2008 Alliance Conference

If you attended the recent Alliance conference held in Orlando, I invite you to post your observations about all things CME. Heck, even if you didn't attend, you are welcome to comment on the "CME Landscape". I'd love to get some discussion going. Thanks!

ACCME publishes booklet

“CME as a Bridge to Quality” is available on the ACCME website. Click here to access.

What???!!!!

From the Baltimore Sun article:

When Dr. Peter Pronovost assembled a checklist of proven safety procedures and required critical care doctors to use it, the results were indisputable: It prevented infections and saved lives.

But the veteran Johns Hopkins safety researcher also drew critical scrutiny from government regulators. In a decision last month that upset his colleagues nationwide, the federal Office of Human Research Protections said using a safety checklist - and studying its effects - amounted to conducting an experiment without a patient's consent.

Click here to access the article (and to read the offending checklist).

Antidepressants under the microscope

From the Wall Street Journal article:

The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results, according to a review of unpublished data submitted to the Food and Drug Administration.
...
Since the overwhelming amount of published data on the drugs show they are effective, doctors unaware of the unpublished data are making inappropriate prescribing decisions that aren't in the best interest of their patients, according to researchers led by Erick Turner, a psychiatrist at Oregon Health & Science University. Sales of antidepressants total about $21 billion a year, according to IMS Health.

Click here to read the article (sub. req.).

Do you know the average cost of a primary care pharma rep?

According to the latest research from Cutting Edge Information it's $175,000 per rep per year. Click here for additional information.

Medinnovation Blog Entry - Big Pharma, Balance & Fairness

Click here to read Dr. Reece's recent blog entry on Big Pharma.

New strain of MRSA!

From the New York Times article:

A new, highly drug-resistant strain of the “flesh-eating” MRSA bacteria is being spread among gay men in San Francisco and Boston, researchers reported on Monday.

In a study published online by the journal Annals of Internal Medicine, the bacteria seemed to be spread most easily through anal intercourse but also through casual skin-to-skin contact and touching contaminated surfaces.

Click here to access the NYT article; click here to access the Annals of Internal Medicine article (sub. req.).

New CME Section on AAMC Website

From the AAMC website:

Who is it for?

This site is intended for those who plan and design programs for practicing clinicians, staff physicians, faculty members—and others interested in quality improvement, clinical outcomes, faculty development (especially related to CME teaching and planning), performance measurement and improvement, and for those engaged in health services and related research and related areas.

What is it about?

Partly a portal, partly a resource, the site is regularly updated and is focused on moving CME from a purely conference-based model to one which employs best educational and quality principles to close the clinical care gap. It is linked to our colleagues in the GEA's sections on UME, GME, and RIME, elsewhere across the AAMC, and beyond. Mostly, this site is about you, and what you need for effective practice.

Click here to access.

Ouch...Macy Foundation Issues Report on CME

The Josiah Macy, Jr. Foundation held a conference this past November on continuing education in the health professions and just published their findings. An excerpt from their report:

Current accreditation mechanisms for CE are unnecessarily complex yet insufficiently rigorous. Compared to earlier, formal stages of health professions education, the CE enterprise is fragmented, poorly regulated, and uncoordinated; as a result, CE is highly variable in quality and poorly aligned with efforts to improve quality and enhance health outcomes.

The report also includes some strong statements about commercial support of CME. Click here to access the report.

SACME Posts Position Paper on LOAs

From the SACME website (with Melinda's permission!):

Introduction:
Accredited providers of Continuing Medical Education activities have a responsibility to ensure that activities they certify for credit meet the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME). Compliance with the Standards for Commercial Support of Continuing Medical Education is an integral part of the process. One of the key factors related to the use of commercial support is the execution of a Letter of Agreement (LOA) between the Accredited Provider and the Commercial Interest (grantor) providing funding to support the activity. The purpose of the LOA is to document the independence of the Accredited Provider from any control of the commercial interest in the development and conduct of the educational activity.

For questions, comments, endorsement privileges or copyright permission, please contact the authors: Melinda Steele (melinda.steele@ttuhsc.edu) or Mark Schaffer (mark.schaffer@ppscme.com). Click here to access the full paper.

FDA questions safety and efficacy of bio-identical hormones

From the FDA news release:

The U.S. Food and Drug Administration (FDA) sent letters warning seven pharmacy operations that the claims they make about the safety and effectiveness of their so-called "bio-identical hormone replacement therapy," or "BHRT" products are unsupported by medical evidence, and are considered false and misleading by the agency. FDA is concerned that unfounded claims like these mislead women and health care professionals.

The pharmacy operations improperly claim that their drugs, which contain hormones such as estrogen, progesterone, and estriol (which is not a component of an FDA-approved drug and has not been proven safe and effective for any use) are superior to FDA-approved menopausal hormone therapy drugs and prevent or treat serious diseases, including Alzheimer's disease, stroke, and various forms of cancer.

Click here to access the FDA news release. (Someone in Malibu is probably furiously working that thighmaster).

Joint Commission patient safety solutions online survey

From the Joint Commissions' website:

We invite your participation in an important on-line survey for the World Health Organization's Collaborating Centre for Patient Safety. The survey seeks your help in determining the final content for the 2008 Patient Safety Solutions. Since the solutions will be distributed to all WHO member states, your assistance is needed to ready them for widespread adoption.

Deadline for responses is Friday, February 29, 2008. Click here to access.

Oncologists and empathy

From the New York Times article "For Cancer Patients, Empathy Goes a Long Way":

“It is absolutely the role of the oncologist” to provide a bit of emotional support, said Dr. James A. Tulsky, director of the Center for Palliative Care at Duke University Medical Center.

