Alicia Ault

WASHINGTON – Even as the economic downturn causes private health spending to slow, public sector health spending is rising, according to a federal analysis.

An estimated 3.4 million people may lose private health insurance coverage in 2009 and another 2.6 million may lose coverage in 2010, said Sean Keehan, an actuary at the Center for Medicare and Medicaid Services' Office of the Actuary.

Total U.S. health care spending was an estimated $2.4 trillion in 2008–an increase of 6.1% over 2007, according to the annual projection of health spending trends published online in the journal Health Affairs. This year, spending is expected to grow by only 5.5%.

That rate of growth is expected to far outpace the nation's gross domestic product in 2009. Economists for the CMS said they predict the GDP to shrink by 0.2% this year.

Meanwhile, the health care share of GDP is expected to grow 1.4%–the biggest annual jump as a portion of GDP since economists first started tracking this indicator in 1960, said Christopher Truffer, who is an actuary with CMS.

Health spending will account for 17.6% of the GDP in 2009, according to the report (Health Affairs 2009 Feb. 24 [doi:10.1377/hlthaff.28.2.w346

Absent any policy changes, health care is on track to gobble up one-fifth of the nation's dollar by 2018, Mr. Truffer and his colleagues said.

The economists projected that overall health spending will rise by only 4.6% in 2010, thanks largely to the mandated 21% reduction in physician payments required under the Sustainable Growth Rate target set by Medicare.

However, since Congress usually eliminates the cuts or grants a fee increase every year, the CMS economists calculated some alternative scenarios. If payments were kept constant, Medicare spending would rise 6.4%, or 3.9% faster than if the cuts went into effect. Overall national health spending would rise 5.4%, or 0.8% more.

Medicaid spending will grow 9.6% in 2009, up from 6.9% in 2008. Private health insurance benefits spending grew an estimated 5.8% in 2008, but will rise only 4.1% in 2009.

The CMS projections make it seem like cost-containment efforts are having a negligible effect on restraining overall health spending. The economists said the Medicare fee cuts would make a difference, but that they did not have the data to calculate whether other cost-containment efforts in the private sector in particular were having any effect on restraining health spending. However, prescription drug spending has dropped as a result of insurers successfully driving an increase in the use of generic drugs, said John Poisal, deputy director of the Office of the Actuary. Overall, the public and private sector spent 3.5% more on drugs in 2008, compared with a 4.9% increase the previous year.

Overall, the nation spent $235 billion on prescriptions in 2008. The analysts expected to see a 4% increase this year.

Hospital spending is expected to grow only 5.7% in 2009, compared with a 7.2% increase in 2008.

The analysts projected spending trends to 2018, but said their assumptions would change if the recession continues beyond early 2010. Their macroeconomic assumptions are based on the Blue Chip Consensus forecast, an amalgamation of the views of expert economists. That forecast predicts positive economic growth beginning in the second half of 2009.

The assumptions could change if significant health care reform occurs. CMS Chief Actuary Rick Foster has told reporters that he does not expect to see significant health reform proposals in the budget.

“I don't believe the administration is yet in the position to announce specifics or build a detailed plan,” he said.

WASHINGTON – Even as the economic downturn causes private health spending to slow, public sector health spending is rising, according to a federal analysis.

An estimated 3.4 million people may lose private health insurance coverage in 2009 and another 2.6 million may lose coverage in 2010, said Sean Keehan, an actuary at the Center for Medicare and Medicaid Services' Office of the Actuary.

Total U.S. health care spending was an estimated $2.4 trillion in 2008–an increase of 6.1% over 2007, according to the annual projection of health spending trends published online in the journal Health Affairs. This year, spending is expected to grow by only 5.5%.

That rate of growth is expected to far outpace the nation's gross domestic product in 2009. Economists for the CMS said they predict the GDP to shrink by 0.2% this year.

Meanwhile, the health care share of GDP is expected to grow 1.4%–the biggest annual jump as a portion of GDP since economists first started tracking this indicator in 1960, said Christopher Truffer, who is an actuary with CMS.

Health spending will account for 17.6% of the GDP in 2009, according to the report (Health Affairs 2009 Feb. 24 [doi:10.1377/hlthaff.28.2.w346

Absent any policy changes, health care is on track to gobble up one-fifth of the nation's dollar by 2018, Mr. Truffer and his colleagues said.

The economists projected that overall health spending will rise by only 4.6% in 2010, thanks largely to the mandated 21% reduction in physician payments required under the Sustainable Growth Rate target set by Medicare.

However, since Congress usually eliminates the cuts or grants a fee increase every year, the CMS economists calculated some alternative scenarios. If payments were kept constant, Medicare spending would rise 6.4%, or 3.9% faster than if the cuts went into effect. Overall national health spending would rise 5.4%, or 0.8% more.

Medicaid spending will grow 9.6% in 2009, up from 6.9% in 2008. Private health insurance benefits spending grew an estimated 5.8% in 2008, but will rise only 4.1% in 2009.

The CMS projections make it seem like cost-containment efforts are having a negligible effect on restraining overall health spending. The economists said the Medicare fee cuts would make a difference, but that they did not have the data to calculate whether other cost-containment efforts in the private sector in particular were having any effect on restraining health spending. However, prescription drug spending has dropped as a result of insurers successfully driving an increase in the use of generic drugs, said John Poisal, deputy director of the Office of the Actuary. Overall, the public and private sector spent 3.5% more on drugs in 2008, compared with a 4.9% increase the previous year.

Overall, the nation spent $235 billion on prescriptions in 2008. The analysts expected to see a 4% increase this year.

Hospital spending is expected to grow only 5.7% in 2009, compared with a 7.2% increase in 2008.

The analysts projected spending trends to 2018, but said their assumptions would change if the recession continues beyond early 2010. Their macroeconomic assumptions are based on the Blue Chip Consensus forecast, an amalgamation of the views of expert economists. That forecast predicts positive economic growth beginning in the second half of 2009.

The assumptions could change if significant health care reform occurs. CMS Chief Actuary Rick Foster has told reporters that he does not expect to see significant health reform proposals in the budget.

“I don't believe the administration is yet in the position to announce specifics or build a detailed plan,” he said.

WASHINGTON – Even as the economic downturn causes private health spending to slow, public sector health spending is rising, according to a federal analysis.

An estimated 3.4 million people may lose private health insurance coverage in 2009 and another 2.6 million may lose coverage in 2010, said Sean Keehan, an actuary at the Center for Medicare and Medicaid Services' Office of the Actuary.

Total U.S. health care spending was an estimated $2.4 trillion in 2008–an increase of 6.1% over 2007, according to the annual projection of health spending trends published online in the journal Health Affairs. This year, spending is expected to grow by only 5.5%.

That rate of growth is expected to far outpace the nation's gross domestic product in 2009. Economists for the CMS said they predict the GDP to shrink by 0.2% this year.

Meanwhile, the health care share of GDP is expected to grow 1.4%–the biggest annual jump as a portion of GDP since economists first started tracking this indicator in 1960, said Christopher Truffer, who is an actuary with CMS.

Health spending will account for 17.6% of the GDP in 2009, according to the report (Health Affairs 2009 Feb. 24 [doi:10.1377/hlthaff.28.2.w346

Absent any policy changes, health care is on track to gobble up one-fifth of the nation's dollar by 2018, Mr. Truffer and his colleagues said.

The economists projected that overall health spending will rise by only 4.6% in 2010, thanks largely to the mandated 21% reduction in physician payments required under the Sustainable Growth Rate target set by Medicare.

However, since Congress usually eliminates the cuts or grants a fee increase every year, the CMS economists calculated some alternative scenarios. If payments were kept constant, Medicare spending would rise 6.4%, or 3.9% faster than if the cuts went into effect. Overall national health spending would rise 5.4%, or 0.8% more.

Medicaid spending will grow 9.6% in 2009, up from 6.9% in 2008. Private health insurance benefits spending grew an estimated 5.8% in 2008, but will rise only 4.1% in 2009.

The CMS projections make it seem like cost-containment efforts are having a negligible effect on restraining overall health spending. The economists said the Medicare fee cuts would make a difference, but that they did not have the data to calculate whether other cost-containment efforts in the private sector in particular were having any effect on restraining health spending. However, prescription drug spending has dropped as a result of insurers successfully driving an increase in the use of generic drugs, said John Poisal, deputy director of the Office of the Actuary. Overall, the public and private sector spent 3.5% more on drugs in 2008, compared with a 4.9% increase the previous year.

Overall, the nation spent $235 billion on prescriptions in 2008. The analysts expected to see a 4% increase this year.

Hospital spending is expected to grow only 5.7% in 2009, compared with a 7.2% increase in 2008.

The analysts projected spending trends to 2018, but said their assumptions would change if the recession continues beyond early 2010. Their macroeconomic assumptions are based on the Blue Chip Consensus forecast, an amalgamation of the views of expert economists. That forecast predicts positive economic growth beginning in the second half of 2009.

The assumptions could change if significant health care reform occurs. CMS Chief Actuary Rick Foster has told reporters that he does not expect to see significant health reform proposals in the budget.

“I don't believe the administration is yet in the position to announce specifics or build a detailed plan,” he said.

WASHINGTON — The three committees with jurisdiction over health care in the House of Representatives will make their health reform “framework” public by early June, Rep. Henry Waxman (D-Calif.) said at a forum sponsored by the policy analysis firm Avalere Health.

Rep. Waxman, chairman of the House Energy and Commerce Committee, said that his staff, along with the staffs of the Ways and Means and the Education and Labor committees, have been collaborating to create a “proposal that will allow all three to start from a common point.”

Once the framework has been developed, House Republicans will be brought into the process, Rep. Waxman said, emphasizing that Democrats will work “very, very closely” with their colleagues across the aisle. After the plan has been released publicly, the three committees will hold hearings to get “viewpoints from stakeholders,” he added.

Then the committees will work with the Rules Committee and the House leadership to bring the bill to the House floor, Rep. Waxman said. He predicted passage of a reform bill by the end of July in the House and by the end of the year for both the House and the Senate.

