Mayo CME Consensus Conference Proceedings now available

The proceedings of the September 24-26, 2008 invitational Mayo CME Consensus Conference held at the Mayo Clinic in Rochester, MN, and co-sponsored by the Society for Academic Continuing Medical Education (SACME), the Accreditation Council for Continuing Medical Education (ACCME), and the Mayo Clinic has been posted online. Click here to access.

ACCME's New Approach to Transparency

Click here to read Dr. Kopelow's memo. I'd like to see ACCME require CME providers placed on probation to have to utilize a different accreditation statement, one that denotes that status.

Fair Market Value?

Check out the article on fair market value over at Pharmaceutical Executive, an excerpt:

The best approach is to rely on the knowledge base of fair market value that exists in other settings. Fair market value is a term of art. It's generally defined as a value negotiated at arm's length between a hypothetical willing buyer and a hypothetical willing seller. The IRS has very clear guidelines on methodologies that are acceptable from the standpoint of a fair market value standard. Those standards and the fair market value body of knowledge can generally be cross-walked to the determination of the fair market value of a compensation arrangement. For example, with traditional business valuations the primary approaches are cost, income, and market. Likewise, in a compensation valuation setting, consideration can be given to the same three valuation approaches—so we're using the guidelines and the techniques that were developed in business valuations and applying them to compensation valuation.

As CME providers conduct their annual review of their faculty honorarium policy, they might want to include this article as part of that review process. Click here to access the article.

$20 Billion allocated for Health IT

is included as part of the $825 economic stimulus proposal released by the House Appropriations Committee. From the iHealthBeat article:

Of the $20 billion, $2 billion would go to HHS' Office of the National Coordinator for Health IT (Ferris, Government Health IT, 1/15).

ONCHIT could use the funding to:

* Invest in IT architecture supporting health information exchanges and the national health information network;
* Provide grants to help health care providers adopt health IT products; and
* Train health care providers and IT professionals (Health Data Management, 1/15).

Some experts said that there are reports that at least some of the remaining $18 billion would be used to provide health IT grants to states (Government Health IT, 1/15).

Click here to access the article.

Updated AdvaMed Code

AdvaMed or the Advanced Medical Technology Association has updated their code of ethics and it takes effect July 1, 2009. Click here to access the updated code. Click here to access a comparison chart (compares old and updated code with the PhRMA code). A tad interesting, methinks, where they place "grand rounds" in their code.

FDA Guidance on "Good Reprint Practices" for Industry

Yep! The FDA has issued recommendations, but keep in mind this excerpt from the introduction:

FDA's guidance documents do not establish legally enforceable rights or responsibilities. Instead, guidances describe the Agency's current thinking on a topic and should be viewed only as recommendations, unless specific regulatory or statutory requirements are cited. The use of the word should in Agency guidances means that something is suggested or recommended, but not required.

Also from the document:

FDA does recognize, however, the important public health and policy justification supporting dissemination of truthful and non-misleading medical journal articles and medical or scientific reference publications on unapproved uses of approved drugs and approved or cleared medical devices to healthcare professionals and healthcare entities. Once a drug or medical device has been approved or cleared by FDA, generally, healthcare professionals may lawfully use or prescribe that product for uses or treatment regimens that are not included in the product's approved labeling (or, in the case of a medical device cleared under the 510(k) process, in the product's statement of intended uses). These off-label uses or treatment regimens may be important and may even constitute a medically recognized standard of care. Accordingly, the public health may be advanced by healthcare professionals' receipt of medical journal articles and medical or scientific reference publications on unapproved new uses of approved or cleared medical products that are truthful and not misleading.

It will be interesting to see what happens with the new administration. Click here to access the guidance document.

New clinician-consumer health info website

From the istockanalysis.com article:

A new educational Web site offers expert perspectives, advice and guidance on drugs, biological products and medical devices from the Agency for Healthcare Research and Quality's Centers for Education and Research on Therapeutics (CERTs), a federally sponsored network of more than a dozen leading research centers nationwide. The Clinician-Consumer Health Advisory Information Network (CHAIN) http://www.chainonline.org links clinicians and consumers with therapeutics information to assist in clinical practice and health care decision-making in areas where evidence is undergoing significant and rapid changes.

Click here to access the website.

ACCME makes headlines

From the New York Times article "Medical Journal Changes Its Policy After Criticism by Group":

But the Accreditation Council for Continuing Medical Education, in a letter to a cancer research newsletter, said the journal and its publisher, the Massachusetts Medical Society, had erred in failing to disclose “relevant financial conflicts of interests of the authors.”

The study failed to disclose that Dr. Henschke’s work had been underwritten in part by a $3.6 million grant from the parent company of the Liggett Group, a cigarette maker, something the journal editors said they had been unaware of.

Click here to read. What about content validation?

