Senate hearing: Industry support for medical education

Lots of locals at Thursday’s Senate hearing on health care industry support for continuing medical education (CME) for doctors.

Click here for the video.

From the U.S. Senate Special Committee on Aging web site.

Dr. Eric Campbell, Associate Professor at Harvard University, discussed the Institute of Medicine’s (IoM) recent study on conflict of interest in medical research, education, and practice.

Jack Rusley, a fourth year medical student (at Brown) and the Chair of the Culture of Medicine at the American Medical Student Association (AMSA) provided information on the AMSA Scorecard and its methodology for ranking medical schools’ policies on transparency in medical education, as well as his personal experience as a student advocate for reform.

 Dr. Thomas Stossel, Professor at Harvard University and Director of Translational Medicine at Brigham Women’s Hospital, offered testimony concerning the newly formed Association of Clinical Researchers and Educators (ACRE), which contends that restricting industry funding of education programs would be counterproductive and may ultimately harm both patients and the practice of medicine.

Happy Birthday Medicare

On the 44th anniversary of President Lyndon B. Johnson signing the Medicare program into law, Rep. Anthony Weiner (D-Brooklyn and Queens), a member of the Health Subcommittee, announced he will offer an amendment to the America’s Affordable Health Choices Act that would eliminate the Medicare program. The move comes amid a chorus of Republican members decrying the notion of government run healthcare.

Find some photos here of a local rally the same day in support of single payer health care. More on that event here.

photo courtesy jwj

photo courtesy JWJ

Snowe on health reform: Local coverage

On Maine’s Republican Senator from today’s Lewiston Sun Journal:

Photo by var resa

Photo by Var Resa

Snowe is one of six senators — three Democrats and three Republicans — who have worked methodically during all-day, closed-door meetings for weeks on what they hope will be a widely supported compromise bill to expand access to health care and control costs.

 

“We don’t want to create an exodus from employer coverage,” Snowe said. “We won’t mandate the kind of coverage or that (employers) have to provide coverage. If you have coverage that you like, we want you to be able to keep it.”

She said she had gotten advice from many Mainers on how to best develop a health care policy that provides universal, affordable coverage. That advice comes from a range of people, from constituents calling her office to family members trying to bend her ear.

“It’s helpful to me and I bring that input into meetings,” Snowe said. “After all of this, you have to evaluate, is this the right and best policy for America? That’s the crucial question, and it weighs heavily on all of us because we have tremendous regard for the value for this reform.”

From today’s Globe story on health reform ad barrage:

In New England, Maine voters are likely to be targeted by liberal groups because its two senators – particularly Olympia Snowe, a key negotiator in the healthcare discussions – are poised to play a crucial role in deciding the fate of the legislation.

“It’s really up to Senator Snowe whether we will have health insurance reform . . . or whether premiums keep going up and more and more Americans lose healthcare,’’ says one radio ad that began running this week. In New Hampshire, Republicans have targeted Representative Carol Shea Porter as vulnerable.

Is health reform momentum slipping away? Plus, Jacoby on mandates

IMG_1462Obama’s health people may have to opt for a plan B in terms of strategy. Using the post election momentum to get it done quickly does not seem to be working. This from a new NPR poll of 850 voters: 

 

Poll respondents liked a Democratic statement on solving health care problems better than a Republican statement (51 percent to 42 percent). However, when asked about the plan now moving through Congress, a plurality of 47 percent was opposed and 42 percent said they were in favor, based on what they had heard about the plan so far.

Still, the poll suggests that health care is a high priority issue for people, consistently coming in second after the economy. So, at least we’re paying attention.

A recent Kaiser Family Foundation poll had similar results.

For more on what’s up, Kaiser Health News is posting daily roundups each morning, with links to national stories reporting on infighting between the Democrats, the possible demise of the public plan, genetic biologics and the revamping of MedPAC.

Also,  referring  to a Kay Lazar story that ran in Monday’s Boston Globe’s, the paper’s conservative columnist Jeff Jacoby argues against health insurance mandate – laws requiring insurers to cover certain treatments.

Rather than allow the free market to determine which medical services health plans will cover, states force consumers to pay for an array of covered benefits they may not need or want. For example, 45 states require insurance policies to include treatment for alcoholism and 34 mandate coverage of drug abuse treatment. Contraceptives are covered in 31 states, as are hairpieces in 10 states, and in-vitro fertilization in 13 states.

BHN exclusive: Relman on ACRE conflict of interest meeting

RelmanDuring his 14 years as editor of the New England Journal of Medicine – most of the 80’s and some change – Dr. Arnold S. Relman often commented on the influence of money on medicine. He still doesn’t like it. BHN noticed him at last week’s meeting of Association of Clinical Researchers and Educators (ACRE) “an organization of medical professionals dedicated to the advancement of patient care through productive collaboration with industry and its counterparts.”  (See previous blog post about the meeting.)

