Mary Ellen Schneider

Stem Cell Research Fund

Following the example set by California, Connecticut has established a special fund devoted to fostering embryonic stem cell research. Gov. M. Jodi Rell (R) last month signed into law a bill to set up a 10-year, $100 million fund. The law bans human cloning and sets guidelines for the donation of embryos, embryonic stem cells, unfertilized eggs, and sperm. A 9-member stem cell research advisory committee will be responsible for administering grants from the fund in consultation with the commissioner of the department of public health and a 5-member stem cell research peer review committee. “This fund is a catalyst, intended to attract other investments and generate opportunities for growth,” Gov. Rell said in a statement.

Abstinence Education

Elementary and middle school children who participated in abstinence education programs were more likely to report being more supportive of abstinence and less supportive of teen sex than were peers who did not receive abstinence education, according to a preliminary report. Mathematica Policy Research Inc. last month announced the results of its 1-year follow-up comparing children in federally funded abstinence education programs with children who received the usual health, family life, and sex education services available in the school and community. The Mathematica study is part of a multiyear evaluation authorized by Congress. The abstinence programs also were linked with increased perceptions about the potential adverse consequences of teen and nonmarital sex. But the program and control groups had similar results related to views on marriage, self-concept, refusal skills, and communication with parents. “Students who are in these programs are recognizing that abstinence is a positive choice,” Michael O'Grady, Health and Human Services assistant secretary for planning and evaluation said in a statement. But Planned Parenthood Federation of America noted that abstinence-only-until-marriage programs have not proved effective in delaying sexual activity or reducing the teen pregnancy rate. The preliminary report is available at

http://aspe.hhs.gov/hsp/05/abstinence

EC for Rape Survivors

Federal lawmakers are proposing legislation that would require federally funded hospitals to offer rape victims information and access to emergency contraception (EC). Sen. Hillary R. Clinton (D-N.Y.), Sen. Jon S. Corzine (D-N.J.), and Sen. Olympia J. Snowe (R-Maine) introduced the Compassionate Assistance for Rape Emergencies Act in the Senate (S. 1264). Companion legislation was introduced in the House (H.R. 2928) by Rep. Steve Rothman (D-N.J.) and Rep. Rob R. Simmons (R-Conn.). The bill would also mandate that patients be able to receive postexposure treatment for sexually transmitted diseases. In the meantime, another state has increased access to emergency contraception without a prescription. New Hampshire Gov. John Lynch (D) last month signed legislation that authorizes pharmacists to dispense EC without a prescription if they have a collaborative relationship with a physician.

Understanding Pap Tests

Low-income women lack a good understanding of Pap testing, according to a study published in the June issue of the Perspectives on Sexual and Reproductive Health. Researchers used a questionnaire on Pap testing to evaluate the knowledge of 338 women aged 18–50. More than half of the women answered “don't know” to questions about colposcopy and human papillomavirus. More than 60% gave incorrect answers to questions about the purpose of the Pap test. One-third of the women incorrectly answered that the purpose of the test was to treat cancer.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring every health plan serving Medicare patients to include all the drugs in six particular categories on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released last month, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—which include antidepressants, antipsychotics, anticonvulsants, anticancer drugs, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame.”

Stem Cell Research Fund

Following the example set by California, Connecticut has established a special fund devoted to fostering embryonic stem cell research. Gov. M. Jodi Rell (R) last month signed into law a bill to set up a 10-year, $100 million fund. The law bans human cloning and sets guidelines for the donation of embryos, embryonic stem cells, unfertilized eggs, and sperm. A 9-member stem cell research advisory committee will be responsible for administering grants from the fund in consultation with the commissioner of the department of public health and a 5-member stem cell research peer review committee. “This fund is a catalyst, intended to attract other investments and generate opportunities for growth,” Gov. Rell said in a statement.

Abstinence Education

Elementary and middle school children who participated in abstinence education programs were more likely to report being more supportive of abstinence and less supportive of teen sex than were peers who did not receive abstinence education, according to a preliminary report. Mathematica Policy Research Inc. last month announced the results of its 1-year follow-up comparing children in federally funded abstinence education programs with children who received the usual health, family life, and sex education services available in the school and community. The Mathematica study is part of a multiyear evaluation authorized by Congress. The abstinence programs also were linked with increased perceptions about the potential adverse consequences of teen and nonmarital sex. But the program and control groups had similar results related to views on marriage, self-concept, refusal skills, and communication with parents. “Students who are in these programs are recognizing that abstinence is a positive choice,” Michael O'Grady, Health and Human Services assistant secretary for planning and evaluation said in a statement. But Planned Parenthood Federation of America noted that abstinence-only-until-marriage programs have not proved effective in delaying sexual activity or reducing the teen pregnancy rate. The preliminary report is available at

