Mary Ellen Schneider

PHILADELPHIA – A study assessing the impact of institutional living on Romanian children shows that foster care is effective at reversing some developmental delays, as well as decreasing rates of depression and anxiety, Charles A. Nelson III, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

In the 1960s, child abandonment became a national problem in Romania after the communist party instituted policies to increase the population as a way to increase national production. Taxes were levied on families with fewer than five children, and the government outlawed contraception and abortion.

Families unable to afford to care for their children were encouraged to turn them over to the state to be raised in government-run institutions. In the early 1990s, these institutions came under close scrutiny, revealing that children raised there were at increased risk for social and behavioral abnormalities.

These developmental problems probably result from deprivation inherent in the institutional system, said Dr. Nelson, director of research in the developmental medicine center at Children's Hospital in Boston. Dr. Nelson and his colleagues wanted to look at whether removing these children from an institutional environment would improve social and behavioral problems.

In the ongoing study, called the Bucharest Early Intervention Project, the researchers randomized 136 children between 6 and 31 months of age who had been institutionalized to remain in the institution or to move to foster care.

After a baseline assessment, 68 children were assigned to remain at their institutions and 68 were removed and placed in foster care. A control group of 72 children who had never been institutionalized was matched for age and gender. Because of dropouts and changes in status, only 17 children remain in the institutional setting, 38 remain in foster care, and 46 never-institutionalized children are still in the study.

The children were assessed at baseline, 9 months, 18 months, 30 months, 42 months, and most recently at 54 months of age. The researchers plan to assess the children again when they are 7–8 years old.

At the time of the study, Romania did not have a foster care system, so the researchers had to build a foster care program from scratch. To participate, the families can only accept one child in the home and one parent has to stay home with the child. Foster families receive a stipend and have constant access to a pediatrician, but they are not allowed to put the children in day care full time. The children placed in foster care also have regular contact with project social workers, Dr. Nelson said.

He and his colleagues found that children placed in foster care were less likely to have an emotional disorder than were children who were institutionalized, but no significant differences were found between the prevalence of behavioral disorders between the two groups.

But when it came to emotional disorders such as depression and anxiety, foster care seemed to be making a difference, Dr. Nelson said. Rates of depression were 8.5% in the institutionalized children, compared with 3% among children in foster care. The prevalence of anxiety disorders in the institutional group was 44% when the children were 54 months old, compared with 20% among foster care children at the same age.

PHILADELPHIA – A study assessing the impact of institutional living on Romanian children shows that foster care is effective at reversing some developmental delays, as well as decreasing rates of depression and anxiety, Charles A. Nelson III, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

In the 1960s, child abandonment became a national problem in Romania after the communist party instituted policies to increase the population as a way to increase national production. Taxes were levied on families with fewer than five children, and the government outlawed contraception and abortion.

Families unable to afford to care for their children were encouraged to turn them over to the state to be raised in government-run institutions. In the early 1990s, these institutions came under close scrutiny, revealing that children raised there were at increased risk for social and behavioral abnormalities.

These developmental problems probably result from deprivation inherent in the institutional system, said Dr. Nelson, director of research in the developmental medicine center at Children's Hospital in Boston. Dr. Nelson and his colleagues wanted to look at whether removing these children from an institutional environment would improve social and behavioral problems.

In the ongoing study, called the Bucharest Early Intervention Project, the researchers randomized 136 children between 6 and 31 months of age who had been institutionalized to remain in the institution or to move to foster care.

After a baseline assessment, 68 children were assigned to remain at their institutions and 68 were removed and placed in foster care. A control group of 72 children who had never been institutionalized was matched for age and gender. Because of dropouts and changes in status, only 17 children remain in the institutional setting, 38 remain in foster care, and 46 never-institutionalized children are still in the study.

The children were assessed at baseline, 9 months, 18 months, 30 months, 42 months, and most recently at 54 months of age. The researchers plan to assess the children again when they are 7–8 years old.

At the time of the study, Romania did not have a foster care system, so the researchers had to build a foster care program from scratch. To participate, the families can only accept one child in the home and one parent has to stay home with the child. Foster families receive a stipend and have constant access to a pediatrician, but they are not allowed to put the children in day care full time. The children placed in foster care also have regular contact with project social workers, Dr. Nelson said.

He and his colleagues found that children placed in foster care were less likely to have an emotional disorder than were children who were institutionalized, but no significant differences were found between the prevalence of behavioral disorders between the two groups.

But when it came to emotional disorders such as depression and anxiety, foster care seemed to be making a difference, Dr. Nelson said. Rates of depression were 8.5% in the institutionalized children, compared with 3% among children in foster care. The prevalence of anxiety disorders in the institutional group was 44% when the children were 54 months old, compared with 20% among foster care children at the same age.

PHILADELPHIA – A study assessing the impact of institutional living on Romanian children shows that foster care is effective at reversing some developmental delays, as well as decreasing rates of depression and anxiety, Charles A. Nelson III, Ph.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

In the 1960s, child abandonment became a national problem in Romania after the communist party instituted policies to increase the population as a way to increase national production. Taxes were levied on families with fewer than five children, and the government outlawed contraception and abortion.

Families unable to afford to care for their children were encouraged to turn them over to the state to be raised in government-run institutions. In the early 1990s, these institutions came under close scrutiny, revealing that children raised there were at increased risk for social and behavioral abnormalities.

These developmental problems probably result from deprivation inherent in the institutional system, said Dr. Nelson, director of research in the developmental medicine center at Children's Hospital in Boston. Dr. Nelson and his colleagues wanted to look at whether removing these children from an institutional environment would improve social and behavioral problems.

In the ongoing study, called the Bucharest Early Intervention Project, the researchers randomized 136 children between 6 and 31 months of age who had been institutionalized to remain in the institution or to move to foster care.

After a baseline assessment, 68 children were assigned to remain at their institutions and 68 were removed and placed in foster care. A control group of 72 children who had never been institutionalized was matched for age and gender. Because of dropouts and changes in status, only 17 children remain in the institutional setting, 38 remain in foster care, and 46 never-institutionalized children are still in the study.

The children were assessed at baseline, 9 months, 18 months, 30 months, 42 months, and most recently at 54 months of age. The researchers plan to assess the children again when they are 7–8 years old.

At the time of the study, Romania did not have a foster care system, so the researchers had to build a foster care program from scratch. To participate, the families can only accept one child in the home and one parent has to stay home with the child. Foster families receive a stipend and have constant access to a pediatrician, but they are not allowed to put the children in day care full time. The children placed in foster care also have regular contact with project social workers, Dr. Nelson said.

He and his colleagues found that children placed in foster care were less likely to have an emotional disorder than were children who were institutionalized, but no significant differences were found between the prevalence of behavioral disorders between the two groups.

But when it came to emotional disorders such as depression and anxiety, foster care seemed to be making a difference, Dr. Nelson said. Rates of depression were 8.5% in the institutionalized children, compared with 3% among children in foster care. The prevalence of anxiety disorders in the institutional group was 44% when the children were 54 months old, compared with 20% among foster care children at the same age.

PHILADELPHIA – Autism-specific screening conducted at critical intervals is more effective in the early identification of autism than is using a general developmental instrument as a first-line screening technique, Dr. Susan E. Levy said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

In a study of 152 children aged 15–30 months, a general pediatric developmental screening tool did not adequately examine certain “red flag” items for autism that are included in autism-specific screening tools, she said. For example, some of these red flags include when children do not babble or point, do not make meaningful gestures by age 1 year, have poor eye contact, or are losing language or social skills.

Dr. Levy, of Children's Hospital of Philadelphia, and her colleagues at the University of Pennsylvania School of Nursing, Philadelphia, compared the effectiveness of a general screening tool, the Parents' Evaluation of Developmental Status (PEDS), to an autism-specific tool, the Modified Checklist for Autism in Toddlers (M-CHAT), in screening for autism spectrum disorders in the primary care setting.

The study involved administering a general developmental screening tool first, and then an autism-specific screening of children who failed the general developmental screening tool.

The researchers enrolled 152 children with a mean age of 21 months at the Children's Hospital of Philadelphia urban pediatric primary care center and first administered the PEDS and then the M-CHAT instruments. The results were analyzed taking into account the two screening strategies. The PEDS found that in 75% of the children, parents had nonsignificant concerns or no developmental or behavioral concerns. Parents reported one or more concerns for 25% of the children. In contrast, about 14% of children in the sample scored as at risk for autism spectrum disorders through the M-CHAT, and 86% were considered not at risk.

Of the 114 children who did not have significant concerns after the PEDS, 98 (86%) passed the M-CHAT and 16 (14%) were scored as at risk for autism spectrum disorders after the M-CHAT screening tool. Of the 38 children who had concerns noted with the PEDS, 32 (84%) passed the M-CHAT and 6 (16%) were scored as at risk with the M-CHAT.

“Children who screen negative for general developmental concerns may score positive on the M-CHAT and vice versa,” Dr. Levy said.

In this study, the PEDS screening tool did not appear to be a good substitute for the M-CHAT when screening specifically for autism spectrum disorders in a general pediatric practice in an urban setting, Dr. Levy said.

Instead, the data seems to support using an autism-specific screening tool for all children at critical ages (18 months, 24 months, and 30 months). The children who score as having concerns on the PEDS but not on the M-CHAT may be at risk for other delays or disabilities.

These interim results are part of an ongoing study conducted by the Pennsylvania Center for Autism and Developmental Disability and Research and Epidemiology (PA-CADDRE), which is funded by the Centers for Disease Control and Prevention. The Pennsylvania site is one of six centers around the country collaborating on projects to establish the prevalence, etiology, and risk factors of children with autism spectrum disorders, Dr. Levy said.

PHILADELPHIA – Autism-specific screening conducted at critical intervals is more effective in the early identification of autism than is using a general developmental instrument as a first-line screening technique, Dr. Susan E. Levy said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

In a study of 152 children aged 15–30 months, a general pediatric developmental screening tool did not adequately examine certain “red flag” items for autism that are included in autism-specific screening tools, she said. For example, some of these red flags include when children do not babble or point, do not make meaningful gestures by age 1 year, have poor eye contact, or are losing language or social skills.

Dr. Levy, of Children's Hospital of Philadelphia, and her colleagues at the University of Pennsylvania School of Nursing, Philadelphia, compared the effectiveness of a general screening tool, the Parents' Evaluation of Developmental Status (PEDS), to an autism-specific tool, the Modified Checklist for Autism in Toddlers (M-CHAT), in screening for autism spectrum disorders in the primary care setting.

The study involved administering a general developmental screening tool first, and then an autism-specific screening of children who failed the general developmental screening tool.

The researchers enrolled 152 children with a mean age of 21 months at the Children's Hospital of Philadelphia urban pediatric primary care center and first administered the PEDS and then the M-CHAT instruments. The results were analyzed taking into account the two screening strategies. The PEDS found that in 75% of the children, parents had nonsignificant concerns or no developmental or behavioral concerns. Parents reported one or more concerns for 25% of the children. In contrast, about 14% of children in the sample scored as at risk for autism spectrum disorders through the M-CHAT, and 86% were considered not at risk.

Of the 114 children who did not have significant concerns after the PEDS, 98 (86%) passed the M-CHAT and 16 (14%) were scored as at risk for autism spectrum disorders after the M-CHAT screening tool. Of the 38 children who had concerns noted with the PEDS, 32 (84%) passed the M-CHAT and 6 (16%) were scored as at risk with the M-CHAT.

“Children who screen negative for general developmental concerns may score positive on the M-CHAT and vice versa,” Dr. Levy said.

In this study, the PEDS screening tool did not appear to be a good substitute for the M-CHAT when screening specifically for autism spectrum disorders in a general pediatric practice in an urban setting, Dr. Levy said.

Instead, the data seems to support using an autism-specific screening tool for all children at critical ages (18 months, 24 months, and 30 months). The children who score as having concerns on the PEDS but not on the M-CHAT may be at risk for other delays or disabilities.

