Photo courtesy Flickr Creative Commons user Mccready
The House approves a health care reform bill, but Democrats splinter over an abortion provision. The bill receives support from the American Medical Association, but some surgeons’ groups beg to differ. And physicians of all specialties await a Congressional fix to the Medicare SGR formula.
It’s all in this week’s Policy & Practice podcast. Take a listen and let us know what you think.
–Joyce Frieden (Twitter @joycefr)
From the annual meeting of the American Academy of Child and Adolescent Psychiatry, Honolulu
“Speakers and Attendees: Please check with the Press Office in Sea Pearl 4 before accepting a media interview.”
This message appeared prominently on page 11 of the program for the AACAP meeting, which I just finished covering.
My next hint that reporters at the meeting were in for a difficult time was a warning that was read by session moderators and also appeared in a black-box on page 7 of the program:
“This presentation and the accompanying materials are protected by copyright and may not be reproduced or summarized, in whole or in part, for any commercial purpose without prior written authorization from the copyright holders.”
Now I’m no lawyer, but I do know that no one can copyright an idea, only a particular expression of an idea. Any summary that a reporter writes in his or her own words cannot on its face constitute a copyright violation. In addition, the Fair Use provisions of copyright law permit anyone to quote brief word-for-word excerpts.
So what gives?
I spoke with Rob Grant, AACAP’s new communications manager, to register my objections to this policy. He said these standards were established about 2 years ago after members of an anti-psychiatry organization gained entry to the meeting by posing as reporters. Rob wouldn’t discuss details, and said the AACAP did not intend to prevent attendees from talking to legitimate members of the press. He gave me his mobile phone number and said to please phone him directly or give the number to any attendees who balked at talking to me.
Fortunately, none of the speakers and attendees who I interviewed insisted on talking first to Rob or being lugged up to the Press Office for preapproval.
Yet another proviso, a ban on taking pictures, and the unavailability of PowerPoint slides for the press, certainly got in the way of confirming that the numbers and other details in my articles are accurate.
As an alternative to setting up roadblocks, perhaps the American Academy of Child and Adolescent Psychiatry could adopt procedures for credentialling reporters. The American Society of Clinical Oncology, for example, requires online registration for reporters and asks them to submit recent examples of their reporting, preferably about cancer topics.
It’s not a foolproof solution, but it would seem preferable to threats and limitations.
—Bob Finn (@bobfinn on Twitter)
From the FDA’s Public Meeting on Transparency at the National Transportation Safety Board Conference Center, Washington, DC
Outside of the C.I.A., the Food and Drug Administration (FDA) has been one of the most enigmatic federal agencies, inscrutable to the industries it regulates, a mystery to the public, and feared by executives at small publicly traded companies whose stock can take wild swings in response to the slightest whisper from the Emerald City, that is, White Oak, Md.
Courtesy Flickr Creative Commons User dbking
But like Dorothy and her raggedy band of cohorts, FDA Commissioner Margaret Hamburg and her deputy Joshua Sharfstein are determined to pull back the curtain and expose the inner workings of Oz.
As a start, they’ve organized a “transparency” initiative (details are here). On Tuesday, Dr. Sharfstein led discussions with a panel of agency colleagues, industry, physicians, and consumers on hypothetical situations where the agency would be called on to say, communicate to the public about a foodborne disease outbreak, or let manufacturers know how and why it had made a decision about a new drug approval.
The agency plans to eventually make all its decision-making processes more accessible to everyone – and soon, said Dr. Sharfstein. First, it will create an “FDA 101” area on its website, envisioned as an interactive area for consumers to learn all about the agency’s mission and inner workings.
The second phase will be finding a way to explain to the public how the agency makes its decisions; last, it will become more accountable to industry.
With almost-daily and ever-larger outbreaks of foodborne illnesses, growing pharmaceutical and device recalls, and sporadic epidemics like H1N1 influenza, the discussions are not just academic. Being able to communicate – and quickly communicate — fact-based public health information is crucial, especially when misinformation proliferates so quickly these days.
The Centers for Disease Control and Prevention has long cultivated its reputation as a credible source of information in times of crisis and has also developed strong relationships with the partners it needs to rely on – physicians and scientists – during those crises.
