Michigan podiatrists skipping out on CE?

Two Michigan Podiatric Medical Association employees blew the whistle on their own organization's practices, were fired, and now have filed a lawsuit against the association. From the Lansing State Journal:

The suit against the association and seven board members alleges some podiatrists would get credits at a major annual conference without attending the lectures. Continuing education credits are required for podiatrists to renew their medical licenses.

"People would sign in and either not attend the lectures or leave and go back to their offices and work and come back at the end of the day, sign in and get full credits," said former executive director Mark Dickens said. "There were instances where the lecture never occurred, and there was no one there."

Dickens and former marketing director Meghan Webber claim the association board of directors resisted their efforts to fix the system and fired them after they filed complaints with the state.

Last week, state community health officials got the go-ahead to launch a formal investigation.

Click here to access the article.

Survey on Impact of Senate Finance Committee Report

My friends over at Medical Meetings magazine took me up on my suggestion to post an online survey on this topic. What impact do you think the recent Senate Finance Committee Report will have on the world of CME? -- click here to access this short survey and tell MM what you think (Thank you, Medical Meetings magazine!). Click here to access the Senate Finance Committee's Report.

Physicians and industry survey results

The results of a 2003-2004 survey of 3,167 physicians representing six specialties have just been published in the New England Journal of Medicine:

Most physicians (94%) reported some type of relationship with the pharmaceutical industry, and most of these relationships involved receiving food in the workplace (83%) or receiving drug samples (78%). More than one third of the respondents (35%) received reimbursement for costs associated with professional meetings or continuing medical education, and more than one quarter (28%) received payments for consulting, giving lectures, or enrolling patients in trials. Cardiologists were more than twice as likely as family practitioners to receive payments.

Click here to access the abstract.

Short sightedness?

Jerry Avorn, MD, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, gives his perspective on the Prescription Drug User Fee Act (PDUFA) in the New England Journal of Medicine:

There were problems with the user-fee approach from the beginning. The original legislation required that no portion of companies' fees (about half a million dollars per drug reviewed) could be spent to evaluate drug side effects after approval — the time when many important safety concerns become apparent. The new law mandated strict deadlines for approval decisions. To comply, the FDA reassigned staff scientists to work on new drug applications, pulling the scientists from other regulatory activities. Several were taken from the Office of Drug Safety, which conducts adverse-effects surveillance — a move that helped to shrink and demoralize that unit.

Click here to access (registration required; NEJM is offering as a free text article). Please note there are a couple of other free text articles on FDA reform in the same issue.

Senate Finance Committee issues report on educational grants from industry

Well, here it finally is -- "Use of Educational Grants by Pharmaceutical Manufacturers" -- an excerpt from the Executive Summary of this report:

Indeed, ACCME’s records reveal numerous cases over the past 3
years in which companies had too much influence over the content of supposedly independent educational programs. In one case, a CME provider was cited for allowing a company to help select presenters; in another, the company allegedly influenced the setting and frequency of educational events. One CME provider was cited for promoting the ‘‘proprietary business interests of a commercial interest’’ during an educational program. During 2005 and 2006, 18 of the 76 CME providers reviewed by ACCME—or 24 percent—did not comply with at least one of the standards meant to ensure independence.

Another continuing concern for the Committee staff is the lack of proactive or real time oversight for educational grant programs. CME providers are not required to run prepared text by the FDA, ACCME, or any regulatory authority in advance of CME programs, and the FDA and ACCME do not routinely place monitors in CME audiences to assess what information is presented. Both the FDA and ACCME have intervened after the fact when presented with evidence that abuse occurred in educational grant programs. They do not, however, pre-approve or directly monitor educational grant programs and oversight actions may occur long after the problematic educational activity occurred. Even when ACCME determines that the CME providers repeatedly failed to distance themselves from the drug companies that sponsor them, ACCME can take years to impose penalties. Based on ACCME policies, it can take as long as 9 years from the date of a non-compliant educational activity for an educational provider to lose accreditation.

Click here to access the report.

Do drug reps "play" doctors?