http://aspe.hhs.gov/hsp/05/abstinence

EC for Rape Survivors

Federal lawmakers are proposing legislation that would require federally funded hospitals to offer rape victims information and access to emergency contraception (EC). Sen. Hillary R. Clinton (D-N.Y.), Sen. Jon S. Corzine (D-N.J.), and Sen. Olympia J. Snowe (R-Maine) introduced the Compassionate Assistance for Rape Emergencies Act in the Senate (S. 1264). Companion legislation was introduced in the House (H.R. 2928) by Rep. Steve Rothman (D-N.J.) and Rep. Rob R. Simmons (R-Conn.). The bill would also mandate that patients be able to receive postexposure treatment for sexually transmitted diseases. In the meantime, another state has increased access to emergency contraception without a prescription. New Hampshire Gov. John Lynch (D) last month signed legislation that authorizes pharmacists to dispense EC without a prescription if they have a collaborative relationship with a physician.

Understanding Pap Tests

Low-income women lack a good understanding of Pap testing, according to a study published in the June issue of the Perspectives on Sexual and Reproductive Health. Researchers used a questionnaire on Pap testing to evaluate the knowledge of 338 women aged 18–50. More than half of the women answered “don't know” to questions about colposcopy and human papillomavirus. More than 60% gave incorrect answers to questions about the purpose of the Pap test. One-third of the women incorrectly answered that the purpose of the test was to treat cancer.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring every health plan serving Medicare patients to include all the drugs in six particular categories on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released last month, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—which include antidepressants, antipsychotics, anticonvulsants, anticancer drugs, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame.”

Stem Cell Research Fund

Following the example set by California, Connecticut has established a special fund devoted to fostering embryonic stem cell research. Gov. M. Jodi Rell (R) last month signed into law a bill to set up a 10-year, $100 million fund. The law bans human cloning and sets guidelines for the donation of embryos, embryonic stem cells, unfertilized eggs, and sperm. A 9-member stem cell research advisory committee will be responsible for administering grants from the fund in consultation with the commissioner of the department of public health and a 5-member stem cell research peer review committee. “This fund is a catalyst, intended to attract other investments and generate opportunities for growth,” Gov. Rell said in a statement.

Abstinence Education

Elementary and middle school children who participated in abstinence education programs were more likely to report being more supportive of abstinence and less supportive of teen sex than were peers who did not receive abstinence education, according to a preliminary report. Mathematica Policy Research Inc. last month announced the results of its 1-year follow-up comparing children in federally funded abstinence education programs with children who received the usual health, family life, and sex education services available in the school and community. The Mathematica study is part of a multiyear evaluation authorized by Congress. The abstinence programs also were linked with increased perceptions about the potential adverse consequences of teen and nonmarital sex. But the program and control groups had similar results related to views on marriage, self-concept, refusal skills, and communication with parents. “Students who are in these programs are recognizing that abstinence is a positive choice,” Michael O'Grady, Health and Human Services assistant secretary for planning and evaluation said in a statement. But Planned Parenthood Federation of America noted that abstinence-only-until-marriage programs have not proved effective in delaying sexual activity or reducing the teen pregnancy rate. The preliminary report is available at

http://aspe.hhs.gov/hsp/05/abstinence

EC for Rape Survivors

Federal lawmakers are proposing legislation that would require federally funded hospitals to offer rape victims information and access to emergency contraception (EC). Sen. Hillary R. Clinton (D-N.Y.), Sen. Jon S. Corzine (D-N.J.), and Sen. Olympia J. Snowe (R-Maine) introduced the Compassionate Assistance for Rape Emergencies Act in the Senate (S. 1264). Companion legislation was introduced in the House (H.R. 2928) by Rep. Steve Rothman (D-N.J.) and Rep. Rob R. Simmons (R-Conn.). The bill would also mandate that patients be able to receive postexposure treatment for sexually transmitted diseases. In the meantime, another state has increased access to emergency contraception without a prescription. New Hampshire Gov. John Lynch (D) last month signed legislation that authorizes pharmacists to dispense EC without a prescription if they have a collaborative relationship with a physician.

Understanding Pap Tests

Low-income women lack a good understanding of Pap testing, according to a study published in the June issue of the Perspectives on Sexual and Reproductive Health. Researchers used a questionnaire on Pap testing to evaluate the knowledge of 338 women aged 18–50. More than half of the women answered “don't know” to questions about colposcopy and human papillomavirus. More than 60% gave incorrect answers to questions about the purpose of the Pap test. One-third of the women incorrectly answered that the purpose of the test was to treat cancer.

Medicare Drug Benefit Explained

The Centers for Medicare and Medicaid Services is requiring every health plan serving Medicare patients to include all the drugs in six particular categories on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released last month, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—which include antidepressants, antipsychotics, anticonvulsants, anticancer drugs, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame.”