Rep. Waxman was less certain regarding the substance of the legislation. “It must solve the problems of coverage, cost, and quality together,” he said, adding, “There's no real way to solve one without dealing with the others.”

The bill will build on what's currently in place, including Medicare, Medicaid, and private insurance, he said. But he left no doubt where he stood on having a government-supported “public plan” as an option for those who could not buy insurance in the private market.

“This system will work better if there is a public health insurance plan available as an alternative to private health insurance,” Rep. Waxman said. But he also said he wanted to ensure that public and private plans would be placed on a “level playing field. We must allow private insurers a fair opportunity to compete.”

Rep. Waxman said that he was confident that health reform will succeed in 2009, noting that President Obama has given it a high priority, and that House and Senate leaders, as well almost all other players in the debate, are unified in achieving that goal.

Rep. Waxman said that he sees action by the Energy and Commerce Committee as a significant predictor of how health reform will fare in the Congress overall. Noting that the panel has 59 members, the chairman said that the panel comprises 15% of the House and numerically represents 60% of the Senate. The committee balances urban and rural areas, and conservative and liberal ideologies, he said. “If we can find consensus in the Energy and Commerce Committee,” he said, “we'll be pretty close to what we need in the House and Senate.”

WASHINGTON — The three committees with jurisdiction over health care in the House of Representatives will make their health reform “framework” public by early June, Rep. Henry Waxman (D-Calif.) said at a forum sponsored by the policy analysis firm Avalere Health.

Rep. Waxman, chairman of the House Energy and Commerce Committee, said that his staff, along with the staffs of the Ways and Means and the Education and Labor committees, have been collaborating to create a “proposal that will allow all three to start from a common point.”

Once the framework has been developed, House Republicans will be brought into the process, Rep. Waxman said, emphasizing that Democrats will work “very, very closely” with their colleagues across the aisle. After the plan has been released publicly, the three committees will hold hearings to get “viewpoints from stakeholders,” he added.

Then the committees will work with the Rules Committee and the House leadership to bring the bill to the House floor, Rep. Waxman said. He predicted passage of a reform bill by the end of July in the House and by the end of the year for both the House and the Senate.

Rep. Waxman was less certain regarding the substance of the legislation. “It must solve the problems of coverage, cost, and quality together,” he said, adding, “There's no real way to solve one without dealing with the others.”

The bill will build on what's currently in place, including Medicare, Medicaid, and private insurance, he said. But he left no doubt where he stood on having a government-supported “public plan” as an option for those who could not buy insurance in the private market.

“This system will work better if there is a public health insurance plan available as an alternative to private health insurance,” Rep. Waxman said. But he also said he wanted to ensure that public and private plans would be placed on a “level playing field. We must allow private insurers a fair opportunity to compete.”

Rep. Waxman said that he was confident that health reform will succeed in 2009, noting that President Obama has given it a high priority, and that House and Senate leaders, as well almost all other players in the debate, are unified in achieving that goal.

Rep. Waxman said that he sees action by the Energy and Commerce Committee as a significant predictor of how health reform will fare in the Congress overall. Noting that the panel has 59 members, the chairman said that the panel comprises 15% of the House and numerically represents 60% of the Senate. The committee balances urban and rural areas, and conservative and liberal ideologies, he said. “If we can find consensus in the Energy and Commerce Committee,” he said, “we'll be pretty close to what we need in the House and Senate.”

WASHINGTON — The three committees with jurisdiction over health care in the House of Representatives will make their health reform “framework” public by early June, Rep. Henry Waxman (D-Calif.) said at a forum sponsored by the policy analysis firm Avalere Health.

Rep. Waxman, chairman of the House Energy and Commerce Committee, said that his staff, along with the staffs of the Ways and Means and the Education and Labor committees, have been collaborating to create a “proposal that will allow all three to start from a common point.”

Once the framework has been developed, House Republicans will be brought into the process, Rep. Waxman said, emphasizing that Democrats will work “very, very closely” with their colleagues across the aisle. After the plan has been released publicly, the three committees will hold hearings to get “viewpoints from stakeholders,” he added.

Then the committees will work with the Rules Committee and the House leadership to bring the bill to the House floor, Rep. Waxman said. He predicted passage of a reform bill by the end of July in the House and by the end of the year for both the House and the Senate.

Rep. Waxman was less certain regarding the substance of the legislation. “It must solve the problems of coverage, cost, and quality together,” he said, adding, “There's no real way to solve one without dealing with the others.”

The bill will build on what's currently in place, including Medicare, Medicaid, and private insurance, he said. But he left no doubt where he stood on having a government-supported “public plan” as an option for those who could not buy insurance in the private market.

“This system will work better if there is a public health insurance plan available as an alternative to private health insurance,” Rep. Waxman said. But he also said he wanted to ensure that public and private plans would be placed on a “level playing field. We must allow private insurers a fair opportunity to compete.”

Rep. Waxman said that he was confident that health reform will succeed in 2009, noting that President Obama has given it a high priority, and that House and Senate leaders, as well almost all other players in the debate, are unified in achieving that goal.

Rep. Waxman said that he sees action by the Energy and Commerce Committee as a significant predictor of how health reform will fare in the Congress overall. Noting that the panel has 59 members, the chairman said that the panel comprises 15% of the House and numerically represents 60% of the Senate. The committee balances urban and rural areas, and conservative and liberal ideologies, he said. “If we can find consensus in the Energy and Commerce Committee,” he said, “we'll be pretty close to what we need in the House and Senate.”

No Word From CBO Yet on Mohs

In November 2008, the Mohs Coalition, made up of the American Academy of Dermatology, the American College of Mohs Surgery, the American Society for Dermatologic Surgery, and the American Society for Mohs Surgery asked the Congressional Budget Office to determine how much Medicare's 2007 multiple-procedure payment reduction rule has saved the Centers for Medicare and Medicaid Services. The CBO has not yet responded, said AAD President David Pariser at the annual meeting of the American College of Mohs Surgery. Dr. Pariser said that the rule has had an adverse impact on Mohs surgeons. Because of fears that the technique is being overused, "people are shooting darts at Mohs," Dr. Pariser said. He encouraged Mohs surgeons to begin gathering data about the value of their work. The coalition is also mulling whether to request a national coverage decision from CMS for Mohs.

AAD Launches Lexicon

The American Academy of Dermatology launched DermLex, an online database of dermatologic terms that had been in beta testing for several months (SKIN & ALLERGY NEWS, March 2009, p. 11). "With widespread electronic health record adoption on the horizon and patient safety and quality of care always a top priority for dermatologists, this database can assist all physicians in the correct interpretation of a patient's dermatologic history," said Dr. Pariser in a statement. The AAD intends to eventually equip the database with online tools to work with electronic medical records.

Company Would Grow Derm Role

GlaxoSmithKline has offered $2.9 billion for Stiefel Laboratories Inc. If the deal closes, the combined entity would be one of the largest dermatology specialty companies in the world. The new company would still operate as Stiefel and continue to offer such brands as Duac, Olux E, Soriatane, Bactroban, Cutivate, and Altabax, according to GSK. Combined revenues for the two companies would have totaled $1.5 billion in 2008, and accounted for 8% of the global prescription dermatology market. Stiefel stockholders have already approved the acquisition, but it still has to be given a green light by federal regulators. GSK said that it expects the transaction to close some time in the third quarter of this year.

HHS Launches Lupus Campaign

The Department of Health and Human Services, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. "Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country," said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18–44 in the United States have little or no knowledge of lupus.

PhRMA Revises Trial Standards

The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drugmakers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to "greatly expand transparency in medical research" by providing summaries of results from all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drugmakers to adopt the authorship standards of the International Committee of Medical Journal Editors.

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The group's "Voices of Physicians" campaign has collected comments nationwide and put them on the Web site

www.voicesofphysicians.org

Small Promo Items Have Influence

Subtle exposures to small promotional items, such as notepaper with printed logos, influences attitudes of medical students toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might affect whether students' attitudes toward drug brands are favorable, the researchers noted. At one institution, where a strong school policy warned against persuasion tactics underlying pharmaceutical marketing, the students had more negative reactions to a brand-name drug after exposure to small promotional items. At another institution, where no such policy was in place, students had more positive reactions to the same product after promotional item exposure. An editorial accompanying the study noted that medical schools have been slow to enact widespread restrictions on academic-industry interactions.

No Word From CBO Yet on Mohs

In November 2008, the Mohs Coalition, made up of the American Academy of Dermatology, the American College of Mohs Surgery, the American Society for Dermatologic Surgery, and the American Society for Mohs Surgery asked the Congressional Budget Office to determine how much Medicare's 2007 multiple-procedure payment reduction rule has saved the Centers for Medicare and Medicaid Services. The CBO has not yet responded, said AAD President David Pariser at the annual meeting of the American College of Mohs Surgery. Dr. Pariser said that the rule has had an adverse impact on Mohs surgeons. Because of fears that the technique is being overused, "people are shooting darts at Mohs," Dr. Pariser said. He encouraged Mohs surgeons to begin gathering data about the value of their work. The coalition is also mulling whether to request a national coverage decision from CMS for Mohs.

AAD Launches Lexicon

The American Academy of Dermatology launched DermLex, an online database of dermatologic terms that had been in beta testing for several months (SKIN & ALLERGY NEWS, March 2009, p. 11). "With widespread electronic health record adoption on the horizon and patient safety and quality of care always a top priority for dermatologists, this database can assist all physicians in the correct interpretation of a patient's dermatologic history," said Dr. Pariser in a statement. The AAD intends to eventually equip the database with online tools to work with electronic medical records.

Company Would Grow Derm Role

GlaxoSmithKline has offered $2.9 billion for Stiefel Laboratories Inc. If the deal closes, the combined entity would be one of the largest dermatology specialty companies in the world. The new company would still operate as Stiefel and continue to offer such brands as Duac, Olux E, Soriatane, Bactroban, Cutivate, and Altabax, according to GSK. Combined revenues for the two companies would have totaled $1.5 billion in 2008, and accounted for 8% of the global prescription dermatology market. Stiefel stockholders have already approved the acquisition, but it still has to be given a green light by federal regulators. GSK said that it expects the transaction to close some time in the third quarter of this year.

