Mary Ellen Schneider

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

▸ Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

▸ Make scoring simple and explicit.

BOSTON — Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.

A group of about 100 physicians, nurse “informaticians,” clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR. Participants in the work group, who had a range of experience with EHRs, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.

Here are some of the recommendations from the AMIA work group:

Readiness Assessment

▸ Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.

“If you don't have an information strategy, first and foremost, you're really not ready,” said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.

▸ Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.

▸ Let everyone in the organization know this is a business transformation process, not an IT project.

▸ Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.

▸ Determine the capabilities, willingness, and expectations of everyone in the practice.

Needs Assessment

Next, practices should assess their needs in terms of features and functions, the work group concluded.

▸ Focus on “pain points” to uncover functional requirements. “Don't ask people what you want the EHR to do for you, ask people where does it hurt,” Dr. Rose said.

▸ Figure out the organization-wide goals and objectives to determine EHR needs.

▸ Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.

▸ Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an EHR selector at

www.ehrselector.com

How to Write an RFP

Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).

▸ Keep it simple. “The more complex your RFP is, the more complex the responses will be,” Dr. Rose said.

▸ Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?

▸ Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.

▸ Involve all clinical disciplines in RFP development.

▸ Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.

Site Visits and Demos

When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.

▸ Consider site visit locations other than those suggested by the vendor. The AMIA group recommended doing your own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.

▸ Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.

▸ In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practices ask a few unplanned questions to get around some the lack of transparency in a the scripted process.

▸ Make scoring simple and explicit.

Federal health officials called a press conference to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

Several autism advocacy groups rallied on Capitol Hill recently to protest the use of mercury-containing thimerosal in vaccines.

But Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention, said the predominance of evidence doesn't show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine, though, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies. Food and Drug Administration officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., deputy commissioner for international and special programs at FDA.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year. In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair, department of microbiology and tropical medicine at George Washington University, Washington, and father of an autistic child.

Dr. Hotez said he is confident vaccines has nothing to do with his daughter's autism, and if he could turn back time he would still have his daughter vaccinated.

Parents should be reminded of the consequences of not vaccinating their children, he said.

Federal health officials called a press conference to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

Several autism advocacy groups rallied on Capitol Hill recently to protest the use of mercury-containing thimerosal in vaccines.

But Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention, said the predominance of evidence doesn't show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine, though, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies. Food and Drug Administration officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., deputy commissioner for international and special programs at FDA.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year. In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair, department of microbiology and tropical medicine at George Washington University, Washington, and father of an autistic child.

Dr. Hotez said he is confident vaccines has nothing to do with his daughter's autism, and if he could turn back time he would still have his daughter vaccinated.

Parents should be reminded of the consequences of not vaccinating their children, he said.

Federal health officials called a press conference to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

Several autism advocacy groups rallied on Capitol Hill recently to protest the use of mercury-containing thimerosal in vaccines.

But Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention, said the predominance of evidence doesn't show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine, though, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies. Food and Drug Administration officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., deputy commissioner for international and special programs at FDA.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year. In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair, department of microbiology and tropical medicine at George Washington University, Washington, and father of an autistic child.

Dr. Hotez said he is confident vaccines has nothing to do with his daughter's autism, and if he could turn back time he would still have his daughter vaccinated.

Parents should be reminded of the consequences of not vaccinating their children, he said.

ATLANTA – A significant burden is placed on the family members of children and adolescents with anxiety disorders, regardless of the age of the child, Catherine Mancini, M.D., said in a poster presentation at the annual meeting of the American Psychiatric Association.

The research shows that an anxiety disorder affects various areas of family functioning, including the physical and mental health of family members and family closeness, wrote Dr. Mancini and her associates at McMaster University in Hamilton, Ont.

The study included 24 outpatient children (8–17 years old) with an anxiety disorder and 24 family members. The family members–4 fathers and 20 mothers–each completed self-rated questionnaires on the impact of the child's illness on various areas of family functioning.

Among the family members in the study, 50% reported some degree of family burden, 50% reported an effect on family health, and 25% reported an impact on family closeness.

A total of 17 of the 24 family members reported that their ill child had become “distressed/anxious/angry when we have not provided assistance.” The study results showed that family members also reported disruption of routine activities because of the child's illness and care, or “irrational demands.”

Ten of the 24 parents reported that they or another family member had experienced physical change because of the child's illness, including weight loss, back pain, headaches, or sleeping problems, the investigators said.

Dr. Mancini and her associates did not find any significant differences on family burden scales between children aged 9–12 and adolescents aged 13–17.

Although the type of primary diagnosis did not make a significant difference in the family's burden, the researchers did report that primary obsessive-compulsive disorder rated significantly higher on the overall family burden scale than did other primary conditions.

In addition, anxiety disorders in male youths might be associated with higher rates of overall burden and impact on family closeness, Dr. Mancini and her associates found.

ATLANTA – A significant burden is placed on the family members of children and adolescents with anxiety disorders, regardless of the age of the child, Catherine Mancini, M.D., said in a poster presentation at the annual meeting of the American Psychiatric Association.

The research shows that an anxiety disorder affects various areas of family functioning, including the physical and mental health of family members and family closeness, wrote Dr. Mancini and her associates at McMaster University in Hamilton, Ont.

The study included 24 outpatient children (8–17 years old) with an anxiety disorder and 24 family members. The family members–4 fathers and 20 mothers–each completed self-rated questionnaires on the impact of the child's illness on various areas of family functioning.

Among the family members in the study, 50% reported some degree of family burden, 50% reported an effect on family health, and 25% reported an impact on family closeness.

A total of 17 of the 24 family members reported that their ill child had become “distressed/anxious/angry when we have not provided assistance.” The study results showed that family members also reported disruption of routine activities because of the child's illness and care, or “irrational demands.”

Ten of the 24 parents reported that they or another family member had experienced physical change because of the child's illness, including weight loss, back pain, headaches, or sleeping problems, the investigators said.

Dr. Mancini and her associates did not find any significant differences on family burden scales between children aged 9–12 and adolescents aged 13–17.

Although the type of primary diagnosis did not make a significant difference in the family's burden, the researchers did report that primary obsessive-compulsive disorder rated significantly higher on the overall family burden scale than did other primary conditions.

In addition, anxiety disorders in male youths might be associated with higher rates of overall burden and impact on family closeness, Dr. Mancini and her associates found.

ATLANTA – A significant burden is placed on the family members of children and adolescents with anxiety disorders, regardless of the age of the child, Catherine Mancini, M.D., said in a poster presentation at the annual meeting of the American Psychiatric Association.

The research shows that an anxiety disorder affects various areas of family functioning, including the physical and mental health of family members and family closeness, wrote Dr. Mancini and her associates at McMaster University in Hamilton, Ont.

The study included 24 outpatient children (8–17 years old) with an anxiety disorder and 24 family members. The family members–4 fathers and 20 mothers–each completed self-rated questionnaires on the impact of the child's illness on various areas of family functioning.

Among the family members in the study, 50% reported some degree of family burden, 50% reported an effect on family health, and 25% reported an impact on family closeness.

A total of 17 of the 24 family members reported that their ill child had become “distressed/anxious/angry when we have not provided assistance.” The study results showed that family members also reported disruption of routine activities because of the child's illness and care, or “irrational demands.”

Ten of the 24 parents reported that they or another family member had experienced physical change because of the child's illness, including weight loss, back pain, headaches, or sleeping problems, the investigators said.

Dr. Mancini and her associates did not find any significant differences on family burden scales between children aged 9–12 and adolescents aged 13–17.

Although the type of primary diagnosis did not make a significant difference in the family's burden, the researchers did report that primary obsessive-compulsive disorder rated significantly higher on the overall family burden scale than did other primary conditions.

In addition, anxiety disorders in male youths might be associated with higher rates of overall burden and impact on family closeness, Dr. Mancini and her associates found.

Spotlighting Epidermolysis Bullosa

Members of Congress are trying to raise the public awareness of epidermolysis bullosa by the creation of a national awareness week. Rep. Tim Bishop (D-N.Y.) and Rep. Peter King (R-N.Y.) introduced a resolution (H. Res. 335) this summer that would create a national awareness week for epidermolysis bullosa in October. The resolution, which encourages groups to promote understanding of the impact of the disease on patients and their families, was introduced in the Senate by Sen. Hillary Clinton (D-N.Y.) and Sen. Chuck Schumer (D-N.Y.). Epidermolysis bullosa affects about 12,500 people in the United States. The resolution also notes that more funding is needed in order to conduct research and to develop treatments for the disease.

Psoriasis Awareness Increases

Psoriasis advocates are also celebrating increased awareness on Capitol Hill. As the National Psoriasis Foundation was ramping up awareness activities last month, the U.S. Senate passed a resolution officially designating August 2005 as "Psoriasis Awareness Month" and acknowledging the large physical and financial toll created by the disease. "Awareness is a powerful force against the painful misconceptions that surround many medical problems," Sen. Gordon Smith (R-Ore.), one of the sponsors of the Senate resolution, said in a statement. "To the extent that we can increase the common understanding of this chronic disease, we can improve patients' lives." The National Psoriasis Foundation last month also launched its first-ever Local Lobby Week, in which volunteers from across the country visited their members of Congress in order to talk about psoriasis and how the disease affects their daily lives. The foundation continues to push for increased federal funding for psoriasis research and for the enactment of the Arthritis Prevention, Control, and Cure Act of 2005 (S. 424/H.R. 583).

