluating the program, along with two staff members from the medical association and two individuals from outside organizations.

The program will be offered online and will focus on 12 different subjects. The first, expected to be made available early next year, will focus on Parkinson's disease. Other topics will be determined based on gaps identified by physicians in surveys posted on the CMA website.

Click here to access this article. Hat tip to Capsules!

New Jersey AG tries to clamp down on pharma

The AG's recommendations, as reported in the WSJ's Health Blog, are that physcians must:

• No longer accept food from industry, whether in office or in restaurants (this includes their office staff).
• Disclose, at the time of relicensure, whether they accepted more than $200 worth of payments and/or gifts from industry during the preceding two years.

Another AG recommendation is to curtail prescription data mining (this would require the state legislature to pass a new law).

Comparison of House bill (HR3962) to Senate bill (HR3590)

Click here to access this comparison document compiled by the Kaiser Family Foundation folks.

The ACCME Report (monthly newsletter)

This latest issue contains a link to the presentation given by Kate Regnier at the Fall SACME conference on the ACCME's Program & Activity Reporting System,..."a web-based system designed to collect activity-level and program data from accredited providers to be used for both the reaccreditation and annual report processes." Click here to access the newsletter.

Dr. Healy sounds off on health reform

From her commentary published in U.S. News & World Report :

The ground is being laid already, with the announcement by the U.S. Preventive Services Task Force, a government-appointed body, of new guidelines for mammograms just days ago. Such a board of experts, composed mainly of primary care, prevention, public health, and epidemiology experts, would recommend the list of preventive services covered in the post-health-reform insurance plan that all would have no choice but to buy. Until now, the government's task force has been one voice among several medical groups issuing sometimes conflicting prevention guidelines, leaving room for patient-doctor choice. But in an elevated role under health reform, the federal preventive task force's declarations would carry greater force and have an economic impact on everyone.
...
With the same facts, there are sharp differences in interpretation. Many health experts and economists in armchairs wearing green eyeshades are willing, say, to accept a 20 percent reduction in cancers found if costs are cut in half. But doctors see before them the mothers and grandmothers, sisters and daughters who benefit from early detection of cancer; they see the husbands who still have their wives, the children who still have their moms. They do know the science and statistics, and they know when to pull back and respect a patient's wishes not to have a study or treatment. But they're all too aware that early therapy is easier and more likely to bring a happier outcome.

Click here to access.

The Genetic Information Nondiscrimination Act

From the New York Times editorial:

It is rare when antidiscrimination law is extended to a whole new group of people, but that happened on Saturday, when a federal ban on discriminating on the basis of genetic background took effect. The new law is an important step in protecting people who have inherited a predisposition to disease. It removes a significant obstacle to genetic testing, which can help prevent and treat serious illnesses.

Click here to access the editorial.

ACCME Opacity?

Check out today's Capsules posting by clicking here.

The end of MECCs?

From the Wall Street Journal article:

Health legislation moving through Congress would force drug makers to disclose how much they spend on continuing medical education classes for doctors, sparking some resistance from the industry.

For-profit continuing medical education companies have seen revenue fall by double digits in the last year, according to industry statistics, following congressional investigations into the influence of drug makers on medical research and course content.

Click here to access the WSJ article (sub. req.).

At the end of the ROAD?

From the New York Times article "Primary Care’s Image Problem":

...choosing specialties: I’m heading for the ROAD (radiology, ophthalmology, anesthesia and dermatology).

That ROAD has had devastating effects on the physician work force in the United States. While 50 years ago half of all physicians were in primary care, almost three-quarters are now specialists. The future implications are even more dismal. According to one study published last year in The Journal of the American Medical Association, as few as 2 percent of medical students are choosing to step away from the ROAD or from other similar “high prestige” and competitive specialties in order to pursue general internal medicine. The statistic has the power to bring even the best efforts at reform and universal coverage to a grinding halt. Even with other health care practitioners like nurses and physician assistants helping to care for as many patients as they can, universal health care will be doomed if there are not enough primary care doctors.

Click here to access the NYT article.

ICMJE proposes new disclosure policy for authors

From the American Medical News article:

An influential group of medical journal editors in October announced a new, more probing conflict-of-interest disclosure form that it hopes will become the industry standard. The effort comes in response to criticism that medical journals have failed to properly inform their readers about authors' financial relationships with industry.

The uniform disclosure form, adopted by the International Committee of Medical Journal Editors, asks authors submitting for publication to disclose any payment for the research that generated the article as well as other kinds of industry relationships such as consultancies, honoraria or stock options from the last three years.

The form also asks authors to disclose whether spouses or children have financial relationships with "entities that have an interest in the content of the submitted work." Writers also should provide "any relevant nonfinancial associations or interests" of a personal, political or religious nature "that a reasonable reader would want to know about."

Click here to access the AMN article. Hat tip to FierceHealthcare.

Sunshine in the health care reform bill?

From the New York Times article:

As part of the health care overhaul under consideration by Congress, lawmakers have included so-called sunshine provisions intended to shed light on the financial relationships between the medical industry and doctors.

The targets are common business practices like drug company payments to doctors for speeches and consulting services, which have the potential to influence patient care and drive up the nation’s medical bills.

But if previous attempts by state legislatures, federal agencies and academic hospitals are any indication, such sunshine efforts are all too vulnerable to cloud cover.

Click here to access the NYT article.

News from the AMA

The presentation materials from the 20th Annual Conference of the National Task Force on CME Provider/Industry Collaboration have been posted online. My suggestion, at least check out the keynote slides. Click here to access these materials.

And the Summer/Fall issue of the AMA's CPPD newsletter has been posted online as well. Click here to access the newsletter.

ACCME to post additional information on providers

From the New York Times article "Steps to Greater Accountability in Medical Education":

Dr. Murray Kopelow, chief executive of the Accreditation Council for Continuing Medical Education, said he would make public “within weeks” a previously confidential listing of classes and companies that violated rules against commercial bias.

And at the urging of a prominent critic who successfully filed a complaint alleging bias in a specific course, Dr. Kopelow said his group was reviewing a proposal that would require educators to notify doctors and furnish corrective materials whenever it is later found that the class material was biased in favor of a drug firm.
...
A council spokeswoman, Tamar Hosansky, said the only violations to be posted on the Web site would be those initiated and resolved since February, when the council notified providers that it reserved the right to make the information public.

Click here to access the NYT article.

"Push"

From the Los Angeles Times article "Doctor who treated octuplets mom ejected from Society of Reproductive Medicine":

The Beverly Hills fertility doctor who treated octuplets mom Nadya Suleman has been expelled from the American Society of Reproductive Medicine for a "pattern of behavior" detrimental to the industry, a spokesman for the association confirmed Monday.

Click here to access the LA Times article.

He's back!

Yep, Pharmalot is back!!!!! Click here to access this excellent blog on the pharmaceutical industry.