The FDA, which has just as big a stake, has operated in some kind of alternate universe. But, a whirlwind election blew in the force of change.
Will Dorothy, that is, Dr. Hamburg, be able to bring the agency back to reality?
–Alicia Ault (on Twitter @aliciaault)
From the annual meeting of the American Academy of Psychiatry and the Law in Baltimore, MD:
Photo of Patrick Kennedy courtesy U.S. House of Representatives
It’s not every day when you hear a luncheon speaker discuss how his mom used to greet visitors at the front door while she was less than fully clothed. Especially when the speaker is a member of Congress.
But Rep. Patrick Kennedy (D-R.I.) spoke with no holds barred when he discussed his family’s addiction battles. “My mom had the worst case of alcoholism that you could possibly imagine,” he said to the assembled group of psychiatrists. “And we kept it a big secret — or so we thought. Until one of my friends would come over, and their mom would come over to pick them up, and my mom would answer the door completely naked. And they’d be like, ‘What’s going on in this house?’”
Rep. Kennedy continued, “And you can’t begin to imagine the amount of denial. My mom would be driving us to school … and be sideswiping cars all the way to elementary school. It was the most well-known, least-hidden secret from the world, and yet nobody said a word about ‘Maybe this is not safe.’ … For many famlies, that still happens, and it’s still going on in most of America, and that’s really scary.” He noted that even though addiction is “a physical illness, a genetic illness, yet we do nothing to treat it as such because we’re so mired in an old-fashioned view of this thing as a reflection of someone’s moral turpitude that they’re insufficient in their ability to control their behavior.”
He also discussed his own ongoing addiction battle. “‘When I went back to treatment this last year after having 2 1/2 years of sobriety, I was in treatment with three members of the Special Forces — two Navy SEALs and one Green Beret. Now I’m telling you, if this is about control of your behavior, these are probably the most powerful, self-disciplined, powerful individuals our society could produce … So it just brings home the fact that this isn’t about self-control, because if it were, how could people that could pass every other test in the world in terms of self-discipline lose the one that comes about as a result of controlling themselves with respect to a disease called addiction?”
Members of the audience seemed to like what they heard; they gave him a standing ovation when he finished.
–Joyce Frieden (Twitter @joycefr)
Photo by Mary Ellen Schneider.
From press conferences, interviews, and more around Washington, D.C.
Physicians have a lot riding on what happens in Congress this year. After months of wrangling over health reform, House Speaker Nancy Pelosi (D., Calif.) will try to get her version of the health overhaul bill through the chamber. The bill includes a public plan whose rates would be negotiated with physicians.
But that’s not the only legislative priority of great importance to doctors this year. Unless Congress steps in, doctors will face a 21% Medicare pay cut in 2010 and more cuts in the years to come. A bill that would have scrapped the widely criticized Medicare pay formula failed to gain traction in the Senate, but House Democrats are trying to keep the fix alive with their own bill.
Get all the details in the latest installment of the Policy & Practice podcast.
— Mary Ellen Schneider (@MaryEllenNY on Twitter)
Image courtesy of Flickr user Jim Linwood
from the Kennedy Krieger Institute’s annual autism conference
That’s a line from an Indigo Girls’ songs. While I think their questions were probably aimed at Life, the Universe, and Everything, they could just as easily have been talking about autism. I’ve covered this meeting twice now and both times I’ve been struck by how many possible autism factors are under investigation. There seems to be evidence of a role for genetics, brain abnormalities, and autoimmunity as causes of autism. Today I listened to research on epilepsy and autism spectrum disorders (ASD) and GI symptoms and ASD. This wide range of research made clear to me what a tragic mistake it would be to pin all of our hopes for identifying the cause of autism on just one factor.
The evidence is clear that vaccines do not cause autism but even if there were evidence–and I repeat, there is none–it would be exceptionally harmful to those with autism and their loved ones to limit research to just vaccines. If the true object is to identify the causes of autism in order to develop effective treatments, the most productive strategy is to look at as many possible factors. Everyone affected by or working with those affected by autism should be relieved to know that a great deal of this research is getting done–albeit out of the limelight.