So, we asked for his thoughts about the presentations. Here they are:

“I sat through the whole program, which was a sustained diatribe against conflict-of-interest regulations rather than a scholarly, balanced discussion of the issues. There was practically no time for audience questions or comments, but instead an almost unrelenting barrage of ideological and anecdotal criticism of what was said to be a misguided “belief system” that worries excessively over relations between industry and the medical profession. There was an occasional informative and reasonable contribution, but for the most part sarcasm and anger prevailed.
 
The heavily industry-related audience loved the performance, but the obviously biased, self-serving, and often grossly flawed presentations should have embarrassed the organizers. Although neither Harvard Medical School nor the Brigham & Women’s Hospital sponsored or formally endorsed the meeting, the HMS Dean did give the initial welcoming remarks, and the Hospital offerred its facilities for the event. One can only hope that they are now having second thoughts.”
 
here are some other reports on ACRE and the meeting: Policy and Medicine, Postscript and The Carlat Psychiatry Blog

Health reform activism, left and right

BHN received an announcement of this event, scheduled for Thursday at noon on the steps of the State House. Sponsors include: Mass-Care, Jobs With Justice, Mass Nurses Association Physicians for a National Health June 2009 dump 192Plan and Our Bodies Ourselves,

On July 30th, Medicare turns 44. To celebrate, attend a rally to ask Governor Patrick and candidates Charlie Baker and Christy Mihos to give America the gift of Medicare For All! …Expanding Medicare to cover everyone in America would mean lower health care costs, better medical treatment, and improved access to vital health services for all of us!Join us to ask candidates to give the gift of universal health care to our country!”

 The single payer folks aren’t the only health care advocates voting with their feet. Last week a group of unions and other supporters of the Obama health plan protested outside the offices of the Mass Association of Health Plans to drive this point home.  

 As Congress discusses how to fix our broken health care system those who profit off of our current mess are trying to prevent real health care reform. The insurance companies are spending tens of millions of dollars to lobby our representatives and misinform the public.!

Each event seems to support a somewhat different approach – Obama style with a public plan v. single payer. Each is supported by different, but overlapping, coalitions. But, they both link back to the Jobs with Justice web site.  

 While there hasn’t been much action locally, Tea Party conservatives have been busy too.

 Join your fellow Tea Party Patriots as we begin the next phase in our action plan to fight Government Take over of our Health Care. We are making calls to melt Congress’ Phone Lines this week, planning Tea Party Patriots Health Care Freedom Town Halls, and walking our neighborhoods to engage our neighbors in this fight.

 

BHN Exclusive: Mass gift ban takes a beating from ACRE

IMG_1576_edited

Thursday’s inaugural meeting of the Association of Clinical Researchers and Educators drew a full house to the Bornstein Amphitheater at Brigham and Women’s Hospital.  Members of the group believe that disclosure rules and gift bans for doctors – like the one that just went into effect in Massachusetts –  are too strict.  The meeting program describes the issue this way:

Under mounting pressure from interest groups, the media, and select government officials, academic medical centers have begun adopting restrictive conflict of interest policies that often sever productive relationships between industry and physicians involved in clinical research and educational outreach.

(See this Globe story for  background on the topic or click on the “research integrity” category to the left. Critics of industry support for academic researchers say it creates to conflicts of interest. Supporters believe it encourages innovation. )

So, withportraits of notable BWH doctors looking down on them, researchers, lawmakers and industry reps made a lot of jokes about the corrupting influence of pens with drug company logos. A sampling of the speakers found that they ranged from measured and informative to shrill and angry.

This from a session on the Massachusetts gift ban, which prohibits drug and device companies from marketing products by courting doctors with high end meals, Red Sox tickets and four-star travel.

–State Representative Michael J. Rodrigues, vice chairman of the legislature’s Committee on Public Service, said doctors need to be more involved in fighting the laws like the state’s gift ban law.

“I was very happy with the support I got from industry. But throughout the debate I was wondering – where are the physicians. “

–Sarah Elisabeth Curi, a lawyer with the Mass Medical Society, explained the new law and said the law will focus on industry compliance, not doctors.

 “No physician in Massachusetts is going to be arrested for not complying with the law”

–Dr. Carey D. Kimmelstiel, head of clinical cardiology at the Tufts University School of Medicine talked about the benefits of having clinicians give industry-sponsored talks. Preparing the talk educates the speaker. He or she gets feedback and an audience of busy docs gets a quick update.

