CACHE Open Access Library

The Open Access Library on the CACHE Web site (Canadian Association of Continuing Health Education) contains links to a large number of Open Access publications in continuing medical education. Courtesy of Anne Taylor-Vaisey MLS, Reference Librarian at the CMCC Health Sciences Library, click here for a link to the full text of all the articles in the special March 2009 CME supplement of Chest (as well as links to the PubMed records for these articles). Additionally, you might also want to click here and visit CACHE's Web Resources section (includes an External Power Search engine that searches within many of the sites that CACHE links to). A BIG thanks to Anne!

Make your voice heard!

Do you want to email the President and let him know your thoughts on anything? If so, click here. Google your senators and representatives and email them as well.

Dr. Hamburg to head FDA?

From the New York Times article:

President Obama intends to nominate Dr. Margaret A. Hamburg, a former New York City health commissioner, to lead the Food and Drug Administration, sidestepping a battle between drug safety advocates and the drug industry, people briefed on the decision said.
...
The F.D.A. is arguably the most important public health agency in the country, but its budget has lagged far behind those of agencies like the Centers for Disease Control and Prevention. A growing list of scandals has led a bipartisan chorus on Capitol Hill to demand major changes and larger budgets, with some legislators advocating that the F.D.A. be split in two.

Click here to access the NYT article. Click here to access Dr. Hamburg's bio.

Mass. passes regs on pharma and med device companies

From the Boston Globe article:

State officials gave final approval yesterday to regulations banning pharmaceutical and medical device companies from providing gifts to physicians, limiting when companies can pay for doctors' meals, and requiring companies to publicly disclose payments to doctors over $50 for certain types of consulting and speaking engagements.
...
There are two substantive changes, however. Companies will have to disclose payments to doctors and hospitals for research designed to promote a particular product, sometimes called "seeding trials"; funding for research aimed at answering a scientific question will still not have to be disclosed.

Also, the department eliminated a provision allowing companies to provide financial assistance for medical residents and other trainees to attend conferences and education courses.
...
The regulations will take effect July 1, and the first public reporting by companies will be due by July 1, 2010.

Click here to access.

Seton Hall Law School 's Center for Health & Pharmaceutical Law & Policy Releases White Paper Recommending Reform of Drug & Device Promotion

The recommendations regarding industry support of CME:

• A paradigm shift to end commercial support for CME should be undertaken. This will require fundamental change in practice by industry and by organized medicine, which must design less costly, professionally-driven and controlled mechanisms for CME.

• In the interim, as CME makes this substantial transition, conflicts of interest in CME should be more fully disclosed and managed. Specifically, disclosure to CME providers and attendees by physicians and other speakers should identify the nature and magnitude of the speaker’s financial interests, with such interests defined broadly to include financial relationships and support for the speaker’s academic department.

• The Accreditation Council for Continuing Medical Education (ACCME) should issue more specific guidelines that address financial disclosure, circumstances when safeguards such as independent review are required to manage a conflict of interest, and criteria to determine when conflicts should preclude participation by a presenter. A physician’s role promoting a product should preclude his or her participation as a speaker at an accredited CME event for that product.

Click here to access the white paper.

"Fraud Case Rocks Anesthesiology Community"

From the Anesthesiology News article:

In what experts are calling one of the largest known cases of academic misconduct, a leading anesthesiology researcher has been accused of falsifying data and other fraud in potentially dozens of published studies.

Click here to access the article.

Medical imaging quality gap?

From the New York Times article:

More than 95 million high-tech scans are done each year, and medical imaging, including CT, M.R.I. and PET scans, has ballooned into a $100-billion-a-year industry in the United States, with Medicare paying for $14 billion of that. But recent studies show that as many as 20 percent to 50 percent of the procedures should never have been done because their results did not help diagnose ailments or treat patients.

“The system is just totally, totally broken,” said Dr. Vijay Rao, the chairwoman of the radiology department at Thomas Jefferson University Hospital, in Philadelphia.
...
Accrediting will be partly addressed by a little noticed aspect of a wide-ranging Medicare law passed last year. After it goes into effect in 2012, Medicare will pay only for scans done at accredited centers. But imaging experts say the law fixes only part of the problem. High-tech scanning is complicated, and there is no consensus on objective measures to ensure quality. Even with the new law, there is still little assurance that scans will be appropriately ordered and interpreted or that a scanner will be up to date.

Click here to access.

