Policy, Ethics, Education

Sep 222011
 

Observational epidemiologic data on 132 California kids who caught pertussis (of 15,000 in a cohort), presented at the American Society for Microbiology meeting last week, suggested that protection from pertussis vaccination may wane as soon as 3 years after the last dose. Kids age 8-12 were most at risk (the last dose is given at [… read more]

Sep 132011
 

West et al report survey and in-service exam data from 16,394 internal medicine residents nationwide, 2008-2009. Almost 15% reported that their lives “suck” or “profoundly suck” (I’m paraphrasing slightly). About half reported emotional exhaustion or feeling burned-out. Almost 30% were in a disconnected, fugue-like state. The really depressed ones did worse on their in-service exams, [… read more]

Sep 132011
 
Millions of adults quit smoking since 2005 (MMWR)

From 2005 to 2010, the percent of U.S. adults identifying themselves as smokers fell from 20.9% to 19.3% — about 3 million fewer smokers than would be expected. The results come from the CDC’s national telephone health surveys. More remarkably, adults reported smoking far fewer cigarettes: The proportion of adults reporting smoking more than a [… read more]

Aug 142011
 

Accountability for Medical Error: Moving Beyond Blame to Advocacy. CHEST 2011;140:519-526.  Bell et al’s great essay on the dysfunctional mechanics and culture of liability / safety / blame surrounding medical errors in hospitals and our medical care system in general. They propose steps toward “collective accountability,” e.g., we MDs should sit on hospital safety committees. But [… read more]

Jul 252011
 

Under mandate by the FDA to answer lingering questions about long-acting beta agonists’ safety for treatment of asthma, four major pharma firms will launch five large randomized trials comparing inhaled corticosteroid / long-acting beta agonist combination products vs. ICS alone. The trials (4 in adults, 1 in kids) will enroll >50,000 people starting this year, [… read more]

Jul 202011
 

In a great essay, Coller proposes re-engineering the health care system before Obamacare amplifies our skyrocketing cost problem under fee-for-service. Sounds like a twist on accountable care organizations, but more plausible and on its face politically palatable (after the bloody noses heal). JAMA 2011;306:204-205.

Jul 192011
 

Particulate matter causes cardiovascular deaths, and also worsens respiratory illness. The Environmental Protection Agency plans to reduce acceptable levels of PM and ozone, a move that would force industry to pay for new upgrades. NEJM 2011;365:198-201.

Jul 182011
 

The 18,000 clinical trials published each year aren’t doing much to improve human health, argues Peter Pronovost. Health delivery research can, by improving delivery and impact of already-proven interventions. But doing so will require cutting a slice of the funding pie for social scientists and other untouchables in the “omics”-loving academic caste system. JAMA 2011;306:310-311.

Jul 052011
 

Why are big single center trial effects not often replicated in larger multi-center randomized controlled trials? Dechartres et al did a meta-meta-analysis on 48 meta-analyses comprising 421 randomized clinical trials. Across all their sensitivity analyses, reported treatment effects were consistently and substantially larger in single-center trials than in multi-center trials. No one knows why yet. [… read more]

Jun 202011
 

Menthol doesn’t kill people — cigarettes that are tastier and easier to smoke because of menthol do. The FDA’s Tobacco Products Scientific Advisory Committee blandly concluded that removing menthol from cigarettes would improve public health, but in the current pro-economic recovery environment, there is no political will to take on Big Tobacco, Siegel, Benowitz and [… read more]

Jun 172011
 

Pulmonary rehabilitation, realities in clinical practice. Birnbaum S, CHEST 2011;139:1498-1502. Having trouble finding a pulmonary rehab program to refer your COPD patient into? That may be because in 2011, according to Mr. Birnbaum, Medicare paid outpatient centers $28 per rehabilitation session, per patient.

Jun 142011
 

Gershengorn et al retrospectively compared two MICUs at Beth Israel: one with “midlevels” (nurse practitioners and physician assistants during the day with attending coverage overnight) and one that was all house staff 24/7. There were no differences in important outcomes (mortality, MICU or hospital LOS), although the study was nonrandomized and subject to bias. CHEST [… read more]

Jun 122011
 

The New York Times reported that hundreds of community hospitals frequently perform two chest CT scans back-to-back (one with, one without IV contrast), while academic centers almost never do. More than 70,000 patients were double-scanned; some hospitals did it >80% of the time on their Medicare chest patients. Defenders say they don’t do it to [… read more]

Jun 102011
 

Free et al randomized 5,800 UK ready-to-quit smokers to get regular motivational text messages and help-line access, vs. placebo (texts thanking them for participating). At 6 months, those getting motivational text messages had biochemically-verified continuous abstinence of 11%, vs. 5% in the controls. Verification was by salivary cotinine at 6 months (& showed that 28% [… read more]