According to a press release, the Cosmetic Boot Camp, which focuses on cosmetic dermatology, is restricting registration to physicians who are board certified or board eligible in a relevant specialty. That’s seems pretty unusual to me. They also are developing Cosmetic Boot Camps for Office Staff to “train the office staff to provide an integrated and comprehensive cosmetic experience in the physician’s office.” I like that they’re thinking of a team-based approach to care, but it’s a little strange that they want to keep the training for the different pieces of the team separate. Then again, I know next to nothing about cosmetic dermatology. Maybe there’s some specialty-specific reason for maintaining the training silos?

Despite journal editors’ efforts to crack down on ill-doings and conflicts of interest in the studies they publish, the Wall Street Journal reports that malfeasance is still rampant. One clip from the article (subscription req’d):

Several major pharmaceutical companies are withholding important details about clinical drug trials, despite urging from federal regulators and medical-journal editors to be more forthcoming, according to a study published in this week’s New England Journal of Medicine.



The study says that companies including Merck & Co., Pfizer Inc., and GlaxoSmithKline PLC are obscuring basic information — including the names of some drugs under study — in reporting on trials of drugs to treat serious or life-threatening diseases. Some of the drugs involved are already on the market, and the companies are seeking approval for new uses of them. In an editorial, the medical journal calls for investigators and patients to avoid participating in drug trials where companies take a secretive approach.

I just found Pharma Gossip, and it’s pretty interesting. Check out the predictions for pharma in 2006.

According to this Wall Street Journal article (subscription req’d), resolving author conflicts by disclosing them in a correction after the fact ain’t going to cut it anymore. From the article:

Andrew Wechsler, editor of the Journal of Thoracic and Cardiovascular Surgery, says the publication plans to issue corrections in the two cases to reveal the financial ties of the researchers to AtriCure Inc., a Cincinnati company that makes a system to treat atrial fibrillation, an abnormal heart rhythm.



Prompted by the AtriCure revelations, the American Association of Thoracic Surgery, which owns the journal, decided that a published correction of a conflict of interest — a common remedy when authors fail to disclose industry links — doesn’t go “far enough,” Dr. Wechsler says. He says the tougher sanctions approved by the surgery society will include barring those individuals and their institutions from publishing in the journal for “some period of time.”

I know I’ve heard of some specialty societies having similar policies for CME faculty, and I can’t help but wonder if tougher sanctions for those who fail to disclose conflicts of interest might be coming to a broader realm.

I’ve heard about the dog eating homework excuse, but this article in the Wall Street Journal on a 1992 study about heart attack outcomes and diet is something else. From the article:

In 1992, the British Medical Association’s flagship journal published a study led by Indian doctor Ram B. Singh with a striking finding: Heart-attack victims who ate more fiber, fruits and vegetables for a year cut their risk of death during that period by almost half.



A year later, Richard Smith, the journal’s editor, received two letters questioning the findings. What followed was an extraordinary inquiry stretching over a dozen years and 5,000 miles. Along the way, Dr. Singh contended that termites had eaten crucial data and Dr. Smith spent four years begging a busy statistician to deliver a report.




Finally this July, the journal, called BMJ, lowered the boom. Editors said they had “reasonable grounds to doubt the validity of the 1992 paper” and published an article calling the data in another paper submitted in 1994 “either fabricated or falsified.”




Dr. Singh, while acknowledging some missteps, says he is the victim of scientists who don’t understand what it’s like to work without steady electricity or research grants.

The article goes on to talk about the difficulties involved in journal editors’ finding and exposing questionable or downright fake results. Definitely worth a read for anyone involved in enduring materials.

While this editorial in the North Country Gazette takes a decidedly anti-right-to-die stance, it is interesting to see that George Felos, the attorney who advocated Terri Schiavo’s right to die, will be speaking at a CME cruise meeting (what the writer calls a “death cruise”). From the article:

Felos will be one of two faculty members who will lead a program entitled “Advance Directives/End-of-Life Care and Neurology” on a five-night cruise Jan. 3-8 from Fort Lauderdale to the Bahamas which offers continuing education credits to professionals while they cruise. He will be joined by Dr. James Barnhill of Dunedin, Fla., who has long teamed with Felos as players in the right-to-die movement.

Regardless of your point of view on the Schiavo case, it’s an illustrative case of potential media reactions to a controversial speaker. Does something like this help or hurt the credibility of the activity? I don’t think so, but it is something to think about.

Recommended reading from Anne Taylor-Vaisey:I always enjoy this annual tradition … The BMJ Christmas Double Issue. Here is the 2005 edition:

BMJ Christmas Double Issue; December 24 2005; 331 (7531):

Check out the Sex, Drugs and Rock and Roll section

Also, there are changes coming in 2006 re pricing: All original research articles and selected other articles will be freely available on bmj.com and accessible from the moment of publication. The full text of all other articles wil! l require a subscription for the first 12 months, after which they will be freely accessible. Abstract and extract views of these articles will remain freely accessible as will other website content and functions.