"Well doggies"

Check out the blog posting "Nemeroff, Seroquel, and ACCME" at the Health Care Renewal blog! An excerpt:

On December 23, 2008 I filed a formal complaint about Dr. Nemeroff’s program with ACCME. My bill of particulars was lengthy, detailed, and backed up by extensive materials. In due course, ACCME investigated the complaint and found that the program did violate ACCME standards. With respect to content, ACCME determined that Dr. Nemeroff’s program lacked sufficient information about possible adverse effects of treatment with atypical antipsychotic drugs; and failed to emphasize sufficiently the efficacy of alternative treatments. With respect to commercial bias, ACCME determined that bias existed as a result of the absence of contrasting therapy data, and through downplaying the drawbacks related to treatment with atypical antipsychotic drugs in depressed patients.

Click here to access this blog posting. Hat tip to the Carlat blog. And if you recognize the quoted phrase, we're "in tune".

Orthopedists and disclosure

From the Wall Street Journal article:

Orthopedists failed to disclose over 20% of the payments they receive from makers of hip and knee replacements when presenting research related to the companies' products, a new study found. The finding, published in the New England Journal of Medicine, comes amid growing legislative efforts to require medical companies to disclose payments made to physicians, and researchers to alert the public to potential conflicts of interest that may color how doctors treat them.
...
"We were a little surprised at how high the nondisclosure rate was," said Dr. Kocher, who attended the meeting. "Some of that might have been intentional and perhaps people shouldn't be trusted, but I think the big part is it's very confusing how self-disclosure happens now in scientific meetings and in journals."

Joseph Zuckerman, a New York University doctor who serves as the orthopedist society's president, said the group had significantly tightened its conflict-disclosure policies since the 2008 meeting.

Click here to access the WSJ article (sub. req.). Click here to access the NEJM article.

"FDA Alert: New USP Standards for Heparin Products

Adjustments may be needed to achieve desired anticoagulant effect in some patients New Heparin to Ship Starting October 8" Click here to access the FDA news release.

Pulling no punches

The latest issue of Medical Meetings magazine is now available online, and the lead article is "CME Pros Duke It Out In D.C." Click here to access the article.

Senate Finance Committee rejects public option

From the New York Times article:

After a half-day of animated debate, the Senate Finance Committee on Tuesday rejected efforts by liberal Democrats to add a government-run health insurance plan to major health care legislation, dealing the first official setback to an idea that many Democrats, including President Obama, say they support.

All of the other versions of the health care legislation advancing in Congress — a bill approved by the Senate health committee and a trio of bills in the House — include some version of the government-run plan, or public option.

Click here to access the NYT article.

October 18-24, 2009 is National Healthcare Quality Week

From the National Association for Healthcare Quality website:

Healthcare Quality Week (HQW) features the work of healthcare quality professionals and highlights their influence on improved patient care outcomes and healthcare delivery systems. National Association of Healthcare Quality (NAHQ) members are encouraged to alert administrators, allied health professionals, and the public about the impact of healthcare quality through special events during the week of October 18–24, 2009.

Click here for more information.

Glaxo SmithKline gives MECCs a thumbs down

From the GSK press release:

“GSK will not support as many medical education programs, but we will continue funding those with the greatest potential to improve patient health,” said Deirdre Connelly, GSK’s President North America Pharmaceuticals. “Continuing medical education offers healthcare professionals important information on disease prevention, diagnosis and management. Independent and balanced information on the latest discoveries about disease and treatment options helps healthcare professionals make higher quality decisions and achieve better patient health outcomes.”

GSK will invite grant applications from approximately 20 medical education providers with a documented track record of developing and delivering high quality medical education programs that have a measurable impact on improved patient health. Potential grant applicants will be limited to academic medical centers and their affiliated teaching and patient care institutions, as well as national-level professional medical associations that represent healthcare professionals responsible for the delivery of patient care. All selected providers must be directly accredited by a recognized accrediting body.

GSK will no longer fund CME by commercial providers including medical education and communication companies (MECCs) under the policy which takes effect immediately.

Click here to access the GSK press release.

Ghostbusting

From the New York Times article "Medical Editors Push for Ghostwriting Crackdown":

As Washington tries to revamp the health care system, concerns about ghostwriting are taking on new urgency. One of the underlying assumptions of the health care overhaul effort is that money can be saved and medical care improved by relying more heavily on research showing which drugs and procedures are the most effective. But experts fear that the process could be corrupted if research articles are skewed by the hidden influence of drug or medical device makers.

Click here to access the NYT article.

Chocolat 2009 and 2000

From the New York Times article:

In a study that will provide comfort to chocoholics everywhere, researchers in Sweden have found evidence that people who eat chocolate have increased survival rates after a heart attack — and it may be that the more they eat, the better.

Click here to access the NYT article. Click here to access the Journal of Internal Medicine article (sub. req.). The movie (2000) was right!

Side-by-Side Comparison of Major Health Care Reform Proposals

The Kaiser Family Foundation's has an interactive side-by-side health reform comparison online tool at their website which allows users to compare "any or all of 12 different plans, including the plans approved by the Senate Health, Education, Labor and Pensions Committee and by the three House committees with responsibilities for health reform (H.R. 3200, America's Affordable Health Choices Act of 2009, also known as the House Tri-Committee bill)," and it is current as of today. Click here to access said tool!

Strokes in children

From the upi.com article:

Strokes in infants and children may be two to four times higher than previously thought, U.S. researchers say.

The study, published in Stroke: Journal of the American Heart Association, finds strokes undercounted due to coding errors ranging from typographical mistakes to coders not accustomed to using stroke codes in children.

Click here to access the upi.com article.

ACCME debuts new monthly e-newsletter

Giving new meaning to the phrase "The ACCME Report," the ACCME just published their new monthly e-newsletter of the same name. This first issue contains some important information for accredited providers on ACCME's online program and activity reporting system:

...a web-based portal for the collection and analysis of up-to-date, comprehensive data from CME providers, has moved into the testing phase. With the deployment of the system, the ACCME aims to improve the CME enterprise’s transparency, efficiency and accountability, as well as save time and streamline requirements for accredited CME providers. Currently, the ACCME plans to have the database operational by January 2010.

Click here to access The ACCME Report. Tamar, great job!

FDA Requires Boxed Warning for Promethazine Hydrochloride Injection

Click here to access the FDA release. Click here for information for healthcare professionals. Methinks that if a provider has CME enduring materials in this content area they might want to conduct an internal review of said materials.

20th Annual Conference of the National Task Force on CME Provider/Industry Collaboration

The conference is titled "Learning From the Past; Planning for the Future" and will be held Oct. 14-16, 2009 in Baltimore. Click here for the conference brochure.

Cracking FRAX?

From the New York Times article:

...the World Health Organization has developed an online tool meant to help doctors and patients determine when treatment for deteriorating bones is appropriate.

A preliminary version of the tool, called FRAX, was released last year and can be found at www.shef.ac.uk/FRAX/index.htm. A revised version is to be released later this year.