HHS Launches Lupus Campaign

The Department of Health and Human Services, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. "Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country," said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18–44 in the United States have little or no knowledge of lupus.

PhRMA Revises Trial Standards

The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drugmakers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to "greatly expand transparency in medical research" by providing summaries of results from all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drugmakers to adopt the authorship standards of the International Committee of Medical Journal Editors.

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The group's "Voices of Physicians" campaign has collected comments nationwide and put them on the Web site

www.voicesofphysicians.org

Small Promo Items Have Influence

Subtle exposures to small promotional items, such as notepaper with printed logos, influences attitudes of medical students toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might affect whether students' attitudes toward drug brands are favorable, the researchers noted. At one institution, where a strong school policy warned against persuasion tactics underlying pharmaceutical marketing, the students had more negative reactions to a brand-name drug after exposure to small promotional items. At another institution, where no such policy was in place, students had more positive reactions to the same product after promotional item exposure. An editorial accompanying the study noted that medical schools have been slow to enact widespread restrictions on academic-industry interactions.

No Word From CBO Yet on Mohs

In November 2008, the Mohs Coalition, made up of the American Academy of Dermatology, the American College of Mohs Surgery, the American Society for Dermatologic Surgery, and the American Society for Mohs Surgery asked the Congressional Budget Office to determine how much Medicare's 2007 multiple-procedure payment reduction rule has saved the Centers for Medicare and Medicaid Services. The CBO has not yet responded, said AAD President David Pariser at the annual meeting of the American College of Mohs Surgery. Dr. Pariser said that the rule has had an adverse impact on Mohs surgeons. Because of fears that the technique is being overused, "people are shooting darts at Mohs," Dr. Pariser said. He encouraged Mohs surgeons to begin gathering data about the value of their work. The coalition is also mulling whether to request a national coverage decision from CMS for Mohs.

AAD Launches Lexicon

The American Academy of Dermatology launched DermLex, an online database of dermatologic terms that had been in beta testing for several months (SKIN & ALLERGY NEWS, March 2009, p. 11). "With widespread electronic health record adoption on the horizon and patient safety and quality of care always a top priority for dermatologists, this database can assist all physicians in the correct interpretation of a patient's dermatologic history," said Dr. Pariser in a statement. The AAD intends to eventually equip the database with online tools to work with electronic medical records.

Company Would Grow Derm Role

GlaxoSmithKline has offered $2.9 billion for Stiefel Laboratories Inc. If the deal closes, the combined entity would be one of the largest dermatology specialty companies in the world. The new company would still operate as Stiefel and continue to offer such brands as Duac, Olux E, Soriatane, Bactroban, Cutivate, and Altabax, according to GSK. Combined revenues for the two companies would have totaled $1.5 billion in 2008, and accounted for 8% of the global prescription dermatology market. Stiefel stockholders have already approved the acquisition, but it still has to be given a green light by federal regulators. GSK said that it expects the transaction to close some time in the third quarter of this year.

HHS Launches Lupus Campaign

The Department of Health and Human Services, in cooperation with the American College of Rheumatology and other health care organizations, has launched a national advertising campaign to educate women about lupus. "Despite its prevalence in the United States, lupus is rarely discussed and often misunderstood among women in our country," said Dr. Wanda K. Jones, deputy assistant secretary for women's health at HHS. A recent study by the Ad Council found that about 80% of women aged 18–44 in the United States have little or no knowledge of lupus.

PhRMA Revises Trial Standards

The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drugmakers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to "greatly expand transparency in medical research" by providing summaries of results from all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drugmakers to adopt the authorship standards of the International Committee of Medical Journal Editors.

New Web Site Pushes Reform

Doctors for America, a new grassroots physician organization, is launching a campaign to get physicians' voices heard on health care reform. The group's "Voices of Physicians" campaign has collected comments nationwide and put them on the Web site

www.voicesofphysicians.org

Small Promo Items Have Influence

Subtle exposures to small promotional items, such as notepaper with printed logos, influences attitudes of medical students toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might affect whether students' attitudes toward drug brands are favorable, the researchers noted. At one institution, where a strong school policy warned against persuasion tactics underlying pharmaceutical marketing, the students had more negative reactions to a brand-name drug after exposure to small promotional items. At another institution, where no such policy was in place, students had more positive reactions to the same product after promotional item exposure. An editorial accompanying the study noted that medical schools have been slow to enact widespread restrictions on academic-industry interactions.

AUSTIN, TEX. — The public does not appear to perceive that Mohs surgeons are as capable as plastic surgeons when it comes to removing cutaneous lesions and repairing facial defects, according to a survey of 467 patients.

Dr. Vinh Q. Chung of the department of dermatology at Emory University, Atlanta, said that he often has been asked what he called an "absurd" question by patients—whether they should see a plastic surgeon. To determine why they did not consider a Mohs surgeon to be capable, he and his colleagues conducted a prospective survey of 250 patients at the Emory Student Center and 217 at the Emory Dermatology Clinic.

In the first part, they were asked to rate seven questions about specialists' training and surgical skills on a visual analog scale. Survey respondents were asked to rate dermatologists, plastic surgeons, general surgeons, emergency physicians, and family practitioners.

When they were asked which specialist had the greatest ability to create absolutely no scar, 63% (136) of derm clinic patients and 64% (160) of students said that they had a high confidence in plastic surgeons; a little more than 20% of each group gave the same marks to dermatologists. The scores were significantly higher for plastic surgeons on every question, Dr. Chung said at the annual meeting of the American College of Mohs Surgery.

In the second part of the survey, patients were given a series of images of surgical scars. The images were all the same, but each was labeled with a specialty. The goal was to see if the label biased the patient's perception, he said.

Respondents were asked to rate the image on a scale of 1–10, with 10 being the highest score. Interestingly, scores were fairly consistent among all the images, with dermatologists and plastic surgeons ranking the highest. The dermatology clinic patients' mean score for plastic surgeons was 5.86, compared with 5.48 for the students. Derm clinic patients' mean score for dermatologists was 5.91, compared with 5.28 assigned by the students.

"Our study supports our suspicion that the public has more confidence in the brand 'plastic surgery' than the brand 'dermatology' when it comes to cutaneous surgeries," he said. This was especially surprising since it came from patients in the dermatology clinic. On the other hand, patients were able to be objective when they evaluated the scars.

Students should be required to spend at least a day in the operating room to see what Mohs surgery is, and dermatologic surgeons should continue to "promote our reputation as the experts for skin surgeries," he said.

AUSTIN, TEX. — The public does not appear to perceive that Mohs surgeons are as capable as plastic surgeons when it comes to removing cutaneous lesions and repairing facial defects, according to a survey of 467 patients.

Dr. Vinh Q. Chung of the department of dermatology at Emory University, Atlanta, said that he often has been asked what he called an "absurd" question by patients—whether they should see a plastic surgeon. To determine why they did not consider a Mohs surgeon to be capable, he and his colleagues conducted a prospective survey of 250 patients at the Emory Student Center and 217 at the Emory Dermatology Clinic.

In the first part, they were asked to rate seven questions about specialists' training and surgical skills on a visual analog scale. Survey respondents were asked to rate dermatologists, plastic surgeons, general surgeons, emergency physicians, and family practitioners.

When they were asked which specialist had the greatest ability to create absolutely no scar, 63% (136) of derm clinic patients and 64% (160) of students said that they had a high confidence in plastic surgeons; a little more than 20% of each group gave the same marks to dermatologists. The scores were significantly higher for plastic surgeons on every question, Dr. Chung said at the annual meeting of the American College of Mohs Surgery.

In the second part of the survey, patients were given a series of images of surgical scars. The images were all the same, but each was labeled with a specialty. The goal was to see if the label biased the patient's perception, he said.

Respondents were asked to rate the image on a scale of 1–10, with 10 being the highest score. Interestingly, scores were fairly consistent among all the images, with dermatologists and plastic surgeons ranking the highest. The dermatology clinic patients' mean score for plastic surgeons was 5.86, compared with 5.48 for the students. Derm clinic patients' mean score for dermatologists was 5.91, compared with 5.28 assigned by the students.

"Our study supports our suspicion that the public has more confidence in the brand 'plastic surgery' than the brand 'dermatology' when it comes to cutaneous surgeries," he said. This was especially surprising since it came from patients in the dermatology clinic. On the other hand, patients were able to be objective when they evaluated the scars.

Students should be required to spend at least a day in the operating room to see what Mohs surgery is, and dermatologic surgeons should continue to "promote our reputation as the experts for skin surgeries," he said.

AUSTIN, TEX. — The public does not appear to perceive that Mohs surgeons are as capable as plastic surgeons when it comes to removing cutaneous lesions and repairing facial defects, according to a survey of 467 patients.

Dr. Vinh Q. Chung of the department of dermatology at Emory University, Atlanta, said that he often has been asked what he called an "absurd" question by patients—whether they should see a plastic surgeon. To determine why they did not consider a Mohs surgeon to be capable, he and his colleagues conducted a prospective survey of 250 patients at the Emory Student Center and 217 at the Emory Dermatology Clinic.

In the first part, they were asked to rate seven questions about specialists' training and surgical skills on a visual analog scale. Survey respondents were asked to rate dermatologists, plastic surgeons, general surgeons, emergency physicians, and family practitioners.

When they were asked which specialist had the greatest ability to create absolutely no scar, 63% (136) of derm clinic patients and 64% (160) of students said that they had a high confidence in plastic surgeons; a little more than 20% of each group gave the same marks to dermatologists. The scores were significantly higher for plastic surgeons on every question, Dr. Chung said at the annual meeting of the American College of Mohs Surgery.

In the second part of the survey, patients were given a series of images of surgical scars. The images were all the same, but each was labeled with a specialty. The goal was to see if the label biased the patient's perception, he said.

Respondents were asked to rate the image on a scale of 1–10, with 10 being the highest score. Interestingly, scores were fairly consistent among all the images, with dermatologists and plastic surgeons ranking the highest. The dermatology clinic patients' mean score for plastic surgeons was 5.86, compared with 5.48 for the students. Derm clinic patients' mean score for dermatologists was 5.91, compared with 5.28 assigned by the students.

