Jane Anderson

Physicians, patients, and study participants believe researchers' financial ties to industry decrease the quality of evidence, and patients say that such ties influence professional behavior and should be disclosed, a review of studies has found.

For some, knowledge of the researchers' financial ties to industry would affect their willingness to participate in studies, wrote Dr. Cary Gross of Yale University, New Haven, Conn., and colleagues (Arch. Intern. Med. 2010;170:675–82).

“When any financial tie was disclosed, there was a reduction in the perceived quality of research” among participants and physicians, they reported. Patients believed that financial ties decreased the quality of clinical care and affected prescribing behavior.

The investigators reviewed 11 original quantitative studies of the views of patients, research participants, and journal readers about financial ties and perceptions of quality.

In studies of patient perception of cost, 26%–76% said they believed that gifts to physicians increase the cost of care; fewer patients thought professional gifts were a problem.

“In a 2009 study of 903 patients contacted by telephone, 9% disapproved of physicians receiving free drug samples and 16% disapproved of free medical texts, compared with disapproval rates of 55% and 68%, respectively, for paid dinners and golf tournaments,” Dr. Gross and his colleagues wrote.

In other studies, when asked to rate disclosure statements, respondents said researchers with financial ties were less trustworthy and less important than were those without such ties.

For some potential trial participants, disclosure of financial ties affected their willingness to participate. “Three studies reported that prospective research participants were least willing to participate in a hypothetical clinical trial when a researcher equity ownership was disclosed,” wrote Dr. Gross and his colleagues. “Of note, the participants also reported less trust in researchers after disclosure of financial ties.”

In an editorial, Eric Campbell, Ph.D., of Harvard University, Boston, said public disclosure seems like a likely first step toward a more active government and health care institution role in evaluating and managing physician-industry relationships (Arch. Intern. Med. 2010;170:667).

“This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy,” he wrote. But the transparency “will help prevent the further erosion of public trust in the medical profession.”

The review was funded in part by a Doris Duke Clinical Research Fellowship. Dr. Gross and a coauthor disclosed ties to Genzyme Corp. Dr. Campbell did not report any financial disclosures.

Physicians, patients, and study participants believe researchers' financial ties to industry decrease the quality of evidence, and patients say that such ties influence professional behavior and should be disclosed, a review of studies has found.

For some, knowledge of the researchers' financial ties to industry would affect their willingness to participate in studies, wrote Dr. Cary Gross of Yale University, New Haven, Conn., and colleagues (Arch. Intern. Med. 2010;170:675–82).

“When any financial tie was disclosed, there was a reduction in the perceived quality of research” among participants and physicians, they reported. Patients believed that financial ties decreased the quality of clinical care and affected prescribing behavior.

The investigators reviewed 11 original quantitative studies of the views of patients, research participants, and journal readers about financial ties and perceptions of quality.

In studies of patient perception of cost, 26%–76% said they believed that gifts to physicians increase the cost of care; fewer patients thought professional gifts were a problem.

“In a 2009 study of 903 patients contacted by telephone, 9% disapproved of physicians receiving free drug samples and 16% disapproved of free medical texts, compared with disapproval rates of 55% and 68%, respectively, for paid dinners and golf tournaments,” Dr. Gross and his colleagues wrote.

In other studies, when asked to rate disclosure statements, respondents said researchers with financial ties were less trustworthy and less important than were those without such ties.

For some potential trial participants, disclosure of financial ties affected their willingness to participate. “Three studies reported that prospective research participants were least willing to participate in a hypothetical clinical trial when a researcher equity ownership was disclosed,” wrote Dr. Gross and his colleagues. “Of note, the participants also reported less trust in researchers after disclosure of financial ties.”

In an editorial, Eric Campbell, Ph.D., of Harvard University, Boston, said public disclosure seems like a likely first step toward a more active government and health care institution role in evaluating and managing physician-industry relationships (Arch. Intern. Med. 2010;170:667).

“This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy,” he wrote. But the transparency “will help prevent the further erosion of public trust in the medical profession.”

The review was funded in part by a Doris Duke Clinical Research Fellowship. Dr. Gross and a coauthor disclosed ties to Genzyme Corp. Dr. Campbell did not report any financial disclosures.

Physicians, patients, and study participants believe researchers' financial ties to industry decrease the quality of evidence, and patients say that such ties influence professional behavior and should be disclosed, a review of studies has found.

For some, knowledge of the researchers' financial ties to industry would affect their willingness to participate in studies, wrote Dr. Cary Gross of Yale University, New Haven, Conn., and colleagues (Arch. Intern. Med. 2010;170:675–82).

“When any financial tie was disclosed, there was a reduction in the perceived quality of research” among participants and physicians, they reported. Patients believed that financial ties decreased the quality of clinical care and affected prescribing behavior.

The investigators reviewed 11 original quantitative studies of the views of patients, research participants, and journal readers about financial ties and perceptions of quality.

In studies of patient perception of cost, 26%–76% said they believed that gifts to physicians increase the cost of care; fewer patients thought professional gifts were a problem.

“In a 2009 study of 903 patients contacted by telephone, 9% disapproved of physicians receiving free drug samples and 16% disapproved of free medical texts, compared with disapproval rates of 55% and 68%, respectively, for paid dinners and golf tournaments,” Dr. Gross and his colleagues wrote.

In other studies, when asked to rate disclosure statements, respondents said researchers with financial ties were less trustworthy and less important than were those without such ties.

For some potential trial participants, disclosure of financial ties affected their willingness to participate. “Three studies reported that prospective research participants were least willing to participate in a hypothetical clinical trial when a researcher equity ownership was disclosed,” wrote Dr. Gross and his colleagues. “Of note, the participants also reported less trust in researchers after disclosure of financial ties.”

In an editorial, Eric Campbell, Ph.D., of Harvard University, Boston, said public disclosure seems like a likely first step toward a more active government and health care institution role in evaluating and managing physician-industry relationships (Arch. Intern. Med. 2010;170:667).

“This will likely be seen by some physicians as a direct assault on their sense of professional identity and autonomy,” he wrote. But the transparency “will help prevent the further erosion of public trust in the medical profession.”

The review was funded in part by a Doris Duke Clinical Research Fellowship. Dr. Gross and a coauthor disclosed ties to Genzyme Corp. Dr. Campbell did not report any financial disclosures.

Heart failure patients discharged from hospitals with high levels of early physician evaluation are less likely to be readmitted to the hospital within 30 days, according to an analysis of records on more than 30,000 heart failure patients from 225 hospitals.

However, most heart failure patients do not visit a physician within 7 days of discharge.

The analysis of data from the American Heart Association's Get With The Guidelines–Heart Failure (GWTG–HF) Registry linked to Medicare billing records, which looked at hospital-level rates of early outpatient follow-up after discharge during 2003–2006, found that the median rate of follow-up within 7 days of discharge was 38%.

“For patients with heart failure, the transition from inpatient to outpatient care can be an especially vulnerable period because of the age of the patients, complex medical regimens, the large number of comorbid conditions, and the multiple clinicians who may be involved,” wrote Dr. Adrian F. Hernandez of Duke University, Durham, N.C., and his coauthors. “Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings.”

Overall, about 21% of heart failure patients were readmitted to the hospital within 30 days of discharge. Patients in hospitals with higher rates of early follow-up had a lower risk of readmission, the study found (JAMA 2010;303:1716–22).

After adjustment for case mix, admission laboratory results, provision of discharge instructions, and length of stay, the risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up, the study found. Whereas 20% of patients whose initial hospital stay took place in a hospital with the highest rates of early follow-up were readmitted, 23% of patients in the hospitals with the lowest follow-up rates were readmitted, a significant difference.

Still, the authors only found differences in rehospitalization rates in the hospitals that ranked in the lowest quartile of posthospitalization follow-up; rates at the other 75% of hospitals were similar. They also found some racial differences: The proportion of black patients was “markedly higher” among hospitals with the lowest rates of early follow-up.

They also found that patients discharged from hospitals with the highest rates of early follow-up by a cardiologist had lower risk of 30-day mortality, which they noted is consistent with other studies of cardiology care for heart failure.

Most follow-up during the transitional period, especially during the first week, is handled by general internists, the study authors found. More than two-thirds of patients hospitalized for heart failure are evaluated by a cardiologist during their inpatient stays, but fewer than 10% see a cardiologist within 7 days of hospital discharge. By 21 days post discharge, 76% of patients had been seen by any physician, and 25% by a cardiologist.

However, neither early follow-up with a cardiologist nor continuity of care from the same physician seen during the hospitalization was a significant predictor of 30-day readmission, they wrote.

Documentation of discharge instructions, which many physicians presume helps to ensure early follow-up and better outcomes, also was not associated with lower readmission rates. “This finding raises the possibility that discharge instructions are becoming rote processes that do not adequately address elements of care that ensure a safe transition,” the authors wrote.

The study provides evidence in support of guidelines recommending the use of postdischarge systems of care, the authors said. “Achieving early follow-up may be difficult for some physician practices, but models of care that include nurse practitioners or physician assistants under physician supervision may result in increased access to and timeliness of care.”

Reporting the results at the annual scientific session of the American College of Cardiology in Atlanta in March, Dr. Hernandez said that ensuring that patients hospitalized for heart failure are evaluated by a physician within 7 days after discharge is emerging as a potential new target for hospital quality improvement.

The problem of unplanned early readmissions is a hot button issue that has drawn considerable attention from health policy makers. Roughly 20% of Medicare beneficiaries are readmitted within 30 days of hospitalization. Nearly 90% of these readmissions are unplanned and potentially preventable. These readmissions account for $20 billion annually in Medicare hospital payments. And heart failure is the No. 1 cause of readmission within 30 days, noted Dr. Hernandez of the Duke Clinical Research Institute, Durham, N.C.

One audience member serving on a panel advising the Center for Medicare and Medicaid Services said “these are just the kind of data we've been looking for” in order to make recommendations to the agency regarding new hospital performance standards. However, she questioned whether a physician was necessarily the right person to do the early follow-up evaluation. Fine-tuning of outpatient heart failure management might be better done by a dedicated nurse practitioner or physician assistant.

The study was supported by grants from the American Heart Association, GlaxoSmithKline, Medtronic, and the Agency for Healthcare Research and Quality. Dr. Hernandez reported financial relationships with Johnson & Johnson, Medtronic, Merck, Novartis, and AstraZeneca. Other authors reported a variety of financial support from drug manufacturers, other health care companies, and nonprofit organizations.