Interesting article over at PLoS: "Following the Script: How Drug Reps Make Friends and Influence Doctors." Click here to access the article; if you read it, let me know what you think.
:)

Public Library of Science (PLoS)

A quick post to let readers know about this peer-reviewed open-access online journal. From the PLoS website:

PLoS is a tax-exempt, 501(c)3, nonprofit corporation headquartered in San Francisco, California (Federal Tax ID 68-0492065). PLoS is governed by a Board of Directors chaired by PLoS co-founder Harold Varmus.

PLoS received a $9M start-up grant from the Gordon and Betty Moore Foundation and has received support from the Sandler Family Supporting Foundation, the Open Society Institute, the Irving A Hansen Memorial Foundation, the Doris Duke Charitable Foundation, the Ellison Medical Foundation, the Burroughs Wellcome Fund, and many other foundations, universities, and other organizations and individuals.

Click here to access this online journal.

Are we too used to seeing overweight children?

As reported in the Wall Street Journal, heart researchers at Cincinnati Children's Hospital Medical Center have "found that a number of kids viewed as normal, healthy children by their parents and even the medical staff at the hospital were later found to have enlarged hearts -- a thickening in the wall of the main pumping chamber. Even some children under 10 years old showed signs of the condition, known as left ventricular hypertrophy, or LVH." From the article:

Given the attention on childhood obesity today, how could doctors not notice that these kids were heavy? One argument is that there are so many of them.

"We've grown so accustomed to an overweight child walking into the exam room that we've lost our visual representation of what a normal child is supposed to look like," says Tom Kimball, a pediatric cardiologist at the hospital. In short, overweight is the new "normal."

Click here to read the entire article (subscription required).

Delivering bad news

Is there a good way to tell a mother that her daughter has died? Let's say there is a compassionate way to do so and doctors in training at Emory University School of Medicine get to practice delivering bad news in a simulation workshop:

"They might not remember your name, but they will remember exactly the phrasing you used, how you said it, if they were confused," she tells the doctors. "People can recall that event very, very vividly. People can relive that and replay that." To avoid any confusion or misunderstanding, she advises the doctors to choose their words carefully. Instead of saying "passed on" or "not going to make it," she tells them to be straightforward. "I've seen family members be confused when someone goes in to talk about the news of death and (the doctors) can't actually say the person has died."

Click here to access the CNN.com article.

Medinnovation Blog

Although the writings of Richard L. Reece, M.D. are certainly not new to me, I've just discovered he has his own blog! And, I'm very happy to report, I have his permission to link from my blog to his! (Now if only Sam Elliott will contact me, life will be complete).
:)
Click here to access Doctor Reece's blog; interesting, interesting stuff!

Freaky Friday?

This New York Times article caught my attention "Doctors Try New Surgery for Gallbladder Removal." Apparently some surgeons in New York removed a woman's gallbladder through her vagina as part of a study! Dude, count me out on that approach; if I ever need my gallbladder out I'm going with the current standard of care. Click here to access the article.

New Safety & Quality Proposal from America's Health Insurance Plans

The AHIP's Board of Directors issued a press release on its proposal "Setting A Higher Bar":

The plan calls for the development of a new entity to compare the safety and efficacy of medical procedures and technologies, advocates steps to promote transparency of health care information and speed the adoption of best practices, and calls for the creation of a new patient-centered dispute resolution mechanism.

“Improving the safety and quality of care will allow the nation to more quickly provide coverage to all Americans,” said Karen Ignagni, President and CEO of AHIP. “We can enhance the value of the nation’s investment in health care and ensure that patients receive the right care at the right time in the right setting.”

Read their proposal and let me know what you think. Click here to access the press release and the proposal.

Will the case of Ketek lead to reform?

Check out "The FDA and the Case of Ketek" written by David B. Ross, M.D., Ph.D. and just published in the New England Journal of Medicine. Click here to read this important article (registration required).

