Mary Ellen Schneider

BOSTON — Taking a good history and administering a brief cognitive screening test can go a long way toward identifying Alzheimer's disease and other dementias, according to one family physician.

Currently, too many patients with mild to moderate dementia are being missed in the office, according Dr. Kathleen R. Soch, associate professor in the department of family and community medicine at the Texas A&M Health Science Center in Corpus Christi, Texas.

But physicians can improve their track records by following a few simple steps: take a complete history, administer the Folstein Mini-Mental Status Exam (FMMSE), rule out depression, perform routine laboratory testing, and consider ordering an imaging study.

Most physicians know to ask patients and their family members about memory loss, but they do not realize that family members often overlook problems with memory. A family member might think their parent's memory loss is normal for their age, when in fact the memory impairment could be significant. In those cases, families often come to the office because of the behavioral problems sometimes seen in dementia patients.

For patients with symptoms of dementia, Dr. Soch recommends using the FMMSE as a screening tool. The test is one of the most widely used screening tests. It takes less than 10 minutes to complete in the office, and physicians can administer it themselves or train someone else in the office to do it, she said.

The FMMSE is a 30-point test that asks patients to identify where they are, the date and season, repeat words they have heard, recalls words, spell a word backward, demonstrate simple language skills, and perform simple tasks. The cut off score is 24, and most people without any cognitive impairment should be able to score 29 or 30 on the test, she said.

The test has a sensitivity of 87% and a specificity of 82%. Most people who have a score of 24 or less will have some form of cognitive impairment, but the test also will miss a lot of people with early dementia, she said. The FMMSE also is less accurate in patients with higher and lower levels of education.

Dr. Soch said if she sees a patient who is very well educated and scores 28 or 29 points, she is more likely to consider a diagnosis of dementia. On the other hand, patients who are unable to read will have trouble with the test regardless of any dementia diagnosis. The test is also less accurate as patients get older. Dr. Soch said she often scores the test more leniently for a patient over age 80 years.

For those patients who score around the 24-point cut off, Dr. Soch recommends ordering a few simple laboratory screens including CBC, a comprehensive metabolic panel, a test of TSH levels, and a check of the patient's vitamin B₁₂ level to rule out reversible causes. Physicians also should order an imaging test, either a CT scan or MRI, to eliminate other possible conditions such as vascular dementia.

Physicians should have a high index of suspicion for depression and consider a trial with a selective serotonin reuptake inhibitor, said Dr. Soch, who reported having no conflicts of interest.

BOSTON — Taking a good history and administering a brief cognitive screening test can go a long way toward identifying Alzheimer's disease and other dementias, according to one family physician.

Currently, too many patients with mild to moderate dementia are being missed in the office, according Dr. Kathleen R. Soch, associate professor in the department of family and community medicine at the Texas A&M Health Science Center in Corpus Christi, Texas.

But physicians can improve their track records by following a few simple steps: take a complete history, administer the Folstein Mini-Mental Status Exam (FMMSE), rule out depression, perform routine laboratory testing, and consider ordering an imaging study.

Most physicians know to ask patients and their family members about memory loss, but they do not realize that family members often overlook problems with memory. A family member might think their parent's memory loss is normal for their age, when in fact the memory impairment could be significant. In those cases, families often come to the office because of the behavioral problems sometimes seen in dementia patients.

For patients with symptoms of dementia, Dr. Soch recommends using the FMMSE as a screening tool. The test is one of the most widely used screening tests. It takes less than 10 minutes to complete in the office, and physicians can administer it themselves or train someone else in the office to do it, she said.

The FMMSE is a 30-point test that asks patients to identify where they are, the date and season, repeat words they have heard, recalls words, spell a word backward, demonstrate simple language skills, and perform simple tasks. The cut off score is 24, and most people without any cognitive impairment should be able to score 29 or 30 on the test, she said.

The test has a sensitivity of 87% and a specificity of 82%. Most people who have a score of 24 or less will have some form of cognitive impairment, but the test also will miss a lot of people with early dementia, she said. The FMMSE also is less accurate in patients with higher and lower levels of education.

Dr. Soch said if she sees a patient who is very well educated and scores 28 or 29 points, she is more likely to consider a diagnosis of dementia. On the other hand, patients who are unable to read will have trouble with the test regardless of any dementia diagnosis. The test is also less accurate as patients get older. Dr. Soch said she often scores the test more leniently for a patient over age 80 years.

For those patients who score around the 24-point cut off, Dr. Soch recommends ordering a few simple laboratory screens including CBC, a comprehensive metabolic panel, a test of TSH levels, and a check of the patient's vitamin B₁₂ level to rule out reversible causes. Physicians also should order an imaging test, either a CT scan or MRI, to eliminate other possible conditions such as vascular dementia.

Physicians should have a high index of suspicion for depression and consider a trial with a selective serotonin reuptake inhibitor, said Dr. Soch, who reported having no conflicts of interest.

BOSTON — Taking a good history and administering a brief cognitive screening test can go a long way toward identifying Alzheimer's disease and other dementias, according to one family physician.

Currently, too many patients with mild to moderate dementia are being missed in the office, according Dr. Kathleen R. Soch, associate professor in the department of family and community medicine at the Texas A&M Health Science Center in Corpus Christi, Texas.

But physicians can improve their track records by following a few simple steps: take a complete history, administer the Folstein Mini-Mental Status Exam (FMMSE), rule out depression, perform routine laboratory testing, and consider ordering an imaging study.

Most physicians know to ask patients and their family members about memory loss, but they do not realize that family members often overlook problems with memory. A family member might think their parent's memory loss is normal for their age, when in fact the memory impairment could be significant. In those cases, families often come to the office because of the behavioral problems sometimes seen in dementia patients.

For patients with symptoms of dementia, Dr. Soch recommends using the FMMSE as a screening tool. The test is one of the most widely used screening tests. It takes less than 10 minutes to complete in the office, and physicians can administer it themselves or train someone else in the office to do it, she said.

The FMMSE is a 30-point test that asks patients to identify where they are, the date and season, repeat words they have heard, recalls words, spell a word backward, demonstrate simple language skills, and perform simple tasks. The cut off score is 24, and most people without any cognitive impairment should be able to score 29 or 30 on the test, she said.

The test has a sensitivity of 87% and a specificity of 82%. Most people who have a score of 24 or less will have some form of cognitive impairment, but the test also will miss a lot of people with early dementia, she said. The FMMSE also is less accurate in patients with higher and lower levels of education.

Dr. Soch said if she sees a patient who is very well educated and scores 28 or 29 points, she is more likely to consider a diagnosis of dementia. On the other hand, patients who are unable to read will have trouble with the test regardless of any dementia diagnosis. The test is also less accurate as patients get older. Dr. Soch said she often scores the test more leniently for a patient over age 80 years.

For those patients who score around the 24-point cut off, Dr. Soch recommends ordering a few simple laboratory screens including CBC, a comprehensive metabolic panel, a test of TSH levels, and a check of the patient's vitamin B₁₂ level to rule out reversible causes. Physicians also should order an imaging test, either a CT scan or MRI, to eliminate other possible conditions such as vascular dementia.

Physicians should have a high index of suspicion for depression and consider a trial with a selective serotonin reuptake inhibitor, said Dr. Soch, who reported having no conflicts of interest.

BOSTON – Physicians can go a long way toward helping their patients successfully quit smoking by thinking about tobacco dependence as a chronic disease, according to Dr. Donald J. Brideau Jr., a family physician in Alexandria, Va.

Tobacco dependence, just like diabetes or hypertension, is a chronic problem that requires follow-up and education to prevent relapse, so physicians can use the same types of strategies and patient education techniques that they use for other chronic illnesses, said Dr. Brideau, chief medical officer at Inova Mount Vernon Hospital in Alexandria.

Dr. Brideau offered this and other tips culled from the clinical practice guidelines on smoking cessation at the annual meeting of the American Academy of Family Physicians.

Another important way to increase success in quitting smoking is to offer every tobacco user some form of therapy, whether it's a pure behavioral approach or medication. This, however, requires physicians or their staffs to systematically identify every smoker or former smoker at every visit. It doesn't matter who does it or how it is done, but it should be done at every visit, he said. Practices can use stickers on charts or make smoking a fifth vital sign.

Once the smokers have been identified, it is important to assess their readiness to quit. The amount of time spent counseling them depends on where they are on the quitting spectrum. If patients say they are not ready to quit, keep the discussion brief. Let them know that you will be there when they are ready and that you will continue to ask them about it, Dr. Brideau said.