Bill Would Repeal SGR

Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's current sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medicaid Services, informed Rep. Johnson that such a measure could come at a high cost: specifically, that the Medicare Economic Index-based increases would be $183 billion over 10 years. Rep. Johnson's bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for their participating in performance measurement.

Wisconsin Loses Cap on Damages

The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was "unconstitutional beyond a reasonable doubt." The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision "will force a wave of doctors to retire early or stop performing high-risk procedures," such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.

IT Deficit Noted Among Physicians

Most Medicare fee-for-service outpatient visits in 2001 were made to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that a total of 57% of Medicare outpatient visits were made to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and for writing prescriptions. While half of those patient visits were to physicians using information technology in order to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower. Rates for electronic prescribing fell to 9%. While access to "wired" practices was found to be low for all beneficiaries, HSC determined that there were few differences in access between sicker and healthier beneficiaries.

Disability Call to Action Debuts

The U.S. Surgeon General has issued his first-ever Call to Action on disability. The new report outlines a series of goals that are aimed at helping individuals who have disabilities to receive better health care. The overall goals include providing health care professionals with the tools needed to screen, diagnose, and treat the whole person with a disability with dignity; helping those persons with disabilities to maintain healthy lifestyles; and also increasing accessible health care and various support services for people with disabilities. "The reality is that for too long we provided lesser care to people with disabilities," Surgeon General Richard H. Carmona, M.D., said in a statement. "Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services." The full text of the "Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities" is available at

www.surgeongeneral.gov

Spotlighting Epidermolysis Bullosa

Members of Congress are trying to raise the public awareness of epidermolysis bullosa by the creation of a national awareness week. Rep. Tim Bishop (D-N.Y.) and Rep. Peter King (R-N.Y.) introduced a resolution (H. Res. 335) this summer that would create a national awareness week for epidermolysis bullosa in October. The resolution, which encourages groups to promote understanding of the impact of the disease on patients and their families, was introduced in the Senate by Sen. Hillary Clinton (D-N.Y.) and Sen. Chuck Schumer (D-N.Y.). Epidermolysis bullosa affects about 12,500 people in the United States. The resolution also notes that more funding is needed in order to conduct research and to develop treatments for the disease.

Psoriasis Awareness Increases

Psoriasis advocates are also celebrating increased awareness on Capitol Hill. As the National Psoriasis Foundation was ramping up awareness activities last month, the U.S. Senate passed a resolution officially designating August 2005 as "Psoriasis Awareness Month" and acknowledging the large physical and financial toll created by the disease. "Awareness is a powerful force against the painful misconceptions that surround many medical problems," Sen. Gordon Smith (R-Ore.), one of the sponsors of the Senate resolution, said in a statement. "To the extent that we can increase the common understanding of this chronic disease, we can improve patients' lives." The National Psoriasis Foundation last month also launched its first-ever Local Lobby Week, in which volunteers from across the country visited their members of Congress in order to talk about psoriasis and how the disease affects their daily lives. The foundation continues to push for increased federal funding for psoriasis research and for the enactment of the Arthritis Prevention, Control, and Cure Act of 2005 (S. 424/H.R. 583).

Bill Would Repeal SGR

Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's current sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medicaid Services, informed Rep. Johnson that such a measure could come at a high cost: specifically, that the Medicare Economic Index-based increases would be $183 billion over 10 years. Rep. Johnson's bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for their participating in performance measurement.

Wisconsin Loses Cap on Damages

The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was "unconstitutional beyond a reasonable doubt." The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision "will force a wave of doctors to retire early or stop performing high-risk procedures," such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.

IT Deficit Noted Among Physicians

Most Medicare fee-for-service outpatient visits in 2001 were made to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that a total of 57% of Medicare outpatient visits were made to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and for writing prescriptions. While half of those patient visits were to physicians using information technology in order to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower. Rates for electronic prescribing fell to 9%. While access to "wired" practices was found to be low for all beneficiaries, HSC determined that there were few differences in access between sicker and healthier beneficiaries.

Disability Call to Action Debuts

The U.S. Surgeon General has issued his first-ever Call to Action on disability. The new report outlines a series of goals that are aimed at helping individuals who have disabilities to receive better health care. The overall goals include providing health care professionals with the tools needed to screen, diagnose, and treat the whole person with a disability with dignity; helping those persons with disabilities to maintain healthy lifestyles; and also increasing accessible health care and various support services for people with disabilities. "The reality is that for too long we provided lesser care to people with disabilities," Surgeon General Richard H. Carmona, M.D., said in a statement. "Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services." The full text of the "Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities" is available at

www.surgeongeneral.gov

Spotlighting Epidermolysis Bullosa

Members of Congress are trying to raise the public awareness of epidermolysis bullosa by the creation of a national awareness week. Rep. Tim Bishop (D-N.Y.) and Rep. Peter King (R-N.Y.) introduced a resolution (H. Res. 335) this summer that would create a national awareness week for epidermolysis bullosa in October. The resolution, which encourages groups to promote understanding of the impact of the disease on patients and their families, was introduced in the Senate by Sen. Hillary Clinton (D-N.Y.) and Sen. Chuck Schumer (D-N.Y.). Epidermolysis bullosa affects about 12,500 people in the United States. The resolution also notes that more funding is needed in order to conduct research and to develop treatments for the disease.

Psoriasis Awareness Increases

Psoriasis advocates are also celebrating increased awareness on Capitol Hill. As the National Psoriasis Foundation was ramping up awareness activities last month, the U.S. Senate passed a resolution officially designating August 2005 as "Psoriasis Awareness Month" and acknowledging the large physical and financial toll created by the disease. "Awareness is a powerful force against the painful misconceptions that surround many medical problems," Sen. Gordon Smith (R-Ore.), one of the sponsors of the Senate resolution, said in a statement. "To the extent that we can increase the common understanding of this chronic disease, we can improve patients' lives." The National Psoriasis Foundation last month also launched its first-ever Local Lobby Week, in which volunteers from across the country visited their members of Congress in order to talk about psoriasis and how the disease affects their daily lives. The foundation continues to push for increased federal funding for psoriasis research and for the enactment of the Arthritis Prevention, Control, and Cure Act of 2005 (S. 424/H.R. 583).

Bill Would Repeal SGR

Physician groups are hailing the fact that a forthcoming bill from Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means Subcommittee on Health, would repeal Medicare's current sustainable growth rate and base future updates for physician payments on the Medicare Economic Index. At a recent hearing, Mark McClellan, M.D., administrator for the federal Centers for Medicare and Medicaid Services, informed Rep. Johnson that such a measure could come at a high cost: specifically, that the Medicare Economic Index-based increases would be $183 billion over 10 years. Rep. Johnson's bill seeks to establish a performance measurement and reporting system. C. Anderson Hedberg, M.D., president of the American College of Physicians, testified that Rep. Johnson's bill should provide funding to support quality improvement, so that all physicians would receive a positive update linked to inflation with the opportunity to receive additional reimbursement for their participating in performance measurement.

Wisconsin Loses Cap on Damages

The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases opens the door for a medical liability crisis, the American Medical Association said. The court held that the cap, currently set at $445,775, was "unconstitutional beyond a reasonable doubt." The decision will endanger Wisconsin's stable health care environment, AMA Trustee Cyril M. Hetsko, M.D., said in a statement. Wisconsin medical groups are concerned that the decision "will force a wave of doctors to retire early or stop performing high-risk procedures," such as delivering babies in rural areas, said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.

IT Deficit Noted Among Physicians

Most Medicare fee-for-service outpatient visits in 2001 were made to physicians with limited information technology support for patient care, the Center for Studying Health System Change (HSC) reported. Linking Medicare claims data to HSC's national physician survey, researchers found that a total of 57% of Medicare outpatient visits were made to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and for writing prescriptions. While half of those patient visits were to physicians using information technology in order to obtain treatment guidelines, the proportion of visits to physicians in practices with IT support for other patient care functions was much lower. Rates for electronic prescribing fell to 9%. While access to "wired" practices was found to be low for all beneficiaries, HSC determined that there were few differences in access between sicker and healthier beneficiaries.