These interim results are part of an ongoing study conducted by the Pennsylvania Center for Autism and Developmental Disability and Research and Epidemiology (PA-CADDRE), which is funded by the Centers for Disease Control and Prevention. The Pennsylvania site is one of six centers around the country collaborating on projects to establish the prevalence, etiology, and risk factors of children with autism spectrum disorders, Dr. Levy said.

PHILADELPHIA – Autism-specific screening conducted at critical intervals is more effective in the early identification of autism than is using a general developmental instrument as a first-line screening technique, Dr. Susan E. Levy said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

In a study of 152 children aged 15–30 months, a general pediatric developmental screening tool did not adequately examine certain “red flag” items for autism that are included in autism-specific screening tools, she said. For example, some of these red flags include when children do not babble or point, do not make meaningful gestures by age 1 year, have poor eye contact, or are losing language or social skills.

Dr. Levy, of Children's Hospital of Philadelphia, and her colleagues at the University of Pennsylvania School of Nursing, Philadelphia, compared the effectiveness of a general screening tool, the Parents' Evaluation of Developmental Status (PEDS), to an autism-specific tool, the Modified Checklist for Autism in Toddlers (M-CHAT), in screening for autism spectrum disorders in the primary care setting.

The study involved administering a general developmental screening tool first, and then an autism-specific screening of children who failed the general developmental screening tool.

The researchers enrolled 152 children with a mean age of 21 months at the Children's Hospital of Philadelphia urban pediatric primary care center and first administered the PEDS and then the M-CHAT instruments. The results were analyzed taking into account the two screening strategies. The PEDS found that in 75% of the children, parents had nonsignificant concerns or no developmental or behavioral concerns. Parents reported one or more concerns for 25% of the children. In contrast, about 14% of children in the sample scored as at risk for autism spectrum disorders through the M-CHAT, and 86% were considered not at risk.

Of the 114 children who did not have significant concerns after the PEDS, 98 (86%) passed the M-CHAT and 16 (14%) were scored as at risk for autism spectrum disorders after the M-CHAT screening tool. Of the 38 children who had concerns noted with the PEDS, 32 (84%) passed the M-CHAT and 6 (16%) were scored as at risk with the M-CHAT.

“Children who screen negative for general developmental concerns may score positive on the M-CHAT and vice versa,” Dr. Levy said.

In this study, the PEDS screening tool did not appear to be a good substitute for the M-CHAT when screening specifically for autism spectrum disorders in a general pediatric practice in an urban setting, Dr. Levy said.

Instead, the data seems to support using an autism-specific screening tool for all children at critical ages (18 months, 24 months, and 30 months). The children who score as having concerns on the PEDS but not on the M-CHAT may be at risk for other delays or disabilities.

These interim results are part of an ongoing study conducted by the Pennsylvania Center for Autism and Developmental Disability and Research and Epidemiology (PA-CADDRE), which is funded by the Centers for Disease Control and Prevention. The Pennsylvania site is one of six centers around the country collaborating on projects to establish the prevalence, etiology, and risk factors of children with autism spectrum disorders, Dr. Levy said.

BOSTON — Voters in several states made their voices heard last month on smoking bans and restrictions on abortion.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA).

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax hikes while California and Missouri rejected them.

Social norms around smoking are changing, said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University, Baltimore.

But that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs.

She does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country. “They can't be everywhere at once.”

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act. It prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The measure also raised cigarette taxes.

Arizona voters passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products.

Nevada voters passed a ballot question to ban smoking in indoor areas, including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants.

Ohio voters passed a proposal to prohibit smoking in a number of public places. Voters in Florida passed a constitutional amendment to use tobacco settlement money to fund a statewide tobacco education and prevention program. Voters in South Dakota passed a measure to raise cigarette taxes and dedicate a portion of the funds to tobacco-prevention programs.

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban enacted in South Dakota earlier this year. That controversial law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where an abortion is needed to preserve the woman's health or in cases of rape or incest.

If voters had approved the measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the woman's life or health.

In Oregon and California, voters rejected measures aimed at requiring physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. State voters defeated this measure last year in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board.

“Good family communication unfortunately cannot be imposed by the government,” she said.

BOSTON — Voters in several states made their voices heard last month on smoking bans and restrictions on abortion.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA).

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax hikes while California and Missouri rejected them.

Social norms around smoking are changing, said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University, Baltimore.

But that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs.

She does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country. “They can't be everywhere at once.”

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act. It prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The measure also raised cigarette taxes.

Arizona voters passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products.

Nevada voters passed a ballot question to ban smoking in indoor areas, including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants.

Ohio voters passed a proposal to prohibit smoking in a number of public places. Voters in Florida passed a constitutional amendment to use tobacco settlement money to fund a statewide tobacco education and prevention program. Voters in South Dakota passed a measure to raise cigarette taxes and dedicate a portion of the funds to tobacco-prevention programs.

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban enacted in South Dakota earlier this year. That controversial law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where an abortion is needed to preserve the woman's health or in cases of rape or incest.

If voters had approved the measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the woman's life or health.

In Oregon and California, voters rejected measures aimed at requiring physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. State voters defeated this measure last year in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board.

“Good family communication unfortunately cannot be imposed by the government,” she said.

BOSTON — Voters in several states made their voices heard last month on smoking bans and restrictions on abortion.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA).

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax hikes while California and Missouri rejected them.

Social norms around smoking are changing, said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University, Baltimore.

But that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs.

She does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country. “They can't be everywhere at once.”

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act. It prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The measure also raised cigarette taxes.

Arizona voters passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products.

Nevada voters passed a ballot question to ban smoking in indoor areas, including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants.

Ohio voters passed a proposal to prohibit smoking in a number of public places. Voters in Florida passed a constitutional amendment to use tobacco settlement money to fund a statewide tobacco education and prevention program. Voters in South Dakota passed a measure to raise cigarette taxes and dedicate a portion of the funds to tobacco-prevention programs.

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban enacted in South Dakota earlier this year. That controversial law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where an abortion is needed to preserve the woman's health or in cases of rape or incest.

If voters had approved the measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the woman's life or health.

In Oregon and California, voters rejected measures aimed at requiring physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. State voters defeated this measure last year in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board.

“Good family communication unfortunately cannot be imposed by the government,” she said.

Telehealth Licensure Studied

Officials at the Federation of State Medical Boards are tackling the issue of licensure for physicians engaged in telehealth and those involved in the multistate practice of medicine. FSMB recently received a grant from the federal government to test different ways to reduce licensure barriers and better share information across jurisdictions. “With telehealth playing an increasingly important role in meeting the needs of underserved patient populations, the ability of physicians to be able to quickly obtain licensure in multiple jurisdictions has never been more important,” Dr. James N. Thompson, FSMB president and CEO, said in a statement. “This grant will allow us to find ways to streamline the licensure process while maintaining appropriate standards for public protection.” A centralized database also could streamline the verification of physician credentials in times of disaster, according to the FSMB.

CDC Finances Investigated

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Standardization

The Certification Commission for Healthcare Information Technology (CCHIT), founded in 2004 by three health IT industry organizations, has been designated officially as a Recognized Certification Body by the Health and Human Services Department. CCHIT has already given its seal of approval to 33 ambulatory electronic health record products. The organization will continue to work on certification criteria for inpatient and hospital systems and the architecture that allows information exchange between health care providers and institutions. “Broad adoption of health information technology that is interoperable is absolutely crucial to providing patients with better care, at lower cost, and with less hassle,” HHS Secretary Mike Leavitt said in a statement. “I applaud the CCHIT for meeting the requirements to become a Recognized Certification Body and for their efforts to help bring the benefits of health IT within reach of consumers.”

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. They cited several factors contributing to the stall, including smaller increases in cigarette prices and a 27% reduction in funding for state tobacco control and prevention programs for 2002–2006. Smoking rates are highest among people with less education—43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes within 5–10 years. The strongest support came from 18- to 29-year-olds; 57% favored criminalization, reported the DPA, which advocates medical treatment for drug use and is about to launch a public service campaign on the potential unintended consequences of a cigarette ban.

Medicare Handbook Bias

A group of senior House and Senate Democrats have charged that the 2007 Medicare Handbook casts HMO plans in a more favorable light than fee-for-service plans. The Bush Administration favors Medicare Advantage, the HMO program, which had enrolled about 7.5 million out of 42 million beneficiaries as of mid-year. But it's no secret that Democrats have been unhappy with the program. At the National Medicare Congress in Washington in mid-October, Rep. Pete Stark (D-Calif.) said the program is “overpaid” relative to fee-for-service and that “Medicare loses money on everyone who signs up.” Rep. Stark joined Rep. Charles Rangel (D-N.Y.), Rep. John Dingell (D-Mich.), and Rep. Sherrod Brown (D-Ohio), and Sen. Max Baucus (D-Mont.) and Sen. Jay Rockefeller (D-W.Va.) in writing HHS Secretary Mike Levitt charging that the 2007 handbook “presents a misleading and biased view of Medicare coverage and options.” Though no changes can be made to the 2007 book, the legislators urged CMS to ensure that other beneficiary materials take their concerns into account.

Telehealth Licensure Studied

Officials at the Federation of State Medical Boards are tackling the issue of licensure for physicians engaged in telehealth and those involved in the multistate practice of medicine. FSMB recently received a grant from the federal government to test different ways to reduce licensure barriers and better share information across jurisdictions. “With telehealth playing an increasingly important role in meeting the needs of underserved patient populations, the ability of physicians to be able to quickly obtain licensure in multiple jurisdictions has never been more important,” Dr. James N. Thompson, FSMB president and CEO, said in a statement. “This grant will allow us to find ways to streamline the licensure process while maintaining appropriate standards for public protection.” A centralized database also could streamline the verification of physician credentials in times of disaster, according to the FSMB.

CDC Finances Investigated

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Standardization

The Certification Commission for Healthcare Information Technology (CCHIT), founded in 2004 by three health IT industry organizations, has been designated officially as a Recognized Certification Body by the Health and Human Services Department. CCHIT has already given its seal of approval to 33 ambulatory electronic health record products. The organization will continue to work on certification criteria for inpatient and hospital systems and the architecture that allows information exchange between health care providers and institutions. “Broad adoption of health information technology that is interoperable is absolutely crucial to providing patients with better care, at lower cost, and with less hassle,” HHS Secretary Mike Leavitt said in a statement. “I applaud the CCHIT for meeting the requirements to become a Recognized Certification Body and for their efforts to help bring the benefits of health IT within reach of consumers.”

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. They cited several factors contributing to the stall, including smaller increases in cigarette prices and a 27% reduction in funding for state tobacco control and prevention programs for 2002–2006. Smoking rates are highest among people with less education—43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes within 5–10 years. The strongest support came from 18- to 29-year-olds; 57% favored criminalization, reported the DPA, which advocates medical treatment for drug use and is about to launch a public service campaign on the potential unintended consequences of a cigarette ban.

Medicare Handbook Bias

A group of senior House and Senate Democrats have charged that the 2007 Medicare Handbook casts HMO plans in a more favorable light than fee-for-service plans. The Bush Administration favors Medicare Advantage, the HMO program, which had enrolled about 7.5 million out of 42 million beneficiaries as of mid-year. But it's no secret that Democrats have been unhappy with the program. At the National Medicare Congress in Washington in mid-October, Rep. Pete Stark (D-Calif.) said the program is “overpaid” relative to fee-for-service and that “Medicare loses money on everyone who signs up.” Rep. Stark joined Rep. Charles Rangel (D-N.Y.), Rep. John Dingell (D-Mich.), and Rep. Sherrod Brown (D-Ohio), and Sen. Max Baucus (D-Mont.) and Sen. Jay Rockefeller (D-W.Va.) in writing HHS Secretary Mike Levitt charging that the 2007 handbook “presents a misleading and biased view of Medicare coverage and options.” Though no changes can be made to the 2007 book, the legislators urged CMS to ensure that other beneficiary materials take their concerns into account.

