Saturday, October 4, 2014

Dallas Ebola case spurs concern about hospital readiness - The Washington Post

A Washington-area hospital announced Friday that it had admitted a patient with symptoms and a travel history associated with Ebola. The case has not been confirmed, but the number of similar incidents around the country and a confirmed Ebola patient in Dallas have spurred concerns about whether U.S. hospitals are as prepared to deal with the virus as federal officials insist they are.

Since July, hospitals around the country have reported more than 100 cases involving Ebola-like symptoms to the federal Centers for Disease Control and Prevention, officials there said. Only one patient so far — Thomas Duncan in Dallas — has been diagnosed with Ebola.

But in addition to lapses at the Dallas hospital where Duncan is being treated, officials say they are fielding inquiries from hospitals and health workers that make it clear that serious questions remain about how to properly and safely care for potential Ebola patients.

A CDC official said the agency realized that many hospitals remain confused and unsure about how they are supposed to react when a suspected patient shows up. The agency sent additional guidance to health-care facilities around the country this week, just as it has numerous times in recent months, on everything from training personnel to spot the symptoms of Ebola to using protective gear.

Emory University Hospital in Atlanta, which has treated several Ebola patients who were flown from West Africa, also has provided information and advice to dozens of hospitals, many of which are struggling with a lack of awareness about safety protocols and fear among some workers who feel ill-prepared. Washington-area health officials also said they are trying to identify gaps in their preparedness plans.

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Friday, October 3, 2014

Facebook plots first steps into health care - Reuters

Facebook already knows who your friends are and the kind of things that grab your attention. Soon, it could also know the state of your health.

On the heels of fellow Silicon Valley technology companies Apple and Google, Facebook is plotting its first steps into the fertile field of health care, said three people familiar with the matter. The people requested anonymity as the plans are still in development.

The company is exploring creating online "support communities" that would connect Facebook users suffering from various ailments. A small team is also considering new "preventative care" applications that would help people improve their lifestyles. In recent months, the sources said, the social networking giant has been holding meetings with medical industry experts and entrepreneurs, and is setting up a research and development unit to test new health apps. Facebook is still in the idea-gathering stage, the people said. Healthcare has historically been an area of interest for Facebook, but it has taken a backseat to more pressing products.

Recently, Facebook executives have come to realize that healthcare might work as a tool to increase engagement with the site.

One catalyst: the unexpected success of Facebook's "organ-donor status initative," introduced in 2012. The day that Facebook altered profile pages to allow members to specify their organ donor-status, 13,054 people registered to be organ donors online in the United States, a 21 fold increase over the daily average of 616 registrations, according to a June 2013 study published in the American Journal of Transplantation.

Separately, Facebook product teams noticed that people with chronic ailments such as diabetes would search the social networking site for advice, said one former Facebook insider. In addition, the proliferation of patient networks such as PatientsLikeMe demonstrate that people are increasingly comfortable sharing symptoms and treatment experiences online.

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Wednesday, October 1, 2014

Interview with Dennis Rosen, author of “Vital Conversations”

Question: So what is Vital Conversations about?

Dennis Rosen: Vital Conversations is about why good communication between doctors and patients is so important to achieving better—and less expensive—health outcomes. It explores many of the reasons that this communication becomes compromised, such as cultural and socioeconomic differences; stigma and bias; and external meddling in the actual content of the medical visit that takes away from the direct face time between doctors and patients. Vital Conversations concludes with clear suggestions—for both patients and doctors—about ways each can improve the quality of their interactions in order to get more out of them. It also provides suggestions for how the health-care system can prioritize this issue in ways that will serve us all.

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A Doctor, a Rabbi and a Chicken -

"Doctor, is it O.K. for our rabbi to visit my father?" 

I was an intern on call in one of the internal medicine wards in an Israeli hospital just south of Tel Aviv. The first day of the Jewish holiday of Sukkot had just ended, and the ward was beginning to fill up with visitors who had been unable to drive until after sunset.

Looking up from what I was doing, I saw the son of one of my patients standing at the counter of the nursing station. He and I had already spoken several times that day about his 75-year-old father, who had been admitted the night before because of a stroke.

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Internal Medicine: A Doctor’s Stories. Terrence Holt - Books - The Boston Globe

Although described as memoir, it quickly becomes clear that the boundaries between fiction and nonfiction in Terrence Holt's "Internal Medicine: A Doctor's Stories'' will be murky. On the third page of the introduction, Holt refers to his stories as parables of life in a hospital and the making of doctors (himself in particular); by the fourth, he explains that the patients in the book are not "based upon specific individuals . . . They aren't 'facts.' " 

Furthermore, despite having drawn upon his experiences as an internal-medicine resident for the content of the stories, told mostly in the first person, he writes that their narrator evolved "into someone else [who] dealt with patients different from the ones I cared for, and . . . in ways I never did."

