Princess Health and Wall Street Journal: Medical Editor Turns Activist On Drug Trials. Princessiccia

Princess Health and Wall Street Journal: Medical Editor Turns Activist On Drug Trials. Princessiccia

Gusty 08:39 Add Comment

NEJM editor Drazen returns to the Light Side of the Force. The revelation about academic medical centers willingly accepting ghost-writing or marginalization of their faculty as principal authors is stunning.

JEFFREY DRAZEN, editor of the prestigious New England Journal of Medicine, has prescribed a strong dose of disclosure for the pharmaceutical industry he was once accused of embracing too closely.

This week, Dr. Drazen accused three big pharmaceutical companies of "making a mockery" of a government database designed to provide accessible information about drug trials. He also joined a dozen other medical-journal editors in again warning that they might refuse to publish studies that don't adhere to their disclosure demands. Dr. Drazen has also recently written, and his journal has published, pieces critical of companies suppressing negative information about drug trials.

And the journal today plans to publish a study suggesting that drug companies may be exerting more influence over the supposedly independent academic investigators that they hire to conduct drug trials than had previously been known. The study, a survey of 107 medical-school research centers, shows that half would allow sponsors of their research to draft manuscripts reporting the results while limiting the role of the investigator to suggesting revisions.

... Dr. Drazen's newfound activism is especially striking since he came under fire for his own financial ties to the pharmaceutical industry when he took his current job at the New England Journal five years ago.

"He's been converted," said Marcia Angell, senior lecturer at Harvard Medical School and Dr. Drazen's predecessor as editor-in- chief. "Through painful experience, Jeff is learning what these companies are about. He sees the ugly side that he hadn't seen before -- the bias that company-sponsored research contains, the suppression of results that they don't like, the spin of unfavorable results."

-- SS

Princess Health and Wall Street Journal: Medical Editor Turns Activist On Drug Trials.Princessiccia

Princess Health and Wall Street Journal: Medical Editor Turns Activist On Drug Trials.Princessiccia

Gusty 08:39 Add Comment

NEJM editor Drazen returns to the Light Side of the Force. The revelation about academic medical centers willingly accepting ghost-writing or marginalization of their faculty as principal authors is stunning.

JEFFREY DRAZEN, editor of the prestigious New England Journal of Medicine, has prescribed a strong dose of disclosure for the pharmaceutical industry he was once accused of embracing too closely.

This week, Dr. Drazen accused three big pharmaceutical companies of "making a mockery" of a government database designed to provide accessible information about drug trials. He also joined a dozen other medical-journal editors in again warning that they might refuse to publish studies that don't adhere to their disclosure demands. Dr. Drazen has also recently written, and his journal has published, pieces critical of companies suppressing negative information about drug trials.

And the journal today plans to publish a study suggesting that drug companies may be exerting more influence over the supposedly independent academic investigators that they hire to conduct drug trials than had previously been known. The study, a survey of 107 medical-school research centers, shows that half would allow sponsors of their research to draft manuscripts reporting the results while limiting the role of the investigator to suggesting revisions.

... Dr. Drazen's newfound activism is especially striking since he came under fire for his own financial ties to the pharmaceutical industry when he took his current job at the New England Journal five years ago.

"He's been converted," said Marcia Angell, senior lecturer at Harvard Medical School and Dr. Drazen's predecessor as editor-in- chief. "Through painful experience, Jeff is learning what these companies are about. He sees the ugly side that he hadn't seen before -- the bias that company-sponsored research contains, the suppression of results that they don't like, the spin of unfavorable results."

-- SS

Princess Health and "Another Guy Who Ethically Ran Amok": Bellevue Hospital Executive Fired. Princessiccia

Princess Health and "Another Guy Who Ethically Ran Amok": Bellevue Hospital Executive Fired. Princessiccia

