From Health Affairs, Vol 24, Issue 4, 949-960: New Federal Guidelines For Physician-Pharmaceutical Industry Relations: The Politics Of Policy Formation, by Susan Chimonas and David J. Rothman. Here’s the abstract:

In October 2002 the federal government issued a draft “Compliance Program Guidance for Pharmaceutical Manufacturers.” The draft Guidance questioned the legality of many arrangements heretofore left to the discretion of physicians and drug companies, including industry-funded educational and research grants, consultantcies, and gifts. Medical organizations and drug manufacturers proposed major revisions to the draft, arguing that current practices were in everyone‘s best interest. To evaluate the impact of their responses, we compare the draft, the changes requested by industry and organized medicine, and the final Guidance document (issued in April 2003). We also explore the implications–some intended, others unanticipated–of the final document.



This post courtesy of Anne Taylor-Vaisey.

This post courtesy of Anne Taylor-Vaisey :

Emerg Infect Dis. 2005 Jun;11(6):904-11.

Clinician knowledge and beliefs after statewide program to promote appropriate antimicrobial drug use. Kiang KM, Kieke BA, Como-Sabetti K, Lynfield R, Besser RE, Belongia EA.

Minnesota Department of Health, Minneapolis, Minnesota, USA. In 1999, Wisconsin initiated an educational campaign fo r primary care clinicians and the public to promote judicious antimicrobial drug use. We evaluated its impact on clinician knowledge and beliefs; Minnesota served as a control state. Results of pre- (1999) and post- (2002) campaign questionnaires indicated that Wisconsin clinicians perceived a significant decline in the proportion of patients requesting antimicrobial drugs (50% in 1999 to 30% in 2002; p<0.001) and in antimicrobial drug requests from parents for children (25% in 1999 to 20% in 2002; p = 0.004). Wisconsin clinicians were less influenced by nonpredictive clinical findings (purulent nasal discharge [p = 0.044], productive cough [p = 0.010]) in terms of antimicrobial drug prescribing. In 2002, clinicians from both states were less likely to recommend antimicrobial agent treatment for the adult case scenarios of viral respiratory illness. For the comparable pediatric case scenarios, only Wisconsin clinicians improved significantly from 1999 to 2002. Although clinicians in both states improved on several survey responses, greater overall improvement occurred in Wisconsin.

Emerg Infect Dis. 2005 Jun;11(6):912-20.

Impact of statewide program to promote appropriate antimicrobial drug use.

Belongia EA, Knobloch MJ, Kieke BA, Davis JP, Janette C, Besser RE.

Marshfield Clinic Research Foundation, Marshfield, Wisconsin 54449, USA. belongia.edward@marshfieldclinic.org The Wisconsin Antibiotic Resistance Network (WARN) was launched in 1999 to educate physicians and the public about judicious antimicrobial drug use. Public education included radio and television advertisements, posters, pamphlets, and presentations at childcare centers. Physician education included mailings, susceptibility reports, practice guidelines, satellite conferences, and presentations. We analyzed antimicrobial prescribing data for primary care physicians in Wisconsin and Minnesota (control state). Antimicrobial prescribing declined 19.8% in Minnesota and 20.4% in Wisconsin from 1998 to 2003. Prescribing by internists declined significantly more in Wisconsin than Minnesota, but the opposite was true for pediatricians. We conclude that the secular trend of declining antimicrobial drug use continued through 2003, but a large-scale educational program did not generate greater reductions in Wisconsin despite improved knowledge. State and local organizations should consider a balanced approach that includes limited statewide educational activities with increasing emphasis on local, provider-level interventions and policy development to promote careful antimicrobial drug use.

Cadent Medical Communications, Irving, Texas, has a couple of new hires. From the press release:

• Kimbre Myers has been named meeting planner. She is responsible for the day-to-day planning and management of medical meetings and events. Myers returns to Cadent Medical Communications from TD Jakes Ministries, where she served as conference planner responsible for planning conferences and meetings for their minister, Bishop Jakes. Prior to TD Jakes, she was the speaker corps manager at Cadent Medical Communications. Myers holds a bachelor’s degree from Oklahoma University.


• Lindsay Shanahan has been named meeting coordinator. She is responsible for coordinating meeting and event logistics. Prior to Cadent Medical Communications, Shanahan served as event coordinator at Tony’s Wine Company, where she coordinated events for the company’s clients. Prior to Tony’s, she served as event coordinator at Shadow Ridge Country Club. Shanahan holds a bachelor’s degree from the University of Nebraska.

Congratulations to both!

According to a report called Missed Opportunity: The CASA National Survey of Primary Care Physicians and Patients, there’s a screaming need for CME on drug and alcohol abuse CME. A snip:

Nine out of ten primary care physicians in the United States fail to correctly diagnose alcohol abuse even when their adult patients present classic early symptoms, according to a survey by the Center on Addiction and Drug Abuse (CASA) at Columbia University.



Even more startling perhaps, 41 percent of pediatricians fail to diagnose illegal drug abuse when presented with a classic description of a drug abusing teenage patient.




The doctors responding to the survey cited lack of adequate training in medical school, residency or continuing medical education courses; skepticism about treatment effectiveness; discomfort discussing substance abuse, time constraints and patient resistance…




Only a small percentage of physicians consider themselves “very prepared” to diagnose alcoholism (19.9 percent), illegal drug use (16.9 percent) and prescription drug abuse (30.2 percent). In sharp contrast, 82.8 percent feel “very prepared” to identify hypertension; 82.3 percent, diabetes; 44.1 percent, depression.