But in a study published last month in the Journal of Clinical Oncology, Dr. Tulsky and other researchers found that doctors and patients weren’t communicating all that well about emotions.

Click here to read the article.

FDA issues safety alert on bisphosphonates

FDA informed healthcare professionals and patients of the possibility of severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain in patients taking bisphosphonates.

Click here to read the entire alert.

Medical device company in the news

From the Boston Globe article:

The Massachusetts subsidiary of an international surgical device manufacturer is under federal investigation for allegedly paying kickbacks to doctors to use its equipment, according to court documents and company disclosures.

Click here to access the article.

"The Cost of Pushing Pills:..."

Hey, it's not my title but the title of a new article over at PLos Medicine; from the article:

Methodological differences between the ways that IMS and CAM collect data will affect the values for promotional spending depending on the category being considered. Because of the problematic nature of some data from each firm, we believe that the most precise picture of industry spending can be obtained by selectively using both sets of figures.

CAM compiles its data on the value of detailing and samples through systematic surveys of primary care providers and specialists and by estimating an average cost for each visit by a sales representative according to the type of physician. By contrast, IMS compiles its data on the value of detailing through surveys of firms, while its data on samples are obtained by monitoring products directly from manufacturers.

Click here to read this article; interestin' stuff!

Free drug sample study

From the Boston Globe article:

Fewer than one-third of all people who received samples in a 32,000-person, nationally representative survey had low incomes, and fewer than one-fifth who got the free drugs were uninsured at any point in 2003, the year analyzed by researchers at Cambridge Health Alliance and Harvard Medical School. Low income was defined as less than 200 percent of the federal poverty line.
...
Free samples with a retail value of $16.4 billion were given out in 2004, the study says, up from $4.9 billion in 1996. Most were the newest, most expensive drugs, Cutrona said. Giving them away to patients is a way for pharmaceutical companies to introduce their new products to doctors and patients.

Click here to access. Study results will be published in the February issue of the American Journal of Public Health.

Drug reps using technology for sales calls

From the charleston.net article:

Patients today are less likely to bump into drug sales representatives at a doctor's office, as pharmaceutical companies adopt cheaper technologies and more discreet ways to pitch drugs.

The changes are partly in response to a backlash against overly aggressive marketing of the past decade, when many executives believed the company with the biggest sales force would have the highest sales. From 1999 to 2001, U.S. drug companies expanded their sales staffs, on average, by 42 percent, according to the most recent research available from Datamonitor.

Click here to access the article.

"As I've matured..."

From the 12/30/07 post on the "Musings of a Dinosaur" blog...one of my Linky-Loves:

• I've learned that whatever hits the fan will not be evenly distributed.
• I've learned that you shouldn't compare yourself to others - they are more screwed up than you think.
• I've learned age is a very high price to pay for maturity.

If you liked these, then click here. What better way to ring in the New Year than with a few chuckles!

Should physicians disclose to their patients that they receive gifts from pharma?

From the AMNews article:

Drug and medical device manufacturers cultivate physician relationships with the help of complimentary gifts and services. Some say that disclosing to patients the value of these gifts resolves the physicians' possible conflicts of interest. Others say no gifts at all is the only ethical course.

Click here to access.

CME requirements by state -- 2008

Click here to access.

Just when Big Pharma didn't think it could get any worse...

From the Belfast Telegraph article:

A third British pharmaceutical company has confirmed it's under investigation on suspicion of fraud.

Click here to read the brief article.

Fish oil in the news!

From the Washington Post article:

The omega-3 fatty acids found in fish oil might play an important role in preventing Alzheimer's disease, according to a research team at the University of California, Los Angeles (UCLA).

Publishing in the Dec. 26 issue of theJournal of Neuroscience, the scientists demonstrated that the omega-3 fatty acid docosahexaenoic acid (DHA) increases the production of LR11, a protein that is found at reduced levels in Alzheimer's patients. LR11 is known to destroy the protein that forms the plaques associated with the disease, the researchers explained.

Click here to access the article.

New restrictive UMass policy on industry ties

From the Boston Globe article:

Under the UMass Memorial policy, companies may still fund continuing medical educational courses, but the money must be funneled through the UMass Memorial Foundation and cannot be earmarked for a specific topic or doctor - a compromise reached with doctors after executives said they wanted to ban company educational funding entirely. Doctors say this is a crucial source for keeping up their skills.

Companies can direct funding to a specific department, such as surgery. A special committee will review all donations over $10,000 for potential conflicts of interest.

The goal is to ensure that companies do not influence the content of courses so as to place their drug or device in a favorable light.

Click here to access the article.

No "happy feet" here...

This "hit the penguin" game is probably not PC; but what the heck!

Severe Combined Immune Deficiency in Native Americans

From the Farmington Daily Times article:

In the Navajo population, one in every 2,500 children inherits SCID, a condition that endows them virtually no immune system. In the general population, SCID is much more rare, affecting one in 100,000 children.

Click here to access the article.

Drug Rep Whistle-Blower

From the New York Times article:

A former drug sales representative who became a whistle-blower has been awarded $1.6 million for bringing a drug marketing fraud to light, despite efforts by the Justice Department to prevent his receiving the money.

Click here to access.

Medical board rehab programs -- should they be confidential?

From the msnbc.com article:

Nearly all states have confidential rehab programs that let doctors continue practicing as long as they stick with the treatment regimen. Nationwide, as many as 8,000 doctors may be in such programs, by one estimate.