Telehealth Licensure Studied

Officials at the Federation of State Medical Boards are tackling the issue of licensure for physicians engaged in telehealth and those involved in the multistate practice of medicine. FSMB recently received a grant from the federal government to test different ways to reduce licensure barriers and better share information across jurisdictions. “With telehealth playing an increasingly important role in meeting the needs of underserved patient populations, the ability of physicians to be able to quickly obtain licensure in multiple jurisdictions has never been more important,” Dr. James N. Thompson, FSMB president and CEO, said in a statement. “This grant will allow us to find ways to streamline the licensure process while maintaining appropriate standards for public protection.” A centralized database also could streamline the verification of physician credentials in times of disaster, according to the FSMB.

CDC Finances Investigated

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Standardization

The Certification Commission for Healthcare Information Technology (CCHIT), founded in 2004 by three health IT industry organizations, has been designated officially as a Recognized Certification Body by the Health and Human Services Department. CCHIT has already given its seal of approval to 33 ambulatory electronic health record products. The organization will continue to work on certification criteria for inpatient and hospital systems and the architecture that allows information exchange between health care providers and institutions. “Broad adoption of health information technology that is interoperable is absolutely crucial to providing patients with better care, at lower cost, and with less hassle,” HHS Secretary Mike Leavitt said in a statement. “I applaud the CCHIT for meeting the requirements to become a Recognized Certification Body and for their efforts to help bring the benefits of health IT within reach of consumers.”

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. They cited several factors contributing to the stall, including smaller increases in cigarette prices and a 27% reduction in funding for state tobacco control and prevention programs for 2002–2006. Smoking rates are highest among people with less education—43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes within 5–10 years. The strongest support came from 18- to 29-year-olds; 57% favored criminalization, reported the DPA, which advocates medical treatment for drug use and is about to launch a public service campaign on the potential unintended consequences of a cigarette ban.

Medicare Handbook Bias

A group of senior House and Senate Democrats have charged that the 2007 Medicare Handbook casts HMO plans in a more favorable light than fee-for-service plans. The Bush Administration favors Medicare Advantage, the HMO program, which had enrolled about 7.5 million out of 42 million beneficiaries as of mid-year. But it's no secret that Democrats have been unhappy with the program. At the National Medicare Congress in Washington in mid-October, Rep. Pete Stark (D-Calif.) said the program is “overpaid” relative to fee-for-service and that “Medicare loses money on everyone who signs up.” Rep. Stark joined Rep. Charles Rangel (D-N.Y.), Rep. John Dingell (D-Mich.), and Rep. Sherrod Brown (D-Ohio), and Sen. Max Baucus (D-Mont.) and Sen. Jay Rockefeller (D-W.Va.) in writing HHS Secretary Mike Levitt charging that the 2007 handbook “presents a misleading and biased view of Medicare coverage and options.” Though no changes can be made to the 2007 book, the legislators urged CMS to ensure that other beneficiary materials take their concerns into account.

Over the last decade, health care within the Department of Veterans Affairs has transformed itself from a notorious near failure to a national model for quality improvement, leaving many asking how they can incorporate those lessons.

The answer may lie in part with the department's electronic health record system. Known as VistA (Veterans Health Information Systems and Technology Architecture), the system recently received the Innovations in American Government Award—a top honor from Harvard University's Kennedy School of Government.

The award was given to seven government programs that each took a unique approach to meeting community needs. All recipients were given a $100,000 grant to share the factors behind their success.

For Dr. Douglas J. Turner, it's clear that the VA is doing something right when it comes to health information technology (IT). Dr. Turner, who is chief of general surgery for the VA Maryland Health Care System at the Baltimore VA Medical Center and is on the surgery faculty at the University of Maryland, Baltimore, has a foot in both the VA system and private sector.

At the University of Maryland Medical Center, he works with at least two different computer systems for reporting patient variables as well as consulting with several different electronic and paper sources to get the information he needs to see patients.

In contrast, at the VA, every clinic is connected in the VistA system with a single patient identifier. "Everything is in the computer," Dr. Turner said.

The VA computerized patient record system, which sits atop the VistA platform, includes the physician's notes, lab results, and results of consults and surgical procedures. It also generally includes information from visits made outside the system. A hard copy of the clinical record from an outside visit can be scanned into the VA system and made available within a day, Dr. Turner said.

Quality of care has improved since the implementation of VistA, Dr. Turner said. The system includes a check for drug-drug interactions plus several other alerts that let the physician know what's been going on with the patient since the last visit. "Hands down, I would take the VA computer [system] anywhere," Dr. Turner concluded.

"VA officials began building the first generation of the computerized patient record system in the late 1980s out of a need to deal with the increasing number of veterans coming into the system, while resources remained tight," said Linda Fischetti, R.N., acting chief health informatics officer at the Veterans Health Administration's Office of Information. "We had to find ways that we could reduce redundancies and care for more patients."

And the move to an electronic system was driven largely by clinicians who said they needed better tools. "We had clinicians actively saying, 'We need this, we need this, we need this,'" Ms. Fischetti said.

The idea was to create a single system with robust functionality in every health care environment—the inpatient hospital, the outpatient hospital, the long-term care facility, and clinics within the community. The current system is the second generation and VA officials continue to modernize it, Ms. Fischetti said. Today the system allows VA clinicians access to complete historical information on their patients, as well as real-time clinical reminders and real-time decision support.

The No. 1 lesson from the VA experience is that the system must be driven by the needs of the clinician, Ms. Fischetti said. The system also needs to do more than just replace the paper chart. If the health IT product does not succeed in adding value for physicians, she said, they might not adopt it.

She noted, however, that the VA, as both the payer and provider of health care services, distinguishes itself from most of the care providers in the United States. "We are definitely different because we have the alignment of the payer and provider within our own enterprise."

While the VA is a unique system, there are lessons that can be applied in large hospital systems and even in solo physician practices, said Tom Leary, director of federal affairs at the Healthcare Information and Management Systems Society.

For example, successful adoption of a health IT system requires buy-in from clinician leadership. While clinician use of a system can be mandated to some extent in any organization, it does not produce the same results unless physicians and nurses want to use the technology, Mr. Leary said.

Success also depends on getting a return on investment—improvement in quality and cost effectiveness of care—as seen in VistA.

These ideas are applicable as well to the small practice, Mr. Leary said, where the return may be an improvement not only in quality of care for patients, but also in quality of life for providers. Physicians have the opportunity to provide better care, without, for example, having to drive back to the office on the weekend to answer a call about a patient, he said.

Other systems can also learn from the VA's approach to designing the system with the needs of its clinicians in mind, said Dr. Dennis Weaver, acting chief medical officer for the National Alliance for Health Information Technology. "You've got to build it for the clinicians," he said.

But that doesn't mean just automating patient charts, he said, because recreating paper processes doesn't work. Physicians and administrators who are selecting an electronic health record system need to resist the urge to "pave the cow path." They must let clinicians know up front that the workflow is going to change.

Over the last decade, health care within the Department of Veterans Affairs has transformed itself from a notorious near failure to a national model for quality improvement, leaving many asking how they can incorporate those lessons.

The answer may lie in part with the department's electronic health record system. Known as VistA (Veterans Health Information Systems and Technology Architecture), the system recently received the Innovations in American Government Award—a top honor from Harvard University's Kennedy School of Government.

The award was given to seven government programs that each took a unique approach to meeting community needs. All recipients were given a $100,000 grant to share the factors behind their success.

For Dr. Douglas J. Turner, it's clear that the VA is doing something right when it comes to health information technology (IT). Dr. Turner, who is chief of general surgery for the VA Maryland Health Care System at the Baltimore VA Medical Center and is on the surgery faculty at the University of Maryland, Baltimore, has a foot in both the VA system and private sector.

At the University of Maryland Medical Center, he works with at least two different computer systems for reporting patient variables as well as consulting with several different electronic and paper sources to get the information he needs to see patients.

In contrast, at the VA, every clinic is connected in the VistA system with a single patient identifier. "Everything is in the computer," Dr. Turner said.

The VA computerized patient record system, which sits atop the VistA platform, includes the physician's notes, lab results, and results of consults and surgical procedures. It also generally includes information from visits made outside the system. A hard copy of the clinical record from an outside visit can be scanned into the VA system and made available within a day, Dr. Turner said.

Quality of care has improved since the implementation of VistA, Dr. Turner said. The system includes a check for drug-drug interactions plus several other alerts that let the physician know what's been going on with the patient since the last visit. "Hands down, I would take the VA computer [system] anywhere," Dr. Turner concluded.

"VA officials began building the first generation of the computerized patient record system in the late 1980s out of a need to deal with the increasing number of veterans coming into the system, while resources remained tight," said Linda Fischetti, R.N., acting chief health informatics officer at the Veterans Health Administration's Office of Information. "We had to find ways that we could reduce redundancies and care for more patients."

And the move to an electronic system was driven largely by clinicians who said they needed better tools. "We had clinicians actively saying, 'We need this, we need this, we need this,'" Ms. Fischetti said.

The idea was to create a single system with robust functionality in every health care environment—the inpatient hospital, the outpatient hospital, the long-term care facility, and clinics within the community. The current system is the second generation and VA officials continue to modernize it, Ms. Fischetti said. Today the system allows VA clinicians access to complete historical information on their patients, as well as real-time clinical reminders and real-time decision support.

The No. 1 lesson from the VA experience is that the system must be driven by the needs of the clinician, Ms. Fischetti said. The system also needs to do more than just replace the paper chart. If the health IT product does not succeed in adding value for physicians, she said, they might not adopt it.

She noted, however, that the VA, as both the payer and provider of health care services, distinguishes itself from most of the care providers in the United States. "We are definitely different because we have the alignment of the payer and provider within our own enterprise."

While the VA is a unique system, there are lessons that can be applied in large hospital systems and even in solo physician practices, said Tom Leary, director of federal affairs at the Healthcare Information and Management Systems Society.

For example, successful adoption of a health IT system requires buy-in from clinician leadership. While clinician use of a system can be mandated to some extent in any organization, it does not produce the same results unless physicians and nurses want to use the technology, Mr. Leary said.

Success also depends on getting a return on investment—improvement in quality and cost effectiveness of care—as seen in VistA.

These ideas are applicable as well to the small practice, Mr. Leary said, where the return may be an improvement not only in quality of care for patients, but also in quality of life for providers. Physicians have the opportunity to provide better care, without, for example, having to drive back to the office on the weekend to answer a call about a patient, he said.

Other systems can also learn from the VA's approach to designing the system with the needs of its clinicians in mind, said Dr. Dennis Weaver, acting chief medical officer for the National Alliance for Health Information Technology. "You've got to build it for the clinicians," he said.

But that doesn't mean just automating patient charts, he said, because recreating paper processes doesn't work. Physicians and administrators who are selecting an electronic health record system need to resist the urge to "pave the cow path." They must let clinicians know up front that the workflow is going to change.

Over the last decade, health care within the Department of Veterans Affairs has transformed itself from a notorious near failure to a national model for quality improvement, leaving many asking how they can incorporate those lessons.

The answer may lie in part with the department's electronic health record system. Known as VistA (Veterans Health Information Systems and Technology Architecture), the system recently received the Innovations in American Government Award—a top honor from Harvard University's Kennedy School of Government.

The award was given to seven government programs that each took a unique approach to meeting community needs. All recipients were given a $100,000 grant to share the factors behind their success.

For Dr. Douglas J. Turner, it's clear that the VA is doing something right when it comes to health information technology (IT). Dr. Turner, who is chief of general surgery for the VA Maryland Health Care System at the Baltimore VA Medical Center and is on the surgery faculty at the University of Maryland, Baltimore, has a foot in both the VA system and private sector.

At the University of Maryland Medical Center, he works with at least two different computer systems for reporting patient variables as well as consulting with several different electronic and paper sources to get the information he needs to see patients.

In contrast, at the VA, every clinic is connected in the VistA system with a single patient identifier. "Everything is in the computer," Dr. Turner said.