But FRAX is proving almost as controversial as the diagnosis of osteopenia. While some experts applaud it for taking factors besides bone density into account, others say that the formula on which the tool is based is faulty and that the advised threshold for medication is too low.

“FRAX is coming from the same people who came up with osteopenia in the first place,” said Dr. Nelson Watts, director of Bone Health and Osteoporosis Center at the University of Cincinnati, who said the diagnosis unnecessarily frightened women and should be abolished.

Click here to access the NYT article.

Shortage of primary care physicians!

From the Boston Herald article:

Among the many hurdles facing President Obama’s plan to revamp the nation’s health care system is a shortage of primary care physicians - those legions of overworked doctors who provide the front line of medical care for both the sick and those hoping to stay healthy.
...
To keep up with the demand for primary care doctors, the country will need to add another 40,000 to the existing 100,000 doctors over the next decade or face a soaring backlog, according to Dr. Ted Epperly, president of the Kansas-based American Academy of Family Physicians.

Click here to access the BH article.

Scary stuff?

From the New York Times article "Ghostwriting Is Called Rife in Medical Journals":

Six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies, according to a study released Thursday by editors of The Journal of the American Medical Association.

Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.

Click here to access the NYT article.

Will tort reform happen?

From the Wall Street Journal Opinion Journal (Kimberly A. Strassel):

Tort reform is a policy no-brainer. Experts on left and right agree that defensive medicine—ordering tests and procedures solely to protect against Joe Lawyer—adds enormously to health costs. The estimated dollar benefits of reform range from a conservative $65 billion a year to perhaps $200 billion. In context, Mr. Obama's plan would cost about $100 billion annually. That the president won't embrace even modest change that would do so much, so quickly, to lower costs, has left Americans suspicious of his real ambitions.

It's also a political no-brainer. Americans are on board. Polls routinely show that between 70% and 80% of Americans believe the country suffers from excess litigation. The entire health community is on board. Republicans and swing-state Democrats are on board. State and local governments, which have struggled to clean up their own civil-justice systems, are on board. In a debate defined by flash points, this is a rare area of agreement.

Click here to access (sub. req.).

Murray Kopelow, MD, Appointed Special Advisor to White House Office of National Drug Control Policy

From the ONDCP press release:

The Office of National Drug Control Policy (ONDCP) has engaged experts to help formulate and address long-term policy goals for increasing the Nation's focus on preventing and treating substance abuse. With backgrounds in continuing medical education, state and local substance abuse prevention systems, and academia, these specialists bring a wealth of knowledge and experience to ONDCP, which is working to develop the Administration's first National Drug Control Strategy.

Currently there are three experts on detail to ONDCP: Dr. Keith Humphreys, Professor of Psychiatry, Stanford University; Dr. Murray Kopelow, Chief Executive, Accreditation Council for Continuing Medical Education; and Mike Lowther, Director of the Division of State Programs at Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Prevention.

Click here to access the press release.

"Framework for Comprehensive Health Care Reform"

is posted at the website of Senator Baucus. Some excerpts:

Health Insurance Exchange. States would establish an exchange in 2010 to provide easier, more efficient comparison of health insurance plan benefits and premium costs. Information about coverage and cost-sharing would be available in a standard format. So-called “mini-medical” plans with limited benefits and low annual caps would not be offered in the exchange.

Ombudsman. In 2010, states would be required to establish an ombudsman office to act as a consumer advocate for those with private coverage in the individual and small group markets. Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.

Transparency. Beginning in 2010, to ensure transparency and accountability, health plans would be required to report the proportion of premium dollars that are spent on items other than medical care. Also, beginning in 2010, hospitals would be required to list standard charges for all services and Medicare DRGs.
...
Individual Responsibility. Beginning in 2013, all US citizens and legal residents would be required to purchase health insurance or have health coverage from an employer, through a public program (i.e., Medicare, Medicaid, or CHIP), or through some other source that meets the minimum creditable coverage standard. Exemptions from the requirement would be allowed for religious objections consistent with those allowed under Medicare and for undocumented immigrants. Individuals who choose to keep the plan they have today would be deemed to have satisfied the requirement.
...
Employer Responsibility. Employers would not be required to offer health insurance coverage. However, employers with more than 50 full-time employees (30 hours and above) that do not offer health coverage must pay a fee for each employee who receives the tax credit for health insurance through an exchange. The assessment is based on the amount of the tax credit received by the employee(s), but would be capped at an amount equal to $400 multiplied by the total number of employees at the firm (regardless of how many receive a credit in the exchange). Employees participating in a welfare-to-work program, children in foster care and workers with a disability are exempted from this calculation.
...
Interstate Sale of Insurance. Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

State Health Insurance Exchanges. State-based “exchanges” will be established to facilitate enrollment for individuals and separately for small group (through a SHOP exchange modeled after S. 979, the “Small Business Health Options Program Act”). The exchange will provide a standardized enrollment application, a standard format for describing insurance options and marketing, call center support and customer service. The exchanges must be self-sustaining after the first year.

Click here to access the posted document.

Advamed speaks out against proposed $4 billion tax

From the New York Times article:

The future of Senator Max Baucus’s compromise health care proposal is far from certain, but one industry group was quick to fire back on Tuesday. The protest came from makers of medical devices like heart pacemakers and artificial hips – companies that would have to pay hefty new fees under the Baucus plan.

Click here to access the NYT article.

Accreditation Council for CME Releases Summary of July Board of Directors Meeting

Click here to access the news release.

Panda boy (or should that be boy panda?)

From the San Diego Zoo's website:

We are thrilled that our newest panda is a sturdy little male that is healthy and well fed. His first exam, on September 3, also told us that at four weeks of age he weighs 2.8 pounds (1,259 grams) and is 14.7 inches (37 centimeters) long.

Click here to access the pandacam.

"Third Party Educational Activity"

Click here to access Pfizer's Corporate Integrity Agreement. CME providers should read all the stuff relating to Third Party Educational Activity. Keep smiling!

Pfizer to pay $2.3 Billion in settlement

From the bloomberg.com article:

Pfizer Inc. agreed to a $1.2 billion criminal fine, the largest in U.S. history, and a felony plea by a subsidiary to close an investigation into what government lawyers described as fraudulent marketing of drugs.

The fine, over sales practices for a painkiller since pulled from the market, makes up the biggest single share of a record $2.3 billion settlement, announced today, between the U.S. Justice Department and New York-based Pfizer. The deal includes $1 billion in civil penalties, the largest non-criminal fraud case against a drugmaker, the department said.

Click here to access the bloomberg.com article. Also check out the examiner.com article, an excerpt:

In an FBI press release today, the federal government announced that pharmaceutical giant Pfizer will pay $2.3 billion in civil and criminal fines for promoting "off label" uses of three of its big selling drugs by doctors treating patients in the Defense Department and Postal Service health plans. Even the FBI admits in its release that the "fraud" charges result not from injury or illness suffered by any of these patients, but rather from government payment of health insurance claims for "off label" prescriptions to federal employees.

Click here to access the examiner.com article. Click here to read the FBI news release.

Where there's smoke, there's

just smoke? From the the Milwaukee Journal Sentinel article "Academic Integrity in UW's CME program" written by Robert N. Golden, Dean of the University of Wisconsin-Madison School of Medicine and Public Health and Vice Chancellor for Medical Affairs:

An objective, unbiased assessment confirms that the academic integrity of the UW School of Medicine and Public Health's Office of Continuing Professional Development is not in question. The Accreditation Council for Continuing Medical Education, the nonpartisan organization that sets and monitors the standards for CME programs across the country, recently completed an independent inquiry, which was triggered by the Journal Sentinel's first article about our CME activities.

The ACCME wrote that we had "implemented a careful and deliberate process to ensure that large amounts of commercial support do not in any way compromise the integrity of the university or the integrity of the continuing medical education program."

This assessment of our Office of Continuing Professional Development is consistent with other recent evaluations of our approach to identifying and managing apparent conflicts of interest.

Click here to access the article. Hat tip to Capsules.

Forest and the trees

From the New York Times article "Document Details Plan to Promote Costly Drug":

The document, “Lexapro Fiscal 2004 Marketing Plan,” is an outline of the many steps Forest used to make Lexapro a success. Because of concerns from Forest, the Senate committee released only 88 pages of the document, which may have originally run longer than 270 pages. “Confidential” is stamped on every page.

But those 88 pages make clear that one of the principal means by which Forest hoped to persuade psychiatrists, primary care doctors and other medical specialists to prescribe Lexapro was by finding many ways to put money into doctors’ pockets and food into their mouths.

Click here to access the NYT article. Click here to access the aforementioned plan.

ICD-10 implementation

October 1, 2013 is the deadline for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). CMS has published a fact sheet which has a number of recommendations for implementation which, big surprise, includes education and training. The fact sheet also lists website resources. FYI, a number of countries have already implemented ICD-10 coding (Britain, Australia, France, Germany, and Canada). Click here to access a free version of ICD-10-CM index, tabular, and GEMS files courtesy of the CDC (and your taxes). Click here to access the HHS Final Rule.

Failure to disclose?

From the dotmednews.com article:

Under intense scrutiny for not revealing a relationship with Medtronic, Dr. David Polly, a well-known spine surgeon, has resigned from the American Academy of Orthopaedic Surgeons Board.
...
In a letter from Grassley to Medtronic, it was suggested that the payments to Polly could be considered a conflict of interest and that updates from Polly were given to Medtronic in violation of a set agreement with the University of Minnesota and might contain false information to the university's ethics committee.

Click here to access.

ACCME posts updated list of providers

The following additional information is now on the updated list for each provider:

•Current accreditation status (Accreditation, Accreditation with Commendation, Probation or Provisional Accreditation)
•Accredited based on the ACCME 2006 Accreditation Criteria (yes or no)
•Total numbers of activities, hours and participants reported
•Types of activities produced
•Receives commercial support (yes or no)
•Receives income from advertising or exhibits (yes or no)
•Participates in joint sponsorship (yes or no)

Click here to access.

The elephant in the room (the metaphor, not the political party)

Hat tip to Drug and Device Law blog.

Build it and they will use it (imaging that is)

From the New York Times article:

Federal rules allow physicians to profit from the use of machines they own or lease. But Dr. Harlan M. Krumholz, a cardiologist at Yale and an author of the paper, said financial incentives were only part of the reason the number of tests had risen so fast.

“I think the central driver is more about culture than anything else,” Dr. Krumholz said. “People use imaging instead of examining the patient; they use imaging instead of talking to the patient.

“Patients should be asking the question: ‘Do I really need this test? Is the information in this test going to help in the decision-making process?’ ”

In many cases, there is little evidence that the routine use of scans helps physicians make better decisions, especially in cases where the treatments that follow are also of questionable efficacy.

Click here to access the NYT article. Click here to access the NEJM article on this study (sub. req.). Risk/benefits, folks!

On the right road?

From the Forbes article:

Patrick Soon-Shiong, a self-made billionaire through injectable and breakthrough nanoparticle anticancer technology drug development, is now focusing his philanthropic efforts on creating a national highway for health care.
...
The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid.

Click here to read more.

Off-label prescription and physician knowledge (or lack thereof)

From the New York Times article "Disparities: Study Finds Risk in Off-Label Prescribing":

Physicians are allowed to use drugs in ways that are not specifically approved by the Food and Drug Administration, a practice called off-label prescribing. There is usually less scientific evidence to support nonapproved uses, and a new survey of physicians has found that many might not even know when they are prescribing off label.

Click here to access the NYT article. Click here to access the peer-reviewed article published in Pharmacoepidemiology and Drug Safety (sub. req.).

Sue Pelletier's blog CAPSULES is back!

Yep, it's true! And not only is her blog back but she is now executive editor of Medical Meetings magazine, which is a great resource for CME folks. Click here to access Sue's blog; click here to access Medical Meetings magazine. I know that we in CME all welcome Sue back to where she belongs!!!!

A haunting?

From the New York Times article "Senator Moves to Block Medical Ghostwriting":

With a letter last week, a senator who helps oversee public funding for medical research signaled that he was running out of patience with the practice of ghostwriting. Senator Charles E. Grassley, an Iowa Republican who has led a long-running investigation of conflicts of interest in medicine, is starting to put pressure on the National Institutes of Health to crack down on the practice.

Click here to access the NYT article. Click here to access Senator Grassley's letter. Click here to see what Dr. Carlat has to say about this (yep that graphic is pretty good, no matter what one's opinion is on this issue).

Macy Foundation on "Developing a Strong Primary Care Workforce"

From the publication:

The United States does not have enough health professionals in primary care to meet the anticipated demand. To have any hope of meeting that demand, major changes in the education and reimbursement for primary care professionals will be required. Any effort at healthcare reform must place healthcare workforce issues front and center.

In April 2009, the Josiah Macy, Jr. Foundation convened a meeting in Washington, DC, to discuss the nation’s healthcare workforce. Individuals representing four organizations with expertise in primary care and prevention were in attendance. These professionals work in the trenches of primary care, representing groups that recruit high school and college students into the health professions, nudge medical education toward a greater appreciation of primary care, and guide training for physicians, nurse practitioners, physician assistants, and others on the front lines of healthcare delivery. Their insights are compelling.

To read this publication (which is a summary of the meeting), click here.

Two noteworthy books by physicians

Check out Obama, Doctors, and Health Reform: A Doctor Assesses the Odds for Success by Richard Reece, M.D. and Declarations of a Dinosaur: 10 Laws I've Learned as a Family Doctor by Doctor Lucy E. Hornstein. Both are sold on amazon.com and both are well worth reading.

The vomiting bug?

From the BBC News article:

A spokeswoman for the Health Protection Agency said: "There are several vaccines for norovirus in development but all are probably several years away from being in general use.

