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Medical students need more training in practice management and ownership, survey shows

Medical Economics

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Board certification in optometry: a former insider’s view from the outside

Optometry Times

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DEA cracks down on 2 CVS pharmacies in Florida

Drug Topics

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Improving the patient experience can build up your practice

Medical Economics

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L’Oreal anti-aging claims draw FDA warning

Cosmetic Surgery Times/Dermatology Times

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Pain drug kills resistant tuberculosis

Formulary

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Survey: Hospitals skeptical of health reform, ACOs

Managed Healthcare Executive

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Health providers could be hit with $11 billion in Medicare cuts next year, White House warns

Medical Economics

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Sexting leads adolescents to sexual risk taking

Contemporary Pediatrics

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Tanning industry vilifies health authorities

Dermatology Times

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FDA to crash medical app development party

More than 40,000 medical apps are now available for download to smartphones or tablets, and government regulators have taken notice.

In fact, the Food and Drug Administration (FDA) crafted a set of guidelines

Full Story Here

U.S. watchdog calls for review of cell phone radiation rules

U.S. regulators should take a fresh look at 15-year-old standards on radiofrequency energy from mobile phones, an investigative arm of the U.S. Congress said on Tuesday amid lingering concerns the devices may cause brain tumors.

Before a mobile phone comes on the U.S. market, it is first tested to ensure its emissions are within a limit determined by the Federal Communications Commission to be safe for human exposure.

But that limit may not reflect the latest research, and testing may not reflect the actual conditions under which mobile phones are used, such as when stored directly against the body in a pocket while someone talks through an ear piece, according to a Government Accountability Office report.

The report concludes a year-long investigation prompted by Democratic Representatives Edward Markey, Henry Waxman and Anna Eshoo.

“While the GAO report indicates there is no evidence to suggest using a cell phone causes cancer, it’s important that safety standards are current and account for changing trends in cell phone use and technology,” Eshoo said.

The GAO recommended that the FCC conduct a formal reassessment of its emissions limit and testing requirements and change them if appropriate.

FCC Chairman Julius Genachowski in June circulated a proposal to his fellow commissioners calling for a formal inquiry into the mobile phone emissions standards set in 1996.

If it is approved by a majority of the FCC’s five commissioners, the agency would consider changing its testing procedures and seek input on the need either to strengthen or ease the current standards. The proposal also considers whether emission standards should be different for devices used by children.

The FCC would solicit input from a variety of experts, including federal health agencies, and take the GAO’s report into consideration as part of its review, FCC spokesman Neil Grace said.

The agency has stressed that it believes there is no evidence tying cancer, headaches, dizziness, memory loss or other health problems to mobile phones.

NO CONSISTENT EVIDENCE OF LINK

Demand for wireless devices has surged in recent years, with some consumers opting to forego landline phone service altogether.

The sharp increase in mobile phone usage has fueled lengthy debate about the potential link to the main types of brain tumor, glioma and meningioma.

In May 2011 the World Health Organization added cell phone radiation to a list of possible carcinogens, putting it in the same category as lead, chloroform and coffee and said more study is needed.

Unlike ionizing radiation, such as that from gamma rays, radon and X-rays, which can break chemical bonds in the body and are known to cause cancer, radiofrequency devices such as cell phones and microwaves emit radiofrequency energy, a form of non-ionizing radiation.

According to the National Cancer Institute, there is no consistent evidence that non-ionizing radiation increases the risk of cancer.

But these do produce energy in the form of heat, and the concern is that frequent use of cell phones held up to the ear can change brain cell activity, as some studies have suggested.

What is not yet clear is whether this causes harm, which is why the WHO and other health bodies have called for further study.

The wireless trade association, CTIA, noted that two decades of scientific research, evaluated by government agencies and impartial health organizations, have yet to establish that wireless phone use causes adverse health effects.

“The FCC’s safety standards include a 50-fold safety factor and, as the FCC has noted, are the most conservative in the world,” John Walls, CTIA’s vice president of public affairs, said.

 

Copyright 2012 Thomson Reuters. Click for Restrictions.

China detains almost 2,000 in fake drug sweep

 

Chinese police have detained almost 2,000 people in a nationwide sweep on fake drugs, seizing more than $180 million worth of counterfeit products and destroying some 1,100 production facilities, the public security ministry said on Sunday.

