My lede:

The American Medical Association, the American College of Physicians and others have declared unethical the practice of paying doctors “finder’s fees” for recruiting patients as clinical research subjects. But only half of institutional review boards address in writing the conflict of interest these kinds of payment incentives pose, according to a survey of IRB policies at 117 medical schools that received National Institutes of Health research funding.

About a quarter of the IRB policies prohibit investigators from offering finder’s fees to doctors or other health professionals, said the study in the January-February IRB: Ethics & Human Research, a journal published by the Garrison, N.Y.-based Hastings Center. Payments can range from $2,000 to $10,000 per patient enrolled in a clinical trial, according to published reports.

The whole shebang.

My lede:

For the first time, the country’s two leading professional organizations devoted to pain medicine jointly released comprehensive guidelines for physicians using opioids to treat patients with chronic non-cancer pain.

The recommendations, published in the Feb. 6 Journal of Pain, are intended to help doctors navigate the tricky terrain of caring for the estimated 9% of Americans living with severe chronic pain while averting recreational use and diversion (www.jpain.org/article/piis1526590008008316/abstract/).

Meanwhile, the Food and Drug Administration announced plans to work with manufacturers of 24 long-release opioids to develop a single plan to manage the risk of opioid misuse and overdoses. The plan could include some sort of education requirement for doctors prescribing these opioids.

The whole shebang.

My lede:

There are more than 78,000 Americans waiting for a kidney transplant, according to the United Network for Organ Sharing. Worse, the gap between the number of patients waiting and the number of kidney transplants performed has grown by 110% in the last decade.

Cutting the lengthy wait for a kidney will take more than innovative changes in medical practice, according to the National Kidney Foundation. As part of a new initiative unveiled in late January, the patient service and advocacy organization said compensation should be part of the solution.

That represents a shift from the group’s 2003 position that “offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society.” Now, NKF recommends that deceased donors’ families and living donors be reimbursed for donation-related costs or medical care. For living donors, that would include lifelong coverage for any medical problems related to the donation.

The whole shebang.

My lede:

Physicians who receive $100 or more from drugmakers or device manufacturers over the course of a year would have those payments posted to the Web under bipartisan Senate legislation introduced in January.

The new bill is stricter than a version of the measure circulated last year that received support from industry and organized medicine groups, including the Pharmaceutical Research and Manufacturers of America and the American Medical Association.

The reintroduced legislation, known as the Physician Payments Sunshine Act, came amid another round of disclosure and conflict-of-interest policies announced by doctors and academic health systems.

The whole shebang.

My lede:

The rate of patients entering the hospital with methicillin-resistant Staphylococcus aureus increased eightfold between 1999 and 2006. Politicians in statehouses around the country say hospitals need to take a more active approach to stopping MRSA’s spread.

Since 2007, four states — California, Illinois, New Jersey and Pennsylvania — have enacted laws requiring hospitals to screen high-risk patients for MRSA infection or colonization and follow precautions to prevent other patients from becoming infected. Eight states considered similar legislation last year, and as of late January, new bills had been filed in Washington and Kentucky.

The whole shebang.

My lede:

What began in late January as a feel-good story of a California medical team’s Herculean efforts to deliver octuplets after a 31-week pregnancy quickly morphed into a controversy over the medical ethics of fertility practices.

The octuplets’ mother, 33-year-old Nadya Suleman, said in an interview on NBC’s “Today” that her physician transferred six embryos and two split. Suleman is single, unemployed and has six other young children. All were conceived through in vitro fertilization at the same clinic, she said. For each pregnancy, her doctor transferred six embryos, Suleman said.

If that is true, the physician’s actions went well beyond American Society for Reproductive Medicine guidelines, society president R. Dale McClure, MD, said in a statement. The Medical Board of California is investigating, and the ASRM has offered to aid the inquiry. The AMA referred requests for comment to the ASRM.

“What was done is clearly irresponsible, clearly unethical, and it placed the life and health of the mother as well as the fetuses at great risk,” said Samuel H. Wood, MD, PhD, a La Jolla, Calif., reproductive endocrinologist. “It’s simply the wrong thing to do.”

The whole shebang.

The lede:

Virtually all hospitals allow physicians and other health professionals to report adverse events, but a new study finds that most reporting systems fail to cultivate a so-called culture of safety that can help prevent future errors.

Less than a third of hospital reporting systems let doctors, nurses and others recount mistakes anonymously and promise privacy for those who identified themselves, said the survey of risk managers at 1,652 U.S. hospitals reported in the December 2008 Quality & Safety in Health Care. Only 13% of hospitals drew adverse-event reports from a wide variety of health staff. More than 80% of risk managers said they received few or no reports from physicians.

Just one in five hospitals issued adverse-event reports within two weeks of an incident. About the same number gave those reports to the key hospital departments and committees charged with protecting patients. One in three hospitals failed to disseminate analyses of the adverse events and near mistakes that were reported.