In contrast, if patients say they want to quit and could be ready to do so in the next 30 days, they will need information on pharmacologic therapy and advice on other ways they can prepare for their quit date.

When it comes to actually quitting, the literature supports the use of counseling, pharmacologic treatments, and the combination of the two, said Dr. Brideau, who disclosed a financial relationship with Pfizer and the Candela Corp.

In terms of counseling, the evidence shows that the duration and number of sessions is important to increasing success rates. Dr. Brideau tries to get his patients to commit to coming to four office visits over 3–4 months to discuss their progress.

For most patients, pharmacologic intervention should be a part of the approach. Patients will have the greatest chance for success, f they receive a combination of medication and counseling. Prat could mean coupling medication with a 15-minute office visit that is devoted exclusively to a diussing smoking cessation.

Another effective approach is use of telephone quit lines. Multiple randomized controlled trials support the use of these hotlines in increasing success rates. It's no surprise that the quit lines are successful, because they offer individualized counseling to patients, he said.

When patients are unwilling to quit, don't give up. Instead, consider using motivational interviewing techniques. When talking to a patient about quitting, for example, focus on their feelings and why they don't want to set a quit date. Try to figure out what rewards they get from smoking and what the roadblocks are to making a cessation attempt, Dr. Brideau advised.

BOSTON – Physicians can go a long way toward helping their patients successfully quit smoking by thinking about tobacco dependence as a chronic disease, according to Dr. Donald J. Brideau Jr., a family physician in Alexandria, Va.

Tobacco dependence, just like diabetes or hypertension, is a chronic problem that requires follow-up and education to prevent relapse, so physicians can use the same types of strategies and patient education techniques that they use for other chronic illnesses, said Dr. Brideau, chief medical officer at Inova Mount Vernon Hospital in Alexandria.

Dr. Brideau offered this and other tips culled from the clinical practice guidelines on smoking cessation at the annual meeting of the American Academy of Family Physicians.

Another important way to increase success in quitting smoking is to offer every tobacco user some form of therapy, whether it's a pure behavioral approach or medication. This, however, requires physicians or their staffs to systematically identify every smoker or former smoker at every visit. It doesn't matter who does it or how it is done, but it should be done at every visit, he said. Practices can use stickers on charts or make smoking a fifth vital sign.

Once the smokers have been identified, it is important to assess their readiness to quit. The amount of time spent counseling them depends on where they are on the quitting spectrum. If patients say they are not ready to quit, keep the discussion brief. Let them know that you will be there when they are ready and that you will continue to ask them about it, Dr. Brideau said.

In contrast, if patients say they want to quit and could be ready to do so in the next 30 days, they will need information on pharmacologic therapy and advice on other ways they can prepare for their quit date.

When it comes to actually quitting, the literature supports the use of counseling, pharmacologic treatments, and the combination of the two, said Dr. Brideau, who disclosed a financial relationship with Pfizer and the Candela Corp.

In terms of counseling, the evidence shows that the duration and number of sessions is important to increasing success rates. Dr. Brideau tries to get his patients to commit to coming to four office visits over 3–4 months to discuss their progress.

For most patients, pharmacologic intervention should be a part of the approach. Patients will have the greatest chance for success, f they receive a combination of medication and counseling. Prat could mean coupling medication with a 15-minute office visit that is devoted exclusively to a diussing smoking cessation.

Another effective approach is use of telephone quit lines. Multiple randomized controlled trials support the use of these hotlines in increasing success rates. It's no surprise that the quit lines are successful, because they offer individualized counseling to patients, he said.

When patients are unwilling to quit, don't give up. Instead, consider using motivational interviewing techniques. When talking to a patient about quitting, for example, focus on their feelings and why they don't want to set a quit date. Try to figure out what rewards they get from smoking and what the roadblocks are to making a cessation attempt, Dr. Brideau advised.

BOSTON – Physicians can go a long way toward helping their patients successfully quit smoking by thinking about tobacco dependence as a chronic disease, according to Dr. Donald J. Brideau Jr., a family physician in Alexandria, Va.

Tobacco dependence, just like diabetes or hypertension, is a chronic problem that requires follow-up and education to prevent relapse, so physicians can use the same types of strategies and patient education techniques that they use for other chronic illnesses, said Dr. Brideau, chief medical officer at Inova Mount Vernon Hospital in Alexandria.

Dr. Brideau offered this and other tips culled from the clinical practice guidelines on smoking cessation at the annual meeting of the American Academy of Family Physicians.

Another important way to increase success in quitting smoking is to offer every tobacco user some form of therapy, whether it's a pure behavioral approach or medication. This, however, requires physicians or their staffs to systematically identify every smoker or former smoker at every visit. It doesn't matter who does it or how it is done, but it should be done at every visit, he said. Practices can use stickers on charts or make smoking a fifth vital sign.

Once the smokers have been identified, it is important to assess their readiness to quit. The amount of time spent counseling them depends on where they are on the quitting spectrum. If patients say they are not ready to quit, keep the discussion brief. Let them know that you will be there when they are ready and that you will continue to ask them about it, Dr. Brideau said.

In contrast, if patients say they want to quit and could be ready to do so in the next 30 days, they will need information on pharmacologic therapy and advice on other ways they can prepare for their quit date.

When it comes to actually quitting, the literature supports the use of counseling, pharmacologic treatments, and the combination of the two, said Dr. Brideau, who disclosed a financial relationship with Pfizer and the Candela Corp.

In terms of counseling, the evidence shows that the duration and number of sessions is important to increasing success rates. Dr. Brideau tries to get his patients to commit to coming to four office visits over 3–4 months to discuss their progress.

For most patients, pharmacologic intervention should be a part of the approach. Patients will have the greatest chance for success, f they receive a combination of medication and counseling. Prat could mean coupling medication with a 15-minute office visit that is devoted exclusively to a diussing smoking cessation.

Another effective approach is use of telephone quit lines. Multiple randomized controlled trials support the use of these hotlines in increasing success rates. It's no surprise that the quit lines are successful, because they offer individualized counseling to patients, he said.

When patients are unwilling to quit, don't give up. Instead, consider using motivational interviewing techniques. When talking to a patient about quitting, for example, focus on their feelings and why they don't want to set a quit date. Try to figure out what rewards they get from smoking and what the roadblocks are to making a cessation attempt, Dr. Brideau advised.

Dr. Sylvia McKean was on the ground floor of the hospitalist movement in the mid-1990s, and now she is helping to spearhead a new trend: comanagement of patients with surgeons and other specialists.

“This is really, I think, the critical direction for hospital medicine,” said Dr. McKean, who founded the hospitalist program at Brigham and Women's Hospital in Boston. She chairs the Comanagement Task Force and Advisory Board for the Society of Hospital Medicine (SHM), and is editing a comprehensive textbook on hospital medicine to be published in 2010 by McGraw-Hill.

As the patient population ages and develops complex medical problems, hospitalists are increasingly being asked to care for patients on other inpatient services, such as neurosurgery or orthopedics. Acute medical issues, rather than surgical considerations, may determine the timing of surgery, risk of postoperative complications, resource utilization, and hospital length of stay, Dr. McKean said.

When Dr. McKean was director of the SHM's annual meeting in 2008, she heard from attendees seeking education on comanagement as well as benchmarking data on what other hospital groups were doing. With that in mind, the SHM chartered a new task force to examine the educational needs and scope of practice issues involved in comanagement. The SHM also created an advisory board of interdisciplinary team leaders to develop an approach for establishing comanagement services with orthopedic surgeons.

Drawing on the experience of hospitalist services that have already ventured into comanagement, the task force has sought to develop a framework for hospitalists in both community and academic settings. The key is to agree on the “rules of engagement,” Dr. McKean said. “It's really critical to make sure everybody's on the same side of the page to prevent problems down the road.”

For example, everyone involved should recognize that it's “truly” comanagement. This means that hospitalists, most of whom were trained in internal medicine or family medicine, should not function as surgical residents managing surgical issues such as wound care, which requires additional training.

Every hospital will have its own approach, Dr. McKean said, but it is critical for the two services involved in comanagement to agree on job descriptions specifying who does what—for example, when preparing discharge summaries. Those agreements should be reevaluated on a regular basis.

Measurement also is essential for a successful comanagement program. Creating a “report card” with the most important metrics allows for “strategic planning at a glance,” she said, and lets the administration see when the service needs more resources.

But Dr. McKean cautioned physicians not to look at any of the comanagement measures in isolation.