The operation, involving around 18,000 police officers, discovered fake or adulterated drugs purporting to deal with illnesses ranging from diabetes to high blood pressure and rabies, the ministry said in a statement.

The suspects went so far as to advertise their drugs online, in newspapers and on television, and the drugs caused problems ranging from liver and kidney damage to heart failure, it added.

The government has repeatedly promised to tighten regulatory systems after safety scandals involving fish, drugs, toys, toothpaste, children’s clothes, tires, drugs and milk fortified with melamine, used in the manufacture of tabletops.

But little has been done apart from a few, highly publicized arrests. Tackling the issue has not been helped by China’s confused and still developing regulatory environment, corruption and the high profits counterfeiters can rake in.

Earlier this year, Chinese consumers recoiled at stories of drug capsules tainted with chromium, long-term exposure to which can cause serious organ damage.

While it hailed the success of the latest raids, the ministry warned it was too soon to be able to rest on their laurels.

“The crime of making fake drugs is still far from eradicated, and criminals are coming up with new schemes, becoming craftier and better able to deceive,” it said.

The ministry called on consumers to only use above board pharmacies and hospitals and not “easily believe advertisements.”

Copyright © 2012 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Copyright 2012 Thomson Reuters. Click for Restrictions.

More than 40% of urologists to retire within decade

 

 

A new, nationwide survey of U.S. physicians shows that 42% of urologists say they will retire by 2022.

Overall, 34% of physicians say they will leave the practice of medicine in the next decade. In 2012 alone, 16% percent of physicians are going part-time, retiring, or leaving medicine, or considering retiring or leaving medicine, according to the survey conducted by Jackson Healthcare, a health care staffing company in Atlanta.

“Physicians are retiring in large numbers just as baby boomers are starting to turn 65,” said Richard L. Jackson, of Jackson Healthcare. “That creates a real health care access problem. Many are demoralized and weighing their options.”

The primary reason physicians cite are economic and political: medical malpractice and overhead costs closely followed by not wanting to practice medicine in the era of health care reform. Fifty-six percent cited economic factors for retiring or leaving medicine in 2012, while 51% cited health reform. The survey was conducted prior to the Supreme Court’s ruling on the Affordable Care Act.

Not all of the physicians who were considering leaving medicine this year were older. Of those who said they would leave the practice or are strongly considering so by the end of 2012, 55% were under the age of 55 years. Those physicians also reported that the cost of running a practice was too high and that they didn’t want to practice medicine in the era of health reform.

Fifty-seven percent of oncologists and hematologists and 49% of general surgeons said they would retire by 2022.

Go back to this issue of Urology Times eNews.

Affordable Care Act brings influx of patients

Law’s impact forever changes healthcare financing and access to care

With the U.S. Supreme Court’s landmark decision to allow most of the Affordable Care Act (ACA) to stand, tens of millions of patients are about to acquire health insurance in 2014, some for the first time. This represents a monumental change in our nation’s approach to healthcare delivery, and it will forever change the financing of medical care. But with a shortage of primary care physicians (PCPs), many doctors are uncertain about its initial effect on primary care and the future of it.

Glen Stream, MD, MBI, FAAFP, president of

the American Academy of Family Physicians (AAFP), agrees.

 

This has been shown to be the case in Massachusetts, where a study by the Blue Cross Blue Shield of Massachusetts Foundation found that the use of emergency rooms for nonemergency reasons declined 4% from 2006 to 2010 (see Massachusetts case study).

Stream knows that primary care is already at capacity in many parts of the United States, especially family medicine. An AAFP study in 2000 found that a national shortfall of 3,900 family medicine practitioners will occur by 2020. The Association of American Medical Colleges (AAMC) estimates a national shortfall of more than 90,000 physicians across all specialties by 2020.

“By 2014 [when the new laws fully take effect], thousands of family practitioners aren’t going to suddenly appear,” Stream says. But an estimated 32 million new patients will.

The increased demand could bring new attention to solving the problem, Stream adds. The AAFP advocates for issues such as how to get more medical students interested in family practice and help them cope with the lower salaries while facing burdensome debt and achieve higher reimbursement, he says.

Richard M. Dupee, MD, chief of the geriatrics service at Tufts Medical Center in Boston and governor of the American College of Physicians’ Massachusetts chapter, sees the aging workforce as another major problem.

