Dr. Carlat gets a boost from the health/science journalism reviewers

Over at Nature Network News, we gave a shout out to the Knight Science Journalism Tracker and Health News Review this morning.  Last week, the Knight site offered as good analysis of the stories about MGH’s new melanoma treatment.

So, we do it again. Today’s feed from the Knight site highlights the Newburyport-based Carlat Psychiatry blog: 

The notion that drug-company sponsorship of a clinical trial might affect the outcome will come as no surprise to most Tracker readers. Numerous studies have shown that drug-company studies are more likely to show favorable results than are studies sponsored by the government.

Many of us, as a result, might have lapsed into a sort of reflexive view that drug-company-sponsored trials are always problematic. Dr. Daniel Carlat (left), a psychiatrist in private practice in Newburyport, Massachusetts, takes a more nuanced view in The Carlat Psychiatry Blog. He’s a sharp critic of many drug-industry practices, but one who’s willing to probe the details and correct himself when he’s wrong–meaning he’s the kind of guy you can trust.

 

Smoking at the Globe, Times

The days of the smokey newsroom are over but the papers are full of stories about evil weed.

A front page Globe story asks –Too many cigarette ads in lower-income neighborhoods?

A dozen years after Massachusetts attempted to ban storefront tobacco ads within 1,000 feet of schools and playgrounds, a prohibition thwarted by a tobacco company’s legal challenge, the signs remain prolific and prominent in Boston’s lower-income neighborhoods, especially those with substantial African-American and Hispanic populations.

On today’s Globe op-ed page, a wine shop worker bemoans his new title: “tobacco retail clerk“:

I work a couple days a week in a wine and cheese shop, which has a number of advantages, not the least of which is buying Hendrick’s gin at a good price.

Among the items offered for sale are cigarettes and cigars. That makes me a tobacco retail clerk. And that being so, I was recently informed that my training class was to be on such and such a day. Class? To sell cigarettes?

An editorial in Sunday’s paper said – Get the cigs out of the movies.

WATCHING CHARACTERS smoke in movies is the single most powerful pro-smoking influence for children: It accounts for 44 percent of kids who smoke pick up a cigarette for the first time, according to an analysis of four separate studies.

That’s why it is good news that the number of smoking incidents in movies has steadily gone down in the last few years, according to a new study by researchers at the University of California San Francisco. The study, published by the Centers for Disease Control and Prevention, found that among the top-grossing movies released in the United States between 1991 and 2009, smoking incidents peaked at around 4,000 in 2005 and have since dropped by half, to a little below 2,000 for 2009. Last year was also the first time that just over one half of top-grossing movies didn’t show any tobacco use at all. Encouragingly, and perhaps partly as a result, the nationwide rates of trying cigarettes among high-school students dropped from 54 percent in 2005 to 46 percent in 2009.

Hold on — The NY Times has a piece on “hold-out” smokers and their sidewalk community.

Parliament, Marlboro, Winston, Benson & Hedges glow throughout the day in this canyon as smoker after smoker dashes down, lights up and vanishes again like a wisp of smoke. Between drags, they gab into their cellphones, soak in the solitude, pace to the curb and back, or chat briefly, most conversations lasting only as long as the ember at the tip of their cigarettes.

Finally, if your doc prescribes the other weed, make sure your drug-testing boss approves it too. Also from the Times:

Residents in 14 states and Washington can now appeal to their doctors for prescriptions for medical marijuana to help them with their pain.

Their employers, however, may not be so understanding.

In some cases, workers have been fired for failing drug tests despite having prescriptions saying, in effect, that what they are doing is legal according to the laws of their states.

Though the number of such cases appears to be small, they are exposing a new legal gray area, with workers complaining of rights violations and company officials scratching their heads over how to enforce a uniform policy for a drug that the federal government has not recognized as having a legitimate medical purpose.

Boston ED doc/clinical researcher and entreprenuer McAfee killed in scooter crash

Update : BWH will hold a a memorial service for Dr.  McAfee on Tuesday at 11 a.m. at Temple Israel of Boston.
From the Globe:

The accident occurred when Dr. Andrew T. McAfee, an attending physician in the Department of Emergency Medicine at Brigham and Women’s and an instructor at Harvard Medical School, collided with a truck, according to Ron M. Walls, chairman of the Department of Emergency Medicine at Brigham and Women’s.

In addition to his work at the Brigham and Women’s, McAfee served as executive director of epidemiology for i3 Drug Safety in Waltham, a global pharmaceutical services company, Walls said…

As a medical researcher, McAfee’s work primarily dealt with the outcomes of drug therapy, Walls said. Among other things, he studied the possible links between treatments for children with attention deficit hyperactivity disorder and seizures.