The VA computerized patient record system, which sits atop the VistA platform, includes the physician's notes, lab results, and results of consults and surgical procedures. It also generally includes information from visits made outside the system. A hard copy of the clinical record from an outside visit can be scanned into the VA system and made available within a day, Dr. Turner said.

Quality of care has improved since the implementation of VistA, Dr. Turner said. The system includes a check for drug-drug interactions plus several other alerts that let the physician know what's been going on with the patient since the last visit. "Hands down, I would take the VA computer [system] anywhere," Dr. Turner concluded.

"VA officials began building the first generation of the computerized patient record system in the late 1980s out of a need to deal with the increasing number of veterans coming into the system, while resources remained tight," said Linda Fischetti, R.N., acting chief health informatics officer at the Veterans Health Administration's Office of Information. "We had to find ways that we could reduce redundancies and care for more patients."

And the move to an electronic system was driven largely by clinicians who said they needed better tools. "We had clinicians actively saying, 'We need this, we need this, we need this,'" Ms. Fischetti said.

The idea was to create a single system with robust functionality in every health care environment—the inpatient hospital, the outpatient hospital, the long-term care facility, and clinics within the community. The current system is the second generation and VA officials continue to modernize it, Ms. Fischetti said. Today the system allows VA clinicians access to complete historical information on their patients, as well as real-time clinical reminders and real-time decision support.

The No. 1 lesson from the VA experience is that the system must be driven by the needs of the clinician, Ms. Fischetti said. The system also needs to do more than just replace the paper chart. If the health IT product does not succeed in adding value for physicians, she said, they might not adopt it.

She noted, however, that the VA, as both the payer and provider of health care services, distinguishes itself from most of the care providers in the United States. "We are definitely different because we have the alignment of the payer and provider within our own enterprise."

While the VA is a unique system, there are lessons that can be applied in large hospital systems and even in solo physician practices, said Tom Leary, director of federal affairs at the Healthcare Information and Management Systems Society.

For example, successful adoption of a health IT system requires buy-in from clinician leadership. While clinician use of a system can be mandated to some extent in any organization, it does not produce the same results unless physicians and nurses want to use the technology, Mr. Leary said.

Success also depends on getting a return on investment—improvement in quality and cost effectiveness of care—as seen in VistA.

These ideas are applicable as well to the small practice, Mr. Leary said, where the return may be an improvement not only in quality of care for patients, but also in quality of life for providers. Physicians have the opportunity to provide better care, without, for example, having to drive back to the office on the weekend to answer a call about a patient, he said.

Other systems can also learn from the VA's approach to designing the system with the needs of its clinicians in mind, said Dr. Dennis Weaver, acting chief medical officer for the National Alliance for Health Information Technology. "You've got to build it for the clinicians," he said.

But that doesn't mean just automating patient charts, he said, because recreating paper processes doesn't work. Physicians and administrators who are selecting an electronic health record system need to resist the urge to "pave the cow path." They must let clinicians know up front that the workflow is going to change.

Reexamining Abstinence Information

Officials in the Department and Health and Human Services should review materials produced by federally funded abstinence education programs to ensure that they provide medically accurate information about condoms, according to the general counsel of the Government Accountability Office. In a legal opinion sent to HHS Secretary Mike Leavitt and members of Congress, GAO General Counsel Gary Kepplinger wrote that materials produced by federal grantees containing information on sexually transmitted diseases must also include medically accurate information on the efficacy of condoms in preventing the STD described, as required by the Public Health Service Act. The GAO rejected arguments from HHS officials that the law does not apply to abstinence programs. GAO officials did not assess materials for compliance with the requirement.

UK Weighs Embryo-Transfer Limits

An expert panel in the United Kingdom has recommended elective single-embryo transfer for women at the greatest risk for having twins. By offering elective single-embryo transfer to about half of in vitro fertilization patients, the twin rate would drop to less than 10%, down from about 25%, according to the panel. Making elective single-embryo transfer “the norm” is the only way to reduce the high risk of twinning, the panel wrote. The expert panel was convened by the UK's Human Fertilisation and Embryology Authority, which regulates fertility treatment and embryo research. The authority will consider the recommendations and could revise the policy in late 2007. The current policy calls for no more than two embryos to be implanted in women under age 40 years.

Group to Study Sex Differences

The Society for Women's Health Research has launched a new division tasked with evaluating the role of sex differences in health and medicine. One of the goals of the new division—the Organization for the Study of Sex Differences—is to spur interdisciplinary collaboration among scientists and clinicians from various fields. “OSSD will provide researchers and clinicians from a broad spectrum of disciplines the opportunity to gain new insights into their areas of respective interest through sharing information about the impact of sex chromosomes on basic biological processes and disease expression,” Kathryn Sandberg, Ph.D., president of the new organization, said in a statement. Cook Women's Health, a division of the medical device company Cook, provided the initial funding for the launch of the organization.

Wal-Mart Expands $4 Generic Access

Wal-Mart has expanded its $4 generic drug program to an additional 14 states. The program, which was launched in September in Florida, covers 30-day supplies of generic drugs at commonly prescribed dosages and includes 314 generic drugs, including 143 compounds in 24 therapeutic categories. Wal-Mart had originally planned to pilot the program in Florida and roll it out to additional states sometime next year, but accelerated expansion because of consumer demand. The move by Wal-Mart is likely to be good for the company's bottom line, according to the results of a Wall Street Journal Online/Harris Interactive poll. The poll of 2,493 adults found that currently only 13% of adults most often purchase drugs from a discount store such as Wal-Mart or Target. However, when told about the availability of discounted generic drugs, 50% of respondents said they would be likely, very likely, or absolutely certain to fill their prescriptions for generic drugs at discount retailers. The program is now available at Wal-Mart stores in Alaska, Arizona, Arkansas, Delaware, Florida, Illinois, Indiana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas, and Vermont.

Ex-FDA Chief Pleads Guilty

Former Food and Drug Administration Commissioner Lester M. Crawford, D.V.M., has pleaded guilty to lying about stock he held during his tenure, in violation of federal conflict-of-interest and stock ownership rules. Dr. Crawford was charged with two misdemeanors and is scheduled to be sentenced Jan. 22 in Federal District Court in Washington. He could receive a year in prison and could be fined $200,000. According to the plea, Dr. Crawford failed to sell shares in Sysco, Pepsico, and Kimberly-Clark, all of which have products that are regulated by the FDA. Federal rules require senior officials to divest shares in companies that their agency regulates. Dr. Crawford also did not disclose his wife's ownership of Wal-Mart stock. Dr. Crawford was charged with conflict of interest for owning the Pepsico and Sysco shares while he was chairman of FDA's Obesity Working Group.

Reexamining Abstinence Information

Officials in the Department and Health and Human Services should review materials produced by federally funded abstinence education programs to ensure that they provide medically accurate information about condoms, according to the general counsel of the Government Accountability Office. In a legal opinion sent to HHS Secretary Mike Leavitt and members of Congress, GAO General Counsel Gary Kepplinger wrote that materials produced by federal grantees containing information on sexually transmitted diseases must also include medically accurate information on the efficacy of condoms in preventing the STD described, as required by the Public Health Service Act. The GAO rejected arguments from HHS officials that the law does not apply to abstinence programs. GAO officials did not assess materials for compliance with the requirement.

UK Weighs Embryo-Transfer Limits

An expert panel in the United Kingdom has recommended elective single-embryo transfer for women at the greatest risk for having twins. By offering elective single-embryo transfer to about half of in vitro fertilization patients, the twin rate would drop to less than 10%, down from about 25%, according to the panel. Making elective single-embryo transfer “the norm” is the only way to reduce the high risk of twinning, the panel wrote. The expert panel was convened by the UK's Human Fertilisation and Embryology Authority, which regulates fertility treatment and embryo research. The authority will consider the recommendations and could revise the policy in late 2007. The current policy calls for no more than two embryos to be implanted in women under age 40 years.

Group to Study Sex Differences

The Society for Women's Health Research has launched a new division tasked with evaluating the role of sex differences in health and medicine. One of the goals of the new division—the Organization for the Study of Sex Differences—is to spur interdisciplinary collaboration among scientists and clinicians from various fields. “OSSD will provide researchers and clinicians from a broad spectrum of disciplines the opportunity to gain new insights into their areas of respective interest through sharing information about the impact of sex chromosomes on basic biological processes and disease expression,” Kathryn Sandberg, Ph.D., president of the new organization, said in a statement. Cook Women's Health, a division of the medical device company Cook, provided the initial funding for the launch of the organization.

Wal-Mart Expands $4 Generic Access

Wal-Mart has expanded its $4 generic drug program to an additional 14 states. The program, which was launched in September in Florida, covers 30-day supplies of generic drugs at commonly prescribed dosages and includes 314 generic drugs, including 143 compounds in 24 therapeutic categories. Wal-Mart had originally planned to pilot the program in Florida and roll it out to additional states sometime next year, but accelerated expansion because of consumer demand. The move by Wal-Mart is likely to be good for the company's bottom line, according to the results of a Wall Street Journal Online/Harris Interactive poll. The poll of 2,493 adults found that currently only 13% of adults most often purchase drugs from a discount store such as Wal-Mart or Target. However, when told about the availability of discounted generic drugs, 50% of respondents said they would be likely, very likely, or absolutely certain to fill their prescriptions for generic drugs at discount retailers. The program is now available at Wal-Mart stores in Alaska, Arizona, Arkansas, Delaware, Florida, Illinois, Indiana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas, and Vermont.

Ex-FDA Chief Pleads Guilty

Former Food and Drug Administration Commissioner Lester M. Crawford, D.V.M., has pleaded guilty to lying about stock he held during his tenure, in violation of federal conflict-of-interest and stock ownership rules. Dr. Crawford was charged with two misdemeanors and is scheduled to be sentenced Jan. 22 in Federal District Court in Washington. He could receive a year in prison and could be fined $200,000. According to the plea, Dr. Crawford failed to sell shares in Sysco, Pepsico, and Kimberly-Clark, all of which have products that are regulated by the FDA. Federal rules require senior officials to divest shares in companies that their agency regulates. Dr. Crawford also did not disclose his wife's ownership of Wal-Mart stock. Dr. Crawford was charged with conflict of interest for owning the Pepsico and Sysco shares while he was chairman of FDA's Obesity Working Group.

Reexamining Abstinence Information

Officials in the Department and Health and Human Services should review materials produced by federally funded abstinence education programs to ensure that they provide medically accurate information about condoms, according to the general counsel of the Government Accountability Office. In a legal opinion sent to HHS Secretary Mike Leavitt and members of Congress, GAO General Counsel Gary Kepplinger wrote that materials produced by federal grantees containing information on sexually transmitted diseases must also include medically accurate information on the efficacy of condoms in preventing the STD described, as required by the Public Health Service Act. The GAO rejected arguments from HHS officials that the law does not apply to abstinence programs. GAO officials did not assess materials for compliance with the requirement.

UK Weighs Embryo-Transfer Limits

An expert panel in the United Kingdom has recommended elective single-embryo transfer for women at the greatest risk for having twins. By offering elective single-embryo transfer to about half of in vitro fertilization patients, the twin rate would drop to less than 10%, down from about 25%, according to the panel. Making elective single-embryo transfer “the norm” is the only way to reduce the high risk of twinning, the panel wrote. The expert panel was convened by the UK's Human Fertilisation and Embryology Authority, which regulates fertility treatment and embryo research. The authority will consider the recommendations and could revise the policy in late 2007. The current policy calls for no more than two embryos to be implanted in women under age 40 years.

Group to Study Sex Differences

The Society for Women's Health Research has launched a new division tasked with evaluating the role of sex differences in health and medicine. One of the goals of the new division—the Organization for the Study of Sex Differences—is to spur interdisciplinary collaboration among scientists and clinicians from various fields. “OSSD will provide researchers and clinicians from a broad spectrum of disciplines the opportunity to gain new insights into their areas of respective interest through sharing information about the impact of sex chromosomes on basic biological processes and disease expression,” Kathryn Sandberg, Ph.D., president of the new organization, said in a statement. Cook Women's Health, a division of the medical device company Cook, provided the initial funding for the launch of the organization.