"In the meantime, until one is produced that is effective and safe we recommend strict adherence to the outbreak control measures that exist to stop the virus spreading in hospitals and cruise ships.

"On an individual level, if someone has a norovirus infection they are advised to stay at home and practise good hand hygiene using soap and water to stop the virus from spreading to other members of the household."

Click here to access the BBC News article.

Patient (non)compliance

From the PharmaTimes article:

One third to a half of all US patients do not take their medications as prescribed, and this is costing the nation $290 billion - 13% of total health expenditures - every year, says a new report.

Such poor levels of compliance are fuelling - and are fuelled by - the rising tide of chronic disease, says the report, by researchers at the New England Healthcare Institute (NEHI). In general, people with chronic illnesses are worse at taking their medications as prescribed than those with acute conditions, and medication persistence – the length of time a patient continues to take a prescribed drug – tends to be very low among this group.

Click here to access this article.

A voice of reason on health care reform

Please check out Doctor Reece's blog posting on twenty stories of health care reform by clicking here.

Every woman on earth already knew this!

(Ok, at least those of a certain age)...From the New York Times article:

Men who strongly endorsed old-school notions of masculinity — believing the ideal man is the strong, silent type who doesn’t complain about pain — were only half as likely as other men to seek preventive health care services, like an annual physical or a flu shot, the study found.
...
The analysis is believed to be the first population-based study of men’s masculinity beliefs and preventive health behaviors.

Click here to access the NYT article.

Stanford researchers, comparative research, and labeling

From the individual.com article:

The researchers want the U.S. Food and Drug Administration to require drug manufacturers to state how new medications compare with similar, existing treatments. In many instance, these statements would indicate that there is no evidence that a new drug is more effective than older ones.
...
The Stanford researchers recommend that the FDA require new treatments to carry a label that would read, for instance: "Although this drug has been shown to lower blood pressure more effectively than placebo, it has not been shown to be more effective than other members of the same drug class."

Click here to access the individual.com article. Click here to access the researchers' article published in the NEJM (free full text).

Testosterone and CME

From the Milwaukee Wisconsin Journal Sentinel article "UW tied to male hormone marketing":

A rash of television commercials in recent months have told millions of middle-age men that their diminished sex life and somber mood may be the result of low levels of testosterone.

Setting the stage for the ads was a series of medical journal articles that first appeared four years ago. The articles, which were sponsored by the University of Wisconsin School of Medicine and Public Health, read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.

While the TV commercials were intended for consumers, the medical articles were written for thousands of doctors who could earn continuing medical education credit by reading them. Presumably, they also would write more testosterone prescriptions.

Click here to access the MWSJ article. Click here to access Dr. Carlat's blog posting on this news item.

Multimedia Education Resources added to ACCME's website

Click here to access ACCME's news release. Click here to access the educational resource website.

The New England Journal Medicine

has a website devoted to articles on health care reform. Click here to access said website.

America’s Health Insurance Plans survey on health care pricing

From the New York Times article "Survey Finds High Fees Common in Medical Care":

“A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for.
...
It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.
...
But Dr. Robert M. Wah, a spokesman for the American Medical Association, said there was another side to the story: insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all.
...
Karen M. Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying: “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

Click here to access the NYT article.

ACCME issues news release to remind providers about

the deadline for corporate structure changes and the need for review of commercial support policies and agreements; this news release also announces the new standard accreditation interview format. Click here to access the release.

National Association for Healthcare Quality publications win awards

From the NAHQ news release:

NAHQ e-news was recognized with a Gold Circle Award by the ASAE & The Center for Association Leadership in the category of Newsletter (Digital/Interactive). Receiving a Gold Circle Award is an outstanding achievement, especially because NAHQ competed against more than 300 associations nationwide this year, including a record-setting number of digital entries.

In addition, NAHQ was awarded two APEX awards for NAHQ e-news and the second edition of Q Solutions: Essential Resources for the Healthcare Quality Professional, which was edited by Luc Pelletier and Christy Beaudin.

Click here to access the news release.

Pharmascold?

From the AMNews article:

In late July, a new organization called the Assn. of Clinical Researchers and Educators held its charter meeting before a 200-plus crowd in an amphitheater at Brigham and Women's Hospital in Boston. Participants assailed conflict-of-interest rules that they argue impede physician-industry collaboration.
...
One ACRE founder, Thomas P. Stossel, MD, said critics of physician-industry relationships are "pharmascolds" who aim to bring about a "conflict-of-interest police state."
...
Houston endocrinologist Steven M. Petak, MD, led the task force that developed the statement. "There have been some abuses, but for the most part, physicians have the best interest of their patients in mind," he said.

Click here to access the article.

Who is to blame for delays in diagnosis?

From Dr. Pauline Chen's column in the New York Times:

...diagnostic failures are often due to missed steps, so-called “process of care lapses,” that stem from both doctors and patients.

In the June issue of The Journal of General Internal Medicine, for example, investigators from Harvard Medical School studied the records of over 100 women with breast cancer diagnosed late or at advanced stages and found that roughly a quarter of patients had experienced process of care lapses. Examples of such lapses included inadequate physical exams, delayed physician involvement and incomplete diagnostic and laboratory tests. But while the investigators discovered that nearly 20 percent of the women were missing as many as two or more steps in their care, they also found that doctors and patients contributed equally to the resulting diagnostic failures.

Click here to access.

The importance of data

From the USA Today article:

Data can serve as a tool to identify potential solutions, just as a high blood pressure test not only yields a diagnosis but also points the way to better treatment, says Elliot Fisher, director of the Dartmouth institute, which has pioneered the study of variations in health care by Medicare region.

The goal is to combat rising costs without sacrificing quality, he says.
...
The Dartmouth analysis shows that in 2006, hospitals in higher-performing regions had up to 14% fewer medical admissions, 17% fewer days in the hospital and 36% fewer visits to specialists, and they spent up to 21% less on medical imaging.

Their overall Medicare spending was 12.7% to 16.2% lower than hospitals with poorer performance.

Click here to access.

Lilly Faculty Registry for contracted services Q1/2009 posted

Click here to access the faculty registry. Click here to access Lilly's educational grant registry for the U.S.; click here to access Lilly's international educational grant registry.

ACCME news release on Dr. Kopelow's testimony

Click here to access.

Special Committee on Aging hearing on CME and industry

If you missed the live webcast, click here to access the archived hearing.

Text of H.R. 3200: America's Affordable Health Choices Act of 2009

Click here to read the 1,000+ document.

U.S. Sen. Kohl: To hold hearing on conflicts of interest in medical education & research

From the press release:

On Wednesday, July 29, U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI) will hold a hearing on conflicts of interest in the fields of Continuing Medical Education (CME) and other medical research. As with many professions, physicians are required to participate in CME in order to maintain their license. In recent years, the pharmaceutical and medical device industries have increased their funding of CME, as well as other medical education programs, medical schools, and professional medical associations. The industries also pay physicians directly for their service as educational consultants. According to the Institute of Medicine, industry funding for accredited CME quadrupled from $302 million to $1.2 billion between 1998 and 2006.