—Kerri Wachter, @knwachter on Twitter
The ACG blue bag. Photo by Sherry Boschert.
From the American College of Gastroenterology annual meeting, San Diego
I was pleasantly surprised to see the American College of Gastroenterology promoting its eco-friendly iniatives at its annual meeting. So much so, in fact, that I think the ACG has thrown down a green gauntlet. Will other medical societies take up the challenge? Anyone know of other large medical conferences that can top the following?
A sign at the ACG meeting. Photo by Sherry Boschert.
- Forget the generic black shoulder bag made from unidentified petroleum products that you get at registration. The ACG’s blue bag is made from recycled content.
- Printing only session and abstract titles — but not the abstracts — reduced the program book by 300 pages, down to 172 pages. Multiply 300 by 4,000 attendees, and that’s 1.2 million paper pages saved. Abstracts were available online and on compact disk. On the other hand, the abstracts did fill the pages of a print supplement of The American Journal of Gastroenterology. The program book, meeting newspaper, and other materials did not seem to be on recycled paper.
Better than trash. Photo by Sherry Boschert.
- Bins collected name badges and program books for recycling.
- Meeting hotels were chosen within walking distance of the convention center to avoid using shuttle buses.
- The decorator of the conference and exhibit hall, a company called Freeman, donates the signs afterward to schools to use the foam cores for arts and crafts. Aisle carpets get recycled into a second life as drainage pipe for septic systems. Fancier booth carpeting gets re-used in affordable housing facilities or in “pet-related products.” (Huh?) Recycled aluminum forms the frames of most booths.
- The San Diego Convention Center itself provides ubiquitous recycling bins, uses low-flow sinks and toilets, has drought-tolerant landscaping with efficient drip-system irrigation, donates excess food from meeting events to local charities, uses recycled content in all paper products (copy paper, toilet paper, towels, etc.), and plans to install solar panels on the building within the year.
Exhibits = exercise??? Photo by Sherry Boschert.
But let me offer a friendly caution to meeting organizers — don’t get carried away trying to flaunt the whole good, green lifestyle thing. It’s fine to encourage attendees to exercise (especially in beautiful, warm Southern California), but to suggest that they exercise in 1/4-mile or 1/2-mile routes in the exhibit hall? That’s a stretch.
Sherry Boschert (@sherryboschert on Twitter)
courtesy of flickr user Lafayette (creative commons)
From the annual scientific meeting of the Obesity Society, Washington, DC–
Like it or not, bariatric surgery is becoming more common as a treatment for morbid (and even not so morbid) obesity, especially in adolescents and young adults.
Bariatric surgery sounds like a quick and easy fix–have surgery, lose weight, feel great. But, of course, it’s not that simple. A bariatric surgery symposium at this year’s annual scientific meeting of the Obesity Society included not only talks about pre- and post-op patient care, but also a talk and discussion about psychology and body image.
On one hand, many bariatric surgery patients struggle with body image after the procedure–their “love handles” are replaced by saggy skin, and they are still unhappy with their appearance. A new subset of plastic surgery is evolving to do body contouring on bariatric surgery patients, and some surgeons have been sued by dissatisfied patients, noted David Sarwer, Ph.D., a psychologist at the University of Pennsylvania, Philadelphia.
On the other hand, some bariatric surgery patients (perhaps adolescents and young adults in particular) are so thrilled with their results that they want to make up for lost time by being promiscuous and engaging in other high-risk behaviors. “They’ve got a new sports car and they are taking it out for a ride,” Dr. Sarwer said. These young adults may go from “never been kissed” to dating three or four people at once, he said. Some clinicians have raised the issue of whether bariatric surgery patients who were addicted to food are likely to replace that addicition with something else, such as sex, drugs, or alcohol.
The bottom line for clinicians: Be aware of the range of possible psychological issues faced by patients who have had bariatric surgery, whether it brings out the beauty, the beast, or both.
–Heidi Splete (on twitter @hsplete)
Entrance to Semmelweis University School of Medicine, BudapestPhoto by Bruce Jancin
From Semmelweis University Medical School, Budapest
Question: What did Dr. Ignaz Semmelweis have in common with Hollywood legend Fred Zinnemann, four-time Oscar-winning director of such classics as High Noon, From Here to Eternity, and A Man for All Seasons?