Disability Call to Action Debuts

The U.S. Surgeon General has issued his first-ever Call to Action on disability. The new report outlines a series of goals that are aimed at helping individuals who have disabilities to receive better health care. The overall goals include providing health care professionals with the tools needed to screen, diagnose, and treat the whole person with a disability with dignity; helping those persons with disabilities to maintain healthy lifestyles; and also increasing accessible health care and various support services for people with disabilities. "The reality is that for too long we provided lesser care to people with disabilities," Surgeon General Richard H. Carmona, M.D., said in a statement. "Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services." The full text of the "Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities" is available at

www.surgeongeneral.gov

Contraceptive Patch Lawsuit

Ten women filed a lawsuit against the makers of the Ortho Evra contraceptive patch, alleging they were not adequately warned of the product's risks. The plaintiffs said they experienced blood clots after using the patch. The lawsuit, which was filed in New Jersey last month, claims Johnson & Johnson; Johnson & Johnson Pharmaceutical Research and Development LLC; and Ortho-McNeil Pharmaceutical Inc. “negligently designed, manufactured, marketed, advertised, and sold the Ortho Evra contraceptive patch by misrepresenting its safety, and failing to adequately warn of its risks.” The plaintiffs are seeking compensatory and punitive damages. The company said it had not received a copy of the charges and therefore could not comment, said Ortho-McNeil spokesman Michael J. Beckerich. However, he said when used as labeled Ortho Evra is a “safe and effective birth control choice for many women” and the types of adverse event reports that have been received for the patch are “consistent with the health risks of other hormonal birth control methods and the Ortho Evra product label.”

EC Web sites

Women need more information about emergency contraception (EC), according to articles in the July and August issues of the journal, Contraception. The article in the July issue examined usage of an English-language EC Web site by looking at e-mail queries received from July 1999 to June 2004. The second study, published in August, looked at an Arabic-language version of the Web site by analyzing user profiles and use patterns from June 1, 2003 to Dec. 31, 2004. Analyses of questions posed on an English-language Web site shows users are concerned about issues such as bleeding after EC use and whether EC use will prevent pregnancy if they engage in intercourse shortly after treatment. Users of the Arabic-language site also were interested in information about bleeding after use and in Web sites designed for an Arabic-speaking audience.

No More Caps in Wisconsin

The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases will have a devastating effect on physicians and patients, according to the American College of Obstetricians and Gynecologists. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The cap had for the most part protected the state from the “medical liability insurance crisis sweeping the country,” ACOG President-Elect Douglas W. Laube, M.D., said in a statement. In 2004, Wisconsin ob.gyns. paid slightly more than $23,000 a year for their medical liability insurance compared with their colleagues in parts of Illinois, where annual premiums for ob.gyns. are more than $230,000, according to ACOG. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.

Tracking Birth Defects

The states and the federal government should devote more resources to birth defect surveillance systems and autism registries, according to a new report from the nonprofit group Trust for America's Health. While 47 states and territories are operating or actively planning birth defect surveillance programs, only 15 of the programs receive some financial support from the Centers for Disease Control and Prevention, though technical assistance is available to all programs through the CDC. The report also calls on officials to link existing data systems such as vital records, birth defects surveillance systems, newborn screening programs, immunization registries, educational data, and nationwide health tracking. The report is available online at

www.healthyamericans.org

Legislating Reproductive Health

A number of states have enacted laws addressing access to reproductive health services, according to an analysis by the Alan Guttmacher Institute. Since January, 17 states have enacted 23 laws that the group characterized as aiming to limit access to such services. These measures include mandating parental involvement for, or reporting of, minors' abortions; requiring that women seeking abortion receive counseling 24 hours before undergoing the procedure; and directing that women seeking an abortion be told that a fetus can feel pain after 20 weeks' gestation. But 14 states also have enacted measures that the Institute termed “positive” for women's access. The measures include protecting access to abortion clinics, permitting pharmacists to dispense emergency contraception, mandating insurance coverage of contraceptives, expanding Medicaid eligibility for family planning, and funding research involving embryonic stem cells.

Contraceptive Patch Lawsuit

Ten women filed a lawsuit against the makers of the Ortho Evra contraceptive patch, alleging they were not adequately warned of the product's risks. The plaintiffs said they experienced blood clots after using the patch. The lawsuit, which was filed in New Jersey last month, claims Johnson & Johnson; Johnson & Johnson Pharmaceutical Research and Development LLC; and Ortho-McNeil Pharmaceutical Inc. “negligently designed, manufactured, marketed, advertised, and sold the Ortho Evra contraceptive patch by misrepresenting its safety, and failing to adequately warn of its risks.” The plaintiffs are seeking compensatory and punitive damages. The company said it had not received a copy of the charges and therefore could not comment, said Ortho-McNeil spokesman Michael J. Beckerich. However, he said when used as labeled Ortho Evra is a “safe and effective birth control choice for many women” and the types of adverse event reports that have been received for the patch are “consistent with the health risks of other hormonal birth control methods and the Ortho Evra product label.”

EC Web sites

Women need more information about emergency contraception (EC), according to articles in the July and August issues of the journal, Contraception. The article in the July issue examined usage of an English-language EC Web site by looking at e-mail queries received from July 1999 to June 2004. The second study, published in August, looked at an Arabic-language version of the Web site by analyzing user profiles and use patterns from June 1, 2003 to Dec. 31, 2004. Analyses of questions posed on an English-language Web site shows users are concerned about issues such as bleeding after EC use and whether EC use will prevent pregnancy if they engage in intercourse shortly after treatment. Users of the Arabic-language site also were interested in information about bleeding after use and in Web sites designed for an Arabic-speaking audience.

No More Caps in Wisconsin

The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases will have a devastating effect on physicians and patients, according to the American College of Obstetricians and Gynecologists. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The cap had for the most part protected the state from the “medical liability insurance crisis sweeping the country,” ACOG President-Elect Douglas W. Laube, M.D., said in a statement. In 2004, Wisconsin ob.gyns. paid slightly more than $23,000 a year for their medical liability insurance compared with their colleagues in parts of Illinois, where annual premiums for ob.gyns. are more than $230,000, according to ACOG. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.

Tracking Birth Defects

The states and the federal government should devote more resources to birth defect surveillance systems and autism registries, according to a new report from the nonprofit group Trust for America's Health. While 47 states and territories are operating or actively planning birth defect surveillance programs, only 15 of the programs receive some financial support from the Centers for Disease Control and Prevention, though technical assistance is available to all programs through the CDC. The report also calls on officials to link existing data systems such as vital records, birth defects surveillance systems, newborn screening programs, immunization registries, educational data, and nationwide health tracking. The report is available online at

www.healthyamericans.org

Legislating Reproductive Health

A number of states have enacted laws addressing access to reproductive health services, according to an analysis by the Alan Guttmacher Institute. Since January, 17 states have enacted 23 laws that the group characterized as aiming to limit access to such services. These measures include mandating parental involvement for, or reporting of, minors' abortions; requiring that women seeking abortion receive counseling 24 hours before undergoing the procedure; and directing that women seeking an abortion be told that a fetus can feel pain after 20 weeks' gestation. But 14 states also have enacted measures that the Institute termed “positive” for women's access. The measures include protecting access to abortion clinics, permitting pharmacists to dispense emergency contraception, mandating insurance coverage of contraceptives, expanding Medicaid eligibility for family planning, and funding research involving embryonic stem cells.

Contraceptive Patch Lawsuit

Ten women filed a lawsuit against the makers of the Ortho Evra contraceptive patch, alleging they were not adequately warned of the product's risks. The plaintiffs said they experienced blood clots after using the patch. The lawsuit, which was filed in New Jersey last month, claims Johnson & Johnson; Johnson & Johnson Pharmaceutical Research and Development LLC; and Ortho-McNeil Pharmaceutical Inc. “negligently designed, manufactured, marketed, advertised, and sold the Ortho Evra contraceptive patch by misrepresenting its safety, and failing to adequately warn of its risks.” The plaintiffs are seeking compensatory and punitive damages. The company said it had not received a copy of the charges and therefore could not comment, said Ortho-McNeil spokesman Michael J. Beckerich. However, he said when used as labeled Ortho Evra is a “safe and effective birth control choice for many women” and the types of adverse event reports that have been received for the patch are “consistent with the health risks of other hormonal birth control methods and the Ortho Evra product label.”

EC Web sites

Women need more information about emergency contraception (EC), according to articles in the July and August issues of the journal, Contraception. The article in the July issue examined usage of an English-language EC Web site by looking at e-mail queries received from July 1999 to June 2004. The second study, published in August, looked at an Arabic-language version of the Web site by analyzing user profiles and use patterns from June 1, 2003 to Dec. 31, 2004. Analyses of questions posed on an English-language Web site shows users are concerned about issues such as bleeding after EC use and whether EC use will prevent pregnancy if they engage in intercourse shortly after treatment. Users of the Arabic-language site also were interested in information about bleeding after use and in Web sites designed for an Arabic-speaking audience.

No More Caps in Wisconsin

The Wisconsin Supreme Court's decision to remove a 30-year-old cap on noneconomic damages in malpractice cases will have a devastating effect on physicians and patients, according to the American College of Obstetricians and Gynecologists. The court held that the cap, currently set at $445,775, was “unconstitutional beyond a reasonable doubt.” The cap had for the most part protected the state from the “medical liability insurance crisis sweeping the country,” ACOG President-Elect Douglas W. Laube, M.D., said in a statement. In 2004, Wisconsin ob.gyns. paid slightly more than $23,000 a year for their medical liability insurance compared with their colleagues in parts of Illinois, where annual premiums for ob.gyns. are more than $230,000, according to ACOG. Wisconsin medical groups are concerned that the decision “will force a wave of doctors to retire early or stop performing high-risk procedures,” said Susan Turney, M.D., chief executive officer of the Wisconsin Medical Society.