Click here to access the press release (and see the list of panel members)!

A debate on interactions between physicians and pharma

From the PLoS Medicine article "Can the Relationship between Doctors and Drug Companies Ever Be a Healthy One?":

But there is surely one thing we can all agree upon: both the pharmaceutical industry and health care professionals must focus on the goal of improving health. We seem to have lost sight of the shared aspirations between medical and pharmaceutical professionals. It is in everyone's interest that medicines are safe and effective. It is not credible to imply that health care professionals are easy victims to an industry that readily fools them with its marketing tactics. Many physician leaders find it condescending to be considered so malleable to “marketing exercises,” and it is offensive to suggest they cannot conduct an ethical exchange with industry. Despite strong differences between doctors and drug companies, now is surely a critical time to determine how to establish and nourish authentic alliances between these professionals.
...
In my view the nascent moves towards disentanglement witnessed in recent years—in hospitals, universities, and professional associations—will only intensify, as new disclosure regimes attract even more public attention to these unhealthy relationships. Visits by “sexy” sales representatives, drug-sponsored continuing medical education, or scientific conferences in exotic locations could very quickly become laughable images of a bygone era.

A pretty interesting read! Click here to access this article.

Reining in of DTC advertising?

From the New York Times article:

Representative James P. Moran, Democrat of Virginia, is sponsoring a House bill that would ban ads for prescription sexual aids like Viagra and Levitra from prime-time television, on decency grounds. Representative Henry A. Waxman, Democrat of California, has said he favors empowering the Food and Drug Administration to bar consumer advertisements for new drugs for an initial period after the F.D.A. approves them — until there has been more real-world experience with the medications.

Meanwhile, Representative Jerrold Nadler, Democrat of New York, has introduced a bill called the Say No to Drug Ads Act. It would amend the federal tax code to prevent pharmaceutical companies from deducting the cost of direct-to-consumer drug advertisements as a business expense.

Click here to access the NYT article.

Culture and health care delivery

From the U.S. World & News Report article:

A new study finds that the high death rates from breast cancer in American Indian and Alaskan native women are linked to cultural beliefs, not barriers such as poor access to health care.

Click here to access this article.

Will the health insurance industry change?

With health care reform on the shelf until Congress reconvenes, will the health insurance industry start making any changes? From the Business Week article:

Karen Ignagni, president of the lobbying group America's Health Insurance Plans (AHIP), told Congress in a letter that a public plan would "significantly increase costs for those who remain in private coverage."
...
"We do think comprehensive reform is needed," says Alissa Fox, senior vice-president of Blue Cross Blue Shield.

AHIP even launched an ad campaign on July 20 titled "Let's Fix Health Care," a far cry from the devastating "Harry and Louise" ads that helped sink reform efforts in the early 1990s. The ads call for a health-system overhaul but don't mention the public plan, which polls show the public supports. As Charles Boorady, health-care analyst with Citi Investment Research & Analysis, says: "The health insurers ... have a difficult PR battle."

Click here to access the BW article. Here's a hint, rethink your acceptable profit margin.

Cleveland Clinic in the spotlight

From the Wall Street Journal article:

According to a study of U.S. medical-cost patterns known as the Dartmouth Atlas of Health Care, chronically ill patients in the last two years of life cost Medicare $55,000 on average when they are treated at the Cleveland Clinic, tens of thousands of dollars less than at many highly-ranked academic medical centers.

"We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm," the president wrote in a letter to Sens. Edward Kennedy and Max Baucus last month. "We need to learn from their successes."

Click here to access the WSJ article (sub.req.).

Pay for Value?

From the Washington Post blog posting (Daily Dose):

Some of the nation's most prestigious, innovative health-care providers are giving their blessing to legislative proposals to grant broad new authority to the Medicare Advisory Payment Commission.

Click here to access the WP blog posting. Click here to read the letter these providers sent to Congress.

Parental stress plus pollution factors in childhood asthma

From the Time article:

Studying a combination of factors can help explain why some kids are more likely to develop asthma than others, says Rob McConnell, lead author of the study published in the Proceedings of the National Academy of Sciences. "Childhood asthma is a complex disease, and probably has many contributing causes," he says. "This study provides another clue to what might be causing it."

The results also shed light on how risk factors such as stress can increase the vulnerability of the respiratory system to environmental pollution or allergens.

Click here to access.

ACCME Releases 2008 Annual Report Data

Total income and commercial support both down a bit in 2008. Click here to access the report.

A "rose" by another name?

From the Boston Globe article:

A state commission recommended yesterday that Massachusetts dramatically change how doctors and hospitals are paid, essentially putting providers on a budget as a way to control exploding healthcare costs and improve the quality of care...the group wants private insurers and the state and federal Medicaid program to pay providers a set payment for each patient that covers all that person’s care for an entire year and to make the radical shift within five years. Providers would have to work within a predetermined budget, forcing them to better coordinate patients’ care, which could improve quality and reduce costs.

Click here to access the BG article.

Medical device companies ridin' the range (so to speak) in Texas

From the Wall Street Journal article:

Former employees of certain medical-device makers allege in lawsuits unsealed in a Texas federal court that the companies paid kickbacks to heart surgeons to get the doctors to use their products to treat the heart-rhythm defect called atrial fibrillation.
...
The case against Boston Scientific was filed by a former saleswoman who says she was fired after complaining about illegal practices at the company.

Does this case involve unapproved uses? Yep! Click here to access the WSJ article (sub. req.).

ACCME to host Educational Measurement Workshop

Click here to access the news release. Click here to access the workshop brochure.

Variation in outcomes for MI, HF, and pneumonia

In an interactive USA TODAY graphic, death rates and readmission rates can be easily calculated for heart attack, heart failure, and pneumonia (from more than 4,400 hospitals in the nation). The data comes from CMS, mid-2005 to 2008. Click here to access the interactive map. Click here to access Hospital Compare, CMS's website where one can compare hospitals (big surprise, huh?) on numerous process and outcome of care measures.

Doctors are human, too

From Pauline Chen's article "When Doctors Make Mistakes" in the New York Times:

While doctors should strive for as few errors as possible, “you can’t go through training without making an error unless you are not taking care of patients,” Dr. West said. “And if you are really invested in the care of patients, there’s a personal cost when things don’t go well.”
...
Greater support for doctors from both the training process and patients could help to improve patient outcomes and strengthen the patient-doctor relationship. “In 21st century medicine, there’s no reason for a patient to accept suboptimal care,” Dr. West said. “At the same time, patients need to balance their expectations against the reality of the physician experience. And the medical establishment needs to do a better job of helping patients understand what physician lives are really like.”

Click here to access the article.

Senator Grassley sends letter to medical journals asking about ghostwriting

Click here to access the press release and Senator Grassley's letter.