New California health care-related laws in effect Jan 1, 2009

From the CaliforniaHealthline article (the bolding is mine):

Hospital Infection Control

* SB 1058, also by Alquist, requires hospitals to screen certain high-risk patients for Methicillin-resistant Staphylococcus aureus and report their infection rates to the state. Beginning in 2011, the information will be accessible to the public on a state Web site.
* SB 158 by Sen. Dean Florez (D-Shafter) gives the state additional authority to look into infection outbreaks and complaints about lax infection control practices. The law also requires hospitals to provide education and training opportunities for workers (Rojas, Sacramento Bee, 12/27/08).

End-of-Life Care

* Doctors who treat terminally ill patients will be required to inform them on all end-of-life options, including hospice care and the right to refuse treatment.

Click here to access this article and read about even more health care-related laws.

Doctor appointments on the web

An online service that offers doctor appointments via a webcam will go live in Hawaii on Jan 15. From the New York Times article on this new service:

Patients use the service by logging on to participating health plans’ Web sites. Doctors hold 10-minute appointments, which can be extended for a fee, and can file prescriptions and view patients’ medical histories through the system. American Well is working with HealthVault, Microsoft’s electronic medical records service, and ActiveHealth Management, a subsidiary of Aetna, which scans patients’ medical history for gaps in their previous care and alerts doctors during their American Well appointment.

Click here to access. Disclosure: I have no financial relationship with this new service.

Editorial in the New York Times on the new pharma rules

Check out the New York Times editorial: "No Mugs, but What About Those Fees?" An excerpt:

The updated rules are the industry’s latest attempt to restore public confidence that doctors are prescribing medicines in the patient’s interest. The code still has too many loopholes.

Click here to access. What do y'all think?

Overprescription of fluoroquinolones?

From the Atlanta Journal Constitution article:

In 2007, U.S. patients received more than 40 million prescriptions for fluoroquinolone antibiotics, according to IMS Health, a health care information company. Some studies have found these drugs are often misprescribed, chosen first by doctors when other antibiotics are more appropriate — or when none are needed.

Click here to access the AJC article.

ACCME releases examples of real-world compliance with the updated criteria

Click here to access.

True blue?

From the Washington Post article:

The Afghan chieftain looked older than his 60-odd years, and his bearded face bore the creases of a man burdened with duties as tribal patriarch and husband to four younger women. His visitor, a CIA officer, saw an opportunity, and reached into his bag for a small gift.

Four blue pills. Viagra.

"Take one of these. You'll love it," the officer said. Compliments of Uncle Sam.

Click here to access.

Doctor Nemeroff steps down

From Emory's news release:

Emory University has conducted an investigation into allegations of conflicts of interest involving Dr. Charles Nemeroff, the long-time chair of the Department of Psychiatry and Behavioral Sciences at the Emory University School of Medicine. Based on the results of that investigation, Dr. Nemeroff has agreed to step down from the departmental leadership post he held for 17 years and to follow new restrictions on his outside activities.

Additionally, Emory will not submit any NIH or other sponsored grant or contract requests in which he is listed as an investigator or has any other role for a period of at least two years. He will remain in the Department as a professor and will focus on clinical care, teaching and other academic pursuits.

Click here to access.

Medical Board of California changes CME requirements

From the California Physician article:

New CME reporting requirements recently passed by the medical board take effect in 2009. Physicians will now be required to complete 50 CME hours during every two-year licensure period. Previously, physicians were required to complete 100 hours every four years. CME will also be calculated based on the physician’s personal license renewal date (the last day of the month of your birthday), not the calendar year.

Click here to access.

Wishing Everyone Happy Holidays!

Gratitude is not only the greatest of virtues, but the parent of all others.
- Cicero (106 BC - 43 BC), 'Pro Plancio,' 54 B.C.

Medical publisher and Wyeth under scrutiny

From the New York Times article:

Mr. Grassley, a member of the Senate Finance Committee who is investigating drug company influence on doctors, contends that Wyeth commissioned the articles and had them ghostwritten by a medical writing firm. Only after the articles were conceived and under way did the firm line up doctors to put their names on them, Mr. Grassley contends.

“The charges made by Senator Grassley’s office with regard to the article published in 2003 by Dr. Eden are a significant concern to The Journal and Elsevier,” Glen P. Campbell, the senior vice president for Elsevier’s US Health Sciences Journals unit, said in a statement. “As with any charge of misconduct or inappropriate publishing acts, The Journal has launched its own investigation into the claims of ghostwriting and undisclosed financial support.”

The journal article, published more than a year after a landmark federal study linked Wyeth’s Prempro hormone product to breast cancer in women, said there was “no definitive evidence” the hormones caused breast cancer.

Click here to access the NYT article.

Barbara Barnes, MD, and Claudette Dalton, MD Named Chair and Vice Chair of the Accreditation Council for Continuing Medical Education

Click here to access this ACCME news release.

Wilford Brimley receives American Diabetes Association award

From the tcpalm.com article:

“I didn’t know about this,” he said after accepting the award. “I’m truly honored. I don’t know what to say here about this. I do know that I am responsible to share my experience, whatever strength I may have and my hope with anybody who cares to jump in the water.”