ATLANTA — Results from new research point to a possible alternative to stimulants for the treatment of attention-deficit hyperactivity disorder in children and adolescents.

Two phase III studies presented at the annual meeting of the American Psychiatric Association show that a once-daily pediatric formulation of modafinil is well tolerated and improves attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents.

Modafinil is currently marketed by Cephalon under the brand name Provigil in 100-mg and 200-mg strengths. Provigil is indicated for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorder.

The company, which funded the phase II trials, is seeking approval from the Food and Drug Administration to market modafinil in 85-mg, 170-mg, 255-mg, 340-mg, and 425-mg strengths. If approved, the drug would be indicated for treatment of ADHD in children and adolescents aged 6–17 years. The company is planning to launch the drug under the brand name Attenace by early 2006.

In one study, 189 patients with ADHD aged 6–17 years were randomized to a 7-week double-blind, fixed-dose treatment with either modafinil or placebo. This regimen was followed by a 2-week withdrawal period in which half of the modafinil-treated patients were placed on placebo without tapering, and half were continued on the drug, said Joseph Biederman, M.D., the lead investigator in the study and professor of psychiatry at Harvard University in Boston.

Modafinil was administered once daily, starting at 85 mg/day, and was rapidly titrated over 7–9 days to dosages of either 340 mg/day for patients who weighed less than 30 kg or 425 mg/day for patients who weighed 30 kg or more.

The results of the study were assessed using the school and home ADHD Rating Scale-IV total score change from baseline to last treatment visit.

After 1 week, the 125 modafinil-treated patients had significantly greater improvements in school scores, compared with the 64 placebo patients, and those results were maintained through week 7.

On the school scale, patients on modafinil experienced a 17.2-point drop in symptoms, compared with an 8.2-point drop for patients on placebo. Modafinil also significantly improved total scores from parents, compared with placebo.

The side effects included insomnia and appetite decrease. Overall, the side effects were generally mild and occurred at initiation of the treatment. There were two serious adverse events not associated with the trial, said Dr. Biederman, who is an advisory board member for Cephalon and receives research/grant support from the company.

The researchers also assessed ADHD symptoms and physical/emotional response after rapid discontinuation. During the 2-week withdrawal phase, there were no reported symptom rebounds, no adverse events related to withdrawal, and no physical or emotional responses.

Modafinil appears to work like a gentler stimulant, Dr. Biederman told this newspaper. The findings present possible new treatment options, he said. Although stimulants are effective, they are not universally effective. About 30%–40% of patients are nonresponsive to stimulants, and some patients also have tolerability problems.

Stimulants have the potential for acute deterioration and symptom rebound if treatment is interrupted or discontinued without tapering, he said.

In the second study, researchers considered the effect of a flexible dose of modafinil in children and adolescents.

The study included 198 patients aged 6–17 years who were started on a dose of 85 mg/day of modafinil, which was titrated over 22 days based on clinical effectiveness. The maximum dose was 425 mg/day with once-daily dosing, said James Swanson, Ph.D., of the University of California at Irvine Child Development Center, who was the lead investigator.

The results were assessed using the school and home ADHD Rating Scale-IV, the Clinical Global Impression of Improvement (CGI-I), and Test Variables of Attention (TOVA).

The home score showed a mean drop of 17.6 points in symptoms for the 131 patients receiving modafinil at a mean stable dose of 361 mg/day, compared with a 7.5-point drop in symptoms for the 67 patients on placebo. The improvement in the total school score was also significantly greater for modafinil patients, Dr. Swanson said.

Modafinil was shown to significantly improve inattention and hyperactivity/impulsivity, and there was an improvement in overall clinical condition and in the TOVA measurements of ADHD.

The researchers focused not only on decreasing symptoms of ADHD, but on increasing positive interaction and social skills, and they saw an increase in positive behaviors, he said.

The side effects included insomnia, headache, and appetite problems, which are similar to the side effects for stimulants, said Dr. Swanson, who is an advisory board member with Cephalon, receives research/grant support from the company, and is a member of the company's speakers' bureau.

ATLANTA — Results from new research point to a possible alternative to stimulants for the treatment of attention-deficit hyperactivity disorder in children and adolescents.

Two phase III studies presented at the annual meeting of the American Psychiatric Association show that a once-daily pediatric formulation of modafinil is well tolerated and improves attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents.

Modafinil is currently marketed by Cephalon under the brand name Provigil in 100-mg and 200-mg strengths. Provigil is indicated for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorder.