Bruce Jancin, reporting from the annual scientific sessions of the ACC in Atlanta, contributed to this article.

Heart failure patients discharged from hospitals with high levels of early physician evaluation are less likely to be readmitted to the hospital within 30 days, according to an analysis of records on more than 30,000 heart failure patients from 225 hospitals.

However, most heart failure patients do not visit a physician within 7 days of discharge.

The analysis of data from the American Heart Association's Get With The Guidelines–Heart Failure (GWTG–HF) Registry linked to Medicare billing records, which looked at hospital-level rates of early outpatient follow-up after discharge during 2003–2006, found that the median rate of follow-up within 7 days of discharge was 38%.

“For patients with heart failure, the transition from inpatient to outpatient care can be an especially vulnerable period because of the age of the patients, complex medical regimens, the large number of comorbid conditions, and the multiple clinicians who may be involved,” wrote Dr. Adrian F. Hernandez of Duke University, Durham, N.C., and his coauthors. “Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings.”

Overall, about 21% of heart failure patients were readmitted to the hospital within 30 days of discharge. Patients in hospitals with higher rates of early follow-up had a lower risk of readmission, the study found (JAMA 2010;303:1716–22).

After adjustment for case mix, admission laboratory results, provision of discharge instructions, and length of stay, the risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up, the study found. Whereas 20% of patients whose initial hospital stay took place in a hospital with the highest rates of early follow-up were readmitted, 23% of patients in the hospitals with the lowest follow-up rates were readmitted, a significant difference.

Still, the authors only found differences in rehospitalization rates in the hospitals that ranked in the lowest quartile of posthospitalization follow-up; rates at the other 75% of hospitals were similar. They also found some racial differences: The proportion of black patients was “markedly higher” among hospitals with the lowest rates of early follow-up.

They also found that patients discharged from hospitals with the highest rates of early follow-up by a cardiologist had lower risk of 30-day mortality, which they noted is consistent with other studies of cardiology care for heart failure.

Most follow-up during the transitional period, especially during the first week, is handled by general internists, the study authors found. More than two-thirds of patients hospitalized for heart failure are evaluated by a cardiologist during their inpatient stays, but fewer than 10% see a cardiologist within 7 days of hospital discharge. By 21 days post discharge, 76% of patients had been seen by any physician, and 25% by a cardiologist.

However, neither early follow-up with a cardiologist nor continuity of care from the same physician seen during the hospitalization was a significant predictor of 30-day readmission, they wrote.

Documentation of discharge instructions, which many physicians presume helps to ensure early follow-up and better outcomes, also was not associated with lower readmission rates. “This finding raises the possibility that discharge instructions are becoming rote processes that do not adequately address elements of care that ensure a safe transition,” the authors wrote.

The study provides evidence in support of guidelines recommending the use of postdischarge systems of care, the authors said. “Achieving early follow-up may be difficult for some physician practices, but models of care that include nurse practitioners or physician assistants under physician supervision may result in increased access to and timeliness of care.”

Reporting the results at the annual scientific session of the American College of Cardiology in Atlanta in March, Dr. Hernandez said that ensuring that patients hospitalized for heart failure are evaluated by a physician within 7 days after discharge is emerging as a potential new target for hospital quality improvement.

The problem of unplanned early readmissions is a hot button issue that has drawn considerable attention from health policy makers. Roughly 20% of Medicare beneficiaries are readmitted within 30 days of hospitalization. Nearly 90% of these readmissions are unplanned and potentially preventable. These readmissions account for $20 billion annually in Medicare hospital payments. And heart failure is the No. 1 cause of readmission within 30 days, noted Dr. Hernandez of the Duke Clinical Research Institute, Durham, N.C.

One audience member serving on a panel advising the Center for Medicare and Medicaid Services said “these are just the kind of data we've been looking for” in order to make recommendations to the agency regarding new hospital performance standards. However, she questioned whether a physician was necessarily the right person to do the early follow-up evaluation. Fine-tuning of outpatient heart failure management might be better done by a dedicated nurse practitioner or physician assistant.

The study was supported by grants from the American Heart Association, GlaxoSmithKline, Medtronic, and the Agency for Healthcare Research and Quality. Dr. Hernandez reported financial relationships with Johnson & Johnson, Medtronic, Merck, Novartis, and AstraZeneca. Other authors reported a variety of financial support from drug manufacturers, other health care companies, and nonprofit organizations.

Bruce Jancin, reporting from the annual scientific sessions of the ACC in Atlanta, contributed to this article.

Heart failure patients discharged from hospitals with high levels of early physician evaluation are less likely to be readmitted to the hospital within 30 days, according to an analysis of records on more than 30,000 heart failure patients from 225 hospitals.

However, most heart failure patients do not visit a physician within 7 days of discharge.

The analysis of data from the American Heart Association's Get With The Guidelines–Heart Failure (GWTG–HF) Registry linked to Medicare billing records, which looked at hospital-level rates of early outpatient follow-up after discharge during 2003–2006, found that the median rate of follow-up within 7 days of discharge was 38%.

“For patients with heart failure, the transition from inpatient to outpatient care can be an especially vulnerable period because of the age of the patients, complex medical regimens, the large number of comorbid conditions, and the multiple clinicians who may be involved,” wrote Dr. Adrian F. Hernandez of Duke University, Durham, N.C., and his coauthors. “Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings.”

Overall, about 21% of heart failure patients were readmitted to the hospital within 30 days of discharge. Patients in hospitals with higher rates of early follow-up had a lower risk of readmission, the study found (JAMA 2010;303:1716–22).

After adjustment for case mix, admission laboratory results, provision of discharge instructions, and length of stay, the risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up, the study found. Whereas 20% of patients whose initial hospital stay took place in a hospital with the highest rates of early follow-up were readmitted, 23% of patients in the hospitals with the lowest follow-up rates were readmitted, a significant difference.

Still, the authors only found differences in rehospitalization rates in the hospitals that ranked in the lowest quartile of posthospitalization follow-up; rates at the other 75% of hospitals were similar. They also found some racial differences: The proportion of black patients was “markedly higher” among hospitals with the lowest rates of early follow-up.

They also found that patients discharged from hospitals with the highest rates of early follow-up by a cardiologist had lower risk of 30-day mortality, which they noted is consistent with other studies of cardiology care for heart failure.

Most follow-up during the transitional period, especially during the first week, is handled by general internists, the study authors found. More than two-thirds of patients hospitalized for heart failure are evaluated by a cardiologist during their inpatient stays, but fewer than 10% see a cardiologist within 7 days of hospital discharge. By 21 days post discharge, 76% of patients had been seen by any physician, and 25% by a cardiologist.

However, neither early follow-up with a cardiologist nor continuity of care from the same physician seen during the hospitalization was a significant predictor of 30-day readmission, they wrote.

Documentation of discharge instructions, which many physicians presume helps to ensure early follow-up and better outcomes, also was not associated with lower readmission rates. “This finding raises the possibility that discharge instructions are becoming rote processes that do not adequately address elements of care that ensure a safe transition,” the authors wrote.

The study provides evidence in support of guidelines recommending the use of postdischarge systems of care, the authors said. “Achieving early follow-up may be difficult for some physician practices, but models of care that include nurse practitioners or physician assistants under physician supervision may result in increased access to and timeliness of care.”

Reporting the results at the annual scientific session of the American College of Cardiology in Atlanta in March, Dr. Hernandez said that ensuring that patients hospitalized for heart failure are evaluated by a physician within 7 days after discharge is emerging as a potential new target for hospital quality improvement.

The problem of unplanned early readmissions is a hot button issue that has drawn considerable attention from health policy makers. Roughly 20% of Medicare beneficiaries are readmitted within 30 days of hospitalization. Nearly 90% of these readmissions are unplanned and potentially preventable. These readmissions account for $20 billion annually in Medicare hospital payments. And heart failure is the No. 1 cause of readmission within 30 days, noted Dr. Hernandez of the Duke Clinical Research Institute, Durham, N.C.

One audience member serving on a panel advising the Center for Medicare and Medicaid Services said “these are just the kind of data we've been looking for” in order to make recommendations to the agency regarding new hospital performance standards. However, she questioned whether a physician was necessarily the right person to do the early follow-up evaluation. Fine-tuning of outpatient heart failure management might be better done by a dedicated nurse practitioner or physician assistant.

The study was supported by grants from the American Heart Association, GlaxoSmithKline, Medtronic, and the Agency for Healthcare Research and Quality. Dr. Hernandez reported financial relationships with Johnson & Johnson, Medtronic, Merck, Novartis, and AstraZeneca. Other authors reported a variety of financial support from drug manufacturers, other health care companies, and nonprofit organizations.

Bruce Jancin, reporting from the annual scientific sessions of the ACC in Atlanta, contributed to this article.

FDA Won't Cough Up Guidance

The Food and Drug Administration has again delayed its guidance on cough and cold dosing for children aged 2-11 years, at least until December 2010, a spokeswoman said. The agency has been working on new parent and pediatrician guidelines for this population since it held hearings on the issue in fall 2008. More recently, it said it would issue the guidance this June. The agency did not give a reason for the additional delay. The FDA's Web site,

www.fda.gov

Peds Retract 'Nick' Policy

The American Academy of Pediatrics, under fire for its position on female genital cutting, has withdrawn the statement and reiterated its “strong opposition” to the practice. In April, the journal Pediatrics published an AAP statement suggesting that physicians in certain immigrant communities might substitute a pinprick of the clitoral skin for ritual genital cutting in order to satisfy cultural requirements. The statement warned that parents who are denied the less severe procedure in this country might send their daughters elsewhere to get the full procedure or have it done in the United States by someone not medically trained. But the AAP said in its new statement that it does not endorse the practice of offering a “clitoral nick,” which is forbidden by federal law. Said AAP President Judith Palfrey, “We retracted that policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world.”

Firms Say They'll Cut Calories

A coalition of food and beverage manufacturers has pledged to collectively trim 1.5 trillion calories from their products by the end of 2015 as part of the effort to curb childhood obesity. The companies, which include cereal makers General Mills, Inc. and the Kellogg Company, candy manufacturers Mars Inc. and the Hershey Company, and soda vendors PepsiCo and the Coca-Cola Company, said they will cut calories by creating lower calorie options, changing recipes, and reducing portion sizes. The coalition member companies also said they will add nutrients such as fiber and whole grains, along with fruits and vegetables, to their products as part of their commitment to healthier foods. The Robert Wood Johnson Foundation said it will study the coalition's efforts to reduce calories in the marketplace and how those efforts might affect calories consumed by children and adolescents.

