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.
In closing as in opening, it seems to me that Bernie Sanders was foolish in a Democratic primary to refrain from specifically mentioning the identity groups that Hillary Clinton has just ticked off in her closing statement.
Today’s empires are born on the web, and exert tremendous power in the material world.
Mark Zuckerberg hasn’t had the best week.
First, Facebook’s Free Basics platform was effectively banned in India. Then, a high-profile member of Facebook’s board of directors, the venture capitalist Marc Andreessen, sounded off about the decision to his nearly half-a-million Twitter followers with a stunning comment.
“Anti-colonialism has been economically catastrophic for the Indian people for decades,” Andreessen wrote. “Why stop now?”
After that, the Internet went nuts.
Andreessen deleted his tweet, apologized, and underscored that he is “100 percent opposed to colonialism” and “100 percent in favor of independence and freedom.” Zuckerberg, Facebook’s CEO, followed up with his own Facebook post to say Andreessen’s comment was “deeply upsetting” to him, and not representative of the way he thinks “at all.”
By announcing the first detection of gravitational waves, scientists have vindicated Einstein and given humans a new way to look at the universe.
More than a billion years ago, in a galaxy that sits more than a billion light-years away, two black holes spiraled together and collided. We can’t see this collision, but we know it happened because, as Albert Einstein predicted a century ago, gravitational waves rippled out from it and traveled across the universe to an ultra-sensitive detector here on Earth.
This discovery, announced today by researchers with the Laser Interferometer Gravitational-wave Observatory (LIGO), marks another triumph for Einstein’s general theory of relativity. And more importantly, it marks the beginning of a new era in the study of the universe: the advent of gravitational-wave astronomy. The universe has just become a much more interesting place.
The number of American teens who excel at advanced math has surged. Why?
On a sultry evening last July, a tall, soft-spoken 17-year-old named David Stoner and nearly 600 other math whizzes from all over the world sat huddled in small groups around wicker bistro tables, talking in low voices and obsessively refreshing the browsers on their laptops. The air in the cavernous lobby of the Lotus Hotel Pang Suan Kaew in Chiang Mai, Thailand, was humid, recalls Stoner, whose light South Carolina accent warms his carefully chosen words. The tension in the room made it seem especially heavy, like the atmosphere at a high-stakes poker tournament.
Stoner and five teammates were representing the United States in the 56th International Mathematical Olympiad. They figured they’d done pretty well over the two days of competition. God knows, they’d trained hard. Stoner, like his teammates, had endured a grueling regime for more than a year—practicing tricky problems over breakfast before school and taking on more problems late into the evening after he completed the homework for his college-level math classes. Sometimes, he sketched out proofs on the large dry-erase board his dad had installed in his bedroom. Most nights, he put himself to sleep reading books like New Problems in Euclidean Geometry and An Introduction to Diophantine Equations.
By mining electronic medical records, scientists show the lasting legacy of prehistoric sex on modern humans’ health.
Modern humans originated in Africa, and started spreading around the world about 60,000 years ago. As they entered Asia and Europe, they encountered other groups of ancient humans that had already settled in these regions, such as Neanderthals. And sometimes, when these groups met, they had sex.
We know about these prehistoric liaisons because they left permanent marks on our genome. Even though Neanderthals are now extinct, every living person outside of Africa can trace between 1 and 5 percent of our DNA back to them. (I am 2.6 percent Neanderthal, if you were wondering, which pales in comparison to my colleague James Fallows at 5 percent.)
This lasting legacy was revealed in 2010 when the complete Neanderthal genome was published. Since then, researchers have been trying to figure out what, if anything, the Neanderthal sequences are doing in our own genome. Are they just passive hitchhikers, or did they bestow important adaptations on early humans? And are they affecting the health of modern ones?
If Bernie Sanders is serious about a political transformation in America, he needs a better plan.
If there’s one thing that fires up Bernie Sanders supporters—and makes his detractors roll their eyes—it’s his call for a “political revolution.” To his base, it’s the very point of his anti-establishment, anti-elite candidacy. To his critics, it’s the very embodiment of his campaign’s naïve impracticality and vagueness.