Wal-Mart Expands $4 Generic Access

Wal-Mart has expanded its $4 generic drug program to an additional 14 states. The program, which was launched in September in Florida, covers 30-day supplies of generic drugs at commonly prescribed dosages and includes 314 generic drugs, including 143 compounds in 24 therapeutic categories. Wal-Mart had originally planned to pilot the program in Florida and roll it out to additional states sometime next year, but accelerated expansion because of consumer demand. The move by Wal-Mart is likely to be good for the company's bottom line, according to the results of a Wall Street Journal Online/Harris Interactive poll. The poll of 2,493 adults found that currently only 13% of adults most often purchase drugs from a discount store such as Wal-Mart or Target. However, when told about the availability of discounted generic drugs, 50% of respondents said they would be likely, very likely, or absolutely certain to fill their prescriptions for generic drugs at discount retailers. The program is now available at Wal-Mart stores in Alaska, Arizona, Arkansas, Delaware, Florida, Illinois, Indiana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas, and Vermont.

Ex-FDA Chief Pleads Guilty

Former Food and Drug Administration Commissioner Lester M. Crawford, D.V.M., has pleaded guilty to lying about stock he held during his tenure, in violation of federal conflict-of-interest and stock ownership rules. Dr. Crawford was charged with two misdemeanors and is scheduled to be sentenced Jan. 22 in Federal District Court in Washington. He could receive a year in prison and could be fined $200,000. According to the plea, Dr. Crawford failed to sell shares in Sysco, Pepsico, and Kimberly-Clark, all of which have products that are regulated by the FDA. Federal rules require senior officials to divest shares in companies that their agency regulates. Dr. Crawford also did not disclose his wife's ownership of Wal-Mart stock. Dr. Crawford was charged with conflict of interest for owning the Pepsico and Sysco shares while he was chairman of FDA's Obesity Working Group.

Physicians may be feeling a sense of déjà vu with the announcement from Medicare that physician payments will be cut 5% as of Jan. 1, 2007.

This is the fifth year in a row that physicians have been threatened with a payment cut under Medicare. Medical specialty societies have been urging Congress to step in and avert this most recent across-the-board cut, as they have for the past 4 years.

The cut, announced in early November by officials at the Centers for Medicare and Medicaid Services, is part of the Medicare Physician Fee Schedule final rule, which is issued annually. This year's rule also sets the Medicare conversion factor—a multiplier used to calculate payments for each service physicians provide—at $35.98.

The 5% cut is required under a payment formula passed by Congress several years ago. That formula, known as the sustainable growth rate (SGR), “was designed to adjust the update to make actual [expenditures] and target expenditures equal over time,” according to CMS policy. “If outlays under the fee schedule are higher than the [spending target set by the government], the update is decreased. Conversely, if outlays are lower than the target, the update is increased.” The cut announced by CMS is slightly less than the 5.1% figure that the agency estimated earlier this year.

The final rule also includes some good news for physicians who spend a lot of time performing evaluation and management services. CMS has finalized plans to increase the work relative value units (RVUs) for evaluation and management services, which make up much of the practice of primary care and other cognitive specialties. Each physician service in the fee schedule has a certain number of RVUs associated with it; the RVUs are then multiplied by the conversion factor to arrive at a charge for the service.

The increases for evaluation and management services were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) as part of a 5-year review. However, they may be largely offset by the 5% across-the-board payment cut, according to the AMA. “For the great majority of primary care physicians, the overall physician payment cut due to the flawed payment formula will negate any payment increases specific to physician office visit payments,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

CMS estimated in the final rule that internal medicine will experience a 1% overall cut in allowed charges under Medicare due to the combination of the changes to work and practice expense RVUs, the SGR cut, and other cuts called for under the Deficit Reduction Act of 2005.

Family physicians will break even once all factors are calculated. CMS estimates that only four specialties will see positive updates in 2007 once all the payment changes are factored in—emergency medicine (2%), endocrinology (1%), infectious disease (4%), and pulmonary disease (1%).

One area of physician services greatly affected by the final rule is imaging services. Starting Jan. 1, physicians who perform multiple imaging procedures on contiguous body parts during the same session will be paid in full for the first procedure and then will receive a 25% cut in the technical component payment for additional imaging procedures.

In addition, the final rule implements imaging cuts called for under the Deficit Reduction Act. Under this provision, the payment for the technical component of certain physician-performed imaging services is capped at the hospital outpatient amount for the same service. This cap does not apply to mammography services.

The AMA and other medical specialty organizations called on Congress to take action when it returns for a short lame-duck session. The groups have been lobbying for months for Congress to pass stopgap legislation that would eliminate the cut this year and give legislators time to agree on a new formula for determining physician payment under Medicare next year.

There is reason to think that Congress will act to reverse the payment cuts. From 2003 to 2006, Congress stopped Medicare payment cuts scheduled to take effect under the SGR formula. And currently, 80 senators and 265 representatives have signed on to letters to the congressional leadership calling for the cuts to be stopped.

In the final regulation, CMS officials are giving with one hand and taking away with the other, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said. CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, he said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.

But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure. Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.

Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them. For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs.

Physicians may be feeling a sense of déjà vu with the announcement from Medicare that physician payments will be cut 5% as of Jan. 1, 2007.

This is the fifth year in a row that physicians have been threatened with a payment cut under Medicare. Medical specialty societies have been urging Congress to step in and avert this most recent across-the-board cut, as they have for the past 4 years.

The cut, announced in early November by officials at the Centers for Medicare and Medicaid Services, is part of the Medicare Physician Fee Schedule final rule, which is issued annually. This year's rule also sets the Medicare conversion factor—a multiplier used to calculate payments for each service physicians provide—at $35.98.

The 5% cut is required under a payment formula passed by Congress several years ago. That formula, known as the sustainable growth rate (SGR), “was designed to adjust the update to make actual [expenditures] and target expenditures equal over time,” according to CMS policy. “If outlays under the fee schedule are higher than the [spending target set by the government], the update is decreased. Conversely, if outlays are lower than the target, the update is increased.” The cut announced by CMS is slightly less than the 5.1% figure that the agency estimated earlier this year.

The final rule also includes some good news for physicians who spend a lot of time performing evaluation and management services. CMS has finalized plans to increase the work relative value units (RVUs) for evaluation and management services, which make up much of the practice of primary care and other cognitive specialties. Each physician service in the fee schedule has a certain number of RVUs associated with it; the RVUs are then multiplied by the conversion factor to arrive at a charge for the service.

The increases for evaluation and management services were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) as part of a 5-year review. However, they may be largely offset by the 5% across-the-board payment cut, according to the AMA. “For the great majority of primary care physicians, the overall physician payment cut due to the flawed payment formula will negate any payment increases specific to physician office visit payments,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

CMS estimated in the final rule that internal medicine will experience a 1% overall cut in allowed charges under Medicare due to the combination of the changes to work and practice expense RVUs, the SGR cut, and other cuts called for under the Deficit Reduction Act of 2005.

Family physicians will break even once all factors are calculated. CMS estimates that only four specialties will see positive updates in 2007 once all the payment changes are factored in—emergency medicine (2%), endocrinology (1%), infectious disease (4%), and pulmonary disease (1%).

One area of physician services greatly affected by the final rule is imaging services. Starting Jan. 1, physicians who perform multiple imaging procedures on contiguous body parts during the same session will be paid in full for the first procedure and then will receive a 25% cut in the technical component payment for additional imaging procedures.

In addition, the final rule implements imaging cuts called for under the Deficit Reduction Act. Under this provision, the payment for the technical component of certain physician-performed imaging services is capped at the hospital outpatient amount for the same service. This cap does not apply to mammography services.

The AMA and other medical specialty organizations called on Congress to take action when it returns for a short lame-duck session. The groups have been lobbying for months for Congress to pass stopgap legislation that would eliminate the cut this year and give legislators time to agree on a new formula for determining physician payment under Medicare next year.

There is reason to think that Congress will act to reverse the payment cuts. From 2003 to 2006, Congress stopped Medicare payment cuts scheduled to take effect under the SGR formula. And currently, 80 senators and 265 representatives have signed on to letters to the congressional leadership calling for the cuts to be stopped.

In the final regulation, CMS officials are giving with one hand and taking away with the other, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said. CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, he said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.

But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure. Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.

Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them. For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs.

Physicians may be feeling a sense of déjà vu with the announcement from Medicare that physician payments will be cut 5% as of Jan. 1, 2007.

This is the fifth year in a row that physicians have been threatened with a payment cut under Medicare. Medical specialty societies have been urging Congress to step in and avert this most recent across-the-board cut, as they have for the past 4 years.

The cut, announced in early November by officials at the Centers for Medicare and Medicaid Services, is part of the Medicare Physician Fee Schedule final rule, which is issued annually. This year's rule also sets the Medicare conversion factor—a multiplier used to calculate payments for each service physicians provide—at $35.98.

The 5% cut is required under a payment formula passed by Congress several years ago. That formula, known as the sustainable growth rate (SGR), “was designed to adjust the update to make actual [expenditures] and target expenditures equal over time,” according to CMS policy. “If outlays under the fee schedule are higher than the [spending target set by the government], the update is decreased. Conversely, if outlays are lower than the target, the update is increased.” The cut announced by CMS is slightly less than the 5.1% figure that the agency estimated earlier this year.

The final rule also includes some good news for physicians who spend a lot of time performing evaluation and management services. CMS has finalized plans to increase the work relative value units (RVUs) for evaluation and management services, which make up much of the practice of primary care and other cognitive specialties. Each physician service in the fee schedule has a certain number of RVUs associated with it; the RVUs are then multiplied by the conversion factor to arrive at a charge for the service.

The increases for evaluation and management services were recommended by the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) as part of a 5-year review. However, they may be largely offset by the 5% across-the-board payment cut, according to the AMA. “For the great majority of primary care physicians, the overall physician payment cut due to the flawed payment formula will negate any payment increases specific to physician office visit payments,” Dr. Cecil B. Wilson, AMA board chair, said in a statement.

CMS estimated in the final rule that internal medicine will experience a 1% overall cut in allowed charges under Medicare due to the combination of the changes to work and practice expense RVUs, the SGR cut, and other cuts called for under the Deficit Reduction Act of 2005.

Family physicians will break even once all factors are calculated. CMS estimates that only four specialties will see positive updates in 2007 once all the payment changes are factored in—emergency medicine (2%), endocrinology (1%), infectious disease (4%), and pulmonary disease (1%).

One area of physician services greatly affected by the final rule is imaging services. Starting Jan. 1, physicians who perform multiple imaging procedures on contiguous body parts during the same session will be paid in full for the first procedure and then will receive a 25% cut in the technical component payment for additional imaging procedures.

In addition, the final rule implements imaging cuts called for under the Deficit Reduction Act. Under this provision, the payment for the technical component of certain physician-performed imaging services is capped at the hospital outpatient amount for the same service. This cap does not apply to mammography services.

The AMA and other medical specialty organizations called on Congress to take action when it returns for a short lame-duck session. The groups have been lobbying for months for Congress to pass stopgap legislation that would eliminate the cut this year and give legislators time to agree on a new formula for determining physician payment under Medicare next year.

There is reason to think that Congress will act to reverse the payment cuts. From 2003 to 2006, Congress stopped Medicare payment cuts scheduled to take effect under the SGR formula. And currently, 80 senators and 265 representatives have signed on to letters to the congressional leadership calling for the cuts to be stopped.

In the final regulation, CMS officials are giving with one hand and taking away with the other, said Dr. Rick Kellerman, president of the American Academy of Family Physicians. For example, the regulation outlines increases to the work RVUs for evaluation and management services often performed by primary care physicians, but uses an inappropriate mechanism to apply budget neutrality to the changes, he said. CMS is required by law to keep the changes budget neutral, so officials at the agency will apply a 10.1% across-the-board cut to work RVUs without changing the number of RVUs assigned to each service. Making this adjustment to the work RVUs distorts the relative value system, he said. The budget neutrality adjustment should instead be made in the conversion factor, where the cut would be more transparent, he said.