Tracking Birth Defects

The states and the federal government should devote more resources to birth defect surveillance systems and autism registries, according to a new report from the nonprofit group Trust for America's Health. While 47 states and territories are operating or actively planning birth defect surveillance programs, only 15 of the programs receive some financial support from the Centers for Disease Control and Prevention, though technical assistance is available to all programs through the CDC. The report also calls on officials to link existing data systems such as vital records, birth defects surveillance systems, newborn screening programs, immunization registries, educational data, and nationwide health tracking. The report is available online at

www.healthyamericans.org

Legislating Reproductive Health

A number of states have enacted laws addressing access to reproductive health services, according to an analysis by the Alan Guttmacher Institute. Since January, 17 states have enacted 23 laws that the group characterized as aiming to limit access to such services. These measures include mandating parental involvement for, or reporting of, minors' abortions; requiring that women seeking abortion receive counseling 24 hours before undergoing the procedure; and directing that women seeking an abortion be told that a fetus can feel pain after 20 weeks' gestation. But 14 states also have enacted measures that the Institute termed “positive” for women's access. The measures include protecting access to abortion clinics, permitting pharmacists to dispense emergency contraception, mandating insurance coverage of contraceptives, expanding Medicaid eligibility for family planning, and funding research involving embryonic stem cells.

Abortion Ban in the Courts

The “Partial Birth Abortion Act of 2003” was ruled unconstitutional last month by the U.S. Court of Appeals for the 8th Circuit. The ruling was based on the law's failure to provide an exception in cases where a woman's health was at stake. The law, which bans the so-called “partial birth” abortion procedure, has already been declared unconstitutional in three federal courts. The U.S. Department of Justice has filed appeals in each case, and this is the first of those appeals to be decided. The government can now seek a rehearing before the full 8th Circuit Court of Appeals or try to bring the case before the U.S. Supreme Court. The National Right to Life Committee's legislative director, Douglas Johnson, said in a statement that the successor to Justice Sandra Day O'Connor—who recently announced her retirement—would cast the deciding vote on whether the “partial birth” abortion method remains legal, if the case goes to the Supreme Court.

Talking About HPV

Less than 20% of women who participated in a recent survey said their health care provider had ever discussed the connection between the human papillomavirus (HPV) and cervical cancer. The survey, commissioned by the Association of Reproductive Health Professionals, examined women's knowledge about HPV and cervical cancer and their interactions with health care providers. About 88% of women surveyed said they were very likely to turn to their health care provider for information on reproductive or gynecologic health issues. However, 43% of women said they had not heard of HPV. The survey was conducted among 1,000 women who were aged 18–65 years.

Alternatives to Malpractice Litigation

Proposed legislation that would provide grants to states to explore alternatives to the current medical malpractice system is gaining support from the American College of Obstetricians and Gynecologists. The “Fair and Reliable Medical Justice Act” (S. 1337) authorizes the secretary of Health and Human Services to award up to 10 demonstration-project grants to states to develop alternatives to the malpractice tort system. The legislation, which was introduced by Sen. Mike Enzi (R-Wyo.) and Sen. Max Baucus (D-Mont.), allows states to test three alternatives systems of dispute resolution—early disclosure and compensation, administrative determination of compensation, and special health care courts. Although ACOG has supported national reform and a cap on noneconomic damages, the college said that state demonstration projects would be a way to explore strategies that complement a national solution. “This legislation is an important step in the right direction toward fostering a reliable system of medical justice and enacting common sense reforms that protect patients, halt lawsuit abuse, and keep doctors in practice,” ACOG President Michael T. Mennuti, M.D., said in a statement. The bill was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Meeting Mammography Goals

More than 75% of women age 40 years and older reported in surveys that they have had a mammogram in the past 2 years, according to a study published in the July/August issue of the American Journal of Health Promotion. This exceeds the Healthy People 2010 target of 70% of women age 40 and older having a mammogram in the last 2 years. While the overall results were positive, some subgroups of women continue to have low use of mammograms. For example, women without health insurance, women who do not have a personal doctor, and women who have not received preventive care are lagging behind, according to the study. The study analyzed results from the 2002 Behavioral Risk Factor Surveillance Survey and the National Health Interview Survey.

Family Planning Use

Publicly funded family planning clinics are serving more clients than ever, according to a report from the Alan Guttmacher Institute. Title X family planning clinics reported serving more than 5 million people in 2004—about a 1% increase over 2003. Of the women clients, 86% (more than 4 million) reported that they use some contraceptive method. In addition, 6% of clients said they are not currently using a contraceptive method because they were pregnant at their last clinic visit. The remaining 8% report not using a contraceptive method for some other reason. About 47% of contraceptive users reported taking oral contraceptives, 18% reported using contraceptive injections, and 18% reported using condoms. But more women are also starting to use other methods, such as contraceptive patches and rings, according to the report. The 2004 Family Planning Annual Report is available online at

www.guttmacher.org

Abortion Ban in the Courts

The “Partial Birth Abortion Act of 2003” was ruled unconstitutional last month by the U.S. Court of Appeals for the 8th Circuit. The ruling was based on the law's failure to provide an exception in cases where a woman's health was at stake. The law, which bans the so-called “partial birth” abortion procedure, has already been declared unconstitutional in three federal courts. The U.S. Department of Justice has filed appeals in each case, and this is the first of those appeals to be decided. The government can now seek a rehearing before the full 8th Circuit Court of Appeals or try to bring the case before the U.S. Supreme Court. The National Right to Life Committee's legislative director, Douglas Johnson, said in a statement that the successor to Justice Sandra Day O'Connor—who recently announced her retirement—would cast the deciding vote on whether the “partial birth” abortion method remains legal, if the case goes to the Supreme Court.

Talking About HPV

Less than 20% of women who participated in a recent survey said their health care provider had ever discussed the connection between the human papillomavirus (HPV) and cervical cancer. The survey, commissioned by the Association of Reproductive Health Professionals, examined women's knowledge about HPV and cervical cancer and their interactions with health care providers. About 88% of women surveyed said they were very likely to turn to their health care provider for information on reproductive or gynecologic health issues. However, 43% of women said they had not heard of HPV. The survey was conducted among 1,000 women who were aged 18–65 years.

Alternatives to Malpractice Litigation

Proposed legislation that would provide grants to states to explore alternatives to the current medical malpractice system is gaining support from the American College of Obstetricians and Gynecologists. The “Fair and Reliable Medical Justice Act” (S. 1337) authorizes the secretary of Health and Human Services to award up to 10 demonstration-project grants to states to develop alternatives to the malpractice tort system. The legislation, which was introduced by Sen. Mike Enzi (R-Wyo.) and Sen. Max Baucus (D-Mont.), allows states to test three alternatives systems of dispute resolution—early disclosure and compensation, administrative determination of compensation, and special health care courts. Although ACOG has supported national reform and a cap on noneconomic damages, the college said that state demonstration projects would be a way to explore strategies that complement a national solution. “This legislation is an important step in the right direction toward fostering a reliable system of medical justice and enacting common sense reforms that protect patients, halt lawsuit abuse, and keep doctors in practice,” ACOG President Michael T. Mennuti, M.D., said in a statement. The bill was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Meeting Mammography Goals

More than 75% of women age 40 years and older reported in surveys that they have had a mammogram in the past 2 years, according to a study published in the July/August issue of the American Journal of Health Promotion. This exceeds the Healthy People 2010 target of 70% of women age 40 and older having a mammogram in the last 2 years. While the overall results were positive, some subgroups of women continue to have low use of mammograms. For example, women without health insurance, women who do not have a personal doctor, and women who have not received preventive care are lagging behind, according to the study. The study analyzed results from the 2002 Behavioral Risk Factor Surveillance Survey and the National Health Interview Survey.

Family Planning Use

Publicly funded family planning clinics are serving more clients than ever, according to a report from the Alan Guttmacher Institute. Title X family planning clinics reported serving more than 5 million people in 2004—about a 1% increase over 2003. Of the women clients, 86% (more than 4 million) reported that they use some contraceptive method. In addition, 6% of clients said they are not currently using a contraceptive method because they were pregnant at their last clinic visit. The remaining 8% report not using a contraceptive method for some other reason. About 47% of contraceptive users reported taking oral contraceptives, 18% reported using contraceptive injections, and 18% reported using condoms. But more women are also starting to use other methods, such as contraceptive patches and rings, according to the report. The 2004 Family Planning Annual Report is available online at

www.guttmacher.org

Abortion Ban in the Courts

The “Partial Birth Abortion Act of 2003” was ruled unconstitutional last month by the U.S. Court of Appeals for the 8th Circuit. The ruling was based on the law's failure to provide an exception in cases where a woman's health was at stake. The law, which bans the so-called “partial birth” abortion procedure, has already been declared unconstitutional in three federal courts. The U.S. Department of Justice has filed appeals in each case, and this is the first of those appeals to be decided. The government can now seek a rehearing before the full 8th Circuit Court of Appeals or try to bring the case before the U.S. Supreme Court. The National Right to Life Committee's legislative director, Douglas Johnson, said in a statement that the successor to Justice Sandra Day O'Connor—who recently announced her retirement—would cast the deciding vote on whether the “partial birth” abortion method remains legal, if the case goes to the Supreme Court.

