Hold the fried chicken: RedSox workout tips from the Globe

Some of the BoSox players were lifting chicken legs instead of weights last spring, but not Ellsbury and Pedroia.  Jacoby returned from an injury for a great year and Dustin was solid all season.

The Globe’s Daily Dose offers some advice from their off-season trainers, who counsel them “on the importance of sleep, self-massage to relieve soreness, and what they need to eat to help build muscle.”

Also, please note this week’s publication of the Health Wonk Review, the biweekly digest of the best of health policy blog. This edition includes links to posts about the upcoming Supreme Court decision on insurance mandates, HIT and primary care and the new Independent Payment Advisory Board. Also note the previous edition, brought to you by Center for Objective Health Policy, a site that encourages “individuals to apply free-market ideas to healthcare.”

Tweets from Boston meeting on health, the Internet and mobile communication

Check out #chs11 f for tweet from the Connected Health Symposium in Boston. Each year, Partners sponsors this meeting to look at how the Internet and mobile communication are changing the health care system.  Here’s a link to the Tweetstream and a few samples below from a session on social networking and health.

“	RT @MGHDiabetesEd: “online patient communities can increase engagement, decrease isolation.” #chs11
	jillplev October 20, 2011

“	@taracousphd at #SoMe panel at #chs11: 35% of young people search for #healthcare informaton online
	sonnyvu October 20, 2011

“	Giving patients the choice to use an alias-based identity on social networks is a key way to address privacy concerns #chs11
	dsgold October 20, 2011

“	@dsgold How so? Alias identity does not equal unidentifiable, does it? I’d be concerned this is a false sense of security. #chs11
	Dermdoc October 20, 2011

“	Facebooking health @taracousphd facebook campaigns have huge opportunity for reaching teens, can use it for health literacy #chs11
	connectedhealth October 20, 2011

“	@lisagualtieri : There are credit #literacy programs for teenagers, why not more health literacy ones? #chs11
	sonnyvu October 20, 2011

“	We need to be inter-generational in our social media “prescription” including seniors as well as youth #chs11
	pamressler October 20, 2011

“	Social media can help make a disease more than just a disease for teens @drjosephkim #chs11
	connectedhealth October 20, 2011

“	@drdannysands telling about how he prescribed acor to @epatientdave & it save his life #chs11 #s4pm
	pjmachado October 20, 2011

“	Next up, Facebooking Health moderated by my wonderful #TUSM colleague @lisagualtieri #chs11
	pamressler October 20, 2011

“	@meyouhealth Chris Catter shows first ever social graph to visually render well-being among participants in social networks #chs11
	dsgold October 20, 2011

“	CDC traditional data tracked same as social media during H1N1 #chs11
	pamressler October 20, 2011

“	should MDs, nurses, etc recommend online pt communities? -yes! #chs11
	ICherryBlsm October 20, 2011

Globe on docs who get $ to pitch for drug companies

In preparation for a new law that requires drug companies to report payments to docs, Lilly, Merck and other have begun posting charts listing payment to doctors who give speeches for the companies.

Today’s Globe uses data compiled by the freelance investigative reporters at ProPublica to point out that, in Massachusetts, about half of that money goes to Harvard docs.

Doctors and researchers affiliated with Harvard Medical School collected 45 percent of the $6.3 million given to Massachusetts doctors in 2009 and 2010 by seven pharmaceutical companies that disclosed their payments for parts of those years. The money was mostly for talking to other physicians about the companies’ drugs and the diseases they treat, but also for consulting on research and marketing.

PhRMA, the trade group for most of the major drug companies, offers a long response on its website:

Speakers bureaus, together with other sources of information including direct interaction between biopharmaceutical companies and healthcare professionals, help improve patient care in various ways, such as disseminating information that will help address treatment gaps.

The fact that Harvard plans to ban the practice takes a little zip out of t Globe story. But docs all over the te accept these funds and, often it is helpful for consumers, payers and researchers to know who they are.  Studies have shown that payment from drug companies tend to influence prescribing practices. Eric Campbell, who is quoted in the Globe story, has done a lot of research in this area.  (He works for the Mongan Institue for Health Policy at Harvard –It can be hard to get away from the Big H in this town.) The PhRMA statement points to studies that say otherwise.

The Globe story lists docs in the state and ProPublica has national listings. Consumer Reports also put together a story on the data.

USA Today on Harvard Vanguard shared appointments, and an aside

Damn — scooped again. Every time  I go to the doctor and see that sign for “shared medical appointments” I say to myself — good story. Then I remember – I should not reports on doctors in the practice where I get care. 

