Jane Anderson

The Institute of Medicine recommended adding eight preventive health services, including birth control and emergency contraception, screening for gestational diabetes, and testing for human papillomavirus, to the list of preventive services that health plans must provide at no cost to patients under the health care reform law that will take full effect in 2014.

In a report released July 19, the IOM said that each of the eight services identified by IOM committee members is critical to ensure "women’s optimal health and well-being." Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

"Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay," said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles.

In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, "It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures."

According to the IOM, the eight preventive services for women that health plans should cover at no cost to patients include:

• Screening for gestational diabetes.

• Human papillomavirus testing as part of cervical cancer screening for women more than 30 years old.

• Counseling on sexually transmitted infections.

• Counseling and screening for HIV.

• Contraceptive methods and counseling to prevent unintended pregnancies.

• Lactation counseling and equipment to promote breastfeeding.

• Screening and counseling to detect and prevent interpersonal and domestic violence.

• Yearly well-woman preventive care visits to obtain recommended preventive services.

HHS Secretary Kathleen Sebelius will issue the final decision on which preventive services will be covered by insurance plans under health care reform. According to Dr. Rosenstock, Ms. Sebelius may decide by Aug. 1 which services on the IOM-recommended list to include.

Of course, many health care plans currently provide coverage for these services, Dr. Rosenstock noted, adding, "This is just a recommendation for first-dollar coverage."

The Patient Protection and Affordable Care Act of 2010 will require health plans to provide first-dollar coverage for the preventive services listed in HHS’ comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women’s health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women. At the request of HHS officials, an IOM committee made up of women’s health experts, headed by Dr. Rosenstock, identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group’s charge also required members to consider only services provided in clinical settings, even though "preventive services can be effective when provided in settings outside the physician’s office," she said.

The report backs up each of the committee’s recommendations with the science behind it. For example, it notes that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women’s preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urges HHS to consider adding the full range of Food and Drug Administration–approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This would include emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report goes further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

The Institute of Medicine recommended adding eight preventive health services, including birth control and emergency contraception, screening for gestational diabetes, and testing for human papillomavirus, to the list of preventive services that health plans must provide at no cost to patients under the health care reform law that will take full effect in 2014.

In a report released July 19, the IOM said that each of the eight services identified by IOM committee members is critical to ensure "women’s optimal health and well-being." Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

"Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay," said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles.

In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, "It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures."

According to the IOM, the eight preventive services for women that health plans should cover at no cost to patients include:

• Screening for gestational diabetes.

• Human papillomavirus testing as part of cervical cancer screening for women more than 30 years old.

• Counseling on sexually transmitted infections.

• Counseling and screening for HIV.

• Contraceptive methods and counseling to prevent unintended pregnancies.

• Lactation counseling and equipment to promote breastfeeding.

• Screening and counseling to detect and prevent interpersonal and domestic violence.

• Yearly well-woman preventive care visits to obtain recommended preventive services.

HHS Secretary Kathleen Sebelius will issue the final decision on which preventive services will be covered by insurance plans under health care reform. According to Dr. Rosenstock, Ms. Sebelius may decide by Aug. 1 which services on the IOM-recommended list to include.

Of course, many health care plans currently provide coverage for these services, Dr. Rosenstock noted, adding, "This is just a recommendation for first-dollar coverage."

The Patient Protection and Affordable Care Act of 2010 will require health plans to provide first-dollar coverage for the preventive services listed in HHS’ comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women’s health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women. At the request of HHS officials, an IOM committee made up of women’s health experts, headed by Dr. Rosenstock, identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group’s charge also required members to consider only services provided in clinical settings, even though "preventive services can be effective when provided in settings outside the physician’s office," she said.

The report backs up each of the committee’s recommendations with the science behind it. For example, it notes that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women’s preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urges HHS to consider adding the full range of Food and Drug Administration–approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This would include emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report goes further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

The Institute of Medicine recommended adding eight preventive health services, including birth control and emergency contraception, screening for gestational diabetes, and testing for human papillomavirus, to the list of preventive services that health plans must provide at no cost to patients under the health care reform law that will take full effect in 2014.

In a report released July 19, the IOM said that each of the eight services identified by IOM committee members is critical to ensure "women’s optimal health and well-being." Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

"Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay," said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles.

In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, "It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures."

According to the IOM, the eight preventive services for women that health plans should cover at no cost to patients include:

• Screening for gestational diabetes.

• Human papillomavirus testing as part of cervical cancer screening for women more than 30 years old.

• Counseling on sexually transmitted infections.

• Counseling and screening for HIV.

• Contraceptive methods and counseling to prevent unintended pregnancies.

• Lactation counseling and equipment to promote breastfeeding.

• Screening and counseling to detect and prevent interpersonal and domestic violence.

• Yearly well-woman preventive care visits to obtain recommended preventive services.

HHS Secretary Kathleen Sebelius will issue the final decision on which preventive services will be covered by insurance plans under health care reform. According to Dr. Rosenstock, Ms. Sebelius may decide by Aug. 1 which services on the IOM-recommended list to include.

Of course, many health care plans currently provide coverage for these services, Dr. Rosenstock noted, adding, "This is just a recommendation for first-dollar coverage."

The Patient Protection and Affordable Care Act of 2010 will require health plans to provide first-dollar coverage for the preventive services listed in HHS’ comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women’s health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women. At the request of HHS officials, an IOM committee made up of women’s health experts, headed by Dr. Rosenstock, identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group’s charge also required members to consider only services provided in clinical settings, even though "preventive services can be effective when provided in settings outside the physician’s office," she said.

The report backs up each of the committee’s recommendations with the science behind it. For example, it notes that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women’s preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urges HHS to consider adding the full range of Food and Drug Administration–approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This would include emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report goes further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

Fight Fat, Clinicians Urged

To curb childhood obesity, health care providers should monitor weight and height as part of every well-child visit, and should teach parents how to increase their children's' physical activity and decrease sedentary behavior, according to a report from the Institute of Medicine. The report also urges pediatricians to encourage breastfeeding and provide guidance on healthy eating strategies for children. In addition, health care providers should counsel parents on limiting television and other media use, including banning televisions and other media devices from young children's bedrooms. The IOM report also details steps that policy makers and federal programs can take to curb early childhood obesity.

Doctors Sue Over Gun Law

The Florida Chapter of the American Academy of Pediatrics has sued Florida Gov. Rick Scott (R) and other state officials in federal court to overturn the new state law that restricts physicians from talking to their patients about gun ownership. The lawsuit, which includes two other physician groups and several individual physicians, says the law violates the First Amendment right to free speech. A health care provider could lose a license to practice and be fined for discussing firearm safety or putting an entry about it a patient's health record. A medical board would have to determine that the information was irrelevant or “unnecessarily harassing.” Florida Pediatric Society President Lisa Cosgrove said in a statement that pediatricians have the responsibility to discuss with patients the “scientifically proven risks to children posed by guns in the home.” With eight children and teens killed by guns every day in the United States, “restricting the ability of pediatricians to fully discuss the significant risks posed by guns is dangerous and a violation of the standard of care we as physicians owe our patients,” she said.

Children's Weight Is Unchecked

About 58% of pediatricians and family physicians fail to track children's weight over time and to provide counseling on weight-related issues when appropriate, according to a survey conducted by federal researchers. Only 18% of physicians caring for children reported referring overweight or obese patients for further evaluation and management. Pediatricians were slightly more likely than family physicians to assess weight status and to provide related counseling, according to the study published in the American Journal of Preventive Medicine and conducted by scientists at the National Institutes of Health and the Centers for Disease Control and Prevention.

Brain Testing Offered Free

The Scottsdale, Ariz.–based Mayo Clinic says it will offer free baseline concussion testing to more than 100,000 high school student athletes statewide. The Computerized Cognitive Assessment Tool, which measures how the brain is working before injury, can be taken over the Internet. Following a concussion, the patient can take the test again – several times, if necessary – to help a physician determine when the student-athlete can return to play safely, according to the Mayo Clinic. A new Arizona state law bars injured high school athletes from play until cleared by a licensed health care provider. The law also requires schools to educate coaches, students, and parents about the dangers of concussions.

Pediatricians' Income Grew Little

Pediatricians and adolescent medicine specialists earned a median income of $192,148 in 2010, an increase of just 0.39% from 2009, according to the Medical Group Management Association's annual survey on physician compensation. During the 4 years from 2006 to 2010, the child-and-adolescent doctors gained slightly more than 10.3% in income, the survey found. However, with the figures adjusted for inflation, the doctors gained only 1.97% for 2006-2010 and lost 1.23% for 2009-2010, the group found. Although pediatrics was the only primary care specialty to lose inflation-adjusted income last year, family practice and general internal medicine physicians failed to gain much ground, seeing growth of only 1.28% and 2.53% last year, respectively.

Fight Fat, Clinicians Urged

To curb childhood obesity, health care providers should monitor weight and height as part of every well-child visit, and should teach parents how to increase their children's' physical activity and decrease sedentary behavior, according to a report from the Institute of Medicine. The report also urges pediatricians to encourage breastfeeding and provide guidance on healthy eating strategies for children. In addition, health care providers should counsel parents on limiting television and other media use, including banning televisions and other media devices from young children's bedrooms. The IOM report also details steps that policy makers and federal programs can take to curb early childhood obesity.

