A major national trial is about to begin actively collecting data. It’ll track kids from pre-birth to the 21st year of life, and identify physical, biological, and social factors in their health. There will be seven locations taking part. Ramsey Co. (St. Paul), MN is one of those locations.[1] Apparently, this trial is described as “landmark” in its information- and data-gathering techniques for the sole purpose of accurately detailing the state of pediatric health in this country.
“Times have changed since the early ’60s,” said Pat McGovern, a University of Minnesota professor who will be lead researcher of the Minnesota arm of the study. “We have more single-parent families [and] more two-parent families in which both parents are working. Immigration patterns have changed. Children’s exercise and diet habits have changed. There’s a whole lot more chemicals we’re all exposed to in the air and water.”
This study aims to provide definitive data on pediatric and adolescent medical care for the 21st century. Dubbed the National Children’s Study, the federally funded venture will continue to provide data over time, gleaning information from as many diverse sources as possible over many years. Perhaps it will provide significant answers surrounding the development and optimal treatment of disorders such as asthma, ADD, and autism. | LINK
When I mas in medical school (and later in residency training) I would crave pharma reps — or, rather, crave the food and gifts that seemed to accompany them with every detail. Of course, that was well over 16 years ago. Much has changed. What apparently hasn’t, however, is that many academic institutions of medicine have been a little slow on their apparent movement to limit pharma company access to providers in comparison to healthcare systems in the private sector.
Conflict-of-interest policies have become increasingly important as academic medical centers worry that promotional talks undermine the credibility of not only the physicians giving them, but also of the institutions they represent.
Yet when it comes to enforcing the policies, universities have allowed permissive interpretations and relied on the honor system. [...] Many physicians are in apparent violation, and ignorance or confusion about the rules is widespread.
Whether it be confusion surrounding med schools’ conflict-of-interest policies or sheer ignorance of their enforcement, many institutions are apparently receiving a failing grade as it applies to compliance…which generates more lip service than actual adherence. | LINK
The role of the physician as spokesperson in the name of “expert analysis” is finally being called for what it is — a sham. Over the middle to latter years of my training, I cannot count the number of times I either received solicitations (in the form of “special invitations”) by pharma representatives to listen to anointed “experts” deliver the latest “research findings” on drugs that I just had to prescribe to my patients — or else.
For years — well before the PR nightmare Pharma found itself in with reports of improper payments to physician cheerleaders for their products and industry-funded problematic trials which resulted in adverse patient events and lawsuits — the physicians who were hired by Pharma to support a new drug hitting the market had free reign essentially to say whatever they wanted about that drug, just as long as it was positive.
Year in and year out, it seems as though we’re greeted with the same news from health organizations: that the worldwide data on HIV/AIDS infection rates and treatments could not be more disparate. We keep hearing about the fact that, although awareness is at an all-time high, outreach to the world’s most affected populations continues to struggle. Two thousand nine/2010 are no different. This year, only a third of treatable persons worldwide are actually being treated.[1] That’s in spite of the fact that world leaders have pledged no narrow that gap, time and time again.
What about on these shores? Two days ago, the U.S. recognized National Gay Men’s Awareness Day. There is no doubt that a major increase in awareness in this country since the late 1980s has brought forth some of the world’s greatest pharmacological achievements in the fight against this dreaded infection. But, there is no escaping the fact that the celebration of 9/27 itself because of these achievements — was eclipsed by one startling statistic: that nearly half of all gay men do not know that they are infected with HIV. The nature of the infection, although constantly changing and being researched, is clearly well known. Perhaps education — or lack of it — about HIV as a sexually transmitted infection needs a re-examination itself. Perhaps, there is still a stigma attached to the relay of that information to the most appropriate points of contact: from the provider to the patient. Or, maybe, its the overconcern of the lifetime cost of care for someone infected with HIV.
All of these reasons (and probably many more too numerous to mention) are valid ones to consider as we pass yet another milestone in the history of HIV/AIDS, and the strategy to make this infection entirely preventable becomes more important than ever. | LINK
A Mayo study out today in JAMA finds that the increasing level of burnout among medical students could be a contributing factor to professional behavioral problems and lapses long after graduation. The study was actually a survey of over 4000 students from the Mayo med school and 5 other schools — including the U of M. Perhaps the major outcome measure in the study was the survey item that measured the students’ attitudes of physicians to society (altruism), essentially characterized by patient advocacy. As a surrogate measure, the researchers concluded that “burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors or holding at least 1 less altruistic view regarding physicians’ responsibility to society”. | LINK
The New England Journal of Medicine, long a standard in peer-reviewed medical research, has updated its website and become a portal of an essential library of text, audio, and video — a thriving primary online brand of itself. What a treat.
Our electronic archive now includes every issue back to the first one, published in 1812. The NEJM Archive from 1812 to 1989 has more than 150,000 articles. All articles are fully searchable, with the content back to 1945 presented in an HTML format similar to that for the current issues. For all the articles in the archive, the PDF files show the original versions as they appeared in print, complete with ads, notices, and various curiosities from earlier eras.
Nice. It was enough for me to subscribe to the Journal (and its online content) for the first time in over 10 years. | LINK
Research into better treatments and possible cures of Alzheimer dementia is one of the bright spots in the potential for better healthcare delivery in the decade of the 2010s. There are many signs that bode well for the approach to this disorder at the dawn of the second decade of the 21st century.
