Sep 22, 2010

The Happy Health Reform Cartoon

Via the Kaiser Family Foundation ... 10 minute animation devoted to helping average Americans understand health reform.  Interesting, but mostly a PR pitch for reform.  Lots of happy cartoon Americans tossing little coins in different directions (mostly at Uncle Sam) makes redistribution seem more fun. (It's also worth noting how rapidly Medicare cuts, a looming political and sustainability problem, are covered.) ... Nonetheless, the video's worth viewing:

Sep 18, 2010

Guest Post: Industry Funding of CME

The last post highlighted a Boston Globe article regarding the role of industry funding in continuing medical education ... in response to the Globe article, I receive this hypothetical interaction between a CME instructor and an attendee that I couldn't resist sharing:

CME REGISTRANT: "What are your credentials to teach this session?"

INSTRUCTOR: "I am a board-certified cardiologist and I have no financial conflicts to report"

CME REGISTRANT: "What will I be learning today?"

INSTRUCTOR: "Evidence-based best practices to open a clogged coronary artery. Let's begin. First, you hold the flint in your dominant hand and strike it sharply with the iron chisel until a sharp edge is fashioned. Be careful with the sparks and stone chips. This technique has been around a long time and is very well described....."
CME REGISTRANT: "What about angioplasty?"

INSTRUCTOR: "Ah, I see the catheter rep has paid you a visit. Angioplasty is a relatively new procedure and the risks are not yet fully understood, nor the long term outcomes. We have much more extensive experience with flint-making. The angioplasty companies are disease mongerers and by using the classical technique, you make a powerful statement that you cannot be bought."

CME REGISTRANT: "Please excuse me, I'm downloading intravascular ultrasound images on my iPhone for a case tomorow......"

INSTRUCTOR: "Please be sure to attend this afternoon's session where I will give an engrossing lecture, 'Fire: Going Beyond Sterilization', you won't want to miss it".

CME REGISTRANT: "Thank you...."

-Anonymous Guest

Sep 16, 2010

People Who Have The Most Expertise ... Are the People Who Work With Industry - Steven Nissen, Cleveland Clinc

The debate over the role of industry funding in continuing medical education (CME) continues on the pages of the Boston Globe this week.  

The article highlights a new company, Lighthouse Learning, that was formed by Dr. Martin Samuels, a neurologist from the Brigham & Women's Hospital and Harvard Medical School, who has a little experience in the field.  In fact, the article highlights that he was the medical director of M/C Communications until last year "when he said he decided that commercial support created an unacceptable conflict."

The curriculum will be developed by 11 specialists, many from Harvard, who will not be allowed to teach other courses funded by drug companies, "to further insulate them from industry influence."  

And the company's advisory board will also help them keep influence peddling in check. The board includes reputable names such as Dr. Joseph Martin, former Dean of Harvard Medical School, who will review the curriculum directors' other relationships with industry.  

(Note: Dr. Martin was also highlighted in a provocative NY Times article earlier this year which highlighted that under the new conflict of interest rules implemented at Partners HealthCare, Inc., he will no longer be able to accept the >$200,000 per year compensation for serving on the Board of Directors at Baxter International.  Interesting, that he will be watching over relationships at Lighthouse).

Non-MD, Dr. Eric Campbell, a vocal critic of industry, noted that Lighthouse may find it more difficult to separate themselves from industry influence than they expect.  He suggests "that companies can offer to pay doctors' tuition to attend certain courses, thereby exerting influence that way."

Oddly, in the article Non-MD-Campbell is noted for "specializing in conflict of interest" but seems unaware of the pharmaceutical industry's own conflict of interest policy, which states that:

"Financial support should not be offered for the costs of travel, lodging, or other personal expenses of non-faculty healthcare professionals attending CME, either directly to the individuals participating in the event or indirectly to the event’s sponsor (except as set out in Section 9 below). Similarly, funding should not be offered to compensate for the time spent by healthcare professionals participating in the CME event."

The final quote from Dr. Steve Nissen, who needs no introduction, sums up the issue quite accurately:

"The biggest name people, the people who have the most expertise and are going to draw an audience -- they are the people who work with industry."

Sep 14, 2010

Banning Industry Sales Reps Increases Cost of Every Prescription by $5.18

Medpage Today puts an interesting spin on findings from a study about to be published in the Annals of Family Medicine.  Despite the headline, "Barring Drug Samples Boosts Use of Other Meds", which suggests a straight-forward response -- ban industry and get results -- the study actually tells a very different and more interesting story...

Study Results
After banning sales representatives and medication samples from their clinic, they found:

  • That "aggregate levels of brand-name drug use didn't change significantly"
  • A non-significant trend toward "reduced prescribing of branded anti-hypertensives and lipid-lowering drugs"
  • That "branded drugs for respiratory disease declined significantly, by 11.34%"
  • That "overall cost of prescription drugs were not reduced.  In fact, they increased by $5.18 per prescription per month immediately after the policy was introduced."
They speculate that the increase in overall cost of prescriptions was likely due to the loss of samples in the clinic, but go on to highlight that the cost of "lipid-lowering drugs were significantly reduced, by $0.70, per prescription per month."  It seems that the differential -- $5.18 increase vs. $0.70 decrease -- is sufficient to conclude that the policy hurt patients more than it helped them.

So, in short, the authors of th study found that the policy achieved one thing: It increase cost for patients.  The question that they did not address is "what impact did the policy have on patients?"  How well are the respiratory patients doing following the 11% drop in prescriptions for branded agents.  That's the interesting question given the push towards efficiency and quality moving forward.

Kristina Fiore, Staff Writer. MedPage Today. Barring drug samples boosts use of other meds. September 13, 2010.
Hartung DM, et al "Effect of drug sample removal on prescribing in a family practice clinic"Ann Fam Med 2010; 8: 402-409.

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