For example, there might be more delirium identified in the comanagement service than in the traditional consultation service, but that does not necessarily mean that hospitalist care is deficient, she said. Instead, it might indicate earlier identification of delirium, the admission of sicker patients to the comanagement service, or the need to target multidisciplinary efforts to improve the hospital setting for vulnerable patients.

Comanagement 'is really, I think, the critical direction for hospital medicine.

Dr. Sylvia McKean was on the ground floor of the hospitalist movement in the mid-1990s, and now she is helping to spearhead a new trend: comanagement of patients with surgeons and other specialists.

“This is really, I think, the critical direction for hospital medicine,” said Dr. McKean, who founded the hospitalist program at Brigham and Women's Hospital in Boston. She chairs the Comanagement Task Force and Advisory Board for the Society of Hospital Medicine (SHM), and is editing a comprehensive textbook on hospital medicine to be published in 2010 by McGraw-Hill.

As the patient population ages and develops complex medical problems, hospitalists are increasingly being asked to care for patients on other inpatient services, such as neurosurgery or orthopedics. Acute medical issues, rather than surgical considerations, may determine the timing of surgery, risk of postoperative complications, resource utilization, and hospital length of stay, Dr. McKean said.

When Dr. McKean was director of the SHM's annual meeting in 2008, she heard from attendees seeking education on comanagement as well as benchmarking data on what other hospital groups were doing. With that in mind, the SHM chartered a new task force to examine the educational needs and scope of practice issues involved in comanagement. The SHM also created an advisory board of interdisciplinary team leaders to develop an approach for establishing comanagement services with orthopedic surgeons.

Drawing on the experience of hospitalist services that have already ventured into comanagement, the task force has sought to develop a framework for hospitalists in both community and academic settings. The key is to agree on the “rules of engagement,” Dr. McKean said. “It's really critical to make sure everybody's on the same side of the page to prevent problems down the road.”

For example, everyone involved should recognize that it's “truly” comanagement. This means that hospitalists, most of whom were trained in internal medicine or family medicine, should not function as surgical residents managing surgical issues such as wound care, which requires additional training.

Every hospital will have its own approach, Dr. McKean said, but it is critical for the two services involved in comanagement to agree on job descriptions specifying who does what—for example, when preparing discharge summaries. Those agreements should be reevaluated on a regular basis.

Measurement also is essential for a successful comanagement program. Creating a “report card” with the most important metrics allows for “strategic planning at a glance,” she said, and lets the administration see when the service needs more resources.

But Dr. McKean cautioned physicians not to look at any of the comanagement measures in isolation.

For example, there might be more delirium identified in the comanagement service than in the traditional consultation service, but that does not necessarily mean that hospitalist care is deficient, she said. Instead, it might indicate earlier identification of delirium, the admission of sicker patients to the comanagement service, or the need to target multidisciplinary efforts to improve the hospital setting for vulnerable patients.

Comanagement 'is really, I think, the critical direction for hospital medicine.

Dr. Sylvia McKean was on the ground floor of the hospitalist movement in the mid-1990s, and now she is helping to spearhead a new trend: comanagement of patients with surgeons and other specialists.

“This is really, I think, the critical direction for hospital medicine,” said Dr. McKean, who founded the hospitalist program at Brigham and Women's Hospital in Boston. She chairs the Comanagement Task Force and Advisory Board for the Society of Hospital Medicine (SHM), and is editing a comprehensive textbook on hospital medicine to be published in 2010 by McGraw-Hill.

As the patient population ages and develops complex medical problems, hospitalists are increasingly being asked to care for patients on other inpatient services, such as neurosurgery or orthopedics. Acute medical issues, rather than surgical considerations, may determine the timing of surgery, risk of postoperative complications, resource utilization, and hospital length of stay, Dr. McKean said.

When Dr. McKean was director of the SHM's annual meeting in 2008, she heard from attendees seeking education on comanagement as well as benchmarking data on what other hospital groups were doing. With that in mind, the SHM chartered a new task force to examine the educational needs and scope of practice issues involved in comanagement. The SHM also created an advisory board of interdisciplinary team leaders to develop an approach for establishing comanagement services with orthopedic surgeons.

Drawing on the experience of hospitalist services that have already ventured into comanagement, the task force has sought to develop a framework for hospitalists in both community and academic settings. The key is to agree on the “rules of engagement,” Dr. McKean said. “It's really critical to make sure everybody's on the same side of the page to prevent problems down the road.”

For example, everyone involved should recognize that it's “truly” comanagement. This means that hospitalists, most of whom were trained in internal medicine or family medicine, should not function as surgical residents managing surgical issues such as wound care, which requires additional training.

Every hospital will have its own approach, Dr. McKean said, but it is critical for the two services involved in comanagement to agree on job descriptions specifying who does what—for example, when preparing discharge summaries. Those agreements should be reevaluated on a regular basis.

Measurement also is essential for a successful comanagement program. Creating a “report card” with the most important metrics allows for “strategic planning at a glance,” she said, and lets the administration see when the service needs more resources.

But Dr. McKean cautioned physicians not to look at any of the comanagement measures in isolation.

For example, there might be more delirium identified in the comanagement service than in the traditional consultation service, but that does not necessarily mean that hospitalist care is deficient, she said. Instead, it might indicate earlier identification of delirium, the admission of sicker patients to the comanagement service, or the need to target multidisciplinary efforts to improve the hospital setting for vulnerable patients.

Comanagement 'is really, I think, the critical direction for hospital medicine.

Recent years have brought a sea change in how state governments and some physicians think about marijuana as a medicine.

Most recently, the American Medical Association's House of Delegates approved a policy recommending that the federal government review its classification of marijuana. Its current designation, as a Schedule I controlled substance, limits the ability of researchers to evaluate the drug's usefulness as a medical therapy, the AMA said. The new AMA policy states that the goal of the reclassification should be to ease the conduct of clinical research and the development of cannabinoid-based medicines and alternative delivery models.

But the policy also clearly states that the request for a federal review should not be seen as an endorsement of state-based medical cannabis programs or the legalization of marijuana.

The AMA joins other medical and public health organizations in favoring a reclassification of marijuana to encourage research. But the AMA's size and clout means people are taking notice of this recommendation, said Bruce Mirken, a spokesperson for the Marijuana Policy Project, an organization that advocates for the decriminalization of marijuana use.

Although the AMA's position won't by itself cause a swift and dramatic political shift, Mr. Mirken said the AMA's previous opposition to a change in Schedule I classification was often seized on by opponents. “They can't really say that anymore,” he said. “That, in the big picture, is significant and it may make it easier for more laws to be passed on the state level.”

Since 1996, laws that allow for some type of medical use of marijuana have been enacted in 13 states: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Additional states have enacted “symbolic” laws that recognize the value of medical marijuana but do not protect individuals from arrest, according to the Marijuana Policy Project.

Further, a recent memorandum from the Department of Justice essentially advocates a hands-off policy on medical marijuana use in states where it is allowed. In October, the DOJ told federal prosecutors in states with laws authorizing the medical use of marijuana not to focus their resources on enforcing the federal prohibition on marijuana. For example, the prosecution of cancer patients who use marijuana as part of a recommended treatment regimen is “unlikely to be an efficient use of limited federal resources,” according to the document.

In California, where medical marijuana has been legal for more than a decade, the law states that physicians will not be punished for recommending marijuana for medical purposes. But even with the latest DOJ memo, federal enforcement is not uniform or predictable.

“That's a very uncomfortable position for a physician,” said Dr. Melvyn Sterling, a palliative care specialist in Orange, Calif. Dr. Sterling said that he feels comfortable recommending marijuana as a treatment when his patients need it, but that he recommends it rarely. “For the most part we have in our therapeutic armamentarium wonderfully effective drugs, and we're not dependent upon cannabinoids,” he said.

In California, the onus is on patients to follow up with their physician when using marijuana as medicine, according to Dr. Denise Greene, a psychiatrist and addiction specialist in the Los Angeles region. In California, physicians may “recommend” that patients obtain marijuana to treat a medical condition; the patient then takes that recommendation to a dispensary. At most dispensaries, that “recommendation” does not need to be renewed or updated, she said.

The system basically gives the patient an open-ended pass to obtain marijuana, Dr. Greene said, especially since unlike traditional prescriptions, these recommendations aren't time- or dose-limited.

“We don't treat this like anything else,” she said. “Physicians prescribe lots of other abusable drugs, but we pay attention to how much and how often and for what purpose they use those drugs.”

