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.
A history of the first African American White House—and of what came next
In the waning days of President Barack Obama’s administration, he and his wife, Michelle, hosted a farewell party, the full import of which no one could then grasp. It was late October, Friday the 21st, and the president had spent many of the previous weeks, as he would spend the two subsequent weeks, campaigning for the Democratic presidential nominee, Hillary Clinton. Things were looking up. Polls in the crucial states of Virginia and Pennsylvania showed Clinton with solid advantages. The formidable GOP strongholds of Georgia and Texas were said to be under threat. The moment seemed to buoy Obama. He had been light on his feet in these last few weeks, cracking jokes at the expense of Republican opponents and laughing off hecklers. At a rally in Orlando on October 28, he greeted a student who would be introducing him by dancing toward her and then noting that the song playing over the loudspeakers—the Gap Band’s “Outstanding”—was older than she was.
In the age of the digital hermit, a psychologist explains what it means to avoid other people—and what to do about it.
People today might not actually be avoiding social interaction any more than they did in past decades, but they’re certainly more vocal about it. The rise of digital communication seems to be spawning a nation of indoor cats, all humble-bragging about how introverted they are and ordering their rides and groceries without ever talking to a human.
Sometimes reclusiveness can be a sign of something more serious, though. Social anxiety is one of the most common mental illnesses, but it’s still poorly understood outside of scientific circles. The good news is that it’s highly treatable, according to Stefan G. Hofmann, the director of the Social Anxiety Program at Boston University.
I recently talked with Hofmann about how social anxiety works and what people who feel socially anxious can do about it. An edited transcript of our conversation follows.
William Jennings Bryan, the populist presidential hopeful, warned of an “epidemic of fake news” in his day.
Fake news is everywhere. The power of the press is said to be waning. And because the nation’s most famous populist—the man with his sights on the presidency—can’t trust the lying media, he says, he has no option but to be a publisher himself.
Oh yeah, and the year is 1896.
The would-be president in question is William Jennings Bryan. In an era before the internet, television, or radio, the best way to reach the masses is with newsprint. So, without the option of tweeting his grievances after losing the election to William McKinley, what does Bryan do? He starts his own newspaper. And he uses it to rail against “fake news.”
I don’t need to tell you a lot of this sounds weirdly familiar.
“There seems to be an epidemic of fake news from the city of Lincoln, [Nebraska], and it all comes from Mr. Bryan’s ‘friends’—names not given,” Bryan’s newspaper, The Commoner,wrote in 1907. “It would seem unnecessary to deny reports sent out to which no name was attached, and yet it has been necessary to send a number of telegrams to notify other papers that the report was unauthorized … As Mr. Bryan has a paper—The Commoner—through which he speaks every week, and as he is speaking often and giving out interviews frequently, a newspaper ought to view with suspicion any report sent out from Lincoln or anywhere else purporting to state what Mr. Bryan thinks or intends to do.” (In this case, the issue at hand was Bryan’s stance against a third term for Teddy Roosevelt, which some papers had apparently questioned.)
More clues that the Facebook founder is eyeing a run for office
There’s a long-running theory that Mark Zuckerberg has presidential aspirations. It makes sense to wonder. After all, if the civically engaged and ambitious billionaire leader of the most powerful media company on the planet wanted to take on a new challenge, why not try running a country? It’s not like he has many other opportunities for a promotion.
But only in recent weeks has a Zuckerberg run for the American presidency started to seem like a legitimate possibility. First there was his personal challenge for 2017: Zuckerberg’s aiming to visit and meet with people in all 50 states by the end of the year.
And not just that, but he framed the exercise in a way that sounds, well, political: “Going into this challenge, it seems we are at a turning point in history,” he wrote in a Facebook post. “For decades, technology and globalization have made us more productive and connected. This has created many benefits, but for a lot of people it has also made life more challenging. This has contributed to a greater sense of division than I have felt in my lifetime. We need to find a way to change the game so it works for everyone.”