But Dr. Kellerman praised the move by CMS to change the way it determines practice expense RVUs, which include the direct and indirect costs associated with a procedure. Under the new system, practice expenses will take into account practice expense data from eight specialties. The changes to the practice expense RVUs are being phased in over 4 years.

Although primary care specialties make out relatively well under the RVU changes, other specialties will face deep cuts under them. For example, CMS estimates that cardiologists will face a 1% cut in allowed charges in 2007, and a 5% cut in 2010 based on changes to the work and practice expense RVUs.

The Endocrine Society is sounding a strong word of caution about androgen therapy with a new clinical practice guideline that recommends against diagnosing and treating androgen deficiency in women.

The guideline cites the “lack of a well-defined clinical syndrome” and the “lack of normative data on total or free testosterone levels across the life span” as reasons why a diagnosis should not be made.

On the issue of treatment, the document acknowledges “evidence for short-term efficacy of testosterone in selected populations, such as surgically menopausal women,” but says that inadequate indications and insufficient evidence of long-term safety means that the “generalized use of testosterone in women” cannot be recommended (J. Clin. Endocrinol. Metab. 2006;91;3697–710).

“Based on [our literature review], we felt that at this time, we could not, as a committee and a society, recommend either for making the diagnosis or for treatment,” said Dr. Margaret E. Wierman, the endocrinologist who chaired the seven-member task force that developed the evidence-based guidelines.

“The quality of the literature was just not up to a standard [needed] to make a global recommendation,” said Dr. Wierman, chief of endocrinology at the Veterans Affairs Medical Center in Denver and professor of medicine, physiology, and biophysics at the University of Colorado, Denver. “The sort of hype that testosterone has been given is not yet based on a lot of scientific fact.”

Earlier this year, the Endocrine Society issued clinical practice guidelines on androgen deficiency in men, recommending against offering testosterone therapy to all older men with low testosterone levels. (See box.)

The new guideline on androgen deficiency in women has a tone and reach that differs from the less conservative “androgen deficiency” section in the American Association of Clinical Endocrinologists' recently updated menopause guidelines.

Dr. Wierman said she hopes that the new guideline—as well as a document to be released by the Endocrine Society in the next 18–24 months on problems with sex steroid assays for both men and women—will drive development of more sensitive and specific assays. “I think the assay issue will soon be improved,” she said.

Physicians must appreciate the fact that the findings on estrogen from the Women's Health Initiative had some impact on the task force, Dr. Wierman said.

“At this point, we felt that the Endocrine Society needs to act as the word of caution so we're not coming back 5 years from now and saying, 'Why weren't we cautious? Why didn't we push our colleagues across academia and research to do the studies to better understand [androgens], so that patients will benefit and won't be harmed?'” she said.

Dr. Steven Petak, president of the American Association of Clinical Endocrinologists, said his organization took a different approach last year in addressing the issue of androgen therapy when updating its menopause guidelines.

“We also were quite cautious, and we agree that long-term safety issues need to be clarified,” he said. “But we still went on and stated that there are some criteria for diagnosis, and we gave some recommendations” for the use of androgen.

The Endocrine Society's guidelines “don't do much for patients whose therapies are being considered now,” said Dr. Petak of the Texas Institute for Reproduction and Endocrinology. “The Endocrine Society's recommendations for further basic and clinical research in the field are of prime importance and we agree wholeheartedly.”

Even With Men, Go Slow With Androgen

The Endocrine Society's earlier guideline on androgen deficiency in men advises physicians to offer testosterone therapy on an individual basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency.

The guideline advises against the use of androgen therapy in the general population because of a lack of consensus on the case definition and a lack of data on the public health impact of androgen deficiency.

To establish the diagnosis of androgen deficiency in men, a reliable assay should be used to measure the morning total testosterone level. This should be confirmed either by repeating the measurement of morning total testosterone or by measuring the free or bioavailable testosterone level (J. Clin. Endocrinol. Metab. 2006;91:1995–2010).

Testosterone therapy is appropriate in symptomatic men who have classic androgen deficiency syndromes and low testosterone levels, say the guidelines. It should be used to induce and maintain secondary sex characteristics and to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density.

Testosterone therapy is not appropriate in patients with metastatic prostate cancer, breast cancer, or a palpable prostate nodule or induration. Patients with a prostate-specific antigen (PSA) greater than 3 ng/mL without further urological evaluation are not candidates for testosterone therapy. Other contraindications include erythrocytosis and hyperviscosity. With a lack of randomized controlled trial data, there was no recommendation on treating men with prostate cancer who have been disease free for 2 years or more.

The task force recommended a standardized monitoring plan with evaluation and measures of testosterone levels at 3 months after initiating treatment and annual assessments.

Hematocrit should be measured at baseline, at 3 months, and annually. If hematocrit exceeds 54%, therapy should be stopped until hematocrit decreases to a safe level. Therapy can be restarted at a lower dosage, but evaluations for hypoxia and sleep apnea should be conducted.

Urological consultation is recommended if there is a verified serum or plasma PSA concentration of more than 4.0 ng/mL or an increase in serum or PSA concentration of more than 1.4 ng/mL in a 12-month period.

The Endocrine Society is sounding a strong word of caution about androgen therapy with a new clinical practice guideline that recommends against diagnosing and treating androgen deficiency in women.

The guideline cites the “lack of a well-defined clinical syndrome” and the “lack of normative data on total or free testosterone levels across the life span” as reasons why a diagnosis should not be made.

On the issue of treatment, the document acknowledges “evidence for short-term efficacy of testosterone in selected populations, such as surgically menopausal women,” but says that inadequate indications and insufficient evidence of long-term safety means that the “generalized use of testosterone in women” cannot be recommended (J. Clin. Endocrinol. Metab. 2006;91;3697–710).

“Based on [our literature review], we felt that at this time, we could not, as a committee and a society, recommend either for making the diagnosis or for treatment,” said Dr. Margaret E. Wierman, the endocrinologist who chaired the seven-member task force that developed the evidence-based guidelines.

“The quality of the literature was just not up to a standard [needed] to make a global recommendation,” said Dr. Wierman, chief of endocrinology at the Veterans Affairs Medical Center in Denver and professor of medicine, physiology, and biophysics at the University of Colorado, Denver. “The sort of hype that testosterone has been given is not yet based on a lot of scientific fact.”

Earlier this year, the Endocrine Society issued clinical practice guidelines on androgen deficiency in men, recommending against offering testosterone therapy to all older men with low testosterone levels. (See box.)

The new guideline on androgen deficiency in women has a tone and reach that differs from the less conservative “androgen deficiency” section in the American Association of Clinical Endocrinologists' recently updated menopause guidelines.

Dr. Wierman said she hopes that the new guideline—as well as a document to be released by the Endocrine Society in the next 18–24 months on problems with sex steroid assays for both men and women—will drive development of more sensitive and specific assays. “I think the assay issue will soon be improved,” she said.

Physicians must appreciate the fact that the findings on estrogen from the Women's Health Initiative had some impact on the task force, Dr. Wierman said.

“At this point, we felt that the Endocrine Society needs to act as the word of caution so we're not coming back 5 years from now and saying, 'Why weren't we cautious? Why didn't we push our colleagues across academia and research to do the studies to better understand [androgens], so that patients will benefit and won't be harmed?'” she said.

Dr. Steven Petak, president of the American Association of Clinical Endocrinologists, said his organization took a different approach last year in addressing the issue of androgen therapy when updating its menopause guidelines.

“We also were quite cautious, and we agree that long-term safety issues need to be clarified,” he said. “But we still went on and stated that there are some criteria for diagnosis, and we gave some recommendations” for the use of androgen.

The Endocrine Society's guidelines “don't do much for patients whose therapies are being considered now,” said Dr. Petak of the Texas Institute for Reproduction and Endocrinology. “The Endocrine Society's recommendations for further basic and clinical research in the field are of prime importance and we agree wholeheartedly.”

Even With Men, Go Slow With Androgen

The Endocrine Society's earlier guideline on androgen deficiency in men advises physicians to offer testosterone therapy on an individual basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency.

The guideline advises against the use of androgen therapy in the general population because of a lack of consensus on the case definition and a lack of data on the public health impact of androgen deficiency.

To establish the diagnosis of androgen deficiency in men, a reliable assay should be used to measure the morning total testosterone level. This should be confirmed either by repeating the measurement of morning total testosterone or by measuring the free or bioavailable testosterone level (J. Clin. Endocrinol. Metab. 2006;91:1995–2010).

Testosterone therapy is appropriate in symptomatic men who have classic androgen deficiency syndromes and low testosterone levels, say the guidelines. It should be used to induce and maintain secondary sex characteristics and to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density.

Testosterone therapy is not appropriate in patients with metastatic prostate cancer, breast cancer, or a palpable prostate nodule or induration. Patients with a prostate-specific antigen (PSA) greater than 3 ng/mL without further urological evaluation are not candidates for testosterone therapy. Other contraindications include erythrocytosis and hyperviscosity. With a lack of randomized controlled trial data, there was no recommendation on treating men with prostate cancer who have been disease free for 2 years or more.

The task force recommended a standardized monitoring plan with evaluation and measures of testosterone levels at 3 months after initiating treatment and annual assessments.

Hematocrit should be measured at baseline, at 3 months, and annually. If hematocrit exceeds 54%, therapy should be stopped until hematocrit decreases to a safe level. Therapy can be restarted at a lower dosage, but evaluations for hypoxia and sleep apnea should be conducted.

Urological consultation is recommended if there is a verified serum or plasma PSA concentration of more than 4.0 ng/mL or an increase in serum or PSA concentration of more than 1.4 ng/mL in a 12-month period.

The Endocrine Society is sounding a strong word of caution about androgen therapy with a new clinical practice guideline that recommends against diagnosing and treating androgen deficiency in women.

The guideline cites the “lack of a well-defined clinical syndrome” and the “lack of normative data on total or free testosterone levels across the life span” as reasons why a diagnosis should not be made.

On the issue of treatment, the document acknowledges “evidence for short-term efficacy of testosterone in selected populations, such as surgically menopausal women,” but says that inadequate indications and insufficient evidence of long-term safety means that the “generalized use of testosterone in women” cannot be recommended (J. Clin. Endocrinol. Metab. 2006;91;3697–710).

“Based on [our literature review], we felt that at this time, we could not, as a committee and a society, recommend either for making the diagnosis or for treatment,” said Dr. Margaret E. Wierman, the endocrinologist who chaired the seven-member task force that developed the evidence-based guidelines.

“The quality of the literature was just not up to a standard [needed] to make a global recommendation,” said Dr. Wierman, chief of endocrinology at the Veterans Affairs Medical Center in Denver and professor of medicine, physiology, and biophysics at the University of Colorado, Denver. “The sort of hype that testosterone has been given is not yet based on a lot of scientific fact.”

Earlier this year, the Endocrine Society issued clinical practice guidelines on androgen deficiency in men, recommending against offering testosterone therapy to all older men with low testosterone levels. (See box.)

The new guideline on androgen deficiency in women has a tone and reach that differs from the less conservative “androgen deficiency” section in the American Association of Clinical Endocrinologists' recently updated menopause guidelines.

Dr. Wierman said she hopes that the new guideline—as well as a document to be released by the Endocrine Society in the next 18–24 months on problems with sex steroid assays for both men and women—will drive development of more sensitive and specific assays. “I think the assay issue will soon be improved,” she said.

Physicians must appreciate the fact that the findings on estrogen from the Women's Health Initiative had some impact on the task force, Dr. Wierman said.

“At this point, we felt that the Endocrine Society needs to act as the word of caution so we're not coming back 5 years from now and saying, 'Why weren't we cautious? Why didn't we push our colleagues across academia and research to do the studies to better understand [androgens], so that patients will benefit and won't be harmed?'” she said.