Click here to read the article.

"'CME-like'"

Apparently a new term coined by Emory? Check out Senator Grassley's most recent letter to the NIH regarding Dr. Nemeroff's conflict of interest "issues"; click here to access.

ADA/ACCF/AHA issue position statement

"Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials"; click here to access.

Breast Cancer and HRT

From the The Washington Post article:

Taking menopause hormones for five years doubles the risk for breast cancer, according to a new analysis of a big federal study that reveals the most dramatic evidence yet of the dangers of these still-popular pills.

Even women who took estrogen and progestin pills for as little as a couple of years had a greater chance of getting cancer. And when they stopped taking them, their odds quickly improved, returning to a normal risk level roughly two years after quitting.

Collectively, these new findings are likely to end any doubt that the risks outweigh the benefits for most women.

Click here to access the WP article.

PhRMA issues guiding principles on DTC advertising

Click here to access.

Electronic prescribing

The authors of a study just published in the Archives of Internal Medicine report that electronic prescribing and formulary decision support could result in substantial cost savings ($845,000 per 100,000 patients). Click here to access the abstract.

Drug combo for hypertension superior?

From the New York Times article:

The trial compared two pills, each containing two drugs used to lower blood pressure. Patients taking pills that combined an ACE inhibitor with a calcium-channel blocker suffered 20 percent fewer heart attacks, strokes, heart procedures and deaths than those taking an ACE inhibitor with a diuretic, the investigators found.

The study was funded by Novartis, which makes both of the two-in-one pill treatments evaluated, and published in Thursday’s issue of The New England Journal of Medicine.
...
Dr. Aram Chobanian, a professor of medicine and pharmacology at Boston University School of Medicine and author of the editorial, said he had questions about whether the diuretic was used appropriately in this trial, adding that a single trial is “not enough to recommend that everyone be on a calcium-channel blocker and an ACE inhibitor.”

Click here to access the NYT article.

Penn School of Medicine to disclose doc industry ties online

From the Philadelphia Inquirer article:

Some local patients may soon be able to learn whether their doctors are paid on the side by pharmaceutical firms or medical-implant makers.

In the spring, the University of Pennsylvania School of Medicine and its health system, known collectively as Penn Medicine, plan to launch a Web site that will contain searchable information on all outside activities of its doctors and scientists.

"When all of us are up there transparently, it may make us a little more responsible," said Arthur H. Rubenstein, dean of the medical school and head of Penn Medicine. "It is just human nature: If you know someone else is going to know what you are doing, you may be more careful."

Click here to access.

Cleveland Clinic's new online disclosure plan

From the New York Times article:

The Cleveland Clinic plans to announce this week it has begun publicly reporting the business relationships that any of its 1,800 staff doctors and scientists have with drug and device makers.

The clinic, one of the nation’s most prominent medical research centers, is making a complete disclosure of doctors’ and researchers’ financial ties available on its Web site, www.clevelandclinic.org.
...
“They are breaking a new path here,” said Dr. David J. Rothman, the president of the Institute on Medicine as a Profession, a nonprofit group based at Columbia University that studies potential conflicts of interest.

Click here to access the NYT article.

IOM report on resident fatigue

From the Washington Post article:

Medical and surgical residents in hospitals should work no more than 16 hours without taking a mandatory five-hour sleep break, and they should get one full day off a week and at least two back-to-back days off a month, a panel of experts at the Institute of Medicine recommended yesterday.

Click here to access.

Brand-name versus generic, is perception reality?

Check out the recent JAMA article "Clinical Equivalence of Generic and Brand-Name Drugs Used in Cardiovascular Disease." The results and the authors' conclusions:

Results: We identified 47 articles covering 9 subclasses of cardiovascular medications, of which 38 (81%) were randomized controlled trials (RCTs). Clinical equivalence was noted in 7 of 7 RCTs (100%) of β-blockers, 10 of 11 RCTs (91%) of diuretics, 5 of 7 RCTs (71%) of calcium channel blockers, 3 of 3 RCTs (100%) of antiplatelet agents, 2 of 2 RCTs (100%) of statins, 1 of 1 RCT (100%) of angiotensin-converting enzyme inhibitors, and 1 of 1 RCT (100%) of {alpha}-blockers. Among narrow therapeutic index drugs, clinical equivalence was reported in 1 of 1 RCT (100%) of class 1 antiarrhythmic agents and 5 of 5 RCTs (100%) of warfarin. Aggregate effect size (n = 837) was –0.03 (95% confidence interval, –0.15 to 0.08), indicating no evidence of superiority of brand-name to generic drugs. Among 43 editorials, 23 (53%) expressed a negative view of generic drug substitution.

Conclusions: Whereas evidence does not support the notion that brand-name drugs used in cardiovascular disease are superior to generic drugs, a substantial number of editorials counsel against the interchangeability of generic drugs.

