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Showing posts from June, 2011

New Restrictions on Financial Conflicts of Interest in CME

As reported in The Carlat Psychiatry Blog, the American Medical Association recently approved a report that may have substantial impacts on industry funding of continuing medical education. This report, authored by the AMA's Council on Ethical and Judicial Affairs, recommends:

"When possible, CME should be provided without [industry] support or the participation of individuals who have financial interests in the educational subject matter. " (page 99 of report)


What good is such a qualified recommendation from a mere report? The difference is that this report comes from, and was officially approved by, the AMA. The Accreditation Council for Continuing Medical Education (ACCME), which certifies providers of CME, is tightly linked to the AMA, such that CME credits are labelled "AMA PRA Category 1 Credit". Thus, the ACCME will likely need to modify its Standards for Commercial Support to impose greater restrictions on how CME can be funded and on the use of speake…

Poor Health Outcomes of Older Cancer Patients in the UK: Is Age Discrimination at Play?

Age discrimination can have many negative effects on the livelihoods of older people. Among these effects are poor health outcomes in older Britons suffering from cancer, according to a recent report from the King’s Fund, a health think tank, and Cancer Research UK.

In 2004-2005, England was spending close to £4 billion on cancer care, its 4th largest health expenditure among 24 health conditions. Although England’s healthcare spending is similar to other European countries, its health outcomes are worse in older adults with cancer. The report titled “How to improve cancer survival: Explaining England’s relatively poor rates,” looks at why poor health outcomes exist among cancer patients.

The report shows that cancer survival rates in England are worse than in other countries due to late diagnosis, delayed treatment, and under-treatment in the older patient population. Age is considered an influential factor in delaying cancer diagnosis, and older cancer patients reportedly receive les…

GeriPal Enters into the Terrible Twos

On June 19, 2009, GeriPal was born. On that date the post 'Support the Independence at Home Act' was published to the world. Well, really, just probably published to two people: Alex and Eric.

Times have changed since that first post. Our community is larger than we ever expected. Every month we have around 30,000 pageviews from an international audience (the top 5 countries being the United States, Canada, Germany, the United Kingdom and Australia). In addition to those who come to our website, we also have close to 1,200 individuals who receive our posts via email or RSS readers. We are also now on Twitter (nearly 1000 followers) and Facebook (over 200 followers).

As GeriPal's community grew, so did its recognition. For instance, GeriPal has been mentioned in the NY Times, MSNBC, and the Lancet, as well being recognized as the 2010 Best Clinical Blog in the medical weblogs awards.

All of this would never have happened if was not for our amazing contributors, who have re…

Get Out the Vote GeriPal Style II

"Hospice Care" is up against "Institute for Healthcare Improvement" (IHI) in the ModernHealthcare finals!

OK, it's kind of a ridiculous idea.  But hey, it's fun!  March madness style pitting of ideas, groups, and people against each other. 

Notables who didn't make it to the finals:
President Obama.  Lost in the great 8 to his appointee for the Centers for Medicare and Medicaid, Don Berwick.Don Berwick, who lost in the final 4 to the organization he created (IHI)The Patient Protection and Affordable Care Act (Health Reform).  Lost in the great 8 to the Institute of Medicine Report "To Err is Human".The Health Insurance Portability and Accountability Act (HIPAA).  Who on earth is voting for HIPAA?  This darkhorse made it to the round of 32.Note - if I'm counting correctly, "Hospice" was a 12 seed!  We're the Cinderella team, how can you not vote for us?  We crushed the #1 seed in our bracket "Electronic Health Records&qu…

Look SHARP

Last week, results of the SHARP trial were released with great fanfare. In this study, investigators randomized over 9000 patients with chronic kidney disease (creatinine ≥ 1.7 mg/dL in men and ≥ 1.5 mg/dL in women) to placebo vs. a combination of ezetimibe and simvastatin, marketed under the brand name Vytorin. Over a median follow-up of 5 years, patients who received the study drug had a 1% lower risk of stroke and a 1.5% lower risk of requiring opening or bypassing a blocked artery in the heart or elsewhere. However, there was no difference in rates of heart attack, death from heart disease, or death from any cause.

What is extraordinary about this trial is not the mixed effect on outcomes, but the fact that it represents yet another wasted opportunity to learn whether ezetimibe actually has any clinical benefit. This drug, launched in the US in 2002, has enjoyed a meteoric rise in sales. By 2006, ezetimibe accounted for 15% of all prescriptions for cholesterol-lowering drugs, and…

Lessons I learned by Examining Miracles

 "If it is a Miracle, any sort of evidence will answer, but if it is a Fact, proof is necessary”
Mark Twain
If you were tasked to take an evidence based approach to miracles in medicine, where would you start? Would you search Pubmed, Web of Science, or PsychInfo? Would you start off asking your colleagues and experts in the field? Would you just give up and say that miracles are based on faith, so one cannot explore spiritual beliefs and practices from an evidence-based approach?

In a journey that I started a little over a year ago, I stumbled along many different paths to try to use scientific evidence to answer the question of how one should approach patients and family members who hope for a miracle. Luckily, I had some of the very best minds helping me along, including the likes of Ken Rosenfeld, Erik Fromme, Dan Sulmasy, and Bob Arnold.

I began my journey with trying to answer the question of what constitutes a miracle and whether they actually occur in medicine. You can t…

Book Review - My Mother's Hip: Lessons from the World of Eldercare

“When the parent gives to the child, the parent laughs, but when the child gives to the parents, the child cries and the parent cries.”

This proverb is befitting of how caregiving may oftentimes be perceived as taxing and resented by adult children who unenthusiastically accept the responsibility of caring for an aging parent.

My Mother’s Hipis Luisa Margolies’ personal account of her caregiving experience, which depicts the opposite reaction to caregiving as that suggested by the proverb; instead of being reluctant or expressing any resentment toward becoming her mother’s informal caregiver, Margolies takes the experience in great stride, no matter how physically or emotionally taxing.

Margolies was living in Caracas, Venezuela as a medical anthropologist with her family when her mother, June, fell and suffered a double hip fracture. June survived the operation only to enter into a period of emotional and physical distress as her preexisting chronic diseases, such as polymyositis and o…