Doctors Sue Over Gun Law

The Florida Chapter of the American Academy of Pediatrics has sued Florida Gov. Rick Scott (R) and other state officials in federal court to overturn the new state law that restricts physicians from talking to their patients about gun ownership. The lawsuit, which includes two other physician groups and several individual physicians, says the law violates the First Amendment right to free speech. A health care provider could lose a license to practice and be fined for discussing firearm safety or putting an entry about it a patient's health record. A medical board would have to determine that the information was irrelevant or “unnecessarily harassing.” Florida Pediatric Society President Lisa Cosgrove said in a statement that pediatricians have the responsibility to discuss with patients the “scientifically proven risks to children posed by guns in the home.” With eight children and teens killed by guns every day in the United States, “restricting the ability of pediatricians to fully discuss the significant risks posed by guns is dangerous and a violation of the standard of care we as physicians owe our patients,” she said.

Children's Weight Is Unchecked

About 58% of pediatricians and family physicians fail to track children's weight over time and to provide counseling on weight-related issues when appropriate, according to a survey conducted by federal researchers. Only 18% of physicians caring for children reported referring overweight or obese patients for further evaluation and management. Pediatricians were slightly more likely than family physicians to assess weight status and to provide related counseling, according to the study published in the American Journal of Preventive Medicine and conducted by scientists at the National Institutes of Health and the Centers for Disease Control and Prevention.

Brain Testing Offered Free

The Scottsdale, Ariz.–based Mayo Clinic says it will offer free baseline concussion testing to more than 100,000 high school student athletes statewide. The Computerized Cognitive Assessment Tool, which measures how the brain is working before injury, can be taken over the Internet. Following a concussion, the patient can take the test again – several times, if necessary – to help a physician determine when the student-athlete can return to play safely, according to the Mayo Clinic. A new Arizona state law bars injured high school athletes from play until cleared by a licensed health care provider. The law also requires schools to educate coaches, students, and parents about the dangers of concussions.

Pediatricians' Income Grew Little

Pediatricians and adolescent medicine specialists earned a median income of $192,148 in 2010, an increase of just 0.39% from 2009, according to the Medical Group Management Association's annual survey on physician compensation. During the 4 years from 2006 to 2010, the child-and-adolescent doctors gained slightly more than 10.3% in income, the survey found. However, with the figures adjusted for inflation, the doctors gained only 1.97% for 2006-2010 and lost 1.23% for 2009-2010, the group found. Although pediatrics was the only primary care specialty to lose inflation-adjusted income last year, family practice and general internal medicine physicians failed to gain much ground, seeing growth of only 1.28% and 2.53% last year, respectively.

Fight Fat, Clinicians Urged

To curb childhood obesity, health care providers should monitor weight and height as part of every well-child visit, and should teach parents how to increase their children's' physical activity and decrease sedentary behavior, according to a report from the Institute of Medicine. The report also urges pediatricians to encourage breastfeeding and provide guidance on healthy eating strategies for children. In addition, health care providers should counsel parents on limiting television and other media use, including banning televisions and other media devices from young children's bedrooms. The IOM report also details steps that policy makers and federal programs can take to curb early childhood obesity.

Doctors Sue Over Gun Law

The Florida Chapter of the American Academy of Pediatrics has sued Florida Gov. Rick Scott (R) and other state officials in federal court to overturn the new state law that restricts physicians from talking to their patients about gun ownership. The lawsuit, which includes two other physician groups and several individual physicians, says the law violates the First Amendment right to free speech. A health care provider could lose a license to practice and be fined for discussing firearm safety or putting an entry about it a patient's health record. A medical board would have to determine that the information was irrelevant or “unnecessarily harassing.” Florida Pediatric Society President Lisa Cosgrove said in a statement that pediatricians have the responsibility to discuss with patients the “scientifically proven risks to children posed by guns in the home.” With eight children and teens killed by guns every day in the United States, “restricting the ability of pediatricians to fully discuss the significant risks posed by guns is dangerous and a violation of the standard of care we as physicians owe our patients,” she said.

Children's Weight Is Unchecked

About 58% of pediatricians and family physicians fail to track children's weight over time and to provide counseling on weight-related issues when appropriate, according to a survey conducted by federal researchers. Only 18% of physicians caring for children reported referring overweight or obese patients for further evaluation and management. Pediatricians were slightly more likely than family physicians to assess weight status and to provide related counseling, according to the study published in the American Journal of Preventive Medicine and conducted by scientists at the National Institutes of Health and the Centers for Disease Control and Prevention.

Brain Testing Offered Free

The Scottsdale, Ariz.–based Mayo Clinic says it will offer free baseline concussion testing to more than 100,000 high school student athletes statewide. The Computerized Cognitive Assessment Tool, which measures how the brain is working before injury, can be taken over the Internet. Following a concussion, the patient can take the test again – several times, if necessary – to help a physician determine when the student-athlete can return to play safely, according to the Mayo Clinic. A new Arizona state law bars injured high school athletes from play until cleared by a licensed health care provider. The law also requires schools to educate coaches, students, and parents about the dangers of concussions.

Pediatricians' Income Grew Little

Pediatricians and adolescent medicine specialists earned a median income of $192,148 in 2010, an increase of just 0.39% from 2009, according to the Medical Group Management Association's annual survey on physician compensation. During the 4 years from 2006 to 2010, the child-and-adolescent doctors gained slightly more than 10.3% in income, the survey found. However, with the figures adjusted for inflation, the doctors gained only 1.97% for 2006-2010 and lost 1.23% for 2009-2010, the group found. Although pediatrics was the only primary care specialty to lose inflation-adjusted income last year, family practice and general internal medicine physicians failed to gain much ground, seeing growth of only 1.28% and 2.53% last year, respectively.

Youth Have Most Sports Concussions

More than 90% of emergency visits for sports-related concussions occur among children and young adults to age 23, according to the Agency for Healthcare Research and Quality. High-school-aged children, 14–18 years old, made up 58% of all such hospital emergency department visits in 2008, and middle-school-aged children, 11–13 years, made up another 17%. More than three-quarters of the patients treated for the condition were male. Only about 4% of the emergency cases led to hospital admissions.

AAD Affirms Sunscreen Message

Sunscreens are a safe and effective way to protect against the damaging effects of ultraviolet radiation, the American Academy of Dermatology reiterated in a public statement. “Scientific evidence supports the benefits of sunscreen usage to minimize short- and long-term damage to the skin from UV radiation and outweighs any unproven claims of toxicity or human health hazard,” said academy President Ronald Moy. That places the AAD at odds with the Environmental Working Group, an advocacy organization that said in its annual report on sunscreens that consumers can trust only 20% of the 1,700 products it surveyed for the 2011 summer season. Most sunscreens on the market currently offer inadequate protection against UV-A type radiation, the group said, and many contain chemicals that can disrupt children's and teens' endocrine systems.

Antibiotics Prescribed for Asthma

Potentially unnecessary antibiotics are prescribed during nearly one out of six pediatric ambulatory care visits for asthma, a study of nationwide survey data shows. Prescriptions in asthma cases without a documented coexisting bacterial infection account for about 1 million extra prescriptions per year, the researchers asserted in Pediatrics. Physicians may be prescribing these extra antibiotics because of diagnostic uncertainty, undocumented comorbid conditions, or prophylaxis of secondary infections. Doctors also may be attempting to capitalize on the anti-inflammatory properties of macrolide antibiotics, which included about half of those prescribed without indications.

Teen Drinking, Surfing Linked

Teens who drink alcohol spend more recreational time on their computers than other teens, according to a survey of 264 children aged 13–17 years. Drinking correlated with more frequent social networking and listening to and downloading music, according to the report in the journal Addictive Behaviors. The researchers found no link between teen drinking and computer use for schoolwork. Author Dr. Jennifer Epstein of Weill Cornell Medical College, New York, said in a statement that “it seems likely that adolescents are experimenting with drinking and activities on the Internet. In turn, exposure to online material such as alcohol advertising or alcohol-using peers on social networking sites could reinforce teens' drinking.”

Fake Antibiotics Found

Several Texas children, mainly Hispanic, have been treated at an Austin hospital after being given medications falsely advertised as antibiotics and sold as dietary supplements under Spanish names similar to the names of real antibiotics, according to the Texas Department of State Health Services. The products have been sold as dietary supplements under names such as Amoxilina, Pentrexcillina, Ampitrexyl, Citricillin, Amoximiel, and Pentreximil, and the products' labeling falsely suggests that they are antibiotics, the department said. The products – including capsules, ointments, and liquids – don't seem to have active drug ingredients and are not approved to treat health conditions, according to the department.