Click here to access (sub. req.).

Disruptive Docs

From the New York Times article:

A survey of health care workers at 102 nonprofit hospitals from 2004 to 2007 found that 67 percent of respondents said they thought there was a link between disruptive behavior and medical mistakes, and 18 percent said they knew of a mistake that occurred because of an obnoxious doctor. (The author was Dr. Alan Rosenstein, medical director for the West Coast region of VHA Inc., an alliance of nonprofit hospitals.)

Another survey by the Institute for Safe Medication Practices, a nonprofit organization, found that 40 percent of hospital staff members reported having been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. As a result, 7 percent said they contributed to a medication error.

There are signs, however, that such abusive behavior is less likely to be tolerated. Physicians and nurses say they have seen less of it in the past 5 or 10 years, though it is still a major problem, and the Joint Commission is requiring hospitals to have a written code of conduct and a process for enforcing it.

Click here to access.

Allhat isn't "all that"?

Check out the New York Times article "The Minimal Impact of a Big Hypertension Study"; an excerpt:

The findings, from one of the biggest clinical trials ever organized by the federal government, promised to save the nation billions of dollars in treating the tens of millions of Americans with hypertension — even if the conclusions did seem to threaten pharmaceutical giants like Pfizer that were making big money on blockbuster hypertension drugs.

Six years later, though, the use of the inexpensive pills, called diuretics, is far smaller than some of the trial’s organizers had hoped.

Click here to access the NYT article.

Health beliefs

From the Reuters article:

Older African Americans more likely to rate their health as poor compared with older white Americans, even though when the two groups "are functioning extremely well, new research suggests.
...
The most likely explanation for the racial disparities seen in the current study, Spencer said, is that older African Americans have a different way of thinking about their health than do older whites. It's also possible, she added, that the accumulated affects of racism could be driving down their perception of their own health.

Click here to access.

We need hits!

Check it out:

Disclosure: I do not own any stock in this company.

Wartime lessons impacting trauma care

From the San Diego Union article:

Some of the war-zone techniques are forcing trauma specialists to rethink practices that have been standard for years.

“We are learning at warp speed,” said Dr. Michael Sise, a clinical professor of surgery and chief of the trauma unit at Scripps Mercy Hospital in Hillcrest. “This is the fastest transfer of wartime learning in history.”
...
The rapid assimilation of battlefield lessons largely is being driven by health providers who also are military reservists. Upon returning from deployments in Iraq or Afghanistan, they apply newly learned techniques to their civilian jobs, Sise said. The information spreads quickly among hospitals through the nation's highly networked trauma-care system.

Click here to access.

Kickback or incentive?

From the Associated Press article:

All the doctors had to do was show up, enjoy a free dinner at an elegant Rochester, N.Y., area restaurant specializing in steaks, chops and top-shelf wines, and pocket $100 on the way out the door.

Health insurance companies had invited the physicians to hear a pitch about the benefits of prescribing generic drugs instead of their pricier, name-brand competitors.

Click here to access.

ACCME increases fees

Click here to access.

The uninsured and Emergency Department utilization

From the JAMA article:

Available data do not support assumptions that uninsured patients are a primary cause of ED overcrowding, present with less acute conditions than insured patients, or seek ED care primarily for convenience.

Click here to access the abstract. Senators McCain and Obama each have free-text articles on their respective health care plans published in this October 22/29, 2008 issue of JAMA.

Responses to the ACCME Summer 2008 Calls-for-Comment

Click here to access.

Health care solution contest announced!

Win $10 million dollars! From the AP article:

It may not involve rocket science, but a new X Prize Foundation competition for health care reform could pose the institute's most daunting challenge yet.

The California-based foundation, which helped launch the first private manned space flight in 2004, is teaming with the insurer WellPoint Inc. to try to fix the U.S. health care system.

The companies have announced an open competition to devise solutions that improve health care cost and quality, and they're dangling a prize of at least $10 million for the winner.

Click here to access.

"The State of Health Care Quality"

Check out NCQA's report; click here to access.

Culture and cancer

Check out the Wall Street Journal article "In Some Cultures, Cancer Stirs Shame"; an excerpt:

In Mrs. Wong's native China, people often keep illnesses like cancer a secret. That tradition continues even here in America, where her family settled in the 1950s. Years ago, Mrs. Wong's infant daughter developed a brain tumor and her own mother insisted she tell no one. When the baby died, the grandmother tried to dissuade Mrs. Wong from attending the funeral, so great was the stigma.

Click here to access; it was published on October 4th (sub. req.).

New guidelines to reduce side effects of NSAIDs

From the Washington Post article:

Three leading medical associations have created guidelines to help heart disease patients cut their risk of ulcers and gastrointestinal bleeding from the condition's most common treatments -- antiplatelets and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin.

The American College of Cardiology, the American College of Gastroenterology and the American Heart Association guidelines call on doctors to better assess the patient's risk factors before treatment starts.