These arrangements largely escaped public scrutiny until last summer, when California's medical board outraged physicians across the country by abolishing its 27-year-old program. A review concluded that the system failed to protect patients or help addicted doctors get better.

Click here to access.

National survey of physicians on professionalism

Check out the results of a recent survey conducted by the Institute on Medicine as a Profession; there are some very interesting findings. Click here to access.

ACCME News

From the ACCME email announcement:

Drs. R. Russell Thomas and Barbara Barnes were named Chair and Vice Chair of the Accreditation Council for Continuing Medical Education (ACCME) at the conclusion of the ACCME’s November 2007 Board meeting. They will serve as Chair and Vice Chair for 2008.

For further information, please click here to read the news release, or visit www.accme.org and read the item “R. Russell Thomas Jr., DO, MPH and Barbara Barnes, MD Named Chair and Vice Chair of the ACCME.”

Winter 2008 Issue of AMA's CPPDReport

Lead article is "Maintenance of licensure and continuing medical education"; click here to access.

Dr. Lawyer's lawyer?

Okay, I thought I wasn't going to post anything over the next two weeks but I just couldn't help myself when I saw this headline "Doctors: Drug rep may be behind smear -- Anonymous letter attacks physicians and their wives"; an excerpt from the article:

Springfield doctors and their wives have asked local representatives of pharmaceutical companies if they know who mailed anonymous letters that accuse the couples of being heavy drinkers and engaging in professional and personal misconduct.

The letters might have been designed to silence the doctors’ questions about a new medicine, the couples’ lawyer said Monday.

Click here to access.

Happy Holidays

Ummmm...I work in a hospital CME office...

If you do, then check out this excerpt from the Wall Street Journal article "Keeping Patients from Landing Back in the Hospital":

There are about five million readmissions a year in U.S. hospitals, with approximately a third occurring within 90 days of discharge, according to the Institute for Healthcare Improvement, a Boston-based nonprofit. But with so-called transitional-care programs, which follow patients for varying periods of time at home, as many as 46% of readmissions could be prevented, says Pat Rutherford, an IHI vice president.

The institute is working with hospitals to reduce readmissions. Its programs include: identifying patients at risk for return, scheduling follow-up doctor's appointments before patients are discharged, sending nurses to patients' homes within a few days of discharge, monitoring patients at home, and educating patients and families on how to adhere to medication schedules and self-care regimens.

Then march down the hall to Medical Staff Services and introduce yourself! Click here to access the article (sub. req.).

Health care delivery experiment

From the USA Today article:

When Loy Assell or members of her family want to see their doctor, they can get in within hours. If they need to cancel an appointment at the last minute, they can easily reschedule.

The physician, Dr. Cynthia Kizer of Olio Road Family Care, and her colleagues keep about half their daily appointments open for last-minute patients, a system known as advanced open access.

I am so glad that this model of delivery is being trialed! This system also includes email access to the PCP. Click here to access the article.

Recall of vaccines

From the Time.com article:

Merck announced that it is voluntarily recalling 1 million doses of two common childhood vaccines, routinely given to children under 5. Here's everything you need to know about the recall.

Click here to access.

Hi, I'm a LICENSED pharmaceutical sales rep?

From the San Francisco Examiner article:

The District of Columbia would be the first jurisdiction in the country to require licenses for pharmaceutical sales representatives under legislation that has received the city council's initial approval.

The SafeRx Act of 2007 is in effort by the city to reel in the multibillion-dollar prescription drug trade.

To qualify for a license, sales representatives would have to be college graduates and would have to refrain from using titles that would give the impression that they are licensed to practice pharmacy, nursing or medicine. Salespeople also would have to sign a code of ethics and would be regulated by a pharmacy board.

The D.C. Council backed the bill this past Tuesday in a close vote; a final vote will take place on January 8. Click here to read the article.

Is the soul of medicine in jeopardy?

An excerpt from the JAMA article "Medical Professionalism in a Commercialized Health Care Market":

Endangered are the ethical foundations of medicine, including the commitment of physicians to put the needs of patients ahead of personal gain, to deal with patients honestly, competently, and compassionately, and to avoid conflicts of interest that could undermine public trust in the altruism of medicine. It is this commitment, what Freidson called the "soul" of the profession,¹ that is eroding, even while its scientific and technical authority grows stronger. Ironically, medical science and technology are flourishing, even as the moral foundations of the medical profession lose their influence on the behavior of physicians.

Click here to access.

Executive Summary from the ACCME Board of Directors’ Meeting held November 29-30, 2007

Click here.

Professor Chimp?

I find it humorous that we humans think we're so superior to all other species...well, think again -- from Discovery News:

Three five-year-old chimpanzees have soundly defeated nine university students while playing a computer game that tests numerical memory skills, according to a paper published today in Current Biology.

The scores weren't even close. One young chimp named Ayumu who, in his off time, buys his own vending machine snacks, scored 76 percent correct in one game. The adult human average for the same game was 36 percent correct.

The study is one of the first to demonstrate that, at least under certain circumstances, chimp memory may be superior to that of humans.

Click here to read the article.

Re-estimating the HIV estimate

From Time article:

Federal health officials are revising their estimate of how many people are infected by HIV each year, and advocacy groups say the number could rise by 35 percent or more.

The U.S. Centers for Disease Control and Prevention said the numbers are not final and won't be released until early next year.

Click here to access the article.