"Our study supports our suspicion that the public has more confidence in the brand 'plastic surgery' than the brand 'dermatology' when it comes to cutaneous surgeries," he said. This was especially surprising since it came from patients in the dermatology clinic. On the other hand, patients were able to be objective when they evaluated the scars.

Students should be required to spend at least a day in the operating room to see what Mohs surgery is, and dermatologic surgeons should continue to "promote our reputation as the experts for skin surgeries," he said.

AUSTIN, TEX. — The commonly accepted standard of using 5-mm margins for surgical excision of melanoma in situ may not be enough to clear the large majority of tumors, said Dr. Joy Kunishige.

Speaking at the annual meeting of the American College of Mohs Surgery, Dr. Kunishige, a dermatologist in private practice in Pittsburgh, said that since several studies have shown a 5-mm margin to be inadequate, she and her colleagues gathered the latest evidence on clearance rates to update previous National Institutes of Health guidelines, set in 1992 (NIH Consens. Statement 1992 Jan 27–29;10[1]:1–26). The goal was to clear at least 97% of tumors.

They evaluated all primary melanoma in situ cases that were collected as part of a prospective database started in 1982 at the practice. The database included 1,072 patients with 1,120 primary tumors. Of the patients, 675 (63%) were male, and mean age was 65 years, and mean follow-up was 4.7 years. A total of 593 (53%) of the lesions were on the face, 235 (21%) were on the extremities, and 201 (18%) were on the trunk, with the remainder in other locations.

All lesions were excised using the fresh tissue technique of Mohs, with frozen section examination of the margin.

Using 6-mm margins, 86% of the tumors were cleared. With a 9-mm margin, there was a 98% clearance rate; and with a 12-mm margin, a 99.4% clearance rate, said Dr. Kunishige.

The 9-mm margin was equally effective regardless of sex, location, or diameter of the lesion. The overall 5-year survival was 93%; the 5-year melanoma in situ survival was 99.5%. Three patients died of melanoma in situ. Two died from a separate invasive melanoma and 90 died of other causes, free of melanoma, she said.

The investigators concluded that a 9-mm margin was superior to 6 mm.

She reported no disclosures.

A 5-mm margin may not be adequate for removing the majority of tumors. Courtesy Dr. Joy Kunishige

AUSTIN, TEX. — The commonly accepted standard of using 5-mm margins for surgical excision of melanoma in situ may not be enough to clear the large majority of tumors, said Dr. Joy Kunishige.

Speaking at the annual meeting of the American College of Mohs Surgery, Dr. Kunishige, a dermatologist in private practice in Pittsburgh, said that since several studies have shown a 5-mm margin to be inadequate, she and her colleagues gathered the latest evidence on clearance rates to update previous National Institutes of Health guidelines, set in 1992 (NIH Consens. Statement 1992 Jan 27–29;10[1]:1–26). The goal was to clear at least 97% of tumors.

They evaluated all primary melanoma in situ cases that were collected as part of a prospective database started in 1982 at the practice. The database included 1,072 patients with 1,120 primary tumors. Of the patients, 675 (63%) were male, and mean age was 65 years, and mean follow-up was 4.7 years. A total of 593 (53%) of the lesions were on the face, 235 (21%) were on the extremities, and 201 (18%) were on the trunk, with the remainder in other locations.

All lesions were excised using the fresh tissue technique of Mohs, with frozen section examination of the margin.

Using 6-mm margins, 86% of the tumors were cleared. With a 9-mm margin, there was a 98% clearance rate; and with a 12-mm margin, a 99.4% clearance rate, said Dr. Kunishige.

The 9-mm margin was equally effective regardless of sex, location, or diameter of the lesion. The overall 5-year survival was 93%; the 5-year melanoma in situ survival was 99.5%. Three patients died of melanoma in situ. Two died from a separate invasive melanoma and 90 died of other causes, free of melanoma, she said.

The investigators concluded that a 9-mm margin was superior to 6 mm.

She reported no disclosures.

A 5-mm margin may not be adequate for removing the majority of tumors. Courtesy Dr. Joy Kunishige

AUSTIN, TEX. — The commonly accepted standard of using 5-mm margins for surgical excision of melanoma in situ may not be enough to clear the large majority of tumors, said Dr. Joy Kunishige.

Speaking at the annual meeting of the American College of Mohs Surgery, Dr. Kunishige, a dermatologist in private practice in Pittsburgh, said that since several studies have shown a 5-mm margin to be inadequate, she and her colleagues gathered the latest evidence on clearance rates to update previous National Institutes of Health guidelines, set in 1992 (NIH Consens. Statement 1992 Jan 27–29;10[1]:1–26). The goal was to clear at least 97% of tumors.

They evaluated all primary melanoma in situ cases that were collected as part of a prospective database started in 1982 at the practice. The database included 1,072 patients with 1,120 primary tumors. Of the patients, 675 (63%) were male, and mean age was 65 years, and mean follow-up was 4.7 years. A total of 593 (53%) of the lesions were on the face, 235 (21%) were on the extremities, and 201 (18%) were on the trunk, with the remainder in other locations.

All lesions were excised using the fresh tissue technique of Mohs, with frozen section examination of the margin.

Using 6-mm margins, 86% of the tumors were cleared. With a 9-mm margin, there was a 98% clearance rate; and with a 12-mm margin, a 99.4% clearance rate, said Dr. Kunishige.

The 9-mm margin was equally effective regardless of sex, location, or diameter of the lesion. The overall 5-year survival was 93%; the 5-year melanoma in situ survival was 99.5%. Three patients died of melanoma in situ. Two died from a separate invasive melanoma and 90 died of other causes, free of melanoma, she said.

The investigators concluded that a 9-mm margin was superior to 6 mm.

She reported no disclosures.

A 5-mm margin may not be adequate for removing the majority of tumors. Courtesy Dr. Joy Kunishige

NEW ORLEANS — The American Board of Medical Specialties has approved standards for its maintenance of certification program, emphasizing public disclosure and evidence-based continuing medical education, said Dr. Richard E. Hawkins, ABMS senior vice president for professional and scientific affairs.

As part of maintenance of certification (MOC), physicians will now have to show evidence of participation in practice-based assessment and quality improvement every 2–5 years. The ABMS is urging physicians to use nationally approved measures such as those endorsed by the National Quality Forum. By 2011, all 24 ABMS member boards will have to show that diplomates meet these requirements.

At that time, the ABMS will let the public see which physicians are participating in the MOC process, most likely via a Web site, Dr. Hawkins said in an interview.

Dr. Hawkins described the actions taken by the ABMS Board of Directors in a presentation during the annual meeting of the Society of Gynecologic Surgeons. The board voted to require all physicians to complete a patient safety self-assessment program at least once during each MOC cycle, starting in 2010. Because ABMS member boards are at different stages of implementing MOC, some may not be equipped to start requiring this of their diplomates, Dr. Hawkins said. Thus, the ABMS dubbed the program a “developmental standard” and will reevaluate it during the next 5 years.

The ABMS will make modifications, if necessary, Dr. Hawkins said. Even so, the ABMS standards require this module to be in place for all diplomates by 2014.

The board also approved another pilot standard: Starting in 2010, physicians who provide direct patient care will be required to demonstrate communication skills using patient surveys with the Consumer Assessment of Healthcare Providers and Systems instrument, or an equivalent survey that's judged acceptable. The goal is to have the program in place by 2014, he said.

Similarly, the developmental standard on peer surveys—requiring physicians to participate starting in 2012—will be implemented by member boards at their own pace, but will still be expected by 2014. Both of these survey requirements will be evaluated and updated as necessary during the next 5 years.

Since physicians currently have to report quality data and process improvement to various agencies, the ABMS is working on ways to streamline data collection and reporting for MOC, Dr. Hawkins said.

NEW ORLEANS — The American Board of Medical Specialties has approved standards for its maintenance of certification program, emphasizing public disclosure and evidence-based continuing medical education, said Dr. Richard E. Hawkins, ABMS senior vice president for professional and scientific affairs.

As part of maintenance of certification (MOC), physicians will now have to show evidence of participation in practice-based assessment and quality improvement every 2–5 years. The ABMS is urging physicians to use nationally approved measures such as those endorsed by the National Quality Forum. By 2011, all 24 ABMS member boards will have to show that diplomates meet these requirements.

At that time, the ABMS will let the public see which physicians are participating in the MOC process, most likely via a Web site, Dr. Hawkins said in an interview.

Dr. Hawkins described the actions taken by the ABMS Board of Directors in a presentation during the annual meeting of the Society of Gynecologic Surgeons. The board voted to require all physicians to complete a patient safety self-assessment program at least once during each MOC cycle, starting in 2010. Because ABMS member boards are at different stages of implementing MOC, some may not be equipped to start requiring this of their diplomates, Dr. Hawkins said. Thus, the ABMS dubbed the program a “developmental standard” and will reevaluate it during the next 5 years.

The ABMS will make modifications, if necessary, Dr. Hawkins said. Even so, the ABMS standards require this module to be in place for all diplomates by 2014.

The board also approved another pilot standard: Starting in 2010, physicians who provide direct patient care will be required to demonstrate communication skills using patient surveys with the Consumer Assessment of Healthcare Providers and Systems instrument, or an equivalent survey that's judged acceptable. The goal is to have the program in place by 2014, he said.

Similarly, the developmental standard on peer surveys—requiring physicians to participate starting in 2012—will be implemented by member boards at their own pace, but will still be expected by 2014. Both of these survey requirements will be evaluated and updated as necessary during the next 5 years.

Since physicians currently have to report quality data and process improvement to various agencies, the ABMS is working on ways to streamline data collection and reporting for MOC, Dr. Hawkins said.

NEW ORLEANS — The American Board of Medical Specialties has approved standards for its maintenance of certification program, emphasizing public disclosure and evidence-based continuing medical education, said Dr. Richard E. Hawkins, ABMS senior vice president for professional and scientific affairs.

As part of maintenance of certification (MOC), physicians will now have to show evidence of participation in practice-based assessment and quality improvement every 2–5 years. The ABMS is urging physicians to use nationally approved measures such as those endorsed by the National Quality Forum. By 2011, all 24 ABMS member boards will have to show that diplomates meet these requirements.

