When should doctors disclose their relationships with the wider medical industry?
By upholding the Patient Protection and Affordable Care Act, the Supreme Court has ensured that a host of other provisions and attached bills will go into effect. One that affects me personally is the Physician Payments Sunshine Act authored by Sen. Charles Grassley (R) and Herb Kohl (D). It's good legislation overall (If I was getting a knee replacement I'd want to know if my surgeon is a paid shill for the knee device she's implanting) but because the legislation offers no mechanism for doctors to explain themselves alongside the data, in many cases the Act will blow out a lot of suspicious smoke where there's no fire.
Every drug, device or medical supply company must report transfers of value that exceed $10 to the new federal database maintained by the Centers for Medicare and Medicaid Services (CMMS). Last month CMMS announced it's delaying implementation until January 2013 to allow it more time to create the needed infrastructure, but at least twelve companies are already reporting payments in a less uniform and streamlined fashion. A database maintained by ProPublica makes this data easy to search for interested citizens and health care reporters. The ProPublica database has raised important questions for academic medical centers replete with physicians who serve as pharmaceutical company spokespeople. But there are also cases where tight-lipped (or just busy) doctors see their motivations replaced by the reporter's innuendo of malfeasance. I think this genre of information-gap expose will spread like wildfire once Sunshine goes into full effect next year. The CMMS database, like ProPublica's, will list companies, doctors, dollar amounts and payment categories but no context.
"Our research shows hundreds of thousands of dollars in payments for everything from speaking, to travel, to meals from the very companies they could be prescribing to you," reports KOAA in Colorado Springs. The station went on to report from the only two doctors willing to defend themselves. The others "didn't want to talk about it."
Next year there'll be many more physicians in same situation as Dr. Madeleine Hernandez who found herself defending $355 in food she received over the course of a year from Pfizer. When the San Luis Obispo Tribune came calling her excuse went like this: "I don't care what they say or what they feed us -- if the product is not good, I will not use it."
Doctors everywhere had best recognize today that this information is coming to light tomorrow, and they'd better be pro-active in explaining their actions lest they get lumped together or singled out as examples of bad actors too cozy with industry.
As a doctor who sometimes writes about the medical-industrial complex I have a particular interest in holding onto both the reality and image of my own objectivity, but these relationships are everywhere; this is how American medicine works. It's not realistic for me, or in the best interests of my patients, to refuse every industry interaction. Recently I made tentative plans to attend an educational conference about a particular device that would benefit my patients, but I backed out when I realized my attendance would be reported as a gift from the company. Just last week I tried to log onto MerckMedicus.com, a website that offers free access to a few journals, medical news and a few other useful resources. I hadn't been to the site in a while and this time it prompted me to agree to have an educational gift from Merck reported. I clicked no. But at the same time I regularly use sites like Medscape and MedPageToday that are riddled with advertisements from companies like Merck. But because these third-party media companies stand between Merck and me, no reporting is required. If you surf these doctor-media sites you'll see there's no difference in the quality of the information (which often comes from third parties, like Reuters) whether the site as a whole is branded by Merck or Merck is buying a banner ad.
As far as I know, I don't currently show up in any physician payments database. But it's only a matter of time. One day I'll go ahead and click through to see a site like MerckMedicus.com. One day I'll attend the device seminar. I've been thinking about how and when I want to explain myself if somebody decides to inquire about the objectivity of my medical opinion. Will it be to the local paper, to ProPublica, or some other way, on my own terms?
Here's my idea.
Most practices (and individual docs) have websites. I propose that every private practice, hospital and clinic that's interested in how this information gets interpreted take the following measure this year. Simply create a web page called Physician Payments Sunshine Disclosure and update it with a running log of corporate interactions coupled with explanations. Are you consulting for a company? Tell your patients why you decided help that company. Did you attend a device company educational conference? How did this experience add to the care you give? Did you register for a pharmaceutical company educational website? What kind of information are you getting that might help your patients? Did a company support your research or provide free equipment to your clinic? Pro-actively tell the world why you made that choice, before ProPublica starts calling you.
Finally, if you find your explanations are getting a little too long and convoluted that's a good cue that it's time to re-think value of that industry relationship to yourself and your patients. Not everything will survive in the full glare of the sunlight the Supreme Court has forecast for next year.
Black poverty is fundamentally distinct from white poverty—and so cannot be addressed without grappling with racism.