The company, which funded the phase II trials, is seeking approval from the Food and Drug Administration to market modafinil in 85-mg, 170-mg, 255-mg, 340-mg, and 425-mg strengths. If approved, the drug would be indicated for treatment of ADHD in children and adolescents aged 6–17 years. The company is planning to launch the drug under the brand name Attenace by early 2006.

In one study, 189 patients with ADHD aged 6–17 years were randomized to a 7-week double-blind, fixed-dose treatment with either modafinil or placebo. This regimen was followed by a 2-week withdrawal period in which half of the modafinil-treated patients were placed on placebo without tapering, and half were continued on the drug, said Joseph Biederman, M.D., the lead investigator in the study and professor of psychiatry at Harvard University in Boston.

Modafinil was administered once daily, starting at 85 mg/day, and was rapidly titrated over 7–9 days to dosages of either 340 mg/day for patients who weighed less than 30 kg or 425 mg/day for patients who weighed 30 kg or more.

The results of the study were assessed using the school and home ADHD Rating Scale-IV total score change from baseline to last treatment visit.

After 1 week, the 125 modafinil-treated patients had significantly greater improvements in school scores, compared with the 64 placebo patients, and those results were maintained through week 7.

On the school scale, patients on modafinil experienced a 17.2-point drop in symptoms, compared with an 8.2-point drop for patients on placebo. Modafinil also significantly improved total scores from parents, compared with placebo.

The side effects included insomnia and appetite decrease. Overall, the side effects were generally mild and occurred at initiation of the treatment. There were two serious adverse events not associated with the trial, said Dr. Biederman, who is an advisory board member for Cephalon and receives research/grant support from the company.

The researchers also assessed ADHD symptoms and physical/emotional response after rapid discontinuation. During the 2-week withdrawal phase, there were no reported symptom rebounds, no adverse events related to withdrawal, and no physical or emotional responses.

Modafinil appears to work like a gentler stimulant, Dr. Biederman told this newspaper. The findings present possible new treatment options, he said. Although stimulants are effective, they are not universally effective. About 30%–40% of patients are nonresponsive to stimulants, and some patients also have tolerability problems.

Stimulants have the potential for acute deterioration and symptom rebound if treatment is interrupted or discontinued without tapering, he said.

In the second study, researchers considered the effect of a flexible dose of modafinil in children and adolescents.

The study included 198 patients aged 6–17 years who were started on a dose of 85 mg/day of modafinil, which was titrated over 22 days based on clinical effectiveness. The maximum dose was 425 mg/day with once-daily dosing, said James Swanson, Ph.D., of the University of California at Irvine Child Development Center, who was the lead investigator.

The results were assessed using the school and home ADHD Rating Scale-IV, the Clinical Global Impression of Improvement (CGI-I), and Test Variables of Attention (TOVA).

The home score showed a mean drop of 17.6 points in symptoms for the 131 patients receiving modafinil at a mean stable dose of 361 mg/day, compared with a 7.5-point drop in symptoms for the 67 patients on placebo. The improvement in the total school score was also significantly greater for modafinil patients, Dr. Swanson said.

Modafinil was shown to significantly improve inattention and hyperactivity/impulsivity, and there was an improvement in overall clinical condition and in the TOVA measurements of ADHD.

The researchers focused not only on decreasing symptoms of ADHD, but on increasing positive interaction and social skills, and they saw an increase in positive behaviors, he said.

The side effects included insomnia, headache, and appetite problems, which are similar to the side effects for stimulants, said Dr. Swanson, who is an advisory board member with Cephalon, receives research/grant support from the company, and is a member of the company's speakers' bureau.

ATLANTA — Results from new research point to a possible alternative to stimulants for the treatment of attention-deficit hyperactivity disorder in children and adolescents.

Two phase III studies presented at the annual meeting of the American Psychiatric Association show that a once-daily pediatric formulation of modafinil is well tolerated and improves attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents.

Modafinil is currently marketed by Cephalon under the brand name Provigil in 100-mg and 200-mg strengths. Provigil is indicated for the treatment of excessive sleepiness associated with narcolepsy, obstructive sleep apnea, hypopnea syndrome, and shift work sleep disorder.

The company, which funded the phase II trials, is seeking approval from the Food and Drug Administration to market modafinil in 85-mg, 170-mg, 255-mg, 340-mg, and 425-mg strengths. If approved, the drug would be indicated for treatment of ADHD in children and adolescents aged 6–17 years. The company is planning to launch the drug under the brand name Attenace by early 2006.

In one study, 189 patients with ADHD aged 6–17 years were randomized to a 7-week double-blind, fixed-dose treatment with either modafinil or placebo. This regimen was followed by a 2-week withdrawal period in which half of the modafinil-treated patients were placed on placebo without tapering, and half were continued on the drug, said Joseph Biederman, M.D., the lead investigator in the study and professor of psychiatry at Harvard University in Boston.