My Take

Research Needed on Medicinal Uses

The AMA's recommendation is a rational response to the expanded use of medicinal cannabis in many states. For many of the indications advocated for cannabis (such as nausea, anorexia, and pain), modern medicine has alternatives with proven safety and efficacy. Organized medicine is correct to apply the brakes on the use of marijuana as “medicine” until there are adequate data for its safety and efficacy. Advocacy in the absence of such data has the potential to sully the reputation of the medical profession.

Decriminalization or legalization of marijuana should not be tied to its potential medical uses. Before marijuana can be put forth as a legitimate treatment for specific indications, it should be required to undergo the same approval process for those indications as any other proposed medicine. Research into the safety and efficacy of medicinal cannabis will remain limited as long as it remains on Schedule I. The AMA's policy should facilitate the necessary studies.

PETER D. FRIEDMANN, M.D., M.P.H., professor of medicine and community health at the Alpert Medical School of Brown University, Providence, R.I., is board-certified in addiction medicine. He reports no conflicts of interest.

Dr. Friedmann

Recent years have brought a sea change in how state governments and some physicians think about marijuana as a medicine.

Most recently, the American Medical Association's House of Delegates approved a policy recommending that the federal government review its classification of marijuana. Its current designation, as a Schedule I controlled substance, limits the ability of researchers to evaluate the drug's usefulness as a medical therapy, the AMA said. The new AMA policy states that the goal of the reclassification should be to ease the conduct of clinical research and the development of cannabinoid-based medicines and alternative delivery models.

But the policy also clearly states that the request for a federal review should not be seen as an endorsement of state-based medical cannabis programs or the legalization of marijuana.

The AMA joins other medical and public health organizations in favoring a reclassification of marijuana to encourage research. But the AMA's size and clout means people are taking notice of this recommendation, said Bruce Mirken, a spokesperson for the Marijuana Policy Project, an organization that advocates for the decriminalization of marijuana use.

Although the AMA's position won't by itself cause a swift and dramatic political shift, Mr. Mirken said the AMA's previous opposition to a change in Schedule I classification was often seized on by opponents. “They can't really say that anymore,” he said. “That, in the big picture, is significant and it may make it easier for more laws to be passed on the state level.”

Since 1996, laws that allow for some type of medical use of marijuana have been enacted in 13 states: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Additional states have enacted “symbolic” laws that recognize the value of medical marijuana but do not protect individuals from arrest, according to the Marijuana Policy Project.

Further, a recent memorandum from the Department of Justice essentially advocates a hands-off policy on medical marijuana use in states where it is allowed. In October, the DOJ told federal prosecutors in states with laws authorizing the medical use of marijuana not to focus their resources on enforcing the federal prohibition on marijuana. For example, the prosecution of cancer patients who use marijuana as part of a recommended treatment regimen is “unlikely to be an efficient use of limited federal resources,” according to the document.

In California, where medical marijuana has been legal for more than a decade, the law states that physicians will not be punished for recommending marijuana for medical purposes. But even with the latest DOJ memo, federal enforcement is not uniform or predictable.

“That's a very uncomfortable position for a physician,” said Dr. Melvyn Sterling, a palliative care specialist in Orange, Calif. Dr. Sterling said that he feels comfortable recommending marijuana as a treatment when his patients need it, but that he recommends it rarely. “For the most part we have in our therapeutic armamentarium wonderfully effective drugs, and we're not dependent upon cannabinoids,” he said.

In California, the onus is on patients to follow up with their physician when using marijuana as medicine, according to Dr. Denise Greene, a psychiatrist and addiction specialist in the Los Angeles region. In California, physicians may “recommend” that patients obtain marijuana to treat a medical condition; the patient then takes that recommendation to a dispensary. At most dispensaries, that “recommendation” does not need to be renewed or updated, she said.

The system basically gives the patient an open-ended pass to obtain marijuana, Dr. Greene said, especially since unlike traditional prescriptions, these recommendations aren't time- or dose-limited.

“We don't treat this like anything else,” she said. “Physicians prescribe lots of other abusable drugs, but we pay attention to how much and how often and for what purpose they use those drugs.”

My Take

Research Needed on Medicinal Uses

The AMA's recommendation is a rational response to the expanded use of medicinal cannabis in many states. For many of the indications advocated for cannabis (such as nausea, anorexia, and pain), modern medicine has alternatives with proven safety and efficacy. Organized medicine is correct to apply the brakes on the use of marijuana as “medicine” until there are adequate data for its safety and efficacy. Advocacy in the absence of such data has the potential to sully the reputation of the medical profession.

Decriminalization or legalization of marijuana should not be tied to its potential medical uses. Before marijuana can be put forth as a legitimate treatment for specific indications, it should be required to undergo the same approval process for those indications as any other proposed medicine. Research into the safety and efficacy of medicinal cannabis will remain limited as long as it remains on Schedule I. The AMA's policy should facilitate the necessary studies.

PETER D. FRIEDMANN, M.D., M.P.H., professor of medicine and community health at the Alpert Medical School of Brown University, Providence, R.I., is board-certified in addiction medicine. He reports no conflicts of interest.

Dr. Friedmann

Recent years have brought a sea change in how state governments and some physicians think about marijuana as a medicine.

Most recently, the American Medical Association's House of Delegates approved a policy recommending that the federal government review its classification of marijuana. Its current designation, as a Schedule I controlled substance, limits the ability of researchers to evaluate the drug's usefulness as a medical therapy, the AMA said. The new AMA policy states that the goal of the reclassification should be to ease the conduct of clinical research and the development of cannabinoid-based medicines and alternative delivery models.

But the policy also clearly states that the request for a federal review should not be seen as an endorsement of state-based medical cannabis programs or the legalization of marijuana.

The AMA joins other medical and public health organizations in favoring a reclassification of marijuana to encourage research. But the AMA's size and clout means people are taking notice of this recommendation, said Bruce Mirken, a spokesperson for the Marijuana Policy Project, an organization that advocates for the decriminalization of marijuana use.

Although the AMA's position won't by itself cause a swift and dramatic political shift, Mr. Mirken said the AMA's previous opposition to a change in Schedule I classification was often seized on by opponents. “They can't really say that anymore,” he said. “That, in the big picture, is significant and it may make it easier for more laws to be passed on the state level.”

Since 1996, laws that allow for some type of medical use of marijuana have been enacted in 13 states: Alaska, California, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Additional states have enacted “symbolic” laws that recognize the value of medical marijuana but do not protect individuals from arrest, according to the Marijuana Policy Project.

Further, a recent memorandum from the Department of Justice essentially advocates a hands-off policy on medical marijuana use in states where it is allowed. In October, the DOJ told federal prosecutors in states with laws authorizing the medical use of marijuana not to focus their resources on enforcing the federal prohibition on marijuana. For example, the prosecution of cancer patients who use marijuana as part of a recommended treatment regimen is “unlikely to be an efficient use of limited federal resources,” according to the document.

In California, where medical marijuana has been legal for more than a decade, the law states that physicians will not be punished for recommending marijuana for medical purposes. But even with the latest DOJ memo, federal enforcement is not uniform or predictable.

“That's a very uncomfortable position for a physician,” said Dr. Melvyn Sterling, a palliative care specialist in Orange, Calif. Dr. Sterling said that he feels comfortable recommending marijuana as a treatment when his patients need it, but that he recommends it rarely. “For the most part we have in our therapeutic armamentarium wonderfully effective drugs, and we're not dependent upon cannabinoids,” he said.

In California, the onus is on patients to follow up with their physician when using marijuana as medicine, according to Dr. Denise Greene, a psychiatrist and addiction specialist in the Los Angeles region. In California, physicians may “recommend” that patients obtain marijuana to treat a medical condition; the patient then takes that recommendation to a dispensary. At most dispensaries, that “recommendation” does not need to be renewed or updated, she said.

The system basically gives the patient an open-ended pass to obtain marijuana, Dr. Greene said, especially since unlike traditional prescriptions, these recommendations aren't time- or dose-limited.

“We don't treat this like anything else,” she said. “Physicians prescribe lots of other abusable drugs, but we pay attention to how much and how often and for what purpose they use those drugs.”

My Take

Research Needed on Medicinal Uses

The AMA's recommendation is a rational response to the expanded use of medicinal cannabis in many states. For many of the indications advocated for cannabis (such as nausea, anorexia, and pain), modern medicine has alternatives with proven safety and efficacy. Organized medicine is correct to apply the brakes on the use of marijuana as “medicine” until there are adequate data for its safety and efficacy. Advocacy in the absence of such data has the potential to sully the reputation of the medical profession.