Commonhealth has more info on services and a statement from Dr. Ron M. Walls, chair of the hospital’s department of emergency medicine

About Dr. McAfee from the Brigham:

Saving Lives and Preventing Errors

Forget about Hollywood. Forget about primetime. This has nothing to do with “ER.” It has everything to do with preventing errors and facilitating high quality patient care. With nearly two years’ worth of experience, the ED tracking system at BWH has already demonstrated its value in a fast moving environment of complex care….

The innovative system tracks a variety of patient care variables from waiting times to the severity of patient conditions. It also provides a customized interface with the hospital’s computer order entry system prompting physicians about possible allergies and preventing redundant orders from being entered.

The system also incorporates the BWH-developed emergency severity index (ESI) that monitors the level of care required for each patient and provides an accurate reading on the necessary departmental resources. The ESI breaks patient conditions into five categories and allows providers to plan for the efficient care of many patients simultaneously.

“This is a rather unique system that allows our physicians to manage care far more effectively and with greater safety,” said Andrew McAfee, MD, one of the developers of the order entry software. “In this type of environment, verbal orders can be easily misinterpreted. This system is easy to use and provides us with information that we previously did not have access to in our setting of care.”

His company: i3 DrugSafety

From Pub Med:

Comorbidities in patients with persistent or chronic immune thrombocytopenia.

Enger C, Bennett D, Forssen U, Fogarty PF, McAfee AT.

Int J Hematol. 2010 Jul 24.

The thiazolidinediones rosiglitazone and pioglitazone and the risk of coronary heart disease: a retrospective cohort study using a US health insurance database.

Ziyadeh N, McAfee AT, Koro C, Landon J, Arnold Chan K.

Clin Ther. 2009 Nov;31(11):2665-77.

Prognostic value of the duke treadmill score for emergency department patients with chest pain.

Manini AF, McAfee AT, Noble VE, Bohan JS.

J Emerg Med. 2010 Aug;39(2):135-43. Epub 2008 Dec 4.PMID: 19062225 [PubMed - in process]Related citations

4.

The effect of pharmacotherapy for attention deficit hyperactivity disorder on risk of seizures in pediatric patients as assessed in an insurance claims database.

McAfee AT, Holdridge KC, Johannes CB, Hornbuckle K, Walker AM.

Curr Drug Saf. 2008 May;3(2):123-31.

Much in demand, e-patient Dave stays cool

Photo by Gunther Eysenbach via Creative Commons

 

The Med Page Today’s review of Dave deBronkart’s cancer memoir is in a section called “Celebrity Diagnosis.” But don’t think all the attention is getting to e-patient Dave.   

DeBronkart is an activist for patient involvement in care. He joined the connected health movement after he found all kinds of errors in his Google Health records during his treatment.  

At an August health quality seminar at Harvard, deBronkart — also a speaker at the meeting — waited patiently but eagerly to meet writer and doctor Atul Gawande.  New Hampshire-based deBronkart wanted Gawande sign a copy of a magazine article in Health Leaders magazine that featured separate pictures of the two men on the same page. 

 Gawande signed, adding to deBronkart’s steady stream of Tweets. (Do we capitalize t?Tweet?) 

• Beaming: got Atul to sign the @HealthLeaders “20 who make HC better” page we’re both on! http://tweetphoto.com/39595710 11:28 AM Aug 17th  
• Best part: he said “Dave deBronkart? … Oh, e-Patient Dave – that I know.” Ha! 11:30 AM Aug 17th

Here are 2009 and 2010 Globe stories on DeBronkart. 

This from the MedPage review of the book: 

During the 12 months following his diagnosis, Dave wrote a blog chronicling events, both extraordinary and mundane, of his life with cancer. Laugh, Sing, and Eat Like a Pig is a book based on this blog.

  

The title refers to part of Dave’s treatment plan devised by himself and Dr. Sands. Dave had long known about the power of laughter to ameliorate disease through the work of the late Norman Cousins. Then, while speaking with Dr. Sands about adjusting his life to his diminishing energy level, Dave suggested that he drop out of a singing group, an activity that he loved. Dr. Sands would have none of this and Dave continued signing. Then he got the advice of a hospital nutritionist who instructed him to gain weight to prepare his body for the effects of interleukin therapy. His dietary regimen included putting whipped cream on all desserts and liberal doses of pizza for snacks.

 

 Do note that deBronkart’s approach to his disease has its detractors, who are sick of people telling them to have a positive attitude about their disease.  

