The heart of a champion

From the New York Times article:

The high school wrestling career of Dustin Carter ended Friday in defeat but with an ovation from the crowd at the Schottenstein Center in Columbus, Ohio.

Carter, who had an acute bacterial infection in his bloodstream at age 5 and had parts of all of his limbs amputated, battled his way into Ohio’s Division II wrestling tournament as a 103-pound senior for Hillsboro High School.

...

“I told him, ‘Dusty, you went way beyond your expectations,’ ” Russ Carter said by telephone. “ ‘With everything you did, you inspired people out there.’ ”

I've categorized this as "Off topic," but is it really? Click here to access the article.

Rise in nursery product injuries

From the Wall Street Journal article:

Nursery products were involved in 66,400 injuries that sent children to emergency rooms in 2006, an 11% increase from the year earlier, according to the Consumer Product Safety Commission.

The agency said in a report yesterday that the number of injuries to infants and children under age five involving cribs, high chairs, walkers and other items rose by 6,600 from 59,800 in 2005.

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

The China syndrome?

From the Wall Street Journal article:

The Food and Drug Administration needs more inspectors and a comprehensive computer database to better track products entering the U.S. from foreign sources, a top drug-safety official told lawmakers.

Click here to access (sub. req.).

FDA Public Health Update

Recall of Heparin Sodium Injection and Heparin Lock Flush Solution (Baxter)

MDR-TB, WHO knew?

From the WHO website:

Multidrug-resistant tuberculosis (MDR-TB) has been recorded at the highest rates ever, according to a new report published today. The report presents findings from the largest survey to date on the scale of drug resistance in tuberculosis.

The report, "Anti-tuberculosis drug resistance in the world", is based on data collected between 2002 and 2006 on 90 000 TB patients in 81 countries. It found that extensively drug-resistant tuberculosis (XDR-TB), a virtually untreatable form of the respiratory disease, has been recorded in 45 countries.

Click here to go to the WHO website:

America's Health Insurance Plans on the offense

From the Wall Street Journal article:

The health-insurance industry is racing to defuse a growing furor over retroactive policy cancellations that have saddled some patients with big medical bills and sparked lawsuits.

America's Health Insurance Plans, an industry group, is pushing a proposal with state regulators that would give consumers the right to appeal such policy cancellations, known as rescissions, to an external panel, whose decisions would be binding. Some insurance companies, eager for even quicker action, are preparing to roll out their own independent review programs.

Click here to access (sub. req.).

Surgeons as consultants to device companies under more scrutiny

From the Wall Street Journal article:

The Senate Special Committee on Aging plans to discuss the practice of device manufacturers retaining surgeons as paid consultants in today's hearing. Sen. Herb Kohl, a Wisconsin Democrat who is chairman of the committee, has proposed legislation that would mandate disclosure of consulting payments by medical-device makers and drug companies.

Click here to access (sub. req.).

Health insurer's action called "egregious"

From the Los Angeles Times article:

One of California's largest for-profit insurers stopped a controversial practice of canceling sick policyholders Friday after a judge ordered Health Net Inc. to pay more than $9 million to a breast cancer patient it dropped in the middle of chemotherapy.

The ruling by a private arbitration judge was the first of its kind and the most powerful rebuke to the state's major insurers whose cancellation practices are under fire from the courts, state regulators and elected officials.

Calling Woodland Hills-based Health Net's actions "egregious," Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.
...
Earlier, Health Net had defended its actions, saying it never would have issued Bates a policy in the first place if she had disclosed her true weight and a preexisting heart condition on her application.

Click here to access the article.

Freestyle reinin'

Inspiring? You Bet!

"Google this'

From the New York Times article:

For 18 months, Google has been working to come up with a product offering and a strategy in the promising field of consumer health information. Until now, the search giant hasn’t had anything to show for its labors other than bumps along the way — delays and a management change.

But on Thursday, Google’s technology for personal health records, which is still in development, is getting a big endorsement from the Cleveland Clinic. The big medical center is beginning a pilot project to link the health information for some of its patients with Google personal health records.

Click here to access the NYT article.

Study delineates cancer dx disparities

From the New York Times article:

A nationwide study has found that the uninsured and those covered by Medicaid are more likely than those with private insurance to receive a diagnosis of cancer in late stages, often diminishing their chances of survival.