Once when going for a prenatal test at the Univeristy of North Carolina hospital, I lay on the table in a very vulnerable position as a doctor approached me with a very large needle. Didn’t you interview me for a story once?  he asked. The giant, disorganized Rolodex in my brain spun and, amazingly,  I remembered. I did interview him, but didn’t quote him.  Some people take offense to that.  Yes, I did and while I didn’t quote you in the story, our conversation helped me get a better grip on the topic. A stock answer but true.

 More here on the HVMA program:

In 2008, Harvard Vanguard began offering “shared medical appointments,” or SMAs. They’re not classes, emphasizes internist Gretchen Gaida. SMAs are scheduled for physicals, well-child checkups, chronic illness management and other types of primary care, as well as for specialty care. Six to 14 patients, who sign agreements to keep information about the others confidential, participate. SMAs last 1½ hours, but patients can leave when they feel their questions have been answered. Doctors take blood pressures and listen to hearts in front of the room but examine patients in a private room when necessary.

Graduate: MIT Infant Cognition Lab

Physicians bill the same for patients seen in an SMA or individually. Considering doctors might schedule only four individual patient visits in 90 minutes, Gaida says, income from SMAs enables Harvard Vanguard to pay for the extra health professionals needed to run them smoothly.

 Finally, since I’m in rare, chitty-chatty first person mode, check out my post on Nature Network Boston about how that same baby may have been caught up in the Harvard psych research scandal.

Something about Mark Hauser’s now questionable research sounded familiar to me. Then I read that he worked with Harvard researcher Elizabeth Spelke.

Turns out I enrolled my infant son (now 12) in one of her experiments. And the study that appears to be based on the data includes Hauser as a co-author.  

 

Hide and seek with free hospital care

Hospitals say they do a lot of charity care. Who benefits from it? Two local groups surveyed 99 randomly selected hospitals about how they make patient aware of the charity care.  

The survey found that while most hospitals mentioned the existence of charity care programs on either their websites or over the telephone, only about a quarter provided information regarding eligibility for charity care.  Fewer than half provided a charity care application form. Fewer than 1 in 10 provided information on their websites that listed the discounts available to people at different income levels.

 This is how that played out for one patient, according to a press release on the report The Access Project and Community Catalyst. 

 Dawn D’Amico, who sought care at a hospital in Pennsylvania, found out about the existence of charity care programs through an article in a local newspaper.  When she called her hospital to ask for help, staff denied that the hospital offered charity care.  She only succeeded in getting a charity care application after directing hospital staff to an article on the Web.  She said, “If hospitals are being awarded tax breaks for providing these programs, someone needs to make sure they are actually doing so.  I just can’t imagine how many other people were denied care that they desperately needed.”

 The American Hospital Association  told NPR and Kaiser Health News that the sample is too small to be meaningful.

 A survey of 99 hospitals is not convincing to us,” says Melinda Hatton, the industry association’s general counsel. “And it’s out of sync: The concerns at the heart of the report have been dealt with in the health care reform bill, which we supported.”

 She didn’t mention that the group opposed the charity care rules in the bill, according to the Kaiser/NPR report  

 As the health care overhaul legislation made its way through Congress, the association said that new rules on charity care being considered in the legislation were not necessary. In a January letter to House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid, the group urged Congress to drop the requirements, or at least the parts requiring regular reports to Congress on charity-care levels. Such reports, the association warned, would be costly for hospitals and were duplicative of other reports by the Congressional Budget Office and the Government Accountability Office.

 While on the AHA website, check out their response to the Mass AG’s report on health care costs. (Both are .pdf files.) Again, the group questions the reports’ methodology.

Scott Brown joins Avatar in fight again health reform devil

A little game of connect the Globe dots.

1)     With Sen. Scott Brown at this side, Arizona Sen. John McCain sought to out-Bible his Tea Party challenger by defining himself as the Senate’s devil hunter. From the Globe:

“Scott and I just returned from trying to do the Lord’s work in the city of Satan,’’ McCain said. He called the health care plan “unsavory, Chicago-style sausage making,’’ and said, “We’re going to fight, and fight, and fight.’’

In the meantime, McCain’s opponent unleashed an ad in time for the Oscars that cast the former presidential candidate as a character from the movie Avatar. According to the ad, McCain is only acting like a conservative.

2)   In the meantime, back in town, about 20 Tea Party protested gathered outside the Liberty Hotel fundraiser featuring House Speaker Nancy Pelosi. They railed against the Democrats’ health reform plan with Mass General as a backdrop.

3)   Meanwhile, the storied hospital was coping with a letter from the Medicare program, which, during a recent inspection found problems with the quality of care, including one that “constitutes a serious and immediate threat to the health and safety of patients.”

