First there was the whole Vioxx and Celebrex thing. And now there’s a new twist on an old drug: The FDA is doing a pilot study on the use of Ecstasy (methylenedioxymethamphetamine), better known for showing up in dance clubs than hospices, to help terminal patients. This from The Scotsman:

The Food and Drug Administration has approved a pilot study looking at whether the recreational hallucinogen can help terminally-ill patients lessen their fears, quell thoughts of suicide and make it easier for them to deal with loved ones…The small four-month study is expected to begin early next spring. It will test the drug s effects on 12 cancer patients from the Lahey Clinic Medical Centre in the Boston area. The research is being sponsored by the Multidisciplinary Association for Psychedelic Studies, a non-profit group that plans to raise 250,000 (-184,816) to fund it.

So, can we bring Timothy Leary back to teach the course on this one?

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Anne Taylor-Vaisey reminded me this morning about the Canadian Red Cross, which is doing some great work to help the tsunami victims. Here’s the link.

First there was the whole Vioxx and Celebrex thing. And now there’s a new twist on an old drug: The FDA is doing a pilot study on the use of Ecstasy (methylenedioxymethamphetamine), better known for showing up in dance clubs than hospices, to help terminal patients. This from The Scotsman:

The Food and Drug Administration has approved a pilot study looking at whether the recreational hallucinogen can help terminally-ill patients lessen their fears, quell thoughts of suicide and make it easier for them to deal with loved ones…The small four-month study is expected to begin early next spring. It will test the drug s effects on 12 cancer patients from the Lahey Clinic Medical Centre in the Boston area. The research is being sponsored by the Multidisciplinary Association for Psychedelic Studies, a non-profit group that plans to raise 250,000 (-184,816) to fund it.

So, can we bring Timothy Leary back to teach the course on this one?

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This article in AmedNews outlines an interesting new strategy to encourage docs to reduce their liability by doing better risk management:

American Physicians Assurance Corp. through Jan. 31 is collecting stories from its 11,000 policyholders concentrated in Illinois, Indiana, Kentucky, Michigan, New Mexico and Ohio so that it can hand out the company’s first “Excellence in Risk Management Award.”



“We want to encourage physicians who meet high standards in terms of quality care and risk management,” said Cathy Burke, APA’s marketing director. “We think they go hand in hand.”

OK, someone just has to tie CME into this. What better way to both track behavior change and encourage innovative new ways to apply what they learn–without having to foot the bill yourself. I don’t see any downside to it–do you?

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Looks like blogger Benjamin Rosenbaum has pulled together ratings for tsunami relief organizations. So if you want to make sure your donations will be put to good use, this should prove to be a good resource. As he says, give wisely, generously, and soon.

Looks like blogger Benjamin Rosenbaum has pulled together ratings for tsunami relief organizations. So if you want to make sure your donations will be put to good use, this should prove to be a good resource. As he says, give wisely, generously, and soon.

I haven’t been writing about the tsunamis’ horrifying impact on many countries in Asia because, well, it hurts my heart too much and makes me realize again how helpless we are in the face of a natural disaster of such proportions. (For links to info on relief efforts and status reports from the various affected areas, click here.)

I would like to pass along this request from M. Madharudeen in Kampala, Uganda, who in addition to the below is also currently negotiating with few international airlines for logistical support to transport the donated medicines to Colombo International Airport in Sri lanka.

As you may be well aware that Sri Lanka is been badly hit with the highest number of casualties coming from the region. Over 18,700 people confirmed dead and the number is expected to rise well over 25,000. Millions of people are displaced and are very worried about the secondary infections that might be triggered due to polluted water and environment.



The President has declared a state of emergency and has requested international help.




I kindly request that anyone who is interested in contibuting related medicines and/or water-purifying tablets towards this worthy cause contact me. I will help them to link with the necessary authorities to speed up the process. Drugs should have at least 6-10 months of shelf life. It is also an ideal time to donate drugs instead of paying destruction cost when expired.




I have also requested from the Sri Lankan pharma friends to find out exactly what they need.

Contact: M. Madharudeen, Kampala, Uganda, mediceutix@yahoo.com, Tel : 00256 77 951775, if you can help.

Update from M. Madharudeen“The Sri Lankan Airline (formerly known as Air Lanka) has agreed to airlift goods from their UK offices to Sri lanka. A big salute for their contribution. If one can channel the goods to UK offices it would be easier for the moment to facilitate this objective.

“At the same time a fellow lankan who has come up to sort it out at ground level through the Canadian Relief Foundation in Canada which is deeply engaged in Sri Lanka, Eastern Provice, Trincomalee District.

“Currently I have a donor willing to donate bedding (sheets), towels, clothing, toothbrushes, OTC drugs like aspirin and disenfectants, etc., from the Philladelphia, United States.

“Thanks to all of you, we shall work on this to see many lives are saved and rehabilitated.”

Sue again: Please e-mail me if you’d like a list of the drugs and equipment that are most needed.

Lots of interesting stuff in this article from the New York Times, "Program Coaxes Hospitals to See Treatments Under Their Noses." The point is to get docs in hospitals to remember to give standard-of-care treatments in three non-controversial areas, like aspirin to heart attack patients.

Doctors do know what works, said Dr. Steven M. Asch, a health care researcher at the V.A. Greater Los Angeles Health Care System and the RAND Corporation in Santa Monica. But, he found, Americans got just half the tests and treatments they should be getting…At least part of the answer, he and others say, is that doctors are unaware of their shortfalls and are rewarded no matter how well they do.