The study by researchers with the American Cancer Society also found that blacks had a higher risk of late diagnosis, even after accounting for their disproportionately high rates of being uninsured and underinsured. The study’s authors speculated that the disparity might be caused by a lack of health literacy and an inadequate supply of providers in minority communities. The study is to be published online Monday in The Lancet Oncology.

Click here to access the NYT article.

Perhaps he's never heard of pharmacists?

Check out the Forbes.com article "A Free Lunch" by Paul H. Rubin, Professor of Law and Economics at Emory University and former Chief Advertising Economist at the Federal Trade Commission and Chief Economist at the U.S. Consumer Product Safety Commission; an excerpt:

Drug company reps offer overworked doctors useful, lifesaving information in an efficient manner. The drug companies are of course motivated by profit, but economists have known since Adam Smith that the profit motive is the best way to induce someone to do something useful.

Click here to access the article.

Will off-label uses have another avenue besides CME?

Maybe...from the Wall Street Journal article:

The Food and Drug Administration wants to allow drug companies to give doctors information about unapproved uses of prescription drugs, a controversial move that is already drawing objections from Capitol Hill.

Companies generally aren't allowed to advertise or market such "off-label" uses, though doctors can prescribe drugs for any condition. The FDA has proposed guidelines allowing manufacturers to give physicians reprints of medical journal articles about uses of drugs and medical devices that haven't won the agency's approval.

The regulator is stepping into a high-stakes business issue, because off-label uses of prescription drugs are a mainstay of the industry -- an estimated 21% of drug use overall, according to a 2006 analysis published in the Archives of Internal Medicine.

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

ACCME news release re: partnership between ACCME, ANCC, and ACPE

Click here to access.

Institutional conflicts of interest

Interesting survey results just published in JAMA on academic institutional conflicts of interest relating to research (upstream of CME). Click here to read the abstract.

The patient's perspective...what a concept!

Check out the New York Times book review of "When Doctors Become Patients"; an excerpt:

When doctors get sick, they discover fissures in the health system that they didn’t know existed. They learn that seemingly small annoyances they never paid attention to as doctors — like long waiting times or a broken television in a hospital room — really are a big deal when you are the patient. Even doctors who thought of themselves as compassionate recognize they can do better once they experience life as a patient.

The book's author is Columbia University psychiatrist Dr. Robert Klitzman. Click here to read the entire review.

Merck settles whistleblower suit

From the New York Times article:

A sales manager who ''just couldn't abide'' by the way Merck wanted him to market the drugs Vioxx and Zocor to doctors took the lonely step of filing a whistleblower suit against his employer.

Seven years later, Merck & Co. will pay $671 million to settle complaints it overcharged government health programs and gave doctors improper inducements to prescribe its drugs.

Click here to read the article.

Does body double spell double trouble for Dr. Jarvik?

From the New York Times article:

Dr. Robert Jarvik is best known for the artificial heart he pioneered more than a quarter-century ago. Since then he had toiled in relative obscurity — until he began appearing in television ads two years ago for the Pfizer cholesteral drug Lipitor.
...
Some of the questions may involve his credentials. Even though Dr. Jarvik holds a medical degree, for example, he is not a cardiologist and is not licensed to practice medicine. So what, critics ask, qualifies him to recommend Lipitor on television — even if, as he says in some of the ads, he takes the drug himself?

And, for that matter, what qualifies him to pose as a rowing enthusiast? As it turns out, Dr. Jarvik, 61, does not actually practice the sport. The ad agency hired a stunt double for the sculling scenes.

Click here to access.

"Never pay" PA policy for never events...

From the Philadelphia Inquirer article:

In 2006, 11 hospital patients in Southeastern Pennsylvania died after getting transfusions with the wrong blood type. An additional 40 died after medication errors, and four more after being accidentally burned during their stays, according to an Inquirer computer analysis of hospital billing records.

Such deaths, nearly 1,500 all told, are a rough estimate of what the Rendell administration would initially find if it applied its new Medicaid policy on medical errors to all 708,657 hospital admissions in 2006 from Philadelphia, Bucks, Chester, Delaware and Montgomery Counties.