There have been a number of useful entries in the weeks since Senator Bernie Sanders declared himself against reparations. Perhaps the most clarifying comes from Cedric Johnson in a piece entitled, “An Open Letter To Ta-Nehisi Coates And The Liberals Who Love Him.” Johnson’s essay offers those of us interested in the problem of white supremacy and the question of economic class the chance to tease out how, and where, these two problems intersect. In Johnson’s rendition, racism, in and of itself, holds limited explanatory power when looking at the socio-economic problems which beset African Americans. “We continue to reach for old modes of analysis in the face of a changed world,” writes Johnson. “One where blackness is still derogated but anti-black racism is not the principal determinant of material conditions and economic mobility for many African Americans.”
As Coldplay blandly strained for the universal, she and Bruno Mars pulled off something more specific and more daring.
What a perfect Beyoncésong name: “Formation.” All great pop involves people acting in formation. So does all great change. And while fans scream that Beyoncé’s a “queen” and “goddess,” her core appeal really is as a drill sergeant. With Beyoncé in command, greatness is scalable, achievable, for the collective. Everyone waves their hands to the same beat. Everyone walks around like they have hot sauce in their bag.
But in pop and in politics, “everyone” is a loaded term. Stars as ubiquitous as Beyoncé have haters, the “albino alligators” who “Formation” informs us she twirls upon. And in a more general historical sense, “everyone” can be a dangerous illusion that elevates one point of view as universal while minimizing others. Beyoncé gets all of this, it seems. As a pop star, she surely wants to have as broad a reach as possible. But as an artist, she has a specific message, born of a specific experience, meaningful to specific people. Rather than pretend otherwise, she’s going to make art about the tension implied by this dynamic. She’s going to show up to Super Bowl with a phalanx of women dressed as Black Panthers.
The former president’s heated assault on Bernie Sanders is a reminder of how the Clintons have long reacted to any opposition.
One of my oldest Hillary Clinton memories: Twenty-six years ago, I stood in the second-floor rotunda of the Arkansas Capitol half-listening to a news conference by Tom McRae, an earnest Democrat challenging Governor Bill Clinton for re-election. Then I heard it: Click. Clack. Click. Clack. Click. Clack.
The sound of Hillary Clinton’s low-heeled shoes on a hidden marble hallway jarred McRae, who in 1990 was Bill Clinton’s biggest obstacle to a fifth term and a presidential bid two years later. The first lady of Arkansas rounded the corner and stormed his news conference. “Tom!” she shouted. “I think we oughta get the record straight!”
Waving a sheaf of papers, Hillary Clinton undercut McRae’s criticism of her husband’s record by pointing to McRae’s past praise of the governor. It was a brutal sandbagging. “Many of the reports you issued not only praise the governor on his environmental record,” she said, “but his education and his economic record!”
Will the Democratic Party nominate a candidate who hasn’t been a member of their party, and who has long denounced it?
When a party chooses its presidential candidate, it also chooses its party leader in the election. This year the Democrats face an unusual situation. Bernie Sanders isn’t just an outsider to the party establishment; he’s not even been a member of the party, and has long excoriated it in unsparing language. Although the media haven’t much focused on this history, the early signs suggest it could become a problem for Sanders in getting the nomination—and a problem for the party if he does get it.
According to the entrance polls at the Iowa caucuses, there was a 30-percentage-point split between self-identified Democrats and independents in their support for Sanders. Hillary Clinton won 56 percent of self-identified Democrats but only 26 percent of independents, while Sanders won only 39 percent of Democrats but 69 percent of independents.
For decades the Man of Steel has failed to find his groove, thanks to a continual misunderstanding of his strengths.
Superman should be invincible. Since his car-smashing debut in 1938, he’s starred in at least one regular monthly comic, three blockbuster films, and four television shows. His crest is recognized across the globe, his supporting cast is legendary, and anybody even vaguely familiar with comics can recount the broad strokes of his origin. (The writer Grant Morrison accomplished it in eight words: “Doomed Planet. Desperate Scientists. Last Hope. Kindly Couple.”) He’s the first of the superheroes, a genre that’s grown into a modern mass-media juggernaut.
