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.
He lives near San Francisco, makes more than $50,000 per year, and is voting for the billionaire to fight against political correctness.
For several days, I’ve been corresponding with a 22-year-old Donald Trump supporter. He is white, has a bachelor’s degree, and earns $50,000 to $60,000 per year.
He lives near San Francisco.
“I recently became engaged to my Asian fiancée who is making roughly 3 times what I make, and I am completely supportive of her and proud she is doing so well,” he wrote. “We’ve both benefitted a lot from globalization. We are young, urban, and have a happy future planned. We seem molded to be perfect young Hillary supporters,” he observed, “but we're not. In 2016, we're both going for Trump.”
At first, we discussed Bill Clinton.
Last week, I wrote an article asking why Trump supporters aren’t bothered that their candidate called Clinton a shameful abuser of women who may well be a rapist. After all, Trump used to insist that Clinton was a victim of unfair treatment during his sex scandals. Either Trump spent years defending a man that he believed to be a sexual predator, even welcoming him as a guest at his wedding, or Trump is now cynically exploiting a rape allegation that he believes to be false.
In the 1990s, A.J. Benza learned first hand how the real-estate developer got his name––and his net worth––in all the New York City papers.
Earlier this month, I heard A.J. Benza, the host of the celebrity-scandal show “Case Closed with A.J. Benza,” tell the podcast host Adam Carolla about his younger days as a gossip reporter in New York City. He hung out with celebrities until the wee hours of the morning, reported out sensational rumors, and constantly traded favors in order to get juicy tidbits for columns at Newsday and the New York Daily News. Most trades involved information he wanted about a particular person at a particular moment––and he would then owe his source a favor in the future.
“Donald Trump was the biggest guy in the world with that,” he said. “Trump spent every morning on the phone with me, with Page 6––he loved to get his name in the paper. As a result, he would drop dimes on other people in every industry he knew dirt on. You put the story in the paper, and then, three days later, you say, ‘Donald Trump was at a Knicks game with this supermodel.’ And he’s happy. That’s all it took.”
As I learned when I met her, the late author believed that true arrogance lay in denying one's own specialness—and denying the specialness of others.
“You may now kiss my cheek,” said Maya Angelou. Her deep voice hung in the air, filling the large dining room inside of her Harlem home.
Stunned, I sat there for a minute. I had never been asked at the end of an interview to kiss someone else’s cheek.
It was October 2008 and I had flown to New York after haggling for months for an interview for an in-flight magazine cover story. Prior to the interview, a set of “communication courtesy” instructions for meeting Angelou were emailed to me, much like a list I imagine boarding schools send out to students for review before making an appearance.
Greeting & Introductions
Dr. Angelou will greet you by your last name. She will use your title and your last name in all communications. Dr. Angelou may ask you the origin of your name. You should greet her as Dr. or Mrs. Angelou. Please address her staff as Mr., Ms., or Mrs. - using their last name.
Dr. Angelou would like to receive an agenda prior to the meeting.
Dr. Angelou will often pause prior to speaking or when completing her thought.
Please hold your thought until she is finishing speaking.
Dr. Angelou speaks five different languages. She will enjoy speaking French, Spanish, Hebrew, Italian, or Fanti with you.
During formal business, meetings Dr. Angelou ask the men to wear a jacket and tie and women in appropriate business attire.
Dr. Angelou requires warm rooms. You may choose to remove your jacket or loosen your tie if you find the room too warm.
Dr. Angelou would like for participants in the same meeting to arrive together on time.
Dr. Angelou will sit in the chair at the end of the table to have access to her staff and phones.
Dr. Angelou is highly allergic to seafood. Please do not eat any seafood prior to meeting with her.