Bellevue Hospital Center conflicts of interest hospitals Mismanagement

Gusty 12:18 Add Comment

The New York Times reports yet another hospital chief executive leaving in disgrace. Carlos F. Perez, executive director of Bellevue Hospital Center, was fired after he was accused of taking a loan from a company that did business with city hospitals. The acting director the New York City Health and Hospitals Corporation, of which Bellevue is a part, declared, "We have no tolerance for unethical conduct in our city's public hospitals. This breach of the public trust is a disservice to our patients and the thousands of H.H.C employees."
Perez is the second chief executive of a New York City public hospital to depart under a cloud in the last week. We recently posted about how Joseph Orlando, the executive director of Jacobi Hospital, was fired because his hospital failed to notify hundreds of women about suspicious Pap test results.
A City Councilwoman declared, "I am shocked about the development at Bellevue and the fact that in less then [sic] a week we have lost two of our hospital leaders. It really raises questions to me about management of H.H.C. You had one guy who was not managing his staff, and now you have another guy who ethically ran amok."
Earlier this month, we posted about the firing of Joseph Pisani, the Chief Administative Officer of Westchester (NY) County Medical Center, after it was reported he had been involved in fraudulant practices at Staten Island (NY) University Hospital.
It hasn't been a good month for hospital leadership in New York.
However, this is not just a regional problem. This cluster of cases should remind us how widespread the problem of unethical leadership of large health organizations is. If we want things to get better, physicians must get involved in systematically uncovering incompetent, unethical, and corrupt leadership, while fostering representative, transparent, ethical and responsible health care governance.

Princess Health and "Another Guy Who Ethically Ran Amok": Bellevue Hospital Executive Fired.Princessiccia

Princess Health and "Another Guy Who Ethically Ran Amok": Bellevue Hospital Executive Fired.Princessiccia

Bellevue Hospital Center conflicts of interest hospitals Mismanagement

Gusty 12:18 Add Comment

The New York Times reports yet another hospital chief executive leaving in disgrace. Carlos F. Perez, executive director of Bellevue Hospital Center, was fired after he was accused of taking a loan from a company that did business with city hospitals. The acting director the New York City Health and Hospitals Corporation, of which Bellevue is a part, declared, "We have no tolerance for unethical conduct in our city's public hospitals. This breach of the public trust is a disservice to our patients and the thousands of H.H.C employees."
Perez is the second chief executive of a New York City public hospital to depart under a cloud in the last week. We recently posted about how Joseph Orlando, the executive director of Jacobi Hospital, was fired because his hospital failed to notify hundreds of women about suspicious Pap test results.
A City Councilwoman declared, "I am shocked about the development at Bellevue and the fact that in less then [sic] a week we have lost two of our hospital leaders. It really raises questions to me about management of H.H.C. You had one guy who was not managing his staff, and now you have another guy who ethically ran amok."
Earlier this month, we posted about the firing of Joseph Pisani, the Chief Administative Officer of Westchester (NY) County Medical Center, after it was reported he had been involved in fraudulant practices at Staten Island (NY) University Hospital.
It hasn't been a good month for hospital leadership in New York.
However, this is not just a regional problem. This cluster of cases should remind us how widespread the problem of unethical leadership of large health organizations is. If we want things to get better, physicians must get involved in systematically uncovering incompetent, unethical, and corrupt leadership, while fostering representative, transparent, ethical and responsible health care governance.

Princess Health and Lawyers Sue Hospital Based on What it Advertised. Princessiccia

Princess Health and Lawyers Sue Hospital Based on What it Advertised. Princessiccia

Gusty 11:56 Add Comment

Lawyers have noticed how hospitals are making exaggerated claims about their services, as reported by the Boston Globe.
The story involves the unfortunate case of a patient who died after bariatric surgery (i.e., after a procedure meant to reduce stomach size, and so induce weight loss). In Massachusetts, the law limits the damages collectable from civil suits against not-for-profit organizations, including hospitals, to $20,000. However, in this case, the plaintiff's lawyers are contending that "these stomach banding procedures are profit centers, that the hospitals advertise, they make promises, they do all things businesses do." Based on this argument, they initially asked Beth Israel Deaconess Hospital for a settlement of $8.5 million, and then filed a law-suit naming the hospital, as well as three members of the hospital's anesthesia staff.
The article also noted that other states are abolishing restrictions on the damages that can be collected from hospitals, based on reasoning that "the legal system should not treat hospitals differently than other corporations, especially as hospitals merge into large organizations that increasingly market their products and compete for patients."
Health Care Renewal has posted examples of hospitals (and other health care not-for-profits) acting more like for-profit businesses, and of some hospitals exhibiting unethical business practices. In particular, we have posted about questionable hospital advertising claims here and here. The second link is to a study of advertising done by prominent academic medical centers. The authors concluded, "Many of the ads seem to place the interests of the medical center before the interests of the patients."
The law may be a somewhat blunt tool to change these practices, but if we in health care cannot come up with a more nuanced approach, it is a tool likely to be increasingly employed.

