Friday, November 20, 2009
QD: News Every Day--Santa's take on H1N1 influenza, part II
ACP Internist's daily digest of news and events continues with the contentious issues the senate faces for health care reform and Medicare reimbursement, as well as the pecking order for H1N1 flu prioritization
Health care reform
The Senate will vote Saturday whether to proceed with its bill. The issues are contentious: abortion, affluence and affordability, among others. According to ACP Advocate, the Senate likely won't vote on its bill until December, and even after that happens, the two versions will still need to be reconciled with each other and passed again by both chambers. (New York Times, Los Angeles Times, AP, Christian Science Monitor, ACP Advocate)
The House voted to cancel the pending 21% cut to Medicare reimbursement. Now the issue moves to the Senate, which didn't get that accomplished as a single issue when it came up in October. They'll reconsider it as part of overall health care reform legislation.
In case you missed it ...
As we reported yesterday, organizations representing mall Santas want their members added to the priority list for H1N1 influenza vaccination. Now, hog farmers are saying their proximity to pigs trumps the Santa's contact with children. They first want to protect their herd from humans carrying H1N1 influenza. The Santas respond that they should fall in the pecking order when pigs fly, not reindeer.
Labels: H1N1, health care reform, QD, reimbursement
posted by Ryan DuBosar at
11:48 AM
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Thursday, November 19, 2009
Rethink pink: breast cancer screening evidence met politics and lost
The controversy started at exactly 5 p.m. Monday, when the Annals of Internal Medicine lifted its embargo on new breast cancer screening recommendations and the rest of the medical community simultaneously released opposing positions. With lines drawn and positions taken, a furor began ultimately pitted evidence-based medicine against political machinations. So far, medicine has lost. 
The recommendations, issued by the U.S. Preventive Services Task Force, suggest that asymptomatic individuals with no family history or other risk factors could wait before starting mammograms and undergo screening every two years instead of annually. They balanced the benefits of less frequent screening against the harms of more frequent screening by reviewing the evidence and creating models.
The recommendations have since been on the pages of every newspaper in America, from the smallest locals to the biggest dailies. The American College of Physicians is tracking "impressions," as they're called, in the millions.
There's always a downside to new knowledge, and it's playing out in week following the announcement. It will take time for physicians to digest the new recommendations. It will take time to explain them to patients. In the meantime, public discourse has been messy.
Experts have told women to talk to their doctors about how evidence-based recommendations apply to individual circumstances. But other medical societies are sticking to their guns on annual screenings at earlier ages, and it's unsettling for patients to see doctors disagree and even more unsettling when shouting matches erupt on television.
But neither the government nor insurers are rushing out to make dramatic changes to existing practice of medicine. To calm fears, HHS Secretary Kathleen Sebelius clarified that the doctors who drafted the recommendations, the U.S. Preventive Services Task Force, comprise an independent body of experts who review evidence but don't set policy. To calm fears, she stated that women should still go to their doctors to discuss their individual needs. Insurers aren't going to change their policies, either.
In short, the recommendations inform the talks between doctors and patients. They give physicians something to consider during the informed consent process. Consider the words of family physician David Baron, MD, who said, "I respect [USPSTF] a great deal. They've got no horse in the race. They are independent experts." Take it from practicing physician Jan Gurley, MD, who summarized in plain language how recommendations should impact encounters between physicians and patients.
This is in contrast to internist and TV commentator Elizabeth Lee Vliet, MD, who went on the attack about a "distant and impersonal 'review of data' from published studies." In an op-ed shopped around to media outlets, she further ranted that, "I am profoundly concerned that government 'experts,' far removed from the daily care of patients, are sitting 'on high' to proclaim that women don't need to start mammograms at age 40."
And of course, Dr. Vliet decried it as a cost cutting measure and as the start of "government-mandated, guideline-based rationing of health care." Those are her poorly chosen words. But she's not alone.
U.S. Rep. Marsha Blackburn of Tennessee bemoaned that, "This is where you start getting a bureaucrat between you and your physician." Rep. Michele Bachmann of Minnesota joined the misinformation brigade, starting her press conference on the task force recommendations by blaming President Obama and Speaker of the House Nancy Pelosi. Watch for yourself.
Hijacking evidence-based recommendations to further partisan debate is a semantic trick. And it's a disgrace.