Decriminalization or legalization of marijuana should not be tied to its potential medical uses. Before marijuana can be put forth as a legitimate treatment for specific indications, it should be required to undergo the same approval process for those indications as any other proposed medicine. Research into the safety and efficacy of medicinal cannabis will remain limited as long as it remains on Schedule I. The AMA's policy should facilitate the necessary studies.

PETER D. FRIEDMANN, M.D., M.P.H., professor of medicine and community health at the Alpert Medical School of Brown University, Providence, R.I., is board-certified in addiction medicine. He reports no conflicts of interest.

Dr. Friedmann

BOSTON — Experts have been touting the potential of virtual office visits for years, but the concept may finally be hitting the mainstream now that technology, reimbursement, and patient demand are starting to catch up.

Patients are willing to pay a reasonable fee to get advice from their physician without coming in to the office, and some will even transfer to a new practice to get this service, said Dr. John W. Bachman, a consultant in family medicine at the Mayo Clinic in Rochester, Minn. The option to go online for a medical consult is especially appealing for poorer patients who can't afford to take time off from work to get to the doctor's office, Dr. Bachman said at the annual meeting of the American Academy of Family Physicians.

“The biggest problem with doctors is that we think our patients want to be there,” Dr. Bachman said. “The fact is your patients will pay $35 not to see you.”

That's been the experience at the Mayo Clinic in Rochester, where they have been offering online consultations to established patients for $35. The pilot project, which began in July 2007, uses an online patient portal to link patients and physicians. Through the portal, which was developed by Medfusion Inc., patients choose a physician and enter information about their complaint through a structured online questionnaire. They can also include a note to the provider and upload photos.

Physicians receive an e-mail notification when a consult request is made. The portal allows them to bring up templates for common conditions. The portal also includes patient education materials. Physicians can also send links and attachments to the patient.

In the first 2 years of the pilot, more than 4,200 patients registered on the site. Mayo physicians provided approximately 2,531 online visits, and billings were made for 1,159 of these. Although the registration figure is low, the number of online visits and billings are the highest reported in the literature, according to Dr. Bachman. More than 70% of the patients who participated in online visits were women, including some who were seeking consults on behalf of their children.

Making online consults available can help keep the worried well out of the office, leaving time for those patients who need to come in, Dr. Bachman said.

The preliminary analysis of the first 2 years of the Mayo pilot found that online consults saved a trip to the office for about 40% of patients and saved a phone call to the office for 46% of patients. The rest of the time, patients were asked to come in to the office.

Patients and insurers seem willing to pay for the service, and many private insurers in Minnesota are paying part or all of the online visit charge, he said. Although Medicare won't pay for an online visit, Dr. Bachman said he thinks many Medicare patients would be willing to pay the fee themselves. During the pilot, many uninsured patients were willing to pay for the online service.

Overall, the Mayo Clinic physicians billed patients for fewer than half of the online consults completed because they chose not to bill for certain services that involved minimal time and effort.

BOSTON — Experts have been touting the potential of virtual office visits for years, but the concept may finally be hitting the mainstream now that technology, reimbursement, and patient demand are starting to catch up.

Patients are willing to pay a reasonable fee to get advice from their physician without coming in to the office, and some will even transfer to a new practice to get this service, said Dr. John W. Bachman, a consultant in family medicine at the Mayo Clinic in Rochester, Minn. The option to go online for a medical consult is especially appealing for poorer patients who can't afford to take time off from work to get to the doctor's office, Dr. Bachman said at the annual meeting of the American Academy of Family Physicians.

“The biggest problem with doctors is that we think our patients want to be there,” Dr. Bachman said. “The fact is your patients will pay $35 not to see you.”

That's been the experience at the Mayo Clinic in Rochester, where they have been offering online consultations to established patients for $35. The pilot project, which began in July 2007, uses an online patient portal to link patients and physicians. Through the portal, which was developed by Medfusion Inc., patients choose a physician and enter information about their complaint through a structured online questionnaire. They can also include a note to the provider and upload photos.

Physicians receive an e-mail notification when a consult request is made. The portal allows them to bring up templates for common conditions. The portal also includes patient education materials. Physicians can also send links and attachments to the patient.

In the first 2 years of the pilot, more than 4,200 patients registered on the site. Mayo physicians provided approximately 2,531 online visits, and billings were made for 1,159 of these. Although the registration figure is low, the number of online visits and billings are the highest reported in the literature, according to Dr. Bachman. More than 70% of the patients who participated in online visits were women, including some who were seeking consults on behalf of their children.

Making online consults available can help keep the worried well out of the office, leaving time for those patients who need to come in, Dr. Bachman said.

The preliminary analysis of the first 2 years of the Mayo pilot found that online consults saved a trip to the office for about 40% of patients and saved a phone call to the office for 46% of patients. The rest of the time, patients were asked to come in to the office.

Patients and insurers seem willing to pay for the service, and many private insurers in Minnesota are paying part or all of the online visit charge, he said. Although Medicare won't pay for an online visit, Dr. Bachman said he thinks many Medicare patients would be willing to pay the fee themselves. During the pilot, many uninsured patients were willing to pay for the online service.

Overall, the Mayo Clinic physicians billed patients for fewer than half of the online consults completed because they chose not to bill for certain services that involved minimal time and effort.

BOSTON — Experts have been touting the potential of virtual office visits for years, but the concept may finally be hitting the mainstream now that technology, reimbursement, and patient demand are starting to catch up.

Patients are willing to pay a reasonable fee to get advice from their physician without coming in to the office, and some will even transfer to a new practice to get this service, said Dr. John W. Bachman, a consultant in family medicine at the Mayo Clinic in Rochester, Minn. The option to go online for a medical consult is especially appealing for poorer patients who can't afford to take time off from work to get to the doctor's office, Dr. Bachman said at the annual meeting of the American Academy of Family Physicians.

“The biggest problem with doctors is that we think our patients want to be there,” Dr. Bachman said. “The fact is your patients will pay $35 not to see you.”

That's been the experience at the Mayo Clinic in Rochester, where they have been offering online consultations to established patients for $35. The pilot project, which began in July 2007, uses an online patient portal to link patients and physicians. Through the portal, which was developed by Medfusion Inc., patients choose a physician and enter information about their complaint through a structured online questionnaire. They can also include a note to the provider and upload photos.

Physicians receive an e-mail notification when a consult request is made. The portal allows them to bring up templates for common conditions. The portal also includes patient education materials. Physicians can also send links and attachments to the patient.

In the first 2 years of the pilot, more than 4,200 patients registered on the site. Mayo physicians provided approximately 2,531 online visits, and billings were made for 1,159 of these. Although the registration figure is low, the number of online visits and billings are the highest reported in the literature, according to Dr. Bachman. More than 70% of the patients who participated in online visits were women, including some who were seeking consults on behalf of their children.

Making online consults available can help keep the worried well out of the office, leaving time for those patients who need to come in, Dr. Bachman said.

The preliminary analysis of the first 2 years of the Mayo pilot found that online consults saved a trip to the office for about 40% of patients and saved a phone call to the office for 46% of patients. The rest of the time, patients were asked to come in to the office.

Patients and insurers seem willing to pay for the service, and many private insurers in Minnesota are paying part or all of the online visit charge, he said. Although Medicare won't pay for an online visit, Dr. Bachman said he thinks many Medicare patients would be willing to pay the fee themselves. During the pilot, many uninsured patients were willing to pay for the online service.

Overall, the Mayo Clinic physicians billed patients for fewer than half of the online consults completed because they chose not to bill for certain services that involved minimal time and effort.

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, to comply with new requirements aimed at preventing identity theft.

The rule, which was issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement of the rule every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation.

“The Federal Trade Commission went too far and went beyond the intent of Congress,” Rep. Adler said on the House floor Oct. 20.

The rule also is being challenged in court. On Oct. 30, the U.S. District Court for the District of Columbia ruled that the FTC cannot apply the regulation to lawyers.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

“For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation,” Dr. Cecil Wilson, the AMA's president-elect, said in a statement. “The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies.”

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, to comply with new requirements aimed at preventing identity theft.

The rule, which was issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement of the rule every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation.

“The Federal Trade Commission went too far and went beyond the intent of Congress,” Rep. Adler said on the House floor Oct. 20.

The rule also is being challenged in court. On Oct. 30, the U.S. District Court for the District of Columbia ruled that the FTC cannot apply the regulation to lawyers.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

“For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation,” Dr. Cecil Wilson, the AMA's president-elect, said in a statement. “The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies.”