$49 million hospital bill

I'm guessing maybe that includes the $5 million dollar aspirin tablets? From the HealthLeadersMediaFinance article "That'll be $49 Million, Please":

Everyone knows that hospital treatment can be expensive, but this is ridiculous. A software glitch at a southern Arizona hospital in July, coupled with a failure to manually review bills for errors, meant a $49 million bill was sent to one of the 587 patients who received gargantuan hospital bills in error that month.

Nashville-based Healthcare Management Systems, which processes statements for Northern Cochise Community Hospital in Wilcox, AZ, took the heat for the errors, saying they usually check the statements manually, but didn't this time because they had a high volume of bills that day.

Click here to access the article.

And he thought he had enough insurance...

From the Wall Street Journal article "Maxed Out: As Medical Costs Soar, The Insured Face Huge Tab":

One day in late July, Jim Dawson happily returned home. He had spent the previous five months in the hospital battling an infection that nearly killed him. The phone rang shortly after Mr. Dawson and his wife, Loretta, entered their house.

It was the hospital. California Pacific Medical Center was calling to remind the Dawsons that they owed it $1.2 million.

Click here to access (sub. req.).

Global Health Facts

Unless you've been living in a cave, you know that tomorrow, December 1, 2007, is World AIDS Day. Click here for stats on not only HIV Infection around the world but for TB and malaria as well. Move your cursor over the map on the left hand side of the website home page and stats will pop up by the country you've indicated.

A passing...

But such a tide as moving seems asleep,
Too full for sound and foam,
When that which drew from out the boundless deep
Turns again home.

- Alfred Lord Tennyson

Redemption? You decide...

Check out the "Dr. Drug Rep" article in the New York Times Magazine authored by Daniel Carlat (assistant clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report):

On a blustery fall New England day in 2001, a friendly representative from Wyeth Pharmaceuticals came into my office in Newburyport, Mass., and made me an offer I found hard to refuse.

Click here to access.

Contrary finding?

From the Journal of the American College of Surgeons article "Rural Versus Urban Colorectal and Lung Cancer Patients: Differences in Stage at Presentation":

Background

Rural surgeons are often uneasy when their outcomes are compared with those of urban surgeons because they perceive that rural patients typically present with worse disease. Rural patients with cancer are commonly thought to present at a later stage of disease, although this is based largely on anecdotal evidence.

...

Conclusions

Urban rather than rural residence appears to be associated with later stages of lung and colorectal cancer at presentation. This finding is contrary to the common assumption that rural patients present at later stages of disease.

Click here to access the journal abstract; click here to read the MedPageToday take on these results.

Commercial bias?

From the nature.com online article:

Can the pharmaceutical industry be trusted to fund doctors' compulsory education without introducing bias? The issue is dividing Congress, academics and drugs companies. Now, preliminary data have emerged suggesting that industry-sponsored courses skew training material in favour of commercial interests.

Click here to access.

U.S. Copyright information online

From the November 22, 2007 issue of the NewsNet (published by the U.S. Copyright office):

The Copyright Office has made available on its website an updated version of “Copyright Law of the United States and Related Laws Contained in Title 17 of the United States Code.” This edition contains the text of title 17 U.S.C., including all amendments enacted through the end of the second session of the 109th Congress in 2006. It includes the Copyright Act of 1976 and all subsequent amendments to copyright law; the Semiconductor Chip Protection Act of 1984, as amended; and the Vessel Hull Design Protection Act, as amended. In addition, the appendix includes transitional and supplementary copyright provisions that do not amend title 17. (Go to pdf or html format).

Duke in the news!

From the Health Blog over at the Wall Street Journal:

Duke University Medical Center and the FDA are set to launch a partnership to try to improve the nation’s clunky clinical-trials process.

A recent report from the inspector general of the FDA’s parent agency, the Department of Health and Human Services, estimated that the agency inspects only around one percent of clinical trial sites. The FDA also struggles to track trials, and its “guidance and regulations don’t reflect current clinical trials practices” the report says.

Click here to access (sub. req.)

Butterfly "kisses"?

First of all, who in their right mind would pay $140 for "lash enhancement"!? Check out this Wall Street Journal article, "Drug That Lengthens Eyelashes Sets Off Flutter" and you'll hold your Great Lash mascara a little closer:

FDA spokesman Brad Swezey declined to say if the agency is generally investigating cosmetic eyelash products or claims. However, in its press release Friday about the seizing of the original Jan Marini product, the agency said that Age Intervention Eyelash, if used together with a prescription glaucoma drug, could increase the risk of optic-nerve damage. Used on its own, the product "may cause other adverse effects," including swelling of the retina and inflammation in the eye "which may lead to decreased vision." Neither the agency nor the company has received any report of adverse effects, according to Mr. Swezey and Ms. Marini.

Click here to read the article (sub. req.).

Bayou Friday?

Y'all have GOT to view this video; watch for the microphone adjustment near the end:

ACCME staff changes/additions

Click here to access the announcement.

Veterans Day

In 1921, an unknown World War I American soldier was buried in Arlington National Cemetery. This site, on a hillside overlooking the Potomac River and the city of Washington, D.C., became the focal point of reverence for America’s veterans.

Click here to learn more about the origins of Veterans Day.

MedEdforum 2007

This conference is taking place in Philadelphia, PA November 28-30, 2007. The conference theme is "Raising the Bar with Quality, Needs-Based Learning for Commercial Supporters of CME". Click here for additional information.

Patient safety reporting guidelines

From the Washington Post article:

Like the clinical practice assessments, the new guidelines address three key concerns: Are the measures important?; Are they valid?; and Are they useful for the intended goal of improving safety? These three key areas are addressed in an assessment tool with about 30 questions.

The proposed guidelines are published in the Nov. 7 issue of the Journal of the American Medical Association.