Talking About HPV

Less than 20% of women who participated in a recent survey said their health care provider had ever discussed the connection between the human papillomavirus (HPV) and cervical cancer. The survey, commissioned by the Association of Reproductive Health Professionals, examined women's knowledge about HPV and cervical cancer and their interactions with health care providers. About 88% of women surveyed said they were very likely to turn to their health care provider for information on reproductive or gynecologic health issues. However, 43% of women said they had not heard of HPV. The survey was conducted among 1,000 women who were aged 18–65 years.

Alternatives to Malpractice Litigation

Proposed legislation that would provide grants to states to explore alternatives to the current medical malpractice system is gaining support from the American College of Obstetricians and Gynecologists. The “Fair and Reliable Medical Justice Act” (S. 1337) authorizes the secretary of Health and Human Services to award up to 10 demonstration-project grants to states to develop alternatives to the malpractice tort system. The legislation, which was introduced by Sen. Mike Enzi (R-Wyo.) and Sen. Max Baucus (D-Mont.), allows states to test three alternatives systems of dispute resolution—early disclosure and compensation, administrative determination of compensation, and special health care courts. Although ACOG has supported national reform and a cap on noneconomic damages, the college said that state demonstration projects would be a way to explore strategies that complement a national solution. “This legislation is an important step in the right direction toward fostering a reliable system of medical justice and enacting common sense reforms that protect patients, halt lawsuit abuse, and keep doctors in practice,” ACOG President Michael T. Mennuti, M.D., said in a statement. The bill was referred to the Senate Committee on Health, Education, Labor, and Pensions.

Meeting Mammography Goals

More than 75% of women age 40 years and older reported in surveys that they have had a mammogram in the past 2 years, according to a study published in the July/August issue of the American Journal of Health Promotion. This exceeds the Healthy People 2010 target of 70% of women age 40 and older having a mammogram in the last 2 years. While the overall results were positive, some subgroups of women continue to have low use of mammograms. For example, women without health insurance, women who do not have a personal doctor, and women who have not received preventive care are lagging behind, according to the study. The study analyzed results from the 2002 Behavioral Risk Factor Surveillance Survey and the National Health Interview Survey.

Family Planning Use

Publicly funded family planning clinics are serving more clients than ever, according to a report from the Alan Guttmacher Institute. Title X family planning clinics reported serving more than 5 million people in 2004—about a 1% increase over 2003. Of the women clients, 86% (more than 4 million) reported that they use some contraceptive method. In addition, 6% of clients said they are not currently using a contraceptive method because they were pregnant at their last clinic visit. The remaining 8% report not using a contraceptive method for some other reason. About 47% of contraceptive users reported taking oral contraceptives, 18% reported using contraceptive injections, and 18% reported using condoms. But more women are also starting to use other methods, such as contraceptive patches and rings, according to the report. The 2004 Family Planning Annual Report is available online at

www.guttmacher.org

Physicians should screen all pregnant women for HIV infection, according to updated recommendations from the U.S. Preventive Services Task Force.

The task force—an independent panel of experts in prevention and primary care—recommended in 1996 that physicians routinely screen and counsel pregnant women at high risk for HIV and those living in communities with high rates of HIV-infected newborns.

At that time, the task force did not find sufficient evidence to recommend for or against routine screening for pregnant women without identified risk factors for HIV.

The updated recommendation is based on “good evidence” that both standard and rapid screening tests can accurately detect HIV infection in pregnant women and “fair evidence” that the universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery (Ann. Intern. Med. 2005;143:32–7).

The task force also determined that there is “good evidence” that treatments such as highly active antiretroviral therapy (HAART) can lead to significantly reduced rates of HIV transmission from mother to child.

“Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows providers to avoid obstetric practices that may increase the risk for transmission, and allows an opportunity to counsel the mother against breast-feeding,” the task force said.

About 40,000 people are infected with HIV each year in the United States; this number includes about 300 cases of mother-to-child transmission, the task force reported.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend that HIV testing be part of a routine battery of prenatal blood tests unless declined by the patient.

The CDC and ACOG also recommend that women in their third trimester be retested if they are known to be at high risk for acquiring HIV and that rapid HIV testing be done during labor in women whose HIV status is undocumented.

A system in which women are informed of the screening and given the chance to opt out has been shown to produce higher screening rates than opt-in approaches for which specific informed consent is required, according to ACOG.

“Given the enormous advances in HIV prophylaxis for pregnant women and newborns, it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal disease,” ACOG's Committee on Obstetric Practice wrote in a November 2004 committee opinion.

The USPSTF also recommended that physicians screen all adolescents and adults at increased risk for HIV infection. Patients are considered to be at increased risk for HIV if they have one or more individual risk factors or receive health care in a high-prevalence or high-risk clinical setting such as an STD clinic or correctional facility.

The task force did not make a recommendation for routine screening for HIV among adolescents and adults who are not at increased risk.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspshivi.htm

Physicians should screen all pregnant women for HIV infection, according to updated recommendations from the U.S. Preventive Services Task Force.

The task force—an independent panel of experts in prevention and primary care—recommended in 1996 that physicians routinely screen and counsel pregnant women at high risk for HIV and those living in communities with high rates of HIV-infected newborns.

At that time, the task force did not find sufficient evidence to recommend for or against routine screening for pregnant women without identified risk factors for HIV.

The updated recommendation is based on “good evidence” that both standard and rapid screening tests can accurately detect HIV infection in pregnant women and “fair evidence” that the universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery (Ann. Intern. Med. 2005;143:32–7).

The task force also determined that there is “good evidence” that treatments such as highly active antiretroviral therapy (HAART) can lead to significantly reduced rates of HIV transmission from mother to child.

“Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows providers to avoid obstetric practices that may increase the risk for transmission, and allows an opportunity to counsel the mother against breast-feeding,” the task force said.

About 40,000 people are infected with HIV each year in the United States; this number includes about 300 cases of mother-to-child transmission, the task force reported.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend that HIV testing be part of a routine battery of prenatal blood tests unless declined by the patient.

The CDC and ACOG also recommend that women in their third trimester be retested if they are known to be at high risk for acquiring HIV and that rapid HIV testing be done during labor in women whose HIV status is undocumented.

A system in which women are informed of the screening and given the chance to opt out has been shown to produce higher screening rates than opt-in approaches for which specific informed consent is required, according to ACOG.

“Given the enormous advances in HIV prophylaxis for pregnant women and newborns, it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal disease,” ACOG's Committee on Obstetric Practice wrote in a November 2004 committee opinion.

The USPSTF also recommended that physicians screen all adolescents and adults at increased risk for HIV infection. Patients are considered to be at increased risk for HIV if they have one or more individual risk factors or receive health care in a high-prevalence or high-risk clinical setting such as an STD clinic or correctional facility.

The task force did not make a recommendation for routine screening for HIV among adolescents and adults who are not at increased risk.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspshivi.htm

Physicians should screen all pregnant women for HIV infection, according to updated recommendations from the U.S. Preventive Services Task Force.

The task force—an independent panel of experts in prevention and primary care—recommended in 1996 that physicians routinely screen and counsel pregnant women at high risk for HIV and those living in communities with high rates of HIV-infected newborns.

At that time, the task force did not find sufficient evidence to recommend for or against routine screening for pregnant women without identified risk factors for HIV.

The updated recommendation is based on “good evidence” that both standard and rapid screening tests can accurately detect HIV infection in pregnant women and “fair evidence” that the universal prenatal counseling and voluntary testing increases the proportion of HIV-infected women who are diagnosed and treated before delivery (Ann. Intern. Med. 2005;143:32–7).

The task force also determined that there is “good evidence” that treatments such as highly active antiretroviral therapy (HAART) can lead to significantly reduced rates of HIV transmission from mother to child.

“Early identification of maternal HIV seropositivity allows early antiretroviral treatment to prevent mother-to-child transmission, allows providers to avoid obstetric practices that may increase the risk for transmission, and allows an opportunity to counsel the mother against breast-feeding,” the task force said.

About 40,000 people are infected with HIV each year in the United States; this number includes about 300 cases of mother-to-child transmission, the task force reported.

The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention all recommend that HIV testing be part of a routine battery of prenatal blood tests unless declined by the patient.

The CDC and ACOG also recommend that women in their third trimester be retested if they are known to be at high risk for acquiring HIV and that rapid HIV testing be done during labor in women whose HIV status is undocumented.

A system in which women are informed of the screening and given the chance to opt out has been shown to produce higher screening rates than opt-in approaches for which specific informed consent is required, according to ACOG.

“Given the enormous advances in HIV prophylaxis for pregnant women and newborns, it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal disease,” ACOG's Committee on Obstetric Practice wrote in a November 2004 committee opinion.

The USPSTF also recommended that physicians screen all adolescents and adults at increased risk for HIV infection. Patients are considered to be at increased risk for HIV if they have one or more individual risk factors or receive health care in a high-prevalence or high-risk clinical setting such as an STD clinic or correctional facility.