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, to comply with new requirements aimed at preventing identity theft.

The rule, which was issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement of the rule every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation.

“The Federal Trade Commission went too far and went beyond the intent of Congress,” Rep. Adler said on the House floor Oct. 20.

The rule also is being challenged in court. On Oct. 30, the U.S. District Court for the District of Columbia ruled that the FTC cannot apply the regulation to lawyers.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

“For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation,” Dr. Cecil Wilson, the AMA's president-elect, said in a statement. “The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies.”

CDC Eliminates HIV Exclusion

People seeking to immigrate to the United States will no longer be required to undergo HIV testing, under a final rule issued by the Centers for Disease Control and Prevention. “While HIV infection is a serious health condition, it is not a communicable disease that is a significant public health risk for introduction, transmission, and spread to the U.S. population through casual contact,” CDC officials wrote in the Federal Register in November. The rule goes into effect on Jan. 4. Until now, CDC policy has been that individuals with HIV who are living outside the United States are not eligible to receive a visa for admission to the country. The CDC proposed the change earlier this year and received more than 20,000 public comments on it, the majority of which (about 19,500) supported removing HIV from the list of communicable diseases of public health significance, agency officials said.

Court Rejects Defamation Claim

A California appeals court has thrown out the defamation case against Dr. Bruce Flamm, a clinical professor of

Teen Parents Not Stereotypical

While many Americans assume that teenaged parents come from impoverished, single-parent homes, teen pregnancy happens across the socioeconomic spectrum, according to a new analysis. Surveys of middle- and high-school students show that 39% of teens who had ever given birth to or fathered a child as a teenager were living with two biological or adoptive parents before the birth, the National Campaign to Prevent Teen and Unplanned Pregnancy reported. Another 19% of these teens said that they were living with one biological parent and one stepparent. About 72% of teens who had either fathered a child or given birth as a teenager were living in households that were above the federal poverty level. In fact, most of that group was living in households with incomes at or above 200% of poverty. “Despite what many may believe, teen childbearing is not limited to a particular income group or family structure, which means that prevention efforts must be broad in their design and reach,” Sarah Brown, CEO of the National Campaign to Prevent Teen and Unintended Pregnancy, said in a statement. The findings are based on an analysis of the National Longitudinal Study of Adolescent Health and a public opinion poll of more than 1,000 adults.

Embryo Donation Training

The nonprofit group called RESOLVE: The National Infertility Association is developing a series of training programs to help the medical teams at fertility clinics better understand the issues surrounding embryo donation. RESOLVE, which usually focuses on consumer education, will use a grant from the U.S. Health and Human Services Department to create training modules for health care providers, so they in turn can provide information to their patients. As part of the program, clinic staff will assess their knowledge and current practices related to informing patients about the option to donate embryos. The group RESOLVE also plans to develop online programs for continuing education credit and to offer social networking opportunities.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. For example, treatments in the pipeline include 112 for breast cancer, 86 for obstetric/gynecologic conditions, 76 for asthma, 155 for diabetes, 131 for arthritis, and 80 for Alzheimer's disease, according to PhRMA.

CDC Eliminates HIV Exclusion

People seeking to immigrate to the United States will no longer be required to undergo HIV testing, under a final rule issued by the Centers for Disease Control and Prevention. “While HIV infection is a serious health condition, it is not a communicable disease that is a significant public health risk for introduction, transmission, and spread to the U.S. population through casual contact,” CDC officials wrote in the Federal Register in November. The rule goes into effect on Jan. 4. Until now, CDC policy has been that individuals with HIV who are living outside the United States are not eligible to receive a visa for admission to the country. The CDC proposed the change earlier this year and received more than 20,000 public comments on it, the majority of which (about 19,500) supported removing HIV from the list of communicable diseases of public health significance, agency officials said.

Court Rejects Defamation Claim

A California appeals court has thrown out the defamation case against Dr. Bruce Flamm, a clinical professor of

Teen Parents Not Stereotypical

While many Americans assume that teenaged parents come from impoverished, single-parent homes, teen pregnancy happens across the socioeconomic spectrum, according to a new analysis. Surveys of middle- and high-school students show that 39% of teens who had ever given birth to or fathered a child as a teenager were living with two biological or adoptive parents before the birth, the National Campaign to Prevent Teen and Unplanned Pregnancy reported. Another 19% of these teens said that they were living with one biological parent and one stepparent. About 72% of teens who had either fathered a child or given birth as a teenager were living in households that were above the federal poverty level. In fact, most of that group was living in households with incomes at or above 200% of poverty. “Despite what many may believe, teen childbearing is not limited to a particular income group or family structure, which means that prevention efforts must be broad in their design and reach,” Sarah Brown, CEO of the National Campaign to Prevent Teen and Unintended Pregnancy, said in a statement. The findings are based on an analysis of the National Longitudinal Study of Adolescent Health and a public opinion poll of more than 1,000 adults.

Embryo Donation Training

The nonprofit group called RESOLVE: The National Infertility Association is developing a series of training programs to help the medical teams at fertility clinics better understand the issues surrounding embryo donation. RESOLVE, which usually focuses on consumer education, will use a grant from the U.S. Health and Human Services Department to create training modules for health care providers, so they in turn can provide information to their patients. As part of the program, clinic staff will assess their knowledge and current practices related to informing patients about the option to donate embryos. The group RESOLVE also plans to develop online programs for continuing education credit and to offer social networking opportunities.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. For example, treatments in the pipeline include 112 for breast cancer, 86 for obstetric/gynecologic conditions, 76 for asthma, 155 for diabetes, 131 for arthritis, and 80 for Alzheimer's disease, according to PhRMA.

CDC Eliminates HIV Exclusion

People seeking to immigrate to the United States will no longer be required to undergo HIV testing, under a final rule issued by the Centers for Disease Control and Prevention. “While HIV infection is a serious health condition, it is not a communicable disease that is a significant public health risk for introduction, transmission, and spread to the U.S. population through casual contact,” CDC officials wrote in the Federal Register in November. The rule goes into effect on Jan. 4. Until now, CDC policy has been that individuals with HIV who are living outside the United States are not eligible to receive a visa for admission to the country. The CDC proposed the change earlier this year and received more than 20,000 public comments on it, the majority of which (about 19,500) supported removing HIV from the list of communicable diseases of public health significance, agency officials said.

Court Rejects Defamation Claim

A California appeals court has thrown out the defamation case against Dr. Bruce Flamm, a clinical professor of

Teen Parents Not Stereotypical

While many Americans assume that teenaged parents come from impoverished, single-parent homes, teen pregnancy happens across the socioeconomic spectrum, according to a new analysis. Surveys of middle- and high-school students show that 39% of teens who had ever given birth to or fathered a child as a teenager were living with two biological or adoptive parents before the birth, the National Campaign to Prevent Teen and Unplanned Pregnancy reported. Another 19% of these teens said that they were living with one biological parent and one stepparent. About 72% of teens who had either fathered a child or given birth as a teenager were living in households that were above the federal poverty level. In fact, most of that group was living in households with incomes at or above 200% of poverty. “Despite what many may believe, teen childbearing is not limited to a particular income group or family structure, which means that prevention efforts must be broad in their design and reach,” Sarah Brown, CEO of the National Campaign to Prevent Teen and Unintended Pregnancy, said in a statement. The findings are based on an analysis of the National Longitudinal Study of Adolescent Health and a public opinion poll of more than 1,000 adults.

Embryo Donation Training

The nonprofit group called RESOLVE: The National Infertility Association is developing a series of training programs to help the medical teams at fertility clinics better understand the issues surrounding embryo donation. RESOLVE, which usually focuses on consumer education, will use a grant from the U.S. Health and Human Services Department to create training modules for health care providers, so they in turn can provide information to their patients. As part of the program, clinic staff will assess their knowledge and current practices related to informing patients about the option to donate embryos. The group RESOLVE also plans to develop online programs for continuing education credit and to offer social networking opportunities.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. For example, treatments in the pipeline include 112 for breast cancer, 86 for obstetric/gynecologic conditions, 76 for asthma, 155 for diabetes, 131 for arthritis, and 80 for Alzheimer's disease, according to PhRMA.

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, before they have to comply with new requirements aimed at preventing identity theft.

The rule, which was issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement of the rule every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees—as well as small accounting and legal practices—from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation.