Click here to access the WP article. Click here to access the JAMA article (sub. req.).

Heart drug withdrawn from market

From the New York Times article:

Pressured by regulators, the German pharmaceutical giant Bayer AG announced Monday that it had agreed to withdraw the controversial heart surgery drug Trasylol after a Canadian study suggested that it increased death rates.

Click here to access the article.

A closer look at physician-industry relationships

Check out the free full-text NEJM article "Doctors and Drug Companies — Scrutinizing Influential Relationships".

Consumers International report on pharma marketing in developing countries

From the VOA News article:

A report from the watchdog group Consumers International says multi-national pharmaceutical companies are targeting doctors in developing countries with dinners and lavish gifts as incentives to prescribe their drugs. Tendai Maphosa reports for VOA from London Consumers International is also critical of drug advertisements in developing countries that sometimes promote a drug without mentioning the side effects or the restrictions on its use.

Click here to access the article.

MA surgical errors

From the Boston Globe article:

During the past three years, doctors at Massachusetts hospitals mistakenly removed a patient's kidney when they were supposed to take out her gallbladder and performed an unscheduled cervical biopsy on a woman who had the same first name as the patient scheduled for the procedure.
...
In most cases examined by the Globe, patients did not appear to suffer long-term physical harm, but many had to undergo second surgeries to correct problems while others experienced pain before objects were removed.

Click here to read the entire article.

ACCME posts clarification

The ACCME has posted clarification regarding joint sponsorship as it relates to the August 2007 definition of a commercial interest.

Click here to access.

Medical errors and residents

Check out the Archives of Internal Medicine article "Medical Errors Involving Trainees":

Results Among 240 cases, errors in judgment (173 of 240 [72%]), teamwork breakdowns (167 of 240 [70%]), and lack of technical competence (139 of 240 [58%]) were the most prevalent contributing factors. Lack of supervision and handoff problems were most prevalent types of teamwork problems, and both were disproportionately more common among errors that involved trainees than those that did not (respectively, 54% vs 7% [P < .001] and 20% vs 12% [P = .009]). The most common task during which failures of technical competence occurred were diagnostic decision making and monitoring of the patient or situation. Trainee errors appeared more complex than nontrainee errors (mean of 3.8 contributing factors vs 2.5 [P < .001]).

Conclusions In addition to problems with handoffs, house staff are particularly vulnerable to medical errors owing to teamwork failures, especially lack of supervision. Graduate medical education reform should focus on strengthening these aspects of training.

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

Smoky Southern California Sunset

Will health care reform work this time?

Probably not...check out the article by Jonathan Oberlander, Ph.D., "Learning from Failure in Health Care Reform" just published in the New England Journal of Medicine:

...it is easy to forget that Bill Clinton was not the first president to fail at health care reform: he was following in the footsteps of Franklin Roosevelt, Harry Truman, and Richard Nixon. Ultimately, the demise of the Clinton plan says less about the administration’s mistakes than it does about the extraordinary difficulty of adopting comprehensive health care reform in the United States.

Click here to access this free full-text article.

Cultural competency and diabetes

From the Wall Street Journal article:

With minorities accounting for nearly a third of the U.S. population, medical professionals are beginning to bone up on so-called cultural competency, part of an effort to ensure that patients from disparate backgrounds get proper care. Nowhere is the challenge more acute than for those treating diabetics, given the rising incidence of the disease, its prevalence among minority groups and the changes in diet and lifestyle that treatment often entails.

Click here to read the entire article (sub. req.).

Resources for coping with disasters

Click here to access the CDC's resources on coping with disasters.

More on anemia drugs

From the L.A. Times article:

The largest group of U.S. cancer doctors said Monday that Medicare has gone too far in restricting the use of anemia drugs made by Amgen Inc. and Johnson & Johnson and released its own guidelines.

The doctors' recommendations add new warnings about heart risks while saying patients can safely use higher doses than Medicare allows. The guidelines, based on a three-year review of clinical trials, are being published by the American Society of Clinical Oncology, an association of cancer doctors, and the American Society of Hematology, a group of blood experts.

Click here to access the article.

San Diego County Ablaze

John Gastaldo/The San Diego Union-Tribune/Zuma Press

Click here to see additional photos.

Christopher Gist

History fascinates me, especially when it involves one of my ancestors, such is the case with Christopher Gist. From the Ohio History Central website:

Christopher Gist was an explorer, surveyor and accomplished frontiersman. He was born about 1706 in Maryland to Richard and Zipporah Gist.
...
Gist returned to the Ohio Country, this time with George Washington, in the winter of 1753-1754. The Ohio Company sent the two men to the region to negotiate with French military forces. The French had constructed Fort Duquesne near Shannopin's Town to prevent English settlement of the Ohio Country. Negotiations failed, but during the trip Gist saved the young Washington's life on two separate occasions.
...
Gist provided England and its colonists with the first detailed description of southern Ohio and northeastern Kentucky. While Daniel Boone is generally given credit for opening Kentucky to white settlement, Gist preceded the frontiersman by more than fifteen years.

Click here to access the website.

Murphy's law?

From the Pittsburgh Post-Gazette article:

In response to a national report on an increase in staph infections, Pennsylvania's Rep. Tim Murphy, R-Upper St. Clair, yesterday touted a bill that would create a public database showing how many infections are acquired by patients in each of the nation's hospitals.

"A hospital is a place where people go to get better. No one should have to worry about getting sick while they're there," he said.

Click here to access the article.

