State takes first-ever path to approve assisted suicide

Vermont in May became the first state to enact a law authorizing physician-assisted suicide through the legislative process.

After the bill narrowly passed the state Senate, the House passed the measure 75-65 on May 13, concluding Vermont’s decade-long political tussle over doctor-assisted suicide, which advocates call aid in dying. Democratic Gov. Peter Shumlin signed the bill into law on May 20.

“This historic legislative victory proves that the aid-in-dying issue is no longer the third rail of politics,” said Barbara Coombs Lee, president of Compassion & Choices, a Denver organization that advocates for legal access to doctor-hastened death.

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Cancer prevention: Jolie’s choice creates patient demand for tests

On the day that Angelina Jolie’s op-ed discussing her hereditary risk for breast cancer and decision to opt for a prophylactic bilateral mastectomy ran in The New York Times, genetic counselor Lisa Madlensky, PhD, checked in with her scheduler to see if the news had prompted patient inquiries.

“She actually didn’t have time to speak to me because she had all these calls backed up on the line,” said Madlensky, director of the Family Cancer Genetics Program at the University of California, San Diego Moores Cancer Center. “Finally, she put someone on hold. She hadn’t seen the news yet and she said, ‘What’s going on?’ ”

In the wake of the actress’s announcement, genetic counselors and breast and cancer centers are reporting similar increases in calls and visits from patients who want to learn more about being tested for the BRCA1 and BRCA2 gene mutations. The Jolie case shows the power that celebrities wield in driving medical care patterns by raising public awareness and tapping into the emotional connection that patients often form with the women and men who grace the covers of supermarket tabloids.

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Federal action sought to curtail drug noncompliance

A new coalition of patient groups, physician organizations, drugmakers, pharmacists and pharmacies is aiming to make headway in battling the persistent problem of medication noncompliance. The coalition, dubbed Prescriptions for a Healthy America and led by the employer- and insurer-backed Council for Affordable Health Coverage, said it hopes to educate lawmakers about the importance of the issue and pursue public-policy solutions to improve drug adherence.

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Pediatricians offer newborn care standards for home births

Babies born through planned home deliveries should receive the same level of newborn care as those born in hospitals or freestanding birthing centers, according to American Academy of Pediatrics policy published in May.

The academy’s statement, formulated by its Committee on Fetus and Newborn, is meant to supplement the American College of Obstetricians and Gynecologists’ policy adopted in February 2011 and reaffirmed in 2013. The ob-gyns and pediatricians agree that hospitals and birthing centers are the safest settings for birth. Although the ACOG statement acknowledges that women have the right to make a medically informed choice about delivery, the AAP strikes a somewhat softer tone, saying its policy is “intended to help pediatricians provide supportive, informed counsel to women considering home birth.”

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Diagnostic errors are lead cause of medical liability payouts

Errors in diagnosis are responsible for more deaths, disabilities and medical liability payments than any other kind of medical error, according to a review of more than 350,000 paid claims from 1986 to 2010 included in the National Practitioner Data Bank.

The findings echo earlier research and draw on the largest set of cases yet to be analyzed. More than 100,000 medical liability cases involved errors in diagnosis, nearly 30% of the total. That compares with 27% for treatment mistakes and 24% for surgical errors, said the study, published online April 22 in BMJ Quality & Safety.

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Med schools improve grades on cutting links to pharma

Most U.S. medical schools are earning high marks on an influential scorecard that grades their conflict-of-interest policies. In the latest edition of its PharmFree Scorecard, released April 9, the American Medical Student Assn. handed out A’s and B’s to 114, or 72%, of the nation’s 158 allopathic and osteopathic medical schools.

That represents a rise from last year’s results, which saw 102 schools, or 65%, get an A or a B. The scorecard grades schools’ policies on how tightly they restrict interactions with pharmaceutical companies, device makers and other medical industry firms in 11 areas such as gifts, meals, drug samples and faculty participation in speakers’ bureaus.

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Cancer center goes public with assisted-suicide protocol

The physicians who run the Seattle Cancer Care Alliance do their best to treat patients who have cancer. For patients whose disease progression cannot be controlled, the University of Washington-affiliated comprehensive care center offers palliative care and transition to hospice.

And for those who seek physician-assisted suicide under state law, the center is prepared to help them with that, too.

Providing access to doctor-hastened death is an element of top-notch care for terminally ill patients, SCCA’s clinical leaders argue in a first-of-its-kind published report to outline an organization’s physician-assisted suicide protocols and the results for its patients. The authors wrote in the April 11 issue of The New England Journal of Medicine that their program should be “particularly instructive” to other comprehensive cancer centers in states where doctor-assisted suicide is legal or may be legal one day.

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Quality effort yields big drop in death rate at hospitals

Working together to share best practices, analyze data and implement care improvements, 333 hospitals participating in a quality collaborative have cut their risk-adjusted mortality rate by 36% since 2007, said a report issued in March by the project’s organizers.

The Quality, Efficiency, Safety, Transparency initiative — dubbed QUEST for short — was launched in 2007 with 157 hospitals by Premier Inc., a Charlotte, N.C.-based purchasing and quality improvement alliance of more than 2,800 U.S. hospitals.

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Primary care rebounds on Match Day

After a slight dip in the 2012 Match, the share of fourth-year U.S. medical students opting for residencies in primary care specialties rose again in 2013. But physician organizations and medical schools warned that rising student interest in primary care is not enough to avert projected physician shortages and does not make up for the lack of graduate medical education slots available due to a cap on federal funding of such residency positions.

The number of U.S. seniors entering primary care residencies fell by less than 1% in 2012 but saw an increase of 5.5% in 2013. A total of 6,327 seniors opted for GME positions in family medicine, internal medicine and pediatrics. Nearly 700 more residency positions of all kinds were offered this year, yet the share of U.S. students choosing primary care still rose by 1.3% to 38.6% in 2013.

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Doctor-pharma ties defended on eve of pay reporting mandate

With the start of federally required tracking of industry payments to physicians to begin in August, some of the biggest names in medicine are staking a claim that shining a light on the financial ties between health industry companies and physicians should not discourage relationships that yield beneficial innovations in patient care.

In a statement of principles released March 11, a wide range of trade groups for pharmaceutical companies, device manufacturers, clinical research organizations and medical schools joined with physician organizations representing osteopathic doctors, neurosurgeons and other medical specialties to defend the value of research projects and other relationships among doctors and health industry companies.

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