 Also, more on NPR’s Maine Primary care story. We hope Julie Rovner got to relax a bit while she was up there away from the soup that is D.C. in August. She did a great job explaining the complexity of health reform during last year’s debate.  Speaking from experience, that’s no easy task. 

 One of the places working to transform its physician practices into medical homes is Martin’s Point. It’s a large nonprofit primary care group practice with several locations around Maine, including its home base at the actual Martin’s Point at the mouth of the harbor in Portland. 

“What’s become clear to all of us is that the expectations for primary care and the expectations and needs for people in the care system have changed enormously,” says Martin’s Point president and CEO, David Howes. “The expectations of people in primary care are that they will do a great job caring for people with chronic disease, and they’ll identify and know everybody for whom they’re responsible.”

New Commonhealth and Ozzy’s genes

Not in the same story

Check out the new and improved Commonhealth on WBUR.org While you’re there, check out Radio Boston’s conversation with new BC/BS CEO Andrew Dreyfus, in particular the discussion of global payments.

From Commonhealth: Massachusetts is the leading laboratory for health care reform in the nation. It is also the hub of medical innovation. But as the nation looks on, what is the reality on the ground here? We’d like CommonHealth to be your go-to source for news, conversation and analysis about these historic efforts as they unfold. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

With BHN and White Coat Notes at the Globe, Boston is now a three health-news-blogs town. (Not to mention a lot of niche blogs like The Health Blawg , The Health Business blog and Nature Network Boston.)  In blogging, as in  journalism, competition is good. We can see who poaches someone else’s story first.

With that in mind, they did beat me on the link to Julie Rover’s NPR piece on primary care, which features a doc from Maine. But do note that none of the other blogs have this important story:

The Weekly World News — a supermarket tabloid now run as a supplement to the Sun– makes reference to Knome, the Cambridge genome sequencing company. As reported elsewhere, the company is sequencing Ozzy Osbourne’s genome.

Ozzy is interested in finding out why he has survived but the study may well produce an incidental benefit to medical science in general. For instance, it may be that some variant in his genes make this liver better than most at breaking down toxic substances. It that’s true, gene therapies based on Ozzy’s cells could provide powerful weapons in the fight against disease.

Here @ NNB, we scan the all the best medical reporting for links to local scientists.

Boston’s Zon, Daley and Melton on stem cell ruling

From Nature Network Boston:

Leonard Zon of Children’s Hospital on CBS.

Statement:Yesterday’s injunction forbidding the use of federal funds to support embryonic stem cell research threatens the progress of our work and dashes the hopes of patients and their families facing illnesses who will someday benefit from this research. As of today, experiments and studies currently being supported with federal grant dollars will now depend upon support from private donations, and in these difficult economic times, philanthropy is not a viable funding source for research. This decision is a tragic setback not only for patients but for the whole field of stem cell research.–Leonard Zon, MD and George Q. Daley, MD, PhD

Harvard’s Melton

From the Globe:

Before March 2009, when President Obama expanded federal funding for embryonic stem cell research, scientists like those at the Harvard Stem Cell Institute depended on private philanthropy to support their work and maintained dual sets of equipment and supplies to ensure that no federal funds were used on human embryonic stem cell research.

Since the institute was initiated in 2004, it has raised about $90 million in private funding, according to spokesman B.D. Colen. Since federal funding for the research was expanded, about $5.6 million in federal grants to support human embryonic stem cell research have been awarded to Harvard scientists — not including researchers affiliated with hospitals.

“This for me emphasizes just how important private philanthropy has been and will continue to be — it’s the only durable and consistent source” of funding, said Douglas Melton, codirector of the Harvard Stem Cell Institute, who said he has two grants he was preparing to submit to NIH and two active federal grants supporting human embryonic stem cell research in his lab. “We’re on this seesaw.”

From the NYTimes:

Among the projects financed with this money is research by Dr. Doug Melton, co-director of the Harvard Stem Cell Institute, to find a cure for juvenile diabetes. His two children — a 19-year-old son and a 23-year-old daughter — have the disease. Both must inject themselves with insulin, and he said they frequently ask about his work.
Dr. Melton said he was relieved to learn that his present grants would be unaffected by the ruling. But he has been working for months on writing a grant that he was about to submit for more work using human embryonic stem cells, and he feared it would be rejected.

“Imagine when you go home tonight and your son or daughter says, ‘Dad, have you solved this problem?’ ” Dr. Melton asked. “You don’t forget those things.”