New research into alternate pathways of disease development is starting to generate excitement among primary care physicians and geriatricians (such as myself) as potential arenas for new classes of drugs to combat Alzheimer’s. Better care delivery models in long term care of the elderly as part of new initiatives in the Affordable Care Act are already starting to impact chronic disease care management strategies.
Perhaps most important, there is new evidence to suggest that earlier detection of this cognitive disorder can enhance those developments, and more. At an annual meeting of top dementia researchers, guidelines were proposed to expand on the research from the ’00s to diagnose the disorder earlier — a strategy that benefits more than just those potentially afflicted with Alzheimer’s.
If the guidelines are adopted in the fall, as expected, some experts predict a two- to threefold increase in the number of people with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it. The Alzheimer’s Association says 5.3 million Americans now have the disease.
Heavier use of newly discovered biomarkers for earlier detection of the pathology behind Alzheimer dementia will be a closely watched process by both physicians and health policy analysts alike. | LINK
Sad to hear today of the death of Dr. Robert Butler from complications of leukemia. The appellation “father of modern gerontology” is a well-deserved one, as I referenced his research and teachings throughout much of my training as a resident and fellow. Many of the I principles incorporate into my daily practice have come from what this pioneer so dutifully studied in over 300 scholarly articles and publications. Although he was a psychiatrist by training, his contributions to geriatric medicine virtually created the discipline itself.
Butler was the first clinician who coined the term “ageism”, the result of such forward-thinking approaches to the geriatric patient that was characterized by the medical practice free of biased attitudes and treatment assumptions that, if employed today, would cause harm to many elderly patients receiving chronic medical care. Indeed, many of his sound principles so sacrosanct to the practice of geriatrics and study of gerontology sprang forth from his diligence, inquisitiveness, and yearning for the dignified treatment of the elderly patient. He will be missed. | LINK
Although the results of a study from the Annals of Internal Medicine are out today noting an increase in the rate of sexually transmitted infections (STIs) among those taking drugs for erectile dysfunction, this item “hot off the wires” practically invites the media to take a stance assuming direct causation.
Jokes aside — and you can assume that lead-ins are probably replete with them — the compelling numbers[1] suggest a greater problem afoot: the overall numbers of sexually active men over 55 years of age is increasing. Re-evaluating incidence and prevalence rates to include this ever-burgeoning population will only become more commonplace in medical education as this retrospective study underscores one major point: the necessity of other types of trials studying the effects of preventive practices toward STIs in those much younger and applying them to this patient population. | LINK
Most attending physicians well out of training know of the continued discussions on local, regional, and national levels regarding the most “acceptable” amount of hours residents in training are able to work in any given week. I trained in New York state (Syracuse) in the mid-1990s, fresh off of statewide regulations limiting overage due to some high-profile cases out of NYC involving adverse patient outcomes at the hands of fatigued physicians in training. However, no matter how well enforced many of these statutes are by states, training hospitals have always seemed to have the final say — citing financial and training constraints.
This week’s NEJM includes guidelines (still in an advisory period before final recommendations are proposed) put forth by the residency programs’ accrediting body. Among other things, a tiered system of hours is offered for first year residents (interns) to cap hours at no more than 16h/day, as opposed to more senior residents who may be in a better position to supervise and prevent error. These proposals may not go far enough, though, as oftentimes there are a host of other factors at play in overall patient care delivery by residents in an academic hospital setting — qualitative measures that are difficult to quantify for the purpose of making simple preventive interventions. | LINK [PDF]
A new twist on old news. While practically everyone with a vague association to healthcare delivery in this country knows that there is a primary care shortage, it is always refreshing to see fresh innovation to lure more talented docs to the specialty on the part of some medical schools and educational entities (…even hospitals):
[Johns Hopkins] has launched programs to bring cheap specialty care to the uninsured and primary care to those who tend to go to the emergency room. And [John ]Feldman’s [director of the school's Urban Health Residency Program] six-year residency program aims to annually produce four primary care physicians who eventually could become leaders in the field by opening a federally backed health center, directing a primary care clinic or becoming a city health commissioner.
Medical residents are students of medicine. Medical residents are physicians in training. Is it one or the other, or both? For the purposes of the plaintiffs, the University of Minnesota will take up the issue of whether Social Security taxation applies to them before the U.S. Supreme Court. Thanks to a joint filing from the Mayo Foundation for Medical Education and the U of M, the SCOTUS will hear the case — whose bases stretch back some twenty years.
At issue: the potential for upwards of $700M or more yearly in income that would be gained in the U’s budget (and in training programs nationwide) if an exemption on residents is granted with respect to Social Security taxes. The Treasury Dept., which houses the Internal Revenue Service, currently taxes resdients’ incomes; the Internal Revenue Service asserts that doctors in training, and the teaching hospitals that train them, must pay Social Security taxes on the residents’ stipends (incomes).
Residents are taxed at 7.5 percent — as they are considered employees of their training program. Oral arguments could begin in as little as six months. President Obama’s current nominee, Elena Kagan, would not take part in such deliberations because she is part of a brief supporting the federal government’s stance. | LINK
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
#pharma news: Playoff Trifecta Means Windfall Curbed by L.A. Traffic http://t.co/voOlghpt
RT @Ziggy_Daddy: Hunger Growing Problem Among Seniors | Crooks & Liars http://t.co/FRRGv4d4 But hey #GOP, let's turn #Medicare into a voucher system, right?
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