Dr. Steven Petak, president of the American Association of Clinical Endocrinologists, said his organization took a different approach last year in addressing the issue of androgen therapy when updating its menopause guidelines.

“We also were quite cautious, and we agree that long-term safety issues need to be clarified,” he said. “But we still went on and stated that there are some criteria for diagnosis, and we gave some recommendations” for the use of androgen.

The Endocrine Society's guidelines “don't do much for patients whose therapies are being considered now,” said Dr. Petak of the Texas Institute for Reproduction and Endocrinology. “The Endocrine Society's recommendations for further basic and clinical research in the field are of prime importance and we agree wholeheartedly.”

Even With Men, Go Slow With Androgen

The Endocrine Society's earlier guideline on androgen deficiency in men advises physicians to offer testosterone therapy on an individual basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency.

The guideline advises against the use of androgen therapy in the general population because of a lack of consensus on the case definition and a lack of data on the public health impact of androgen deficiency.

To establish the diagnosis of androgen deficiency in men, a reliable assay should be used to measure the morning total testosterone level. This should be confirmed either by repeating the measurement of morning total testosterone or by measuring the free or bioavailable testosterone level (J. Clin. Endocrinol. Metab. 2006;91:1995–2010).

Testosterone therapy is appropriate in symptomatic men who have classic androgen deficiency syndromes and low testosterone levels, say the guidelines. It should be used to induce and maintain secondary sex characteristics and to improve sexual function, sense of well-being, muscle mass, strength, and bone mineral density.

Testosterone therapy is not appropriate in patients with metastatic prostate cancer, breast cancer, or a palpable prostate nodule or induration. Patients with a prostate-specific antigen (PSA) greater than 3 ng/mL without further urological evaluation are not candidates for testosterone therapy. Other contraindications include erythrocytosis and hyperviscosity. With a lack of randomized controlled trial data, there was no recommendation on treating men with prostate cancer who have been disease free for 2 years or more.

The task force recommended a standardized monitoring plan with evaluation and measures of testosterone levels at 3 months after initiating treatment and annual assessments.

Hematocrit should be measured at baseline, at 3 months, and annually. If hematocrit exceeds 54%, therapy should be stopped until hematocrit decreases to a safe level. Therapy can be restarted at a lower dosage, but evaluations for hypoxia and sleep apnea should be conducted.

Urological consultation is recommended if there is a verified serum or plasma PSA concentration of more than 4.0 ng/mL or an increase in serum or PSA concentration of more than 1.4 ng/mL in a 12-month period.

Wyeth Loses Prempro Suit

A Pennsylvania jury has found that the hormone therapy Prempro was a cause of a woman's breast cancer in the case of Jennie Nelson v. Wyeth. At press time, the liability phase of the trial was set to begin; the jury will determine whether Wyeth is liable and is required to pay $1.5 million in compensatory damages. The jury will also decide whether punitive damages should be awarded to the plaintiff. Wyeth officials plan to argue that they “acted responsibly” by performing and supporting studies that evaluated the benefits and risks of hormone therapy, according to a company statement. Wyeth officials also disagreed with the jury's conclusion that Prempro caused the plaintiff's breast cancer, saying there was no scientific basis for that finding. The decision comes on the heels of a September Wyeth victory in a federal case alleging that the Premarin and Prempro products had caused the plaintiff's breast cancer. In the case of Linda Reeves v. Wyeth, the jury said that the plaintiff had not proved that the company had inadequately warned patients of the known risks of hormone therapy treatment.

Teen Abortion Restriction Stalled

Abortion rights advocates are claiming victory after attempts to bring up the Child Interstate Abortion Notification Act were stopped in the Senate. The lack of votes in the Senate means that the legislation, which passed the House in September, is unlikely to reach the president's desk this year. S. 403 would impose fines or prison time on anyone who assisted a minor in crossing state lines to access abortion services in an effort to skirt parental notification and consent laws in the minor's home state. Physicians would also be liable under the law if they performed an abortion on a minor from another state unless they notified the parent at least 24 hours before the procedure.

AIDS Treatment Wait Lists Persist

State AIDS Drug Assistance Programs continue to struggle to keep up with demand, according to the October report of the National Alliance of State and Territorial AIDS Directors. As of September 2006, 302 individuals were on waiting lists for HIV treatment in six states. AIDS Drug Assistance Programs (ADAPs) around the country serve individuals with HIV/AIDS who are low-income, uninsured, or underinsured. Three states also have implemented cost-containment measures such as offering a reduced formulary or imposing an annual per capita expenditure limit. Increased funding is needed to meet demand, according to Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, estimated at $197 million more than the fiscal year 2006 funding levels. “Without a permanent commitment to stable, predictable funding at levels that keep pace with demand, waiting lists will soon become a permanent feature of ADAPs,” she said in a statement.

Supplement Use Undisclosed

More than one-fifth of individuals taking prescription drugs also took a nonvitamin dietary supplement in the last year, according to a study published recently in the Archives of Internal Medicine. Further, 69% of those who used both prescription drugs and supplements failed to tell a physician about their supplement use, the researchers found. The researchers analyzed data from the 2002 National Health Interview Survey, which included 31,044 respondents. Of prescription medication users, the highest rates of supplement use were among menopausal women (33%), individuals with chronic gastrointestinal disorders (28%), and individuals with severe headache or migraine (28%). Patients with heart failure, coronary heart disease, or a history of myocardial infarction were among those reporting the lowest rate of supplement use.

Coalition Seeks More FDA Funds

A coalition of strange bedfellows has joined together to call on the White House and Congress to increase funding for the Food and Drug Administration, saying that the agency's mission and responsibilities have expanded hugely while its appropriations have failed to keep up with inflation or with the growing largess going to other agencies like the National Institutes of Health. That NIH investment will likely result in a large number of new products, all of which the FDA will have to regulate, according to the Coalition for a Stronger FDA. The agency also needs help coping with growing pharmaceutical, medical device, and food safety issues, the group said. The coalition includes the Consumer Federation of America, the Center for Science in the Public Interest, the Grocery Manufacturers Association, the Biotechnology Industry Organization, and the Advanced Medical Technology Association, among others. Cochairing the coalition are the last three secretaries of Health and Human Services: Tommy G. Thompson, Donna E. Shalala, and Louis Sullivan.

Underage Binge Drinking Mapped

The highest rates of underage binge drinking in the United States occurred in the northeast region of North Dakota in 2002–2004, with the lowest rates reported in the District of Columbia's Ward 7, according to a report from the Substance Abuse and Mental Health Services Agency. The report, based on the results of the National Survey on Drug Use and Health, presented rates of binge drinking (consuming five or more drinks on the same occasion) in 340 substate areas among individuals aged 12–20 years. The lowest rate of binge drinking was 10.4% of the 12- to 20-year-old population. The highest rate was 36.1%, according to the SAMHSA report. The full report is available at

www.oas.samhsa.gov/substate2k6/substate.pdf

Wyeth Loses Prempro Suit

A Pennsylvania jury has found that the hormone therapy Prempro was a cause of a woman's breast cancer in the case of Jennie Nelson v. Wyeth. At press time, the liability phase of the trial was set to begin; the jury will determine whether Wyeth is liable and is required to pay $1.5 million in compensatory damages. The jury will also decide whether punitive damages should be awarded to the plaintiff. Wyeth officials plan to argue that they “acted responsibly” by performing and supporting studies that evaluated the benefits and risks of hormone therapy, according to a company statement. Wyeth officials also disagreed with the jury's conclusion that Prempro caused the plaintiff's breast cancer, saying there was no scientific basis for that finding. The decision comes on the heels of a September Wyeth victory in a federal case alleging that the Premarin and Prempro products had caused the plaintiff's breast cancer. In the case of Linda Reeves v. Wyeth, the jury said that the plaintiff had not proved that the company had inadequately warned patients of the known risks of hormone therapy treatment.

Teen Abortion Restriction Stalled

Abortion rights advocates are claiming victory after attempts to bring up the Child Interstate Abortion Notification Act were stopped in the Senate. The lack of votes in the Senate means that the legislation, which passed the House in September, is unlikely to reach the president's desk this year. S. 403 would impose fines or prison time on anyone who assisted a minor in crossing state lines to access abortion services in an effort to skirt parental notification and consent laws in the minor's home state. Physicians would also be liable under the law if they performed an abortion on a minor from another state unless they notified the parent at least 24 hours before the procedure.

AIDS Treatment Wait Lists Persist

State AIDS Drug Assistance Programs continue to struggle to keep up with demand, according to the October report of the National Alliance of State and Territorial AIDS Directors. As of September 2006, 302 individuals were on waiting lists for HIV treatment in six states. AIDS Drug Assistance Programs (ADAPs) around the country serve individuals with HIV/AIDS who are low-income, uninsured, or underinsured. Three states also have implemented cost-containment measures such as offering a reduced formulary or imposing an annual per capita expenditure limit. Increased funding is needed to meet demand, according to Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, estimated at $197 million more than the fiscal year 2006 funding levels. “Without a permanent commitment to stable, predictable funding at levels that keep pace with demand, waiting lists will soon become a permanent feature of ADAPs,” she said in a statement.

Supplement Use Undisclosed

More than one-fifth of individuals taking prescription drugs also took a nonvitamin dietary supplement in the last year, according to a study published recently in the Archives of Internal Medicine. Further, 69% of those who used both prescription drugs and supplements failed to tell a physician about their supplement use, the researchers found. The researchers analyzed data from the 2002 National Health Interview Survey, which included 31,044 respondents. Of prescription medication users, the highest rates of supplement use were among menopausal women (33%), individuals with chronic gastrointestinal disorders (28%), and individuals with severe headache or migraine (28%). Patients with heart failure, coronary heart disease, or a history of myocardial infarction were among those reporting the lowest rate of supplement use.

Coalition Seeks More FDA Funds

A coalition of strange bedfellows has joined together to call on the White House and Congress to increase funding for the Food and Drug Administration, saying that the agency's mission and responsibilities have expanded hugely while its appropriations have failed to keep up with inflation or with the growing largess going to other agencies like the National Institutes of Health. That NIH investment will likely result in a large number of new products, all of which the FDA will have to regulate, according to the Coalition for a Stronger FDA. The agency also needs help coping with growing pharmaceutical, medical device, and food safety issues, the group said. The coalition includes the Consumer Federation of America, the Center for Science in the Public Interest, the Grocery Manufacturers Association, the Biotechnology Industry Organization, and the Advanced Medical Technology Association, among others. Cochairing the coalition are the last three secretaries of Health and Human Services: Tommy G. Thompson, Donna E. Shalala, and Louis Sullivan.

Underage Binge Drinking Mapped

The highest rates of underage binge drinking in the United States occurred in the northeast region of North Dakota in 2002–2004, with the lowest rates reported in the District of Columbia's Ward 7, according to a report from the Substance Abuse and Mental Health Services Agency. The report, based on the results of the National Survey on Drug Use and Health, presented rates of binge drinking (consuming five or more drinks on the same occasion) in 340 substate areas among individuals aged 12–20 years. The lowest rate of binge drinking was 10.4% of the 12- to 20-year-old population. The highest rate was 36.1%, according to the SAMHSA report. The full report is available at

www.oas.samhsa.gov/substate2k6/substate.pdf

Wyeth Loses Prempro Suit

A Pennsylvania jury has found that the hormone therapy Prempro was a cause of a woman's breast cancer in the case of Jennie Nelson v. Wyeth. At press time, the liability phase of the trial was set to begin; the jury will determine whether Wyeth is liable and is required to pay $1.5 million in compensatory damages. The jury will also decide whether punitive damages should be awarded to the plaintiff. Wyeth officials plan to argue that they “acted responsibly” by performing and supporting studies that evaluated the benefits and risks of hormone therapy, according to a company statement. Wyeth officials also disagreed with the jury's conclusion that Prempro caused the plaintiff's breast cancer, saying there was no scientific basis for that finding. The decision comes on the heels of a September Wyeth victory in a federal case alleging that the Premarin and Prempro products had caused the plaintiff's breast cancer. In the case of Linda Reeves v. Wyeth, the jury said that the plaintiff had not proved that the company had inadequately warned patients of the known risks of hormone therapy treatment.