FDA to Collaborate With Web Site

The FDA said it will collaborate with the Web site

Drugs.com

Drugs.com

Drugs.com

Drugs.com

Study: Much Groundwater Tainted

More than 20% percent of untreated water samples from 932 public wells across the nation contained at least one contaminant at a concentration of potential health concern, according to a study by the U.S. Geological Survey. Naturally occurring contaminants, such as radon and arsenic, accounted for about three-quarters of the worrisome contaminant concentrations, the federal agency said. Manmade contaminants, including herbicides, insecticides, solvents, disinfection byproducts, nitrates, and chemicals from gasoline, were detected in 64% of the samples, the USGS said, and these manmade chemicals also were detected in treated water at similar concentrations. Most of the contaminants analyzed are not covered by the federal Safe Drinking Water Act, the agency noted.

FDA Drafts Transparency Rules

The Food and Drug Administration's Transparency Task Force has issued 21 draft proposals concerning public disclosure of FDA operations without compromising patents or companies' trade secrets. The FDA said that one of the draft proposals would support research into rare diseases by freeing the agency to discuss that a company has abandoned its application for an orphan drug. Once made public, this information could enable another drug manufacturer to pick up where the first one left off toward a potentially new therapy for a rare disease.

FDA Won't Cough Up Guidance

The Food and Drug Administration has again delayed its guidance on cough and cold dosing for children aged 2-11 years, at least until December 2010, a spokeswoman said. The agency has been working on new parent and pediatrician guidelines for this population since it held hearings on the issue in fall 2008. More recently, it said it would issue the guidance this June. The agency did not give a reason for the additional delay. The FDA's Web site,

www.fda.gov

Peds Retract 'Nick' Policy

The American Academy of Pediatrics, under fire for its position on female genital cutting, has withdrawn the statement and reiterated its “strong opposition” to the practice. In April, the journal Pediatrics published an AAP statement suggesting that physicians in certain immigrant communities might substitute a pinprick of the clitoral skin for ritual genital cutting in order to satisfy cultural requirements. The statement warned that parents who are denied the less severe procedure in this country might send their daughters elsewhere to get the full procedure or have it done in the United States by someone not medically trained. But the AAP said in its new statement that it does not endorse the practice of offering a “clitoral nick,” which is forbidden by federal law. Said AAP President Judith Palfrey, “We retracted that policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world.”

Firms Say They'll Cut Calories

A coalition of food and beverage manufacturers has pledged to collectively trim 1.5 trillion calories from their products by the end of 2015 as part of the effort to curb childhood obesity. The companies, which include cereal makers General Mills, Inc. and the Kellogg Company, candy manufacturers Mars Inc. and the Hershey Company, and soda vendors PepsiCo and the Coca-Cola Company, said they will cut calories by creating lower calorie options, changing recipes, and reducing portion sizes. The coalition member companies also said they will add nutrients such as fiber and whole grains, along with fruits and vegetables, to their products as part of their commitment to healthier foods. The Robert Wood Johnson Foundation said it will study the coalition's efforts to reduce calories in the marketplace and how those efforts might affect calories consumed by children and adolescents.

FDA to Collaborate With Web Site

The FDA said it will collaborate with the Web site

Drugs.com

Drugs.com

Drugs.com

Drugs.com

Study: Much Groundwater Tainted

More than 20% percent of untreated water samples from 932 public wells across the nation contained at least one contaminant at a concentration of potential health concern, according to a study by the U.S. Geological Survey. Naturally occurring contaminants, such as radon and arsenic, accounted for about three-quarters of the worrisome contaminant concentrations, the federal agency said. Manmade contaminants, including herbicides, insecticides, solvents, disinfection byproducts, nitrates, and chemicals from gasoline, were detected in 64% of the samples, the USGS said, and these manmade chemicals also were detected in treated water at similar concentrations. Most of the contaminants analyzed are not covered by the federal Safe Drinking Water Act, the agency noted.

FDA Drafts Transparency Rules

The Food and Drug Administration's Transparency Task Force has issued 21 draft proposals concerning public disclosure of FDA operations without compromising patents or companies' trade secrets. The FDA said that one of the draft proposals would support research into rare diseases by freeing the agency to discuss that a company has abandoned its application for an orphan drug. Once made public, this information could enable another drug manufacturer to pick up where the first one left off toward a potentially new therapy for a rare disease.

FDA Won't Cough Up Guidance

The Food and Drug Administration has again delayed its guidance on cough and cold dosing for children aged 2-11 years, at least until December 2010, a spokeswoman said. The agency has been working on new parent and pediatrician guidelines for this population since it held hearings on the issue in fall 2008. More recently, it said it would issue the guidance this June. The agency did not give a reason for the additional delay. The FDA's Web site,

www.fda.gov

Peds Retract 'Nick' Policy

The American Academy of Pediatrics, under fire for its position on female genital cutting, has withdrawn the statement and reiterated its “strong opposition” to the practice. In April, the journal Pediatrics published an AAP statement suggesting that physicians in certain immigrant communities might substitute a pinprick of the clitoral skin for ritual genital cutting in order to satisfy cultural requirements. The statement warned that parents who are denied the less severe procedure in this country might send their daughters elsewhere to get the full procedure or have it done in the United States by someone not medically trained. But the AAP said in its new statement that it does not endorse the practice of offering a “clitoral nick,” which is forbidden by federal law. Said AAP President Judith Palfrey, “We retracted that policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world.”

Firms Say They'll Cut Calories

A coalition of food and beverage manufacturers has pledged to collectively trim 1.5 trillion calories from their products by the end of 2015 as part of the effort to curb childhood obesity. The companies, which include cereal makers General Mills, Inc. and the Kellogg Company, candy manufacturers Mars Inc. and the Hershey Company, and soda vendors PepsiCo and the Coca-Cola Company, said they will cut calories by creating lower calorie options, changing recipes, and reducing portion sizes. The coalition member companies also said they will add nutrients such as fiber and whole grains, along with fruits and vegetables, to their products as part of their commitment to healthier foods. The Robert Wood Johnson Foundation said it will study the coalition's efforts to reduce calories in the marketplace and how those efforts might affect calories consumed by children and adolescents.

FDA to Collaborate With Web Site

The FDA said it will collaborate with the Web site

Drugs.com

Drugs.com

Drugs.com

Drugs.com

Study: Much Groundwater Tainted

More than 20% percent of untreated water samples from 932 public wells across the nation contained at least one contaminant at a concentration of potential health concern, according to a study by the U.S. Geological Survey. Naturally occurring contaminants, such as radon and arsenic, accounted for about three-quarters of the worrisome contaminant concentrations, the federal agency said. Manmade contaminants, including herbicides, insecticides, solvents, disinfection byproducts, nitrates, and chemicals from gasoline, were detected in 64% of the samples, the USGS said, and these manmade chemicals also were detected in treated water at similar concentrations. Most of the contaminants analyzed are not covered by the federal Safe Drinking Water Act, the agency noted.

FDA Drafts Transparency Rules

The Food and Drug Administration's Transparency Task Force has issued 21 draft proposals concerning public disclosure of FDA operations without compromising patents or companies' trade secrets. The FDA said that one of the draft proposals would support research into rare diseases by freeing the agency to discuss that a company has abandoned its application for an orphan drug. Once made public, this information could enable another drug manufacturer to pick up where the first one left off toward a potentially new therapy for a rare disease.

Cancer Costs Double in 18 Years

The cost of treating cancer doubled over nearly 2 decades, and treatment has shifted to outpatient settings, according to a study from the Centers for Disease Control and Prevention. However, cancer accounts for about 5% of overall health care spending, a percentage that hasn't changed since 1987 despite the advent of more expensive cancer drugs, according to the study, published in the journal Cancer. The researchers determined that the increase in cancer costs—to $48.1 billion in 2005—came largely from the growing number of cancer patients. The share paid by private insurance increased and that paid out-of-pocket by patients fell. Medicare continued to pay about one-third of total treatment costs, the study found.

Bonuses Risk Medical Disparities

Rewarding primary care physicians for providing better care to patients could widen medical disparities experienced by poorer people and minority groups, according to a RAND Corp. study. Published in the journal Health Affairs, the research suggests that the average-size medical practice serving a vulnerable population would receive $7,100 less annually because of existing gaps in quality of care. “If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse,” lead author Dr. Mark Friedberg, an associate scientist at RAND, said in a statement.

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the Department of Health and Human Services to build health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. Delta Health Alliance in Stoneville, Miss., received $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, while the Indiana Health Information Exchange in Indianapolis, the largest health information exchange in the country, received $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology.

Doctors Still Poor on Food Advice

Only about half of obese adult Americans were told by their doctors to cut down on fatty foods in 2006, a number that hasn't changed significantly since 2002, according to the Agency for Healthcare Research and Quality. The problem is especially acute in minority populations, the AHRQ said. Obese Hispanic patients received advice on healthy eating from their physicians only 42% of the time, while obese black adults received advice 45% of the time. White adults received healthy eating advice 52% of the time. In addition, doctors were less likely to tell poor obese adults and those who did not finish high school to cut down on high-fat, high-cholesterol foods, regardless of race or ethnicity, when compared with advice to higher-income and better-educated counterparts. Black and Hispanic adults have higher obesity rates than whites, as do poor adults and those with limited education, the study noted.

Blues Plan Rewards Primary Care

Pennsylvania-based Independence Blue Cross said it will invest an additional $47 million to supplement compensation to the 1,800 primary care physicians participating in its network in an effort to improve quality of care. More than $33 million of the added investment will enhance an incentive program for “better care, not more care,” the health plan said. Independence will increase the base amount it pays primary care physicians by an average of 10% and will reward physicians who improve quality on measures such as cancer screenings, immunizations, and asthma management. With the new funds, primary care physicians can double their incentive earnings over 2009, according to Independence. Practices that meet some or all of the core requirements for a “patient-centered medical home” and physicians who provide effective coordination will receive additional compensation, Independence said.

Providers Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The FDA announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

Cancer Costs Double in 18 Years

The cost of treating cancer doubled over nearly 2 decades, and treatment has shifted to outpatient settings, according to a study from the Centers for Disease Control and Prevention. However, cancer accounts for about 5% of overall health care spending, a percentage that hasn't changed since 1987 despite the advent of more expensive cancer drugs, according to the study, published in the journal Cancer. The researchers determined that the increase in cancer costs—to $48.1 billion in 2005—came largely from the growing number of cancer patients. The share paid by private insurance increased and that paid out-of-pocket by patients fell. Medicare continued to pay about one-third of total treatment costs, the study found.