At that time, the ABMS will let the public see which physicians are participating in the MOC process, most likely via a Web site, Dr. Hawkins said in an interview.

Dr. Hawkins described the actions taken by the ABMS Board of Directors in a presentation during the annual meeting of the Society of Gynecologic Surgeons. The board voted to require all physicians to complete a patient safety self-assessment program at least once during each MOC cycle, starting in 2010. Because ABMS member boards are at different stages of implementing MOC, some may not be equipped to start requiring this of their diplomates, Dr. Hawkins said. Thus, the ABMS dubbed the program a “developmental standard” and will reevaluate it during the next 5 years.

The ABMS will make modifications, if necessary, Dr. Hawkins said. Even so, the ABMS standards require this module to be in place for all diplomates by 2014.

The board also approved another pilot standard: Starting in 2010, physicians who provide direct patient care will be required to demonstrate communication skills using patient surveys with the Consumer Assessment of Healthcare Providers and Systems instrument, or an equivalent survey that's judged acceptable. The goal is to have the program in place by 2014, he said.

Similarly, the developmental standard on peer surveys—requiring physicians to participate starting in 2012—will be implemented by member boards at their own pace, but will still be expected by 2014. Both of these survey requirements will be evaluated and updated as necessary during the next 5 years.

Since physicians currently have to report quality data and process improvement to various agencies, the ABMS is working on ways to streamline data collection and reporting for MOC, Dr. Hawkins said.

WASHINGTON — Even as the economic downturn causes private health spending to slow, public sector health spending is rising, according to a federal analysis.

An estimated 3.4 million people may lose private health insurance coverage in 2009 and another 2.6 million may lose coverage in 2010, said Sean Keehan, an actuary at the Centers for Medicare and Medicaid Services' Office of the Actuary.

Total U.S. health care spending was an estimated $2.4 trillion in 2008—an increase of 6.1% over 2007, according to the annual projection of health spending trends published online in the journal Health Affairs. This year, spending is expected to grow by only 5.5%.

That rate of growth is expected to far outpace the nation's gross domestic product in 2009. Economists for the CMS said they predict the GDP to shrink by 0.2% this year. Meanwhile, the health care share of GDP is expected to grow 1.4%—the biggest annual jump as a portion of GDP since economists first started tracking this indicator in 1960, said Christopher Truffer, a CMS actuary. Health spending will account for 17.6% of the GDP in 2009, according to the report (Health Affairs 2009 Feb. 24 [doi:10.1377/hlthaff.28.2.w346

Absent any policy changes, health care is on track to gobble up one-fifth of the nation's dollar by 2018, Mr. Truffer and his colleagues said.

The economists projected that overall health spending will rise by only 4.6% in 2010, thanks largely to the mandated 21% reduction in physician payments required under the Sustainable Growth Rate target set by Medicare.

However, since Congress usually eliminates the cuts or grants a fee increase every year, the CMS economists calculated some alternative scenarios. If payments were kept constant, Medicare spending would rise 6.4%, or 3.9% faster than if the cuts went into effect. Overall national health spending would rise 5.4%, or 0.8% more.

Medicaid spending will grow 9.6% in 2009, up from 6.9% in 2008. Private health insurance benefits spending grew an estimated 5.8% in 2008, but will rise only 4.1% in 2009.

The CMS projections make it seem like cost-containment efforts are having a negligible effect on restraining overall health spending. The economists said the Medicare fee cuts would make a difference, but that they did not have the data to calculate whether other cost-containment efforts in the private sector in particular were having any effect on restraining health spending.

However, prescription drug spending has dropped as a result of insurers successfully driving an increase in the utilization of generic drugs, said John Poisal, deputy director of the Office of the Actuary. Overall, the public and private sector spent 3.5% more on drugs in 2008, compared with a 4.9% increase the previous year. Overall, the nation spent $235 billion on prescriptions in 2008. The analysts expected a 4% rise in 2009.

Hospital spending is expected to grow only 5.7% in 2009, compared with a 7.2% increase in 2008, as cash-strapped Americans put off elective procedures and as insurers continue to clamp down, the actuaries said.

The analysts projected spending trends to 2018, but said that their assumptions would change if the recession continued beyond early 2010 or if any significant health care reform occurs.

CMS Chief Actuary Rick Foster said that he did not expect to see significant health reform proposals in the budget, however. “I don't believe the administration is yet in the position to announce specifics or build a detailed plan,” he said. “I do expect there to be a discussion of the general idea or general thoughts” about health reform, he added.

WASHINGTON — Even as the economic downturn causes private health spending to slow, public sector health spending is rising, according to a federal analysis.

An estimated 3.4 million people may lose private health insurance coverage in 2009 and another 2.6 million may lose coverage in 2010, said Sean Keehan, an actuary at the Centers for Medicare and Medicaid Services' Office of the Actuary.

Total U.S. health care spending was an estimated $2.4 trillion in 2008—an increase of 6.1% over 2007, according to the annual projection of health spending trends published online in the journal Health Affairs. This year, spending is expected to grow by only 5.5%.

That rate of growth is expected to far outpace the nation's gross domestic product in 2009. Economists for the CMS said they predict the GDP to shrink by 0.2% this year. Meanwhile, the health care share of GDP is expected to grow 1.4%—the biggest annual jump as a portion of GDP since economists first started tracking this indicator in 1960, said Christopher Truffer, a CMS actuary. Health spending will account for 17.6% of the GDP in 2009, according to the report (Health Affairs 2009 Feb. 24 [doi:10.1377/hlthaff.28.2.w346

Absent any policy changes, health care is on track to gobble up one-fifth of the nation's dollar by 2018, Mr. Truffer and his colleagues said.

The economists projected that overall health spending will rise by only 4.6% in 2010, thanks largely to the mandated 21% reduction in physician payments required under the Sustainable Growth Rate target set by Medicare.

However, since Congress usually eliminates the cuts or grants a fee increase every year, the CMS economists calculated some alternative scenarios. If payments were kept constant, Medicare spending would rise 6.4%, or 3.9% faster than if the cuts went into effect. Overall national health spending would rise 5.4%, or 0.8% more.

Medicaid spending will grow 9.6% in 2009, up from 6.9% in 2008. Private health insurance benefits spending grew an estimated 5.8% in 2008, but will rise only 4.1% in 2009.

The CMS projections make it seem like cost-containment efforts are having a negligible effect on restraining overall health spending. The economists said the Medicare fee cuts would make a difference, but that they did not have the data to calculate whether other cost-containment efforts in the private sector in particular were having any effect on restraining health spending.

However, prescription drug spending has dropped as a result of insurers successfully driving an increase in the utilization of generic drugs, said John Poisal, deputy director of the Office of the Actuary. Overall, the public and private sector spent 3.5% more on drugs in 2008, compared with a 4.9% increase the previous year. Overall, the nation spent $235 billion on prescriptions in 2008. The analysts expected a 4% rise in 2009.

Hospital spending is expected to grow only 5.7% in 2009, compared with a 7.2% increase in 2008, as cash-strapped Americans put off elective procedures and as insurers continue to clamp down, the actuaries said.

The analysts projected spending trends to 2018, but said that their assumptions would change if the recession continued beyond early 2010 or if any significant health care reform occurs.

CMS Chief Actuary Rick Foster said that he did not expect to see significant health reform proposals in the budget, however. “I don't believe the administration is yet in the position to announce specifics or build a detailed plan,” he said. “I do expect there to be a discussion of the general idea or general thoughts” about health reform, he added.

WASHINGTON — Even as the economic downturn causes private health spending to slow, public sector health spending is rising, according to a federal analysis.

An estimated 3.4 million people may lose private health insurance coverage in 2009 and another 2.6 million may lose coverage in 2010, said Sean Keehan, an actuary at the Centers for Medicare and Medicaid Services' Office of the Actuary.

Total U.S. health care spending was an estimated $2.4 trillion in 2008—an increase of 6.1% over 2007, according to the annual projection of health spending trends published online in the journal Health Affairs. This year, spending is expected to grow by only 5.5%.

That rate of growth is expected to far outpace the nation's gross domestic product in 2009. Economists for the CMS said they predict the GDP to shrink by 0.2% this year. Meanwhile, the health care share of GDP is expected to grow 1.4%—the biggest annual jump as a portion of GDP since economists first started tracking this indicator in 1960, said Christopher Truffer, a CMS actuary. Health spending will account for 17.6% of the GDP in 2009, according to the report (Health Affairs 2009 Feb. 24 [doi:10.1377/hlthaff.28.2.w346

Absent any policy changes, health care is on track to gobble up one-fifth of the nation's dollar by 2018, Mr. Truffer and his colleagues said.

The economists projected that overall health spending will rise by only 4.6% in 2010, thanks largely to the mandated 21% reduction in physician payments required under the Sustainable Growth Rate target set by Medicare.

However, since Congress usually eliminates the cuts or grants a fee increase every year, the CMS economists calculated some alternative scenarios. If payments were kept constant, Medicare spending would rise 6.4%, or 3.9% faster than if the cuts went into effect. Overall national health spending would rise 5.4%, or 0.8% more.

Medicaid spending will grow 9.6% in 2009, up from 6.9% in 2008. Private health insurance benefits spending grew an estimated 5.8% in 2008, but will rise only 4.1% in 2009.

The CMS projections make it seem like cost-containment efforts are having a negligible effect on restraining overall health spending. The economists said the Medicare fee cuts would make a difference, but that they did not have the data to calculate whether other cost-containment efforts in the private sector in particular were having any effect on restraining health spending.

However, prescription drug spending has dropped as a result of insurers successfully driving an increase in the utilization of generic drugs, said John Poisal, deputy director of the Office of the Actuary. Overall, the public and private sector spent 3.5% more on drugs in 2008, compared with a 4.9% increase the previous year. Overall, the nation spent $235 billion on prescriptions in 2008. The analysts expected a 4% rise in 2009.

Hospital spending is expected to grow only 5.7% in 2009, compared with a 7.2% increase in 2008, as cash-strapped Americans put off elective procedures and as insurers continue to clamp down, the actuaries said.