Recommended reading from Anne Taylor-Vaisey:

Academic Medicine January 2006; 81(1):

Most Frequently Accessed Articles, September 2004-September 2005:

These lists are based on the total number of times Academic Medicine Online users downloaded the full text PDFs of our published articles. This is a different calculation than the one used in past years. The range of total downloads is 535 to 137. [Available by subscription. A selection is below.]

“>Articles

1. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them

Pat Croskerrry Aug 2003 78: 775ˆ80.

2. Teaching Inpatient Communication Skills to Medical Students: An Innovative Strategy

David P. Losh, Larry B. Mauksch, Richard W. Arnold, Theresa M. Maresca, Michael G. Storck, Raye R. Maestas, Erika GoldsteinFeb 2005 80: 118ˆ24.

3. Generation X: Implications for Faculty Recruitment and Development in Academic Health Centers

Janet Bickel, Ann J. BrownMar 2005 80: 205ˆ10.

4. How Can Physicians’ Learning Styles Drive Educational Planning?

Elizabeth Armstrong, Ramin Parsa-ParsiJul 2005 80: 680ˆ84.

5. Preparing Health Professions Students for Terrorism, Disaster, and Public Health Emergencies: Core Competencies

David Markenson, Charles DiMaggio, Irwin RedlenerJun 2005 80: 517ˆ26.

6. Teaching the Psychosocial Aspects of Care in the Clinical Setting: Practical Recommendations

David E. Kern, William T. Branch, Jeffrey L. Jackson, Donald W. Brady, Mitchell D. Feldman, Wendy Levinson, Mack LipkinJan 2005 80: 8ˆ20.

7. The Importance of Anatomy in Health Professions Education and the Shortage of Qualified Educators

Robert S. McCuskey, Stephen W. Carmichael, Darrell G. KirchApr 2005 80: 349ˆ51.

8. Teaching Professionalism Within a Community Context: Perspectives from a National Demonstration Project

Thomas P. O’Toole, Navneet KathuriaMahita Mishra, Daniela SchukartApr 2005 80: 339ˆ43.

9. Toward a Normative Definition of Medical Professionalism

Herbert M. SwickJun 2000 75: 612ˆ16.

10. Sexual Harassment in Medical Education: Liability and Protection

Patricia Ryan Recupero, Alison M. HeruMarilyn Price, Jody AlvesSept 2004 79: 817ˆ24.

I wonder if there are any providers offering CME on the touchy subject of when and how to shore up or tone down a patient’s hope for a cure. This thought was prompted by a fascinating article in today’s New York Times: Doctors’ Delicate Balance in Keeping Hope Alive. It’s a thought-provoking read. A snip:

“Hope lives inside a patient and the physician’s behavior can either bring it out or suppress it,” said Dr. Susan D. Block, a palliative care leader at Harvard. “When a patient has goals, it’s impossible to be hopeless. And when a physician can help a patient define them, you feel like a healer, even when the patient is dying.”

Or so it would seem when it comes to bad medical students becoming less-than-stellar docs, according to a new study in the New England Journal of Medicine (subscription req’d. Here’s a link to a writeup of it in Forbes, which you don’t need a subscription to read online). From Forbes:

Doctors who had exhibited unprofessional behavior in medical school were three times more likely to be disciplined by a medical board than students who had not had such problems in medical school, the study found.



But doctors who had exhibited certain types of behavior in medical school were even more likely to be cited by a medical board: Those who behaved unprofessionally in school were 8.5 times more likely to be disciplined while those with a diminished capacity for self-improvement were 3.1 times more likely to be disciplined, according to the study.




The students were deemed irresponsible if they were late for rounds, didn’t show up for the clinics they were assigned to, or didn’t finish taking care of a patient.

And the things they end up being disciplined for as docs “use of drugs or alcohol, negligence, sexual misconduct, fraud and failure to meet continuing medical education requirements.” And many of them are repeat offenders. So, it makes sense to try to nip this in the bud in med school. But what to do for today’s former irresponsible students-turned irresponsible doctors? Somehow, I don’t think there’s much CME can do to help develop that sense of professionalism (especially if they’re already skipping out on their CME requirements) once they’ve been in practice a while. Is it possible to reform these people?

As Bard Parker says on A Chance to Cut is a Chance to Cure:

My program director always told us that a residency program can’t purge someone of their personality disorders. Goes along with the conventional wisdom of being unable to change someone after you marry them. This has been my anecdotal experience as well. In Georgia the quarterly report from the medical board has the names of physicians placed on the naughty list during that time period. Occasionally I will recognize a classmate’s name and recall what a buffoon/screwball/jackass he/she was. Could have saved the board a lot of time.