Click here to access.

Manipulation of data?

From the New York Times article:

Pfizer’s tactics included delaying the publication of studies that had found no evidence the drug worked for some other disorders, “spinning” negative data to place it in a more positive light, and bundling negative findings with positive studies to neutralize the results, according to written reports by the experts, who analyzed the documents at the request of the plaintiffs’ lawyers.

One of the experts who reviewed the documents, Dr. Kay Dickersin of the Johns Hopkins Bloomberg School of Public Health, concluded that the Pfizer documents spell out “a publication strategy meant to convince physicians of Neurontin’s effectiveness and misrepresent or suppress negative findings.”

Pfizer issued a statement Tuesday denying that it had manipulated Neurontin data, saying “study results are reported by Pfizer in an objective, accurate, balanced and complete manner, with a discussion of the strengths and limitations of the study, and are reported regardless of the outcome of the study or the country in which the study was conducted.”

Click here to read the NYT article.

Another psychiatrist in the headlines

From the New York Times article:

One of the nation’s most influential psychiatrists earned more than $2.8 million in consulting arrangements with drug makers between 2000 and 2007, failed to report at least $1.2 million of this income to his university, and violated federal research rules, according to documents provided to Congressional investigators.

Click here to access.

A systems approach...

Check out the open access article "Physician attitude toward depression care interventions: implications for implementation of quality improvement initiatives"; click here to access.

SACME posts Responses to the ACCME Calls for Comments

Click here to access.

A gap in empathy?

From the New York Times article "Taking Time for Empathy":

Listening to transcripts and recordings of 20 conversations between men with lung cancer and their doctors, Dr. Diane Morse of the University of Rochester School of Medicine and her colleagues identified 384 “empathic opportunities” in the discussions — moments when a doctor might respond with a few words to address patient concerns ranging from fear of illness and death, to mistrust about care and the health care system, to confusion about treatment.

They found that the physicians missed 90 percent of opportunities to respond empathetically to their patients.

Click here to access.

Eli Lilly and Merck to disclose payments to physicians

From the New York Times article:

Amid a national debate over the influence of industry money on medical research and practice, two pharmaceutical giants say they will begin publicly reporting payments they make to outside doctors.

Click here to access.

Joint Commission issues alert

"Preventing errors relating to commonly used anticoagulants"; click here to access.

Mobile Resource Centers on Epocrates

From Epocrates:

Recent study data from Manhattan Research, reported that nearly three-fourths of physicians say that they would like more specialty-specific drug references, clinical applications, and medical tools/alerts available to them on their PDA.

Epocrates is listening to our users and answering their call with the launch of Mobile Resource Centers! These new Epocrates Mobile Resource Centers (mRC) provide healthcare professionals with access to valuable information to stay up-to-date on diagnoses and treatments in selected clinical areas. The Centers provide practical and highly-relevant content, including breaking news, research findings, conference highlights and related continuing medical education courses.

If you'd like to learn more, email Lisa Wray at lwray@epocrates.com.

Disclosure/disclaimer: I have no financial relationship with Epocrates and am not making a recommendation, just sharing news.

Senator Grassley sends letter to NIH Director

Click here to access.

Watch out for the tie!

From the New York Times article:

In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards. It found that about half the ties worn by medical personnel were a reservoir for germs, compared with just 1 in 10 of the ties taken from the security guards. The doctors’ ties harbored several pathogens, including those that can lead to staph infections or pneumonia.

Another study at a Connecticut hospital sought to gauge the role that clothing plays in the spread of methicillin-resistant Staphylococcus aureus, or MRSA. The study found that if a worker entered a room where the patient had MRSA, the bacteria would end up on the worker’s clothes about 70 percent of the time, even if the person never actually touched the patient.

Click here to access the article.

"45 Ways to Use Technology to Green Meetings"

This article by Corbin Ball offers practical suggestions (and links to websites) for going green. Click here to access. Hat tip to Face2Face.

2009 State Medical Licensure Requirements and Statistics

Click here to access.

Alliance and CMSS respond to ACCME's call for comments

Click here for the Alliance's response; click here for CMSS's response.

Is Internet education effective?

Check out the JAMA article "Internet-Based Learning in the Health Professions"; click here to access (sub. req.).

P4P...unintended consequences?

From the New York Times article written by Sandeep Jauhar, M.D.:

Under P4P, there is pressure to treat even when the diagnosis isn’t firm, as was the case with my patient with heart failure. So more and more antibiotics are being used in emergency rooms today, despite all-too-evident dangers like antibiotic-resistant bacteria and antibiotic-associated infections.

I recently spoke with Dr. Charles Stimler, a senior health care quality consultant, about this problem. “We’re in a difficult situation,” he said. “We’re introducing these things without thinking, without looking at the consequences. Doctors who wrote care guidelines never expected them to become performance measures.”

Click here to read this article.