Bonuses Risk Medical Disparities

Rewarding primary care physicians for providing better care to patients could widen medical disparities experienced by poorer people and minority groups, according to a RAND Corp. study. Published in the journal Health Affairs, the research suggests that the average-size medical practice serving a vulnerable population would receive $7,100 less annually because of existing gaps in quality of care. “If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse,” lead author Dr. Mark Friedberg, an associate scientist at RAND, said in a statement.

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the Department of Health and Human Services to build health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. Delta Health Alliance in Stoneville, Miss., received $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, while the Indiana Health Information Exchange in Indianapolis, the largest health information exchange in the country, received $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology.

Doctors Still Poor on Food Advice

Only about half of obese adult Americans were told by their doctors to cut down on fatty foods in 2006, a number that hasn't changed significantly since 2002, according to the Agency for Healthcare Research and Quality. The problem is especially acute in minority populations, the AHRQ said. Obese Hispanic patients received advice on healthy eating from their physicians only 42% of the time, while obese black adults received advice 45% of the time. White adults received healthy eating advice 52% of the time. In addition, doctors were less likely to tell poor obese adults and those who did not finish high school to cut down on high-fat, high-cholesterol foods, regardless of race or ethnicity, when compared with advice to higher-income and better-educated counterparts. Black and Hispanic adults have higher obesity rates than whites, as do poor adults and those with limited education, the study noted.

Blues Plan Rewards Primary Care

Pennsylvania-based Independence Blue Cross said it will invest an additional $47 million to supplement compensation to the 1,800 primary care physicians participating in its network in an effort to improve quality of care. More than $33 million of the added investment will enhance an incentive program for “better care, not more care,” the health plan said. Independence will increase the base amount it pays primary care physicians by an average of 10% and will reward physicians who improve quality on measures such as cancer screenings, immunizations, and asthma management. With the new funds, primary care physicians can double their incentive earnings over 2009, according to Independence. Practices that meet some or all of the core requirements for a “patient-centered medical home” and physicians who provide effective coordination will receive additional compensation, Independence said.

Providers Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The FDA announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

Cancer Costs Double in 18 Years

The cost of treating cancer doubled over nearly 2 decades, and treatment has shifted to outpatient settings, according to a study from the Centers for Disease Control and Prevention. However, cancer accounts for about 5% of overall health care spending, a percentage that hasn't changed since 1987 despite the advent of more expensive cancer drugs, according to the study, published in the journal Cancer. The researchers determined that the increase in cancer costs—to $48.1 billion in 2005—came largely from the growing number of cancer patients. The share paid by private insurance increased and that paid out-of-pocket by patients fell. Medicare continued to pay about one-third of total treatment costs, the study found.

Bonuses Risk Medical Disparities

Rewarding primary care physicians for providing better care to patients could widen medical disparities experienced by poorer people and minority groups, according to a RAND Corp. study. Published in the journal Health Affairs, the research suggests that the average-size medical practice serving a vulnerable population would receive $7,100 less annually because of existing gaps in quality of care. “If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse,” lead author Dr. Mark Friedberg, an associate scientist at RAND, said in a statement.

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the Department of Health and Human Services to build health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. Delta Health Alliance in Stoneville, Miss., received $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, while the Indiana Health Information Exchange in Indianapolis, the largest health information exchange in the country, received $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology.

Doctors Still Poor on Food Advice

Only about half of obese adult Americans were told by their doctors to cut down on fatty foods in 2006, a number that hasn't changed significantly since 2002, according to the Agency for Healthcare Research and Quality. The problem is especially acute in minority populations, the AHRQ said. Obese Hispanic patients received advice on healthy eating from their physicians only 42% of the time, while obese black adults received advice 45% of the time. White adults received healthy eating advice 52% of the time. In addition, doctors were less likely to tell poor obese adults and those who did not finish high school to cut down on high-fat, high-cholesterol foods, regardless of race or ethnicity, when compared with advice to higher-income and better-educated counterparts. Black and Hispanic adults have higher obesity rates than whites, as do poor adults and those with limited education, the study noted.

Blues Plan Rewards Primary Care

Pennsylvania-based Independence Blue Cross said it will invest an additional $47 million to supplement compensation to the 1,800 primary care physicians participating in its network in an effort to improve quality of care. More than $33 million of the added investment will enhance an incentive program for “better care, not more care,” the health plan said. Independence will increase the base amount it pays primary care physicians by an average of 10% and will reward physicians who improve quality on measures such as cancer screenings, immunizations, and asthma management. With the new funds, primary care physicians can double their incentive earnings over 2009, according to Independence. Practices that meet some or all of the core requirements for a “patient-centered medical home” and physicians who provide effective coordination will receive additional compensation, Independence said.

Providers Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The FDA announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

Nearly half of all U.S. children were obese or overweight in 2007, but substantial variations in obesity and overweight rates between the states may point the way to reducing childhood obesity in the states with the heaviest children, a study showed.

Girls in particular were becoming more obese between 2003 and 2007, the investigators found.

Social and behavioral factors such as poverty level, access to parks or sidewalks, lower levels of physical activity, and television viewing accounted for up to 45% of the variance between states, reported Gopal K. Singh, Ph.D., nd associates at the U.S. Department of Health and Human Services' Maternal and Child Health Bureau, oockville, Md.

Overall, 16.4% of U.S. children aged 10–17 years were obese, and 31.6% were overweight in 2007. Obesity prevalence grew by 10% overall nationwide and by 18% for girls between 2003 and 2007, according to the study in which the authors used data from the 2003 and 2007 National Survey of Children's Health to determine obesity and overweight prevalence in each of the 50 states Arch. Pediatr. Adolesc. Med. 2010 May 3; [doi:10.1001/archpediatrics.2010. 84]). Girls also experienced a 9% increase in overweight prevalence.

Dr. Singh and associates found that Mississippi was the state with the biggest problem, with nearly 22% of children obese and another 44.5% of children overweight. Oregon, meanwhile, had the lowest prevalence of obesity (9.6%), while Utah had the lowest prevalence of overweight in children, with 23.1% of children overweight.

Between 2003 and 2007, while obesity prevalence increased, especially in girls, the rate of obesity fell by 32% for children in Oregon and nearly doubled among girls in Arizona and Kansas. For children in several states, including Tennessee, Kentucky, West Virginia, Georgia, and Kansas, the adjusted odds of being obese was more than twice that of children in Oregon.

Geographic rates of childhood obesity and overweight followed those for adults, the study showed, with several Southern states such as Mississippi, Georgia, Kentucky, Louisiana, and Tennessee in the top quintile for both.

“It is conceivable that recent trends in dietary factors may have contributed to the increase in childhood obesity at the national level as well as in specific states,” Dr. Singh and associates concluded.

Disclosures: The authors did not report any financial disclosures or financial support for the study.

Nearly half of all U.S. children were obese or overweight in 2007, but substantial variations in obesity and overweight rates between the states may point the way to reducing childhood obesity in the states with the heaviest children, a study showed.

Girls in particular were becoming more obese between 2003 and 2007, the investigators found.

Social and behavioral factors such as poverty level, access to parks or sidewalks, lower levels of physical activity, and television viewing accounted for up to 45% of the variance between states, reported Gopal K. Singh, Ph.D., nd associates at the U.S. Department of Health and Human Services' Maternal and Child Health Bureau, oockville, Md.

Overall, 16.4% of U.S. children aged 10–17 years were obese, and 31.6% were overweight in 2007. Obesity prevalence grew by 10% overall nationwide and by 18% for girls between 2003 and 2007, according to the study in which the authors used data from the 2003 and 2007 National Survey of Children's Health to determine obesity and overweight prevalence in each of the 50 states Arch. Pediatr. Adolesc. Med. 2010 May 3; [doi:10.1001/archpediatrics.2010. 84]). Girls also experienced a 9% increase in overweight prevalence.

Dr. Singh and associates found that Mississippi was the state with the biggest problem, with nearly 22% of children obese and another 44.5% of children overweight. Oregon, meanwhile, had the lowest prevalence of obesity (9.6%), while Utah had the lowest prevalence of overweight in children, with 23.1% of children overweight.

Between 2003 and 2007, while obesity prevalence increased, especially in girls, the rate of obesity fell by 32% for children in Oregon and nearly doubled among girls in Arizona and Kansas. For children in several states, including Tennessee, Kentucky, West Virginia, Georgia, and Kansas, the adjusted odds of being obese was more than twice that of children in Oregon.

Geographic rates of childhood obesity and overweight followed those for adults, the study showed, with several Southern states such as Mississippi, Georgia, Kentucky, Louisiana, and Tennessee in the top quintile for both.

“It is conceivable that recent trends in dietary factors may have contributed to the increase in childhood obesity at the national level as well as in specific states,” Dr. Singh and associates concluded.

Disclosures: The authors did not report any financial disclosures or financial support for the study.

Nearly half of all U.S. children were obese or overweight in 2007, but substantial variations in obesity and overweight rates between the states may point the way to reducing childhood obesity in the states with the heaviest children, a study showed.

Girls in particular were becoming more obese between 2003 and 2007, the investigators found.

Social and behavioral factors such as poverty level, access to parks or sidewalks, lower levels of physical activity, and television viewing accounted for up to 45% of the variance between states, reported Gopal K. Singh, Ph.D., nd associates at the U.S. Department of Health and Human Services' Maternal and Child Health Bureau, oockville, Md.

Overall, 16.4% of U.S. children aged 10–17 years were obese, and 31.6% were overweight in 2007. Obesity prevalence grew by 10% overall nationwide and by 18% for girls between 2003 and 2007, according to the study in which the authors used data from the 2003 and 2007 National Survey of Children's Health to determine obesity and overweight prevalence in each of the 50 states Arch. Pediatr. Adolesc. Med. 2010 May 3; [doi:10.1001/archpediatrics.2010. 84]). Girls also experienced a 9% increase in overweight prevalence.

Dr. Singh and associates found that Mississippi was the state with the biggest problem, with nearly 22% of children obese and another 44.5% of children overweight. Oregon, meanwhile, had the lowest prevalence of obesity (9.6%), while Utah had the lowest prevalence of overweight in children, with 23.1% of children overweight.