Embryonic stem cell ban leads to “confusion”

Here’s a round-up of stories on the ESC ruling. For a list of some of the NIH-funded projects in the state, see Nature Network Boston.

The Boston Globe

Kevin Casey, Harvard University’s associate vice president for governmental relations told the Globe that he ruling will “slow progress that so many who suffer afflictions are relying on.’’ But, he added, the university remained optimistic that the courts will ultimately validate the use of federal money for expanded embryonic stem cell research.

Dr. Leonard Zon, director of the stem cell program at Children’s Hospital Boston, called yesterday’s ruling a “step backward.’’

“It throws things into a confused state,’’ he said.

NYTimes:

The ruling came as a shock to scientists at the National Institutes of Health and at universities across the country, which had viewed the Obama administration’s new policy and the grants provided under it as settled law. Scientists scrambled Monday evening to assess the ruling’s immediate impact on their work.

“I have had to tell everyone in my lab that when they feed their cells tomorrow morning, they better use media that has not been funded by the federal government,” said Dr. George Q. Daley, director of the stem cell transplantation program at Children’s Hospital Boston, referring to food given to cells. “This ruling means an immediate disruption of dozens of labs doing this work since the Obama administration made its order.”

Wall Street Journal

Evan Snyder, director of the stem cells and regenerative biology program at Sanford-Burnham Medical Research Institute, La Jolla, Calif., called the ruling “an astounding blow to American biomedical research and to health care.”

LA Times

Advanced Cell Technology Inc. is using the cells to grow retinal pigment epithelium cells that restored vision in rats and mice with a rare childhood disease called Stargardt’s macular dystrophy. The Santa Monica-based company has asked the Food and Drug Administration for permission to use the cells in a clinical trial. But without any prospect of federal funding, the research would be in doubt, said Dr. Robert Lanza, the company’s chief scientific officer.

“This is criminal,” Lanza said. “We are talking about people going blind, people who are dying from a terrifying array of diseases.”

Opinions: One on Medicare, one on investor-owned hospitals in Mass

Three items of note in the morning papers:

• A staff editorial in this morning’s NY Times charges says the Republicans are dangerously clueless about how to preserve Medicare.

Republicans claim to be deeply worried about the deficit — their favorite political target, followed closely by President Obama’s relentlessly demonized health care reform. So why are they so determined to overturn one of the central cost-control mechanisms of the new reform law?

Republicans in both the Senate and the House have introduced bills that would eliminate the new Independent Payment Advisory Board, which is supposed to come up with ways to rein in excessive Medicare spending — and stiffen Congress’s spine.

More fodder to demonize now CMS head Donald Berwick, the NYT says: Republicans are also eagerly, and shamefully, pillorying Dr. Donald Berwick, the new head of the Centers for Medicare and Medicaid Services. There are few figures who command greater respect for uniting health professionals and institutions to improve the quality of medical care while reducing costs. That is not stopping these critics from implying — baselessly — that he will introduce socialized medicine and death panels in this country.

  The truth is that Dr. Berwick has praised the socialized British health care system, especially for  its emphasis on primary care. This country certainly needs to do more to develop its primary care system. And he has, rightly, called for an open discussion of the health care rationing that is already widespread in our system. When insurers decline to cover procedures, or high prices screen out low-income people, that is rationing.

Dr. Berwick has endorsed the use of “comparative effectiveness” research to determine which treatments work best. He would use such research to judge whether a new drug or procedure is worth the cost of coverage, a step the reform law shies away from. He does not have the power to change that law. But the issue will have to be addressed at some point if there is to be any hope of restraining medical spending.

Democrats have to counter the Republicans’ demagoguery with facts. Americans need to understand that if Senator (John) Cornyn (of Texas) and others get their way, runaway health care costs will only get worse.

• And an editorial in the Globe says the state needs to scrutinize the sale of the Caritas hospitals to a group of investors to make sure it’s a good deal for everyone:

 THERE ARE good reasons to support the proposed sale of Boston-based Caritas Christi Health Care to New York private equity firm Cerberus Capital Management. In addition to protecting over 12,000 in-state jobs, Cerberus has promised to pay off the non-profit hospital chain’s debt, permanently secure employees’ pensions, earmark $100 million for hospital renovations and expansions, create up to 4,300 new jobs, and increase the system’s footprint by 117,000 square feet. With promises like that, it’s no wonder elected officials including Senators John Kerry and Scott Brown are urging Attorney General Martha Coakley to approve the deal. But before Coakley signs off, she must obtain from Cerberus a clearer sense of how it plans to achieve these goals, and a new commitment of a longer time period before the firm can back out by selling the hospitals.