National Health Plan Collaborative Publishes Online Toolkit

The National Health Plan Collaborative has created this toolkit of resources, lessons, best practices and case studies to help other health plans join the effort to reduce disparities. The toolkit shares what the Collaborative's members have done to develop and test new methods of measuring and addressing racial and ethnic disparities so that other health care decision-makers and leaders can learn from this work, implement these best practices and make the case for addressing the unacceptable differences in health care and health outcomes for health plan members throughout the country.

Useful resources featured in this toolkit include:

• Health plan case studies;
• Sample tools, forms, policies and resources for implementation;
• Videos of experts talking about the importance of reducing disparities and about firsthand experiences in developing and implementing interventions; and
• A compilation of resources in this field.

Click here to access.

New TV talk show "The Doctors"

Apparently the brain child of Dr. Phil's child, there's a new talk show in town:

...The Doctors, four renowned physicians with different medical specialties – ER physician (and former ABC “Bachelor”) Dr. Travis Stork; OB/GYN Lisa Masterson; cosmetic surgeon Dr. Andrew Ordon and pediatrician Dr. Jim Sears.

This groundbreaking new talk show does for health care what Dr. Phil has done for psychology – provides frank discussions in a fascinating, off-the-cuff manner.

Click here to access this new show's website (above excerpt from said website).

"FDA Final Guidance

on Procedures For Determining Conflict of Interest and Eligibility for Participation in FDA Advisory Committees" is available online. Click here to access.

"Potential Signals of Serious Risks/New Safety Information Identified by the Adverse Event Reporting System"

Quarterly report issued by the FDA, click here to access. Hat tip to Pharmalot.

Senate Finance Committee to continue hearings on health care reform

From the news release:

Senate Finance Committee Chairman Max Baucus (D-Mont.) today announced the next three hearings in the panel’s year-long review of issues in heath care reform. Baucus said the September hearings will focus on health care quality, delivery system reform, and insurance market reform. Throughout 2008, Baucus has convened hearings, roundtables, and events to prepare for congressional action on health reform next year. Baucus said today that he intends for the panel’s comprehensive examination of health care reform to continue to be a top priority during the next session of Congress.

Click here to access.

The implementation buzz

There's a new journal that CME professionals might want to take a serious look at...Implementation Science. Oh, yeah, and it's open access...very cool...

Click here to check it out.

The fight against superbugs

From the Wall Street Journal article:

The efforts, known as antimicrobial stewardship programs, team top pharmacists, infectious-disease specialists and microbiologists. The groups monitor the use of a hospital's antibiotics and restrict prescriptions of specific drugs when they become less effective at fighting infections. The heightened vigilance comes as the federal Medicare program plans to begin refusing to pay hospitals to treat preventable infections that patients contract while under the facilities' care.
...
Some VHA member hospitals are working with the University of Florida in Gainesville, which offers a free program to analyze a hospital's patterns of drug resistance and compares these with regional, state or national benchmarks. The program has been used by about 400 hospitals, according to its developer, John Gums, a professor of pharmacy and medicine, who has financed the program with grants from pharmaceutical companies.

Click here to access (sub. req.)

Interesting JAMA commentaries

Check 'em out:

New Developments in Managing Physician-Industry Relationships
David J. Rothman; Susan Chimonas
JAMA. 2008;300(9):1067-1069.

Industry-Sponsored Clinical Research: A Broken System
Marcia Angell
JAMA. 2008;300(9):1069-1071.

Industry Support of Medical Education
Arnold S. Relman
JAMA. 2008;300(9):1071-1073.

Click here to access (sub. req.).

Operation Medical Libraries (OML)

OML is a grass roots efforts whose mission is providing medical texts and journals to medical schools and hospitals in Iraq and Afghanistan. Originally founded as Books Without Borders, it started in April 2007 by Valerie Walker, Director of the UCLA Medical Alumni Association (MAA).

Click here to access the OML website.

Antipsychotics and risk of stroke

From the Washington Post article:

All antipsychotic drugs can increase the risk of stroke, but the risk is greatest among older patients with dementia, British researchers report.

Concerns about the risk of stroke and antipsychotics were first raised in 2002, especially in people with dementia. In 2004, Britain's Committee on Safety of Medicines recommended that antipsychotics not be used in people with dementia. And, in 2005, the U.S. Food and Drug Administration ordered manufacturers of atypical antipsychotics to add a black box warning to their products about the increased risk for stroke.

Click here to access the WP article.

Thiazolidinediones and heart failure

From the Science Daily article:

A class of oral drugs used to treat type 2 diabetes may make heart failure worse, according to an editorial published online in Heart Wednesday by two Wake Forest University School of Medicine faculty members.