The whole shebang.

The lede:

The last few years have seen a flurry of controversies about physician involvement in capital punishment in California, Missouri and elsewhere. Organized medicine groups, including the American Medical Association, have said physicians should not participate in executions because their professional duties lie in preserving lives, not ending them.

But what constitutes participation? The latest test of this ethical standard comes from Washington state.

Just before Thanksgiving, the director of health services for the state’s prison system resigned his post prior to the scheduled Dec. 3, 2008, execution of Darold Ray Stenson, who was convicted in 1994 of killing his wife and a business partner.

As the corrections department’s top medical officer, Marc F. Stern, MD, MPH, supervised about 700 physicians, pharmacists, nurses and other health professionals. Dr. Stern said that if any of those staffers helped carry out the execution, the actions would put him “in harm’s way” ethically because he supervised them, albeit indirectly.

The whole shebang.

The lede:

Complex pharmacological regimens employed in outpatient cancer treatment and lagging use of health information technology in the specialty have created alarmingly high rates of medication errors, according to a study published in the Jan. 1 Journal of Clinical Oncology.

A review of 1,379 patients’ medical charts and nearly 12,000 medication doses at four oncology clinics around the country found a 7.1% rate of outpatient medication errors in adults — more than double the rate found in a December 2005 study. Slightly less than 1% of the adult medication errors caused injury.

The rate of medication errors among children was 18.8%, with 3.4% of the errors causing injury. More than half the errors in all patients had the potential to cause injury.

The whole shebang.

The lede:

Growing numbers of clinics abroad are marketing unproven, costly stem cell therapies to medical tourists and “exploiting patients’ hopes,” according to a report from the International Society for Stem Cell Research.

The Deerfield, Ill.-based group convened a task force of researchers, ethicists, doctors and regulatory officials from 13 countries to devise guidelines that target clinics offering experimental therapy to patients without appropriate transparency, oversight or patient protections.

“There is this tension between the slow progress of medical science and the desperation of patients and the swiftness with which disease overtakes them,” said Laurie Zoloth, PhD, on the task force that issued the report in December 2008. “Combine that with a flat world and the Internet, and it’s a recipe for stem cell fakery.”

The whole shebang.

The lede:

A Montana state district judge ruled in December 2008 that mentally competent patients with terminal illnesses have the right to physician-assisted suicide under the state’s constitution. In early January the same judge, Dorothy McCarter, rejected the state attorney general office’s request that her order be stayed until the Montana Supreme Court considers the case on appeal.

McCarter said in a one-page order that issuing a stay of her decision in the case of Baxter v. Montana would “deny the fundamental right of Montanans to die with dignity for a lengthy period of time while the case is being appealed.”

The order means that physician-assisted suicide is now legal in three states: Oregon, Washington and Montana. The state’s new attorney general, Democrat Steve Bullock, plans to appeal the Baxter decision, a spokesman said.

The whole shebang.

The lede:

Gregory House, MD, has an unusual view of right and wrong. On several occasions, Dr. House has ordered underlings to break into patients’ houses to search for clues to an elusive diagnosis. He once triggered a seizure — against a patient’s will — to confirm a diagnosis of the rare metabolic disorder acute intermittent porphyria.

Dr. House is the fictional protagonist of Fox TV’s “House,” a medical mystery drama that last year drew an average 16.2 million viewers weekly. The bad-boy antics that made the master diagnostician a hit with American viewers also have made him popular among medical students, according to a December 2008 study in The American Journal of Bioethics.

The survey of nearly 400 medical and nursing students at Johns Hopkins University in Maryland found that 76% of doctors in training watch “House” and 73% watch ABC’s hospital soap opera “Grey’s Anatomy.” Nearly 40% watch NBC’s “ER” and one in five tunes in “Nip/Tuck,” which airs on the FX cable network. Eighty-five percent of medical students said they watched a medical drama in the prior year.

The whole shebang.

The lede:

The Joint Commission has confirmed what many physicians have long suspected: For all the hope that gee-whiz technology can improve quality and safety, even the smartest machines can lead to medical errors.

The commission, which accredits hospitals and other health care organizations, warned in a December 2008 sentinel event alert that “not only must the technology or device be designed to be safe, it must also be operated safely within a safe work flow process.”

At least 10% of harmful medication mistakes are technology-related failures, according to U.S. Pharmacopeia’s Medmarx voluntary drug error-reporting database. Everything from barcodes that fail to scan to confusing computer screen displays were to blame, USP’s 2008 report said.

Other studies have found that computerized physician order entry systems facilitate 22 different types of medical mistakes, while nurses frequently skip scanning barcodes to work around poorly implemented systems.

“Computers don’t make us less stupid,” said Joint Commission President Mark Chassin, MD, MPH, in a news conference. “They make us stupid faster.”

The whole shebang.