Risk Watch e-column
April 2006
An update of risk management news, issues and items of interest
Undue Influence: Drug Company Gifts Under Scrutiny
An article in the January 25 issue of Journal of the American Medical Association called upon all physicians to discontinue accepting gifts from pharmaceutical companies. According to the article’s authors, about 90% of the $21 billion pharmaceutical companies spend in marketing—which includes gifts—is directed toward physicians. Studies have shown that these gifts lead some physicians to overprescribe and/or underreport problems with medications.
Gifts given to physicians by pharmaceutical companies range from the small (e.g., pens and mugs) to the useful (e.g., drug samples) to the lucrative (e.g., high-paying consulting arrangements). The authors of the article—titled “Health Industry Practices that Cause Conflicts of Interest”—recommend stringent guidelines that would prohibit gifts, restrict corporate financial ties and require transparency in medical research contracts.
In reaction, pharmaceutical industry representatives cautioned about putting strict limits on gifts, noting that sales representatives provide information assuring medications are used correctly. A voluntary code limiting gifts to doctors was adopted by the industry three years ago.
The American Medical Association (AMA) has an ethics policy on accepting gifts. However, the AMA stated that it is “examining and updating” its policy.
The authors of the article acknowledge that there may be difficulty implementing the proposed ban because of the importance of pharmaceutical money in funding medical education and luncheon presentations by industry representatives.
(Source: Journal of the American Medical Association)
Is Pay for Performance Just Around the Corner?
If Congress and the American Medical Association (AMA) have their way, physicians will be reporting outcomes to the federal government sooner rather than later.
As a result of a pact it signed with Congress in December 2005, the AMA has promised to develop more than 100 standard measures of physician performance, according to a report in The New York Times. The agreement is part of the Bush Administration’s support for a pay-for-performance program that would tie Medicare payments to quality of care. The move also reflects similar efforts by the private sector and advocacy groups such as the AARP.
Under the agreed plan, the AMA will develop about 140 performance measures in 34 clinical areas by the end of 2006. According to the terms of the plan, physicians will voluntarily report on at least three to five of the 140 measures. The agreement acknowledges that physicians should receive some additional payment from the government for their trouble, according to The New York Times.
Among the types of measures the federal government expects physicians to file:
- The proportion of diabetic patients with blood sugar and cholesterol at the recommended levels
- The percentage of surgical patients who receive medications to prevent blood clots
- The proportion of patients with pneumonia who receive antibiotics within a few hours of diagnosis
- The percentage of heart attack patients who receive blood pressure drugs known as beta-blockers when they arrive at a hospital.
The agreement was signed by Duane M. Cady MD, chairman of the AMA; Senator Charles E. Grassley (R-Iowa); and Representatives Bill Thomas (R-Calif.) and Nathan Deal (R-Ga.). The three government officials are responsible for Medicare legislation.
The plan has met with numerous objections. Some medical organization leaders worry that before signing the agreement, Dr. Cady had not been assured that physicians would be suitably paid for treating Medicare patients.
Other objections center on the quick turnaround for development and implementation of the measures, and the fact that the AMA was the sole negotiator for all U.S. physicians.
(Source: The New York Times)
Patients Not Following Medical Advice
The cover story of the April issue of Physicians Practice magazine reports that up to 50% of patients do not follow their prescription drug regimen, and that between 5% and 20% never bother to have their prescriptions filled. The article discusses ways to enhance patient compliance.
Another study, also cited in the article, performed by researchers at Duke University, found that in 2002 only 39% of 30,000 patients with coronary artery disease consistently followed their physicians’ recommendations for taking aspirin, beta-blockers, and lipid-lowering medications. Among the “eye opening” discoveries made by the researchers: Only 71% of patients take aspirin, despite the fact that it is readily available.
(Source: physicianspractice.com)
TV Health News: Viewer Beware
The first survey of television health reporting has found that medical news stories average a brief 33 seconds, often lack context and are inaccurate or blatantly wrong.
The survey, performed by physicians at the University of Michigan and the University of Wisconsin at Madison, included 2,795 news broadcasts from the top 50 metropolitan areas. Of those broadcasts, about 40% of them included a health story.
The most egregious examples of inaccurate health reporting included
- Four broadcasts that suggested lemon juice could be used as a contraceptive or prevent HIV transmission
- Twenty-three reports on the effectiveness of duct tape in removing warts.
Of the broadcasts that had a health segment, only 27% included an interview with a healthcare professional, only 26% included specific recommendations about how to prevent or ameliorate the medical condition, and only 12% mentioned the prevalence of the disease.
The researchers were also disappointed with the choice of topics. Breast cancer, for example, was thoroughly reported on—but so too West Nile virus, which has little danger for Americans. Serious, prevalent chronic problems, such as heart disease and obesity, received much less attention.
The survey was motivated by reports that found Americans receive much of their news from local television. “We just want people to understand that you need to take TV news with a grain of salt,” said James M. Pribble MD, an emergency physician at the University of Michigan Hospital and the lead author of the study.
(Source: Los Angeles Times)
Flu Pandemic Checklist Released
The U.S. Department of Health and Human Services has released a checklist to help medical practices prepare for a flu pandemic and meet the demands sick patients will place on them.
The checklist, which is available at www.pandemicflu.gov/plan/medical.html, is organized into three broad categories: structure for planning and decision making, development of a written pandemic influenza plan and elements of an influenza pandemic plan.
The checklist includes step-by-step instructions and links to additional government websites to help medical providers formulate an effective response to a flu outbreak.
(Source: www.pandemicflu.gov)
