On 1/1/09, Pharma instituted a voluntary ban on all gifts to physicians — the mugs, pens, post it notes, and all of the other materials involved in even further promotion of their products. The first group to applaud this move is the American Medical Student Association, to which I belonged many, many years ago.

AMSA’s PharmFree campaign has educated and trained thousands of medical students across the country to interact professionally and ethically with the pharmaceutical industry. “Banning gifts from the drug companies is a good first step,” says Dr. Brian Hurley, AMSA’s national president. “There is no role for marketing masquerading as education when our patients’ lives are at stake.”

LINK | AMSA LINK

The ongoing debate around healthcare reform often centers around what is best for the patient as consumer of healthcare. Sure, doctors are often brought into the mix, but are usually relegated to matters of the periphery — portrayed as forced to capitulate to the strong arm of the insurance companies and government payers. Well, in a way, that is partially true. The level of reimbursement from those physicians who see patients covered by Medicare, for example, can make up a significant amount of a primary care physician’s revenue. And, that is where the debate on healthcare reform should steer next, according to those it directly impacts on the front line — the primary care physicians. Bordering on seeming apocalypse, many primary care providers are presaging the death of the specialty — unless something is done to save it. | LINK

Okay, it’s no secret that I consider Beyoncé one of the world’s most talented and accessible megastars. She’s been the subject of a recent Music Club post here on Doctor Pundit, and her video in that post has been downloaded (legally) at least 1 million times since its release. Herein lies the subject of this post. That song. More specifically, that video — the one for her most recent #1 hit “Single Ladies”. Besides being completely compellingly choreographed to the max, the clip has spawned what seems to be a cottage industry of imitators and satirists, and I think that’s awesome. Though it was released in late November 2008, it is truly the first great big hit of 2009. The song is easily one of Beyoncé’s catchiest and, dare I say, most important tracks to date. The ailing music industry needs to stop obsessing about illegal downloads (something they have very little control over) and start focusing on fostering intelligent, lasting pop gems. Props to Beyoncé and her continued positive influence on the music industry. Go ahead and enjoy the song once again (currently #1 on my iPod’s ‘Recurrents’ playlist) and at least one version from one of her many disciples.

Released today, conservative pundit George Will’s WaPo column focuses on healthcare, specifically its portion of the entire GNP for this country. Read more like a pre-apocalyptic lesson in government involvement in healthcare delivery, his piece attempts to explain how real the pending insolvency for Medicare is within the next ten years and the admonition for President Obama to get up and head this disaster off at the pass. Oh, if only it were that easy.

For starters, because of the state of the economy these days, it is much harder to be a cheerleader for the continued, unabashed free market nature of healthcare coverage, purchasing, and delivery. Naturally, the single payer hypothesis has its detractors, and rightly so. Who is going to bail out the government when it doesn’t get things right the first time?

Unchecked rising healthcare costs; the need to temper government reach in healthcare delivery; the rights of patients — both as consumers and as beneficiaries — all of these issues will surely test the mettle of Obama’s healthcare czar-ocracy and its resolve to “become more connected with the people” in reaching common ground with respect to the current healthcare crisis. It is going to be an interesting and unnerving term for Obama, patients, and just as importantly, physicians and other healthcare providers. It’s finally 2009. Might as well dive into it. | LINK

The Centers for Medicare & Medicaid Services is taking the bull by the horns in its efforts to stem the tide of Medicare fraud, especially with respect to suppliers of durable medical equipment who file bogus claims. CMS is announcing that it has revoked the billing privileges of more than 1,100 medical equipment suppliers in south Florida and southern California (the epicenters for such activities) and suspending payments to home health agencies in the Miami-Dade, Fla. area. In addition to suspending payment, CMS is: implementing extensive pre- and post-payment review of claims submitted by ordering/referring physicians; and validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians. A laudable effort whose magnitude is roughly equivalent to an enormous New Year’s resolution to the trim taxpayer burden of the nation’s public healthcare insurer. | LINK

Long known to be a risk factor for infarct-related dementia, cerebral ischemia (lowered blood flow to the brain) is now being postulated as a potential cause for primary degenerative (Alzheimer) dementia. The key is in the development of a signal protein harbinger of the abnormal neural types found later in the chronic course of the disorder. Apparently, the risk for the presence of this protein is inversely related to the vascular perfusion of the brain in aging individuals.