"We strongly recommend restrictions in the use of thiazolidinediones (the class of drugs) and question the rationale for leaving rosiglitazone on the market," write Sonal Singh, M.D., M.P.H., assistant professor of internal medicine, and Curt D. Furberg, M.D., Ph.D., professor of public health sciences. Rosiglitazone and pioglitazone are the two major thiazolidinediones.
...
Singh said in an interview, "Safer, cheaper and more effective treatment alternatives are available that do not carry these negative cardiovascular risks in patients with diabetes. The rationale for the use of the thiazolidinediones is unclear."

Click here to access the SD article.

Study results indicate bypass better than angioplasty

...at least at the one year mark. From the AP article:

For heart patients with clogged arteries, the choice between bypass surgery or an angioplasty may come down to one question: How many procedures would you like to have?

In research presented Monday at the European Society of Cardiology meeting in Munich, experts concluded that while bypass surgery and angioplasty offer comparable results, patients who have angioplasties are twice as likely to require another procedure within a year.

...

Doctors cautioned that more data is still needed about the pros and cons of bypass surgery versus angioplasties, and that patients needed to be tracked for at least five years.

Click here to access.

Ova not so sure?

From the New York Times article "Cancer Test for Women Raises Hope, and Concern":

“You’ve got industry trying to capitalize on fear,” said Dr. Andrew Berchuck, director of gynecologic oncology at Duke University and the immediate past president of the society. “We’d all love to see a screening test for ovarian cancer,” he added, “but OvaSure is very premature.”

OvaSure’s debut also raises questions about whether greater regulation is needed to assure the validity of a trove of sophisticated new diagnostic tests that are entering the market and are being used as the basis for important treatment decisions. OvaSure did not go through review by the Food and Drug Administration because the agency generally has not regulated tests developed and performed by a single laboratory, as opposed to test kits that are sold to laboratories, hospitals and doctors.

Think sensitivity and specificity, and positive and negative predictive values, folks!! Click here to access the NYT article. If you'd like to learn more about sensitivity and specificity, etc., check out the BMJ article "Understanding sensitivity and specificity with the right side of the brain" published in 2003 (sub. req).

ACCME releases 2007 annual report data

Click here to access.

Russia an epicenter for MDR-TB

An excerpt from the Scientific American article "A Report from the Russian Front in the Global Fight Against Drug-Resistant Tuberculosis":

The Siberian provinces of the central Russian plateau—poor, even by Russian standards, with high rates of alcoholism, drug abuse and a large prison population—are among the epicenters of a worldwide epidemic of drug-resistant tuberculosis. Whereas the 490,000 reported cases of MDR-TB account for just a small fraction of the 9.2 million new cases and 1.7 million deaths from TB reported to the World Health Organization in 2006, MDR-TB represents a significant global public health hazard. In parts of Siberia, it accounts for more than 15 percent of all cases.

Click here to access the SA article.

Another medical school moves to pooled funding for CME

From the MarketWatch online article:

The Stanford University School of Medicine will no longer accept support from pharmaceutical or device companies for specific programs in continuing medical education, as industry-directed funding may compromise the integrity of these education programs for practicing physicians, officials said.
...
Under the new guidelines, the school may accept commercial support for CME only if it is provided for broad areas, such as medical, pediatric and surgical specialties; diagnostic and imaging technologies; and health policy and disease prevention. Funding must not be linked to a specific course, topic or program. In addition, commercial exhibits will no longer be permitted at Stanford-sponsored CME activities on or off campus.

Click here to read the entire article.

New FDA labeling rule

From the CCNMoney.com article:

Government regulators have issued new rules designed to keep drug warning labels clear and concise, though some say the new guidelines would also shield drugmakers from lawsuits.

The regulations from the Food and Drug Administration, which were released Thursday and take effect next month, explain when drug and medical device companies are responsible for rushing out safety updates on their products.

Click here to access the CCNMoney.com article. Also check out Drug and Device Law's blog entry on this rule by clicking here.

Ready for some fun?

From the New York TimesN article "Best Online Psychology Tests":

1. The Stroop Test. A fun test that measures how fast and flexible a thinker you are by using color-coded words.

2. The Worst Sounds. Grab your headset and take this online sound test to find out which sounds bother you the most. You’ll hear snoring, crying babies and nails on the chalkboard.

3. Personality Test. Check out the “I Just Get Myself” personality test. It comprises just 40 easy questions but delivers a surprisingly insightful (at least I thought so) assessment of your personality traits.

Click here to access the NYT article (and more online tests).

JAMA article on the history of CME

Recommend y'all read it; click here to access (sub. req.).

FDA to mandate special training on narcotic prescription?

From the New York Times article:

Should doctors be required to undergo special education in order to prescribe powerful narcotics? The Food and Drug Administration may soon recommend that they do so, though such a move would most likely prove controversial.

“I think it is a good idea, and it is something we are considering,” said Dr. Bob Rappaport, the director of the division of Anesthesia, Analgesia and Rheumatology Products at the F.D.A. But the agency itself does not have the authority to take such a step, Dr. Rappaport said.