The analysts projected spending trends to 2018, but said that their assumptions would change if the recession continued beyond early 2010 or if any significant health care reform occurs.

CMS Chief Actuary Rick Foster said that he did not expect to see significant health reform proposals in the budget, however. “I don't believe the administration is yet in the position to announce specifics or build a detailed plan,” he said. “I do expect there to be a discussion of the general idea or general thoughts” about health reform, he added.

FDA Seeks Data on Older Devices

The Food and Drug Administration has ordered manufacturers of 25 class III medical devices that were approved before 1976 to submit safety and effectiveness data to the agency by Aug. 7. The devices include an intra-aortic balloon and its control system, a ventricular bypass assist device, generators, materials for pacemakers, automated external defibrillators, and some types of hip joints. Depending on the data it gets on each device, the FDA will decide whether to require a full approval application or reclassify the device to a lower-risk regulatory category. The Advanced Medical Technology Association issued a statement saying it was pleased the agency is moving ahead with the process, but that “it needs to be clearly understood that the device types subject to the FDA notice have already been thoroughly reviewed by the agency,” based either on technologic and performance data or, in some cases, clinical data.

Device Staff Decries FDA Politics

The FDA is a mess of politics, abuse, and misdeeds, according to members of the agency's Office of Device Evaluation, who sent a six-page letter to President Obama in early April. The staff members called on the president to enact sweeping measures “to end the systemic corruption and wrongdoing that permeates all levels of FDA.” FDA managers have “abused their power and authority” and “engaged in illegal retaliation against those who speak out,” the staffers said. “The culture of wrongdoing is nothing new but is part of a longstanding pattern of behavior,” they stressed. The letter, with all of the signers' names redacted, was released at a congressional hearing.

Bristol-Myers Squibb Fined

Bristol-Myers Squibb Co. will pay $2.1 million—the largest fine allowed by law—for failing to report an agreement it reached with Apotex Inc. on generic competition for its blockbuster cardiovascular drug Plavix (clopidogrel), the Federal Trade Commission reported. Bristol-Myers Squibb did not disclose that in 2006 the two companies made a deal to schedule the releases of their generic versions of the drug to reduce competition, according to the FTC. The agency said that failing to disclose the oral agreement violated both a 2003 FTC order and the Medicare Modernization Act, which requires that certain drug company agreements be accurately reported to both the FTC and the U.S. Department of Justice. In 2007, Bristol-Myers Squibb paid $1 million to settle a criminal complaint that the company had lied about the Plavix agreement with Apotex. The name-brand manufacturer has also settled several state actions arising from the generic-timing agreement, the FTC said.

FDA Warns on Internet Ads

The FDA has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines such as Google as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than the number that applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. In addition, nearly 40% of the applications were for new EHR products, rather than renewals, according to the federally recognized commission. Nearly two-thirds of the applicants qualified as small businesses, the commission noted. So far, 25 of the products have been certified, the commission said.

Issues of Drug Class Pending

Logistic and cost issues must be addressed before a behind-the-counter class of nonprescription drugs can be established officially in the United States, the U.S. Government Accountability Office said in a report on so-called BTC drugs. The GAO stressed that pharmacists must be ready to provide BTC counseling and that pharmacies must physically protect consumer privacy. In addition, policy makers should address cost issues, such as the availability of third-party coverage for BTC drugs and pharmacists' compensation for providing associated services. GAO researchers studied the experiences of five countries, including Italy and the Netherlands, that have a behind-the-counter or similarly restricted drug class.

FDA Seeks Data on Older Devices

The Food and Drug Administration has ordered manufacturers of 25 class III medical devices that were approved before 1976 to submit safety and effectiveness data to the agency by Aug. 7. The devices include an intra-aortic balloon and its control system, a ventricular bypass assist device, generators, materials for pacemakers, automated external defibrillators, and some types of hip joints. Depending on the data it gets on each device, the FDA will decide whether to require a full approval application or reclassify the device to a lower-risk regulatory category. The Advanced Medical Technology Association issued a statement saying it was pleased the agency is moving ahead with the process, but that “it needs to be clearly understood that the device types subject to the FDA notice have already been thoroughly reviewed by the agency,” based either on technologic and performance data or, in some cases, clinical data.

Device Staff Decries FDA Politics

The FDA is a mess of politics, abuse, and misdeeds, according to members of the agency's Office of Device Evaluation, who sent a six-page letter to President Obama in early April. The staff members called on the president to enact sweeping measures “to end the systemic corruption and wrongdoing that permeates all levels of FDA.” FDA managers have “abused their power and authority” and “engaged in illegal retaliation against those who speak out,” the staffers said. “The culture of wrongdoing is nothing new but is part of a longstanding pattern of behavior,” they stressed. The letter, with all of the signers' names redacted, was released at a congressional hearing.

Bristol-Myers Squibb Fined

Bristol-Myers Squibb Co. will pay $2.1 million—the largest fine allowed by law—for failing to report an agreement it reached with Apotex Inc. on generic competition for its blockbuster cardiovascular drug Plavix (clopidogrel), the Federal Trade Commission reported. Bristol-Myers Squibb did not disclose that in 2006 the two companies made a deal to schedule the releases of their generic versions of the drug to reduce competition, according to the FTC. The agency said that failing to disclose the oral agreement violated both a 2003 FTC order and the Medicare Modernization Act, which requires that certain drug company agreements be accurately reported to both the FTC and the U.S. Department of Justice. In 2007, Bristol-Myers Squibb paid $1 million to settle a criminal complaint that the company had lied about the Plavix agreement with Apotex. The name-brand manufacturer has also settled several state actions arising from the generic-timing agreement, the FTC said.

FDA Warns on Internet Ads

The FDA has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines such as Google as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than the number that applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. In addition, nearly 40% of the applications were for new EHR products, rather than renewals, according to the federally recognized commission. Nearly two-thirds of the applicants qualified as small businesses, the commission noted. So far, 25 of the products have been certified, the commission said.

Issues of Drug Class Pending

Logistic and cost issues must be addressed before a behind-the-counter class of nonprescription drugs can be established officially in the United States, the U.S. Government Accountability Office said in a report on so-called BTC drugs. The GAO stressed that pharmacists must be ready to provide BTC counseling and that pharmacies must physically protect consumer privacy. In addition, policy makers should address cost issues, such as the availability of third-party coverage for BTC drugs and pharmacists' compensation for providing associated services. GAO researchers studied the experiences of five countries, including Italy and the Netherlands, that have a behind-the-counter or similarly restricted drug class.

FDA Seeks Data on Older Devices

The Food and Drug Administration has ordered manufacturers of 25 class III medical devices that were approved before 1976 to submit safety and effectiveness data to the agency by Aug. 7. The devices include an intra-aortic balloon and its control system, a ventricular bypass assist device, generators, materials for pacemakers, automated external defibrillators, and some types of hip joints. Depending on the data it gets on each device, the FDA will decide whether to require a full approval application or reclassify the device to a lower-risk regulatory category. The Advanced Medical Technology Association issued a statement saying it was pleased the agency is moving ahead with the process, but that “it needs to be clearly understood that the device types subject to the FDA notice have already been thoroughly reviewed by the agency,” based either on technologic and performance data or, in some cases, clinical data.

Device Staff Decries FDA Politics

The FDA is a mess of politics, abuse, and misdeeds, according to members of the agency's Office of Device Evaluation, who sent a six-page letter to President Obama in early April. The staff members called on the president to enact sweeping measures “to end the systemic corruption and wrongdoing that permeates all levels of FDA.” FDA managers have “abused their power and authority” and “engaged in illegal retaliation against those who speak out,” the staffers said. “The culture of wrongdoing is nothing new but is part of a longstanding pattern of behavior,” they stressed. The letter, with all of the signers' names redacted, was released at a congressional hearing.

Bristol-Myers Squibb Fined

Bristol-Myers Squibb Co. will pay $2.1 million—the largest fine allowed by law—for failing to report an agreement it reached with Apotex Inc. on generic competition for its blockbuster cardiovascular drug Plavix (clopidogrel), the Federal Trade Commission reported. Bristol-Myers Squibb did not disclose that in 2006 the two companies made a deal to schedule the releases of their generic versions of the drug to reduce competition, according to the FTC. The agency said that failing to disclose the oral agreement violated both a 2003 FTC order and the Medicare Modernization Act, which requires that certain drug company agreements be accurately reported to both the FTC and the U.S. Department of Justice. In 2007, Bristol-Myers Squibb paid $1 million to settle a criminal complaint that the company had lied about the Plavix agreement with Apotex. The name-brand manufacturer has also settled several state actions arising from the generic-timing agreement, the FTC said.

FDA Warns on Internet Ads

The FDA has warned 14 drug makers against using brief Internet ads to promote drugs, saying the ads are misleading because they fail to provide full information about risks and indications. The ads typically appear on search engines such as Google as “sponsored links” when patients search for information on medical conditions. The ads cited by the FDA include promotions for multiple sclerosis drug Tysabri (natalizumab), the cardiovascular drug Plavix (clopidogrel), and the diabetes treatment Avandia (rosiglitazone). The sponsored links generally contain only a dozen or so words—not enough to convey detailed treatment or risk information, according to the FDA. The Pew Prescription Project, a nonprofit drug-safety group, has asked the FDA to articulate the rules regulating online advertising and to advise manufacturers on where risk disclosures may appear in Internet ads.

EHR Applications Rise

By a March 31 deadline, 64 companies applied for certification of their electronic health record (EHR) products, one-third more than the number that applied by the same time last year, the Certification Commission for Healthcare Information Technology reported. In addition, nearly 40% of the applications were for new EHR products, rather than renewals, according to the federally recognized commission. Nearly two-thirds of the applicants qualified as small businesses, the commission noted. So far, 25 of the products have been certified, the commission said.