Modafinil was administered once daily, starting at 85 mg/day, and was rapidly titrated over 7–9 days to dosages of either 340 mg/day for patients who weighed less than 30 kg or 425 mg/day for patients who weighed 30 kg or more.

The results of the study were assessed using the school and home ADHD Rating Scale-IV total score change from baseline to last treatment visit.

After 1 week, the 125 modafinil-treated patients had significantly greater improvements in school scores, compared with the 64 placebo patients, and those results were maintained through week 7.

On the school scale, patients on modafinil experienced a 17.2-point drop in symptoms, compared with an 8.2-point drop for patients on placebo. Modafinil also significantly improved total scores from parents, compared with placebo.

The side effects included insomnia and appetite decrease. Overall, the side effects were generally mild and occurred at initiation of the treatment. There were two serious adverse events not associated with the trial, said Dr. Biederman, who is an advisory board member for Cephalon and receives research/grant support from the company.

The researchers also assessed ADHD symptoms and physical/emotional response after rapid discontinuation. During the 2-week withdrawal phase, there were no reported symptom rebounds, no adverse events related to withdrawal, and no physical or emotional responses.

Modafinil appears to work like a gentler stimulant, Dr. Biederman told this newspaper. The findings present possible new treatment options, he said. Although stimulants are effective, they are not universally effective. About 30%–40% of patients are nonresponsive to stimulants, and some patients also have tolerability problems.

Stimulants have the potential for acute deterioration and symptom rebound if treatment is interrupted or discontinued without tapering, he said.

In the second study, researchers considered the effect of a flexible dose of modafinil in children and adolescents.

The study included 198 patients aged 6–17 years who were started on a dose of 85 mg/day of modafinil, which was titrated over 22 days based on clinical effectiveness. The maximum dose was 425 mg/day with once-daily dosing, said James Swanson, Ph.D., of the University of California at Irvine Child Development Center, who was the lead investigator.

The results were assessed using the school and home ADHD Rating Scale-IV, the Clinical Global Impression of Improvement (CGI-I), and Test Variables of Attention (TOVA).

The home score showed a mean drop of 17.6 points in symptoms for the 131 patients receiving modafinil at a mean stable dose of 361 mg/day, compared with a 7.5-point drop in symptoms for the 67 patients on placebo. The improvement in the total school score was also significantly greater for modafinil patients, Dr. Swanson said.

Modafinil was shown to significantly improve inattention and hyperactivity/impulsivity, and there was an improvement in overall clinical condition and in the TOVA measurements of ADHD.

The researchers focused not only on decreasing symptoms of ADHD, but on increasing positive interaction and social skills, and they saw an increase in positive behaviors, he said.

The side effects included insomnia, headache, and appetite problems, which are similar to the side effects for stimulants, said Dr. Swanson, who is an advisory board member with Cephalon, receives research/grant support from the company, and is a member of the company's speakers' bureau.

The federal government should use incentives—not unfunded mandates—to accelerate the adoption of health information technology, according to a panel of corporate executives.

And the government should coordinate the use of interoperable health information technology (IT) systems among its own agencies, the panel said.

The Health Information Technology Leadership Panel is made up of executives from companies that purchase a substantial amount of health care for their employees but have little direct involvement in the health care or IT sectors.

The corporate panel was convened by the Department of Health and Human Services late last year to gather ideas about how IT has been successfully adopted in other sectors and how that could be applied to the health care arena.

“The leadership panel asked the federal government to approach health care in a new way—as a catalyst for change and as a collaborator,” David J. Brailer, M.D., national coordinator for health information technology said in a statement.

The government should be looking for ways to help finance physician adoption of health IT and to allow providers to reap the benefits of the systems, the panel said.

The panel also recommended that the government be involved in promoting the development and adoption of health IT standards, as well as funding demonstrations and evaluations to learn implementation lessons and to disseminate best practices.

Private sector involvement should include the support of leading business organizations such as the National Business Group on Health and the Business Roundtable. This type of private sector involvement would result in wide public and political support for the adoption of health IT, the panel said.

Overall, the panel concluded the system-wide savings from implementing health IT exceed the costs. However, the report also notes that one of the challenges to adoption is that, currently, individual physicians assume the cost of IT without reaping the full savings.

“There are no surprises in the report,” said Mark Leavitt, M.D., medical director for the Healthcare Information and Management Systems Society.

However, the panel's findings help to reinforce that incentives are a big part of the effort to spur health IT adoption. And the report also points out that the health care industry is lagging behind other sectors in its adoption of IT, he said.

The report outlines an appropriate, but limited, role for the federal government, said Dr. Leavitt, who is also the chair of the Certification Commission for Healthcare Information—a voluntary, private-sector initiative to certify health IT products.