Hospitals to give up $155 billion in future payments

From the AP article:

The nation's hospitals will give up $155 billion in future Medicare and Medicaid payments to help defray the cost of President Barack Obama's health care plan, a concession the White House hopes will boost an overhaul effort that's hit a roadblock in Congress.

Vice President Joe Biden announced the deal at the White House on Wednesday, with administration officials and hospital administrators at his side.

"Reform is coming. It is on track; it is coming. We have tried for decades to fix a broken system, and we have never, in my entire tenure in public life, been this close," Biden said. And in a firm message to lawmakers, Biden added, "We must — and we will — enact reform by the end of August."

Click here to access the article.

WHO issues Patient Care Checklist (H1N1)

From WHO's website:

The WHO New Influenza A(H1N1) Clinical Checklist is intended for use by hospital staff treating a patient with a medically suspected or confirmed case of New Influenza A(H1N1). This checklist combines two aspects of care: i) clinical management of the individual patient and ii) infection control measures to limit the spread of New influenza A(H1N1).

The checklist is not intended to be comprehensive. Additions and modifications to fit local practice and circumstances are encouraged.

Click here to access the checklist.

New restrictions on painkillers?

From the Bloomberg article:

The prescription painkillers Percocet and Vicodin should be banned and use of Tylenol, sold over the counter, should be reduced because the ingredient acetaminophen is linked to liver damage, U.S. advisers said.

Outside advisers to the Food and Drug Administration voted 20-17 today in Adelphi, Maryland, for the ban on Percocet and Vicodin, which also contain a narcotic.

Click here to access. This is going to be so interesting...the pendulum swings.

IOM Report recommends research for 100 health topics

From the National Academies news release:

A committee convened by the IOM developed the list of priority topics at the request of Congress as part of a $1.1 billion effort to improve the quality and efficiency of health care through comparative effectiveness research outlined in the American Recovery and Reinvestment Act of 2009. The committee's report provides independent guidance -- informed by extensive public input -- to Congress and the secretary of the U.S. Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care.

Health experts and policymakers anticipate that comparative effectiveness research will yield greater value from America's health care system and better outcomes for patients. Despite spending more on care than any other industrialized nation -- $2.4 trillion in 2008 -- the United States lags behind other countries on many measures of health, such as infant mortality and chronic disease burden.

Click here to access the news release. Click here to access the IOM report (please note the executive summary can be downloaded for free).

Grassley seeks information about medical school policies

for disclosure of financial ties. Click here to access the June 24, 2009 news release.

Would Zeus approve?

From the New York Times column by Pauline Chen, MD:

In the policy journal Health Affairs, Francois de Brantes, a nationally known advocate of health care quality, and his co-authors propose a new health care reimbursement model that comes with a warranty. Developed with the support of the Commonwealth Fund and the Robert Wood Johnson Foundation, this model, called Prometheus Payment, first offers set fees to providers. The fees cover all recommended services, treatments and procedures for specific conditions but are also “risk-adjusted” for patients who may be older or frail.

Click here to access Doctor Chen's column.

NIQIE Educational Opportunity

The National Institute for Quality Improvement and Education (NIQIE) is holding its annual conference "Mastering Continuous Performance Improvement" September 9-11, 2009 in Chicago. The impressive faculty line up includes: Barbara Barnes, MD; Nancy Davis, PhD, FACME; Richard Hawkins, MD; Eric Holmboe, MD; and Don Moore, PhD. Click here to go to NIQIE's website and learn more about this important conference.

Open access KT article

Click here to access "Riding the knowledge translation roundabout: lessons learned from the Canadian Institutes of Health Research Summer Institute in knowledge translation" (just published in the online journal Implementation Science). A key lesson learned is that knowledge translation "is interdisciplinary and collaborative".

Alliance responds to CEJA Report (I-A-09)

Click here to access the response letter.

"ACCME Posts Responses to Spring 2009 Calls-for-Comment"

Click here to access.

Tobacco-control bill passed by U.S. Senate

From the USA Today article:

The legislation, approved by the House in April, is the most sweeping tobacco-control measure ever passed by Congress. It goes now to President Obama, who has said he will sign it.

Click here to access the article.

It's official -- it's a pandemic

The World Health Organization announced that H1N1 has met the scientific criteria for a flu pandemic. Click here to access the WHO announcement.

Check out Dr. Reece's blog posting

"Getting Real About Health Reform"; methinks he makes a number of spot-on points. Click here to access.

What WHO Definition?

From the Associated Press article:

The World Health Organization is gearing up to declare a swine flu pandemic, a move that could trigger both the large-scale production of vaccines and questions about why the step was delayed for weeks as the virus continued to spread.

On Wednesday, WHO chief Dr. Margaret Chan quizzed eight countries with large swine flu outbreaks to see if a pandemic, or global epidemic, should be declared. After Chan's teleconference, the agency announced that an emergency meeting with its flu experts would be held Thursday.
...
In May, several countries urged WHO not to declare a pandemic, fearing it would spark mass panic. The agency appeared to cave into the requests, saying it would rewrite its definition of a global outbreak so that it wouldn't have to declare one right away for swine flu.

But WHO officials have been concerned in recent days after seeing media reports and health experts discussing more swine flu cases than were being reported by the countries themselves.

Click here to access.

Patient-centered care

From the New York Times article:

Dr. Berwick, a Harvard pediatrician and president of the Institute for Healthcare Improvement in Cambridge, Mass., is a leading authority on health care quality. Last month in a national health policy journal, Dr. Berwick published an article titled, “What ’Patient-Centered’ Should Mean: Confessions of an Extremist.” In it, he writes that the United States will require health care systems that are radically different from most of the ones we have today if we are to deliver truly patient-centered care. These systems would transfer control from doctors to the patients themselves.

Some examples of this new model of care? Shared decision-making would be mandatory in all areas of care, with patient preference occasionally putting evidence-based care “in the back seat.” Patients and families would participate in the design of health care processes and services and would be a part of daily rounds.

Click here to access the NYT article. Click here to access the Health Affairs article (sub.req.).

Unintended consequences?

From the Boston Globe article "Doctors warn on patients' falls":

Patient falls and the injuries they cause are considered such a crisis that in October, the federal government stopped paying hospitals for extra care if a fall is deemed preventable. Now, a Boston doctor is warning the pressure to keep patients from falling may lead to greater harm through the use of restraints, reversing a trend of greater mobility among hospitalized patients.
...
Without well-established guidelines on preventing falls, Inouye said she fears restraints will be used. "We have to do something to counteract what may be people's natural tendency to think to stop falls, we've got to tie everyone up," Inouye said in an interview. "We want to open people's eyes to the fact that restraints are actually associated with lots of complications."

Click here to access the BG article.

Core measures and patient safety goals?