They shared a common interest in Dr. Semmelweis. Indeed, Mr. Zinnemann’s first Academy Award was for That Mothers Might Live, the 1938 Best Short Film winner devoted to the Hungarian physician.
And with flu season well underway and the populace engaging in unprecedented furious hand washing in an effort to ward off illness, now seems a good time to reflect on the life of Dr. Semmelweis (1818-1865), who is often called “the savior of mothers,” but also might legitimately be known as “the father of hand washing.”
A commemorative plaque in the main medical lecture hall at Semmelweis University in Budapest tells the story: While the school’s namesake was working in the maternity clinic at Vienna General Hospital in 1847, he had the then-revolutionary insight that it was a bad practice for interns to go straight from performing autopsies to doing pelvic exams without washing their hands. He introduced mandatory hand washing with a chlorinated lime solution, and mortality from puerperal fever was drastically reduced.
This was the prebacteriologic era, however, and the Viennese medical establishment took umbrage at the notion that physicians could transmit disease via their gentlemanly hands. Dr. Semmelweis’ publications on antisepsis were greeted with reactions ranging from indifference to ridicule. He was eventually dismissed from the hospital and hounded back to his native Budapest. There, as the plaque relates, he “began writing open and increasingly angry letters to prominent European obstetricians, at times denouncing them as irresponsible murderers.”
His medical colleagues and family believed he was losing his mind, a distinct possibility given that tertiary syphilis was an occupational hazard of medical practice in public hospital maternity wards in that pre-glove era. Under the ruse of a request that he inspect a new hospital ward, Dr. Semmelweis was tricked into involuntary commitment to a Vienna mental hospital. There, he died just 14 days later, “possibly after being severely beaten by guards,” according to the university plaque.
His reputation was rehabilitated only years later, when Louis Pasteur’s germ theory of disease provided a mechanistic explanation for the striking clinical success of Dr. Semmelweis’ hand-washing program.
—Bruce Jancin
Dr. David A. Greenwald introduces the GI Circle Web page. Photo by Sherry Boschert.
From the American College of Gastroenterology annual meeting, San Diego
The Mayo Clinic has a Facebook page. The Cleveland Clinic posts to YouTube. But the American College of Gastroenterology (ACG) has outdone them both.
Borrowing a page from Facebook and other social media, the ACG has launched its own social-professional networking site, and apparently is the first medical association to do so. It could have revolutionary implications in the long run for medical meetings.
Called ACG GI Circle — and currently accessible only to ACG members, not to nonmembers or the media — the site drew more than 800 subscribers on the first day of the annual meeting out of 4,000-some conference attendees, Dr. David A. Greenwald, a member of the ACG’s Board of Governors, said at a press briefing.
“It’s something that I think is very akin to Facebook,” he said. If you’re a gastroenterologist and don’t know what that means, find a teenager fast.
Participants can “request to connect” with another participant (the equivalent of “friending” on Facebook). Or you can connect with a group of participants (for instance if the Board of Governors created a group for its members). You can search by research topic or find abstracts from ACG meetings and leave comments for others to see and respond to.
A main role for the GI Circle is to supplement an individual’s experience at ACG conferences. “At a meeting like this, you can’t get to everything,” but you can see what you missed and interact with colleagues about those sessions through the GI Circle, Dr. Greenwald said. The site also could host a live presentation as a Webcast, with online discussions about it afterward.
I’m thinking this could be the beginning of the (very gradual) end of large medical meetings as we know them. As worldwide pressures increase for everyone to reduce their carbon footprints, meetings may attract regional attendees, with others “attending” online rather than traveling long distances. Dr. Greenwald said there’s been at least one trial of a regional meeting along those lines, but that model (fewer live attendees) could leave the conference organizers footing a larger share of expenses. So I don’t expect to see a rush to replace some meeting attendance with online participation, even if I think it may be inevitable.
Besides, Dr. Greenwald said, “Nothing replaces face-to-face contact.”
Got that, Facebook?
–Sherry Boschert (@SherryBoschert on Twitter)
Elsevier Global Medical News