Under that policy, the state will stop paying hospitals for the added costs of care for Medicaid patients that result from serious, avoidable medical mistakes.

Click here to read the entire article.

NJ AG issues subpoena to ortho device makers

From the New York Times article:

The New Jersey attorney general’s office issued subpoenas Monday to two companies involved in the development of the Prodisc, an artificial spinal disk for the lower back.

Click here to read the NYT article.

Review article published on herbal extract

From the New York Times article:

Dr. Pittler said it makes him uncomfortable that hawthorn is available without a prescription. “We don’t really know the mechanisms by which hawthorn works,” he said, “and it is important to caution that patients should not self-diagnose, and then self-treat with hawthorn.”

Click here to access the NYT article.

Nurses and pharma

Interesting article "Soft Targets: Nurses and the Pharmaceutical Industry" over at PLoS Medicine; an excerpt:

But it is not only prescribing nurses who must be the focus of these strategies. As we have described above, non-subscribing nurses play an under-appreciated role in prescription and administration choices. One of us (AJ), an experienced staff nurse, recalls guiding new house staff in the choice of treatment; the other (DBM) was grateful for such guidance as a medical intern.

Click here to access.

SafeRX Amendment Act of 2008 in D.C.?

From the AMNews article:

The measure, dubbed SafeRx, would require detailers to pay a licensure fee, adhere to an ethics code, receive continuing education and refrain from misleading doctors about drugs. Sales reps could be fined up to $10,000 for operating without a license.

Click here to access the article.

The heat is on...

Just came across the 1-22-08 entry "Variations on a Theme of Sleaze" at the Health Care Renewal Blog -- an excerpt:

Medical journals are not the only compromised medium. Continuing Medical Education (CME) is a second front in the campaign to expand the AAP drug market. The standard formula calls for corporate sponsorship channeled through an “unrestricted educational grant” to a medical education communications company (MECC). The MECC employs writers to prepare the “educational content,” and academic KOLs are recruited to deliver this content.

Click here to read the entire posting. Fasten your seatbelt!

NAAMECC and Coalition for Healthcare Communication Response

to the Macy conference summary on CE. Click here to access.

Venous thromboembolism prophylaxis gap

From the medpage today article:

Hospital patients at risk for venous thromboembolism don't receive appropriate preventive care, no matter how developed a country they live in, researchers here said.

More than 40% of surgical patients and 60% of medical patients at risk for venous thromboembolism in a large international study failed to receive prophylaxis as recommended by the American College of Chest Physicians, reported Alexander T. Cohen, M.D., of King's College Hospital, and colleagues in the Feb. 1 issue of The Lancet.

Some 5% to 10% of overall inpatient mortality is attributed to pulmonary embolism. It is the leading preventable cause of death in hospitals, Dr. Cohen and colleagues said.

Click here to access the article.

FDA issues Public Health Advisory on Chantix (varenicline)

Click here to access.

Hospitals making the grade...

From the Washington Post article:

Patients admitted to the top-rated hospitals in the United States have an average 27 percent lower risk of dying than patients admitted to other hospitals in the country, a new study shows.

Released Thursday by HealthGrades, an independent health-care ratings organization, the analysis of 27 procedures and diagnoses also found that patients who have surgery at the top-rated hospitals have an average 5 percent lower risk of complications during their hospital stay.

Click here to access the article.

Leaky MD?

From the New York Times article:

A leading member of the Senate said Wednesday that a prominent diabetes expert had leaked an unpublished and confidential medical journal article to GlaxoSmithKline last year, tipping the company to the imminent publication of safety questions involving the company’s diabetes drug Avandia.

Click here to access the article.

New and updated health status stats by state

The website Statehealthfacts.org has added new and updated data on Medicaid and SCHIP, Managed Care and Health Insurance, Health Status, Providers and Service Use, and Demographics and the Economy.

IOM says HHS should establish effectiveness database

From IOM Press Release:

A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also be responsible for developing and promoting rigorous standards for clinical practice guidelines, which could help minimize the use of questionable services and target services to the patients most likely to benefit, said the committee that wrote the report.

Click here to read the press release.

"Wither CME?"

Encourage y'all to read this cleverly titled article (starts on page 13 of the newsletter) in the latest issue of Pharma Marketing News.

Anatomy of a medical error...