Enter the carrot–pay for performance–and the stick, which is the threat of public humiliation when Medicare posts the hospital ratings on the Internet.

What about those reminder sheets CME providers hand out as takeaways? Here’s what the Times article said:

"We tried to come up with a standardized order set," with all the measures that Medicare was asking about, Dr. Gross said. "But the doctors didn’t want to use the sheet," insisting they would just remember those items. Then they forgot.

When they used nurses to remind the docs, success rates soared. Anyway, it’s an interesting article.

Update: Shrinkette has a much better post on this–check it out.

Another update: AmedNews has an article on the AMA’s new initiative to provide prompts that will, they believe, save 100,000 lives over the next 18 months by reducing errors.

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This article in the Sun-Herald points out another reason to make sure the right message from your meeting goes out to the public: The dreaded “oops factor.”

warnings on antidepressants about suicide risks. The war over whether Americans are getting the right advice on fat, calories and carbs. The shocker that hormone therapy increases some health risks instead of easing them.



It’s enough to make a patient wonder if doctors can get it right.




It’s not just patients who wonder. The National Institutes of Health will sponsor a forum on medical studies next month, featuring prominent scientists from around the country. The punch line of the title: “Why Do We Sometimes Get It Wrong?”

One of the reasons for medical reversals, according to the article, is that “Public attention goes not just to studies that are published in medical journals, where they have been reviewed by other scientists. The media also is reporting on studies at medical meetings, even though those results are often preliminary.” Some, like Dr. Lisa Schwartz, associate professor at Dartmouth Medical School, even accuse meetings of being more about getting ink than peer discussion and review.

This article in The Hindu further explores the topic:

“Frequently, the presentations represent work in progress. Unfortunately, many projects fail to live up to their early promise; in some cases, fatal flaws emerge,” the paper states [quoting a 2002 JAMA article].



It goes further to say, “Press coverage at this early stage may leave the public with the false impression that the data are in fact mature, the methods valid, and the findings widely accepted. As a consequence, patients may experience undue hope or anxiety or may seek unproved, useless, or even dangerous tests and treatments.”

It’s all about controlling the message, working with the press to make sure that if a preliminary study comes up with a headline-provoking result, they know to stress that the findings are preliminary and more work needs to be done. The vultures among us may take it and run with it anyway, but responsible journalists are in the business to let people know what’s really going on, not that we’ve discovered a miracle pill that will melt off 50 pounds with no diet or exercise. This article, while aimed at containing bad news, offers some good strategies for dealing with the press.

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The doc who writes CodeBlueBlog has a great rant about the British Medical Journal’s double Christmas issue. Particularly of concern is this bit from the editorial:

Freedom has become the political buzzword of the 21st century. George Bush’s agenda is to bring democracy and freedom to the rest of the peoples of the world, while his own are slaves to work, crippled by personal debt, and trapped in loneliness or loveless relationships the shackles of the rich. Now that the surviving Afghanis and Iraqis are enjoying the benefits of Western freedoms, what will this mean for their health? No empirical studies have explored the relation between the extent of freedom allowed by political regimes and the effect on a nation’s health until now. 

OK, I agree that calling all Americans crippled, trapped, lonely, and loveless is a bit much. And the fact that the acting editor of the BMJ is a sports writer who specializes in covering cricket matches doesn’t give him a lot of credibility to comment on world health or America’s state of freedom. But The Effect of Democracy on Health: Ecological Study, the article referenced in the editorial, actually is pretty interesting. The summary points:

Data now available make it possible to measure the global impact on health of a wide range of political and economic variables

Freedom ratings can be used as proxies to explore the effects of democracy on other variables

After a country’s wealth, level of inequality, and the size of its public sector are adjusted for, democracy has a beneficial effect on health

Maybe I just don’t have enough "shackles of wealth" to qualify as an American to the BMJ’s acting editor’s mind, but I value the freedoms I have as a U.S. citizen, and defend them zealously. That they correlate with better health doesn’t surprise me. But how to teach docs to prescribe health-giving freedom to their patients? Hmm. I’ll leave that one up to you…

Nick over at blogborygmi raises some intriguing questions about whether hospitals’ deals to provide team physicians for sports teams like the Red Sox is actually the equivalent of celebrity endorsements. He says:

There are many ways to attract patients to a particular hospital, but this method isn’t particularly grounded in the patient’s best interests. Why not tout improved outcomes or other evidence-based data? Wouldn’t you rather have surgery at a place with the lowest complication rates, instead of just going where Pedro goes? Wouldn’t your answer be influenced if Pedro’s team was reimbursed for the chance to care for him?

People routinely criticize pharmaceutical companies for vague direct-to-consumer advertising. They say it’s wasteful spending and gives patients false impressions. I have yet to hear these people, however, speak out against hospitals involved in a similar practice. This issue will only grow larger as more hospitals seek, and advertise, relationships with sports teams and celebrities.

A commenter on his site also mentions that it is a breach of HIPPA regulations when  "Privacy is tossed out the window for the sake of advertising" as the public is made aware of players’ injuries. On this point, I would have to assume the players sign some sort of waiver.

Not being a huge sports fan myself, I doubt that a hospital’s "official care-giver of the Boston Red Sox" status would mean much to me one way or the other, but the idea that they pay big bucks for the privilege would give me pause. I’d rather see the money used for things that would improve outcomes for all patients, not just an all-star few in hopes their glamour would reflect in the hospital’s reputation.