McDonald's: Ronald Is Golden

McDonald's Corp. will continue to use mascot Ronald McDonald to advertise Happy Meals to children, despite calls for the fast food giant to cut the clown to help reduce childhood obesity, company CEO Jim Skinner told a shareholders' meeting. Mr. Skinner spoke in answer to a challenge by Donald Zeigler, Ph.D., the American Medical Association's director of prevention and healthy lifestyles, in a statement presented at the meeting. “Changing course now and ending marketing to kids … would have a profound impact on McDonald's reputation and the health and well-being of generations to come throughout the world,” Dr. Zeigler said. Mr. Skinner countered that the marketing strategy has yielded profits. “This is about the personal and individual right to choose,” he said.

You Too Can Fight Obesity

The nonprofit group National Initiative for Children's Healthcare Quality has begun recruiting community teams to its Healthy Weight Collaborative to fight obesity, a program funded by $5 million from the Affordable Care Act's prevention fund. In the first phase, the group is recruiting 10 teams that can be made up of physicians and public health leaders. The second phase, to launch in December, will include about 40 more teams that are to help “develop practical approaches that link primary care, public health, and communities to prevent and treat obesity for children and families, according to the initiative's website.

Youth Have Most Sports Concussions

More than 90% of emergency visits for sports-related concussions occur among children and young adults to age 23, according to the Agency for Healthcare Research and Quality. High-school-aged children, 14–18 years old, made up 58% of all such hospital emergency department visits in 2008, and middle-school-aged children, 11–13 years, made up another 17%. More than three-quarters of the patients treated for the condition were male. Only about 4% of the emergency cases led to hospital admissions.

AAD Affirms Sunscreen Message

Sunscreens are a safe and effective way to protect against the damaging effects of ultraviolet radiation, the American Academy of Dermatology reiterated in a public statement. “Scientific evidence supports the benefits of sunscreen usage to minimize short- and long-term damage to the skin from UV radiation and outweighs any unproven claims of toxicity or human health hazard,” said academy President Ronald Moy. That places the AAD at odds with the Environmental Working Group, an advocacy organization that said in its annual report on sunscreens that consumers can trust only 20% of the 1,700 products it surveyed for the 2011 summer season. Most sunscreens on the market currently offer inadequate protection against UV-A type radiation, the group said, and many contain chemicals that can disrupt children's and teens' endocrine systems.

Antibiotics Prescribed for Asthma

Potentially unnecessary antibiotics are prescribed during nearly one out of six pediatric ambulatory care visits for asthma, a study of nationwide survey data shows. Prescriptions in asthma cases without a documented coexisting bacterial infection account for about 1 million extra prescriptions per year, the researchers asserted in Pediatrics. Physicians may be prescribing these extra antibiotics because of diagnostic uncertainty, undocumented comorbid conditions, or prophylaxis of secondary infections. Doctors also may be attempting to capitalize on the anti-inflammatory properties of macrolide antibiotics, which included about half of those prescribed without indications.

Teen Drinking, Surfing Linked

Teens who drink alcohol spend more recreational time on their computers than other teens, according to a survey of 264 children aged 13–17 years. Drinking correlated with more frequent social networking and listening to and downloading music, according to the report in the journal Addictive Behaviors. The researchers found no link between teen drinking and computer use for schoolwork. Author Dr. Jennifer Epstein of Weill Cornell Medical College, New York, said in a statement that “it seems likely that adolescents are experimenting with drinking and activities on the Internet. In turn, exposure to online material such as alcohol advertising or alcohol-using peers on social networking sites could reinforce teens' drinking.”

Fake Antibiotics Found

Several Texas children, mainly Hispanic, have been treated at an Austin hospital after being given medications falsely advertised as antibiotics and sold as dietary supplements under Spanish names similar to the names of real antibiotics, according to the Texas Department of State Health Services. The products have been sold as dietary supplements under names such as Amoxilina, Pentrexcillina, Ampitrexyl, Citricillin, Amoximiel, and Pentreximil, and the products' labeling falsely suggests that they are antibiotics, the department said. The products – including capsules, ointments, and liquids – don't seem to have active drug ingredients and are not approved to treat health conditions, according to the department.

McDonald's: Ronald Is Golden

McDonald's Corp. will continue to use mascot Ronald McDonald to advertise Happy Meals to children, despite calls for the fast food giant to cut the clown to help reduce childhood obesity, company CEO Jim Skinner told a shareholders' meeting. Mr. Skinner spoke in answer to a challenge by Donald Zeigler, Ph.D., the American Medical Association's director of prevention and healthy lifestyles, in a statement presented at the meeting. “Changing course now and ending marketing to kids … would have a profound impact on McDonald's reputation and the health and well-being of generations to come throughout the world,” Dr. Zeigler said. Mr. Skinner countered that the marketing strategy has yielded profits. “This is about the personal and individual right to choose,” he said.

You Too Can Fight Obesity

The nonprofit group National Initiative for Children's Healthcare Quality has begun recruiting community teams to its Healthy Weight Collaborative to fight obesity, a program funded by $5 million from the Affordable Care Act's prevention fund. In the first phase, the group is recruiting 10 teams that can be made up of physicians and public health leaders. The second phase, to launch in December, will include about 40 more teams that are to help “develop practical approaches that link primary care, public health, and communities to prevent and treat obesity for children and families, according to the initiative's website.

Youth Have Most Sports Concussions

More than 90% of emergency visits for sports-related concussions occur among children and young adults to age 23, according to the Agency for Healthcare Research and Quality. High-school-aged children, 14–18 years old, made up 58% of all such hospital emergency department visits in 2008, and middle-school-aged children, 11–13 years, made up another 17%. More than three-quarters of the patients treated for the condition were male. Only about 4% of the emergency cases led to hospital admissions.

AAD Affirms Sunscreen Message

Sunscreens are a safe and effective way to protect against the damaging effects of ultraviolet radiation, the American Academy of Dermatology reiterated in a public statement. “Scientific evidence supports the benefits of sunscreen usage to minimize short- and long-term damage to the skin from UV radiation and outweighs any unproven claims of toxicity or human health hazard,” said academy President Ronald Moy. That places the AAD at odds with the Environmental Working Group, an advocacy organization that said in its annual report on sunscreens that consumers can trust only 20% of the 1,700 products it surveyed for the 2011 summer season. Most sunscreens on the market currently offer inadequate protection against UV-A type radiation, the group said, and many contain chemicals that can disrupt children's and teens' endocrine systems.

Antibiotics Prescribed for Asthma

Potentially unnecessary antibiotics are prescribed during nearly one out of six pediatric ambulatory care visits for asthma, a study of nationwide survey data shows. Prescriptions in asthma cases without a documented coexisting bacterial infection account for about 1 million extra prescriptions per year, the researchers asserted in Pediatrics. Physicians may be prescribing these extra antibiotics because of diagnostic uncertainty, undocumented comorbid conditions, or prophylaxis of secondary infections. Doctors also may be attempting to capitalize on the anti-inflammatory properties of macrolide antibiotics, which included about half of those prescribed without indications.

Teen Drinking, Surfing Linked

Teens who drink alcohol spend more recreational time on their computers than other teens, according to a survey of 264 children aged 13–17 years. Drinking correlated with more frequent social networking and listening to and downloading music, according to the report in the journal Addictive Behaviors. The researchers found no link between teen drinking and computer use for schoolwork. Author Dr. Jennifer Epstein of Weill Cornell Medical College, New York, said in a statement that “it seems likely that adolescents are experimenting with drinking and activities on the Internet. In turn, exposure to online material such as alcohol advertising or alcohol-using peers on social networking sites could reinforce teens' drinking.”

Fake Antibiotics Found

Several Texas children, mainly Hispanic, have been treated at an Austin hospital after being given medications falsely advertised as antibiotics and sold as dietary supplements under Spanish names similar to the names of real antibiotics, according to the Texas Department of State Health Services. The products have been sold as dietary supplements under names such as Amoxilina, Pentrexcillina, Ampitrexyl, Citricillin, Amoximiel, and Pentreximil, and the products' labeling falsely suggests that they are antibiotics, the department said. The products – including capsules, ointments, and liquids – don't seem to have active drug ingredients and are not approved to treat health conditions, according to the department.

McDonald's: Ronald Is Golden

McDonald's Corp. will continue to use mascot Ronald McDonald to advertise Happy Meals to children, despite calls for the fast food giant to cut the clown to help reduce childhood obesity, company CEO Jim Skinner told a shareholders' meeting. Mr. Skinner spoke in answer to a challenge by Donald Zeigler, Ph.D., the American Medical Association's director of prevention and healthy lifestyles, in a statement presented at the meeting. “Changing course now and ending marketing to kids … would have a profound impact on McDonald's reputation and the health and well-being of generations to come throughout the world,” Dr. Zeigler said. Mr. Skinner countered that the marketing strategy has yielded profits. “This is about the personal and individual right to choose,” he said.

You Too Can Fight Obesity

The nonprofit group National Initiative for Children's Healthcare Quality has begun recruiting community teams to its Healthy Weight Collaborative to fight obesity, a program funded by $5 million from the Affordable Care Act's prevention fund. In the first phase, the group is recruiting 10 teams that can be made up of physicians and public health leaders. The second phase, to launch in December, will include about 40 more teams that are to help “develop practical approaches that link primary care, public health, and communities to prevent and treat obesity for children and families, according to the initiative's website.