The American College of Lifestyle Medicine

First that I've heard of this organization but better late than never... From the New York Times article:

The Centers for Disease Control and Prevention reports that 1.7 million Americans die and 25 million are disabled each year by chronic diseases caused or made worse by unhealthy lifestyles. And a 2005 study in The New England Journal of Medicine predicted that average life expectancy in the United States would decline in the next 20 years as a result of unhealthy lifestyles, reversing a trend dating to the 1850s. The American College of Lifestyle Medicine has 150 members in a wide array of specialties — nutritionists, ophthalmologists, gastroenterologists and oncologists, among others. Helping their cause is a new publication, The American Journal of Lifestyle Medicine, which appears every other month with peer-reviewed research on the way daily habits affect health.

Click here to read the news article. Click here to access the college's website.

Canadian open-access medical journal goes live!

Just learned that a new open-access online medical journal has gone live. From the cta.ca news article:

Open Medicine, to be officially launched Wednesday, was conceived in the bitter aftermath of the February 2006 firing of the editor and deputy editor of the Canadian Medical Association Journal.

The publication's business model differs greatly from standard medical journals. It will be available online only, will have no subscription fees, and no corporate or medical association ownership.

Click here to access the news article. Click here to access Open Medicine.

New IT consulting company launched!

I'm delighted to announce the launch of a brand new company, The Chimera Partnership, LLC. The company was started by the husband, Samir D. Mehta, MCP, of my friend and colleague, Ann Lichti (whom many of you might know from her articles in Medical Meetings magazine).

The Chimera Partnership, LLC states that it is a full-service IT consulting company with a mission to provide clients with reliable, stable and secure IT solutions to whatever technology issues they face. Core capabilities include: Data analysis (including CME/CE outcomes data analysis and report generation); Custom applications (including CME/CE participant databases, patient registries, and clinical trial management systems); Comprehensive network security; Disaster recovery services; Project management; IT manager/staff competency analysis; and comprehensive staff training programs. Click here to access the Chimera Partnership's website.
Disclosure: I have no financial interest in this company.

FDA Seizes All Medical Products From N.J. Device Manufacturer for Significant Manufacturing Violations

Click here to access this FDA alert.

Start low and go slow...

This old adage regarding prescriptions might end up with a new meaning if a bill limiting DTC advertising is passed by Congress:

Pharmaceutical companies could be prohibited from advertising new drugs directly to consumers for the first two years they are on the market under a bill moving through Congress this week.

The goal, supporters say, is to ensure medicines are safe before allowing industry to promote them to consumers in the hopes they will request prescriptions from doctors.

But a reduction in TV and print advertising, which helped transform medications for heartburn and arthritis into blockbusters, would be a serious financial blow to drug makers. According to one study, every $1 spent on pharmaceuticals advertising often adds more than $2 in sales.

Click here to read the WTOPnews.com article. If this bill is passed, would that mean more funding for CME?

Silence is not golden...

An article in today's New York Times points out that, historically, doctors in training learn in an environment that doesn't always welcome their input. From the article:

Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. And students were all too easily intimidated. In a 1993 article in The New England Journal of Medicine, a Harvard medical student reported that although her resident routinely made derisive remarks about her patients on rounds, the rest of the team laughed nervously rather than confront her.

Similarly, as Dr. Adam J. Wolfberg wrote in the same journal last month, for years medical students performed pelvic examinations on anesthetized women who had not given consent because senior obstetricians said it was the best way to learn internal anatomy. Although this practice made many students uncomfortable, most were afraid to speak up.

The good news is that things are changing in this regard. Click here to read this article.

Smart tool aids in triage of emergency room patients

Do patient-centered (or "centred" as they spell it in Canada) information systems assist in the triage of Emergency Room patients? The Scarborough Hospital, Canada's largest urban community hospital, and Canada Health Infoway have launched such a new system:

The user-friendly kiosks are available in English, but will also feature interfaces in seven different languages including English, French, Chinese (Cantonese and Mandarin), Tamil, Punjabi, Farsi, Hindi and Urdu. Patients are asked a number of questions in their native language and can choose answers from a comprehensive list. The system then translates the information into English for use by the care providers. It is estimated that approximately half of the patients at the Scarborough Hospital speak English as a second language.

It will be interesting to see how successful this system will be in the ER setting. I would love to see such a system utilized for office visits. Click here to read the news article.