A conversation about how Game of Thrones’s latest twist fits in with George R.R. Martin’s typically cliché-busting portrayal of disability
In 2014, a few media outlets ran stories diagnosing Game of Thrones’s Hodor as having expressive aphasia, a neurological condition restricting speech. Some aphasia experts pushed back, saying that while Hodor has often been described as “simple-minded” or “slow of wits,” aphasia only affects linguistic communication—not intelligence.
Finally, an explanation for Bitchy Resting Face Nation
Here’s something that has always puzzled me, growing up in the U.S. as a child of Russian parents. Whenever I or my friends were having our photos taken, we were told to say “cheese” and smile. But if my parents also happened to be in the photo, they were stone-faced. So were my Russian relatives, in their vacation photos. My parents’ high-school graduation pictures show them frolicking about in bellbottoms with their young classmates, looking absolutely crestfallen.
It’s not just photos: Russian women do not have to worry about being instructed by random men to “smile.” It is Bitchy Resting Face Nation, seemingly forever responding “um, I guess?” to any question the universe might pose.
This does not mean we are all unhappy! Quite the opposite: The virile ruler, the vodka, the endless mounds of sour cream—they are pleasing to some. It’s just that grinning without cause is not a skill Russians possess or feel compelled to cultivate. There’s even a Russian proverb that translates, roughly, to “laughing for no reason is a sign of stupidity.”
Though Baby Boomers may criticize Millennials for being self-centered, careerist, and politically dispassionate, they are really just adapting to the world they live in today.
Graduation season is almost done, and it has brought the usual spate of commencement speeches that urge graduates to follow their passion, be true to themselves, inspire their fellow humans, and save the world. But in recent years there has been a dissenting note to this feel-good rhetoric. In 2012, the speech that became a YouTube sensation—now viewed by 2.5 million people!—was by a then-obscure high-school English teacher to his senior class. The title was “You Are Not Special,” which also gives you a sense of the thesis. It was an elegant essay that was actually gentle in comparison to some of the other characterizations of young people in the media these days. The “Me Generation” was the name given to the Baby Boomers. Time magazine ran a cover in 2013 on the Millennials with the title “The Me Me Me Generation.”
A rock structure, built deep underground, is one of the earliest hominin constructions ever found.
In February 1990, thanks to a 15-year-old boy named Bruno Kowalsczewski, footsteps echoed through the chambers of Bruniquel Cave for the first time in tens of thousands of years.
The cave sits in France’s scenic Aveyron Valley, but its entrance had long been sealed by an ancient rockslide. Kowalsczewski’s father had detected faint wisps of air emerging from the scree, and the boy spent three years clearing away the rubble. He eventually dug out a tight, thirty-meter-long passage that the thinnest members of the local caving club could squeeze through. They found themselves in a large, roomy corridor. There were animal bones and signs of bear activity, but nothing recent. The floor was pockmarked with pools of water. The walls were punctuated by stalactites (the ones that hang down) and stalagmites (the ones that stick up).
Our peshmerga are the best fighting force against ISIS in Iraq. But we cannot force Sunni and Shia Arabs to live together in peace.
This week marked the start of offensives ultimately aimed at retaking two of ISIS’s last major urban strongholds—Raqqa, the group’s de facto capital in Syria, and Fallujah, the first major Iraqi city to fall to ISIS some two years ago. The final prize, Mosul, seems to remain out of reach for the foreseeable future, despite indications a year ago that a battle to retake the city could come any day. An Iraqi army offensive launched in late March stalled quickly.
Mosul is Iraq’s second-largest city. ISIS wrested it from Iraqi government control in 2014 in its first major show of strength, and it is where Islamic State leader Abu Bakr al-Baghdadi declared a “caliphate” and demanded the allegiance of the world’s Muslims. Taking it back will be essential to winning the war against ISIS. But as fighters opposed to ISIS try to advance elsewhere on the battlefield, little is being done to promote the reconciliation between Shia and Sunni Arabs that Iraq really needs—both to construct a force capable of beating ISIS, in Mosul and beyond, and to create the political conditions to prevent its return.