The federal government has a role in articulating a vision for the adoption of health IT systems and using its purchasing power to accelerate that adoption, he said. But federal officials should not overregulate the area or try to dictate the specific elements of IT systems.

The Health Information Technology Leadership Panel report is available online at www.hhs.gov/healthit/HITFinalReport.pdf

The federal government should use incentives—not unfunded mandates—to accelerate the adoption of health information technology, according to a panel of corporate executives.

And the government should coordinate the use of interoperable health information technology (IT) systems among its own agencies, the panel said.

The Health Information Technology Leadership Panel is made up of executives from companies that purchase a substantial amount of health care for their employees but have little direct involvement in the health care or IT sectors.

The corporate panel was convened by the Department of Health and Human Services late last year to gather ideas about how IT has been successfully adopted in other sectors and how that could be applied to the health care arena.

“The leadership panel asked the federal government to approach health care in a new way—as a catalyst for change and as a collaborator,” David J. Brailer, M.D., national coordinator for health information technology said in a statement.

The government should be looking for ways to help finance physician adoption of health IT and to allow providers to reap the benefits of the systems, the panel said.

The panel also recommended that the government be involved in promoting the development and adoption of health IT standards, as well as funding demonstrations and evaluations to learn implementation lessons and to disseminate best practices.

Private sector involvement should include the support of leading business organizations such as the National Business Group on Health and the Business Roundtable. This type of private sector involvement would result in wide public and political support for the adoption of health IT, the panel said.

Overall, the panel concluded the system-wide savings from implementing health IT exceed the costs. However, the report also notes that one of the challenges to adoption is that, currently, individual physicians assume the cost of IT without reaping the full savings.

“There are no surprises in the report,” said Mark Leavitt, M.D., medical director for the Healthcare Information and Management Systems Society.

However, the panel's findings help to reinforce that incentives are a big part of the effort to spur health IT adoption. And the report also points out that the health care industry is lagging behind other sectors in its adoption of IT, he said.

The report outlines an appropriate, but limited, role for the federal government, said Dr. Leavitt, who is also the chair of the Certification Commission for Healthcare Information—a voluntary, private-sector initiative to certify health IT products.

The federal government has a role in articulating a vision for the adoption of health IT systems and using its purchasing power to accelerate that adoption, he said. But federal officials should not overregulate the area or try to dictate the specific elements of IT systems.

The Health Information Technology Leadership Panel report is available online at www.hhs.gov/healthit/HITFinalReport.pdf

The federal government should use incentives—not unfunded mandates—to accelerate the adoption of health information technology, according to a panel of corporate executives.

And the government should coordinate the use of interoperable health information technology (IT) systems among its own agencies, the panel said.

The Health Information Technology Leadership Panel is made up of executives from companies that purchase a substantial amount of health care for their employees but have little direct involvement in the health care or IT sectors.

The corporate panel was convened by the Department of Health and Human Services late last year to gather ideas about how IT has been successfully adopted in other sectors and how that could be applied to the health care arena.

“The leadership panel asked the federal government to approach health care in a new way—as a catalyst for change and as a collaborator,” David J. Brailer, M.D., national coordinator for health information technology said in a statement.

The government should be looking for ways to help finance physician adoption of health IT and to allow providers to reap the benefits of the systems, the panel said.

The panel also recommended that the government be involved in promoting the development and adoption of health IT standards, as well as funding demonstrations and evaluations to learn implementation lessons and to disseminate best practices.

Private sector involvement should include the support of leading business organizations such as the National Business Group on Health and the Business Roundtable. This type of private sector involvement would result in wide public and political support for the adoption of health IT, the panel said.

Overall, the panel concluded the system-wide savings from implementing health IT exceed the costs. However, the report also notes that one of the challenges to adoption is that, currently, individual physicians assume the cost of IT without reaping the full savings.

“There are no surprises in the report,” said Mark Leavitt, M.D., medical director for the Healthcare Information and Management Systems Society.

However, the panel's findings help to reinforce that incentives are a big part of the effort to spur health IT adoption. And the report also points out that the health care industry is lagging behind other sectors in its adoption of IT, he said.

The report outlines an appropriate, but limited, role for the federal government, said Dr. Leavitt, who is also the chair of the Certification Commission for Healthcare Information—a voluntary, private-sector initiative to certify health IT products.

The federal government has a role in articulating a vision for the adoption of health IT systems and using its purchasing power to accelerate that adoption, he said. But federal officials should not overregulate the area or try to dictate the specific elements of IT systems.

