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.
“Well, you’re just special. You’re American,” remarked my colleague, smirking from across the coffee table. My other Finnish coworkers, from the school in Helsinki where I teach, nodded in agreement. They had just finished critiquing one of my habits, and they could see that I was on the defensive.
I threw my hands up and snapped, “You’re accusing me of being too friendly? Is that really such a bad thing?”
“Well, when I greet a colleague, I keep track,” she retorted, “so I don’t greet them again during the day!” Another chimed in, “That’s the same for me, too!”
Unbelievable, I thought. According to them, I’m too generous with my hellos.
When I told them I would do my best to greet them just once every day, they told me not to change my ways. They said they understood me. But the thing is, now that I’ve viewed myself from their perspective, I’m not sure I want to remain the same. Change isn’t a bad thing. And since moving to Finland two years ago, I’ve kicked a few bad American habits.
Even in big cities like Tokyo, small children take the subway and run errands by themselves. The reason has a lot to do with group dynamics.
It’s a common sight on Japanese mass transit: Children troop through train cars, singly or in small groups, looking for seats.
They wear knee socks, polished patent-leather shoes, and plaid jumpers, with wide-brimmed hats fastened under the chin and train passes pinned to their backpacks. The kids are as young as 6 or 7, on their way to and from school, and there is nary a guardian in sight.
A popular television show called Hajimete no Otsukai, or My First Errand, features children as young as two or three being sent out to do a task for their family. As they tentatively make their way to the greengrocer or bakery, their progress is secretly filmed by a camera crew. The show has been running for more than 25 years.
His paranoid style paved the road for Trumpism. Now he fears what’s been unleashed.
Glenn Beck looks like the dad in a Disney movie. He’s earnest, geeky, pink, and slightly bulbous. His idea of salty language is bullcrap.
The atmosphere at Beck’s Mercury Studios, outside Dallas, is similarly soothing, provided you ignore the references to genocide and civilizational collapse. In October, when most commentators considered a Donald Trump presidency a remote possibility, I followed audience members onto the set of The Glenn Beck Program, which airs on Beck’s website, theblaze.com. On the way, we passed through a life-size replica of the Oval Office as it might look if inhabited by a President Beck, complete with a portrait of Ronald Reagan and a large Norman Rockwell print of a Boy Scout.
A professor of cognitive science argues that the world is nothing like the one we experience through our senses.
As we go about our daily lives, we tend to assume that our perceptions—sights, sounds, textures, tastes—are an accurate portrayal of the real world. Sure, when we stop and think about it—or when we find ourselves fooled by a perceptual illusion—we realize with a jolt that what we perceive is never the world directly, but rather our brain’s best guess at what that world is like, a kind of internal simulation of an external reality. Still, we bank on the fact that our simulation is a reasonably decent one. If it wasn’t, wouldn’t evolution have weeded us out by now? The true reality might be forever beyond our reach, but surely our senses give us at least an inkling of what it’s really like.
Why the ingrained expectation that women should desire to become parents is unhealthy
In 2008, Nebraska decriminalized child abandonment. The move was part of a "safe haven" law designed to address increased rates of infanticide in the state. Like other safe-haven laws, parents in Nebraska who felt unprepared to care for their babies could drop them off in a designated location without fear of arrest and prosecution. But legislators made a major logistical error: They failed to implement an age limitation for dropped-off children.
Within just weeks of the law passing, parents started dropping off their kids. But here's the rub: None of them were infants. A couple of months in, 36 children had been left in state hospitals and police stations. Twenty-two of the children were over 13 years old. A 51-year-old grandmother dropped off a 12-year-old boy. One father dropped off his entire family -- nine children from ages one to 17. Others drove from neighboring states to drop off their children once they heard that they could abandon them without repercussion.
“All the world has failed us,” a resident of the Syrian city of Aleppo told the BBC this week, via a WhatsApp audio message. “The city is dying. Rapidly by bombardment, and slowly by hunger and fear of the advance of the Assad regime.”