 Dr. Henry R. Black  Hypertension Division, New York University Medical Center, President, American Society of Hypertension :On Value of Collaboration to Medical Training Programs & Professional Associations

There were also a few supporters of conflict rules and gift bans in the crowd, including former NEJM editor Arnold Relman, who offered post meeting comments. The American Medical Student Association– a group worried about conflicts  of interest for industry-funded professors  – also sent a few people. Nitin Roper, a University of Connecticut medical student, had this to say about the meeting.

   

Finally, here are some other reports on ACRE and the meeting: Postscript,  The Carlat Psychiatry Blog and Policy and Medicine

 

Stossel, conflicts and the new Health Wonk Review

First, check out this week’s edition of the Health Wonk Review, hosted by The NewHealth Dialogue Blog. Paul Testa goes for the carnival theme.  “It’s time to let your inner wonk wander through a spectacle that’s as uniquely American as apple pie and health reform.”

Then check out the Globe story on docs who are fighting conflict of interest rules.( And, stay tuned. I’m going to head over to the meeting.)

A growing number of hospitals, universities, and states are barring drug companies from buying physicians dinner, hiring them as speakers, and giving them even token gifts.

Now, a new organization of doctors – several from Boston – wants to roll back policies curbing interactions between doctors and drug company representatives, saying restrictive rules ultimately will hurt the patients they’re designed to protect.

The group, called the Association of Clinical Researchers and Educators, plans to hold its first conference today at Brigham and Women’s Hospital to promote “productive collaboration’’ between industry and physicians, which they say leads to better medicines and treatments.

Dr. Thomas Stossel, of BWH, is one of the group’s founders. (He is also the brother of television reporter John Stossel.) Having covered the conflict of interest debate, I appreciate his willingness to offer his point of view.  For more on Dr. Stossel’s view on conflicts of interest, here’s a recording of a 2007 talk he gave at Mass General. (I’m working on snipping off the first three minutes of intro.)

Also, I quoted him in a  2003 story I wrote for Nature Medicine on conflicts of interest.

Harvard University hematologist Thomas Stossel has discovered a coveted method for refrigerating platelets that could revolutionize transfusion therapy. Stossel is seeking an industry partner and stands to earn a fortune if the technique works. But here’s the rub: if he succeeds, Harvard’s rules on conflict of interest will bar him from future research.

“I would love to be involved in the study design [of the trial],” says Stossel. “[But] I can’t, according to the rules—you either take the academic credit or you take the money.”

Harvard’s rationale for the ban is simple, and one many ethicists have repeatedly voiced: when researchers stand to gain from the success of a trial, it can affect their objectivity, and pose a potential risk to enrolled patients. “The appearance of a conflict itself breaks down the trust between the public and the scientific community,” says Sheldon Krimsky, a Tufts University professor who recently published the book Science in the Private Interest.

On your radio: Lots of health news

radioStart with NPR’s Julie Rovner, who reports on a meeting of doctors, hospitals and “health luminaries” about how some communities – including Portland, Maine –have manage to keep costs down while delivering measurably better care.

The health care debate in Washington has basically deteriorated into a choice between raising taxes or cutting care. But “that’s wrong,” says Don Berwick of the Institute for Healthcare Improvement. “There’s a third way. It’s redesign.”

To try to prove his point, Berwick, along with health luminaries Elliott Fisher of the Dartmouth Medical School, Atul Gawande of Harvard and Mark McClellan of the Brookings Institution, brought doctors and hospital officials to Washington from 10 communities around the U.S. where health spending is lower than average and health care outcomes are better than average.

And…

  • Tuesday’s Talk of the Nation asked —  Are Health Insurance Companies The Problem?
  • Then come back to town where Robin Young at WBUR’s Here and Now talks to Paul Ginsburg, president of the Center for Studying Health System Change. Listen here or tune in at noon.
  • Also at WBUR: Martha Bebinger filed two reports last week on the state proposal for global payments. 
  •  More on that topic from a range of players on WBUR’s Commonhealth blog.

Boston Globe: Biotech lobbyists and other health reform updates

Obama was busy pushing health reform on Monday and Foon Ree did a nice job following him on the Globe’s Political Intelligence blog.  

Trying to get healthcare overhaul back on track, Obama took a populist bent, asserting that big insurers and pharmaceutical firms and other special interests are reaping huge benefits from the existing healthcare system, while American families struggle.

Unless healthcare is reformed, he said, families will pay more and more of their income for less and less care.

The blog also includes a transcript of Obama’s morning comments.

Also in the Globe, a story on biotech and pharma lobbying efforts.

Biotech firms, big pharmaceutical companies, hospitals, doctors, and players from every corner of the US healthcare industry are working hard to protect profits, as the government seeks ways to hold down the cost of expanding health insurance to all Americans   

See related post on Kennedy and the fight over generic biotech drugs.

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