Reining in of DTC advertising?

From the New York Times article:

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

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

Click here to access the NYT article.

Culture and health care delivery

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

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

Click here to access this article.

Will the health insurance industry change?

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

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

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

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

Cleveland Clinic in the spotlight

From the Wall Street Journal article:

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

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

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

Pay for Value?

From the Washington Post blog posting (Daily Dose):

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

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

Parental stress plus pollution factors in childhood asthma

From the Time article:

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

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

Click here to access.

ACCME Releases 2008 Annual Report Data

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

A "rose" by another name?

From the Boston Globe article:

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

Click here to access the BG article.

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

From the Wall Street Journal article:

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

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

ACCME to host Educational Measurement Workshop

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

Variation in outcomes for MI, HF, and pneumonia

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

Doctors are human, too

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

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

Click here to access the article.

Senator Grassley sends letter to medical journals asking about ghostwriting

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

Hospitals to give up $155 billion in future payments

From the AP article:

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

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

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

Click here to access the article.

WHO issues Patient Care Checklist (H1N1)

From WHO's website:

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

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

Click here to access the checklist.

New restrictions on painkillers?

From the Bloomberg article:

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

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

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

IOM Report recommends research for 100 health topics

From the National Academies news release:

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

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

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

Grassley seeks information about medical school policies

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

Would Zeus approve?

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

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

Click here to access Doctor Chen's column.

NIQIE Educational Opportunity

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

Open access KT article

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

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

Click here to access the response letter.

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

Click here to access.

Tobacco-control bill passed by U.S. Senate

From the USA Today article:

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

Click here to access the article.

It's official -- it's a pandemic

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

Check out Dr. Reece's blog posting

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

What WHO Definition?

From the Associated Press article:

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

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

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

Click here to access.

Patient-centered care

From the New York Times article:

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

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

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

Unintended consequences?

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

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

Click here to access the BG article.

Core measures and patient safety goals?

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

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

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

Commercial support-free CME?

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

Breast Cancer Patient Protection Act in Congress

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

Physician use of the internet

From the iHealthBeat article:

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

Click here to access the IHB article for the stats.

Taking a moment to reflect

From cnn.com:

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

Click here to access this story.

Health care fraud in Medicare and Medicaid programs

From the Washington Post article:

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

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

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

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

Click here to access.

Doctor Hamburg confirmed by Senate

From the New York Times article:

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

Click here to access the NYT article.

CDC update on H1N1 situation

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

No branded pharma gift too small?

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

Vermont bill amended

From the Prescription Project Blog:

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

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

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

Dr. Frieden to head up the CDC

From the New York Times article:

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

Click here to access the NYT article.

The 2008 AAMC/SACME Harrison Survey

Click here to access.

A cereal prescription?

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

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

Click here to access the letter.

Staffing changes at ACCME

Click here to access ACCME's news release.

Mother of the year?

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

From the MedPage Today® news release:

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

Click here to access.

Sen. Grassley to stay put (for now)

From the FiercePharma article:

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

Click here to access.

Robert Wood Johnson posts "More Than Words Toolkit Series"

From the Robert Wood Johnson website:

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

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

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

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

Click here to access the toolkit.

Additional resources on swine flu

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

Confirmed swine flu cases and precautions by country

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

Grassley leaving Senate Finance Committee?

From the FiercePharma article:

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

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

Click here to access.

Dalhousie offers Online Education on Swine Flu (H1N1)

Click here to access.

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

Click here to access.

Institute of Medicine releases COI report

From the Science News article:

1) Congress should require that pharmaceutical, device and biotechnology companies report on some public website all payments they make to physicians, researchers and medical organizations. "Such a public record would deter inappropriate relationships,” Lo said, and help medical institutions, publishers and others verify that physicians and researchers who do work for them have disclosed all real or potential conflicts of interest.

2) Medical centers and other research institutions should establish a policy prohibiting human trials if the researchers "have a significant financial interest in an existing or potential product or a company that could be affected by the outcome of the research." Any exceptions should be made public and allowed if only if no unbiased researchers can be found. And even then, the report said, a mechanism must exist to make data on the potential bias publicly available.

3) Research centers and hospitals should prohibit faculty, students, residents and medical fellows from: accepting “items of material value” from industry; giving presentations or writing papers where content is controlled by industry or “written by someone who is not identified as an author or who is not properly acknowledged;” consulting without a written contract and receiving payment at “fair market value" for services; using or distributing drug samples provided by industry “except in specified situations for patients who lack financial access to medications.”