“The Federal Trade Commission went too far and went beyond the intent of Congress,” Rep. Adler said on the House floor Oct. 20.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

“For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation,” Dr. Cecil Wilson, the AMA's president-elect, said in a statement. “The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies.”

To see frequently asked questions, go to www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, before they have to comply with new requirements aimed at preventing identity theft.

The rule, which was issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement of the rule every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees—as well as small accounting and legal practices—from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation.

“The Federal Trade Commission went too far and went beyond the intent of Congress,” Rep. Adler said on the House floor Oct. 20.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

“For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation,” Dr. Cecil Wilson, the AMA's president-elect, said in a statement. “The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies.”

To see frequently asked questions, go to www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm

The Federal Trade Commission once again has delayed enforcement of the Red Flags Rule, giving physicians until June 1, 2010, before they have to comply with new requirements aimed at preventing identity theft.

The rule, which was issued by the Federal Trade Commission (FTC) in 2007, most recently had been scheduled to go into effect Nov. 1. But this is not the first time that the FTC has delayed the enforcement date. The agency has been pushing back enforcement of the rule every few months for about a year. Most recently, the FTC issued a statement on Oct. 30 saying that it was again delaying enforcement at the request of members of Congress.

Congress has been working on a legislative solution to exempt some physician practices and other small businesses from the identity theft requirements. On Oct. 20, the House passed a bill (H.R. 3763) that would exempt physician practices with 20 or fewer employees—as well as small accounting and legal practices—from the Red Flags Rule. The Senate has yet to act on the bill.

Rep. John Adler (D-N.J.), one of the chief sponsors of the legislation, said the regulations would be burdensome and expensive for small businesses and that physician practices were not meant to be caught up in this regulation.

“The Federal Trade Commission went too far and went beyond the intent of Congress,” Rep. Adler said on the House floor Oct. 20.

Under the Red Flags Rule, all creditors, including physician practices, must establish a written identify theft–prevention program to protect consumers. The Red Flags Rule requires physician offices and other health care institutions to conduct risk assessments to determine their vulnerabilities to identity theft and respond to those risks.

The rule has raised the hackles of organized medicine. Groups such as the American Medical Association have objected, saying that it is inappropriate to classify physician practices as creditors simply because they allow patients to defer payment while the practices bill insurance companies. The Red Flags Rule also would add financial and administrative burdens on practices, the AMA said, because it duplicates existing privacy and security requirements put in place under the Health Insurance Portability and Accountability Act.

“For over a year, the AMA has continued to make the case to FTC that physicians are not creditors, and the red flags rule should not apply to them—now attorneys and members of Congress are also rightly raising concern with the FTC's broad interpretation,” Dr. Cecil Wilson, the AMA's president-elect, said in a statement. “The FTC's latest delay of 7 months should give them the time they need to take a good, hard look at the rule and finally revise the list of groups to which it applies.”

To see frequently asked questions, go to www.ftc.gov/bcp/edu/microsites/redflagsrule/faqs.shtm

Biosimilars Will Change Market

The manufacturers of tumor necrosis factor–alpha inhibitors could lose billions of dollars in revenue with the introduction of biosimilars in the United States and Europe, according to the research firm Decision Resources. By 2018, biosimilars of TNF-alpha drugs could cut $9.6 billion from brand sales in the United States, France, Germany, Italy, Spain, and the United Kingdom. But the development could also be a boon for payers in those countries, which could save $4 billion during that period. Decision Resources said it expects the movement to TNF-alpha biosimilars to be driven largely by payers, not physicians. “For the second year in a row, surveyed U.S. payers rank TNF-alpha inhibitors as their top priority” for reducing biologics spending, MaryEllen Klusacek, Ph.D., an analyst at the research firm, said in a statement. “Based on this finding, we anticipate that payer pressure on physicians to prescribe biosimilar TNF-alpha inhibitors will be high.”

Arthritis Kit Seller Busted for Fraud

The owner of a Houston-based durable medical equipment company has pleaded guilty to selling medically unnecessary orthotic devices as parts of “arthritis kits” to Medicare beneficiaries. The kits included braces for both sides of the body and related accessories, such as heating pads. Noel Wayne Jhagroo, owner of Trucare Medical Equipment Services, is alleged to have billed Medicare about $4,000 per kit, according to U.S. Health and Human Services Inspector General Daniel R. Levinson. The case was investigated by the FBI and Inspector General Levinson's office as part of a larger HHS effort to crack down on Medicare fraud.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. They include medications for breast and cervical cancers, arthritis and musculoskeletal disorders, diabetes, autoimmune diseases, eye conditions, gastrointestinal problems, kidney and urologic diseases, respiratory diseases, neurologic conditions, psychiatric disorders, sepsis, obstetric and gynecologic diseases, and more, according to the trade group. For example, there are 114 medicines under development for autoimmune diseases, which affect women at a rate three times that for men.

Electronic Tools Effective: AHRQ

Consumer health informatics (electronic tools and applications designed to provide tailored health advice to patients) could save money by eliminating the need for some health education activities now performed by clinicians, said a report from the Agency for Healthcare Research and Quality. The agency reviewed more than 100 studies of consumers' getting health information via the Web, computer programs, and other electronic avenues such as texting and chat groups. The analysis found that the most effective health informatics applications tailor messages using a patient's own health information and give feedback about that person's progress as the intervention progresses. The AHRQ report also found that feedback from a clinician doesn't seem to be any more effective than that provided by computer. The key is timeliness, not the human touch, the study concluded.

Provider Fraud Most Common

By far, most health care fraud (80%) involves providers' systematically overcharging public or private insurers, according to a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. The study found that these schemes disproportionately target demographic groups who are likely to be enrolled in Medicare and Medicaid. However, the study found that fraud information on the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.

DEA Effort Delays Pain Relief

Heightened efforts by the Drug Enforcement Administration to prevent the theft of prescription narcotics are denying pain relief to many nursing home, hospice, and other long-term care patients, said two senators in a letter to Attorney General Eric Holder. Sen. Herb Kohl (D-Wis.), chairman of the Senate Special Committee on Aging, and Sen. Sheldon Whitehouse (D-R.I.) called on Attorney General Holder to issue new directives to the DEA. To deter theft and diversion of prescription drugs, the agency recently stepped up the enforcement of laws that require pharmacies to obtain hard copies of prescriptions with signatures from physicians—instead of routine medication orders—for controlled substances that are prescribed in residential care settings. This has disrupted “well-established medication coordination protocols” and has led to delays in providing those medications to sick patients, the two lawmakers said.

Biosimilars Will Change Market

The manufacturers of tumor necrosis factor–alpha inhibitors could lose billions of dollars in revenue with the introduction of biosimilars in the United States and Europe, according to the research firm Decision Resources. By 2018, biosimilars of TNF-alpha drugs could cut $9.6 billion from brand sales in the United States, France, Germany, Italy, Spain, and the United Kingdom. But the development could also be a boon for payers in those countries, which could save $4 billion during that period. Decision Resources said it expects the movement to TNF-alpha biosimilars to be driven largely by payers, not physicians. “For the second year in a row, surveyed U.S. payers rank TNF-alpha inhibitors as their top priority” for reducing biologics spending, MaryEllen Klusacek, Ph.D., an analyst at the research firm, said in a statement. “Based on this finding, we anticipate that payer pressure on physicians to prescribe biosimilar TNF-alpha inhibitors will be high.”

Arthritis Kit Seller Busted for Fraud

The owner of a Houston-based durable medical equipment company has pleaded guilty to selling medically unnecessary orthotic devices as parts of “arthritis kits” to Medicare beneficiaries. The kits included braces for both sides of the body and related accessories, such as heating pads. Noel Wayne Jhagroo, owner of Trucare Medical Equipment Services, is alleged to have billed Medicare about $4,000 per kit, according to U.S. Health and Human Services Inspector General Daniel R. Levinson. The case was investigated by the FBI and Inspector General Levinson's office as part of a larger HHS effort to crack down on Medicare fraud.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. They include medications for breast and cervical cancers, arthritis and musculoskeletal disorders, diabetes, autoimmune diseases, eye conditions, gastrointestinal problems, kidney and urologic diseases, respiratory diseases, neurologic conditions, psychiatric disorders, sepsis, obstetric and gynecologic diseases, and more, according to the trade group. For example, there are 114 medicines under development for autoimmune diseases, which affect women at a rate three times that for men.