Health advocates

From the San Francisco Chronicle article:

Margalit Mathan and Peter August found themselves caught in a maze of medical appointments and conflicting professional opinions when their 7-year-old daughter developed serious eye problems related to her juvenile rheumatoid arthritis.

The Berkeley family decided to consult yet another professional. They turned to a health care advocate, an adviser who specializes in helping patients and their families cut through the health care bureaucracy to find the help they need..

Click here to access the article; be certain to read the tips for choosing a health advocate.

HealthGrades 10th Annual Report

Click here to check out the latest information on hospital quality courtesy of HealthGrades.

Forget insurance coverage, will there be enough physicians?

From the HealthLeaders cover story:

Americans alive today have never experienced a real physician shortage. Sure, there have been occasional dips every few years in certain specialties, like when we worried that we may not have enough obstetricians to go around. And after the need for HMO gatekeepers went away, a shortage of primary-care physicians developed and is worsening. But a widespread, sustained doctor drought is American healthcare’s disaster without a preparedness plan.

Click here to access the entire article. It's a good read!

Pfizer and Sermo?

From the Boston.com article:

A year-old online forum where 30,000 doctors swap medical observations has lined up a partnership with Pfizer, Inc. - an alliance that runs counter to the site's founding ideal to give doctors a place to communicate without the drug industry listening in.

Under a collaboration to be announced today with Cambridge-based Sermo Inc., Pfizer will work with the fast-growing Web venture and its participating doctors to agree on terms allowing Pfizer's hundreds of staff doctors to view postings and reply.

Click here to access the entire article.

Sink your teeth into this

From the New York Times article:

For American dentists, times have never been better.

The same cannot be said for Americans’ teeth.

With dentists’ fees rising far faster than inflation and more than 100 million people lacking dental insurance, the percentage of Americans with untreated cavities began rising this decade, reversing a half-century trend of improvement in dental health.

Click here to read the entire article.

ACCME posts new FAQs

Click here to access.

Impact of Minnesota limit on industry gifts

From the New York Times article:

Michael Clements, the owner of a food-catering business in St. Paul, said the new rules had been disastrous for him. His business of taking lunches, paid for by drug makers, to doctors’ offices all but disappeared after the rule change, cutting his overall sales by two-thirds, Mr. Clements said.

...

Food has not entirely disappeared from the marketing efforts of drug makers in Minnesota. The companies still rent out private dining rooms in restaurants and still hire influential doctors to deliver educational talks about drugs during dinner. But instead of doctors, the companies now invite nurses and secretaries to dine, drink and listen.

Click here to read the entire article.

The Clooney incident

From the EOnlineNews article:

More than two dozen employees at Palisades Medical Center have been suspended pending an investigation into whether they leaked details about Clooney's condition to the press when the actor and his girlfriend were treated Sept. 21 after a motorcycle crash, New Jersey's WCBS-TV reported Tuesday.

News of Clooney's accident was speedily followed by reports of the injuries he and Sarah Larson suffered—a fractured rib and road rash for him, a broken foot for her. The couple only spent a few hours at the hospital.

Click here to access the article.

Medtronic in the news again

From the Bloomberg.com article:

Medtronic Inc. was warned by the U.S. Food and Drug Administration that a manual for the company's Satellite spinal device encouraged its use in unapproved ways.

The device is intended to be fused with a bone graft to stabilize and hold together parts of the vertebrae while they heal, the FDA said in a warning letter posted today on the agency's Web site. Medtronic's surgical technique manual described a non-fusion procedure without implantation of a bone graft, according to the letter, dated Oct. 1.

Click here to access.

Early treatment key

From the Bloomberg.com article:

Patients who get treatment within a day of having a minor stroke cut their risk of a second stroke by 80 percent, researchers reported.

Aspirin, blood thinners and other common therapies given within 24 hours may prevent almost 10,000 major attacks a year in the U.K., scientists said today in the medical journal The Lancet. Sending patients to a specialized clinic also reduced the risk of a stroke, a separate study in The Lancet Neurology found.

Click here to access.

Facing the serpent

I just found out that Flower, the alpha female on the TV show Meerkat Manor died! I've only watched the show a couple of times, and not recently, but this news certainly moved me.

Flower bravely entered the burrow to protect her pups from a cobra (she kept them safe) but she lost her life in the process. My father always said that animals are a gift from God and could teach us more than we could ever teach them -- a little rodent from the Kalahari Desert proved him right. Click here to check out Meerkat Manor.

"Talking Leaves"

From the Sequoyah Birthplace Museum website:

They called him Sequoyah. And, this great Cherokee Indian gave his people an enduring gift. He gave them a writing system - so that the greatness of the Cherokee Nation will live forever.
...
Although Sequoyah was exposed to the concept of writing early in his life, he never learned the English alphabet. He began to toy with the idea of literacy for the Cherokee people. Unlike the white soldiers, he and the other Cherokees were not able to write letters home, read military orders, or record events as they occurred. After the war, he began in earnest to create a writing system for the Cherokees.
...
In 1821, after 12 years working on the new language, he and his daughter introduced his syllabary to the Cherokee people. Within a few months thousands of Cherokees became literate.

Sequoyah's white name? -- George Gist. Click here to access the museum website.

Surprising smoking prevalence info from the CDC

Smoking prevalence among people with disabilities is nearly 50 percent higher than among people without disabilities (29.9 percent vs. 19.8 percent), according to a new study from the Centers for Disease Control and Prevention (CDC) in Preventing Chronic Disease. The study found that in 2004, smoking prevalence for people with disabilities is highest in Delaware (39.4 percent) and lowest in Puerto Rico (16.5 percent).