Between 2003 and 2007, while obesity prevalence increased, especially in girls, the rate of obesity fell by 32% for children in Oregon and nearly doubled among girls in Arizona and Kansas. For children in several states, including Tennessee, Kentucky, West Virginia, Georgia, and Kansas, the adjusted odds of being obese was more than twice that of children in Oregon.

Geographic rates of childhood obesity and overweight followed those for adults, the study showed, with several Southern states such as Mississippi, Georgia, Kentucky, Louisiana, and Tennessee in the top quintile for both.

“It is conceivable that recent trends in dietary factors may have contributed to the increase in childhood obesity at the national level as well as in specific states,” Dr. Singh and associates concluded.

Disclosures: The authors did not report any financial disclosures or financial support for the study.

In an initiative aimed at cutting childhood obesity rates to 5% by 2030, the White House Task Force on Child Obesity report to the president spelled out a broad ranging of recommendations—from increasing breastfeeding to improving eating patterns and physical activity levels among children.

Nearly half of all U.S. children are obese (16%) or overweight (32%), according to a study of 2007 data published this month. (See story below.)

The task force report spearheaded by First Lady Michelle Obama, which includes 70 specific recommendations, provides goals, benchmarks, and measurable outcomes to reduce childhood obesity.

“We want to marshal every resource—public and private sector, mayors and governors, parents and educators, business owners and health care providers, coaches and athletes—to ensure that we are providing each and every child the happy, healthy future they deserve,” Ms. Obama said in a statement.

The American Academy of Pediatrics, which has partnered with Ms. Obama's “Let's Move!” childhood obesity initiative, agreed that a many-pronged strategy will be necessary to address the problem.

“The AAP is pleased that the report's recommendations mirror many of the academy's long-standing guidelines, including the restrictions on screen time and the calculation of body mass index,” AAP President Judith Palfrey said in a statement.

“In addition, the report incorporates several specific recommendations that the AAP made to the task force, such as the need for insurers to cover obesity prevention, identification, and treatment services appropriately,” Dr. Palfrey said. “The report also provides an important service by proposing benchmarks for measuring progress on various recommendations.”

The task force's recommendations cover five broad areas, including reducing the risk of obesity in early childhood; empowering parents and caregivers; providing healthier food in schools; providing better access to healthy, affordable food in areas where it is not readily available; and increasing physical activity.

As a result of the recommendations, the following actions are slated to occur in the near future:

▸ The U.S. Department of Health and Human Services (HHS) will release guidance in 2010 for standards for physical activity and nutrition in child care settings, and will work with the food and beverage industry to develop a standard “front of packages” food labels.

▸ The U.S. Department of Agriculture will update its food pyramid and dietary guidelines, and will work with Congress to pass a child nutrition reauthorization bill that improves school menu choices.

▸ Federal agencies will make funds available to local communities, including $25 million from HHS, to support obesity prevention and screening services for children.

Other recommendations will require action from the private sector to implement. For example, the task force recommended that providers counsel pregnant women and women planning a pregnancy about the importance of conceiving at a healthy weight, according to Institute of Medicine guidelines.

On breastfeeding, the task force advised hospitals and health care providers to select maternity care practices that empower new mothers to breastfeed, such as the Baby-Friendly Hospital Initiative. It also recommended that health care providers and insurance companies provide information to pregnant women and new mothers on breastfeeding, and that local health departments and community organizations develop peer support programs for breastfeeding mothers.

Regarding early childhood development, the task force recommended that the AAP guidelines on screen time should be more widely disseminated, and that the federal government craft clear guidance on how states, providers, and families can increase physical activity, improve nutrition, and reduce screen time in early child care settings.

Michelle Obama is shown unveiling the findings of the Childhood Obesity Task Force report last month.

Source Official White House Photo by Samantha Appleton

In an initiative aimed at cutting childhood obesity rates to 5% by 2030, the White House Task Force on Child Obesity report to the president spelled out a broad ranging of recommendations—from increasing breastfeeding to improving eating patterns and physical activity levels among children.

Nearly half of all U.S. children are obese (16%) or overweight (32%), according to a study of 2007 data published this month. (See story below.)

The task force report spearheaded by First Lady Michelle Obama, which includes 70 specific recommendations, provides goals, benchmarks, and measurable outcomes to reduce childhood obesity.

“We want to marshal every resource—public and private sector, mayors and governors, parents and educators, business owners and health care providers, coaches and athletes—to ensure that we are providing each and every child the happy, healthy future they deserve,” Ms. Obama said in a statement.

The American Academy of Pediatrics, which has partnered with Ms. Obama's “Let's Move!” childhood obesity initiative, agreed that a many-pronged strategy will be necessary to address the problem.

“The AAP is pleased that the report's recommendations mirror many of the academy's long-standing guidelines, including the restrictions on screen time and the calculation of body mass index,” AAP President Judith Palfrey said in a statement.

“In addition, the report incorporates several specific recommendations that the AAP made to the task force, such as the need for insurers to cover obesity prevention, identification, and treatment services appropriately,” Dr. Palfrey said. “The report also provides an important service by proposing benchmarks for measuring progress on various recommendations.”

The task force's recommendations cover five broad areas, including reducing the risk of obesity in early childhood; empowering parents and caregivers; providing healthier food in schools; providing better access to healthy, affordable food in areas where it is not readily available; and increasing physical activity.

As a result of the recommendations, the following actions are slated to occur in the near future:

▸ The U.S. Department of Health and Human Services (HHS) will release guidance in 2010 for standards for physical activity and nutrition in child care settings, and will work with the food and beverage industry to develop a standard “front of packages” food labels.

▸ The U.S. Department of Agriculture will update its food pyramid and dietary guidelines, and will work with Congress to pass a child nutrition reauthorization bill that improves school menu choices.

▸ Federal agencies will make funds available to local communities, including $25 million from HHS, to support obesity prevention and screening services for children.

Other recommendations will require action from the private sector to implement. For example, the task force recommended that providers counsel pregnant women and women planning a pregnancy about the importance of conceiving at a healthy weight, according to Institute of Medicine guidelines.

On breastfeeding, the task force advised hospitals and health care providers to select maternity care practices that empower new mothers to breastfeed, such as the Baby-Friendly Hospital Initiative. It also recommended that health care providers and insurance companies provide information to pregnant women and new mothers on breastfeeding, and that local health departments and community organizations develop peer support programs for breastfeeding mothers.

Regarding early childhood development, the task force recommended that the AAP guidelines on screen time should be more widely disseminated, and that the federal government craft clear guidance on how states, providers, and families can increase physical activity, improve nutrition, and reduce screen time in early child care settings.

Michelle Obama is shown unveiling the findings of the Childhood Obesity Task Force report last month.

Source Official White House Photo by Samantha Appleton

In an initiative aimed at cutting childhood obesity rates to 5% by 2030, the White House Task Force on Child Obesity report to the president spelled out a broad ranging of recommendations—from increasing breastfeeding to improving eating patterns and physical activity levels among children.

Nearly half of all U.S. children are obese (16%) or overweight (32%), according to a study of 2007 data published this month. (See story below.)

The task force report spearheaded by First Lady Michelle Obama, which includes 70 specific recommendations, provides goals, benchmarks, and measurable outcomes to reduce childhood obesity.

“We want to marshal every resource—public and private sector, mayors and governors, parents and educators, business owners and health care providers, coaches and athletes—to ensure that we are providing each and every child the happy, healthy future they deserve,” Ms. Obama said in a statement.

The American Academy of Pediatrics, which has partnered with Ms. Obama's “Let's Move!” childhood obesity initiative, agreed that a many-pronged strategy will be necessary to address the problem.

“The AAP is pleased that the report's recommendations mirror many of the academy's long-standing guidelines, including the restrictions on screen time and the calculation of body mass index,” AAP President Judith Palfrey said in a statement.

“In addition, the report incorporates several specific recommendations that the AAP made to the task force, such as the need for insurers to cover obesity prevention, identification, and treatment services appropriately,” Dr. Palfrey said. “The report also provides an important service by proposing benchmarks for measuring progress on various recommendations.”

The task force's recommendations cover five broad areas, including reducing the risk of obesity in early childhood; empowering parents and caregivers; providing healthier food in schools; providing better access to healthy, affordable food in areas where it is not readily available; and increasing physical activity.

As a result of the recommendations, the following actions are slated to occur in the near future:

▸ The U.S. Department of Health and Human Services (HHS) will release guidance in 2010 for standards for physical activity and nutrition in child care settings, and will work with the food and beverage industry to develop a standard “front of packages” food labels.

▸ The U.S. Department of Agriculture will update its food pyramid and dietary guidelines, and will work with Congress to pass a child nutrition reauthorization bill that improves school menu choices.

▸ Federal agencies will make funds available to local communities, including $25 million from HHS, to support obesity prevention and screening services for children.

Other recommendations will require action from the private sector to implement. For example, the task force recommended that providers counsel pregnant women and women planning a pregnancy about the importance of conceiving at a healthy weight, according to Institute of Medicine guidelines.

On breastfeeding, the task force advised hospitals and health care providers to select maternity care practices that empower new mothers to breastfeed, such as the Baby-Friendly Hospital Initiative. It also recommended that health care providers and insurance companies provide information to pregnant women and new mothers on breastfeeding, and that local health departments and community organizations develop peer support programs for breastfeeding mothers.

Regarding early childhood development, the task force recommended that the AAP guidelines on screen time should be more widely disseminated, and that the federal government craft clear guidance on how states, providers, and families can increase physical activity, improve nutrition, and reduce screen time in early child care settings.

Michelle Obama is shown unveiling the findings of the Childhood Obesity Task Force report last month.

Source Official White House Photo by Samantha Appleton

Cancer Costs Double in 18 Years

The cost of treating cancer doubled over nearly 2 decades, and treatment has shifted to outpatient settings, according to a study from the Centers for Disease Control and Prevention. However, cancer accounts for about 5% of overall health care spending, a percentage that hasn't changed since 1987 despite the advent of more expensive cancer drugs, according to the study, published in the journal Cancer. The researchers determined that the increase in cancer costs—to $48.1 billion in 2005—came largely from the growing number of cancer patients. The share paid by private insurance increased and that paid out-of-pocket by patients fell. Medicare continued to pay about one-third of total treatment costs, the study found.

Bonuses Risk Medical Disparities

Rewarding primary care physicians for providing better care to patients could widen medical disparities experienced by poorer people and minority groups, according to a RAND Corp. study. Published in the journal Health Affairs, the research suggests that the average-size medical practice serving a vulnerable population would receive $7,100 less annually because of existing gaps in quality of care. “If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse,” lead author Dr. Mark Friedberg, an associate scientist at RAND, said in a statement.