Nearly half of all Medicare beneficiaries receive screening colonoscopies more frequently than current guidelines recommend, while older adults with the best life expectancy were less likely to experience a negative effect on their health from fecal occult blood testing, indicating that clinicians could better target use of that test.

Together, those findings from two studies published May 9 in Archives of Internal Medicine suggest that "there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive," noted Dr. Patrick G. O’Malley, chief of internal medicine at Walter Reed Army Medical Center, Washington, noted in an accompanying editorial (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.198]).

"Many questions about proper processes, who to screen, when to stop screening, and what defines the proper interval for screening have not been adequately studied," Dr. O’Malley said.

No guidelines recommend a colonoscopy screening interval of fewer than 10 years after a negative examination result, but Dr. James S. Goodwin and his colleagues at the University of Texas Medical Branch, Galveston, found that many patients are undergoing screening colonoscopies at much shorter intervals than once every decade.

The researchers examined a 5% national sample of Medicare beneficiaries from 2000 through 2008 to identify average-risk patients who underwent screening colonoscopy and then followed those with a negative screening result for the next 7 years (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.212]).

Among 24,071 beneficiaries who had a negative screening result, 46% underwent screening colonoscopy again within 7 years, they found. In 43% of those patients, the records showed no clear indication for the early repeated examination.

When broken down by age, 46% of patients aged 75-79 years received repeat colonoscopies within the study period, as did a third of those 80 years and older.

Men, patients with more comorbidities, and those treated by high-volume colonoscopists or in an office setting received early repeat examinations more often without a clear reason, the researchers found.

They also found marked geographic variations, with more than 50% of patients in some regions receiving a repeat exam within 7 years, while fewer than 5% of patients in other areas received repeat exams in that time frame.

Overall, more than 57% of the repeat colonoscopies performed during the study period were tagged with a diagnosis that might indicate a legitimate reason for the early examination, the researchers wrote.

But they also noted an "inflection point" at 60 months, where only about 38% of the colonoscopies performed were accompanied by a potentially explanatory diagnosis.

"The rapid increase in colonoscopies in the period around 60 months suggests that those might have been routinely scheduled," the researchers wrote.

Even though Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative screening result, only 2% of the claims for nonindicated, early repeat colonoscopies were denied, the researchers found.

In the second study, Dr. Christine E. Kistler of the University of North Carolina at Chapel Hill and her colleagues looked at long-term outcomes following a positive fecal occult blood test (FOBT) in 212 adults aged 70 years and older who were treated at four Veteran Affairs facilities.

They found that 56% of those patients received follow-up colonoscopies, which revealed 34 significant adenomas and 6 cancers. One in 10 patients experienced complications from the colonoscopy or from their cancer treatments (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.206]).

Meanwhile, 46% of those without follow-up colonoscopy died of other causes within 5 years of their positive FOBT results, while three died of colon cancer within 5 years.

The researchers calculated the net survival benefit from FOBT screening along with the potential burdens, which can include complications from additional testing and/or treatment. Previous trials of FOBT suggest that a person needs a life expectancy of at least 5 years to derive survival benefits from screening; if that person isn’t expected to live 5 years or more, then he or she only risks the potential burdens.

Dr. Kistler and her associates found that 87% of those with the worst life expectancy experienced a negative burden from screening, as did 70% of those with average life expectancy and 65% of those with the best life expectancy. This negative burden could be reduced by better targeting FOBT screening and follow-up to healthy older adults, they said.

"Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates," the study concluded.

The authors of both studies reported no financial conflicts of interest. The screening colonoscopy study was supported by grants from several federal agencies, including the National Institute on Aging and the National Cancer Institute. The FOBT study was supported by grants from the National Institutes of Health and the Cancer Prevention and Research Institute of Texas, Austin.

Nearly half of all Medicare beneficiaries receive screening colonoscopies more frequently than current guidelines recommend, while older adults with the best life expectancy were less likely to experience a negative effect on their health from fecal occult blood testing, indicating that clinicians could better target use of that test.

Together, those findings from two studies published May 9 in Archives of Internal Medicine suggest that "there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive," noted Dr. Patrick G. O’Malley, chief of internal medicine at Walter Reed Army Medical Center, Washington, noted in an accompanying editorial (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.198]).

"Many questions about proper processes, who to screen, when to stop screening, and what defines the proper interval for screening have not been adequately studied," Dr. O’Malley said.

No guidelines recommend a colonoscopy screening interval of fewer than 10 years after a negative examination result, but Dr. James S. Goodwin and his colleagues at the University of Texas Medical Branch, Galveston, found that many patients are undergoing screening colonoscopies at much shorter intervals than once every decade.

The researchers examined a 5% national sample of Medicare beneficiaries from 2000 through 2008 to identify average-risk patients who underwent screening colonoscopy and then followed those with a negative screening result for the next 7 years (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.212]).

Among 24,071 beneficiaries who had a negative screening result, 46% underwent screening colonoscopy again within 7 years, they found. In 43% of those patients, the records showed no clear indication for the early repeated examination.

When broken down by age, 46% of patients aged 75-79 years received repeat colonoscopies within the study period, as did a third of those 80 years and older.

Men, patients with more comorbidities, and those treated by high-volume colonoscopists or in an office setting received early repeat examinations more often without a clear reason, the researchers found.

They also found marked geographic variations, with more than 50% of patients in some regions receiving a repeat exam within 7 years, while fewer than 5% of patients in other areas received repeat exams in that time frame.

Overall, more than 57% of the repeat colonoscopies performed during the study period were tagged with a diagnosis that might indicate a legitimate reason for the early examination, the researchers wrote.

But they also noted an "inflection point" at 60 months, where only about 38% of the colonoscopies performed were accompanied by a potentially explanatory diagnosis.

"The rapid increase in colonoscopies in the period around 60 months suggests that those might have been routinely scheduled," the researchers wrote.

Even though Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative screening result, only 2% of the claims for nonindicated, early repeat colonoscopies were denied, the researchers found.

In the second study, Dr. Christine E. Kistler of the University of North Carolina at Chapel Hill and her colleagues looked at long-term outcomes following a positive fecal occult blood test (FOBT) in 212 adults aged 70 years and older who were treated at four Veteran Affairs facilities.

They found that 56% of those patients received follow-up colonoscopies, which revealed 34 significant adenomas and 6 cancers. One in 10 patients experienced complications from the colonoscopy or from their cancer treatments (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.206]).

Meanwhile, 46% of those without follow-up colonoscopy died of other causes within 5 years of their positive FOBT results, while three died of colon cancer within 5 years.

The researchers calculated the net survival benefit from FOBT screening along with the potential burdens, which can include complications from additional testing and/or treatment. Previous trials of FOBT suggest that a person needs a life expectancy of at least 5 years to derive survival benefits from screening; if that person isn’t expected to live 5 years or more, then he or she only risks the potential burdens.

Dr. Kistler and her associates found that 87% of those with the worst life expectancy experienced a negative burden from screening, as did 70% of those with average life expectancy and 65% of those with the best life expectancy. This negative burden could be reduced by better targeting FOBT screening and follow-up to healthy older adults, they said.

"Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates," the study concluded.

The authors of both studies reported no financial conflicts of interest. The screening colonoscopy study was supported by grants from several federal agencies, including the National Institute on Aging and the National Cancer Institute. The FOBT study was supported by grants from the National Institutes of Health and the Cancer Prevention and Research Institute of Texas, Austin.

Nearly half of all Medicare beneficiaries receive screening colonoscopies more frequently than current guidelines recommend, while older adults with the best life expectancy were less likely to experience a negative effect on their health from fecal occult blood testing, indicating that clinicians could better target use of that test.

Together, those findings from two studies published May 9 in Archives of Internal Medicine suggest that "there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive," noted Dr. Patrick G. O’Malley, chief of internal medicine at Walter Reed Army Medical Center, Washington, noted in an accompanying editorial (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.198]).

"Many questions about proper processes, who to screen, when to stop screening, and what defines the proper interval for screening have not been adequately studied," Dr. O’Malley said.

No guidelines recommend a colonoscopy screening interval of fewer than 10 years after a negative examination result, but Dr. James S. Goodwin and his colleagues at the University of Texas Medical Branch, Galveston, found that many patients are undergoing screening colonoscopies at much shorter intervals than once every decade.

The researchers examined a 5% national sample of Medicare beneficiaries from 2000 through 2008 to identify average-risk patients who underwent screening colonoscopy and then followed those with a negative screening result for the next 7 years (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.212]).

Among 24,071 beneficiaries who had a negative screening result, 46% underwent screening colonoscopy again within 7 years, they found. In 43% of those patients, the records showed no clear indication for the early repeated examination.

When broken down by age, 46% of patients aged 75-79 years received repeat colonoscopies within the study period, as did a third of those 80 years and older.

Men, patients with more comorbidities, and those treated by high-volume colonoscopists or in an office setting received early repeat examinations more often without a clear reason, the researchers found.

They also found marked geographic variations, with more than 50% of patients in some regions receiving a repeat exam within 7 years, while fewer than 5% of patients in other areas received repeat exams in that time frame.