4)     And, the state’s insurance companies want more money to pay for that care. From the Globe:

 Three weeks after Governor Deval Patrick warned that his administration might turn down health insurance premium increases it deemed excessive for individuals and small businesses, insurers have asked the state to approve rate hikes of 8 to 32 percent for April 1.

 

 

 

Health plans milk college students

The state has issued a new report documenting yet another way college students get nickle and dimed – on health insurance. The message here — stay on your parents plan.

Here a link to a PPT on the actual study.  

This from the Globe story:

Insurance companies rack up much higher profits on health coverage sold to nearly 100,000 Massachusetts college students than on plans available to the general public, according to long-awaited data released late yesterday by the state. The figures also show that college-student plans also have higher administrative costs…

The state plans to ”study whether the Connector Authority, the agency that oversees the state’s landmark health insurance law, could create a better product for the student market.”

Isn’t that something the universities should be doing?

 

Academics, industry, health reform and medical devices

The NYTimes business section has an update on academic/industry partnerships and explains new transparency rules in the Senate reform bill. Massachusetts has had a state law on this but it’s only been in effect for a few months. A group of doctors who oppose the law held a meeting in Boston this summer.

Also, read on and find that for first time I my career, I found a device (or drug) maker list payments to med school docs, In this case Mass General.

From the NYTimes:

 Health Bills Aim a Light on Doctors’ Conflicts 

As part of the health care overhaul under consideration by Congress, lawmakers have included so-called sunshine provisions intended to shed light on the financial relationships between the medical industry and doctors.

The targets are common business practices like drug company payments to doctors for speeches and consulting services, which have the potential to influence patient care and drive up the nation’s medical bills.

For more about industry sponsorship of academic research, see the article in the latest issue of Health Affairs. where a group of Boston area researchers found that ”52.8 percent have some form of relationship with industry.”

There are many potential impacts of these data. First, given that industry relationships are frequent and diverse, close scrutiny of researchers’ industry relationships is likely to be a major undertaking for institutions—especially among those with large numbers of researchers. Second, relationships are most common among productive, senior faculty members who contribute substantially to their research community. This finding supports the belief that it is difficult, but not impossible, to find academic scientists without industry relationships to serve in advisory roles for organizations such as the Food and Drug Administration, the NIH, or the Institute of Medicine. Third, the widespread nature of these relationships will raise serious concerns regarding the integrity of the academic research enterprise (either rightly or wrongly) on the part of elected officials, university officials, and perhaps the American public.

In a related story, James Ridgeway comments on a Mother Jones story on medical devices on his excellent “Unsilent Generation” blog. Read both. THe MJ story mentions two companies with ties to the state and, in one case, to Mass General doctors.

These companies makes things like artificial joints and heart valves, which are often needed by older people—and paid for by Medicare.

In recent months, these companies have launched a huge lobbying blitz  in response to provisions in the health care reform bills that would levy fees on their high-profit enterprise. The efforts apparently have not been wasted: In the latest versions of the legislation, the level of fees has dropped considerably (though that hasn’t stopped the manufacturers’ whining).

In the Mother Jones story,  DePuy, is based in Raynham, is one of four companies that in 2007 “said they would pay $311 million to settle federal charges that they gave doctors millions of dollars in kickbacks, often in the guise of consulting fees. The government deferred prosecution of the four companies so long as they complied with the settlement terms.

Another company settling was Indiana-based  Zimmer, which has been a player  at Mass General. On the company website , they list more than $9 million in consulting fees paid to eight doctors at Mass General Hospital since 2007 and another $19 million to some of those docs and others for a total of 14 who  listed under MGH Corporation.  More on MGH’s role in licensing right to material to the company that was used for orthopedic implants.

 For news about the medical device industry, see Mass Device, a website devoted to news about local companies and national trends.

More on journalist Gary Schwitzer’s Health News blog.

Meantime, it doesn’t take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug – with the company’s logo on it, and with the beginning of each chapter crediting the drug company.

BHN Exclusive: Mass gift ban takes a beating from ACRE

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, with portraits 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”

Click here for her powerpoint.

–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.

 Audio:

  Kimmelstiel argues that the rules have tamed some excesses.

 But, he worries they go too far.

 

– 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

Audio: Part 1, Part 2

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.

   

Roper ACRE

►

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

 

Cambridge biotech co. taking bets on HCV drug

The In-Vivo blog reports that Vertex is selling off anticipated payments the Cambridge biotech hopes to earn from a drug development deal.

Vertex announced this morning that it intended to sell (to an unnamed buyer) its future milestone payments associated with the filing, approval and launch of telaprevir in Europe.

Telaprevir is a promising drug for Hepatitis C. This is a case of a big fish betting on a smaller fish. Then, the smaller fish tries to sell off potential future pay-outs on that bet.

For more on this phenom, see my 2007 story in Fast Company magazine.