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Doctors and Drug Companies — Scrutinizing Influential Relationships — NEJM

Doctors and Drug Companies — Scrutinizing Influential Relationships

Eric G. Campbell, Ph.D.

N Engl J Med 2007; 357:1796-1797

On September 6, 2007, Senators Charles Grassley (R-IA), the ranking member of the Committee on Finance, and Herb Kohl (D-WI), chairman of the Special Committee on Aging, introduced the Physician Payments Sunshine Act — so named because it aims to "shine a much needed ray of sunlight on a situation that contributes to the exorbitant cost of health care," according to cosponsor Senator Charles Schumer (D-NY). The bill would require manufacturers of pharmaceuticals and medical devices with annual revenues of more than $100 million to disclose the amount of money they give to physicians — whether in the form of a free dinner or vacation or a consulting fee. "This bill is about letting the sun shine in so that the public can know," says Grassley.
The move was stimulated in part by activity in Minnesota and Vermont, which have made the reporting of such relationships mandatory — Minnesota in 1993 and Vermont in 2003. Three additional states (Maine, West Virginia, and California) and the District of Columbia have now enacted similar disclosure laws, and many other states are considering doing so. Although beliefs vary widely about the overall usefulness of the data collected under state mandates, the movement toward increased transparency is gaining steam.
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Johns Hopkins Experts Say Open Payments Database Casts Shadows, Not Light

 A federal, public database launched September 30 with the intention of bringing transparency to financial relationships between physicians and industry may instead result in opacity and misinterpretation, according to experts in bioethics, clinical care and public health at Johns Hopkins. 
In an opinion published in Annals of Internal Medicine to coincide with the launch of the Open Payments database by the Centers for Medicare & Medicaid Services (CMS), the authors take issue with the monetary value of drugs donated to clinical trials being counted in the database as "research payments" to physicians running those trials. They argue this will likely greatly inflate the total dollar amount of research payments, and dwarf actual cash payments to physicians. Authors Stephanie R. Morain, Charles Flexner, Nancy E. Kass, and Jeremy Sugarman then offer suggestions of how to reduce the potential for misinterpretation of drug donations.
The Open Payments database is an implementation of the Physician Payment Sunshine Act (PPSA), passed as part of the Affordable Care Act healthcare overhaul in 2010, which requires manufacturers of drugs, devices, biologics, and medical supplies to track and report "all transfers of value" to physicians or teaching hospitals.
"Attributing such large payments to individual physician-investigators seems inconsistent with the PPSA's intent. Donated drugs are intended for use by patients and do not provide direct monetary value to physician-investigators. The PPSA rules cloud this critical distinction," the commentary states.
The authors provide a real, illustrative example of how the costs of drugs for some clinical trials add up quickly and distort financial relationships: "The NIH recently initiated a trial of sofosbuvir, a once-daily agent for hepatitis C virus infection whose retail value is approximately $1000 per dose, with a 12-week course of curative treatment, or 84 doses (6). An investigator enrolling just 10 patients would be reported as receiving $840,000 from Gilead Sciences, sofosbuvir's manufacturer."
According to the commentary, the potential for such misleading information could deter some physicians from participating in research, to avoid the appearance of unethical financial relationships with study funders.
"One may presume that the public may have difficulty distinguishing between donated drugs for research and transfers of financial value to physicians. Such confusion frustrates the purpose of the PPSA, casting shadows where bright light had been promised," the commentary states.
Acknowledging that new legislation amending the PPSA is unlikely, the authors offer other potential solutions for avoiding misinterpretation of drug donations:
1. Drug donations could be attributed to research sites (such as medical centers) rather than to individual physician-investigators.
2. CMS could add a category for reporting research payments, to distinguish donations for which the physician receives no direct financial benefit.
3. Manufacturers could be required to include a brief descriptive statement when disclosing drug donations that provides additional context (currently such context is allowed but not a requirement).
"Financial conflicts of interest present clear risks for research integrity, and transparency can play an important role in mitigating these risks. However, care must be taken to ensure that regulations don't discourage participation in socially valuable research," says Stephanie R. Morain, a Hecht-Levi Fellow at the Johns Hopkins Berman Institute of Bioethics and lead author of the commentary. "The effects of implementation should be monitored, and CMS should consider appropriate revisions to truly let the sun shine on important issues."

Detailing Financial Links of Doctors and Drug Makers -

Pharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released Tuesday. Other doctors made millions of dollars in royalties from products they helped develop.

The data sheds new light on the often murky financial ties between physicians and the health care industry. From August to December 2013, drug and device companies made 4.4 million payments to more than half a million health care professionals and teaching hospitals — adding up to about $3.5 billion.

The lucrative arrangements are just some of the findings of the online database, which provides one of the most detailed looks at the payments health care professionals receive from drug and medical device companies. The website also allows consumers to find information about their own doctors to determine whether they might have conflicts of interest.

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