4) Most state licensing boards, medical-specialty boards and hospitals require that physicians commit to lifelong learning. Indeed, participation in continuing medical education, or CME, courses can be essential for a doctor to remain licensed or certified. The new report finds that industry provides roughly 25 percent of the funding to run CME courses offered by professional societies, more than half of the costs to medical schools for CME courses and almost 75 percent of the costs incurred by outside commercial groups who offer CME courses. That’s got to change, the IOM panel argues. Indeed, Lo says, “the goal would be to have a [CME] system . . . that is free of industry or industry influence.”

Click here to access the Science News article. Click here to access the free Executive Summary of the IOM report.

AMA throws their hat into the online ring

From the FierceHealthIT news article:

The American Medical Association is pilot-testing what could turn out to be a hefty portfolio of web services to doctors, including electronic prescribing capabilities, reference databases and access to online continuing medical education. To build the services, the AMA is working with the Detroit-based healthcare IT platform provider Covisint.

Click here to access.

Resources on Swine Flu

Click here to access.

ACCME issues calls for comments...

• ACCME Rule Making


• Commercial Support-Free Accredited Continuing Medical Education designation


• Promotional Teacher and Author-Free Accredited Continuing Medical Education designation


• Independent CME Funding Entity
  
  Click here to access.

CMEHUB (online CME catalog)

Came across an online CME course catalog that allows physicians to search for CME courses by keywords, and CME providers apparently can have their CME courses listed for free. Click here to access. Disclosure: I have no relationship with this website service.

A champion bull rider/an elegant fox trotter

My hat is off to you, Ty!

A checklist for ethics?

From the AMNews article:

For ages, doctors have used lists and other reminders to help them give the right care to patients. Recently, the use of checklists in areas such as surgery and infection control has delivered remarkable results, greatly reducing morbidity and mortality.

Beginning in April, residents working in the intensive care unit at the Washington Hospital Center in Washington, D.C., got a different kind of reminder when caring for patients -- an ethics checklist.

The idea is the brainchild of Daniel K. Sokol, PhD, a medical ethicist at the University of London St. George's Hospital Medical School who served as a visiting bioethics scholar at the Washington Hospital Center in January and February.

Click here to access.

ACCME posts examples from providers

ACCME posted a compendium of actual provider practices that were reviewed through the accreditation process over the past several months. Click here to access this resource.

Harvard-affiliated hospitals issue new COI policy

From the NEWSInferno article:

Hospitals affiliated with Harvard University are implementing a stricter conflicts-of-interest policy for their doctors. According to a press release from Partners in Health Care, the new policy not only bans doctors from accepting gifts from drug or medical device makers, it also prevents physicians from serving as paid speakers for such companies.
...
In addition to banning gifts - including free meals - and paid speaking engagements, the new policy also bars drug makers from accepting fee drug samples. Instead, such samples must be provided through a hospital pharmacy or another central mechanism. Sales reps won’t be able to visit staff unless they have “written invitations defining the purpose and terms of visits”, the press release said.

Click here to access the article.

Google and Microsoft think HIPAA doesn't apply to them

From the iHealthBeat article:

Google and Microsoft maintain that they are not subject to HIPAA privacy regulations, BNET Healthcare reports.

Last month, Google Health Product Manager Roni Zeiger said, "Our understanding is that HITECH, which is the jargon for (the health IT) part of the legislation, did not change the definition for a covered entity or a business associate, so our service is offered directly to the consumer." He added, "(O)ur understanding is that we are neither a covered entity nor a business associate. We're providing a service directly to the consumer or a patient."

At this week's annual Healthcare Information and Management Systems Society conference in Chicago, David Cerino, general manager of Microsoft's Health Solutions Group, said, "We're still outside" of HIPAA.

Click here to access the article.

Something seniors should be aware of...

From the New York Times article:

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?
...
Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

Click here to access the NYT article.

Check out this new JAMA article

"Professional Medical Associations and Their Relationships With Industry: A Proposal for Controlling Conflict of Interest". Click here to access (sub. req.)

End of the industry RFP?

From the Milwaukee Journal Sentinel article "Drug firms' cash skews doctor classes":

Do your legs feel tingly? Do you suffer from mood swings before your period? Would you take a mind-altering drug to quit smoking?

