kboreilly.com :: [Kevin B. O'Reilly]

My lede:

After heated controversy last winter over the birth of octuplets conceived through in vitro fertilization, the American Society for Reproductive Medicine in October announced tightened practice guidelines and a willingness to work with policymakers to put teeth into its recommendations.

ASRM did not change its guidance on the number of embryos to transfer based on different patient prognoses. But it asked that doctors who exceed the recommendation transfer only one additional embryo, note the decision in the medical record and caution patients about the risks of multifetal pregnancies. The society said it is rare that patient circumstances will warrant exceeding its guidelines.

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My lede:

An influential group of medical journal editors in October announced a new, more probing conflict-of-interest disclosure form that it hopes will become the industry standard. The effort comes in response to criticism that medical journals have failed to properly inform their readers about authors’ financial relationships with industry.

The uniform disclosure form, adopted by the International Committee of Medical Journal Editors, asks authors submitting for publication to disclose any payment for the research that generated the article as well as other kinds of industry relationships such as consultancies, honoraria or stock options from the last three years.

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My lede:

The American Academy of Family Physicians announced in October that it was partnering with Coca-Cola Co., the world’s No.1 soft-drink maker, “to develop consumer education content on beverages and sweeteners.”

The one-year deal is the first in the academy’s new “consumer alliance program” and is in the “strong six figures,” according to AAFP Executive Vice President Douglas E. Henley, MD. Coca-Cola is listed as a partner at the academy’s familydoctor.org Web site. The AAFP said it plans to use the funding from Coke and other consumer-goods companies to beef up the site’s educational offerings.

In the fight against childhood obesity, many medical experts have tabbed sugar-sweetened sodas as a principal culprit, and for that reason some have criticized the AAFP deal.

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My lede:

The Centers for Medicare & Medicaid Services has estimated that rules that took effect in October 2008 and denied payment for “reasonably preventable” hospital-associated conditions would save the government $21 million and encourage patient safety improvement.

But the savings probably will be much lower, according to a study in the September/October Health Affairs.

The nonpayment rules are likely to cost hospitals about $2.7 million — $368 per facility — raising the question of whether the no-pay policy will achieve Medicare’s cost and safety objectives. Hospitals and physician organizations, including the American Medical Association, have objected to some of the conditions included in the no-pay list, saying prevention is not always possible.

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My lede:

All adults should be screened for depression, and primary care physicians should do the screening, according to a position statement issued in October by the American College of Preventive Medicine.

With 6.7% of American adults — about 15 million people — experiencing depression in any given year, the prevalence of the disabling and potentially deadly condition makes it imperative that primary care doctors regularly screen their patients, the college’s statement said. The college consists of 2,000 physicians who specialize in preventive medicine practice or research.

Primary care physicians are the principal health care contacts for most patients with mental illnesses, according to the paper, published in the October Journal of Family Practice. More than a third of primary care patients experience some form of depression, and 10% of patients have major depression. But, the college’s position statement said, most depressed patients seeing primary care doctors go undiagnosed.

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My lede:

Two New England physicians are taking on a state law they argue interferes with their ability to prescribe life-ending doses of medication to terminally ill patients who request it.

Gary Blick, MD, an HIV/AIDS specialist in Norwalk, Conn., and Ronald M. Levine, MD, an internist in Greenwich, Conn., in October filed a legal challenge to the state’s assisted-suicide statute, saying the threat of punishment prevents them from prescribing lethal doses of medication.

Dr. Blick said that since he started practicing in 1987, he has received numerous requests for lethal prescriptions from terminally ill patients with “agonizing pain” and poor quality of life. “I always tell them I can’t do that — I could be tried for manslaughter.”

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My lede:

GlaxoSmithKline plc, the world’s No. 2 selling drugmaker, said in September it will stop taking continuing medical education grant applications from medical education and communication companies.

The world’s top-selling drugmaker, Pfizer Inc., in July 2008, became the first company to steer its money away from these for-profit CME companies, often called MECCs. Critics argue that commercial CME providers are more likely than nonprofit providers to let bias slip into their offerings.

“A MECC can’t say to a drug company grant, ‘I can take this or leave this,’ whereas a medical center can say that, because they derive income from so many other sources,” said Daniel J. Carlat, MD, a prominent critic of industry support for CME and assistant clinical professor of psychiatry at the Tufts University School of Medicine in Massachusetts. “The incentives to create obviously promotional CME are much greater with MECCs than with other organizations.”