Electronic Tools Effective: AHRQ

Consumer health informatics (electronic tools and applications designed to provide tailored health advice to patients) could save money by eliminating the need for some health education activities now performed by clinicians, said a report from the Agency for Healthcare Research and Quality. The agency reviewed more than 100 studies of consumers' getting health information via the Web, computer programs, and other electronic avenues such as texting and chat groups. The analysis found that the most effective health informatics applications tailor messages using a patient's own health information and give feedback about that person's progress as the intervention progresses. The AHRQ report also found that feedback from a clinician doesn't seem to be any more effective than that provided by computer. The key is timeliness, not the human touch, the study concluded.

Provider Fraud Most Common

By far, most health care fraud (80%) involves providers' systematically overcharging public or private insurers, according to a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. The study found that these schemes disproportionately target demographic groups who are likely to be enrolled in Medicare and Medicaid. However, the study found that fraud information on the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.

DEA Effort Delays Pain Relief

Heightened efforts by the Drug Enforcement Administration to prevent the theft of prescription narcotics are denying pain relief to many nursing home, hospice, and other long-term care patients, said two senators in a letter to Attorney General Eric Holder. Sen. Herb Kohl (D-Wis.), chairman of the Senate Special Committee on Aging, and Sen. Sheldon Whitehouse (D-R.I.) called on Attorney General Holder to issue new directives to the DEA. To deter theft and diversion of prescription drugs, the agency recently stepped up the enforcement of laws that require pharmacies to obtain hard copies of prescriptions with signatures from physicians—instead of routine medication orders—for controlled substances that are prescribed in residential care settings. This has disrupted “well-established medication coordination protocols” and has led to delays in providing those medications to sick patients, the two lawmakers said.

Biosimilars Will Change Market

The manufacturers of tumor necrosis factor–alpha inhibitors could lose billions of dollars in revenue with the introduction of biosimilars in the United States and Europe, according to the research firm Decision Resources. By 2018, biosimilars of TNF-alpha drugs could cut $9.6 billion from brand sales in the United States, France, Germany, Italy, Spain, and the United Kingdom. But the development could also be a boon for payers in those countries, which could save $4 billion during that period. Decision Resources said it expects the movement to TNF-alpha biosimilars to be driven largely by payers, not physicians. “For the second year in a row, surveyed U.S. payers rank TNF-alpha inhibitors as their top priority” for reducing biologics spending, MaryEllen Klusacek, Ph.D., an analyst at the research firm, said in a statement. “Based on this finding, we anticipate that payer pressure on physicians to prescribe biosimilar TNF-alpha inhibitors will be high.”

Arthritis Kit Seller Busted for Fraud

The owner of a Houston-based durable medical equipment company has pleaded guilty to selling medically unnecessary orthotic devices as parts of “arthritis kits” to Medicare beneficiaries. The kits included braces for both sides of the body and related accessories, such as heating pads. Noel Wayne Jhagroo, owner of Trucare Medical Equipment Services, is alleged to have billed Medicare about $4,000 per kit, according to U.S. Health and Human Services Inspector General Daniel R. Levinson. The case was investigated by the FBI and Inspector General Levinson's office as part of a larger HHS effort to crack down on Medicare fraud.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, according to a report released by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are either in clinical trials or under review by the Food and Drug Administration. They include medications for breast and cervical cancers, arthritis and musculoskeletal disorders, diabetes, autoimmune diseases, eye conditions, gastrointestinal problems, kidney and urologic diseases, respiratory diseases, neurologic conditions, psychiatric disorders, sepsis, obstetric and gynecologic diseases, and more, according to the trade group. For example, there are 114 medicines under development for autoimmune diseases, which affect women at a rate three times that for men.

Electronic Tools Effective: AHRQ

Consumer health informatics (electronic tools and applications designed to provide tailored health advice to patients) could save money by eliminating the need for some health education activities now performed by clinicians, said a report from the Agency for Healthcare Research and Quality. The agency reviewed more than 100 studies of consumers' getting health information via the Web, computer programs, and other electronic avenues such as texting and chat groups. The analysis found that the most effective health informatics applications tailor messages using a patient's own health information and give feedback about that person's progress as the intervention progresses. The AHRQ report also found that feedback from a clinician doesn't seem to be any more effective than that provided by computer. The key is timeliness, not the human touch, the study concluded.

Provider Fraud Most Common

By far, most health care fraud (80%) involves providers' systematically overcharging public or private insurers, according to a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. The study found that these schemes disproportionately target demographic groups who are likely to be enrolled in Medicare and Medicaid. However, the study found that fraud information on the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.

DEA Effort Delays Pain Relief

Heightened efforts by the Drug Enforcement Administration to prevent the theft of prescription narcotics are denying pain relief to many nursing home, hospice, and other long-term care patients, said two senators in a letter to Attorney General Eric Holder. Sen. Herb Kohl (D-Wis.), chairman of the Senate Special Committee on Aging, and Sen. Sheldon Whitehouse (D-R.I.) called on Attorney General Holder to issue new directives to the DEA. To deter theft and diversion of prescription drugs, the agency recently stepped up the enforcement of laws that require pharmacies to obtain hard copies of prescriptions with signatures from physicians—instead of routine medication orders—for controlled substances that are prescribed in residential care settings. This has disrupted “well-established medication coordination protocols” and has led to delays in providing those medications to sick patients, the two lawmakers said.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the pandemic influenza A(H1N1) virus.

As part of an ongoing partnership with Surescripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive electronic prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island Department of Health on all antiviral prescriptions written in the state. Even if a physician uses a handwritten prescription, the information is available from the pharmacy's electronic system.

At a press conference, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Real-time electronic data on antiviral prescriptions also allow health officials to match supply and demand, he said. If prescriptions are about to outpace the supply, the health department can anticipate shortages in the antiviral supply and release more medication.

Additionally, if there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, there might be a need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

“This is really a whole new tool in our tool bag,” Dr. Gifford said.

The statewide initiative is believed to be the first in the nation and allows pharmacies to send data that have been stripped of personal patient information to the health department on a weekly basis. The prescription data include the patient's age and zip code as well as the prescribing physician's name, allowing health officials to track the progress of the outbreak by communities.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the pandemic influenza A(H1N1) virus.

As part of an ongoing partnership with Surescripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive electronic prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island Department of Health on all antiviral prescriptions written in the state. Even if a physician uses a handwritten prescription, the information is available from the pharmacy's electronic system.

At a press conference, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Real-time electronic data on antiviral prescriptions also allow health officials to match supply and demand, he said. If prescriptions are about to outpace the supply, the health department can anticipate shortages in the antiviral supply and release more medication.

Additionally, if there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, there might be a need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

“This is really a whole new tool in our tool bag,” Dr. Gifford said.

The statewide initiative is believed to be the first in the nation and allows pharmacies to send data that have been stripped of personal patient information to the health department on a weekly basis. The prescription data include the patient's age and zip code as well as the prescribing physician's name, allowing health officials to track the progress of the outbreak by communities.

Public health officials in Rhode Island are using electronic pharmacy data to track the use of oseltamivir and other antiviral medications being used to treat patients infected with the pandemic influenza A(H1N1) virus.

As part of an ongoing partnership with Surescripts, an electronic prescribing network, all 181 pharmacies in Rhode Island now can send and receive electronic prescription information over a secure network. As a result, pharmacies are able to transmit information to the Rhode Island Department of Health on all antiviral prescriptions written in the state. Even if a physician uses a handwritten prescription, the information is available from the pharmacy's electronic system.

At a press conference, Dr. David Gifford, director of the Rhode Island Department of Health, said prescriptions for antiviral medications provide a good proxy measure for infection with H1N1 virus and are a complement to other surveillance systems such as school absenteeism and emergency department visits.

Real-time electronic data on antiviral prescriptions also allow health officials to match supply and demand, he said. If prescriptions are about to outpace the supply, the health department can anticipate shortages in the antiviral supply and release more medication.

Additionally, if there are reports of a large volume of H1N1 illness in a community, but not a lot of prescribing of antiviral medication, there might be a need for more physician education, Dr. Gifford said. Conversely, if the pharmacy data show a large amount of antiviral prescribing in areas where there is not a lot of H1N1 activity, it could indicate inappropriate prescribing of oseltamivir (Tamiflu) for seasonal influenza, he said.

“This is really a whole new tool in our tool bag,” Dr. Gifford said.

The statewide initiative is believed to be the first in the nation and allows pharmacies to send data that have been stripped of personal patient information to the health department on a weekly basis. The prescription data include the patient's age and zip code as well as the prescribing physician's name, allowing health officials to track the progress of the outbreak by communities.