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.
“I hope that my story will help you understand the methods of Russian operatives in Washington and how they use U.S. enablers to achieve major foreign policy goals without disclosing those interests,” Browder writes.
The financier Bill Browder has emerged as an unlikely central player in the ongoing investigation of Russian interference in the 2016 elections. Sergei Magnitsky, an attorney Browder hired to investigate official corruption, died in Russian custody in 2009. Congress subsequently imposed sanctions on the officials it held responsible for his death, passing the Magnitsky Act in 2012. Russian President Vladimir Putin’s government retaliated, among other ways, by suspending American adoptions of Russian children.
Natalia Veselnitskaya, the Russian lawyer who secured a meeting with Donald Trump Jr., Jared Kushner, and Paul Manafort, was engaged in a campaign for the repeal of the Magnitsky Act, and raised the subject of adoptions in that meeting. That’s put the spotlight back on Browder’s long campaign for Kremlin accountability, and against corruption—a campaign whose success has irritated Putin and those around him.
For the past few decades, the unstoppable increase in college tuition has been a fact of life, like death and taxes. The sticker price of American college increased nearly 400 percent in the last 30 years, while median household income growth was relatively flat. Student debt soared to more than $1 trillion, the result of loans to cover the difference.
Several people—with varyingdegreesof expertisein higher-ed economics—have predicted that it’s all a bubble, destined to burst. Now after decades of expansion, just about every meaningful statistic—including the number of college students, the growth of tuition costs, and even the total number of colleges—is going down, or at least growing more slowly.
The Arizona Republican is betting his Senate seat on the political appeal of decency—but can that pay off in Trump’s America?
The constituents filing into the Mesa Convention Center one evening in mid-April for the Republican senator Jeff Flake’s town hall had a decidedly un-Republican look. Tattoos and political T-shirts abounded. Activists stood near the entrance distributing stickers, flyers, and other paraphernalia of the resistance and urging attendees to get loud. While chants of “No stupid wall!” and “Health care for all!” echoed through the auditorium, a young woman in a chicken costume wandered the perimeter, clucking and posing for selfies in an act of protest whose meaning remained mysterious to me even after I asked her about it (“Jeff Flake is George Dubya’s chicken,” she said).
Flake couldn’t see any of this from backstage, but he knew that a hostile crowd likely awaited him. The early months of the Trump presidency had inflamed the grassroots left, and Republican lawmakers across the country had lately found themselves standing awkwardly in rooms like this one while liberal voters berated them. Flake is up for reelection next year, and some of his campaign advisers—wanting to avoid the kind of contentious scene that might end up in an attack ad—had suggested that he skip public forums for a while, as many of his colleagues were doing. But he insisted on going ahead.
Exclusion leaves the military weaker and the country more divided.
President Donald Trump issued a ruling on Wednesday outlawing military service by people who do not conform to a binary gender system.
“Please be advised that the United States Government will not accept or allow transgender individuals to serve in any capacity in the U.S. Military,” he wrote in a string of tweets. “Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.”
Trump previously promised to be an advocate for transgender people, writing during the campaign, “Thank you to the LGBT community! I will fight for you while Hillary brings in more people that will threaten your freedoms and beliefs.”
The GOP’s options are dwindling ahead of the expected failure of an amendment that would scrap Obamacare without replacing it. Party leaders are now looking for any plan that can pass.
One by one, the Senate’s options for overhauling the nation’s health-care system are dwindling—but they still have a few left.
Republicans on Wednesday were poised to reject a straight repeal of much of the Affordable Care Act, leaving them far short of a consensus one day into debate on health-care legislation passed by the House in May. The amendment, scheduled for an afternoon vote, was virtually identical to legislation Republicans passed on a party-line vote in 2015 and would have scrapped the law on a two-year delay. Then-President Barack Obama vetoed the measure. Conservatives led by Senator Rand Paul of Kentucky have tried to revive the “clean repeal” option in recent days to break the impasse within the GOP, but moderates are—for now—objecting to proposals that only repeal but do not replace the current law.
