New immigration policy endangers patients needing life-saving care

A new policy implemented by U.S. Citizenship and Immigration Services (USCIS) bars its field offices from accepting or adjudicating requests for temporary deferral of deportation for immigrants with serious medical illnesses.

The AMA is strongly urging the USCIS to reverse the move. The agency has long used deferred action, which is a form of prosecutorial discretion, and in recent years the USCIS has allowed it for immigrants suffering serious medical conditions.

My latest for the AMA. The whole shebang.

Court blocks law that would force physicians to mislead patients

A federal district court in North Dakota has sided with the AMA and others and issued a preliminary injunction to block enforcement of a state law that would force physicians to violate the ”AMA Code of Medical Ethics” and act as mouthpieces for a politically motivated message that is misleading and could harm patients.

The provision would have forced North Dakota physicians to tell women “that it may be possible to reverse the effect of an abortion-inducing drug if she changes her mind, but time is of the essence, and information and assistance with reversing the effects of an abortion-inducing drug are available” in government-printed materials to be given to the patients.

“State legislatures should not be mandating unproven medical treatments, or requiring physicians to provide patients with misleading and inaccurate information,” says Chief Judge Daniel Hovland’s decision. “The provisions of [this law] violate a physician’s right not to speak and go far beyond any informed consent laws addressed by the United States Supreme Court, the 8th Circuit Court of Appeals, or other courts to date.”

The lawsuit was filed by the AMA in in the U.S. District Court for the District of North Dakota, in Bismarck, on behalf of the Red River Women’s Clinic, and the clinic’s medical director, AMA member Kathryn Eggleston, MD, as co-plaintiffs.

My lede. The whole shebang.

Also recently published at the AMA website:

New BRCA recommendations: What primary care doctors must know

The U.S. Preventive Services Task Force (USPSTF) has updated its recommendations on screening for the BRCA1 and BRCA2 genetic mutations that account for 15% of ovarian cancer cases and between 5% and 10% of breast cancer cases. Here is what primary care physicians should know about the new recommendations.

The USPSTF’s recommendation statement, published in JAMA along with the task force’s evidence report, represents a significant change to the group’s 2013 recommendations and broadens the pool of women for whom primary care physicians should conduct a risk assessment and potentially refer for genetic counseling and testing.

My latest for the AMA. The whole shebang.

Proposal would roll back LGBTQ protections. That’s an awful idea.

What’s the news: The AMA is strongly criticizing a proposed Department of Health and Human Services rule that would do away with Affordable Care Act (ACA) protections for LGBTQ people, women, immigrants, minorities and other patients.

“This proposal marks the rare occasion in which a federal agency seeks to remove civil rights protections,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a sharply worded letter to HHS Secretary Alex Azar. “It legitimizes unequal treatment of patients by not only providers, health care organizations, and insurers, but also by the government itself—and it will harm patients. Such policy should not be permitted by the U.S. government, let alone proposed by it.”

My latest for the AMA. The whole shebang.

E-prescribing controlled substances: Here’s why the clicks add up

Electronic prescribing has taken off, making it easier for physicians to get orders quickly and safely to the pharmacy of the patient’s choice. Yet while 70% of physicians e-prescribe, only 20% are able to electronically order controlled substances such as analgesic opioids.

And accessing the information in state prescription drug-monitoring program databases—a key tool to prevent opioid misuse or diversion—is another question altogether. It often means that physicians have to start a separate workflow with new windows, logins, and more clicks and keystrokes.

My latest for the AMA. The whole shebang.

Doctors battle state law that forces them to mislead patients

The AMA has filed a federal lawsuit challenging the constitutionality of North Dakota legal provisions forcing physicians to violate the AMA Code of Medical Ethics and act as mouthpieces for politically motivated messages that are misleading and could lead to patient harm.

North Dakota law already requires physicians or members of the doctor’s care team to tell women set to have an abortion that the procedure “will terminate the life of a whole, separate, unique, living human being.”

Now a provision set to take effect Aug. 1 would force them to also tell women “that it may be possible to reverse the effect of an abortion-inducing drug if she changes her mind, but time if of the essence, and information and assistance with reversing the effects of an abortion-inducing drug are available” in government-printed materials to be given to the patients.