Labels: cancer, evidence-based medicine, guidelines, health care reform, health policy, patient communication, patient education, women's health
posted by Ryan DuBosar at
12:15 PM
1 Comments
QD: News Every Day--Santa's take on H1N1 influenza
ACP Internist's daily digest of news and events continues with the latest progress on health care reform measures in the Senate, and a caution that Santa is looking at who's naughty, nice and vaccinated this year.
Health care reform
After a few quiet days, Senate Majority Leader Harry Reid set up a potential Saturday vote to take the legislation to the Senate floor. According to the Congressional Budget Office:
--the bill would cost $848 billion over the next decade
--the bill would reduce the federal deficit by $127 billion over the first decade and $650 billion over the second decade,
--it would cover more than 94% of Americans, and
--it would reduce the number of uninsured Americans by 31 million.
A wrap-up digests the breaking news from multiple sources. (Washington Post, Kaiser Health News)
In case you missed it ...
The Amalgamated Order of Real Bearded Santas wants its members to be added to the priority list for H1N1 influenza vaccination, both because of their contact with children and their (likely) obesity. Meanwhile, states' attorneys general are investigating why liquid Tamiflu doses range in price from $43 to $130. That will put some retailers on the naughty list for sure. (New York Daily News, ABC News)
Labels: H1N1, health care reform, QD
posted by Ryan DuBosar at
12:01 PM
0 Comments
Wednesday, November 18, 2009
QD: News Every Day--when evidence and politics collide
ACP Internist's daily digest of news and events continues with health care reform and how it intersects with the primary care shortage.
Health care reform
As far as the poll numbers are concerned, the public wants improvements to the healthcare system. (Who wouldn't want improvement, to anything?) But they don't want to pay for it themselves. (Los Angeles Times)
Primary care shortage
While waiting for the Senate to pick up the health care debate, newspapers' opinion sections are humming with analysis. ACP President Joseph Stubbs, FACP, and former ACP chapter governor for Massachusetts, Allan Goroll, MACP, say that health care reform is essentially a discussion of a primary care shortage. ACP's Tennessee chapter governor, Kenneth Olive, FACP, watches as his chapter's members struggle with the issues of cost, access to care, and inadequate numbers of primary care physicians on a daily basis. Sabitha Vasireddy, ACP Member, agrees. For the patients at her free clinic in Danbury, Pa., health care access is just as important as reform. It can't be worse than Oklahoma, which ranks 50th of the states in terms of active medical doctors per 100,000 population and last in primary care doctors. (The Hill, Kingsport Times-News, Danville News, Oklahoma City Journal Record)
H1N1 influenza
Despite an increase in deaths in Canada, official believe flu season may peak there earlier than predicted; 20% of the population has been vaccinated. (Reuters)
In case you missed it ...
Politicians are using evidence-based medicine as political fodder. Monday's announcement in the Annals of Internal Medicine stated that breast cancer screening recommendations should change. Now, opponents of health care reform are using it as evidence of government interference in health decisions--one slim step away from "death panels" and other easily disproven myths. (ACP Internist, Los Angeles Times)
Labels: health care reform, primary care shortage, QD
posted by Ryan DuBosar at
12:58 PM
0 Comments
Ghostwriting haunts Congress' hallowed halls
The U.S. Chamber of Commerce and other business groups are shopping around for an economist to study the impact of current health care legislation and then distribute results that health care reform is a job killer, reports the Washington Post. Joining the U.S. Chamber are some other mighty big names, such as the National Association of Manufacturers.
The U.S. Chamber wanted to hire an economist to study the issue, then get other economists to sign onto the results, and then attack health care legislation in an ad campaign. (Oops, they assumed the economist's results would be unfavorable.) Isn't this like a drugmaker drafting a medical study and then shopping around for a doctor to put his or her name on it?
Ghostwriting is a huge problem for the credibility of peer reviewed studies, so why would this be any different? Should we hold economic research to the same standards as other scientific research?
No, because this isn't peer-reviewed. This is politics.
Medical research authors are required to disclose funding for their research. In this case, any economist who might sign onto to the project would have to disclose conflicts of interest with not only the U.S. Chamber, but from the other lobbying groups who contributed to the study (in this case, $5,000 apiece).
Medical researchers are required to report their outcomes, good or bad. But positive publication bias is a known factor in medical research. In the case of the U.S. Chamber, it was questioned whether a positive outcome would be reported. After some hemming and hawing, a spokesman later said it would educate the organization's position.