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My lede:

Sporting a pair of stylish aviator sunglasses as a hip-hop beat swells on the soundtrack, John D. Clarke, MD, seems at home in the rap video for which he won a national contest to find the best flu-prevention public service announcement.

But the first giveaway that the lyrics to this rap will stray far from typical Jay-Z fare is a close-up of Dr. Clarke’s name in script over the pocket on his white coat. Then he dishes out the rhyme: “Hand sanitizer, I advise you get it — why? It makes germs die when you rub and let it dry.”

The minute-long music video also advises patients to seek medical care if they believe they are infected with influenza A(H1N1), stay home when sick, use tissues when sneezing, wash their hands for 20 seconds, and avoid touching the nose, eyes and mouth.

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The video:

My lede:

“Oh, I forgot all about that,” Monal Joshi, MD, responded to a question from a senior resident during morning report. The internal medicine intern, entering the 25th hour of a 30-hour shift at Rush University Medical Center in Chicago, had overlooked a patient’s test result.

The slip was quickly caught by a supervisor, and no harm was done. But was the resident’s momentary lapse due to fatigue?

Dr. Joshi had at least two hours of sleep the night before — pretty good for when she’s on call.

Some other members of the five-person Rush internal medicine residency team looked worse for wear as their shifts neared the end one day last spring. Third-year medical student Shikha Wadhwani rested her hand on her head, blinking slowly and yawning widely, as the others went through their reports.

But Yoojin Kim, MD, an intern who slept from 3:30 a.m. to 6 a.m., looked bright as a fluorescent light as she sped through her patient reports.

Sleep scientists say staying awake for more than 16 hours decreases the ability to concentrate, impairs memory and hinders the ability to do tasks such as tracking test results on a monitor.

Yet sleep deprivation does not affect everyone the same way. Such is the enigma of the debate on whether resident duty-hour limits have helped patients.

Six years have passed since the Accreditation Council for Graduate Medical Education cut resident workweeks to 80 hours. The council also restricted shifts to 24 hours of call plus six hours of patient transition and educational activities.

Some health leaders said cutting back the weekend-long shifts and 120-hour workweeks that were common before the 2003 rules would yield a safety benefit — fewer patient deaths and fewer complications. But it is hard to make a definitive, evidence-based argument that the work-hour limits have improved patient outcomes, experts said.

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My lede:

White physicians, like white lawyers and white people with doctoral degrees, are not immune from an implicit preference for white people over black people, according to a study in the August Journal of Health Care for the Poor and Underserved.

Psychological testing shows that doctors do not differ from the general population or from other highly educated people in unconscious racial bias, the study said. But critics doubt whether these test results are associated with unequal treatment of black patients. Other research, including a new study of patients with breast or colon cancer, has concluded that disparities are driven not by racial bias, but by differences in where patients get medical care.

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My lede:

A $2.3 billion settlement with Pfizer Inc. over off-label drug promotion has industry observers wondering whether the record-breaking deal will deter drugmakers from talking up unapproved medication uses with doctors.

A Pfizer subsidiary, Pharmacia & Upjohn Co., agreed to plead guilty in early September to a felony violation of the Food, Drug and Cosmetic Act for misbranding its COX-2 inhibitor, Bextra, for off-label uses. The company agreed to pay $1.3 billion in criminal fines for systematically promoting off-label Bextra use to physicians through marketing materials, drug rep talking points and more.

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My lede:

Research participants want to be told about clinical investigators’ financial conflicts, and sharing that information usually enhances trust, a new study says.

But researchers behind the five-year, $3 million Conflict of Interest Notification Study, or COINS, warn that disclosure should not be the only strategy used to protect human subjects from the potential harms posed by investigators’ financial relationships with research sponsors.

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This is a big feature story, so here is my longish lede:

Deciding whether to participate in a clinical trial is not easy, no matter where the study takes place. Patients are faced with a mountain of information about the potential risks and uncertain benefits of becoming research subjects.

Add to that heady brew the stark disparity among patients in rich countries and those in developing nations, and concerns mount quickly about the growing number of global clinical trials tapping the poor as research subjects.

Compare, for example, the United States and India.

The average American income is $47,000 a year — 16 times what the average Indian takes home, according to the CIA World Factbook. There is one doctor for every 384 Americans, while there are 1,667 patients for each Indian doctor, the World Health Organization says. The average American patient consumes nearly $7,000 in medical care each year; the average Indian’s annual health care tally is $39. Nearly every American adult can read, but 39% of Indians are illiterate.

What does it mean for research subjects around the world to give informed consent when the playing field is so uneven?

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