“Some older physicians are retiring rather than bothering with the requirements to adopt electronic medical records, and they are not being replaced by younger ones,” he says. “In rural areas, there are fewer of the academic hospital-owned clinics to take up the slack.”

Massachusetts is in the process of trying to fix another disincentive to primary care careers: low reimbursement. A bill is pending in the state legislature to raise payments. Nationally, the Centers for Medicare and Medicaid Services recently announced plans to give family physicians, internists, and others providing primary care a raise, too. But the trend for doctor reimbursements has been going down, and it may likely get worse for some.

“If reimbursement is fair, physicians with capacity will welcome [newly insured patients], but if it is not adequate, they will not,” Dupee says. “Most seasoned physicians in their 50s or 60s are already maxed out. They can’t absorb more volume without more money to cover the extra staff they will need.”

ADVOCACY

The AAMC notes that U.S. medical schools have complied with requests to boost class sizes by 30% time over the past 6 years, but the overall supply of U.S. physicians cannot expand unless Congress increases the number of federally funded residency training positions, a number that has been frozen since 1997.

“The AAMC is working hard to revisit this freeze,” says Christiane Mitchell, director of federal affairs. “Staying where we are will leave U.S. medical school graduates without a training position. This is an immediate issue.”

She notes that there is no real policy justification for the freeze; it was merely a victim of budget-cutting. The possibility of further federal cuts also has been raised.

“Medical school graduates need a place to train. Without one, it limits their options and may discourage the best and the brightest from choosing medicine as a career,” she says.

Close relationships tied to ovarian cancer survival

Women with ovarian cancer may have somewhat better survival odds when they feel emotionally supported by family and friends, a new study suggests.

Of 168 ovarian cancer patients in the study, 95 had “high social attachment” – meaning they had relationships that made them feel emotionally secure and closely connected to at least one other person.

After almost five years, 59% of those women were still alive, vs 38% of patients with lesser emotional bonds.

The researchers are not sure of the reasons for the link. It seemed to go beyond practical factors, like having someone who helped patients out day-to-day. But the study cannot say whether a close emotional relationship, itself, affects women’s survival odds.

And a researcher not involved in the work cautioned against making too much of the findings.

It is “strictly a correlational study,” said Dr. James C. Coyne, director of the behavioral oncology program at the University of Pennsylvania School of Medicine in Philadelphia, in an email.

There could be various reasons for the connection between emotional support and survival, according Dr. Susan K. Lutgendorf of the University of Iowa in Iowa City, who led the new study.

“We’re talking about people who feel a close connection with someone else. They feel they have someone they can confide in,” Dr. Lutgendorf said.

One possibility is that women with such supportive relationships feel less stress – which, in turn, might affect their well-being in a number of ways. Based on other research, people who feel support from family and friends may stick with their medical treatment more closely, Dr. Lutgendorf noted.

But in past studies, she and her colleagues have seen some potential direct links. They’ve found that ovarian cancer patients’ levels of “social attachment” seem to correlate with certain markers of inflammation and immune function, for instance.

Still, no one knows if close emotional relationships can actually boost women’s cancer survival odds.

In fact, Dr. Coyne said, some clinical trials have looked at whether boosting social support, through support groups or psychotherapy, can extend cancer patients’ lives.

“And the findings are universally negative,” he said.

As reported online July 16th in the Journal of Clinical Oncology, the women were followed from the time of surgery for their ovarian cancer. They all completed questionnaires on social support and depression symptoms.

Even after adjustment for depression, age, and the stage of the cancer, women who felt strong emotional support were 13% less likely to die during the study period, the authors said. On the other hand, “instrumental” support was not tied to survival.

Dr. Lutgendorf said it was surprising that type of support was not also linked to survival.

What does it all mean for women with ovarian cancer?

“Many women have wonderful support from family and friends,” Dr. Lutgendorf said – but if they think they need more support, they should reach out.

Cancer centers often have “wellness” services that offer support groups or other types of psychological and emotional help, Dr. Lutgendorf noted. There are also national resources, like the American Cancer Society.

Dr. Lutgendorf also said doctors can ask cancer patients about their relationships – whether they have “someone they can talk to,” for instance.

Dr. Coyne said that if he were to study the issue, he’d want to follow a larger group of women over time. He would want to monitor any “medically significant events” and see how social relationships helped women deal with those health problems.