Together, the two provisions “compel physicians and their agents to speak government-mandated messages that entail providing to their patients misleading or even patently false, nonmedical information with which they disagree,” says the complaint filed by the AMA and other plaintiffs.

My latest for the AMA. The whole shebang.

Men at Work

For blocks around, the black and yellow towers
Soar above the construction site
Approach to hear its cacophony
Of grinding, hammering, shouting
Men at work

Look up for a glimpse of their project
Come closer and the view ahead’s obscured
By tarpaulin-shielded, chain-link fencing
Come closer yet to find
Not all is opaque

See the upturned earth where the new building
Will have its foundation
The broken-up rock and concrete that
Will be carried away
See immense machines marching and
Men at work
In their hard hats and reflective gear
Work gloves and blue jeans

This morning’s kindergartners
Scattered the playground at summer camp
Letting the sand slip through their fingers
And the cool wind ruffle their t-shirts
Grinding down their temporary towers
Hammering away at invisible inventions
Yelling away, but with their reasons
Deeply engaged in the earnest business of
Children at play

Back at the work site
Look about to find
A bald-headed old man
In a beat-up windbreaker
Use the fence to steady himself
And discover a spot
Where two posts
Are imperfectly joined
To offer an unimpeded view of
Men at work
That leaves the old-timer
Shining the ecstatic beam of a
Little boy

— 30 —

AMA principles will further gender equity among physicians

The AMA House of Delegates has adopted a comprehensive set of principles on gender equity in medicine designed to address what an AMA Board of Trustees report calls “a complex, pervasive issue that requires a multilayered approach.”

“The statistics on pay and leadership disparities in medicine are jarring, but sadly, unsurprising,” said AMA Board of Trustees Chair Jesse M. Ehrenfeld, MD, MPH. “Even as the number of women in medicine increases—and women now outnumber men as physicians-in-training—more must be done to spur change and eliminate the bias and discrimination that adversely affect women and, consequently, our profession.”

My latest for the AMA. The whole shebang.

Time to scrutinize PBMs’ outsized role in Rx decision-making

The increasingly powerful role that pharmacy benefit managers play in the prices and availability of prescription drugs is one that merits careful scrutiny from regulators, says an AMA Council on Medical Service report whose recommendations were adopted at the 2019 AMA Annual Meeting in Chicago.

“It’s time to pull back the curtain on pharmacy benefit managers and how their practices negatively impact patients. How is it that PBMs and health plans profit from negotiated discounts on prescription drugs, while patients pay co-pays based on high drug list prices that even the plans themselves are not paying?” said Russell Kridel, MD, a member of the AMA Board of Trustees. “Because of market concentration and lack of transparency, patients and physicians are essentially powerless in the face of PBM pricing and coverage decisions.”

My latest for the AMA. The whole shebang.

Physicians: The ACA should be strengthened, not abandoned

The AMA House of Delegates today adopted new policy to boost its push for universal coverage by improving the Affordable Care Act (ACA) while maintaining the Association’s opposition to a single-payer approach to health system reform.

“Since the ACA was enacted into law in 2010, millions of Americans have gained health insurance. The policy question now is how to improve the law to insure even more,” said AMA President Barbara L. McAneny, MD. “We need policies to make coverage more affordable for millions of Americans—both in the premiums they pay, as well as their cost-sharing responsibilities.”

My latest for the AMA. The whole shebang.

What’s at stake in this week’s CVS-Aetna merger hearing

What’s the news: In an unprecedented three-day hearing this week, Judge Richard Leon of the U.S. District Court for the District of Columbia will hear from six witnesses about the $70 billion merger of pharmacy giant CVS Corp. and mega-insurer Aetna Inc. The U.S. Department of Justice (DOJ) decided in October 2018 to allow the merger after requiring a divestiture of Aetna’s Medicare Part D business.

Judge Leon’s decision to hold a hearing that includes live witnesses as part of a Tunney Act review of the DOJ action is a first, antitrust experts say.

My latest for the AMA. The whole shebang.