Overall, more than 57% of the repeat colonoscopies performed during the study period were tagged with a diagnosis that might indicate a legitimate reason for the early examination, the researchers wrote.

But they also noted an "inflection point" at 60 months, where only about 38% of the colonoscopies performed were accompanied by a potentially explanatory diagnosis.

"The rapid increase in colonoscopies in the period around 60 months suggests that those might have been routinely scheduled," the researchers wrote.

Even though Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative screening result, only 2% of the claims for nonindicated, early repeat colonoscopies were denied, the researchers found.

In the second study, Dr. Christine E. Kistler of the University of North Carolina at Chapel Hill and her colleagues looked at long-term outcomes following a positive fecal occult blood test (FOBT) in 212 adults aged 70 years and older who were treated at four Veteran Affairs facilities.

They found that 56% of those patients received follow-up colonoscopies, which revealed 34 significant adenomas and 6 cancers. One in 10 patients experienced complications from the colonoscopy or from their cancer treatments (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.206]).

Meanwhile, 46% of those without follow-up colonoscopy died of other causes within 5 years of their positive FOBT results, while three died of colon cancer within 5 years.

The researchers calculated the net survival benefit from FOBT screening along with the potential burdens, which can include complications from additional testing and/or treatment. Previous trials of FOBT suggest that a person needs a life expectancy of at least 5 years to derive survival benefits from screening; if that person isn’t expected to live 5 years or more, then he or she only risks the potential burdens.

Dr. Kistler and her associates found that 87% of those with the worst life expectancy experienced a negative burden from screening, as did 70% of those with average life expectancy and 65% of those with the best life expectancy. This negative burden could be reduced by better targeting FOBT screening and follow-up to healthy older adults, they said.

"Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates," the study concluded.

The authors of both studies reported no financial conflicts of interest. The screening colonoscopy study was supported by grants from several federal agencies, including the National Institute on Aging and the National Cancer Institute. The FOBT study was supported by grants from the National Institutes of Health and the Cancer Prevention and Research Institute of Texas, Austin.

Nearly half of all Medicare beneficiaries receive screening colonoscopies more frequently than current guidelines recommend, while older adults with the best life expectancy were less likely to experience a negative effect on their health from fecal occult blood testing, indicating that clinicians could better target use of that test.

Together, those findings from two studies published May 9 in Archives of Internal Medicine suggest that "there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive," noted Dr. Patrick G. O’Malley, chief of internal medicine at Walter Reed Army Medical Center, Washington, noted in an accompanying editorial (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.198]).

"Many questions about proper processes, who to screen, when to stop screening, and what defines the proper interval for screening have not been adequately studied," Dr. O’Malley said.

No guidelines recommend a colonoscopy screening interval of fewer than 10 years after a negative examination result, but Dr. James S. Goodwin and his colleagues at the University of Texas Medical Branch, Galveston, found that many patients are undergoing screening colonoscopies at much shorter intervals than once every decade.

The researchers examined a 5% national sample of Medicare beneficiaries from 2000 through 2008 to identify average-risk patients who underwent screening colonoscopy and then followed those with a negative screening result for the next 7 years (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.212]).

Among 24,071 beneficiaries who had a negative screening result, 46% underwent screening colonoscopy again within 7 years, they found. In 43% of those patients, the records showed no clear indication for the early repeated examination.

When broken down by age, 46% of patients aged 75-79 years received repeat colonoscopies within the study period, as did a third of those 80 years and older.

Men, patients with more comorbidities, and those treated by high-volume colonoscopists or in an office setting received early repeat examinations more often without a clear reason, the researchers found.

They also found marked geographic variations, with more than 50% of patients in some regions receiving a repeat exam within 7 years, while fewer than 5% of patients in other areas received repeat exams in that time frame.

Overall, more than 57% of the repeat colonoscopies performed during the study period were tagged with a diagnosis that might indicate a legitimate reason for the early examination, the researchers wrote.

But they also noted an "inflection point" at 60 months, where only about 38% of the colonoscopies performed were accompanied by a potentially explanatory diagnosis.

"The rapid increase in colonoscopies in the period around 60 months suggests that those might have been routinely scheduled," the researchers wrote.

Even though Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative screening result, only 2% of the claims for nonindicated, early repeat colonoscopies were denied, the researchers found.

In the second study, Dr. Christine E. Kistler of the University of North Carolina at Chapel Hill and her colleagues looked at long-term outcomes following a positive fecal occult blood test (FOBT) in 212 adults aged 70 years and older who were treated at four Veteran Affairs facilities.

They found that 56% of those patients received follow-up colonoscopies, which revealed 34 significant adenomas and 6 cancers. One in 10 patients experienced complications from the colonoscopy or from their cancer treatments (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.206]).

Meanwhile, 46% of those without follow-up colonoscopy died of other causes within 5 years of their positive FOBT results, while three died of colon cancer within 5 years.

The researchers calculated the net survival benefit from FOBT screening along with the potential burdens, which can include complications from additional testing and/or treatment. Previous trials of FOBT suggest that a person needs a life expectancy of at least 5 years to derive survival benefits from screening; if that person isn’t expected to live 5 years or more, then he or she only risks the potential burdens.

Dr. Kistler and her associates found that 87% of those with the worst life expectancy experienced a negative burden from screening, as did 70% of those with average life expectancy and 65% of those with the best life expectancy. This negative burden could be reduced by better targeting FOBT screening and follow-up to healthy older adults, they said.

"Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates," the study concluded.

The authors of both studies reported no financial conflicts of interest. The screening colonoscopy study was supported by grants from several federal agencies, including the National Institute on Aging and the National Cancer Institute. The FOBT study was supported by grants from the National Institutes of Health and the Cancer Prevention and Research Institute of Texas, Austin.

Nearly half of all Medicare beneficiaries receive screening colonoscopies more frequently than current guidelines recommend, while older adults with the best life expectancy were less likely to experience a negative effect on their health from fecal occult blood testing, indicating that clinicians could better target use of that test.

Together, those findings from two studies published May 9 in Archives of Internal Medicine suggest that "there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive," noted Dr. Patrick G. O’Malley, chief of internal medicine at Walter Reed Army Medical Center, Washington, noted in an accompanying editorial (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.198]).

"Many questions about proper processes, who to screen, when to stop screening, and what defines the proper interval for screening have not been adequately studied," Dr. O’Malley said.

No guidelines recommend a colonoscopy screening interval of fewer than 10 years after a negative examination result, but Dr. James S. Goodwin and his colleagues at the University of Texas Medical Branch, Galveston, found that many patients are undergoing screening colonoscopies at much shorter intervals than once every decade.

The researchers examined a 5% national sample of Medicare beneficiaries from 2000 through 2008 to identify average-risk patients who underwent screening colonoscopy and then followed those with a negative screening result for the next 7 years (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.212]).

Among 24,071 beneficiaries who had a negative screening result, 46% underwent screening colonoscopy again within 7 years, they found. In 43% of those patients, the records showed no clear indication for the early repeated examination.

When broken down by age, 46% of patients aged 75-79 years received repeat colonoscopies within the study period, as did a third of those 80 years and older.

Men, patients with more comorbidities, and those treated by high-volume colonoscopists or in an office setting received early repeat examinations more often without a clear reason, the researchers found.

They also found marked geographic variations, with more than 50% of patients in some regions receiving a repeat exam within 7 years, while fewer than 5% of patients in other areas received repeat exams in that time frame.

Overall, more than 57% of the repeat colonoscopies performed during the study period were tagged with a diagnosis that might indicate a legitimate reason for the early examination, the researchers wrote.

But they also noted an "inflection point" at 60 months, where only about 38% of the colonoscopies performed were accompanied by a potentially explanatory diagnosis.

"The rapid increase in colonoscopies in the period around 60 months suggests that those might have been routinely scheduled," the researchers wrote.

Even though Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative screening result, only 2% of the claims for nonindicated, early repeat colonoscopies were denied, the researchers found.

In the second study, Dr. Christine E. Kistler of the University of North Carolina at Chapel Hill and her colleagues looked at long-term outcomes following a positive fecal occult blood test (FOBT) in 212 adults aged 70 years and older who were treated at four Veteran Affairs facilities.

They found that 56% of those patients received follow-up colonoscopies, which revealed 34 significant adenomas and 6 cancers. One in 10 patients experienced complications from the colonoscopy or from their cancer treatments (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.206]).

Meanwhile, 46% of those without follow-up colonoscopy died of other causes within 5 years of their positive FOBT results, while three died of colon cancer within 5 years.

The researchers calculated the net survival benefit from FOBT screening along with the potential burdens, which can include complications from additional testing and/or treatment. Previous trials of FOBT suggest that a person needs a life expectancy of at least 5 years to derive survival benefits from screening; if that person isn’t expected to live 5 years or more, then he or she only risks the potential burdens.

Dr. Kistler and her associates found that 87% of those with the worst life expectancy experienced a negative burden from screening, as did 70% of those with average life expectancy and 65% of those with the best life expectancy. This negative burden could be reduced by better targeting FOBT screening and follow-up to healthy older adults, they said.

"Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates," the study concluded.