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the Department of Health and Human Services to build their health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. For example, Delta Health Alliance in Stoneville, Miss., received about $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, while the Indiana Health Information Exchange in Indianapolis, the largest health information exchange in the country, received about $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology to other communities.

Doctors Still Poor on Food Advice

Only about half of obese adult Americans were told by their doctors to cut down on fatty foods in 2006, a number that hasn't changed significantly since 2002, according to the Agency for Healthcare Research and Quality. The problem is especially acute in minority populations, the AHRQ said. Obese Hispanic patients received advice on healthy eating from their physicians 42% of the time, while obese black adults received advice 45% of the time, compared with 52% for whites. Doctors also were less likely to tell poor obese adults and those who did not finish high school to improve their diets, regardless of race or ethnicity, when compared with higher-income and better-educated counterparts. Black and Hispanic adults have higher obesity rates than whites, as do poor adults and those with limited education, the study noted.

Blues Plan Rewards Primary Care

Pennsylvania-based Independence Blue Cross said it will invest an additional $47 million to supplement compensation to the 1,800 primary care physicians participating in its network in an effort to improve the quality of care. More than $33 million of the added investment will enhance an incentive program for “better care, not more care,” the health plan said. Independence will increase the base amount it pays primary care physicians by an average of 10% and will reward physicians who improve quality on measures such as cancer screenings, immunizations, and asthma management. With the new funds, primary care physicians can double their incentive earnings over 2009, according to Independence. Practices that meet some or all of the core requirements for a “patient-centered medical home” and physicians who provide effective care coordination will receive additional compensation, Independence said.

Doctors Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The FDA announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

Cancer Costs Double in 18 Years

The cost of treating cancer doubled over nearly 2 decades, and treatment has shifted to outpatient settings, according to a study from the Centers for Disease Control and Prevention. However, cancer accounts for about 5% of overall health care spending, a percentage that hasn't changed since 1987 despite the advent of more expensive cancer drugs, according to the study, published in the journal Cancer. The researchers determined that the increase in cancer costs—to $48.1 billion in 2005—came largely from the growing number of cancer patients. The share paid by private insurance increased and that paid out-of-pocket by patients fell. Medicare continued to pay about one-third of total treatment costs, the study found.

Bonuses Risk Medical Disparities

Rewarding primary care physicians for providing better care to patients could widen medical disparities experienced by poorer people and minority groups, according to a RAND Corp. study. Published in the journal Health Affairs, the research suggests that the average-size medical practice serving a vulnerable population would receive $7,100 less annually because of existing gaps in quality of care. “If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse,” lead author Dr. Mark Friedberg, an associate scientist at RAND, said in a statement.

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the Department of Health and Human Services to build their health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. For example, Delta Health Alliance in Stoneville, Miss., received about $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, while the Indiana Health Information Exchange in Indianapolis, the largest health information exchange in the country, received about $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology to other communities.

Doctors Still Poor on Food Advice

Only about half of obese adult Americans were told by their doctors to cut down on fatty foods in 2006, a number that hasn't changed significantly since 2002, according to the Agency for Healthcare Research and Quality. The problem is especially acute in minority populations, the AHRQ said. Obese Hispanic patients received advice on healthy eating from their physicians 42% of the time, while obese black adults received advice 45% of the time, compared with 52% for whites. Doctors also were less likely to tell poor obese adults and those who did not finish high school to improve their diets, regardless of race or ethnicity, when compared with higher-income and better-educated counterparts. Black and Hispanic adults have higher obesity rates than whites, as do poor adults and those with limited education, the study noted.

Blues Plan Rewards Primary Care

Pennsylvania-based Independence Blue Cross said it will invest an additional $47 million to supplement compensation to the 1,800 primary care physicians participating in its network in an effort to improve the quality of care. More than $33 million of the added investment will enhance an incentive program for “better care, not more care,” the health plan said. Independence will increase the base amount it pays primary care physicians by an average of 10% and will reward physicians who improve quality on measures such as cancer screenings, immunizations, and asthma management. With the new funds, primary care physicians can double their incentive earnings over 2009, according to Independence. Practices that meet some or all of the core requirements for a “patient-centered medical home” and physicians who provide effective care coordination will receive additional compensation, Independence said.

Doctors Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The FDA announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

Cancer Costs Double in 18 Years

The cost of treating cancer doubled over nearly 2 decades, and treatment has shifted to outpatient settings, according to a study from the Centers for Disease Control and Prevention. However, cancer accounts for about 5% of overall health care spending, a percentage that hasn't changed since 1987 despite the advent of more expensive cancer drugs, according to the study, published in the journal Cancer. The researchers determined that the increase in cancer costs—to $48.1 billion in 2005—came largely from the growing number of cancer patients. The share paid by private insurance increased and that paid out-of-pocket by patients fell. Medicare continued to pay about one-third of total treatment costs, the study found.

Bonuses Risk Medical Disparities

Rewarding primary care physicians for providing better care to patients could widen medical disparities experienced by poorer people and minority groups, according to a RAND Corp. study. Published in the journal Health Affairs, the research suggests that the average-size medical practice serving a vulnerable population would receive $7,100 less annually because of existing gaps in quality of care. “If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse,” lead author Dr. Mark Friedberg, an associate scientist at RAND, said in a statement.

Health Information Grants Set

Fifteen communities are splitting about $220 million in grant money from the Department of Health and Human Services to build their health information technology infrastructures and capabilities. The Beacon Community grants provide funding to “communities at the cutting edge of electronic health record adoption and health information exchange,” the HHS said. For example, Delta Health Alliance in Stoneville, Miss., received about $14 million to electronically link systems for care management, medication therapy, and patient education in diabetes, while the Indiana Health Information Exchange in Indianapolis, the largest health information exchange in the country, received about $16 million to improve cholesterol and blood sugar control in diabetic patients and to reduce hospital readmissions through telemonitoring. The program is intended to demonstrate the advantages of health information technology to other communities.

Doctors Still Poor on Food Advice

Only about half of obese adult Americans were told by their doctors to cut down on fatty foods in 2006, a number that hasn't changed significantly since 2002, according to the Agency for Healthcare Research and Quality. The problem is especially acute in minority populations, the AHRQ said. Obese Hispanic patients received advice on healthy eating from their physicians 42% of the time, while obese black adults received advice 45% of the time, compared with 52% for whites. Doctors also were less likely to tell poor obese adults and those who did not finish high school to improve their diets, regardless of race or ethnicity, when compared with higher-income and better-educated counterparts. Black and Hispanic adults have higher obesity rates than whites, as do poor adults and those with limited education, the study noted.

Blues Plan Rewards Primary Care

Pennsylvania-based Independence Blue Cross said it will invest an additional $47 million to supplement compensation to the 1,800 primary care physicians participating in its network in an effort to improve the quality of care. More than $33 million of the added investment will enhance an incentive program for “better care, not more care,” the health plan said. Independence will increase the base amount it pays primary care physicians by an average of 10% and will reward physicians who improve quality on measures such as cancer screenings, immunizations, and asthma management. With the new funds, primary care physicians can double their incentive earnings over 2009, according to Independence. Practices that meet some or all of the core requirements for a “patient-centered medical home” and physicians who provide effective care coordination will receive additional compensation, Independence said.

Doctors Asked to Find 'Bad Ads'

The Food and Drug Administration has launched a program to get health care providers to detect and report misleading drug ads. The “Bad Ad” program seeks to educate health care providers about their role in ensuring that prescription drug advertising is truthful and not misleading, the FDA said. Initially, FDA officials will meet with providers at selected medical conventions and will partner with a handful of medical groups to distribute educational materials. The agency said it will then expand its collaborations with medical societies. The FDA announcement encouraged health care professionals to report a potential violation in drug promotion by sending e-mails to

badad@fda.gov

The Food and Drug Administration released draft guidance designed to provide more information on conflicts of interest involving members of its advisory committees, and the waivers that allow them to participate in specific meetings.

The draft guidance is designed to bring agency policy in line with standard conflict of interest practice in the academic community, where medical journals require disclosures to be specific and thorough, Jill Hartzler Warner, acting associate commissioner for special medical programs at the FDA, said in a press briefing. “When final, the guidance will increase transparency of the waiver process so that the public can understand the nature of the potential conflict,” she said.

The FDA has 49 advisory committees with a total of more than 600 positions that provide advice on specific regulatory decisions, such as drug and device approvals, and general policy matters, such as regulations. For highly technical subjects, the FDA often must choose from a small pool of potential advisers, and these people frequently have conflicts of interest, she said.

Federal law allows the FDA to grant waivers so that experts who have conflicts of interest can participate in advisory committee meetings; however, the process has been controversial. Federal law requires the FDA to disclose the type, nature, and magnitude of the conflict on its Web site.

The draft guidance can be viewed at www.fda.gov/downloads/RegulatoryInformation/Guidances/UCM209201.pdf

The Food and Drug Administration released draft guidance designed to provide more information on conflicts of interest involving members of its advisory committees, and the waivers that allow them to participate in specific meetings.

The draft guidance is designed to bring agency policy in line with standard conflict of interest practice in the academic community, where medical journals require disclosures to be specific and thorough, Jill Hartzler Warner, acting associate commissioner for special medical programs at the FDA, said in a press briefing. “When final, the guidance will increase transparency of the waiver process so that the public can understand the nature of the potential conflict,” she said.

The FDA has 49 advisory committees with a total of more than 600 positions that provide advice on specific regulatory decisions, such as drug and device approvals, and general policy matters, such as regulations. For highly technical subjects, the FDA often must choose from a small pool of potential advisers, and these people frequently have conflicts of interest, she said.

Federal law allows the FDA to grant waivers so that experts who have conflicts of interest can participate in advisory committee meetings; however, the process has been controversial. Federal law requires the FDA to disclose the type, nature, and magnitude of the conflict on its Web site.

The draft guidance can be viewed at www.fda.gov/downloads/RegulatoryInformation/Guidances/UCM209201.pdf

The Food and Drug Administration released draft guidance designed to provide more information on conflicts of interest involving members of its advisory committees, and the waivers that allow them to participate in specific meetings.

The draft guidance is designed to bring agency policy in line with standard conflict of interest practice in the academic community, where medical journals require disclosures to be specific and thorough, Jill Hartzler Warner, acting associate commissioner for special medical programs at the FDA, said in a press briefing. “When final, the guidance will increase transparency of the waiver process so that the public can understand the nature of the potential conflict,” she said.