Teen Abortion Restriction Stalled

Abortion rights advocates are claiming victory after attempts to bring up the Child Interstate Abortion Notification Act were stopped in the Senate. The lack of votes in the Senate means that the legislation, which passed the House in September, is unlikely to reach the president's desk this year. S. 403 would impose fines or prison time on anyone who assisted a minor in crossing state lines to access abortion services in an effort to skirt parental notification and consent laws in the minor's home state. Physicians would also be liable under the law if they performed an abortion on a minor from another state unless they notified the parent at least 24 hours before the procedure.

AIDS Treatment Wait Lists Persist

State AIDS Drug Assistance Programs continue to struggle to keep up with demand, according to the October report of the National Alliance of State and Territorial AIDS Directors. As of September 2006, 302 individuals were on waiting lists for HIV treatment in six states. AIDS Drug Assistance Programs (ADAPs) around the country serve individuals with HIV/AIDS who are low-income, uninsured, or underinsured. Three states also have implemented cost-containment measures such as offering a reduced formulary or imposing an annual per capita expenditure limit. Increased funding is needed to meet demand, according to Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, estimated at $197 million more than the fiscal year 2006 funding levels. “Without a permanent commitment to stable, predictable funding at levels that keep pace with demand, waiting lists will soon become a permanent feature of ADAPs,” she said in a statement.

Supplement Use Undisclosed

More than one-fifth of individuals taking prescription drugs also took a nonvitamin dietary supplement in the last year, according to a study published recently in the Archives of Internal Medicine. Further, 69% of those who used both prescription drugs and supplements failed to tell a physician about their supplement use, the researchers found. The researchers analyzed data from the 2002 National Health Interview Survey, which included 31,044 respondents. Of prescription medication users, the highest rates of supplement use were among menopausal women (33%), individuals with chronic gastrointestinal disorders (28%), and individuals with severe headache or migraine (28%). Patients with heart failure, coronary heart disease, or a history of myocardial infarction were among those reporting the lowest rate of supplement use.

Coalition Seeks More FDA Funds

A coalition of strange bedfellows has joined together to call on the White House and Congress to increase funding for the Food and Drug Administration, saying that the agency's mission and responsibilities have expanded hugely while its appropriations have failed to keep up with inflation or with the growing largess going to other agencies like the National Institutes of Health. That NIH investment will likely result in a large number of new products, all of which the FDA will have to regulate, according to the Coalition for a Stronger FDA. The agency also needs help coping with growing pharmaceutical, medical device, and food safety issues, the group said. The coalition includes the Consumer Federation of America, the Center for Science in the Public Interest, the Grocery Manufacturers Association, the Biotechnology Industry Organization, and the Advanced Medical Technology Association, among others. Cochairing the coalition are the last three secretaries of Health and Human Services: Tommy G. Thompson, Donna E. Shalala, and Louis Sullivan.

Underage Binge Drinking Mapped

The highest rates of underage binge drinking in the United States occurred in the northeast region of North Dakota in 2002–2004, with the lowest rates reported in the District of Columbia's Ward 7, according to a report from the Substance Abuse and Mental Health Services Agency. The report, based on the results of the National Survey on Drug Use and Health, presented rates of binge drinking (consuming five or more drinks on the same occasion) in 340 substate areas among individuals aged 12–20 years. The lowest rate of binge drinking was 10.4% of the 12- to 20-year-old population. The highest rate was 36.1%, according to the SAMHSA report. The full report is available at

www.oas.samhsa.gov/substate2k6/substate.pdf

EHR Adoption Advice

Neurologists considering the purchase of an electronic health record product can get some practical tips in a new report from the American Academy of Neurology. AAN conducted a year-long study to evaluate the best EHR products for neurologists working in groups of 25 physicians or fewer. An AAN work group evaluated more than 70 vendors based on a number of factors, such as functionality, end-user satisfaction, the company's financial viability, and the total price tag including implementation and maintenance. Of the vendors evaluated, only seven met the criteria for a comprehensive EHR product. The AAN work group also researched EHR costs and estimated that vendor prices can vary from $1,000 to $50,000 per provider over a 3-year period. Neurologists should create a side-by-side comparison of vendor costs using a 3- to 5-year total cost of ownership of the system, the report recommends. The full EHR product report is available at

www.aan.com/professionals/patient/ehr.cfm

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” according to Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities.

Alzheimer's Disease Research

The Alzheimer's Disease Cooperative Study, a consortium that includes sites in the United States and Canada, will spend $52 million over the next 6 years to test new drugs to treat the symptoms of Alzheimer's disease. The consortium, which is coordinated by the National Institutes of Health and the University of California, will also look into new methods of conducting dementia research. For example, the consortium will investigate whether intravenous immunoglobulin can be used to treat Alzheimer's disease and also will test whether home-based assessments can be used in primary prevention trials with older individuals. “We have learned a great deal from basic and observational research about how Alzheimer's and other neurodegenerative diseases develop,” Dr. Richard J. Hodes, director of the National Institute on Aging, said in a statement. “The consortium's work will translate this knowledge in clinical trials of interventions that target the mechanisms underlying Alzheimer's disease.”

McClellan Accepts Think Tank Post

Former Medicare Chief Mark B. McClellan has accepted a new post as a visiting senior fellow with the AEI (American Enterprise Institute)-Brookings Joint Center for Regulatory Studies in Washington. The new job will keep Dr. McClellan involved in health care policy issues. He also will remain as an associate professor of both economics and medicine at Stanford (Calif.) University. Dr. McClellan had been on leave from Stanford for several years while working in the federal government. Before taking the post as administrator of the Centers for Medicare and Medicaid Services, Dr. McClellan served from 2002 to 2004 as the commissioner of the Food and Drug Administration. He also served as an economic and health care advisor to President Bush from 2001 to 2002.

NIH Adds Advisors

Officials at the National Institute of Neurological Disorders and Stroke have appointed six new members to its advisory panel of neurologic disorders and stroke. The new members of the National Advisory Neurological Disorders and Stroke Council will review grant applications and advise the NIH. The members, who include patient advocates, scientists, and physicians, will serve through July 2010.

EHR Adoption Advice

Neurologists considering the purchase of an electronic health record product can get some practical tips in a new report from the American Academy of Neurology. AAN conducted a year-long study to evaluate the best EHR products for neurologists working in groups of 25 physicians or fewer. An AAN work group evaluated more than 70 vendors based on a number of factors, such as functionality, end-user satisfaction, the company's financial viability, and the total price tag including implementation and maintenance. Of the vendors evaluated, only seven met the criteria for a comprehensive EHR product. The AAN work group also researched EHR costs and estimated that vendor prices can vary from $1,000 to $50,000 per provider over a 3-year period. Neurologists should create a side-by-side comparison of vendor costs using a 3- to 5-year total cost of ownership of the system, the report recommends. The full EHR product report is available at

www.aan.com/professionals/patient/ehr.cfm

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” according to Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities.

Alzheimer's Disease Research

The Alzheimer's Disease Cooperative Study, a consortium that includes sites in the United States and Canada, will spend $52 million over the next 6 years to test new drugs to treat the symptoms of Alzheimer's disease. The consortium, which is coordinated by the National Institutes of Health and the University of California, will also look into new methods of conducting dementia research. For example, the consortium will investigate whether intravenous immunoglobulin can be used to treat Alzheimer's disease and also will test whether home-based assessments can be used in primary prevention trials with older individuals. “We have learned a great deal from basic and observational research about how Alzheimer's and other neurodegenerative diseases develop,” Dr. Richard J. Hodes, director of the National Institute on Aging, said in a statement. “The consortium's work will translate this knowledge in clinical trials of interventions that target the mechanisms underlying Alzheimer's disease.”

McClellan Accepts Think Tank Post

Former Medicare Chief Mark B. McClellan has accepted a new post as a visiting senior fellow with the AEI (American Enterprise Institute)-Brookings Joint Center for Regulatory Studies in Washington. The new job will keep Dr. McClellan involved in health care policy issues. He also will remain as an associate professor of both economics and medicine at Stanford (Calif.) University. Dr. McClellan had been on leave from Stanford for several years while working in the federal government. Before taking the post as administrator of the Centers for Medicare and Medicaid Services, Dr. McClellan served from 2002 to 2004 as the commissioner of the Food and Drug Administration. He also served as an economic and health care advisor to President Bush from 2001 to 2002.

NIH Adds Advisors

Officials at the National Institute of Neurological Disorders and Stroke have appointed six new members to its advisory panel of neurologic disorders and stroke. The new members of the National Advisory Neurological Disorders and Stroke Council will review grant applications and advise the NIH. The members, who include patient advocates, scientists, and physicians, will serve through July 2010.

EHR Adoption Advice

Neurologists considering the purchase of an electronic health record product can get some practical tips in a new report from the American Academy of Neurology. AAN conducted a year-long study to evaluate the best EHR products for neurologists working in groups of 25 physicians or fewer. An AAN work group evaluated more than 70 vendors based on a number of factors, such as functionality, end-user satisfaction, the company's financial viability, and the total price tag including implementation and maintenance. Of the vendors evaluated, only seven met the criteria for a comprehensive EHR product. The AAN work group also researched EHR costs and estimated that vendor prices can vary from $1,000 to $50,000 per provider over a 3-year period. Neurologists should create a side-by-side comparison of vendor costs using a 3- to 5-year total cost of ownership of the system, the report recommends. The full EHR product report is available at

www.aan.com/professionals/patient/ehr.cfm

CDC Launches Autism Study

Officials at the Centers for Disease Control and Prevention are launching a multistate study aimed at pinpointing the risk factors for autism spectrum disorders. The $5.9 million study will include about 2,700 children aged 2–5 and their parents. The study will be conducted over 5 years and will look at possible associations with factors such as infections or abnormal responses to infections, genetic factors, the mother's reproductive history, family history of medical and developmental problems, and abnormal hormone function. “We hope this national study will help us learn more about the characteristics of children with [autism spectrum disorders], factors associated with developmental delays, and how genes and the environment may affect child development,” according to Dr. José F. Cordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities.

Alzheimer's Disease Research

The Alzheimer's Disease Cooperative Study, a consortium that includes sites in the United States and Canada, will spend $52 million over the next 6 years to test new drugs to treat the symptoms of Alzheimer's disease. The consortium, which is coordinated by the National Institutes of Health and the University of California, will also look into new methods of conducting dementia research. For example, the consortium will investigate whether intravenous immunoglobulin can be used to treat Alzheimer's disease and also will test whether home-based assessments can be used in primary prevention trials with older individuals. “We have learned a great deal from basic and observational research about how Alzheimer's and other neurodegenerative diseases develop,” Dr. Richard J. Hodes, director of the National Institute on Aging, said in a statement. “The consortium's work will translate this knowledge in clinical trials of interventions that target the mechanisms underlying Alzheimer's disease.”

McClellan Accepts Think Tank Post

Former Medicare Chief Mark B. McClellan has accepted a new post as a visiting senior fellow with the AEI (American Enterprise Institute)-Brookings Joint Center for Regulatory Studies in Washington. The new job will keep Dr. McClellan involved in health care policy issues. He also will remain as an associate professor of both economics and medicine at Stanford (Calif.) University. Dr. McClellan had been on leave from Stanford for several years while working in the federal government. Before taking the post as administrator of the Centers for Medicare and Medicaid Services, Dr. McClellan served from 2002 to 2004 as the commissioner of the Food and Drug Administration. He also served as an economic and health care advisor to President Bush from 2001 to 2002.

NIH Adds Advisors

Officials at the National Institute of Neurological Disorders and Stroke have appointed six new members to its advisory panel of neurologic disorders and stroke. The new members of the National Advisory Neurological Disorders and Stroke Council will review grant applications and advise the NIH. The members, who include patient advocates, scientists, and physicians, will serve through July 2010.