In recent weeks, the Syrian military, backed by Russian air power and Iran-affiliated militias, has swiftly retaken most of eastern Aleppo, the last major urban stronghold of rebel forces in Syria. Tens of thousands of besieged civilians are struggling to survive and escape the fighting, amid talk of a rebel retreat. One of the oldest continuously inhabited cities on earth, the city of the Silk Road and the Great Mosque, of muwashshah and kibbeh with quince, of the White Helmets and Omran Daqneesh, is poised to fall to Bashar al-Assad and his benefactors in Moscow and Tehran, after a savage four-year stalemate. Syria’s president, who has overseen a war that has left hundreds of thousands of his compatriots dead, will inherit a city robbed of its human potential and reduced to rubble.
The same part of the brain that allows us to step into the shoes of others also helps us restrain ourselves.
You’ve likely seen the video before: a stream of kids, confronted with a single, alluring marshmallow. If they can resist eating it for 15 minutes, they’ll get two. Some do. Others cave almost immediately.
This “Marshmallow Test,” first conducted in the 1960s, perfectly illustrates the ongoing war between impulsivity and self-control. The kids have to tamp down their immediate desires and focus on long-term goals—an ability that correlates with their later health, wealth, and academic success, and that is supposedly controlled by the front part of the brain. But a new study by Alexander Soutschek at the University of Zurich suggests that self-control is also influenced by another brain region—and one that casts this ability in a different light.
Trinidad has the highest rate of Islamic State recruitment in the Western hemisphere. How did this happen?
This summer, the so-called Islamic State published issue 15 of its online magazine Dabiq. In what has become a standard feature, it ran an interview with an ISIS foreign fighter. “When I was around twenty years old I would come to accept the religion of truth, Islam,” said Abu Sa’d at-Trinidadi, recalling how he had turned away from the Christian faith he was born into.
At-Trinidadi, as his nom de guerre suggests, is from the Caribbean island of Trinidad and Tobago (T&T), a country more readily associated with calypso and carnival than the “caliphate.” Asked if he had a message for “the Muslims of Trinidad,” he condemned his co-religionists at home for remaining in “a place where you have no honor and are forced to live in humiliation, subjugated by the disbelievers.” More chillingly, he urged Muslims in T&T to wage jihad against their fellow citizens: “Terrify the disbelievers in their own homes and make their streets run with their blood.”
Studies show that for most types of cognitively demanding tasks, anything but quiet hurts performance.
Like most modern “knowledge” workers, I spend my days in an open office. That means I also spend my days amid ringing phones, the inquisitive tones of co-workers conducting interviews, and—because we work in a somewhat old, infamous building—the pounding and drilling of seemingly endless renovations.
Even so, the #content must still be wrung from my distracted brain. And so, I join the characters of trend pieces everywhere in wearing headphones almost all day, every day. And what better to listen to with headphones than music? By now, I’ve worked my way through all the “Focus” playlists on Spotify—most of which sound like they were meant for a very old planetarium—and I’ve looped back around to a genre I like to call “soft, synthy pop songs whose lyrics don’t make much sense:” Think Miike Snow rather than Michael Jackson.
A recent study shows that people who simply ate more fiber lost about as much weight as those who went on a complicated diet.
By this time of year, many peoples’ best-laid New Year’s Resolutions have died, just seven short weeks after they were born. One reason why it’s difficult to lose weight—the most common resolution—is that dieting is so confusing.
For instance, the American Heart Association's recommended diet is one of the most effective food plans out there. It’s also one of the most complicated. It requires, according to a recent study, “consuming vegetables and fruits; eating whole grains and high-fiber foods; eating fish twice weekly; consuming lean animal and vegetable proteins; reducing intake of sugary beverages; minimizing sugar and sodium intake; and maintaining moderate to no alcohol intake.” On top of that, adherents should derive half of their calories from carbs, a fifth from protein, and the rest from fat—except just 7 percent should be saturated fat. (Perhaps the goal is to keep people busy doing long division so they don't have time to eat food.)