Check out the free full text article "Linking Joint Commission inpatient core measures and National Patient Safety Goals with evidence" published by Baylor University Medical Center. An excerpt:

Despite widespread dissemination of the core measures, safety goals, and related quality guidelines, there is significant variation in their application across hospitals (8–13). Reasons for this variance are complex and may include differences in guideline familiarity, provider training, and tools and systems to ensure that recommended care is provided and documented (8). In addition, hospital type, size, and location have been found to correlate with compliance rates (9, 12). Other hospital characteristics such as physician leadership and organizational support also appear to contribute to the consistent use of evidence-based processes of care (14–17).

Click here to access the article; it's worth a careful read by CME professionals.

Commercial support-free CME?

Check out Dr. Carlat's blog posting "ACCME's Good Courses, Bad Courses -- Mystery Solved?" by clicking here.

Breast Cancer Patient Protection Act in Congress

To learn more about this patient protection act, click here to access Lifetime television's website (which also has an online petition y'all can complete and submit IF interested).

Physician use of the internet

From the iHealthBeat article:

According to Manhattan Research, physicians use the online information to support clinical decisions, make recommendations to patients and stay up-to-date with the latest medical advances.

Click here to access the IHB article for the stats.

Taking a moment to reflect

From cnn.com:

Americans are being asked to stop whatever they are doing at 3 p.m. local time Monday to share a minute on Memorial Day and honor those who have died in the cause of freedom.

Click here to access this story.

Health care fraud in Medicare and Medicaid programs

From the Washington Post article:

Health-care fraud is among the top enforcement priorities of the new team at the Justice Department, which is working closely with the inspector general at HHS and the FBI to collect and analyze computerized information about fraudulent claims.

As part of the effort, authorities this afternoon launched a new task force, the Health Care Enforcement Action Team, to be led by senior officials at Justice and HHS.

"With this announcement, we raise the stakes on health-care fraud," Holder said.

Trade groups estimate that as much as 3 percent of health-care spending, or $60 billion, is lost to fraud each year.

Click here to access.

Doctor Hamburg confirmed by Senate

From the New York Times article:

Dr. Margaret A. Hamburg will be sworn in as commissioner of food and drugs this week after the Senate voted unanimously on Monday night to confirm her.

Click here to access the NYT article.

CDC update on H1N1 situation

For additional information, click here to access the CDC's website.

No branded pharma gift too small?

Check out the Archives of Internal Medicine article "Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences" to find the answer. Click here to access.

Vermont bill amended

From the Prescription Project Blog:

In the eleventh hour of its legislative session Friday night, Vermont passed a bill that would:

-ban most gifts to physicians,
-lift the trade secrets exemption in Vermont’s current gifts disclosure and transparency law,
-extend it to medical device manufacturers, create a public website to house the information, and
-broaden the type of payment recipients that companies would be required to disclose.

The bill now goes to the governor. Click here to access.

Dr. Frieden to head up the CDC

From the New York Times article:

President Obama announced on Friday that he has chosen Dr. Thomas R. Frieden, the New York City health commissioner, as the next director of the Centers for Disease Control and Prevention.
...
At the C.D.C., he will inherit a host of immediate and long-term problems, including a looming decision about whether and how to produce a swine flu vaccine. Health experts say the agency must resolve serious morale and organizational issues even as the administration struggles to overhaul the nation’s health care system.
...
Dr. Frieden has a history of focusing on health threats that endanger large numbers of people, sometimes at the expense of more popular causes.

Click here to access the NYT article.

The 2008 AAMC/SACME Harrison Survey

Click here to access.

A cereal prescription?

The FDA issued a warning letter to Ken Powell, Chairman of the Board and CEO of General Mills relative to the "the label and labeling" of Cheerios® Toasted Whole Grain Oat Cereal. From the letter:

FDA's review found serious violations of the Federal Food, Drug, and Cosmetic Act (the Act) and the applicable regulations in Title 21, Code of Federal Regulations (21 CFR).
...
Based on claims made on your product's label, we have determined that your Cheerios® Toasted Whole Grain Oat Cereal is promoted for conditions that cause it to be a drug because the product is intended for use in the prevention, mitigation, and treatment of disease.

Click here to access the letter.

Staffing changes at ACCME

Click here to access ACCME's news release.

Mother of the year?

MedPage Today® named the Best Overall Web Publication by the ASHPE

From the MedPage Today® news release:

A first-time entrant, MedPage Today took the top spot and earned the Gold Award in the ASHPE competition's Online Category. A panel of well-respected business journalists and academics judged the entries against the publication's mission, the relevance to the category for which it was being considered, and its significance to the publication's target audience.

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Sen. Grassley to stay put (for now)

From the FiercePharma article:

Big Pharma won't escape from Sen. Charles Grassley's eagle eye yet. Rather than slipping into newly Democratic Sen. Arlen Specter's seat on the Senate Judiciary Committee, Grassley made a deal to postpone his move until the next Congress launches in 2011, the New York Times reports. In the meantime, the ranking Republic on Judiciary will be Sen. Jeff Sessions--and Grassley will stay firmly fixed on the Finance Committee, the better to influence healthcare reform and follow through on his pharma-oversight initiatives.

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Robert Wood Johnson posts "More Than Words Toolkit Series"

From the Robert Wood Johnson website:

Clear communication is a cornerstone of patient safety and quality health care. Quality translated health materials can serve as valuable communications tools for both patients and providers, and can help to ensure the delivery of safe, effective and high-quality care.

The More Than Words Toolkit Series, a resource developed by Hablamos Juntos with support from the Robert Wood Johnson Foundation, clarifies the translation process and provides a roadmap to help health care organizations improve the quality of their translated materials in order to get better results.

The More than Words Toolkit Series draws on the scientific literature, the experience of 10 Hablamos Juntos demonstrations and the initiative’s own research on translation quality. It is designed to assist individuals and organizations in initiating translations of health care text of all types.

For organizations that need to assess the quality of translated materials, users can find professionals who can rate materials based on the Translation Quality Assessment (TQA) tool.

Click here to access the toolkit.

Additional resources on swine flu

Click here for the WHO updates. Click here to access PandemicFlu.gov. Let's all take a few deep breaths (just not around anyone who is coughing and sneezing).

Confirmed swine flu cases and precautions by country

USA Today has posted an interactive map which they indicate will be updated as the outbreak progresses. Click here to access.

Grassley leaving Senate Finance Committee?

From the FiercePharma article:

Dancing in the streets yet? If you're not, then you haven't heard that Sen. Charles Grassley, the perpetual thorn in pharma's side, looks to be stepping down from his post as chief of the Senate Finance Committee. He's planning to move to Senate Judiciary instead, where the top Republican post was abandoned by Sen. Arlen Specter, a newly minted Democrat.

If the word on Grassley is true, then pharma may be able to say sayonara to the steady flow of letters from Grassley, who demanded answers on a plethora of industry issues, from drugmakers' relationships with prominent doctors and academic researchers to a host of drug safety questions.

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Dalhousie offers Online Education on Swine Flu (H1N1)

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CDC Interim Guidance for Clinicians & Public Health Professionals on Swine Flu (H1N1)

Click here to access.