Curfews, sports, and understanding kids’ brain chemistry have all helped dramatically curb substance abuse in the country.
It’s a little before 3 p.m. on a sunny Friday afternoon and Laugardalur Park, near central Reykjavik, looks practically deserted. There’s an occasional adult with a stroller, but the park’s surrounded by apartment blocks and houses, and school’s out—so where are all the kids?
Walking with me are Gudberg Jónsson, a local psychologist, and Harvey Milkman, an American psychology professor who teaches for part of the year at Reykjavik University. Twenty years ago, says Gudberg, Icelandic teens were among the heaviest-drinking youths in Europe. “You couldn’t walk the streets in downtown Reykjavik on a Friday night because it felt unsafe,” adds Milkman. “There were hordes of teenagers getting in-your-face drunk.”
How the vice president spent a few of his closing days in office
When I boarded Air Force Two for Vice President Joe Biden’s final overseas mission, he had four days left in office. His leverage was diminishing by the hour, with every new question at a Trump nominee confirmation hearing, with every new @RealDonaldTrump tweet.
There was no chance of a miracle at that point, a few days away from Vice President-elect Mike Pence getting Biden’s keys to Air Force Two—to somehow rid Ukraine of its debilitating corruption, pull off a Cyprus deal, or stand between Kosovo and Serbia and neutralize the tension between them for good. It’s hard to shame Russian President Vladimir Putin or to inspire him to spiff up his behavior if the president-elect seems to accept Putin just as he is. And of course, there’s Iraq.
The president-elect filled out his Cabinet on Thursday by nominating former Georgia Governor Sonny Perdue for agriculture secretary.
Updated on January 19, 2017
A day before his inauguration, President-elect Donald Trump has filled out his Cabinet.
Trump on Thursday morning announced the nomination of former Georgia Governor Sonny Perdue as secretary of agriculture, completing a search that took the duration of his presidential transition.
Perdue, who served as governor from 2003 to 2011, grew up on a farm in Georgia and earned a doctorate in veterinary medicine. “Sonny Perdue is going to accomplish great things as Secretary of Agriculture,” Trump said in a statement. “From growing up on a farm to being governor of a big agriculture state, he has spent his whole life understanding and solving the challenges our farmers face, and he is going to deliver big results for all Americans who earn their living off the land.”
Unlike past presidents-elect, Donald Trump hasn’t expanded his support since the election. His belligerent attitude toward his critics may be one reason why.
Donald Trump always seems most grounded in chaos. He thrives on contradicting his aides, surprising his allies, disparaging his opponents. He revels in the tempest.
This combustible approach has touched a chord with his base of primarily non-college-educated and non-urban white voters who have felt eclipsed both economically and culturally and slighted by the nation’s leadership. But he will arrive at his inaugural Friday facing more resistance in public opinion than any newly elected president in the history of polling, and with lingering clouds over his legitimacy—symbolized by the surprisingly widespread House Democratic boycott of the ceremony. Trump’s agenda is polarizing enough, but the intensity of that opposition appears rooted even more in his relentless belligerence toward any critical voice or institution.
Without any of his key appointees confirmed by the Senate, the incoming president has turned to existing officials to help smooth the transition.
Donald Rumsfeld is not joining the Trump administration, but one of his most famous rules is: “You go to war with the Army you have—not the Army you might wish you have.” Or the secretary of the Army, as the case might be.
With the process of vetting and appointing, to say nothing of confirming, executive-branch officials well behind the optimal pace, incoming White House Press Secretary Sean Spicer said during a briefing on Thursday that “over 50” members of the Obama administration will temporarily remain in their posts to help smooth the transition to the Trump administration.
Spicer did not name all of the officials, nor did he indicate whether others had been asked and declined to stay on. A message to the Trump transition team, asking for a full list, has not been answered. Reuters reported Thursday afternoon that some individuals on a list, dated Tuesday, of appointees being asked to stay on had declined to do so, including the principal deputy director of national intelligence, an undersecretary of state, and an assistant secretary of state.