Issues of Drug Class Pending

Logistic and cost issues must be addressed before a behind-the-counter class of nonprescription drugs can be established officially in the United States, the U.S. Government Accountability Office said in a report on so-called BTC drugs. The GAO stressed that pharmacists must be ready to provide BTC counseling and that pharmacies must physically protect consumer privacy. In addition, policy makers should address cost issues, such as the availability of third-party coverage for BTC drugs and pharmacists' compensation for providing associated services. GAO researchers studied the experiences of five countries, including Italy and the Netherlands, that have a behind-the-counter or similarly restricted drug class.

NEW ORLEANS — The American Board of Medical Specialties has approved standards to its maintenance of certification program, with a growing emphasis on more public disclosure and more evidence-based continuing medical education, said Dr. Richard E. Hawkins, ABMS senior vice president for professional and scientific affairs.

Speaking to the Society of Gynecologic Surgeons, Dr. Hawkins outlined the actions taken by the ABMS Board of Directors in March.

As part of the maintenance of certification (MOC) process, physicians will now have to provide evidence of participation in practice-based assessment and quality improvement every 2-5 years. The ABMS is urging physicians to use nationally approved measures such as those endorsed by the National Quality Forum. By 2011, all 24 of the ABMS member boards will have to document that diplomates are meeting these requirements.

At that time, the ABMS will allow the public to see which physicians are participating in the MOC process, most likely through a searchable Web site, Dr. Hawkins said in an interview. Details on how the data will be presented are still being worked out with the 24 member boards, he said.

The ABMS Board of Directors voted to require all physicians to complete a patient safety self-assessment program at least once during each MOC cycle, beginning in 2010. Because ABMS member boards are at different stages of implementing MOC, some may not be equipped to start requiring this of their diplomates, said Dr. Hawkins. In recognition of this, the ABMS board dubbed the patient safety program a “developmental standard,” which means that it is essentially a pilot that will be reevaluated during the next 5 years.

The ABMS will be looking at what works and what doesn't, and will make modifications, if necessary, said Dr. Hawkins. Even so, the ABMS standards require this module to be in place for all diplomates by 2014.

The board also approved another pilot standard: Beginning in 2010, physicians who provide direct patient care will be required to submit patient surveys using the Consumer Assessment of Healthcare Providers and Systems instrument, or an equivalent survey that's judged acceptable by the ABMS Committee on Monitoring and Oversight of the MOC. This is to demonstrate communication skills. Again, not all 24 member boards are ready to start requiring this, but the goal is for everyone to have the program in place by 2014, said Dr. Hawkins.

Similarly, the developmental standard on peer surveys—requiring physicians to participate beginning in 2012—will be implemented by member boards at their own pace, but will still be expected by 2014. Both of these survey requirements will be evaluated and updated as necessary during the next 5 years.

Dr. Hawkins said that some of the surgical boards within ABMS have been discussing the creation of a national surgical clinical registry to track individual surgeons' performance, a development that is “likely to happen.”

Since physicians currently have to report quality data and process improvement to various agencies, the ABMS is working on ways to streamline data collection and reporting for MOC, said Dr. Hawkins. The ABMS also is in discussions with insurers, government agencies, and purchasers to determine how to make MOC more valuable to those entities, he said.

In a statement issued by the ABMS, Dr. Kevin Weiss, ABMS president and CEO, echoed that sentiment. “Ultimately, it's our patients and the public of this country for whom these principles were developed to ensure they are receiving high-quality health care,” he said.

NEW ORLEANS — The American Board of Medical Specialties has approved standards to its maintenance of certification program, with a growing emphasis on more public disclosure and more evidence-based continuing medical education, said Dr. Richard E. Hawkins, ABMS senior vice president for professional and scientific affairs.

Speaking to the Society of Gynecologic Surgeons, Dr. Hawkins outlined the actions taken by the ABMS Board of Directors in March.

As part of the maintenance of certification (MOC) process, physicians will now have to provide evidence of participation in practice-based assessment and quality improvement every 2-5 years. The ABMS is urging physicians to use nationally approved measures such as those endorsed by the National Quality Forum. By 2011, all 24 of the ABMS member boards will have to document that diplomates are meeting these requirements.

At that time, the ABMS will allow the public to see which physicians are participating in the MOC process, most likely through a searchable Web site, Dr. Hawkins said in an interview. Details on how the data will be presented are still being worked out with the 24 member boards, he said.

The ABMS Board of Directors voted to require all physicians to complete a patient safety self-assessment program at least once during each MOC cycle, beginning in 2010. Because ABMS member boards are at different stages of implementing MOC, some may not be equipped to start requiring this of their diplomates, said Dr. Hawkins. In recognition of this, the ABMS board dubbed the patient safety program a “developmental standard,” which means that it is essentially a pilot that will be reevaluated during the next 5 years.

The ABMS will be looking at what works and what doesn't, and will make modifications, if necessary, said Dr. Hawkins. Even so, the ABMS standards require this module to be in place for all diplomates by 2014.

The board also approved another pilot standard: Beginning in 2010, physicians who provide direct patient care will be required to submit patient surveys using the Consumer Assessment of Healthcare Providers and Systems instrument, or an equivalent survey that's judged acceptable by the ABMS Committee on Monitoring and Oversight of the MOC. This is to demonstrate communication skills. Again, not all 24 member boards are ready to start requiring this, but the goal is for everyone to have the program in place by 2014, said Dr. Hawkins.

Similarly, the developmental standard on peer surveys—requiring physicians to participate beginning in 2012—will be implemented by member boards at their own pace, but will still be expected by 2014. Both of these survey requirements will be evaluated and updated as necessary during the next 5 years.

Dr. Hawkins said that some of the surgical boards within ABMS have been discussing the creation of a national surgical clinical registry to track individual surgeons' performance, a development that is “likely to happen.”

Since physicians currently have to report quality data and process improvement to various agencies, the ABMS is working on ways to streamline data collection and reporting for MOC, said Dr. Hawkins. The ABMS also is in discussions with insurers, government agencies, and purchasers to determine how to make MOC more valuable to those entities, he said.

In a statement issued by the ABMS, Dr. Kevin Weiss, ABMS president and CEO, echoed that sentiment. “Ultimately, it's our patients and the public of this country for whom these principles were developed to ensure they are receiving high-quality health care,” he said.

NEW ORLEANS — The American Board of Medical Specialties has approved standards to its maintenance of certification program, with a growing emphasis on more public disclosure and more evidence-based continuing medical education, said Dr. Richard E. Hawkins, ABMS senior vice president for professional and scientific affairs.

Speaking to the Society of Gynecologic Surgeons, Dr. Hawkins outlined the actions taken by the ABMS Board of Directors in March.

As part of the maintenance of certification (MOC) process, physicians will now have to provide evidence of participation in practice-based assessment and quality improvement every 2-5 years. The ABMS is urging physicians to use nationally approved measures such as those endorsed by the National Quality Forum. By 2011, all 24 of the ABMS member boards will have to document that diplomates are meeting these requirements.

At that time, the ABMS will allow the public to see which physicians are participating in the MOC process, most likely through a searchable Web site, Dr. Hawkins said in an interview. Details on how the data will be presented are still being worked out with the 24 member boards, he said.

The ABMS Board of Directors voted to require all physicians to complete a patient safety self-assessment program at least once during each MOC cycle, beginning in 2010. Because ABMS member boards are at different stages of implementing MOC, some may not be equipped to start requiring this of their diplomates, said Dr. Hawkins. In recognition of this, the ABMS board dubbed the patient safety program a “developmental standard,” which means that it is essentially a pilot that will be reevaluated during the next 5 years.

The ABMS will be looking at what works and what doesn't, and will make modifications, if necessary, said Dr. Hawkins. Even so, the ABMS standards require this module to be in place for all diplomates by 2014.

The board also approved another pilot standard: Beginning in 2010, physicians who provide direct patient care will be required to submit patient surveys using the Consumer Assessment of Healthcare Providers and Systems instrument, or an equivalent survey that's judged acceptable by the ABMS Committee on Monitoring and Oversight of the MOC. This is to demonstrate communication skills. Again, not all 24 member boards are ready to start requiring this, but the goal is for everyone to have the program in place by 2014, said Dr. Hawkins.

Similarly, the developmental standard on peer surveys—requiring physicians to participate beginning in 2012—will be implemented by member boards at their own pace, but will still be expected by 2014. Both of these survey requirements will be evaluated and updated as necessary during the next 5 years.

Dr. Hawkins said that some of the surgical boards within ABMS have been discussing the creation of a national surgical clinical registry to track individual surgeons' performance, a development that is “likely to happen.”

Since physicians currently have to report quality data and process improvement to various agencies, the ABMS is working on ways to streamline data collection and reporting for MOC, said Dr. Hawkins. The ABMS also is in discussions with insurers, government agencies, and purchasers to determine how to make MOC more valuable to those entities, he said.

In a statement issued by the ABMS, Dr. Kevin Weiss, ABMS president and CEO, echoed that sentiment. “Ultimately, it's our patients and the public of this country for whom these principles were developed to ensure they are receiving high-quality health care,” he said.

State's Psychiatrists Top List

Once again in Vermont, psychiatrists were identified as the top recipients of pharmaceutical industry funding in an annual report compiled by the state's attorney general. The data are from drug manufacturers' public disclosures between July 2007 and June 2008. They include consulting and speaking fees, travel, gifts, and other payments to physicians, nurses, physician assistants, hospitals, and universities. The largest dollar amount–$500,000–went to 11 psychiatrists, with 1 receiving $112,000. Internal medicine, neurology, endocrinology, and physicians with ionizing radiation privileges completed the top five recipients by specialty. Interestingly, in the past 4 fiscal years, there's been a significant increase in the companies reporting their expenditures, while expenditures have dropped by a third. The top five 2007-2008 spenders were Eli Lilly–the leader for 3 years consecutively–Pfizer, Novartis Pharmaceuticals, Merck, and Forest Pharmaceuticals. The full report can be found at

www.atg.state.vt.us

NAMI Queried on Industry Funds

Sen. Chuck Grassley (R-Iowa) continued his pursuit of conflicts of interest in psychiatry with a request in April to the National Alliance for Mental Illness (NAMI) that the patient advocacy-group disclose how much of its funding comes from pharmaceutical manufacturers. NAMI received $13 million in revenue and support for the year that ended June 30, 2008. The organization lists corporate and other donors in its annual report but does not disclose how much it gets from each source, according to NAMI spokesman Bob Carolla. He added that the organization has a policy that guides its acceptance of industry money and aims to protect its independence. Mr. Carolla said NAMI would meet with Sen. Grassley' about his request.