Sebelius nominated for HHS secretary

From the New York Times article:

Gov. Kathleen Sebelius of Kansas was chosen as secretary of health and human services on Monday by President Obama, who hailed her as an ideal person to work with Republicans as well as Democrats to fix an ailing health care system.
...
But on matters of health policy, which she will oversee if her nomination is confirmed by the Senate, Ms. Sebelius’s efforts to forge bipartisan consensus have rarely succeeded. She recently observed that the greatest frustration of her six years in office had been her inability to persuade lawmakers to raise tobacco taxes for a modest expansion of government health coverage.

Now, with the backing of a Democratic Congress, Ms. Sebelius will have a chance to achieve in Washington what she failed to accomplish in Topeka, and then some. Mr. Obama is effectively making her the point person for what may become the largest expansion of taxpayer-subsidized health insurance in more than four decades.

Click here to access.

Forest accused of fraud

From the FierceBiotech article:

A Complaint was unsealed today in U.S. District Court in Massachusetts against a New York pharmaceutical company for alleged False Claims Act violations arising from the company's marketing the drugs Celexa and Lexapro for unapproved pediatric use and for paying kickbacks to induce physicians to prescribe the drugs.
...
The United States alleges that federal health care programs have paid thousands of false and fraudulent claims for Celexa and Lexapro prescriptions that were not covered for off-label pediatric use and/or were ineligible for payment as a result of illegal kickbacks paid by Forest.

Click here to access the article.

Responses to AMA Council on Ethical and Judicial Affairs and the Council on Medical Education on Conflict of Interest and Bias

For SACME's response, click here.
For NAAMECC's response, click here.
For CMSS's response, click here.
Thanks to SACME for posting all of these responses! It will be interesting to see the outcomes of the 2/25/09 CME Stakeholders Meeting in Chicago.

Vitamin D lessens the chance of catching a cold?

From the CNN.com article:

One reason vitamin D is so interesting is that unlike other vitamins, vitamin D acts as a hormone in the body and is known to help regulate at least a thousand genes, said Melamed. It's a cell-signaling molecule that may play a role in controlling the immune system, fighting cancer, improving cardiovascular health, and possibly regulating blood sugar. (There are vitamin D receptors in blood vessels and in the pancreas, which regulates blood sugar.)

For now, the jury is still out on vitamin D's link to respiratory infections. But it's a tantalizing link.

Click here to access the article.

IOM releases report on uninsured in U.S.

From the National Academies press release:

The evidence shows more clearly than ever that having health insurance is essential for people's health and well-being, and safety-net services are not enough to prevent avoidable illness, worse health outcomes, and premature death, says a new report from the Institute of Medicine. Moreover, new research suggests that when local rates of uninsurance are relatively high, even people with insurance are more likely to have difficulty obtaining needed care and to be less satisfied with the care they receive.
...
The report responds to key questions being raised in the national debate about health care reform, including whether having insurance is essential for gaining access to necessary services given the availability of charity and free emergency care, and whether lack of coverage has wider ripple effects on whole communities. Written by a committee of experts in medical care, emergency medicine, health policy, business, economics, and health research, the report provides an independent assessment of published studies and surveys as well as newly commissioned research on the impacts of lack of coverage.

Click here to access the press release.

Pneumonia vaccine may cut risk of MIs

From the Canada.com article:

A vaccine that helps protect against pneumonia can also cut the risk of heart attacks, opening the door to a safe and inexpensive way to prevent thousands of cardiac deaths each year, new research shows.

The vaccine, typically used to protect the elderly against the most common cause of bacterial pneumonia, can lower the rate of heart attacks by as much as 50 per cent, says the study, published in the latest issue of the Canadian Medical Association Journal.

Click here to access the lay article. Click here to access the CMAJ abstract (sub. req.).

Army Medical goes to voice recognition technology

From the Healthcare IT News article:

The U.S. Army Medical Department has expanded its use of speech technology to 10,000 of its physicians to more than 90,000 worldwide.
...
"The use of voice-recognition software with the AHLTA e-health record system is freeing doctors from several hours of typing into AHLTA their various patient notes each week," said Robert Bell Walker, European Regional Medical Command AHLTA consultant and a family practice physician for the military.

Click here to access.

"Comparative effectiveness research"

From the New York Times article:

The $787 billion economic stimulus bill approved by Congress will, for the first time, provide substantial amounts of money for the federal government to compare the effectiveness of different treatments for the same illness.

Click here to access.

Medical Meetings Magazine's Annual Physicians' CME Preferences Survey

Click here to access the MM article on the survey results.