A federal judge affirmed a $1,000 fine for the leader of President Trump’s election-integrity panel, saying the Kansas secretary of state had undermined his credibility with misstatements.
Kansas Secretary of State Kris Kobach could use a little credibility at the moment. President Trump’s so-called election-integrity commission, of which he is the de facto chief, has come under suspicion for both its methods and its purpose. But citizens seeking assurance about Kobach’s motives won’t find that from the federal courts.
In a ruling yesterday, flagged by the indefatigable Rick Hasen, Judge Julie Robinson of the U.S. District Court of Kansas rejected Kobach’s request that she overturn a $1,000 fine levied on him by a U.S. magistrate judge. That wasn’t the most significant part of the ruling. Over 13 pages, Robinson carefully lays out ways in which Kobach appeared to be playing fast and loose with the facts in the lower court. And in affirming Magistrate Judge James O’Hara’s fine, she became the second federal judge to deem Kobach at the very least misleading in his court appearances:
The Dunkirk director has been loudly dismissive of the company’s policy on theatrical releases—but he’s really just arguing for a different streaming model.
Christopher Nolan’s Dunkirk is not what you’d call a typical summer blockbuster in 2017. It’s a sober, intense World War II epic, starring a total unknown (Fionn Whitehead), with no potential as a franchise. It’s not a story of triumph, but rather an edgy chronicle of soldiers surviving by the skin of their teeth (it also features only British troops; at the time of the Dunkirk evacuation, America hadn’t even entered the war). In the current Hollywood landscape, which shunts such “prestige” pictures to the fall or winter to try and curry Oscar favor, Dunkirk’s July 21 release was extremely unusual, and itsbroad success (a $50 million opening weekend, well above tracking numbers) was a relative surprise.
The president’s announcement reverses the Obama-era plan to phase in the open participation of these Americans.
President Trump has announced that transgender Americans will not be allowed to serve “in any capacity” in the U.S. military, a move that could affect thousands of people serving in the armed forces and which resulted in almost immediate pushback from influential Republicans.
Trump tweeted Wednesday that the U.S. military “must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.”
After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow......
Surprise eggs and slime are at the center of an online realm that’s changing the way the experts think about human development.
Toddlers crave power. Too bad for them, they have none. Hence the tantrums and absurd demands. (No, I want this banana, not that one, which looks identical in every way but which you just started peeling and is therefore worthless to me now.)
They just want to be in charge! This desire for autonomy clarifies so much about the behavior of a very small human. It also begins to explain the popularity of YouTube among toddlers and preschoolers, several developmental psychologists told me.
If you don’t have a 3-year-old in your life, you may not be aware of YouTube Kids, an app that’s essentially a stripped-down version of the original video blogging site, with videos filtered by the target audience’s age. And because the mobile app is designed for use on a phone or tablet, kids can tap their way across a digital ecosystem populated by countless videos—all conceived with them in mind.
Once again, the president helped revive a bill that was considered dead, mostly by refusing to allow Congress to move on.
Like a figure in a classic Western—whether he’s a hero or villain depends on your political views—Donald Trump keeps being left for dead in the desert, and he keeps sauntering into the town saloon with a smirk on his face, to gasps all around.
Tuesday afternoon, the Senate voted to proceed on debate on the latest attempt to repeal Obamacare. It is an early, incremental, and partial victory for the president, but it is a victory nonetheless. And it is the second time that a bill has appeared dead in one of the chambers of Congress, only to be resuscitated—in part by Trump’s refusal to let legislators move on.
The ultimate fate of the health-care effort remains murky. The Senate voted to open debate, but then failed to approve a broad repeal Tuesday night, leaving it unclear what bill if any the Senate might pass, or what might happen in conference committee with the House.