But now that voters in Iowa and New Hampshire have spoken, it’s time to take the idea of political revolution more seriously—more seriously, indeed, than Sanders himself appears to have. It’s time to ask: What exactly would it take?
It starts with Congress. And here it’s instructive to compare Sanders and Donald Trump. Both rely on broad, satisfying refrains of “We’re gonna”: We’re gonna break up the big banks. We’re gonna make Mexico build the wall. We’re gonna end the rule of Wall Street billionaires. We’re gonna make China stop ripping us off.
When four American women were murdered during El Salvador’s dirty war, a young U.S. official and his unlikely partner risked their lives to solve the case.
On December 1, 1980, two American Catholic churchwomen—an Ursuline nun and a lay missionary—sat down to dinner with Robert White, the U.S. ambassador to El Salvador. They worked in rural areas ministering to El Salvador’s desperately impoverished peasants, and White admired their commitment and courage. The talk turned to the government’s brutal tactics for fighting the country’s left-wing guerrillas, in a dirty war waged by death squads that dumped bodies in the streets and an army that massacred civilians. The women were alarmed by the incoming Reagan administration’s plans for a closer relationship with the military-led government. Because of a curfew, the women spent the night at the ambassador’s residence. The next day, after breakfast with the ambassador’s wife, they drove to San Salvador’s international airport to pick up two colleagues who were flying back from a conference in Nicaragua. Within hours, all four women would be dead.
Once it was because they weren’t as well educated. What’s holding them back now?
Though headway has been made in bringing women’s wages more in line with men’s in the past several decades, that convergence seems to have stalled in more recent years. To help determine why, Francine D. Blau and Lawrence M. Kahn, the authors of a new study from the National Bureau of Economic Research parse data on wages and occupations from 1980 to 2010. They find that as more women attended and graduated college and headed into the working world, education and professional experience levels stopped playing a significant role in the the difference between men and women’s wages. Whatever remains of the discrepancy can’t be explained by women not having basic skills and credentials. So what does explain it?
The hit new indie release is the opposite of action-packed, yet it’s compelling in its simplicity.
Solitude, it turns out, can be addictive. So I learned playing the new hit indie game Firewatch, where all the action amounts to you, the player, being alone in the woods. You’re a lookout assigned to a summer posting in the Shoshone National Forest of Wyoming in 1989, meaning your job consists of nothing more than wandering around, clearing brush, and calling in any fires you might spot. Most video games equip you with tools and weapons, complex missions, and action sequences. All Firewatch gives you is a map, a compass, and a walkie-talkie—but it’s still one of the most compelling video games I’ve ever played.
It’s the latest in a quiet movement of video games, more psychological products that tap into the atmosphere and wonder of loneliness rather than looking for the simpler thrills the medium usually provides. It’s tempting to trace this trend’s origins back to Minecraft, which launched in 2009 and became a worldwide phenomenon on the back of its extraordinary simplicity. But in Minecraft, you start armed only with your bare hands in a world of monsters, and can eventually upgrade into a city-builder armed with powerful tools. Firewatch is a more intimate affair: a short story, playable over a few hours, that succeeds first and foremost as an emotional experience.
A new report from the company finds that American daters are growing more traditional in some ways, and more open-minded in others.
It was the best of times, it was the worst of times, it was Carrie Underwood’s time. It was the age of wisdom, but also of low-rise jeans. It was only just over a decade ago, but oh, how things have changed since 2005.
The dating site OkCupid had launched the previous year, and it’s been asking its users questions about their relationship preferences ever since. This week, the company released a survey comparing the responses they received in 2005 to those collected in 2015. Though not as rigorous as a truly random survey, the data hint at changing views of sex, love, and gender norms among online daters in the U.S.
Surprisingly, OkCupid found that people have become more sexually conservative in certain ways. For example, fewer people now say they would have sex on the first date: