The lede:

Under intense criticism for its slow response to drug and device safety problems, the Food and Drug Administration last month announced a new initiative to detect adverse event patterns and warn physicians earlier.

The effort, known as the Sentinel Initiative, marks a significant shift from relying on physicians and patients to report adverse events toward a program of high-tech, active postmarket surveillance.

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Seven in 10 doctors agree that chronic noncancer pain is undertreated in the U.S.

Nearly half of 150 practicing primary care physicians surveyed said they used nonclinical considerations to determine whether to prescribe opioids to treat such pain. In a recent study by the American Pain Foundation, the doctors ranked regulatory and law enforcement scrutiny as the biggest barriers.

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The deadly aftermath of Hurricane Katrina and concerns about a pandemic avian influenza have driven disaster preparedness and surge capacity planning, but physicians and others are starting to wrestle with perhaps an even trickier set of issues.

What if, despite efforts to ramp up capacity and provide disaster response at the local, state and federal levels, the number of seriously ill patients exceeds the supply of critical care resources needed to keep them alive? Who should get care?

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A new study finding a much higher rate of pediatric hospital adverse drug events than previously thought sparked the Joint Commission last month to issue an alert advising physicians and hospitals how to reduce such mistakes.

About 11% of child patients experience adverse drug events during hospitalizations, according to an April study in Pediatrics — a rate nearly five times higher than in previous studies.

Despite the higher rate, the review of 960 randomly selected charts from 12 children’s hospitals showed that more than three-quarters of the medication side effects were unpreventable. But the study said 17.8% of side effects could have been identified earlier, and 16.8% could have been mitigated more effectively.

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It was 10 springs ago that a Portland woman in her mid-80s sat to talk about her impending death. Doctors guessed the metastatic breast cancer wracking her body would kill her within two months. As the city shook off its winter slumber, the woman — whose identity is still a secret — anticipated her eternal rest.

“I’m looking forward to it,” she said in a recording later made available to reporters. “I can’t see myself living a few more months like this.”

Disease set her on the path toward death, but the woman was determined to choose when and how to take her final steps. For that, she needed a doctor’s help.

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The lede:

The Centers for Medicare & Medicaid Services last month proposed to stop paying for nine hospital-associated conditions that it says can be prevented and that cost Medicare about $25 billion last year.

The nine conditions would join a list of eight others adopted last year. CMS will stop paying for those eight this October. While some welcomed the proposal as a sign Medicare is stepping up efforts to encourage hospitals to improve patient safety, others said CMS should wait to see how implementation of the first round of no-pay conditions unfolds.

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The number of disciplinary actions against doctors by state medical boards has fallen for three straight years.

Nationwide, total disciplinary actions are down 15% from a 2004 high, according to an April report by the Federation of State Medical Boards. Prejudicial actions, which include serious discipline such as license revocations and suspensions, have dropped 17% from 2004 to 2007.

The news comes on the heels of intense scrutiny of boards in Kansas and Nevada and legislation proposed or enacted in more than a dozen states aimed at strengthening medical boards’ powers.

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The lede:

In 2004, MatchingDonors.com helped arrange an organ transplant between a donor and recipient who met through its Web site, sparking a heated debate about public solicitation of donors.

The conversation at the Frontiers of Ethics in Transplantation conference, held last month in Chicago, showed that the controversy still hasn’t abated, even as more transplant centers soften their stance on these types of donations.

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The lede:

The pace of health care quality improvement appears to be slowing, according to the Agency for Healthcare Research and Quality’s fifth annual report compiling federal and state data on more than 200 quality metrics.

A composite measure of health care quality improved at a 2.3% average annualized rate between 1994 and 2005, with the rate falling to 1.5% from 2000 to 2005. And in a first stab at examining the cost efficiency of the American health care system, AHRQ noted that costs, as estimated by the Centers for Medicare & Medicaid Services, jumped 6.7% from 1994 to 2005.

AHRQ, part of the U.S. Dept. of Health and Human Services, said in its March report that cost and quality cannot be reliably compared because “expenditures are comprehensively measured, but quality is not.” Still, experts said, the new report represents another high-profile effort to link cost and quality.

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The lede:

Three in five inpatients are extremely satisfied with their hospital care. And two of three patients would definitely recommend their hospital to friends and family, according to new survey data released last month by the U.S. Dept. of Health and Human Services.

The patient satisfaction data also show that eight in 10 patients said their physicians always explained things clearly, listened carefully and treated them with courtesy and respect.

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Under fire from anti-abortion physicians and Health and Human Services Secretary Michael Leavitt, the American College of Obstetricians and Gynecologists announced in March that it will re-examine a controversial November 2007 opinion outlining the limits of conscientious refusal.

The ACOG ethics committee opinion said physicians who have religious or moral objections to “standard practices,” such as abortion, sterilization or the prescribing of contraceptives, are not ethically obligated to provide those services but do owe patients a timely referral to another doctor willing to deliver them.

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One physician’s faxed order to discontinue hydrocodone, marketed as Anexsia, was misread by the pharmacist as an order to discontinue Arixtra, an anticoagulant. Another doctor intended to electronically order clonidine, an antihypertensive, but accidentally ordered the sedative clonazepam because both appeared as “CLON” on the computer screen.

These are just two of the 3,170 pairs of drug names that look or sound alike and can result in medication errors. They were found in a recent U.S. Pharmacopeia review of more than 26,000 patient records submitted over three years by 870 health care organizations. That total is nearly double the 1,750 similarly named drug pairs identified in a 2004 report issued by USP, a Rockville, Md.-based nonprofit standards-setting organization.

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The lede:

When revelers rang in the New Year, Robert Jarvik, MD, was the star of a massive Pfizer Inc. advertising campaign for Lipitor (atorvastatin). By the end of February, Pfizer had ended the campaign, under the pressure of a U.S. House Energy and Commerce Committee probe.

The committee’s chair, Rep. John Dingell (D, Mich.), charged that the ads misled the public because they created the impression that Dr. Jarvik is a practicing physician, when he is a biomedical engineer not licensed to practice medicine. The committee disclosed that Dr. Jarvik received $1.35 million under a two-year contract set to expire this month, according to media reports.

Dr. Jarvik, who had helped develop the Jarvik-7 artificial heart, defended his role as a physician spokesman, adding in a statement that his “credibility as a heart expert is fully justified and is fairly represented” in the ads.

But the controversy has sparked a broader conversation about the ethical ramifications of physicians serving as commercial endorsers. While the Lipitor campaign is the most prominent use of a paid physician spokesperson, it is not the only one.

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