The FDA has 49 advisory committees with a total of more than 600 positions that provide advice on specific regulatory decisions, such as drug and device approvals, and general policy matters, such as regulations. For highly technical subjects, the FDA often must choose from a small pool of potential advisers, and these people frequently have conflicts of interest, she said.

Federal law allows the FDA to grant waivers so that experts who have conflicts of interest can participate in advisory committee meetings; however, the process has been controversial. Federal law requires the FDA to disclose the type, nature, and magnitude of the conflict on its Web site.

The draft guidance can be viewed at www.fda.gov/downloads/RegulatoryInformation/Guidances/UCM209201.pdf

Filling Slots Takes 6 Months

Recruiters took an average 180 days to fill an internal medicine or family medicine physician position in 2008, according to the Medical Group Management Association. Since this was the first time MGMA collected such data, it's not clear how 2008 compared to previous years, an MGMA spokesperson said. The cost of filling positions in these and other specialties declined, which the group attributed to the economic downturn and a marked increase in the use of Internet job boards in recruiting. The time to fill positions in nonmetropolitan areas, where the impact of the primary care shortage is greatest, was longer than that needed in large population centers, according to MGMA.

On-Call Pay for Primary Care

More than 43% of primary care providers received some form of additional compensation for on-call coverage, according to another MGMA survey. Family practitioners with and without OB/GYN coverage earned between $100 and $110 per day and $588 on holidays, MGMA said, while internists earned about $200 per day. In comparison, general surgeons earned $905 per day and $3,000 on holidays, the group said. Almost half of nonsurgical specialists responding to the MGMA survey reported no additional compensation for their on-call coverage, while nearly three-fourths of surgery specialists were compensated for on-call services.

Push for FDA Drug Enforcement

Two minority advocacy groups are urging the Food and Drug Administration to work harder to remove unapproved drugs from the market. The National Minority Quality Forum and MANA, a national Hispanic-American organization, both asked the FDA to push harder on its unapproved drug initiative, launched in 2006. MANA said that only 400 of what could be thousands of unapproved drugs have been removed from the market since 2006, and NMQF warned that patients and physicians may not know that some drugs are unapproved. “These unapproved drugs, which have not been evaluated by FDA's rigorous approval process, may compromise the health of patients and create increased liability for the physicians who prescribe them,” the NMQF said in its letter.

CDC to States: Stop Smoking

The Centers for Disease Control and Prevention has urged a 50-state antismoking effort to reduce the more than 400,000 annual tobacco-related deaths in the United States, saying that if all states utilized proven strategies, smoking-related diseases, deaths, and costs could fall substantially. Worthwhile strategies include hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices, the CDC said in a report. Nearly one in five American deaths is caused by cigarette smoking, and reductions in adult and teen smoking rates have stalled since 2004, the CDC said. “This report shows that states know how to end the smoking epidemic,” Dr. Thomas R. Frieden, CDC director, said in a statement. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use.”

Chemical Reforms Introduced

After months of hearings, Sen. Frank Lautenberg (D-N.J.), chairman of a Senate environmental health subcommittee, has introduced legislation that would significantly strengthen federal enforcement powers over potentially toxic chemicals and their uses. The Safe Chemicals Act of 2010 would grant the Environmental Protection Agency additional powers to get safety information from chemical manufacturers, to categorize chemicals based on risk, and to remove dangerous chemicals from the market. Laws governing chemical regulation have not been updated in 34 years and currently give the EPA little regulatory authority, according to the group Health Care Without Harm. “The EPA has been able to require comprehensive testing on just 200 of the more than 80,000 chemicals produced and used in the U.S., and only five chemical groups have been regulated under this law,” the group said in a statement.

Liability Fund Shift Was Illegal

Pennsylvania should not have sought help from state budget difficulties by diverting funds from compensation of victims of medical malpractice, the state's Commonwealth Court ruled in two separate cases. Between 2003 and 2007, Pennsylvania officials failed to transfer up to $616 million to a fund that pays malpractice awards beyond what health providers' insurance covers. The state also wrongly transferred $100 million from the fund to the state's general fund, the court found. The Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania filed the two lawsuits, arguing that the money was intended to control the cost of malpractice coverage. State officials have said they will appeal the two decisions.

Filling Slots Takes 6 Months

Recruiters took an average 180 days to fill an internal medicine or family medicine physician position in 2008, according to the Medical Group Management Association. Since this was the first time MGMA collected such data, it's not clear how 2008 compared to previous years, an MGMA spokesperson said. The cost of filling positions in these and other specialties declined, which the group attributed to the economic downturn and a marked increase in the use of Internet job boards in recruiting. The time to fill positions in nonmetropolitan areas, where the impact of the primary care shortage is greatest, was longer than that needed in large population centers, according to MGMA.

On-Call Pay for Primary Care

More than 43% of primary care providers received some form of additional compensation for on-call coverage, according to another MGMA survey. Family practitioners with and without OB/GYN coverage earned between $100 and $110 per day and $588 on holidays, MGMA said, while internists earned about $200 per day. In comparison, general surgeons earned $905 per day and $3,000 on holidays, the group said. Almost half of nonsurgical specialists responding to the MGMA survey reported no additional compensation for their on-call coverage, while nearly three-fourths of surgery specialists were compensated for on-call services.

Push for FDA Drug Enforcement

Two minority advocacy groups are urging the Food and Drug Administration to work harder to remove unapproved drugs from the market. The National Minority Quality Forum and MANA, a national Hispanic-American organization, both asked the FDA to push harder on its unapproved drug initiative, launched in 2006. MANA said that only 400 of what could be thousands of unapproved drugs have been removed from the market since 2006, and NMQF warned that patients and physicians may not know that some drugs are unapproved. “These unapproved drugs, which have not been evaluated by FDA's rigorous approval process, may compromise the health of patients and create increased liability for the physicians who prescribe them,” the NMQF said in its letter.

CDC to States: Stop Smoking

The Centers for Disease Control and Prevention has urged a 50-state antismoking effort to reduce the more than 400,000 annual tobacco-related deaths in the United States, saying that if all states utilized proven strategies, smoking-related diseases, deaths, and costs could fall substantially. Worthwhile strategies include hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices, the CDC said in a report. Nearly one in five American deaths is caused by cigarette smoking, and reductions in adult and teen smoking rates have stalled since 2004, the CDC said. “This report shows that states know how to end the smoking epidemic,” Dr. Thomas R. Frieden, CDC director, said in a statement. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use.”

Chemical Reforms Introduced

After months of hearings, Sen. Frank Lautenberg (D-N.J.), chairman of a Senate environmental health subcommittee, has introduced legislation that would significantly strengthen federal enforcement powers over potentially toxic chemicals and their uses. The Safe Chemicals Act of 2010 would grant the Environmental Protection Agency additional powers to get safety information from chemical manufacturers, to categorize chemicals based on risk, and to remove dangerous chemicals from the market. Laws governing chemical regulation have not been updated in 34 years and currently give the EPA little regulatory authority, according to the group Health Care Without Harm. “The EPA has been able to require comprehensive testing on just 200 of the more than 80,000 chemicals produced and used in the U.S., and only five chemical groups have been regulated under this law,” the group said in a statement.

Liability Fund Shift Was Illegal

Pennsylvania should not have sought help from state budget difficulties by diverting funds from compensation of victims of medical malpractice, the state's Commonwealth Court ruled in two separate cases. Between 2003 and 2007, Pennsylvania officials failed to transfer up to $616 million to a fund that pays malpractice awards beyond what health providers' insurance covers. The state also wrongly transferred $100 million from the fund to the state's general fund, the court found. The Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania filed the two lawsuits, arguing that the money was intended to control the cost of malpractice coverage. State officials have said they will appeal the two decisions.

Filling Slots Takes 6 Months

Recruiters took an average 180 days to fill an internal medicine or family medicine physician position in 2008, according to the Medical Group Management Association. Since this was the first time MGMA collected such data, it's not clear how 2008 compared to previous years, an MGMA spokesperson said. The cost of filling positions in these and other specialties declined, which the group attributed to the economic downturn and a marked increase in the use of Internet job boards in recruiting. The time to fill positions in nonmetropolitan areas, where the impact of the primary care shortage is greatest, was longer than that needed in large population centers, according to MGMA.

On-Call Pay for Primary Care

More than 43% of primary care providers received some form of additional compensation for on-call coverage, according to another MGMA survey. Family practitioners with and without OB/GYN coverage earned between $100 and $110 per day and $588 on holidays, MGMA said, while internists earned about $200 per day. In comparison, general surgeons earned $905 per day and $3,000 on holidays, the group said. Almost half of nonsurgical specialists responding to the MGMA survey reported no additional compensation for their on-call coverage, while nearly three-fourths of surgery specialists were compensated for on-call services.

Push for FDA Drug Enforcement

Two minority advocacy groups are urging the Food and Drug Administration to work harder to remove unapproved drugs from the market. The National Minority Quality Forum and MANA, a national Hispanic-American organization, both asked the FDA to push harder on its unapproved drug initiative, launched in 2006. MANA said that only 400 of what could be thousands of unapproved drugs have been removed from the market since 2006, and NMQF warned that patients and physicians may not know that some drugs are unapproved. “These unapproved drugs, which have not been evaluated by FDA's rigorous approval process, may compromise the health of patients and create increased liability for the physicians who prescribe them,” the NMQF said in its letter.

CDC to States: Stop Smoking

The Centers for Disease Control and Prevention has urged a 50-state antismoking effort to reduce the more than 400,000 annual tobacco-related deaths in the United States, saying that if all states utilized proven strategies, smoking-related diseases, deaths, and costs could fall substantially. Worthwhile strategies include hard-hitting education and media campaigns, smoke-free air laws, and higher cigarette prices, the CDC said in a report. Nearly one in five American deaths is caused by cigarette smoking, and reductions in adult and teen smoking rates have stalled since 2004, the CDC said. “This report shows that states know how to end the smoking epidemic,” Dr. Thomas R. Frieden, CDC director, said in a statement. “Smoke-free laws, hard-hitting ads, and higher cigarette prices are among our strongest weapons in this fight against tobacco use.”