•  WIth that — and Partners — in mind, check out this story from The Washington Post on the pros and cons of large health care systems, including one in with Roanoke, Virginia. 

ROANOKE — Railroads put this city on the map, but the king of the domain is now health care — or rather, the Carilion Clinic.

Carilion owns the two hospitals in town and six others in the region, employs 550 doctors and has set off a bitter local debate: Is its dominance a new model for health care or a blatant attempt to corner the market?

Carilion says it represents an ideal envisioned by the nation’s new health-care law: a network that increases efficiency by bringing more doctors and hospitals onto one team, integrating care from the doctor’s office to the operating room. The name for such networks, which the new law strongly promotes with pilot programs, is accountable care organizations, or ACOs — providers joining together to be “accountable” for the total care of patients, with incentives from insurers to keep people healthy and costs down.

“We need to fundamentally get off a transaction system where you’re paid for what you do to patients to being paid to care for them,” says Carilion chief executive Edward Murphy.

But skeptics apply a more old-fashioned term to networks like Carilion: monopolies, which they say will make health care even more expensive.

“The only way to decrease costs that truly works is increasing competition, but for some reason in health care, we’re supposed to believe that competition drives up costs,” said ophthalmologist Frank Cotter.

The gap between those two views is at the heart of whether the law succeeds in controlling costs. Meanwhile, the question is creating a schism in the Roanoke Valley, a region of more than 250,000 people that depends on Carilion’s 12,300 jobs but also worries about health-care costs out of proportion to the area’s cost of living.

Evil regulators, greedy drug companies and gift bans

On Saturday,  New Hampshire’s Dr. Kevin’s retweets  a 2009 post  with a photo of a huge Schering-Plough placard from a Boston meeting of emergency department docs.  In response to state bans on drug makers offering doctors gifts and free meals,  the sign asks those from Minnesota, Vermont and Massachusetts to “please refrain from consuming the food and/or beverages offered at this exhibit…”  

Why the old tweet? Perhaps as a follow-up on a  post about a study that found many docs found “physicians’ generally positive attitudes toward drug and device manufacturers’ marketing activities.”

According to the law, Massachusetts prohibits companies are barred from from providing “meals” to doctors outside the hospital or office, with several exceptions, including this one.  

 ..”a CME provider or conference or meeting organizer may, at its own discretion, apply any financial support provided by a pharmaceutical or medical device manufacturing company for the event to provide meals for all participants.”

The Minnesota law doesn’t mention meals but allows “gifts” up to $50 in value.

New Hampshire’s Dr K. says it’s “almost farcical.” Some would argue that it IS farcical –designed to make regulators sound like overbearing parents. The rules, supporters say, are designed to get at more lavish gift like expensive dinners and travel, not coffee and pens. Opponents say the rules go too far.

 Check out Dr. K’s repost:

I’ve heard similar stories from other national meetings, where, for instance, doctors from Massachusetts are barred from attending dinner CME lectures or other educational activities. Driver licenses are indeed checked.

I understand the crackdown on accepting drug company gifts, but I wonder if there’s any resentment from these doctors for being blatantly singled out.

But, according to the Massachusetts state law, companies are barred from providing “meals” to doctors, with several exceptions, including this one:  

 ..”a CME provider or conference or meeting organizer may, at its own discretion, apply any financial support provided by a pharmaceutical or medical device manufacturing company for the event to provide meals for all participants.”

In July Radio Boston’s offer an in-depth look look at the Massachusetts gift ban:

 Last year, Massachusetts enacted what is considered the country’s most stringent ban on gifts and meals to doctors from the pharmaceutical and medical device industry. But last week the House quietly voted to repeal the ban, citing a negative impact on restaurant and convention business. One year in, we examine the impact of the gift ban and its future.

Since this program aired, the effort to repeal the device died with the Senate taking action on it. See Mass Device for more.

 In the meantime, BHN will check in with Minnesota, Vermont and Massachusetts to find out if the state laws bar docs from “consuming the food and/or beverages” offered at an exhibit.” Will also check out those stories of carded doctors.

No vacation for reform: Health Wonk Review

Health reform may not be big news anymore, but as Atul Gawande said a speech earlier this week — the execution is the hard part.

Find links to my story on that speech as well as other insightful observations about the health reform train on this week’s Health Wonk Review. This edition of the best-of-the-blogs digest is hosted by Managed Care Matters.

And, see my post on Nature Network Boston for news on Harvard’s errant phsych researcher and a new HBS study that found scientists in one biotech company published ended up out of the company loop.