The Health Information Technology Leadership Panel report is available online at www.hhs.gov/healthit/HITFinalReport.pdf

Drug Use During Pregnancy

A report from the Substance Abuse and Mental Health Services Administration says that 4.3% of pregnant women aged 15–44 years used an illicit drug in the past month, compared with 10.4% of nonpregnant women in this age group. SAMHSA extracted data from the 2002 and 2003 National Survey on Drug Use and Health to show that among pregnant women in this age group, 9.8% also reported drinking alcohol in the past month, and 4.1% reported binge alcohol use of five or more drinks on the same occasion on at least one day in the past month. The report is available online at www.oas.samhsa.gov

Florida's Parental Notification Law

After a court battle and a constitutional amendment, the requirement for parental notification when a minor seeks an abortion is now the law in Florida. The “Parental Notice of Abortion Act,” which was signed by Gov. Jeb Bush (R) in May, became effective July 1. The legislation requires a physician to notify the parent or guardian of a minor at least 48 hours before the termination of a pregnancy. The law allows for the courts to waive the notification process in cases of medical emergency. The physician can also determine that a medical emergency exists, and there is insufficient time to comply with notification requirements; however, he or she must document the reason for the medical necessity in the patient's medical record. The Florida legislature had previously enacted a parental notification bill, but it was struck down by the courts as unconstitutional. Supporters of the law reintroduced legislation this year after voters passed a constitutional amendment in November 2004 that would allow such legislation to become law.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital for noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Cloning Policy

The science of human cloning is moving faster than the public's understanding of it and government's ability to enact policy about it, according to a study from the Genetics and Public Policy Center. “Scientists have cloned cows, cats, and human embryos. Meanwhile, the public and policy makers have reached a political impasse—we're embroiled in a complex and divisive ethical and policy debate that too often is rushed and emotionally charged,” Kathy Hudson, Ph.D., director of center, said in a statement. For example, there is still no federal policy on human cloning, even though a number of bills have been introduced in Congress since 1997. Currently, five states ban all forms of cloning, and four have banned reproductive cloning but allow the technology to be used for research or therapeutic purposes. Three states restrict the use of state funds for research or therapeutic cloning. Conversely, California is using state funds to promote stem-cell research. And public opinion varies often depending on what terms are used and the context of the questions, the report said. The Genetics and Public Policy Center is a project of The Pew Charitable Trusts and Johns Hopkins University in Baltimore. The report is available online at www.dnapolicy.org

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, whereas that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan J. Cohen, M.D., president of the Association of American Medical Colleges.

Drug Use During Pregnancy

A report from the Substance Abuse and Mental Health Services Administration says that 4.3% of pregnant women aged 15–44 years used an illicit drug in the past month, compared with 10.4% of nonpregnant women in this age group. SAMHSA extracted data from the 2002 and 2003 National Survey on Drug Use and Health to show that among pregnant women in this age group, 9.8% also reported drinking alcohol in the past month, and 4.1% reported binge alcohol use of five or more drinks on the same occasion on at least one day in the past month. The report is available online at www.oas.samhsa.gov

Florida's Parental Notification Law

After a court battle and a constitutional amendment, the requirement for parental notification when a minor seeks an abortion is now the law in Florida. The “Parental Notice of Abortion Act,” which was signed by Gov. Jeb Bush (R) in May, became effective July 1. The legislation requires a physician to notify the parent or guardian of a minor at least 48 hours before the termination of a pregnancy. The law allows for the courts to waive the notification process in cases of medical emergency. The physician can also determine that a medical emergency exists, and there is insufficient time to comply with notification requirements; however, he or she must document the reason for the medical necessity in the patient's medical record. The Florida legislature had previously enacted a parental notification bill, but it was struck down by the courts as unconstitutional. Supporters of the law reintroduced legislation this year after voters passed a constitutional amendment in November 2004 that would allow such legislation to become law.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital for noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Cloning Policy

The science of human cloning is moving faster than the public's understanding of it and government's ability to enact policy about it, according to a study from the Genetics and Public Policy Center. “Scientists have cloned cows, cats, and human embryos. Meanwhile, the public and policy makers have reached a political impasse—we're embroiled in a complex and divisive ethical and policy debate that too often is rushed and emotionally charged,” Kathy Hudson, Ph.D., director of center, said in a statement. For example, there is still no federal policy on human cloning, even though a number of bills have been introduced in Congress since 1997. Currently, five states ban all forms of cloning, and four have banned reproductive cloning but allow the technology to be used for research or therapeutic purposes. Three states restrict the use of state funds for research or therapeutic cloning. Conversely, California is using state funds to promote stem-cell research. And public opinion varies often depending on what terms are used and the context of the questions, the report said. The Genetics and Public Policy Center is a project of The Pew Charitable Trusts and Johns Hopkins University in Baltimore. The report is available online at www.dnapolicy.org

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, whereas that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan J. Cohen, M.D., president of the Association of American Medical Colleges.