Chemical Reforms Introduced

After months of hearings, Sen. Frank Lautenberg (D-N.J.), chairman of a Senate environmental health subcommittee, has introduced legislation that would significantly strengthen federal enforcement powers over potentially toxic chemicals and their uses. The Safe Chemicals Act of 2010 would grant the Environmental Protection Agency additional powers to get safety information from chemical manufacturers, to categorize chemicals based on risk, and to remove dangerous chemicals from the market. Laws governing chemical regulation have not been updated in 34 years and currently give the EPA little regulatory authority, according to the group Health Care Without Harm. “The EPA has been able to require comprehensive testing on just 200 of the more than 80,000 chemicals produced and used in the U.S., and only five chemical groups have been regulated under this law,” the group said in a statement.

Liability Fund Shift Was Illegal

Pennsylvania should not have sought help from state budget difficulties by diverting funds from compensation of victims of medical malpractice, the state's Commonwealth Court ruled in two separate cases. Between 2003 and 2007, Pennsylvania officials failed to transfer up to $616 million to a fund that pays malpractice awards beyond what health providers' insurance covers. The state also wrongly transferred $100 million from the fund to the state's general fund, the court found. The Pennsylvania Medical Society and the Hospital and Health System Association of Pennsylvania filed the two lawsuits, arguing that the money was intended to control the cost of malpractice coverage. State officials have said they will appeal the two decisions.

Major Finding: Risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up.

Data Source: More than 30,000 heart failure patients from 225 hospitals.

Disclosures: Study was supported by grants from the American Heart Association, GlaxoSmithKline, Medtronic, and the Agency for Healthcare Research and Quality. The authors reported a variety of financial support, research grants, consulting arrangements and honoraria from drug manufacturers, other health care companies, and nonprofit organizations.

Heart failure patients discharged from hospitals with high levels of early postdischarge follow-up are less likely to be readmitted to the hospital within 30 days, according to a new study.

However, most heart failure patients do not visit a physician within 7 days of discharge (JAMA 2010;303:1716-22).

The study, which looked at hospital-level rates of early outpatient follow-up after discharge, included data on more than 30,000 heart failure patients from 225 hospitals. It found that the median rate of follow-up within 7 days of discharge was 38%.

“For patients with heart failure, the transition from inpatient to outpatient care can be an especially vulnerable period because of the age of the patients, complex medical regimens, the large number of comorbid conditions, and the multiple clinicians who may be involved,” wrote Dr. Adrian F. Hernandez of Duke University, Durham, N.C., and his coauthors. “Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings.”

Overall, about 21% of heart failure patients were readmitted to the hospital within 30 days of discharge. Patients in hospitals with higher rates of early follow-up had a lower risk of readmission, the study found.

After adjustment for case mix, admission laboratory results, provision of discharge instructions, and length of stay, the risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up, the study found. Whereas 20% of patients whose initial hospital stay took place in a hospital with the highest rates of early follow-up were readmitted, 23% of patients in the hospitals with the lowest follow-up rates were readmitted, a significant difference.

Still, the authors only found differences in rehospitalization rates in the hospitals that ranked in the lowest quartile of posthospitalization follow-up; rates at the other 75% of hospitals were similar.

The researchers did find some racial differences: The proportion of black patients was “markedly higher” among hospitals with the lowest rates of early follow-up.

They also found that patients discharged from hospitals with the highest rates of early follow-up by a cardiologist had lower risk of 30-day mortality, which they noted is consistent with other studies of cardiology care for heart failure.

Most follow-up during the transitional period, especially during the first week, is handled by general internists, the study authors found. More than two-thirds of patients hospitalized for heart failure are evaluated by a cardiologist during their inpatient stays, but fewer than 10% see a cardiologist within 7 days of hospital discharge.

However, neither early follow-up with a cardiologist nor continuity of care from the same physician seen during the hospitalization was a significant predictor of 30-day readmission, they wrote.

Documentation of discharge instructions, which many physicians presume helps to ensure early follow-up and better outcomes, also was not associated with lower readmission rates. “This finding raises the possibility that discharge instructions are becoming rote processes that do not adequately address elements of care that ensure a safe transition,” the authors wrote.

The study provides evidence in support of guidelines recommending the use of postdischarge systems of care, the authors said. “Achieving early follow-up may be difficult for some physician practices, but models of care that include nurse practitioners or physician assistants under physician supervision may result in increased access to and timeliness of care.”

In addition, they said, early follow-up is a potential quality measure that could be used as part of heart failure performance measure sets.

Major Finding: Risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up.

Data Source: More than 30,000 heart failure patients from 225 hospitals.

Disclosures: Study was supported by grants from the American Heart Association, GlaxoSmithKline, Medtronic, and the Agency for Healthcare Research and Quality. The authors reported a variety of financial support, research grants, consulting arrangements and honoraria from drug manufacturers, other health care companies, and nonprofit organizations.

Heart failure patients discharged from hospitals with high levels of early postdischarge follow-up are less likely to be readmitted to the hospital within 30 days, according to a new study.

However, most heart failure patients do not visit a physician within 7 days of discharge (JAMA 2010;303:1716-22).

The study, which looked at hospital-level rates of early outpatient follow-up after discharge, included data on more than 30,000 heart failure patients from 225 hospitals. It found that the median rate of follow-up within 7 days of discharge was 38%.

“For patients with heart failure, the transition from inpatient to outpatient care can be an especially vulnerable period because of the age of the patients, complex medical regimens, the large number of comorbid conditions, and the multiple clinicians who may be involved,” wrote Dr. Adrian F. Hernandez of Duke University, Durham, N.C., and his coauthors. “Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings.”

Overall, about 21% of heart failure patients were readmitted to the hospital within 30 days of discharge. Patients in hospitals with higher rates of early follow-up had a lower risk of readmission, the study found.

After adjustment for case mix, admission laboratory results, provision of discharge instructions, and length of stay, the risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up, the study found. Whereas 20% of patients whose initial hospital stay took place in a hospital with the highest rates of early follow-up were readmitted, 23% of patients in the hospitals with the lowest follow-up rates were readmitted, a significant difference.

Still, the authors only found differences in rehospitalization rates in the hospitals that ranked in the lowest quartile of posthospitalization follow-up; rates at the other 75% of hospitals were similar.

The researchers did find some racial differences: The proportion of black patients was “markedly higher” among hospitals with the lowest rates of early follow-up.

They also found that patients discharged from hospitals with the highest rates of early follow-up by a cardiologist had lower risk of 30-day mortality, which they noted is consistent with other studies of cardiology care for heart failure.

Most follow-up during the transitional period, especially during the first week, is handled by general internists, the study authors found. More than two-thirds of patients hospitalized for heart failure are evaluated by a cardiologist during their inpatient stays, but fewer than 10% see a cardiologist within 7 days of hospital discharge.

However, neither early follow-up with a cardiologist nor continuity of care from the same physician seen during the hospitalization was a significant predictor of 30-day readmission, they wrote.

Documentation of discharge instructions, which many physicians presume helps to ensure early follow-up and better outcomes, also was not associated with lower readmission rates. “This finding raises the possibility that discharge instructions are becoming rote processes that do not adequately address elements of care that ensure a safe transition,” the authors wrote.

The study provides evidence in support of guidelines recommending the use of postdischarge systems of care, the authors said. “Achieving early follow-up may be difficult for some physician practices, but models of care that include nurse practitioners or physician assistants under physician supervision may result in increased access to and timeliness of care.”

In addition, they said, early follow-up is a potential quality measure that could be used as part of heart failure performance measure sets.

Major Finding: Risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up.

Data Source: More than 30,000 heart failure patients from 225 hospitals.

Disclosures: Study was supported by grants from the American Heart Association, GlaxoSmithKline, Medtronic, and the Agency for Healthcare Research and Quality. The authors reported a variety of financial support, research grants, consulting arrangements and honoraria from drug manufacturers, other health care companies, and nonprofit organizations.

Heart failure patients discharged from hospitals with high levels of early postdischarge follow-up are less likely to be readmitted to the hospital within 30 days, according to a new study.

However, most heart failure patients do not visit a physician within 7 days of discharge (JAMA 2010;303:1716-22).

The study, which looked at hospital-level rates of early outpatient follow-up after discharge, included data on more than 30,000 heart failure patients from 225 hospitals. It found that the median rate of follow-up within 7 days of discharge was 38%.

“For patients with heart failure, the transition from inpatient to outpatient care can be an especially vulnerable period because of the age of the patients, complex medical regimens, the large number of comorbid conditions, and the multiple clinicians who may be involved,” wrote Dr. Adrian F. Hernandez of Duke University, Durham, N.C., and his coauthors. “Our findings highlight a need for improvement and greater uniformity in coordination of care from inpatient to outpatient settings.”

Overall, about 21% of heart failure patients were readmitted to the hospital within 30 days of discharge. Patients in hospitals with higher rates of early follow-up had a lower risk of readmission, the study found.

After adjustment for case mix, admission laboratory results, provision of discharge instructions, and length of stay, the risk-adjusted hazard of 30-day readmission was 15% lower in the hospitals with higher rates of early follow-up, the study found. Whereas 20% of patients whose initial hospital stay took place in a hospital with the highest rates of early follow-up were readmitted, 23% of patients in the hospitals with the lowest follow-up rates were readmitted, a significant difference.

Still, the authors only found differences in rehospitalization rates in the hospitals that ranked in the lowest quartile of posthospitalization follow-up; rates at the other 75% of hospitals were similar.

The researchers did find some racial differences: The proportion of black patients was “markedly higher” among hospitals with the lowest rates of early follow-up.

They also found that patients discharged from hospitals with the highest rates of early follow-up by a cardiologist had lower risk of 30-day mortality, which they noted is consistent with other studies of cardiology care for heart failure.

Most follow-up during the transitional period, especially during the first week, is handled by general internists, the study authors found. More than two-thirds of patients hospitalized for heart failure are evaluated by a cardiologist during their inpatient stays, but fewer than 10% see a cardiologist within 7 days of hospital discharge.

However, neither early follow-up with a cardiologist nor continuity of care from the same physician seen during the hospitalization was a significant predictor of 30-day readmission, they wrote.

Documentation of discharge instructions, which many physicians presume helps to ensure early follow-up and better outcomes, also was not associated with lower readmission rates. “This finding raises the possibility that discharge instructions are becoming rote processes that do not adequately address elements of care that ensure a safe transition,” the authors wrote.

The study provides evidence in support of guidelines recommending the use of postdischarge systems of care, the authors said. “Achieving early follow-up may be difficult for some physician practices, but models of care that include nurse practitioners or physician assistants under physician supervision may result in increased access to and timeliness of care.”

In addition, they said, early follow-up is a potential quality measure that could be used as part of heart failure performance measure sets.