From the Los Angeles Times article:

A technician mistakes an "a" for an "o" in a drug name. A doctor misplaces a decimal point in a prescription order. A nurse reaches for a vial in a cabinet as she's done hundreds of times before, only this time the light is dim and she fails to notice that the powder-blue label is more of a sky blue. The slip-ups are often simple, and always human, and all have happened in U.S. hospitals.

Each simple mistake is supposed to be countered by a recommended backup, a second or third set of eyes -- in other words, guidelines to reduce human error. A lot has to be overlooked in the cascade of errors that result in serious patient harm.

Click here to access the article.

The cost of diabetes

From the Forbes.com article:

The economic costs of diabetes in 2007 were estimated to be $58 billion, a figure that includes reduced productivity of both people in the labor force and unpaid workers, unemployment from diabetes-related disability, and increased absenteeism.

It's believed that about 6 million people in the United States have undiagnosed diabetes, which means the actual total cost of diabetes in 2007 may have been much more than $174 billion, the study said.

Click here to read the entire article. Might CME Providers collaborate regionally and nationally on this topic? And what about Big Pharma -- would they fund such an effort?

"FDA Warns Public of Contaminated Syringes"

From the FDA News Release:

The U.S. Food and Drug Administration (FDA) today announced a nationwide recall of all lots of heparin and saline pre-filled flush syringes manufactured by AM2 PAT, Inc., of Angier, N.C. Two lots have been found to be contaminated with Serratia marcescens, a bacterium that can cause serious injury or death.

These syringes are manufactured by AM2 PAT under the brand names Sierra Pre-filled, Inc. and B. Braun. They are sold in fill sizes of 3mL, 5mL and 10mL and syringe sizes of 6mL and 12mL.

Consumers and health care facilities with any of the recalled, pre-filled Heparin Lock or Normal Saline IV Flush syringes should stop using the product immediately. Health care facilities should immediately quarantine the products in their inventory and return them to their distributor. Individual consumers should return them to the location from which they were received, such as a pharmacy or hospital. They should also let their health care providers know that they have been exposed to syringes recalled by FDA.

Click here to access.

Are brand name "cholesterol" drugs more effective?

From the Wall Street Journal article:

Merck & Co. and Schering-Plough Corp. defended their actions Friday involving a recently released study that raised questions about the effectiveness of cholesterol drugs Vytorin and Zetia.

The Food and Drug Adminstration, meanwhile, said it will review the partially completed study once it has been finished.

The companies are being sued in several states over allegations they misled consumers into thinking the drugs were more effective than generics. In a statement Friday, the companies said they acted "with integrity and good faith."

Click here to access (sub. req.).

A side effect of the Pill

From the New York Times article:

British researchers found that women taking the pill for 15 years halved their chances of developing ovarian cancer and that the risk remained low more than 30 years later.

The findings were to be published Friday in The Lancet.

“Not only does the pill prevent pregnancy, but in the long term, you actually get less cancer as well,” said Valerie Beral, the study’s lead author and director of the Cancer Research UK Epidemiology Unit at Oxford University. The study was financed by Cancer Research UK, a charity, and Britain’s Medical Research Council.

Click here to access.

New FDA rule for clinical trials

From the New York Times article:

After decades of inattention to the possible psychiatric side effects of experimental medicines, the Food and Drug Administration is now requiring drug makers to study closely whether patients become suicidal during clinical trials.

The new rules represent one of the most profound changes of the past 16 years to regulations governing drug development. But since the F.D.A.’s oversight of experimental medicines is done in secret, the agency’s shift has not been announced publicly.

Click here to access the article.

And another COI headline (research)

From the New York Times article "Researchers Go Unchecked, Report Says":

Universities are increasingly seeking other sources of income to support research, and drug and device makers have become an important resource. But blending these sources of financing can often present researchers with troubling conflicts of interest, and managing such conflicts has become dizzyingly complex.

Indeed, academic medicine has become so rife with conflicts of interests in recent years that the Food and Drug Administration has complained that it has difficulty finding experts for its advisory boards who do not have a conflict.

Click here to access the NYT article; click here to access the OIG report.

Do the conflicts of interest ever end? Further comments on the Macy Report

Check out yesterday's posting on Dr. Carlat's blog; click here.

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.