According to this article in the Journal of the American Medical Association (subscription req’d), the AMA and the Association of American Medical Colleges signed a “statement of cooperation” a month or so ago at the AMA’s 2005 Annual Meeting. The statement calls for a total overhaul of the medical education system, from soup (undergrad) to nuts (continuing med ed).

While the article mainly focuses on the problems that need to be addressed and suggested reforms at the undergrad and resident levels, it does say this about CME:

Michael E. Whitcomb, MD, senior vice president of medical education at the AAMC and director of its Institute for Improving Medical Education, said that if medical education reform is to improve the quality of health care, it must address continuing medical education. He said most physicians do not change their practice behaviors as a result of CME; they obtain credits primarily to meet licensure requirements.



While Whitcomb questioned the logic of CME requirements that specify a certain number of hours be taken in Category I rather than in the physician‘s specialty, [Kenneth I. Shine, MD, executive vice chancellor for health affairs of the University of Texas System and former president of the Institute of Medicine] questioned whether partial credit should be withheld if a physician cannot demonstrate a subsequent improvement in clinical practice after attending a CME presentation.




“There is a tremendous challenge in thinking about the continuum of medical education,” said Whitcomb. “We have to understand what our real purpose is as educators, and it is not to recreate the next generation of physicians in our own likeness.”

Well, we’ve heard calls for reform before, and yet the changes are coming slowly and reluctantly. They sound pretty determined to rebuild the system from the ground up, though, so maybe the momentum will pick up now.

This post courtesy of Anne Taylor-Vaisey : There’s a really nice cover piece in the July 2005 Joint Commission Journal on Quality and Patient Safety about using simulation.

Salas E, Wilson KA, Burke CS, Priest HA.

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Here’s yet another take on pharma gifts to doctors, from The Washington Post this time: These Gifts are Bad for Our Health.

Update: The Dead Armadillos blogger (fun name, I know) adds to the author’s list of proposed legislative solutions:

1) Set up a data model that uniquely identifies each medical provider by their DEA number

2) Pharm companies are required to electronically submit an XML formatted report of all their gifts to medical providers on a periodic basis

3) The state health department publishes a website that incorporates all the data submitted by the Pharm companies and allows John Q. Public to easily look up how many thousands of dollars his doctors are accepting in bribes (and for which drugs)



Using XML formatting and open source web application tools, a system like this could be easily and inexpensively set up and then made available to other state health departments. Once installed, it would not be a significant administrative burden for the health department — the data would be updated automatically because of the XML formatting.

From Electric News: Surgeons in a spat: Those in private practice upset over proposal to keep a log of the number of operations they perform. A snip:

A PETITION. Disagreements.



Professor Low Cheng Hock, master of the Academy of Medicine, who said it’s early days yet for the proposed maintenance of certification.




Letters flying here and there.




And an entire committee of doctors stepping down.




That was the ruckus among Singapore’s surgeons when their representative body introduced a proposal.




The College of Surgeons suggested that all surgeons keep a log of all the operations they do. This would form part of a proposed maintenance of certification (MOC), to ensure that their skills are being kept up to date.




This angered about 120 private surgeons who submitted a petition of no confidence to the body.




Sources say private surgeons do fewer operations than those in government or re-structured hospitals. Hence, they felt they would be shown up.

Just think of how well-received such logs would be here in the U.S. And yet they seem to have figured it out in England, from my understanding.

This post courtesy of Anne Taylor-Vaisey :

Jt Comm J Qual Patient Saf. 2005 Apr;31(4):185-202.

The role of teamwork in the professional education of physicians: current status and assessment recommendations. Baker DP, Salas E, King H, Battles J, Barach P. American Institutes for Research, Washington, DC, USA. Dbaker@air.org

BACKGROUND: The Institute of Medicine (IOM) has recommended that organizations establish interdisciplinary team training programs that incorporate proven methods for team management. Teamwork can be assessed during physician medical education, board certification, licensure, and continuing practice. Team members must possess specific knowledge, skills, and attitudes (KSAs), such as the ability to exchange information, which enable individual team members to coordinate.

ASSESSING PHYSICIAN TEAMWORK: KSAs might be elicited and assessed across a physician’s career, starting in medical school and continuing through licensure and board certification. Professional bodies should be responsible for the development of specific team knowledge and skill competencies and for promoting specific team attitude competencies. Tools are available to assess medical student, resident, and physician competence in these critical team KSAs. CHALLENGES AND COMPLEXITIES IN TEAM

PERFORMANCE MEASUREMENT: For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement.

It looks like the University of Toronto is doing just what we want to do at Medical Meetings’ Web site: Create e-accessible tools for “knowledge translation programs,” which I’d just call CME for our purposes. Here’s a link to the page. (Thanks to Anne Taylor-Vaisey for letting me know about this!)

Actually, what we want to do is a little different. We’re constantly getting requests for examples of different forms and templates which we, not being CME providers ourselves, don’t have on hand. What we’d like to do to develop a one-stop shop of resources that CME providers can use, free of charge, as templates to develop their own forms, letters, and policies. Do you have sample speaker invitation letters, new ACCME Standards conflict-of-interest policies or disclosure forms, sample needs assessments, and activity evaluation forms you‘d be willing to share?

If so, send them to me at this address. We will take out all identifying information (if you don’t do it first yourself) and post it to a special resources section of MM‘s Web site to be used as a free, accessible central depository. But it’ll only work if you all provide the forms and temp lates, so send ‘em on in! It’ll be a good service for everyone.