The authors of both studies reported no financial conflicts of interest. The screening colonoscopy study was supported by grants from several federal agencies, including the National Institute on Aging and the National Cancer Institute. The FOBT study was supported by grants from the National Institutes of Health and the Cancer Prevention and Research Institute of Texas, Austin.

Nearly half of all Medicare beneficiaries receive screening colonoscopies more frequently than current guidelines recommend, while older adults with the best life expectancy were less likely to experience a negative effect on their health from fecal occult blood testing, indicating that clinicians could better target use of that test.

Together, those findings from two studies published May 9 in Archives of Internal Medicine suggest that "there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive," noted Dr. Patrick G. O’Malley, chief of internal medicine at Walter Reed Army Medical Center, Washington, noted in an accompanying editorial (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.198]).

"Many questions about proper processes, who to screen, when to stop screening, and what defines the proper interval for screening have not been adequately studied," Dr. O’Malley said.

No guidelines recommend a colonoscopy screening interval of fewer than 10 years after a negative examination result, but Dr. James S. Goodwin and his colleagues at the University of Texas Medical Branch, Galveston, found that many patients are undergoing screening colonoscopies at much shorter intervals than once every decade.

The researchers examined a 5% national sample of Medicare beneficiaries from 2000 through 2008 to identify average-risk patients who underwent screening colonoscopy and then followed those with a negative screening result for the next 7 years (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.212]).

Among 24,071 beneficiaries who had a negative screening result, 46% underwent screening colonoscopy again within 7 years, they found. In 43% of those patients, the records showed no clear indication for the early repeated examination.

When broken down by age, 46% of patients aged 75-79 years received repeat colonoscopies within the study period, as did a third of those 80 years and older.

Men, patients with more comorbidities, and those treated by high-volume colonoscopists or in an office setting received early repeat examinations more often without a clear reason, the researchers found.

They also found marked geographic variations, with more than 50% of patients in some regions receiving a repeat exam within 7 years, while fewer than 5% of patients in other areas received repeat exams in that time frame.

Overall, more than 57% of the repeat colonoscopies performed during the study period were tagged with a diagnosis that might indicate a legitimate reason for the early examination, the researchers wrote.

But they also noted an "inflection point" at 60 months, where only about 38% of the colonoscopies performed were accompanied by a potentially explanatory diagnosis.

"The rapid increase in colonoscopies in the period around 60 months suggests that those might have been routinely scheduled," the researchers wrote.

Even though Medicare regulations preclude reimbursement for screening colonoscopy within 10 years of a negative screening result, only 2% of the claims for nonindicated, early repeat colonoscopies were denied, the researchers found.

In the second study, Dr. Christine E. Kistler of the University of North Carolina at Chapel Hill and her colleagues looked at long-term outcomes following a positive fecal occult blood test (FOBT) in 212 adults aged 70 years and older who were treated at four Veteran Affairs facilities.

They found that 56% of those patients received follow-up colonoscopies, which revealed 34 significant adenomas and 6 cancers. One in 10 patients experienced complications from the colonoscopy or from their cancer treatments (Arch. Intern. Med. 2011 May 9 [doi:10.1001/archinternmed.2011.206]).

Meanwhile, 46% of those without follow-up colonoscopy died of other causes within 5 years of their positive FOBT results, while three died of colon cancer within 5 years.

The researchers calculated the net survival benefit from FOBT screening along with the potential burdens, which can include complications from additional testing and/or treatment. Previous trials of FOBT suggest that a person needs a life expectancy of at least 5 years to derive survival benefits from screening; if that person isn’t expected to live 5 years or more, then he or she only risks the potential burdens.

Dr. Kistler and her associates found that 87% of those with the worst life expectancy experienced a negative burden from screening, as did 70% of those with average life expectancy and 65% of those with the best life expectancy. This negative burden could be reduced by better targeting FOBT screening and follow-up to healthy older adults, they said.

"Our study supports guidelines that recommend using life expectancy to guide colorectal cancer screening decisions in older adults and argues against one-size-fits-all interventions that simply aim to increase overall screening and follow-up rates," the study concluded.

The authors of both studies reported no financial conflicts of interest. The screening colonoscopy study was supported by grants from several federal agencies, including the National Institute on Aging and the National Cancer Institute. The FOBT study was supported by grants from the National Institutes of Health and the Cancer Prevention and Research Institute of Texas, Austin.

Hospitals and hospitalists should ex­pect more aggressive enforcement of protected health information reg­ulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which

********* TEXT BREAK *********HHS found had violated 41 patients’ rights by failing to provide them with ac­cess to their own medical records.

Dr. Chad Whelan, director of the di­vision of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforce­ment of HIPAA is coming.

<[stk -3.7]>“Given the large fines and the high-pro­file institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”<[etk]>

<[stk -3]>To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health infor­mation across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.<[etk]>

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share informa­tion,” he said. “The terrifying thing about computers, smartphones, and elec­tronic medical records is that [they make it] amazingly easy to store, access, and share information.

<[stk -1]>“Medical centers and hospitalists must be aware of this tension between im­proving care through information access and sharing and the risk to confidential­ity through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” he said.<[etk]>

<[stk -3]>Office of Civil Rights director Georgina Verdugo said as much in a statement in­volving the MassGen settlement. “We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA en­forcement. It is a covered entity’s respon­sibility to protect its patients’ health information,” Ms. Verdugo said.<[etk]>

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and in­cluded patients with HIV and AIDS, ac­cording to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying infor­mation such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the infor­mation on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating pro­visions of the HIPAA Privacy Rule.”

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to en­hance protection of protected health in­formation when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryp­tion and USB drive encryption.

“After these policies and procedures are issued, we will be providing manda­tory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that can cause trouble. “It is far more likely that a well-meaning employee simply forgets the ba­sics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer
hardware, such as hard drives, CDs, and laptops, he said. But “with the increased availability of electronic medical records, it will only become easier to have infor­mation about patients in portable for­mats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

<[stk -3]>The rise of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. “How many peo­ple have patient information stored or ac­cessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easi­ly accessed through a smartphone. Hos­pitals need to develop policies around encryption and support end users in en­crypting the multiple devices they may use to levels that are acceptable to HHS.”<[etk]>

I have checked the following facts in my story: (Please initial each.)

·Drug names and dosages n.a.

<[stk -3]>In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information man­agement, but also need to help employees make certain any data-storage or trans­mission devices they use are HIPAA-com­pliant, Dr. Whelan said. <[etk]>

<[stk -3]>“Hospitalists should be involved in both policy development and process imple­mentation to assure that the benefits of electronic data storage are not lost in or­der to reduce the risk of HIPAA viola­tion,” he added.

Hospitals and hospitalists should ex­pect more aggressive enforcement of protected health information reg­ulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which

********* TEXT BREAK *********HHS found had violated 41 patients’ rights by failing to provide them with ac­cess to their own medical records.

Dr. Chad Whelan, director of the di­vision of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforce­ment of HIPAA is coming.

<[stk -3.7]>“Given the large fines and the high-pro­file institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”<[etk]>

<[stk -3]>To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health infor­mation across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.<[etk]>

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share informa­tion,” he said. “The terrifying thing about computers, smartphones, and elec­tronic medical records is that [they make it] amazingly easy to store, access, and share information.

<[stk -1]>“Medical centers and hospitalists must be aware of this tension between im­proving care through information access and sharing and the risk to confidential­ity through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” he said.<[etk]>

<[stk -3]>Office of Civil Rights director Georgina Verdugo said as much in a statement in­volving the MassGen settlement. “We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA en­forcement. It is a covered entity’s respon­sibility to protect its patients’ health information,” Ms. Verdugo said.<[etk]>

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and in­cluded patients with HIV and AIDS, ac­cording to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying infor­mation such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the infor­mation on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating pro­visions of the HIPAA Privacy Rule.”

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to en­hance protection of protected health in­formation when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryp­tion and USB drive encryption.

“After these policies and procedures are issued, we will be providing manda­tory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that can cause trouble. “It is far more likely that a well-meaning employee simply forgets the ba­sics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer
hardware, such as hard drives, CDs, and laptops, he said. But “with the increased availability of electronic medical records, it will only become easier to have infor­mation about patients in portable for­mats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

<[stk -3]>The rise of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. “How many peo­ple have patient information stored or ac­cessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easi­ly accessed through a smartphone. Hos­pitals need to develop policies around encryption and support end users in en­crypting the multiple devices they may use to levels that are acceptable to HHS.”<[etk]>

I have checked the following facts in my story: (Please initial each.)

·Drug names and dosages n.a.

<[stk -3]>In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information man­agement, but also need to help employees make certain any data-storage or trans­mission devices they use are HIPAA-com­pliant, Dr. Whelan said. <[etk]>

<[stk -3]>“Hospitalists should be involved in both policy development and process imple­mentation to assure that the benefits of electronic data storage are not lost in or­der to reduce the risk of HIPAA viola­tion,” he added.

Hospitals and hospitalists should ex­pect more aggressive enforcement of protected health information reg­ulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which

********* TEXT BREAK *********HHS found had violated 41 patients’ rights by failing to provide them with ac­cess to their own medical records.