And yet, for a character who gains his power from the light of the sun, Superman is curiously eclipsed by other heroes. According to numbers provided by Diamond Distributors, the long-running Superman comic sold only 55,000 copies a month in 2015, down from around 70,000 in 2010—a mediocre showing even for the famously anemic comic-book market. That’s significantly less than his colleague Batman, who last year moved issues at a comparatively brisk 150,000 a month. Mass media hasn’t been much kinder: The longest-running Superman television show, 2001’s Smallville, kept him out of his iconic suit for a decade. Superman Returns recouped its budget at the box office, but proved mostly forgettable.2013’s Man of Steel drew sharp criticism from critics and audiences alike for its bleak tone and rampaging finale. Trailers for the sequel, Batman v Superman: Dawn of Justice, have shifted the focus (and top billing) to the Dark Knight. Worst of all, conventional wisdom puts the blame on Superman himself. He’s boring, people say; he’s unrelatable, nothing like the Marvel characters dominating the sales charts and the box office. More than anything, he seems embarrassing. Look at him. Truth? Justice? He wears his underwear on the outside.
Humbled by his struggling presidential campaign, can the once-mighty New Jersey governor vault back into contention after Saturday’s debate?
SALEM, New Hampshire—Chris Christie was accustomed to being a big man: a man of stature, a man of power, a man who demands and gets his way.
But recently, the big man (this is a description of his personality, not his size) was seeming awfully small.
On Friday evening here, the governor of New Jersey was desperately trying to talk some sense into the people of New Hampshire, a couple hundred of whom had come out to see him on a snowy night. The night before, Christie’s rival Marco Rubio had played the same venue, filling a larger room of the elementary school beyond its capacity. Christie was begging the crowd not to pile on the bandwagon of the apparent winner, but instead, to show some courage.
Immediately, the pings from fellow journalists (and media-adjacent folk) came pouring in, all saying something along the lines of, “Can you actually let me know what you find out? I’m addicted to that stuff.”
They mean “addicted” in the jokey, dark-chocolate-and-Netflix-streaming way, but the habit can border on pathological. For me, rock bottom was a recent, obscenely long workday during which an entire 12-pack of coconut La Croix somehow made it down my throat, can by shining can.
Tracking them down is a globe-trotting adventure that rivals any jungle expedition.
In the darkness of the Akeley Hall of Mammals, swarms of kids gawk at beautifully staged dioramas of Africa’s wildlife. The stuffed safari, nestled in the American Museum of Natural History (AMNH) in New York, includes taxidermied leopards stalking a bush pig, preserved ostriches strutting in front of warthogs, and long-dead baboons cautiously considering a viper. In one corner, in a display marked “Upper Nile Region,” a lone hippo grazes next to a herd of lechwe, roan antelope, and a comically stern shoebill stork.
“This is my favorite one,” says Evon Hekkala, pointing to the display. “There’s a taxidermied crocodile tucked away down there.”
It takes a while to spot it and I have to crane my head to do so, but yes, there it is—a large crocodile, in the back, mouth agape, next to the hippo. It’s mostly hidden from view, and until recently, it was hidden from science, too.
Because it’s an old tired man perplexed by modernity, and it’s having trouble pooping.
Each year, the great minds that sell us so many of our beloved consumer staples get together to assess the state of the American psyche. Is America tired? Hangry? Missing the golden age of Bruces Willis and Springsteen, the Buick GNX, and avuncular sexism?
Believe it or not, this meeting happens not at a Madison Avenue steakhouse, or atop a mountain in Jackson Hole, or even in Papa John Schnatter’s meteor-crater lair. Instead, it plays out in full view of the American public during the 47 hours or so of television advertisements that punctuate the Super Bowl. As the nation’s burliest athletes wrestle each other’s lycra-clad bodies for control of that most potent symbol of fragile masculinity (literally an ovoid ball), corporations take stock of a more general struggle happening off the pitch: an existential crisis that concerns the very fabric of the American character.
A Chicago cop who shot the 19-year-old seeks $10 million in damages in a countersuit filed against the man’s family.
In a country where police are rarely prosecuted for killing civilians, and where those who are prosecuted are rarely convicted, civil lawsuits filed by victims of police violence and their families have become perhaps the foremost tool for law-enforcement accountability. The wrongful-death suit is a familiar step in the all-too-common story arc.
But something stranger is happening in Chicago: The police officer is suing the estate of his victim.
On December 26, Chicago police officers responded to a domestic-disturbance call. According to police, 19-year-old Quintonio LeGrier was threatening his father and wielding a baseball bat. During the response, Officer Robert Rialmo shot and killed LeGrier as well as Bettie Jones, a mother of five and downstairs neighbor.