The task force did not make a recommendation for routine screening for HIV among adolescents and adults who are not at increased risk.

The task force recommendations are available online at www.ahrq.gov/clinic/uspstf/uspshivi.htm

Federal health officials called a press conference last month to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

The issue has become a hot topic with print and online articles by Robert F. Kennedy Jr. in support of a link between autism and use of mercury-based thimerosal as a preservative in childhood vaccines. In those articles and during at least one television appearance, Mr. Kennedy also charged that there has been a federal cover up of data confirming the link. The day after the Washington, D.C., press conference, several autism advocacy groups rallied on Capitol Hill to protest the use of thimerosal in vaccines.

But CDC director Julie Gerberding, M.D., said the predominance of evidence does not show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine. However, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies.

FDA officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., acting deputy commissioner for international and special programs at the Food and Drug Administration.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year.

In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair of the department of microbiology and tropical medicine at George Washington University, Washington, and the father of an autistic child.

Dr. Hotez said he is confident that vaccines had nothing to do with his daughter's autism, and if he could turn back time he would still give his daughter the full complement of vaccines.

Instead, he said that parents should be reminded of the consequences of not vaccinating their children. And attention should shift from unfounded claims about vaccines to the need for respite care and other services for families with autistic children.

Dr. Hotez also called for more research into the cause of autism and genetic testing for the disease.

Federal health officials called a press conference last month to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

The issue has become a hot topic with print and online articles by Robert F. Kennedy Jr. in support of a link between autism and use of mercury-based thimerosal as a preservative in childhood vaccines. In those articles and during at least one television appearance, Mr. Kennedy also charged that there has been a federal cover up of data confirming the link. The day after the Washington, D.C., press conference, several autism advocacy groups rallied on Capitol Hill to protest the use of thimerosal in vaccines.

But CDC director Julie Gerberding, M.D., said the predominance of evidence does not show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine. However, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies.

FDA officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., acting deputy commissioner for international and special programs at the Food and Drug Administration.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year.

In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair of the department of microbiology and tropical medicine at George Washington University, Washington, and the father of an autistic child.

Dr. Hotez said he is confident that vaccines had nothing to do with his daughter's autism, and if he could turn back time he would still give his daughter the full complement of vaccines.

Instead, he said that parents should be reminded of the consequences of not vaccinating their children. And attention should shift from unfounded claims about vaccines to the need for respite care and other services for families with autistic children.

Dr. Hotez also called for more research into the cause of autism and genetic testing for the disease.

Federal health officials called a press conference last month to try to restore public confidence in childhood vaccines despite the charge by some parents that there is a connection between the vaccines and autism.

The issue has become a hot topic with print and online articles by Robert F. Kennedy Jr. in support of a link between autism and use of mercury-based thimerosal as a preservative in childhood vaccines. In those articles and during at least one television appearance, Mr. Kennedy also charged that there has been a federal cover up of data confirming the link. The day after the Washington, D.C., press conference, several autism advocacy groups rallied on Capitol Hill to protest the use of thimerosal in vaccines.

But CDC director Julie Gerberding, M.D., said the predominance of evidence does not show an association between thimerosal in vaccines and autism.

Thimerosal has been used in vaccines as a preservative. However, since 2001 all vaccines recommended for children age 6 years and younger have either had no thimerosal or have contained only trace amounts.

One exception is the inactivated influenza vaccine. However, a preservative-free version, which contains trace amounts of thimerosal, is available in limited supplies.

FDA officials are working with vaccine manufacturers to increase the supply of those doses, said Murray M. Lumpkin, M.D., acting deputy commissioner for international and special programs at the Food and Drug Administration.

In addition, all new vaccines licensed since 1999 are free of thimerosal as a preservative. Dr. Lumpkin said.

Dr. Gerberding said government researchers will continue to look at whether the evidence supports a link between thimerosal and autism but said it's important for researchers, policy makers, and parents not to base decisions on “unproved hypotheses.”

“Today the best available science indicates to us that vaccines save lives,” she said.

Researchers are trying to get an estimate of the prevalence of autism in children, and Dr. Gerberding said some of that data will be available next year.

In addition, researchers with the National Institutes of Health are investigating the risk factors and biological markers for autism.

“We need a war on autism, not a war on childhood vaccines,” said Peter Hotez, M.D., chair of the department of microbiology and tropical medicine at George Washington University, Washington, and the father of an autistic child.

Dr. Hotez said he is confident that vaccines had nothing to do with his daughter's autism, and if he could turn back time he would still give his daughter the full complement of vaccines.

Instead, he said that parents should be reminded of the consequences of not vaccinating their children. And attention should shift from unfounded claims about vaccines to the need for respite care and other services for families with autistic children.

Dr. Hotez also called for more research into the cause of autism and genetic testing for the disease.

The Fate of COX-2s

The first of several lawsuits against Merck, the manufacturer of the cyclooxygenase-2 inhibitor rofecoxib (Vioxx), got underway in Texas last month. More suits are expected to follow, including one brought by the Physicians Committee for Responsible Medicine which charges that Merck relied on animal tests showing that Vioxx was safe while ignoring mounting clinical evidence that the drug increased cardiac risks in people. Meanwhile, across the border in Canada, an expert panel convened by national health officials recommended last month that Vioxx be allowed back on the market. The panel also voted that celecoxib (Celebrex) should continue to be marketed in Canada and that valdecoxib (Bextra) should not be allowed back on the market. Celebrex is currently the only COX-2 inhibitor available in Canada. Merck voluntarily withdrew Vioxx from the market in 2004 in response to evidence that the drug increases the risk of cardiovascular events. Pfizer suspended sales of Bextra last year due to concerns about a serious skin disorder and short-term cardiovascular risk.

Rheumatologist Takes Helm

A rheumatologist is now heading the U.S. Bone & Joint Decade, a 10-year effort to raise awareness and improve treatment of musculoskeletal diseases. Nancy Lane, M.D., was elected to a 2-year term as president at the group's annual board meeting in June. Dr. Lane currently serves as the director of the Center for Healthy Aging and is a professor of medicine and rheumatology at the University of California, Davis. She is also the coeditor for the journal Arthritis & Rheumatism. Dr. Lane succeeds Regis O'Keefe, M.D., who served as president of the initiative since 2003. Dr. O'Keefe is a professor of orthopedics at the University of Rochester (N.Y.).

The Cost of Smoking Deaths

Smoking deaths cost the nation $92 billion in lost productivity on an annual basis, from 1997 to 2001, the Centers for Disease Control and Prevention reported. This reflects an increase of about $10 billion from the annual mortality losses for the years 1995 through 1999. During the same period, an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. To reduce the toll, “we must provide the 32 million smokers who say they want to quit with the tools and support to do it successfully,” CDC Director Julie Gerberding, M.D., said in a statement. In an independent action, the American Medical Association's House of Delegates took measures to discourage tobacco use at its annual meeting, voting to support increases in federal, state, and local excise taxes on tobacco. Such increases in the excise taxes should be used to fund the treatment of those afflicted by tobacco-related illness, and to support counter-advertising efforts, the resolution stated.

Health Insurance Statistics

The ranks of the uninsured appear to be leveling off, according to a survey conducted by the CDC's National Center for Health Statistics. In 2004, 42 million Americans of all ages were without health insurance, about the same level as in 1997, the first year this survey began tracking these statistics. In addition, one in five adults aged 18–64 years were without health insurance last year, a number that had been steadily rising in recent years, but also leveled off in 2004. The survey showed continued improvements in coverage for children: Seven million children aged under 18 years were without health insurance in 2004, compared with 10 million children in 1997.

Uneasy Retirement

Baby boomers are concerned about their financial and health security—and would favor setting aside a portion of their earnings in a special account to save for future medical expenses, a report from the Commonwealth Fund stated. In a nationally representative sample of 2,000 adults aged 50–70, very few thought they would have enough income and savings for retirement and three of five adults in this age group worry that they will not be able to afford medical care in the future. More than 50% of those working or with a working spouse said they would not have job-based retiree health benefits when they retire. These fears are somewhat warranted: 12 million older adults are currently uninsured or have had histories of unstable coverage. The survey reflected a strong interest among older adults in a Medicare health account that would allow people to add to savings as well as receive the traditional Medicare benefit.

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees at the National Institutes of Health more time to report prohibited financial interests and to divest stock. In its announcement of the extension, HHS wrote that the department is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests, such as stocks, in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. This is the second extension offered to NIH employees. “There's no doubt in my mind that at the end of the day the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

The Fate of COX-2s

The first of several lawsuits against Merck, the manufacturer of the cyclooxygenase-2 inhibitor rofecoxib (Vioxx), got underway in Texas last month. More suits are expected to follow, including one brought by the Physicians Committee for Responsible Medicine which charges that Merck relied on animal tests showing that Vioxx was safe while ignoring mounting clinical evidence that the drug increased cardiac risks in people. Meanwhile, across the border in Canada, an expert panel convened by national health officials recommended last month that Vioxx be allowed back on the market. The panel also voted that celecoxib (Celebrex) should continue to be marketed in Canada and that valdecoxib (Bextra) should not be allowed back on the market. Celebrex is currently the only COX-2 inhibitor available in Canada. Merck voluntarily withdrew Vioxx from the market in 2004 in response to evidence that the drug increases the risk of cardiovascular events. Pfizer suspended sales of Bextra last year due to concerns about a serious skin disorder and short-term cardiovascular risk.