Dr. Chad Whelan, director of the di­vision of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforce­ment of HIPAA is coming.

<[stk -3.7]>“Given the large fines and the high-pro­file institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”<[etk]>

<[stk -3]>To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health infor­mation across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.<[etk]>

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share informa­tion,” he said. “The terrifying thing about computers, smartphones, and elec­tronic medical records is that [they make it] amazingly easy to store, access, and share information.

<[stk -1]>“Medical centers and hospitalists must be aware of this tension between im­proving care through information access and sharing and the risk to confidential­ity through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” he said.<[etk]>

<[stk -3]>Office of Civil Rights director Georgina Verdugo said as much in a statement in­volving the MassGen settlement. “We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA en­forcement. It is a covered entity’s respon­sibility to protect its patients’ health information,” Ms. Verdugo said.<[etk]>

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and in­cluded patients with HIV and AIDS, ac­cording to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying infor­mation such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the infor­mation on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating pro­visions of the HIPAA Privacy Rule.”

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to en­hance protection of protected health in­formation when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryp­tion and USB drive encryption.

“After these policies and procedures are issued, we will be providing manda­tory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that can cause trouble. “It is far more likely that a well-meaning employee simply forgets the ba­sics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer
hardware, such as hard drives, CDs, and laptops, he said. But “with the increased availability of electronic medical records, it will only become easier to have infor­mation about patients in portable for­mats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

<[stk -3]>The rise of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. “How many peo­ple have patient information stored or ac­cessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easi­ly accessed through a smartphone. Hos­pitals need to develop policies around encryption and support end users in en­crypting the multiple devices they may use to levels that are acceptable to HHS.”<[etk]>

I have checked the following facts in my story: (Please initial each.)

·Drug names and dosages n.a.

<[stk -3]>In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information man­agement, but also need to help employees make certain any data-storage or trans­mission devices they use are HIPAA-com­pliant, Dr. Whelan said. <[etk]>

<[stk -3]>“Hospitalists should be involved in both policy development and process imple­mentation to assure that the benefits of electronic data storage are not lost in or­der to reduce the risk of HIPAA viola­tion,” he added.

ADHD Drugs OK, for Now

The Food and Drug Administration said it has gotten preliminary results on the possible cardiovascular risks associated with medications for attention-deficit/hyperactivity disorder, but the agency isn't recommending any labeling changes – at least for now. “Because the review is ongoing, FDA does not recommend that patients, caregivers, or health care professionals change their use or prescribing patterns of stimulant medications for ADHD” in children or adults, the agency said in a statement. It noted that the drug labels and medication guides for stimulants already contain warnings about the risk of cardiovascular events. The agency left open the possibility that it will call for labeling changes once officials complete their analysis of the studies that the FDA commissioned.

Better Chemical Policy Sought

The American Academy of Pediatrics said the nation's current toxic-chemicals policy fails to protect children and pregnant women. The Toxic Substances Control Act hasn't been revised substantially since it was created in 1976, and only five chemicals or chemical classes have been regulated under it, the AAP said. Meanwhile, manufacturers have created and introduced tens of thousands of new chemicals. The law doesn't require chemical companies to perform testing or follow-up on any of their products and in fact discourages companies from producing such data. “These chemicals are found throughout the tissues and body fluids of children and adults alike, including blood, cord blood, and human milk,” the AAP said. It called for an overhaul of the law.

Medicaid IT Incentives Offered

The federal government will provide more money for states to develop and upgrade their information technology systems and help people enroll in Medicaid and the Children's Health Insurance Program, a Department of Health and Human Services statement said. The new policy will give states 90% of the cost of developing systems and 75% of ongoing operational costs, an increase over the previous federal matching rate of 50%. The boost should help states prepare for the 2014 Medicaid expansion and coordinate their Medicare programs with health insurance exchanges, both coming as provisions of the health care reform act that passed last year. The policy also establishes performance standards for the public-insurance programs to promote greater efficiency and more consumer-friendly enrollment processes.

New Anesthesiology Subspecialty

The American Board of Medical Specialties has approved a new subspecialty in pediatric anesthesiology, to be administered by the American Board of Anesthesiology. That board and the American Board of Pediatrics currently coadminister a 5-year training program in pediatrics and anesthesiology at four U.S. medical centers. For the new subspecialty, the two boards will create standards, approve new training programs, and develop an examination. Physicians who have practiced in the area of pediatric anesthesiology can take the examination and become certified without additional training.

Voluntary Ad Standards Released

The Obama administration has asked food manufacturers to voluntarily limit advertising aimed at children, especially for products high in sugar, saturated fat, and sodium. The proposed principles, available for public comment through June 13, say ads should encourage children to make healthier food choices, such as vegetables, fruit, and whole grains. Four agencies – the FDA, Federal Trade Commission, Centers for Disease Control and Prevention, and U.S. Department of Agriculture – issued the principles, and it's possible that one or more of those agencies could move to make them mandatory if food manufacturers fail to comply. The new document asks food manufacturers to curb unhealthy product ads by 2016. “To their credit, some of the leading companies are already reformulating products and rethinking marketing strategies to promote healthier foods to kids,” said FTC Chairman Jon Leibowitz in a statement. “This proposal encourages all food marketers to expand voluntary efforts to reduce kids' waistlines.”

Kids With Diabetes Cost More

Medical costs for children with diabetes are six times those of other children, according to the Centers for Disease Control and Prevention. Researchers studied administrative claim data for 50,000 children 19 years old or younger, 8,226 of whom had diabetes. The average annual medical costs in 2007 for those with diabetes was &dollar;9,061, compared with &dollar;1,468 for children without diabetes, CDC researchers reported in the May issue of Diabetes Care. Children who received insulin treatment had medical costs of &dollar;9,333, while children with diabetes but not getting insulin cost their families and private insurance companies &dollar;5,683. The authors attributed higher costs with diabetes to medication expenses, specialist visits, and supplies.

ADHD Drugs OK, for Now

The Food and Drug Administration said it has gotten preliminary results on the possible cardiovascular risks associated with medications for attention-deficit/hyperactivity disorder, but the agency isn't recommending any labeling changes – at least for now. “Because the review is ongoing, FDA does not recommend that patients, caregivers, or health care professionals change their use or prescribing patterns of stimulant medications for ADHD” in children or adults, the agency said in a statement. It noted that the drug labels and medication guides for stimulants already contain warnings about the risk of cardiovascular events. The agency left open the possibility that it will call for labeling changes once officials complete their analysis of the studies that the FDA commissioned.

Better Chemical Policy Sought

The American Academy of Pediatrics said the nation's current toxic-chemicals policy fails to protect children and pregnant women. The Toxic Substances Control Act hasn't been revised substantially since it was created in 1976, and only five chemicals or chemical classes have been regulated under it, the AAP said. Meanwhile, manufacturers have created and introduced tens of thousands of new chemicals. The law doesn't require chemical companies to perform testing or follow-up on any of their products and in fact discourages companies from producing such data. “These chemicals are found throughout the tissues and body fluids of children and adults alike, including blood, cord blood, and human milk,” the AAP said. It called for an overhaul of the law.

Medicaid IT Incentives Offered

The federal government will provide more money for states to develop and upgrade their information technology systems and help people enroll in Medicaid and the Children's Health Insurance Program, a Department of Health and Human Services statement said. The new policy will give states 90% of the cost of developing systems and 75% of ongoing operational costs, an increase over the previous federal matching rate of 50%. The boost should help states prepare for the 2014 Medicaid expansion and coordinate their Medicare programs with health insurance exchanges, both coming as provisions of the health care reform act that passed last year. The policy also establishes performance standards for the public-insurance programs to promote greater efficiency and more consumer-friendly enrollment processes.

New Anesthesiology Subspecialty

The American Board of Medical Specialties has approved a new subspecialty in pediatric anesthesiology, to be administered by the American Board of Anesthesiology. That board and the American Board of Pediatrics currently coadminister a 5-year training program in pediatrics and anesthesiology at four U.S. medical centers. For the new subspecialty, the two boards will create standards, approve new training programs, and develop an examination. Physicians who have practiced in the area of pediatric anesthesiology can take the examination and become certified without additional training.

Voluntary Ad Standards Released

The Obama administration has asked food manufacturers to voluntarily limit advertising aimed at children, especially for products high in sugar, saturated fat, and sodium. The proposed principles, available for public comment through June 13, say ads should encourage children to make healthier food choices, such as vegetables, fruit, and whole grains. Four agencies – the FDA, Federal Trade Commission, Centers for Disease Control and Prevention, and U.S. Department of Agriculture – issued the principles, and it's possible that one or more of those agencies could move to make them mandatory if food manufacturers fail to comply. The new document asks food manufacturers to curb unhealthy product ads by 2016. “To their credit, some of the leading companies are already reformulating products and rethinking marketing strategies to promote healthier foods to kids,” said FTC Chairman Jon Leibowitz in a statement. “This proposal encourages all food marketers to expand voluntary efforts to reduce kids' waistlines.”