Pfizer Transparency

From Pfizer's press release:

Pfizer Inc today announced its plans to make publicly available its compensation of U.S. healthcare professionals for consulting, speaking engagements and clinical trials. The disclosure will include payments made to practicing U.S. physicians and other healthcare providers, as well as principal investigators, major academic institutions and research sites for clinical research. This makes Pfizer the first biopharmaceutical company to commit to reporting payments for conducting Phase I-IV clinical trials in addition to disclosing payments for speaking and consulting. This disclosure demonstrates Pfizer’s commitment to increased transparency and public candor.

Click here to access.

Additional ACCME info on that breakout session at the Alliance

Click here to access.

Patient education?

From the Healthcare Finance News article:

Thirty days after their hospital discharge, the 370 patients who participated in the RED program had 30 percent fewer subsequent emergency visits and readmissions than the 368 patients who did not. Nearly all (94 percent) of the patients who participated in the RED program left the hospital with a follow-up appointment with their primary care physician, compared to 35 percent for patients who did not participate.

And 91 percent of participants had their discharge information sent to their primary care physician within 24 hours of leaving the hospital.

Click here to access the HFN article. Click here to access the Annals of Internal Medicine article (sub. req.).

"Closing the Quality Gaps Using the ACCME Updated Accreditation Criteria"

This session was presented at the recent Alliance conference by Steve Singer, PhD, Director, and Marcia K. Martin, Manager, respectively, of the ACCME's Education , Monitoring,and Improvement Division. Click here to access their materials posted online at the ACCME web site.

More docs in Congress

From the Chicago Tribune article:

"The number of physicians in Congress continues to grow, with 16 physicians in the 111th Congress, demonstrating intense physician interest in making a difference in people's health and their lives," said Dr. Nancy Nielsen, president of the AMA.

Click here to access the article.

New AMA web site

From the Medical News Today article:

Offering a fresh look and redesigned content, the American Medical Association (AMA) today launches a new Web site to help physicians, residents, and medical students easily obtain resources and tools relevant to their individual professional needs.
...
Physicians can find useful billing and reimbursement resources, along with numerous tools ranging from patient education to clinical practice standards.

Click here to access the article; click here to access the new AMA web site.

Harvard medical school to toughen COI policy

From the Boston Globe article:

Harvard Medical School plans to strengthen its conflict-of-interest rules for doctors and researchers, amid a US Senate investigation into several faculty members and a new state law that will make public some of the payments doctors receive from pharmaceutical and medical-device companies.

Many top medical schools, including Stanford University, the University of Pennsylvania, the University of California at Los Angeles and at San Francisco, and the University of Massachusetts have adopted stricter policies in the past two years. Last year, the American Medical Student Association graded Harvard with an F on its conflict-of-interest policy because it does not address issues like whether companies can provide gifts and meals for faculty.

Click here to access the article.

FDA to research DTC advertising

From the AMNews article:

The Food and Drug Administration has outlined a novel study designed to measure participants' recall and comprehension of risk and benefit information in television ads.

The agency will produce ads for a fictitious blood pressure medication and recruit 2,400 participants to view them and report on the messages they take away. The study design was announced in the Dec. 30, 2008, Federal Register, and the agency is gathering comments until Jan. 29. The FDA's intention to conduct the study was first announced in 2007.

Click here to access the article.

Fantastic Voyage?

From the New York Times article:

THE doctor’s advice to “take two aspirin and call me in the morning” may one day be updated to “take this pill, and it will call me in the morning.”

Philips Research in Eindhoven, the Netherlands, has developed a prototype for a pill that can be programmed to navigate toward a specific trouble spot in the body and deposit its medicine there, radioing dispatches to the doctor as it travels.

Click here to access the NYT article.

Doctor Who?

From the New York Times article:

Researchers at the University of Chicago interviewed 2,807 adults admitted to the school’s hospital over a 15-month period. The patients were asked about the roles of the various physicians attending to them and to name the doctors on those teams. Medical teams consisted of three to four people, including medical students, residents and attending physicians.

Some 75 percent of the patients were unable to name a single doctor assigned to their care. Of the 25 percent who responded with a name, only 40 percent were correct. Those patients who claimed to understand the roles of their doctors were more likely to correctly identify at least one of their physicians.

Click here to access the article.

Delays in getting women with heart trouble to ERs

From the New York Times article:

But 647 patients, about 11 percent, were delayed, spending 45 minutes or longer in the care of emergency workers.

Women were 52 percent more likely than men to be among the delayed, said Thomas W. Concannon, an assistant professor of medicine at Tufts University who was lead author of the study, published this month in Circulation: Cardiovascular Quality and Outcomes.

It is not clear what caused the waits, he said, but other studies have suggested that heart problems in women are not recognized as readily by medical personnel.

Click here to access the NYT article. Click here to access the Circulation: Cardiovascular Quality and Outcomes journal article.

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.