Typically, state medical boards, rather than the federal government, impose licensing requirements on doctors, including the type of continuing education they must receive. A few states, including California, now provide doctors with education about the treatment of pain patients. But nationally, state medical boards have shown little interest in mandating added training in the use of potent pain medications or in screening patients for those prone to drug abuse.

Click here to access.

Survey indicates disruptive behaviors impact patient care

Check out the Joint Commission Journal on Quality and Patient Safety article "A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety." The authors make 12 recommendations on how organizations can address/prevent disruptive behaviors; ONE of which is education and training. A tidbit -- physicians are not alone in exhibiting disruptive behaviors.

Click here to access (sub. req.).

Coalition for Healthcare wants your input

regarding ACCME's Calls for Comments; from the Coalition's website posting:

We seek data and information that will support our comments as well as volunteers to help craft the Coalition comment. Please participate in the Coalition effort and support individual comments by your company or yourself. The Coalition comment would be strengthened by position statements supported by compelling data and examples of how commercially funded programs advance clinical knowledge in critical areas and advance patient care.

Click here to access the Coalition's commentary on this and how you can provide your input into this debate.

MA Governor signs 2863

From the Boston Globe article:

Governor Deval Patrick yesterday signed into law one of the nation's strictest limits on gifts given to medical professionals by drug salespeople, the most contentious measure contained in a broad package intended to improve healthcare safety and curb skyrocketing costs.
...
Still, the limits in the law put Massachusetts at the forefront of states in cracking down on the use of financial incentives to persuade doctors to prescribe particular drugs or medical devices. In addition to banning some gifts and requiring disclosure of others, it calls for the state to develop a code of conduct for industry representatives that includes a $5,000 fine for each violation.

Click here to access the TBG article.

6 rules for providers to keep in mind when they see patients...

From the New York Times article "Six Rules Doctors Need to Know":

Rule 1: They don’t want to be at your office.
Rule 2: They have a reason to be at your office.
Rule 3: They feel what they feel.
Rule 4: They don’t want to look stupid.
Rule 5: They pay for a plan.
Rule 6: The visit is about them.

Do you think any of these link up with the ACGME/ABMS core competencies? Click here to access the NYT article.

FDA alert issued...

"Information for Healthcare Professionals Simvastatin (marketed as Zocor and generics), Ezetimibe/Simvastatin (marketed as Vytorin), Niacin extended-release/Simvastatin (marketed as Simcor), used with Amiodarone (Cordarone, Pacerone)"

Click here to access the alert.

Important legislation introduced

From the news release on the Comparative Effectiveness Research Act of 2008:

Senate Finance Committee Chairman Max Baucus (D-Mont.) and Budget Committee Chairman Kent Conrad (D-N. D.) introduced last night legislation to improve the quality of health care that Americans receive, by creating national priorities for, and conducting and distributing research findings on the effectiveness of different health care treatments. The Comparative Effectiveness Research Act of 2008 will establish the Health Care Comparative Effectiveness Research Institute to review evidence and produce new information on how diseases, disorders, and other health conditions can be treated to achieve the best clinical outcome for patients. The Congressional Budget Office has signaled that national health care spending could be reduced if physicians and patients had more unbiased data on the effectiveness of the treatments available to them.

Click here to access the entire news release.

Med com companies take another hit

From the Business Week article "Teaching Doctors--or Selling to Them?":

Trying to steer clear of potential conflicts of interest, two medical industry giants are distancing themselves from a little-known breed of marketing specialists. The recent steps by the drugmaker Pfizer (PFE) and Zimmer Holdings (ZMH), a medical device manufacturer, illuminate subtle promotional tactics other companies continue to aim at doctors, despite mounting concern on the part of some physicians and ethicists.

Click here to access. Hat tip to Dr. Carlat.

SACME and NAAMECC release "joint" assessment tool

What's it used for?...to assess potential joint sponsors. Click here to access.

Regional differences in health care (and cost)

I've directed your attention to this resource before, but methinks it bears repeating. If, for instance, you are interested in seeing how your region stacks up against the national average (surgery rates per 1,000 Medicare enrollees) on knee replacement, heart bypass, mastectomy, then click here. Encourage y'all to click around in it...as indicated by the blog heading, there is cost information as well.

New study indicates that U.S. HIV infection rates higher than previously estimated

From the New York Times article:

The United States has significantly underreported the number of new H.I.V. infections occurring nationally each year, with a study released here on Saturday showing that the annual infection rate is 40 percent higher than previously estimated.
...
The findings confirm that H.I.V., the virus that causes AIDS, has its greatest effect among gay and bisexual men of all races (53 percent of all new infections) and among African-American men and women.
...
Dr. Gerberding said the new findings were “unacceptable,” adding that new efforts must be made to lower the infection rates. “We are not effectively reaching men who have sex with men and African-Americans to lower their risk,” she said.

The study will be published in the August 8th issue of JAMA. Click here to access the NYT article.

MA bill 2863 passes (altho altered a bit)

Click here to access.