Rheumatologist Takes Helm

A rheumatologist is now heading the U.S. Bone & Joint Decade, a 10-year effort to raise awareness and improve treatment of musculoskeletal diseases. Nancy Lane, M.D., was elected to a 2-year term as president at the group's annual board meeting in June. Dr. Lane currently serves as the director of the Center for Healthy Aging and is a professor of medicine and rheumatology at the University of California, Davis. She is also the coeditor for the journal Arthritis & Rheumatism. Dr. Lane succeeds Regis O'Keefe, M.D., who served as president of the initiative since 2003. Dr. O'Keefe is a professor of orthopedics at the University of Rochester (N.Y.).

The Cost of Smoking Deaths

Smoking deaths cost the nation $92 billion in lost productivity on an annual basis, from 1997 to 2001, the Centers for Disease Control and Prevention reported. This reflects an increase of about $10 billion from the annual mortality losses for the years 1995 through 1999. During the same period, an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. To reduce the toll, “we must provide the 32 million smokers who say they want to quit with the tools and support to do it successfully,” CDC Director Julie Gerberding, M.D., said in a statement. In an independent action, the American Medical Association's House of Delegates took measures to discourage tobacco use at its annual meeting, voting to support increases in federal, state, and local excise taxes on tobacco. Such increases in the excise taxes should be used to fund the treatment of those afflicted by tobacco-related illness, and to support counter-advertising efforts, the resolution stated.

Health Insurance Statistics

The ranks of the uninsured appear to be leveling off, according to a survey conducted by the CDC's National Center for Health Statistics. In 2004, 42 million Americans of all ages were without health insurance, about the same level as in 1997, the first year this survey began tracking these statistics. In addition, one in five adults aged 18–64 years were without health insurance last year, a number that had been steadily rising in recent years, but also leveled off in 2004. The survey showed continued improvements in coverage for children: Seven million children aged under 18 years were without health insurance in 2004, compared with 10 million children in 1997.

Uneasy Retirement

Baby boomers are concerned about their financial and health security—and would favor setting aside a portion of their earnings in a special account to save for future medical expenses, a report from the Commonwealth Fund stated. In a nationally representative sample of 2,000 adults aged 50–70, very few thought they would have enough income and savings for retirement and three of five adults in this age group worry that they will not be able to afford medical care in the future. More than 50% of those working or with a working spouse said they would not have job-based retiree health benefits when they retire. These fears are somewhat warranted: 12 million older adults are currently uninsured or have had histories of unstable coverage. The survey reflected a strong interest among older adults in a Medicare health account that would allow people to add to savings as well as receive the traditional Medicare benefit.

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees at the National Institutes of Health more time to report prohibited financial interests and to divest stock. In its announcement of the extension, HHS wrote that the department is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests, such as stocks, in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. This is the second extension offered to NIH employees. “There's no doubt in my mind that at the end of the day the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

The Fate of COX-2s

The first of several lawsuits against Merck, the manufacturer of the cyclooxygenase-2 inhibitor rofecoxib (Vioxx), got underway in Texas last month. More suits are expected to follow, including one brought by the Physicians Committee for Responsible Medicine which charges that Merck relied on animal tests showing that Vioxx was safe while ignoring mounting clinical evidence that the drug increased cardiac risks in people. Meanwhile, across the border in Canada, an expert panel convened by national health officials recommended last month that Vioxx be allowed back on the market. The panel also voted that celecoxib (Celebrex) should continue to be marketed in Canada and that valdecoxib (Bextra) should not be allowed back on the market. Celebrex is currently the only COX-2 inhibitor available in Canada. Merck voluntarily withdrew Vioxx from the market in 2004 in response to evidence that the drug increases the risk of cardiovascular events. Pfizer suspended sales of Bextra last year due to concerns about a serious skin disorder and short-term cardiovascular risk.

Rheumatologist Takes Helm

A rheumatologist is now heading the U.S. Bone & Joint Decade, a 10-year effort to raise awareness and improve treatment of musculoskeletal diseases. Nancy Lane, M.D., was elected to a 2-year term as president at the group's annual board meeting in June. Dr. Lane currently serves as the director of the Center for Healthy Aging and is a professor of medicine and rheumatology at the University of California, Davis. She is also the coeditor for the journal Arthritis & Rheumatism. Dr. Lane succeeds Regis O'Keefe, M.D., who served as president of the initiative since 2003. Dr. O'Keefe is a professor of orthopedics at the University of Rochester (N.Y.).

The Cost of Smoking Deaths

Smoking deaths cost the nation $92 billion in lost productivity on an annual basis, from 1997 to 2001, the Centers for Disease Control and Prevention reported. This reflects an increase of about $10 billion from the annual mortality losses for the years 1995 through 1999. During the same period, an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. To reduce the toll, “we must provide the 32 million smokers who say they want to quit with the tools and support to do it successfully,” CDC Director Julie Gerberding, M.D., said in a statement. In an independent action, the American Medical Association's House of Delegates took measures to discourage tobacco use at its annual meeting, voting to support increases in federal, state, and local excise taxes on tobacco. Such increases in the excise taxes should be used to fund the treatment of those afflicted by tobacco-related illness, and to support counter-advertising efforts, the resolution stated.

Health Insurance Statistics

The ranks of the uninsured appear to be leveling off, according to a survey conducted by the CDC's National Center for Health Statistics. In 2004, 42 million Americans of all ages were without health insurance, about the same level as in 1997, the first year this survey began tracking these statistics. In addition, one in five adults aged 18–64 years were without health insurance last year, a number that had been steadily rising in recent years, but also leveled off in 2004. The survey showed continued improvements in coverage for children: Seven million children aged under 18 years were without health insurance in 2004, compared with 10 million children in 1997.

Uneasy Retirement

Baby boomers are concerned about their financial and health security—and would favor setting aside a portion of their earnings in a special account to save for future medical expenses, a report from the Commonwealth Fund stated. In a nationally representative sample of 2,000 adults aged 50–70, very few thought they would have enough income and savings for retirement and three of five adults in this age group worry that they will not be able to afford medical care in the future. More than 50% of those working or with a working spouse said they would not have job-based retiree health benefits when they retire. These fears are somewhat warranted: 12 million older adults are currently uninsured or have had histories of unstable coverage. The survey reflected a strong interest among older adults in a Medicare health account that would allow people to add to savings as well as receive the traditional Medicare benefit.

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees at the National Institutes of Health more time to report prohibited financial interests and to divest stock. In its announcement of the extension, HHS wrote that the department is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests, such as stocks, in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. This is the second extension offered to NIH employees. “There's no doubt in my mind that at the end of the day the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

Public Reporting Impact

Public reporting could be causing physicians to shy away from aggressive approaches in high-risk cardiac patients, according to a published study (J. Am. Coll. Cardiol. 2005;45:1759-65). Researchers compared the use of percutaneous coronary intervention (PCI) in patients in Michigan, where public reporting is not required, and patients in New York, where it is mandatory. They found that patients in Michigan underwent PCI for acute myocardial infarction, cardiac arrest, and cardiogenic shock more often than did patients in New York. And patients in New York had a significantly lower unadjusted mortality than did patients in Michigan. However, after adjustment for comorbidities there was no significant difference between patients in the two states. “Although making accurate outcomes information accessible has the potential to improve health care, our study suggests that public reporting of outcome data might also have an unintended effect on case selection, leading to a tendency toward not intervening on higher-risk patients,” the researchers wrote.

Heart Disease Fears

More women may be getting the message that heart disease poses a serious risk to them, according to a survey commissioned by the Society for Women's Health Research. The survey, which included responses from more than 1,000 adult women, found that 9.7% list heart disease as the disease they fear most, up from 5.3% in 2002. Heart disease came in as the third most feared disease in the survey. An unspecified type of cancer ranked first with 24% of women citing that as their most feared disease. Breast cancer ranked second (22.1%). “Women increasingly recognize that heart disease is the biggest health threat they face over the course of their life,” Phyllis Greenberger, president and CEO of SWHR said in a statement.

Boston Scientific Settlement

Officials at Boston Scientific have agreed to pay $74 million to the federal government to resolve an investigation into the company's 1998 distribution and recall of one of its coronary stent delivery systems. This resolves a civil complaint filed by the U.S. Attorney's Office that alleged that the company distributed 34,589 of the NIR ON Ranger with SOX stent systems which had a manufacturing defect that resulted in random failures of the balloons used to deploy the stents. The complaints also alleged that the company failed to identify and separate the defective devices and that it failed to establish proper internal procedures to identify the causes of the defects. Boston Scientific's agreement to pay $74 million resolves the allegations without admitting liability. Boston Scientific President and CEO Jim Tobin said the company's employees acted “legally, responsibly, and appropriately. … We elected to settle this lingering matter so we could put it behind us and devote our full energies to developing our life-saving medical technologies.”