Any economist who'd sign on with the U.S. Chamber's project would skip the peer review process and enter straight into the hardscrabble world of politics and lobbying. Yes, these lobbyists are entering into the public discourse and trying to influence the outcomes of legislation that impacts every person. But there are different standards for political lobbying groups like the U.S. Chamber than for medical researchers, so it's a bit Pollyanna-ish to expect them to be above board.
Besides, the Chamber's own message boards are clobbering the organization's opposition to health care reform. Check out the responses to a recent Chamber post that chastised the House vote on its legislation. Start here and keep scrolling down as members and small businesses speak their mind.
Labels: conflict-of-interest, health care reform
posted by Ryan DuBosar at
8:00 AM
0 Comments
Tuesday, November 17, 2009
QD: News Every Day--payment fix inches forward (for this year, anyway)
ACP Internist's daily digest of news and events continues with incremental progress on fixing physician payments, and a double-take on Twitter during surgery.
Health care reform
Health care reform is increasingly unlikely to fix the annual threat of Medicare reimbursement cuts. For this year, at least, the U.S. House is expected to pass its part of the fix on Thursday. (Politico, New York Times)
Instead of a legislative solution, fixing health care will require a profound shift in what patients expect from a doctor's visit. And, the patient-centered medical home has to be at the center of any future health-care system, says one doctor. (WBUR FM of Boston, Indianapolis Star)
There won't be enough doctors to handle the uninsured, said one editorial. But, without health insurance, there are more deaths, said one survey that linked lack of insurance to ED mortality. (Wall Street Journal, AP)
In case you missed it ...
One article questions whether surgeons who broadcast procedures in- step-by-step detail using social media outlets such as Twitter are going too far. When patients do it, too, then maybe it's too much. (Biz Report, ACP Internist)
Labels: health care reform, primary care shortage, QD, social media
posted by Ryan DuBosar at
12:10 PM
0 Comments
Monday, November 16, 2009
QD: News Every Day--not the intended effect
ACP Internist's daily digest of news and events continues with backlash from an analysis of proposed health care reform legislation, voices from middle American and an ACP Fellow's controversial stance on just how much money is wasted in our current health care system.
Health care reform
Medicare's chief actuary reports that legislation in the U.S. House would raise health care costs by $289 billion over the next 10 years and reduce benefits and access to services. (The Hill, Washington Post)
Meanwhile, 43% of Americans oppose the health care plans underway in Congress, 41% approve, 15% are undecided, the latest poll figures show. But opponents are more strongly against it than supporters are in favor, say numbers provided in a study by Stanford University and the Robert Wood Johnson Foundation. (AP/Washington Post)
Peter Reiter, FACP of Ottumwa, Iowa, describes the need for health care in his community, while Robert Vautrain, ACP Member, of Springfield Il., asks for a public option specifically. (Ottumwa Courier of Iowa, State Journal-Register of Illinois)
H1N1 influenza
Airlines are chafing at CDC recommendations that they filter air for H1N1 influenza even while at the terminals. They say it's costly, but just 20 minutes on the ground is long enough to spread the virus. (CBS 11 of Dallas-Forth Worth)
Primary care shortage
Concierge medicine rankles some in communities already stretched by a lack of primary care providers. Read how the controversy is playing out in Waco, Texas. (Waco Tribune-Herald)
Medical education
To accommodate the arrival of the first baby boomers, the American Geriatrics Society is proposing that elder care be added to the list of medical education's six core areas. (Boston Globe)
In case you missed it ...
Richard A. Cooper, FACP, blasts the vaunted Dartmouth Atlas for its statement that one-third of the nation's health care goes toward wasted expenses. He counters that the analysis is unfair toward urban hospitals, which treat more poor who lack primary care. His critics are just as harsh. But Dr. Cooper is not afraid of taking strong, pro-primary care position. He's taken on concierge medicine (opens as 1-hour video) and The Mayo Clinic. (Kaiser Health News)
Is Medicare fraud getting worse, or are the documentation requirements just becoming more onerous? (Washington Post)
Labels: concierge medicine, geriatrics, H1N1, health care reform, medicare, primary care shortage, QD
posted by Ryan DuBosar at
11:29 AM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- QD: News Every Day--Santa's take on H1N1 influenza...
- Rethink pink: breast cancer screening evidence met...
- QD: News Every Day--Santa's take on H1N1 influenza...
- QD: News Every Day--when evidence and politics col...
- Ghostwriting haunts Congress' hallowed halls
- QD: News Every Day--payment fix inches forward (fo...
- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
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