Pharmaceutical companies have slashed their sales rep force by about 30% from a high of 105,000 five years ago, according to industry figures. And as the number of detailers has fallen, so, too, has another hallmark of pharmaceutical marketing: drug samples.

Drugmaker spending on the samples that drug reps leave behind in physician offices has gone down by 25% since 2007, said Cegedim Strategic Data, a global pharmaceutical market-research firm that surveys a rotating panel of 2,300 U.S. physicians to generate its industrywide estimates. In 2007, drugmakers spent nearly $8.4 billion on samples. That figure fell to about $6.3 billion in 2011, the most recent data available.

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Peter A. Goodwin, MD, a family physician who lobbied for passage of Oregon’s Death with Dignity Act, died March 11 after ingesting medication prescribed to him by a doctor under the law. He was 82.

Dr. Goodwin was diagnosed with the progressive neurogenerative disease corticobasal degeneration in 2006. He said in a recent online video that three physicians gave him a prognosis of less than six months.

“I’ve always accepted the idea that if push came to shove, and if I qualified for the [Death with Dignity Act], that I’d use the law,” Dr. Goodwin said in the video.

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Seven years after the federal government started publicly reporting hospitals’ performance on quality measures, evidence suggests that this transparency effort has not improved patient outcomes measurably.

The latest discouraging finding is in a study in the March issue of Health Affairs that analyzes death rates among Medicare patients with heart attack, heart failure and pneumonia in the five years before the launch of the government’s Hospital Compare website and in the three years afterward. Although individual hospitals’ compliance with quality metrics for these conditions was reported publicly, the effort reduced the odds of a heart failure patient dying within 30 days by only 3%. Heart attack and pneumonia patients saw no improvement in death rates, the study concluded.

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Many patients struggle to understand written health materials, as well as their physicians’ spoken instructions. Doctors can help their patients get the message.

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A coalition of health care organizations is highlighting how collecting patients’ demographic data, expanding cultural competency training and diversifying health leadership can help reduce care disparities.

For example, New York-Presbyterian Hospital started an initiative to improve care for patients in the largely Hispanic neighborhoods of Washington Heights and Inwood in New York City. The effort included a four-hour training program for health professionals to help address patients’ cultural, language and literacy needs.

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Community health centers that implement the most sophisticated elements of the medical home concept may not achieve superior quality outcomes compared with centers that meet basic medical home criteria, said a study published online Feb. 13 in Health Affairs.

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The proportion of newborn boys circumcised in U.S. community hospitals is at its lowest level, 54.5%, since the federal government starting tracking the statistic in 1993.

The rate has fallen from its peak of 62.7% in 1999, when the American Academy of Pediatrics adopted a neutral position on the procedure.

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