Psych Care Often Inaccessible

Two-thirds of primary care physicians said they cannot get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. Sixty-seven percent of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.

Bill Would Restrict Ingredient

The U.S. House in late March passed the Dextromethorphan Distribution Act (H.R. 1259), which would restrict purchases of dextromethorphan, the active ingredient in many over-the-counter cough medicines. Only entities that had registered with the Food and Drug Administration or certain state agencies could buy the raw product. The Consumer Healthcare Products Association endorsed the legislation. “There is no good reason for anyone but manufacturers, pharmacists, and researchers to have the raw form of this ingredient,” said association's president, Linda Suydam, in a statement.

Alzheimer's as Economic Threat

Without decisive political action, the economic consequences of Alzheimer's disease could dwarf the current economic crisis, according to the final report of the Alzheimer's Study Group. The group was created by Congress in 2007 and includes politicians, advocates, physicians, and researchers. Its “National Alzheimer's Strategic Plan” calls for reengineering dementia care delivery and more research focused on delaying and preventing Alzheimer's disease. It also calls on Medicare to increasingly reimburse physicians for dementia care according to the quality of their work. By 2016, these “value-based payments” should cover half of all dementia care, said the group cochaired by former House speaker Newt Gingrich and former Democratic senator Bob Kerrey. The Alzheimer's Association praised the strategic plan for bringing attention to the “looming national crisis” created by the condition.

Administration Posts Filling Up

The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the director of the White House Office of Health Reform, administrator of the Health Resources and Services Administration (HRSA), and the new National Coordinator for Health Information Technology. Nancy-Ann DeParle, who ran Medicaid and Medicare under President Clinton, will now lead the White House office. Rural health expert Mary Wakefield, Ph.D., was selected to head HRSA, joining the agency from the University of North Dakota, Grand Forks. Internist David Blumenthal, former director of the Institute for Health Policy at Massachusetts General Hospital, Boston, will take the lead on creating a nationwide health information technology infrastructure. And three new members will join the U.S. Preventive Services Task Force: Susan Curry, Ph.D., of Iowa City, an expert on tobacco use; Dr. Joy Melnikow of Sacramento, a family physician; and Dr. Wanda Nicholson of Baltimore, a board-certified ob.gyn. and a perinatal epidemiologist.

State's Psychiatrists Top List

Once again in Vermont, psychiatrists were identified as the top recipients of pharmaceutical industry funding in an annual report compiled by the state's attorney general. The data are from drug manufacturers' public disclosures between July 2007 and June 2008. They include consulting and speaking fees, travel, gifts, and other payments to physicians, nurses, physician assistants, hospitals, and universities. The largest dollar amount–$500,000–went to 11 psychiatrists, with 1 receiving $112,000. Internal medicine, neurology, endocrinology, and physicians with ionizing radiation privileges completed the top five recipients by specialty. Interestingly, in the past 4 fiscal years, there's been a significant increase in the companies reporting their expenditures, while expenditures have dropped by a third. The top five 2007-2008 spenders were Eli Lilly–the leader for 3 years consecutively–Pfizer, Novartis Pharmaceuticals, Merck, and Forest Pharmaceuticals. The full report can be found at

www.atg.state.vt.us

NAMI Queried on Industry Funds

Sen. Chuck Grassley (R-Iowa) continued his pursuit of conflicts of interest in psychiatry with a request in April to the National Alliance for Mental Illness (NAMI) that the patient advocacy-group disclose how much of its funding comes from pharmaceutical manufacturers. NAMI received $13 million in revenue and support for the year that ended June 30, 2008. The organization lists corporate and other donors in its annual report but does not disclose how much it gets from each source, according to NAMI spokesman Bob Carolla. He added that the organization has a policy that guides its acceptance of industry money and aims to protect its independence. Mr. Carolla said NAMI would meet with Sen. Grassley' about his request.

Psych Care Often Inaccessible

Two-thirds of primary care physicians said they cannot get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. Sixty-seven percent of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.

Bill Would Restrict Ingredient

The U.S. House in late March passed the Dextromethorphan Distribution Act (H.R. 1259), which would restrict purchases of dextromethorphan, the active ingredient in many over-the-counter cough medicines. Only entities that had registered with the Food and Drug Administration or certain state agencies could buy the raw product. The Consumer Healthcare Products Association endorsed the legislation. “There is no good reason for anyone but manufacturers, pharmacists, and researchers to have the raw form of this ingredient,” said association's president, Linda Suydam, in a statement.

Alzheimer's as Economic Threat

Without decisive political action, the economic consequences of Alzheimer's disease could dwarf the current economic crisis, according to the final report of the Alzheimer's Study Group. The group was created by Congress in 2007 and includes politicians, advocates, physicians, and researchers. Its “National Alzheimer's Strategic Plan” calls for reengineering dementia care delivery and more research focused on delaying and preventing Alzheimer's disease. It also calls on Medicare to increasingly reimburse physicians for dementia care according to the quality of their work. By 2016, these “value-based payments” should cover half of all dementia care, said the group cochaired by former House speaker Newt Gingrich and former Democratic senator Bob Kerrey. The Alzheimer's Association praised the strategic plan for bringing attention to the “looming national crisis” created by the condition.

Administration Posts Filling Up

The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the director of the White House Office of Health Reform, administrator of the Health Resources and Services Administration (HRSA), and the new National Coordinator for Health Information Technology. Nancy-Ann DeParle, who ran Medicaid and Medicare under President Clinton, will now lead the White House office. Rural health expert Mary Wakefield, Ph.D., was selected to head HRSA, joining the agency from the University of North Dakota, Grand Forks. Internist David Blumenthal, former director of the Institute for Health Policy at Massachusetts General Hospital, Boston, will take the lead on creating a nationwide health information technology infrastructure. And three new members will join the U.S. Preventive Services Task Force: Susan Curry, Ph.D., of Iowa City, an expert on tobacco use; Dr. Joy Melnikow of Sacramento, a family physician; and Dr. Wanda Nicholson of Baltimore, a board-certified ob.gyn. and a perinatal epidemiologist.

State's Psychiatrists Top List

Once again in Vermont, psychiatrists were identified as the top recipients of pharmaceutical industry funding in an annual report compiled by the state's attorney general. The data are from drug manufacturers' public disclosures between July 2007 and June 2008. They include consulting and speaking fees, travel, gifts, and other payments to physicians, nurses, physician assistants, hospitals, and universities. The largest dollar amount–$500,000–went to 11 psychiatrists, with 1 receiving $112,000. Internal medicine, neurology, endocrinology, and physicians with ionizing radiation privileges completed the top five recipients by specialty. Interestingly, in the past 4 fiscal years, there's been a significant increase in the companies reporting their expenditures, while expenditures have dropped by a third. The top five 2007-2008 spenders were Eli Lilly–the leader for 3 years consecutively–Pfizer, Novartis Pharmaceuticals, Merck, and Forest Pharmaceuticals. The full report can be found at

www.atg.state.vt.us

NAMI Queried on Industry Funds

Sen. Chuck Grassley (R-Iowa) continued his pursuit of conflicts of interest in psychiatry with a request in April to the National Alliance for Mental Illness (NAMI) that the patient advocacy-group disclose how much of its funding comes from pharmaceutical manufacturers. NAMI received $13 million in revenue and support for the year that ended June 30, 2008. The organization lists corporate and other donors in its annual report but does not disclose how much it gets from each source, according to NAMI spokesman Bob Carolla. He added that the organization has a policy that guides its acceptance of industry money and aims to protect its independence. Mr. Carolla said NAMI would meet with Sen. Grassley' about his request.

Psych Care Often Inaccessible

Two-thirds of primary care physicians said they cannot get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. Sixty-seven percent of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.

Bill Would Restrict Ingredient

The U.S. House in late March passed the Dextromethorphan Distribution Act (H.R. 1259), which would restrict purchases of dextromethorphan, the active ingredient in many over-the-counter cough medicines. Only entities that had registered with the Food and Drug Administration or certain state agencies could buy the raw product. The Consumer Healthcare Products Association endorsed the legislation. “There is no good reason for anyone but manufacturers, pharmacists, and researchers to have the raw form of this ingredient,” said association's president, Linda Suydam, in a statement.

Alzheimer's as Economic Threat

Without decisive political action, the economic consequences of Alzheimer's disease could dwarf the current economic crisis, according to the final report of the Alzheimer's Study Group. The group was created by Congress in 2007 and includes politicians, advocates, physicians, and researchers. Its “National Alzheimer's Strategic Plan” calls for reengineering dementia care delivery and more research focused on delaying and preventing Alzheimer's disease. It also calls on Medicare to increasingly reimburse physicians for dementia care according to the quality of their work. By 2016, these “value-based payments” should cover half of all dementia care, said the group cochaired by former House speaker Newt Gingrich and former Democratic senator Bob Kerrey. The Alzheimer's Association praised the strategic plan for bringing attention to the “looming national crisis” created by the condition.

Administration Posts Filling Up

The Obama administration has named officials to several top health care-related positions that do not require Senate confirmation, including the director of the White House Office of Health Reform, administrator of the Health Resources and Services Administration (HRSA), and the new National Coordinator for Health Information Technology. Nancy-Ann DeParle, who ran Medicaid and Medicare under President Clinton, will now lead the White House office. Rural health expert Mary Wakefield, Ph.D., was selected to head HRSA, joining the agency from the University of North Dakota, Grand Forks. Internist David Blumenthal, former director of the Institute for Health Policy at Massachusetts General Hospital, Boston, will take the lead on creating a nationwide health information technology infrastructure. And three new members will join the U.S. Preventive Services Task Force: Susan Curry, Ph.D., of Iowa City, an expert on tobacco use; Dr. Joy Melnikow of Sacramento, a family physician; and Dr. Wanda Nicholson of Baltimore, a board-certified ob.gyn. and a perinatal epidemiologist.