“This finding is significant because it suggests that improving blood flow to the brain might be an effective therapeutic approach to prevent or treat Alzheimer’s,” said [Robert] Vassar, a professor of cell and molecular biology at the Feinberg School. A simple preventive strategy people can follow to improve blood flow to the brain is getting exercise, reducing cholesterol and managing hypertension. “If people start early enough, maybe they can dodge the bullet,” Vassar said. For people who already have symptoms, vasodilators, which increase blood flow, may help the delivery of oxygen and glucose to the brain, he added.

You can add this hypothesis to the inflammatory mediation and spinal fluid postulates currently being actively researched in the fight against Alzheimer dementia. | LINK

Happy New Year! from Doctor Pundit. Posting to resume on 1/2/09.

• Minnesota’s most populous county will end fee-for-service Medicare. Sign of the troubled economy? Docs gotta put food on the table, too.
• Medicare Part D open enrollment to end on 12/31.
• Healthcare plan beneficiaries scramble to take advantage of last minute procedures before benefit resets on 1/1. Looks like some docs will put food on the table.

At a time when the weak economy is hurting the industry, medical groups say they are grateful for the bump in business, however temporary. To cope with demand, doctors are adding hours and delaying vacations. High-deductible plans with health savings accounts were introduced in 2004 and now cover about 10 percent of insured Minnesotans. At the same time, deductibles for traditional plans — known as preferred provider organizations — also have jumped, with a $1,000 deductible now the national norm, according to benefits consultant firm Mercer.

The reports of sexual abuse in nursing homes which two recent cases catalyzed the issue into the national spotlight is a mixed blessing. For years incidence of these cases was rare, simply because of the stigma involved among all parties. Over the past 10 years, however, it has been brought squarely into the spotlight, undoubtedly the result of massive paradigm shifts in patient advocacy and Boomer generational values — as the latter group represents a potentially affected age demographic. The recent cases of bizarre abuse of nursing home residents in southern Minnesota at the hands of female staff illustrate how atypical this issue is, and how atypical the need to contain such episodes needs to be. | LINK

What motivation do, um, motivated smokers have in their arsenal to kick the habit? They need look no further than the efforts of the President (-Elect) of the United States, Barack Obama.

He told Tom Brokaw of NBC several weeks ago, for example, that he “had stopped” but that “there are times where I’ve fallen off the wagon.” He promised to obey the no-smoking rules in the White House, but whether that meant he would be ducking out the back door for a smoke is not known. His transition team declined to answer any questions about his smoking, past or present, or his efforts to quit.Antismoking activists would love to see him use his bully pulpit to inspire others to join him in trying to kick the habit, but he has not yet taken up their cause.

An interesting history of those Commanders-In-Chief who were defined, in part, by the stogies they nursed, in the NYT.

With the clock ticking ever so quickly toward Jan. 1, asthma sufferers will no doubt try to make a run for the border to get refill scripts on their inhalers. Because, effective that date, metered dosed inhalers must go green:

“It’s possible people may skimp on their medicine because of the cost,” said Dr. Bradley A. Becker, co-director of the Asthma Center for Children at Cardinal Glennon Children’s Medical Center in St. Louis. “Clearly that would not be a good strategy because you might end up in the emergency room.”

Many doctors have been prescribing the new inhalers for several months, helping their patients transition to the devices, which use the more environmentally friendly propellant hydrofluoralkane (HFA) and deliver the quick-relief drug albuterol.

Some physicians and pharmacists, however, say they wouldn’t be surprised to see patients rush to snag up the old inhalers, which utilize harmful chlorofluorocarbon as a propellant. The last day for the old inhalers to be sold is Wednesday.

Seems a little late for environmental concerns, don’t you think?

I really don’t know what it is, but I’m really, really feeling the latest album from NeYo, the new wunderkind of “sophisticated” R&B. In almost three years, this artist has managed to transcend even the most jaded middle-age target R&B demographic who considers such travails into to hitmaking suspect in this nascent century, to say the least. (Force MD’s, where are you?) For the stylin’ peers of my generation^[1] raised upon the maturation of “Black music” seemingly confined to the 1980s, the sound of this artist puts a smile on my face. Here’s hoping that the album Year Of The Gentleman takes the award for Grammy© Album of the Year. Yeeow! Fave track: “Fade Into The Background”. | LINK

1. Yes, those of us who just turned forty — unfortunately. [↩]

Hiring freezes. Acute care and same-day procedure clinic closures. Shrinking inpatient censuses. These are the problems healthcare organizations’ hospitals and clinics are having in these troubled economic times. Brought on by beneficiaries’ lack of coverage via job losses and lingering Medicaid and Medicare cuts in reimbursements, the financial crises shared by these institutions have led to rather disastrous results, bankruptcies chief among them. | LINK | RELATED LINK