This isn’t the first time compounders have been linked to safety problems. Physicians can seek out the rare accredited pharmacies or carefully question nonaccredited suppliers.

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The comparative effectiveness research program that is getting $3.5 billion in federal funding through 2019 under the Affordable Care Act aims to deliver actionable information to help physicians and patients decide among competing treatment options.

That money is meant to fix what many experts see as a market failure. To get Food and Drug Administration approval, pharmaceutical companies need not demonstrate that their drug is superior to others already approved. Once drugs and other treatments are available on the market, there is little financial incentive for companies to fund expensive studies that may show their option is inferior.

Yet an analysis of high-profile comparison trials during the past decade suggests that a lack of funding for comparative research has not been the only obstacle to using top-flight evidence to shape patient care. Even when they contradict prevailing practice, comparative effectiveness studies often fail to translate into substantial changes in patient care, said a study in the October issue of Health Affairs.

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The rate of article retractions in the biomedical and life-sciences literature has risen tenfold in the last 35 years. Most retractions are due to fraud, plagiarism and other misconduct, said a study published online Oct. 1 in the journal Proceedings of the National Academy of Sciences.

The proliferation of journals and the intense competition for research grants and academic tenure may be contributing to the growing problem, experts said. Along with continuing concerns about researchers’ financial relationships with industry, the rise of scientific misconduct adds yet another reason for practicing physicians to scrutinize carefully what they read in medical journals, they added.

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Physicians are deeply suspicious of industry-funded randomized clinical trials, even when they are of high methodological rigor, according to recently published findings.

The study, which appeared in the Sept. 20 issue of The New England Journal of Medicine, comes amid efforts by leading pharmaceutical companies to close what they see as a “credibility gap” faced by industry-sponsored research. The study’s authors and other experts argue that high-profile controversies such as misleading and selectively reported trial data related to Merck’s Vioxx (rofecoxib) and GlaxoSmithKline’s Avandia (rosiglitazone) have made physicians more doubtful of pharma-sponsored studies.

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Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.

Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors saw 16.6% fewer patients, according to a survey of nearly 14,000 doctors released in September. If the trend continues through 2016, it would equate to the loss of 44,250 full-time physicians, said the report, conducted by the doctor-recruiting firm Merritt Hawkins & Associates for the Physicians Foundation.

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The vast majority of patients have never asked a physician or other health professional if they washed their hands before a physical exam or medical procedure, said a survey released in September.

Only 21% of patients have asked about hand hygiene in the hospital, and just 17% have inquired about hand-washing at their doctor’s office, said the nationwide online survey of 1,020 U.S. adults. Fewer than 10% of patients said they ask “frequently” or “all the time.”

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Despite repeated warnings from the Centers for Disease Control and Prevention and others, unsafe injection practices continue to lead to disease outbreaks. Though rare in the U.S., safety experts say these mishaps should never happen.

Health industry companies say they have a solution: injection systems they say are designed to make it easier for physicians, nurses and other health professionals to deliver shots safely.

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More than a half-million preventable drug-related injuries occur among Medicare outpatients each year. And a quarter of medication errors are attributed to poor drug packaging and labeling.

To combat this, the Institute of Medicine recommends generally applicable safety strategies such as reducing polypharmacy and spreading adoption of electronic prescribing, medication reconciliation and clinical decision support. Yet new research suggests that interventions are needed to target the specific medicines that most commonly harm patients.

Adverse drug events send at least 265,000 seniors to U.S. emergency departments every year and hospitalize nearly 100,000 patients 65 and older, according to a Nov. 24, 2011, study in The New England Journal of Medicine. What is striking, experts say, is the study’s finding that four kinds of medications — warfarin, insulins, oral antiplatelet agents and oral hypoglycemic agents — together account for seven in 10 emergency hospitalizations among seniors.

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