“My basic hypothesis would be that women who have close relationships have more opportunities to be vigilant for and address surgical complications, (other concurrent illnesses) and signs of (cancer) recurrence in a timely fashion,” Dr. Coyne said.

He was critical of the theory that emotional bonds could have effects on the immune system that boost cancer survival. For one, he said, it’s not clear yet whether and how various “immunological variables” affect cancer progression.

He cautioned against raising people’s hopes on that front.

“Cancer patients are particularly vulnerable to unrealistic expectations that they can extend their life by strengthening their immune systems,” Dr. Coyne said.

SOURCE: http://bit.ly/QfBx7T

J Clin Oncol 2012.

Copyright © 2012 Reuters Limited.

AIDS deaths worldwide drop as drug access improves

By Deena Beasley and Tom Miles

LOS ANGELES/GENEVA (Reuters) –

Fewer people infected with HIV globally are dying as more of them get access to crucial antiretroviral drugs.

Particularly in sub-Saharan Africa, the United Nations AIDS program said on Wednesday.

The United Nations estimates that about 34 million people are living with the human immunodeficiency virus (HIV). In a report released ahead of the International AIDS Society’s 2012 annual meeting set for next week in Washington, D.C., it said the number of worldwide AIDS-related deaths fell to 1.7 million last year from some 1.8 million in 2010. AIDS deaths peaked at 2.3 million in 2005.

The decline has been fueled by greater access to medications that help more people live with the disease. An estimated eight million people in lower-income countries are receiving antiretroviral drugs, and the United Nations has set a target to raise that to 15 million by 2015.

Funding for HIV prevention and treatment totaled $16.8 billion last year. Of that amount, $8.2 billion came from international sources including the United States, which donated 48% of it. The amount of money spent by poor and middle-income countries reached $8.6 billion last year, surpassing international investment for the first time. The U.N. estimates that another $5 billion is needed to reach its 2015 goals.

The U.N. is also talking with pharmaceutical companies about how to improve access to lower-cost versions of simpler HIV treatments that combine several drugs in a single pill.

“We need innovation which will reduce the cost of medicine,” Michel Sidibe, executive director of UNAIDS, said during a telephone interview. “If we want to maintain people on second- and third-line medicine it will not be possible with the price of the drugs we have today.”

Paul De Lay, UNAIDS deputy executive director, speaking at a briefing in Geneva, said overall progress in treating the disease could be jeopardized by a surge in infection seen in smaller patient groups, including in Eastern Europe and the United States.

“We are looking at an epidemic that’s going to last another 40 to 50 years to get down to what we would consider the lowest possible number of infections,” De Lay said.

“It reminds us that prevention must be sustained, just the way we talk about sustaining treatment. Until we have a vaccine this is still going to have to be part of all countries’ health programs,” he said.

LOOKING FOR MORE OPTIONS

Public health officials are considering wider use of HIV medications in people who are not infected with the virus but have a high risk of contracting it. Earlier this week, U.S. health regulators for the first time approved use of Gilead Sciences Inc’s Truvada drug for preventing HIV.

Researchers are also working on using HIV-fighting antibodies to prevent infection, and they say their efforts could yield a licensed vaccine.

In the meantime, treating more people infected with HIV remains a priority. UNAIDS estimated that in sub-Saharan Africa, a region encompassing countries like Kenya, Nigeria and South Africa, 31% fewer people died from AIDS-related causes in 2011 compared with 2005.

The region “has actually been able to scale up more than other parts of the world, more than Eastern Europe and Central Asia, more than North Africa and the Middle East, and even more than Asia, with a 62% coverage rate of people eligible for treatment able to access treatment,” said Dr. Gottfried Hirnschall, director of the HIV Department at the World Health Organization.

Access to therapy also led to lower rates of AIDS-related deaths in Latin America, the Caribbean and Oceania.

In Western and Central Europe, as well as North America, where antiretroviral therapy is extensively available, the combined number of AIDS-related deaths has varied little over the past decade, totaling about 29,000 last year, according to the United Nations.

Death rates were also stable in Asia at an estimated 330,000, while AIDS-related deaths continued to rise in Eastern Europe, Central Asia, the Middle East and North Africa.

New infections among children declined for the second year in a row amid focused efforts to protect them and their mothers against HIV. About 330,000 children were newly infected with HIV in 2011, down from 570,000 in 2003.

Copyright © 2012 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Copyright 2012 Thomson Reuters.  Click for Restrictions.