The study found that about 70 percent of people with disabilities who smoke and had visited a doctor in the last year had been advised to quit smoking. However, more than 40 percent of those advised to quit reported not being told about the types of tobacco-cessation treatment available.

Click here to access the CDC press release.

Planned behavior theory

From the psychservices.psychiatryonline.org article "The Theory of Planned Behavior Applied to Continuing Education for Mental Health Professionals":

OBJECTIVE: This study evaluated the effects of a continuing education class that applied the theory of planned behavior to the intentions and behavior of mental health practitioners.
METHODS: In 2006 a total of 94 mental health practitioners were randomly assigned to either a standard continuing education class or one that applied principles of the theory of planned behavior. The class topic was a brief, self-report tool that assesses felt need for employment among people with serious mental illnesses. Participants' intentions to apply the tool were evaluated before and after each class. Participants' implementation of the tool was measured three months after the class.
RESULTS: The class guided by the theory of planned behavior significantly and substantially increased the participants' intentions to use the tool in comparison with the standard class. Significantly more participants in the theory-guided class than in the standard class (74% versus 42%) had applied the tool by the three-month follow-up. Among those who implemented the assessment tool, the participants in the theory of planned behavior class also assessed significantly more of their caseload.
CONCLUSION: The theory of planned behavior can improve and may be well suited to continuing education in psychiatry.

Click here to access this article (sub. req.).

If they were psychic, shouldn't they have known this would happen?

From the Skeptical Inquirer Magazine article:

A continuing-education workshop titled “Coming to Our Senses: Psychic Events in the Lives of Clinicians and Clients” was touted in North Carolina this year by Beth Wechsler, MSW. According to the brochure, the topics to be covered included an account of the nature of ESP (with perspectives from parapsychology and quantum physics, as well as material from Einstein, Edison, and Jung), ESP and medicine, psychics and mediums (and how to detect fakes!), telepathy, precognition, and apparitions.
...
An e-mail addressing the content of the workshop was sent to the associations and boards that had designated PESI as an approved provider. Karen Kanefield, the director of the Continuing Education Sponsor Approval System of the American Psychological Association, responded immediately. She said that the content of the psychic-events workshop does not meet the curriculum-content requirements of the APA and that PESI would be informed that the workshop “is not suitable as continuing education for psychologists.”

Please note the new label. Click here to read the entire article.

BMS to pay $515 million

From the AP article:

Bristol-Myers Squibb Co. and a former subsidiary have agreed to pay more than $515 million to settle federal and state investigations into their drug marketing and pricing practices.

The civil settlement announced Friday resolves a broad array of allegations against Bristol-Myers Squibb, dating from 1994 through 2005.

Among them were a charge that the New York-based pharmaceutical company illegally promoted the sale of Abilify, an anti-psychotic drug, for pediatric use and to treat dementia-related psychoses. Neither use is approved by the U.S. Food and Drug Administration.

Click here to access the article.

Orthopedic companies to pay $311 million

From the Wall Street Journal article:

Four makers of orthopedic devices have entered deferred-prosecution agreements and agreed to pay a total of $311 million to settle criminal and civil probes into allegations they paid kickbacks to surgeons to use their products, prosecutors said.

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

New AACVPR/ACC/AHA Guidelines

From the Washington Post article:

Experts in cardiac care have issued new "performance measures" meant to boost patient enrollment in cardiac rehabilitation programs.

They say too many heart attack patients aren't getting the benefit of this form of care.

Click here to access the article.

International Severe Adverse Events Consortium

From the Boston Globe article:

A rare collaboration of top pharmaceutical companies, regulators and university researchers has begun attacking one of the toughest problems in medicine: why severe drug side effects strike a small percentage of patients.

Click here to access the article.

Medtronic on the hot seat!

From the New York Times article:

Medtronic, which reached a $40 million settlement last year with the federal government over accusations that the company had paid illegal kickbacks to doctors for using its spinal devices, has continued to pay doctors millions of dollars in consulting fees, according to a lawyer representing a whistle-blower involved in the case.

Senator Charles E. Grassley, Republican of Iowa, has written to Medtronic, asking the company to explain, among other things, any payments made since the period covered by the settlement. The letter is part of a broad inquiry by Mr. Grassley into the financial ties that often exist between doctors and the companies that make medical devices and drugs.

Medtronic defended the continuing payments as legitimate compensation for work the doctors have done. Medtronic said it welcomed the opportunity to speak with Mr. Grassley and his staff.

Click here to read the entire article (reg. req.).

Survey shows heath care is a ministry priority in the U.S.

From the news release:

A groundbreaking survey of more than 6,000 American congregations reveals that churches spend a significant amount of time, energy and money in the ministries of health care.

The Congregational Health Ministry Survey, conducted by the National Council of Churches USA (NCC) with support from the Robert Wood Johnson Foundation, shows that a majority of churches are serving their communities by providing health care ministries. As the number of uninsured Americans reaches 47 million people, congregations are supplying health education and direct health care services. Many are advocating on behalf of public policy issues related to health care.

Click here to access.

Tink and Henry

If you'd like to learn more about Henry, click here.

New dress code for UK physicians

From the Associated Press:

British hospitals are banning neckties, long sleeves and jewelry for doctors — and their traditional white coats — in an effort to stop the spread of deadly hospital-borne infections, according to new rules published Monday.

Hospital dress codes typically urge doctors to look professional, which, for male practitioners, has usually meant wearing a tie. But as concern over hospital-borne infections has intensified, doctors are taking a closer look at their clothing.

Click here to access the article.