If so, the pharmaceutical industry and the University of Wisconsin-Madison want to teach your doctor a lesson.

Drug companies have largely taken over the field of doctor education, in part by bankrolling physician education courses at medical schools.

Critics say the practice increases medical costs by encouraging doctors to write prescriptions for expensive brand-name drugs and by exaggerating the frequency and prevalence of rare conditions. It also promotes the use of drugs not approved for the ailments.

A Journal Sentinel investigation found that industry-funded doctor education courses offered at UW often present a slanted view by favoring prescription medications over non-drug therapies and by failing to mention important side effects.

Click here to access the MJS article. Click here to read Dr. Carlat's blog posting on this article. Hey, I just tell you what's out there in the news!

Joint Accreditation for the Provider of Continuing Education for the Healthcare Team Now Available

Click here for the news release. Click here for information on eligibility, accreditation criteria, accreditation processes and outcomes.

ACCME releases new Q&A on the Standards for Commercial Support of CME

Click here to access. Oh, if only it were this simple....there might be another consideration regarding the provision of skills training. What do y'all think?

ABMS announces new standards on physician life-long learning

From the ABMS news release:

The ABMS Board of Directors (BOD) approved the standards, proposed by the ABMS Committee on Oversight and Monitoring of Maintenance of Certification (COMMOC), at its March 16 meeting. This uniform set of standards outlines and sets timelines for officially adopting several new MOC program elements, including:

* Documentation that physicians are meeting continued medical education (CME) and self-assessment requirements
* Evidence of participation in practice-based assessment and quality improvement every two to five years
* Completion of a patient safety self-assessment program at least once during each MOC cycle .
* Assessment of communication skills as a standard for all physician diplomates with direct patient care - using a Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient survey (or other COMMOC-approved survey), and an approved peer survey

Click here to access the news release.

Vitamin D3

Check out the Archives of Internal Medicine article on Vitamin D3. The authors' conclusion?

Nonvertebral fracture prevention with vitamin D is dose dependent, and a higher dose should reduce fractures by at least 20% for individuals aged 65 years or older.

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

CDC statistics on non-fatal falls associated with dogs and cats

From the MMWR report:

Falls are the leading cause of nonfatal injuries in the United States. In 2006, nearly 8 million persons were treated in emergency departments (EDs) for fall injuries (1). Pets might present a fall hazard (2), but few data are available to support this supposition. To assess the incidence of fall-related injuries associated with cats and dogs, CDC analyzed data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) for the period 2001--2006. This report describes the results of that analysis, which showed that an estimated average of 86,629 fall injuries each year were associated with cats and dogs, for an average annual injury rate of 29.7 per 100,000 population. Nearly 88% of injuries were associated with dogs, and among persons injured, females were 2.1 times more likely to be injured than males. Prevention strategies should focus on 1) increasing public awareness of pets and pet items as fall hazards and of situations that can lead to fall injuries and 2) reinforcing American Veterinary Medical Association recommendations emphasizing obedience training for dogs (3).

Click here to access the MMWR report. Bob (above) swears he's not responsible for any of those falls!

AARP's take on the top 125 hospitals

From the AARP The Magazine: article

But just because a particular hospital appears to be the most successful at treating your disorder doesn't mean you should go there. Deciding whether to travel for care can involve weighing difficult trade-offs. Travel costs money, even if insurance covers the cost of treatment...And it's impossible to put a price tag on the advantages of being in familiar surroundings, cocooned by family and friends who can stay by your side and ask questions.

Click here to access the AARP article.

APA just says no to satellite industry events at annual meeting

From the New York Times article:

Amid increasing Congressional scrutiny of ties between doctors and drug makers, the American Psychiatric Association announced on Wednesday that it would end industry-financed medical seminars at its annual meeting. The association, the field’s premier organization, said it would also phase out meals at the meeting paid for with industry money.
...
Industry-supported seminars are commonplace at annual meetings throughout medicine, as are payments to doctors and other financial arrangements. The psychiatric association said it had no plans to eliminate drug advertisements in its journals, commercial exhibits at meetings, or industry-sponsored fellowships for doctors.

Click here to access the NYT article.

Tuberculosis worldwide

The website GlobalHealthFacts.org has just posted the 2007 stats on TB. Click here to access. Remember that book The Coming Plaque? Well, the author, Laurie Garrett also wrote this book: Betrayal of Trust: The Collapse of Global Public Health.

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.