Princess Health and Lawyers Sue Hospital Based on What it Advertised.Princessiccia

Princess Health and Lawyers Sue Hospital Based on What it Advertised.Princessiccia

Gusty 11:56 Add Comment

Lawyers have noticed how hospitals are making exaggerated claims about their services, as reported by the Boston Globe.
The story involves the unfortunate case of a patient who died after bariatric surgery (i.e., after a procedure meant to reduce stomach size, and so induce weight loss). In Massachusetts, the law limits the damages collectable from civil suits against not-for-profit organizations, including hospitals, to $20,000. However, in this case, the plaintiff's lawyers are contending that "these stomach banding procedures are profit centers, that the hospitals advertise, they make promises, they do all things businesses do." Based on this argument, they initially asked Beth Israel Deaconess Hospital for a settlement of $8.5 million, and then filed a law-suit naming the hospital, as well as three members of the hospital's anesthesia staff.
The article also noted that other states are abolishing restrictions on the damages that can be collected from hospitals, based on reasoning that "the legal system should not treat hospitals differently than other corporations, especially as hospitals merge into large organizations that increasingly market their products and compete for patients."
Health Care Renewal has posted examples of hospitals (and other health care not-for-profits) acting more like for-profit businesses, and of some hospitals exhibiting unethical business practices. In particular, we have posted about questionable hospital advertising claims here and here. The second link is to a study of advertising done by prominent academic medical centers. The authors concluded, "Many of the ads seem to place the interests of the medical center before the interests of the patients."
The law may be a somewhat blunt tool to change these practices, but if we in health care cannot come up with a more nuanced approach, it is a tool likely to be increasingly employed.

Princess Health and Fewer Physicians Interested in Generalist Careers. Princessiccia

Princess Health and Fewer Physicians Interested in Generalist Careers. Princessiccia

physicians primary care

Gusty 14:28 Add Comment

There is more information available about the decreasing number of physicians interested in being generalists.
A detailed survey based study of internal medicine residents' career choices just appeared in Academic Medicine, and was discussed in the American Medical News. [The article citation is: Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med 2005; 80: 507-512.]
The article shows that the proportion of residents who go into general internal medicine has fallen from 54% in 1998 to 27% in 2003 (34% if hospitalists are added to general internists.) Reasons for going into sub-specialties admitted by survey respondents included higher income, and narrow practice area.
The American Medical News did not try to white-wash these results. It quoted a third year resident, chair of the AMA Resident's and Fellow's Section, who is going into gastroenterology because, "I'll be paid what my education is worth," and contrasted that situation with the lot of the general internist who makes "$110,000 a year.... That's a salary someone with less education and training can earn in other fields, without the debt of medical school, years spent training and commitment to a lifetime of being on call."
Steve Fihn, past President of the Society of General Internal Medicine, said "It's a pretty daunting task trying to reverse this trend when the economic forces are so strong."
On the other hand, the ASP Observer featured an article about the results of this year's internship match, i.e., how many medical students chose internal medicine training. The article was mainly positive, since the numbers choosing internal medicine have gone up slightly. "That's good news," since the numbers were dropping from 1998 to 2003.
However, the report also included the observation that internal medicine training program directors report that the proportion of residents going into general internal medicine has dropped from about 50% to about 20-25%, similar figures to those in the article by Garibaldi et al. But Steven E. Weinberger, ACP Vice President for Medical Knowledge and Education, suggested that the solution for dropping interest in general internal medicine would be the ACP's efforts to "fix Medicare reimbursement, for instance, and to help craft new chronic care models.... Creative models of high quality, team-based care offer a real opportunity to address the lifestyle issues." What sort of "chronic care models" he envisions, and how they will help generalists practice medicine, was not very obvious.
So the big question is whether our health care leaders and policy makers will make an effective attempt to reverse the decline of the generalist physician before the species becomes extinct.
At least some show understanding of the severity of stresses on generalists. Dr. Fihn, for example, is frank about the economic incentives.
However, as demonstrated by the issues discussed on this blog, not only are generalists at the bottom of the economic pecking order, they seem particularly impacted by the huge rise in health care bureaucracy, and particularly vulnerable to challenges to physicians' professional values instigated by large organizations lead by leaders with conflicting interests. They will need more than new "chronic care models" to survive these threats.