The next surgical evolution?

From the Archives of Surgery article "Surgery Without Scars: Report of Transluminal Cholecystectomy in a Human Being":

Hypothesis Natural orifice transluminal endoscopic surgery (NOTES) provides the potential for performance of incisionless operations. This would break the physical barrier between bodily trauma and surgery, representing an epical revolution in surgery. Our group at IRCAD-EITS (Institut de Recherche contre les Cancers de l’Appareil Digestif [Institute of Digestive Cancer Research]–European Institute of TeleSurgery) has been actively involved in the development of NOTES since 2004 with a dedicated project created to develop feasibility and survival studies and new endoscopic technology.

Design NOTES cholecystectomy in a woman via a transvaginal approach.

Setting University hospital.

Patient The patient was a 30-year-old woman with symptomatic cholelithiasis.

Intervention The procedure was carried out by a multidisciplinary team using a standard double-channel flexible videogastroscope and standard endoscopic instruments. The placement of a 2-mm needle port, mandatory to insufflate carbon dioxide and to monitor the pneumoperitoneum, was helpful for further retraction of the gallbladder. At no stage of the procedure was there need for laparoscopic assistance. All of the principles of cholecystectomy were strictly adhered to.

Results The postoperative course was uneventful. The patient had no postoperative pain and no scars, and was discharged on the second postoperative day.

Conclusions Transluminal surgery is feasible and safe. NOTES, a radical shift in the practice and philosophy of interventional treatment, is becoming established and is enormously advantageous to the patient. With its invisible mending and tremendous potential, NOTES might be the next surgical evolution.

Click here to access the article (sub. req.). I think that if I needed my gallbladder out I'd still go laparoscopic.

'Bout time!

I remember when my stepfather had to be returned to the OR after heart surgery and I was surprised when he was charged for the additional OR time, etc. (hey, I was naive then). From the Boston Globe article:

About half of Massachusetts hospitals say they have adopted policies to waive charges for serious medical errors such as wrong-site surgery and harmful medication mistakes, and others say they plan to, amid growing resistance from government and health insurers to paying for poor outcomes.

Thirty-three of 61 hospitals recently reported to a national hospital-quality organization, The Leapfrog Group, that they have voluntarily stopped charging for 28 serious and rare errors, called "never events." But consumer groups, health insurers, legislators, and employers are pushing for more far-reaching and mandatory policies as ways to reduce errors, and hospital executives said they expect to forgo payments in an increasing number of cases, including those in which patients require additional treatment because they contracted an infection in the hospital or fell in their room.

Click here to access the article.

Jessica...

She must be a metaphor for something:

Click here to view the video.

Prescription drug labels

From the Archives of Internal Medicine article, "The Variability and Quality of Medication Container Labels":

Results We evaluated 85 labels after excluding 11 ibuprofen prescriptions that were filled with over-the-counter containers that lacked labels printed at the pharmacy. The pharmacy name or logo was the most prominent item on 71 (84%) of the labels, with a mean font size of 13.6 point. Font sizes were smaller for medication instructions (9.3 point), medication name (8.9 point), and warning and instruction stickers (6.5 point). Color, boldfacing, and highlighting were most often used to identify the pharmacy and items most useful to pharmacists. While the content of the main label was generally consistent, there was substantial variability in the content of instruction and warning stickers from different pharmacies, and independent pharmacies were less likely to use such stickers (P < .001). None of the ibuprofen containers were delivered with Food and Drug Administration–approved medication guides, as required by law.

Conclusions The format of most container labels emphasizes pharmacy characteristics and items frequently used by pharmacists rather than use instructions or medication warnings. The content of warning and instruction stickers is highly variable depending on the pharmacy selected.

Click here to access the article (free full text).

Gee, do you think they'll look at any CME activities?

From the Wall Street Journal article:

Drug maker Cephalon Inc. sent letters to doctors this week warning them that several deaths have been linked to Fentora, its powerful narcotic to treat acute cancer pain.

Fentora and its predecessor, Actiq, are approved by the Food and Drug Administration only for use in cancer patients, but they are often prescribed by physicians "off-label" for such ailments as headaches and back pain.

Cephalon denies marketing the two drugs outside their indication, but its marketing practices are under scrutiny in three separate probes: investigations by the U.S. attorney in Philadelphia and the Connecticut attorney general, and a congressional probe into off-label treatments.

Click here to access (sub. req.).

Latest FDA news on anemia drugs

From the Wall Street Journal article:

A Food and Drug Administration advisory committee stopped short of supporting a clear-cut new limit on kidney-failure patients' use of the blockbuster anemia drugs made by Amgen Inc. and Johnson & Johnson, but members split over what doses of the medications are appropriate.

Click here to access (sub. req.).

PDA and brain-injured veterans

From the News Observer article:

Troops who lose limbs in Iraq are fitted with sophisticated replacements such as computer-controlled legs. Now, some of the thousands who have returned with brain injuries are getting a prosthetic for the mind -- a personal digital assistant that serves as their short-term memory.

"If I couldn't use it, I basically wouldn't be able to function," said Master Sgt. Tony Wisyanski, an 82nd Airborne Division paratrooper based at Fort Bragg.

Wisyanski suffered a brain injury and other wounds Oct. 1, 2006, in Iraq when his Humvee was struck by two rocket-propelled grenades. While he was being treated at a brain-injury center in Virginia, a speech pathologist ordered a PDA for him. Among other things, he programs it to beep an audio alert to remind him about appointments and to record phone numbers.

You'd think at least one of these companies would step up and donate PDAs to these veterans. Click here to access the article.