Kids With Diabetes Cost More

Medical costs for children with diabetes are six times those of other children, according to the Centers for Disease Control and Prevention. Researchers studied administrative claim data for 50,000 children 19 years old or younger, 8,226 of whom had diabetes. The average annual medical costs in 2007 for those with diabetes was &dollar;9,061, compared with &dollar;1,468 for children without diabetes, CDC researchers reported in the May issue of Diabetes Care. Children who received insulin treatment had medical costs of &dollar;9,333, while children with diabetes but not getting insulin cost their families and private insurance companies &dollar;5,683. The authors attributed higher costs with diabetes to medication expenses, specialist visits, and supplies.

ADHD Drugs OK, for Now

The Food and Drug Administration said it has gotten preliminary results on the possible cardiovascular risks associated with medications for attention-deficit/hyperactivity disorder, but the agency isn't recommending any labeling changes – at least for now. “Because the review is ongoing, FDA does not recommend that patients, caregivers, or health care professionals change their use or prescribing patterns of stimulant medications for ADHD” in children or adults, the agency said in a statement. It noted that the drug labels and medication guides for stimulants already contain warnings about the risk of cardiovascular events. The agency left open the possibility that it will call for labeling changes once officials complete their analysis of the studies that the FDA commissioned.

Better Chemical Policy Sought

The American Academy of Pediatrics said the nation's current toxic-chemicals policy fails to protect children and pregnant women. The Toxic Substances Control Act hasn't been revised substantially since it was created in 1976, and only five chemicals or chemical classes have been regulated under it, the AAP said. Meanwhile, manufacturers have created and introduced tens of thousands of new chemicals. The law doesn't require chemical companies to perform testing or follow-up on any of their products and in fact discourages companies from producing such data. “These chemicals are found throughout the tissues and body fluids of children and adults alike, including blood, cord blood, and human milk,” the AAP said. It called for an overhaul of the law.

Medicaid IT Incentives Offered

The federal government will provide more money for states to develop and upgrade their information technology systems and help people enroll in Medicaid and the Children's Health Insurance Program, a Department of Health and Human Services statement said. The new policy will give states 90% of the cost of developing systems and 75% of ongoing operational costs, an increase over the previous federal matching rate of 50%. The boost should help states prepare for the 2014 Medicaid expansion and coordinate their Medicare programs with health insurance exchanges, both coming as provisions of the health care reform act that passed last year. The policy also establishes performance standards for the public-insurance programs to promote greater efficiency and more consumer-friendly enrollment processes.

New Anesthesiology Subspecialty

The American Board of Medical Specialties has approved a new subspecialty in pediatric anesthesiology, to be administered by the American Board of Anesthesiology. That board and the American Board of Pediatrics currently coadminister a 5-year training program in pediatrics and anesthesiology at four U.S. medical centers. For the new subspecialty, the two boards will create standards, approve new training programs, and develop an examination. Physicians who have practiced in the area of pediatric anesthesiology can take the examination and become certified without additional training.

Voluntary Ad Standards Released

The Obama administration has asked food manufacturers to voluntarily limit advertising aimed at children, especially for products high in sugar, saturated fat, and sodium. The proposed principles, available for public comment through June 13, say ads should encourage children to make healthier food choices, such as vegetables, fruit, and whole grains. Four agencies – the FDA, Federal Trade Commission, Centers for Disease Control and Prevention, and U.S. Department of Agriculture – issued the principles, and it's possible that one or more of those agencies could move to make them mandatory if food manufacturers fail to comply. The new document asks food manufacturers to curb unhealthy product ads by 2016. “To their credit, some of the leading companies are already reformulating products and rethinking marketing strategies to promote healthier foods to kids,” said FTC Chairman Jon Leibowitz in a statement. “This proposal encourages all food marketers to expand voluntary efforts to reduce kids' waistlines.”

Kids With Diabetes Cost More

Medical costs for children with diabetes are six times those of other children, according to the Centers for Disease Control and Prevention. Researchers studied administrative claim data for 50,000 children 19 years old or younger, 8,226 of whom had diabetes. The average annual medical costs in 2007 for those with diabetes was &dollar;9,061, compared with &dollar;1,468 for children without diabetes, CDC researchers reported in the May issue of Diabetes Care. Children who received insulin treatment had medical costs of &dollar;9,333, while children with diabetes but not getting insulin cost their families and private insurance companies &dollar;5,683. The authors attributed higher costs with diabetes to medication expenses, specialist visits, and supplies.

When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.

The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.

"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions" (Arch. Intern. Med. 2011;171:630-4).

The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.

In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.

The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.

The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.

"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.

When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.

In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.

The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.

That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.

As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.

It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.

However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.

The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.

When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.

The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.

"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions" (Arch. Intern. Med. 2011;171:630-4).

The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.

In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.

The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.

The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.

"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.

When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.

In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.

The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.

That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.

As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.

It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.

However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.

The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.

When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.

The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.

"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions" (Arch. Intern. Med. 2011;171:630-4).

The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.

In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.

The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.

The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.

"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.

When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.

In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.

The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.

That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.

As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.

It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.

However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.

The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.

When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.

The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.

"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions" (Arch. Intern. Med. 2011;171:630-4).

The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.

In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.

The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.

The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.

"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.

When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.

In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.

The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.

That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.

As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.

It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.

However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.

The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.

When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.

The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.

"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions" (Arch. Intern. Med. 2011;171:630-4).

The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.

In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.

The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.

The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.

"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.

When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.

In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.

The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.

That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.

As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.

It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.

However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.

The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.

When faced with decisions that involve life-threatening conditions and potentially life-altering treatments, many physicians would choose different treatments for themselves than they would recommend to patients, according to a study published April 11 in the Archives of Internal Medicine.

The results of the study, which involved hypothetical illnesses and treatment choices, indicate that the "very act of making a recommendation" changes the ways that physicians think about and weigh medical choices, explained Dr. Peter A. Ubel of Duke University, Durham, N.C., and his coauthors.

"When physicians make treatment recommendations, they think differently than when making decisions for themselves," the study said. "In some circumstances, making recommendations could reduce the quality of medical decisions. In at least some circumstances, however, such as when emotions interfere with optimal decision making, this change in thinking could lead to more optimal decisions" (Arch. Intern. Med. 2011;171:630-4).

The study’s authors chose two random samples of U.S.-based general internists and family medicine physicians and presented each with one of two hypothetical scenarios. In each scenario, one alternative offered a lower risk of mortality in exchange for a life-altering treatment complication.

In the first scenario, which involved a diagnosis of colon cancer, the 242 physicians surveyed each were offered a choice between two different surgeries. About half the physicians were told the choice was for them, while the other half had to choose what to recommend to a patient.

The first surgery would cure colon cancer without any complications in 80% of patients, while it would not cure the cancer in 16% of patients, leading to death within 2 years. The remaining 4% of patients would be cured of their colon cancer, but would experience one of four side effects: a colostomy, chronic diarrhea, intermittent bowel obstruction, or a wound infection.

The second surgery would cure colon cancer without complications in 80% of patients, while 20% of patients would not be cured and would die within 2 years.

"The best choice in this circumstance depends on the relative value a given patient places on avoiding these complications versus reducing his or her chance of death," the study said.

When asked which surgery they’d prefer for themselves, 37.8% chose the second procedure, with its higher mortality rate but lower risk of complications. When asked which procedure they’d recommend to patients, however, only 24.5% of the physicians surveyed recommended the second procedure.

In the second hypothetical scenario, 698 physicians were asked to choose between two situations potentially involving an immunoglobulin treatment for a hypothetical new strain of avian influenza. One group of physicians was asked to imagine that they had been infected with the virus, while the second group was asked to imagine that a patient had been infected.

The physicians were told that people who contracted the flu virus had a 10% death rate from the flu and a 30% hospitalization rate, with a 1-week average length of stay. Meanwhile, they also could choose a new immunoglobulin treatment for the avian flu.

That treatment had been tried out in several hundred volunteers in both Asia and Europe, and cut the chances of adverse events from the virus in half – meaning there would be a 5% death rate and a 15% hospitalization rate. However, the treatment would cause death in 1% of patients, along with permanent neurological paralysis – typically of the lower extremities – in 4% of patients.

As in the hypothetical colon cancer scenario, physicians presented with the avian flu scenario more often chose the treatment with a higher death rate for themselves: 62.9% chose to forgo the potentially lifesaving benefits of immunoglobulin treatment to avoid the adverse effects associated with that treatment. However, only 48.5% said they would recommend the immunoglobulin treatment for one of their patients who had contracted avian flu.

It’s obvious that the physicians in the study placed different weights on treatment outcomes when considering them for patients than they did when considering the various options for themselves, the study’s authors said. Physicians were less susceptible to psychological processes that potentially interfere with optimal decision-making when they made recommendations to hypothetical patients, the study said.

However, the study doesn’t suggest that physicians always make better, less-biased decisions for their patients than they would for themselves, the investigators wrote. "Indeed, the best choice in each of the two study scenarios is debatable," they said.

The study was funded by grants and awards from the National Institutes of Health, the American Cancer Society, the National Science Foundation, and the Robert Wood Johnson Foundation. The authors reported no disclosures.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.