The Cost of Smoking Deaths

Smoking deaths cost the nation $92 billion in lost productivity annually, from 1997 to 2001, the Centers for Disease Control and Prevention reported. This reflects an increase of about $10 billion from the annual mortality losses for the years 1995-1999. During the same period, an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. In an independent action, the American Medical Association's House of Delegates took measures to discourage tobacco use at its annual meeting, voting to support increases in federal, state, and local excise taxes on tobacco. Such increases in the excise taxes should be used to fund the treatment of those afflicted by tobacco-related illness, and to support counter-advertising efforts, the resolution stated.

Health Insurance Statistics

The ranks of the uninsured appear to be leveling off, according to a survey conducted by the CDC's National Center for Health Statistics. In 2004, 42 million Americans of all ages were without health insurance, about the same level as in 1997, the first year this survey began tracking these statistics. In addition, one in five working age adults (aged 18-64 years) were without health insurance last year, a number that had been steadily rising in recent years, but also leveled off in 2004. The survey showed continued improvements in coverage for children: Seven million children aged under 18 years were without health insurance in 2004, compared with 10 million children in 1997.

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees at the National Institutes of Health more time to report prohibited financial interests and to divest stock. In its announcement of the extension, HHS wrote that the it is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. “There's no doubt in my mind that at the end of the day the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

Public Reporting Impact

Public reporting could be causing physicians to shy away from aggressive approaches in high-risk cardiac patients, according to a published study (J. Am. Coll. Cardiol. 2005;45:1759-65). Researchers compared the use of percutaneous coronary intervention (PCI) in patients in Michigan, where public reporting is not required, and patients in New York, where it is mandatory. They found that patients in Michigan underwent PCI for acute myocardial infarction, cardiac arrest, and cardiogenic shock more often than did patients in New York. And patients in New York had a significantly lower unadjusted mortality than did patients in Michigan. However, after adjustment for comorbidities there was no significant difference between patients in the two states. “Although making accurate outcomes information accessible has the potential to improve health care, our study suggests that public reporting of outcome data might also have an unintended effect on case selection, leading to a tendency toward not intervening on higher-risk patients,” the researchers wrote.

Heart Disease Fears

More women may be getting the message that heart disease poses a serious risk to them, according to a survey commissioned by the Society for Women's Health Research. The survey, which included responses from more than 1,000 adult women, found that 9.7% list heart disease as the disease they fear most, up from 5.3% in 2002. Heart disease came in as the third most feared disease in the survey. An unspecified type of cancer ranked first with 24% of women citing that as their most feared disease. Breast cancer ranked second (22.1%). “Women increasingly recognize that heart disease is the biggest health threat they face over the course of their life,” Phyllis Greenberger, president and CEO of SWHR said in a statement.

Boston Scientific Settlement

Officials at Boston Scientific have agreed to pay $74 million to the federal government to resolve an investigation into the company's 1998 distribution and recall of one of its coronary stent delivery systems. This resolves a civil complaint filed by the U.S. Attorney's Office that alleged that the company distributed 34,589 of the NIR ON Ranger with SOX stent systems which had a manufacturing defect that resulted in random failures of the balloons used to deploy the stents. The complaints also alleged that the company failed to identify and separate the defective devices and that it failed to establish proper internal procedures to identify the causes of the defects. Boston Scientific's agreement to pay $74 million resolves the allegations without admitting liability. Boston Scientific President and CEO Jim Tobin said the company's employees acted “legally, responsibly, and appropriately. … We elected to settle this lingering matter so we could put it behind us and devote our full energies to developing our life-saving medical technologies.”

The Cost of Smoking Deaths

Smoking deaths cost the nation $92 billion in lost productivity annually, from 1997 to 2001, the Centers for Disease Control and Prevention reported. This reflects an increase of about $10 billion from the annual mortality losses for the years 1995-1999. During the same period, an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. In an independent action, the American Medical Association's House of Delegates took measures to discourage tobacco use at its annual meeting, voting to support increases in federal, state, and local excise taxes on tobacco. Such increases in the excise taxes should be used to fund the treatment of those afflicted by tobacco-related illness, and to support counter-advertising efforts, the resolution stated.

Health Insurance Statistics

The ranks of the uninsured appear to be leveling off, according to a survey conducted by the CDC's National Center for Health Statistics. In 2004, 42 million Americans of all ages were without health insurance, about the same level as in 1997, the first year this survey began tracking these statistics. In addition, one in five working age adults (aged 18-64 years) were without health insurance last year, a number that had been steadily rising in recent years, but also leveled off in 2004. The survey showed continued improvements in coverage for children: Seven million children aged under 18 years were without health insurance in 2004, compared with 10 million children in 1997.

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees at the National Institutes of Health more time to report prohibited financial interests and to divest stock. In its announcement of the extension, HHS wrote that the it is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. “There's no doubt in my mind that at the end of the day the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.

Public Reporting Impact

Public reporting could be causing physicians to shy away from aggressive approaches in high-risk cardiac patients, according to a published study (J. Am. Coll. Cardiol. 2005;45:1759-65). Researchers compared the use of percutaneous coronary intervention (PCI) in patients in Michigan, where public reporting is not required, and patients in New York, where it is mandatory. They found that patients in Michigan underwent PCI for acute myocardial infarction, cardiac arrest, and cardiogenic shock more often than did patients in New York. And patients in New York had a significantly lower unadjusted mortality than did patients in Michigan. However, after adjustment for comorbidities there was no significant difference between patients in the two states. “Although making accurate outcomes information accessible has the potential to improve health care, our study suggests that public reporting of outcome data might also have an unintended effect on case selection, leading to a tendency toward not intervening on higher-risk patients,” the researchers wrote.

Heart Disease Fears

More women may be getting the message that heart disease poses a serious risk to them, according to a survey commissioned by the Society for Women's Health Research. The survey, which included responses from more than 1,000 adult women, found that 9.7% list heart disease as the disease they fear most, up from 5.3% in 2002. Heart disease came in as the third most feared disease in the survey. An unspecified type of cancer ranked first with 24% of women citing that as their most feared disease. Breast cancer ranked second (22.1%). “Women increasingly recognize that heart disease is the biggest health threat they face over the course of their life,” Phyllis Greenberger, president and CEO of SWHR said in a statement.

Boston Scientific Settlement

Officials at Boston Scientific have agreed to pay $74 million to the federal government to resolve an investigation into the company's 1998 distribution and recall of one of its coronary stent delivery systems. This resolves a civil complaint filed by the U.S. Attorney's Office that alleged that the company distributed 34,589 of the NIR ON Ranger with SOX stent systems which had a manufacturing defect that resulted in random failures of the balloons used to deploy the stents. The complaints also alleged that the company failed to identify and separate the defective devices and that it failed to establish proper internal procedures to identify the causes of the defects. Boston Scientific's agreement to pay $74 million resolves the allegations without admitting liability. Boston Scientific President and CEO Jim Tobin said the company's employees acted “legally, responsibly, and appropriately. … We elected to settle this lingering matter so we could put it behind us and devote our full energies to developing our life-saving medical technologies.”

The Cost of Smoking Deaths

Smoking deaths cost the nation $92 billion in lost productivity annually, from 1997 to 2001, the Centers for Disease Control and Prevention reported. This reflects an increase of about $10 billion from the annual mortality losses for the years 1995-1999. During the same period, an estimated 438,000 premature deaths occurred each year as a result of smoking and exposure to secondhand smoke. In an independent action, the American Medical Association's House of Delegates took measures to discourage tobacco use at its annual meeting, voting to support increases in federal, state, and local excise taxes on tobacco. Such increases in the excise taxes should be used to fund the treatment of those afflicted by tobacco-related illness, and to support counter-advertising efforts, the resolution stated.

Health Insurance Statistics

The ranks of the uninsured appear to be leveling off, according to a survey conducted by the CDC's National Center for Health Statistics. In 2004, 42 million Americans of all ages were without health insurance, about the same level as in 1997, the first year this survey began tracking these statistics. In addition, one in five working age adults (aged 18-64 years) were without health insurance last year, a number that had been steadily rising in recent years, but also leveled off in 2004. The survey showed continued improvements in coverage for children: Seven million children aged under 18 years were without health insurance in 2004, compared with 10 million children in 1997.

NIH Extends Disclosure Deadline

Officials at the Department of Health and Human Services are giving employees at the National Institutes of Health more time to report prohibited financial interests and to divest stock. In its announcement of the extension, HHS wrote that the it is considering issuing revisions to its current ethics regulations. In February, the agency issued regulations prohibiting NIH employees from engaging in consulting relationships with organizations that are substantially affected by NIH decisions. And NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in these affected organizations. NIH employees now have until Oct. 3, 2005, to file financial disclosure reports and until Jan. 2, 2006, to divest of prohibited financial interests. “There's no doubt in my mind that at the end of the day the advice that NIH gives has to be completely untainted, completely unimpeachable, and completely trusted,” NIH Director Elias Zerhouni, M.D., said during a teleconference sponsored by the Kaiser Family Foundation.