Drug Use During Pregnancy

A report from the Substance Abuse and Mental Health Services Administration says that 4.3% of pregnant women aged 15–44 years used an illicit drug in the past month, compared with 10.4% of nonpregnant women in this age group. SAMHSA extracted data from the 2002 and 2003 National Survey on Drug Use and Health to show that among pregnant women in this age group, 9.8% also reported drinking alcohol in the past month, and 4.1% reported binge alcohol use of five or more drinks on the same occasion on at least one day in the past month. The report is available online at www.oas.samhsa.gov

Florida's Parental Notification Law

After a court battle and a constitutional amendment, the requirement for parental notification when a minor seeks an abortion is now the law in Florida. The “Parental Notice of Abortion Act,” which was signed by Gov. Jeb Bush (R) in May, became effective July 1. The legislation requires a physician to notify the parent or guardian of a minor at least 48 hours before the termination of a pregnancy. The law allows for the courts to waive the notification process in cases of medical emergency. The physician can also determine that a medical emergency exists, and there is insufficient time to comply with notification requirements; however, he or she must document the reason for the medical necessity in the patient's medical record. The Florida legislature had previously enacted a parental notification bill, but it was struck down by the courts as unconstitutional. Supporters of the law reintroduced legislation this year after voters passed a constitutional amendment in November 2004 that would allow such legislation to become law.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. In May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital for noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Cloning Policy

The science of human cloning is moving faster than the public's understanding of it and government's ability to enact policy about it, according to a study from the Genetics and Public Policy Center. “Scientists have cloned cows, cats, and human embryos. Meanwhile, the public and policy makers have reached a political impasse—we're embroiled in a complex and divisive ethical and policy debate that too often is rushed and emotionally charged,” Kathy Hudson, Ph.D., director of center, said in a statement. For example, there is still no federal policy on human cloning, even though a number of bills have been introduced in Congress since 1997. Currently, five states ban all forms of cloning, and four have banned reproductive cloning but allow the technology to be used for research or therapeutic purposes. Three states restrict the use of state funds for research or therapeutic cloning. Conversely, California is using state funds to promote stem-cell research. And public opinion varies often depending on what terms are used and the context of the questions, the report said. The Genetics and Public Policy Center is a project of The Pew Charitable Trusts and Johns Hopkins University in Baltimore. The report is available online at www.dnapolicy.org

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Of those who responded to the survey, 20% recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, whereas that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan J. Cohen, M.D., president of the Association of American Medical Colleges.

Progress for Project 100

Officials at the U.S. Bone and Joint Decade are moving forward with their initiative to increase the amount of musculoskeletal course work required in medical schools. The effort, called Project 100, aims to get 100% of medical schools to incorporate musculoskeletal medicine into their core curricula. Officials at the Decade are working with the National Board of Medical Examiners to create a subject test in musculoskeletal medicine that would quiz students in broad areas of the discipline. The idea is that the creation of the test could make it easier for schools to offer courses in musculoskeletal medicine. The goal is to make the subject test happen this year, said Decade spokesman Toby King. In addition, the Association of American Medical Colleges Objectives Project Panel in Musculoskeletal Medicine is finalizing a white paper report on the best education objectives for the discipline.

Bone Fracture Coverage

Medicare officials plan to begin providing coverage for noninvasive ultrasound stimulation for the treatment of nonunion bone fractures prior to a surgical intervention. Officials at the Centers for Medicare and Medicaid Services (CMS) plan to change the Medicare National Coverage Determinations Manual to remove the requirement that a patient fail at least one surgical intervention before the ultrasound stimulation can be used. The agency took up a review of those requirements at the request of Smith & Nephew Inc., the manufacturer of an ultrasound bone healing system. Based on the scientific literature and expert opinion, the agency determined that there was adequate evidence to support using the procedure prior to surgery; however, CMS plans to continue examining the overall net health benefits of the procedure.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Pay-for-Performance Shortfalls

The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Studies on Gender Differences Stall

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding, but they are encouraged that some NIH institutes have established mechanisms to foster this research.

Progress for Project 100

Officials at the U.S. Bone and Joint Decade are moving forward with their initiative to increase the amount of musculoskeletal course work required in medical schools. The effort, called Project 100, aims to get 100% of medical schools to incorporate musculoskeletal medicine into their core curricula. Officials at the Decade are working with the National Board of Medical Examiners to create a subject test in musculoskeletal medicine that would quiz students in broad areas of the discipline. The idea is that the creation of the test could make it easier for schools to offer courses in musculoskeletal medicine. The goal is to make the subject test happen this year, said Decade spokesman Toby King. In addition, the Association of American Medical Colleges Objectives Project Panel in Musculoskeletal Medicine is finalizing a white paper report on the best education objectives for the discipline.

Bone Fracture Coverage

Medicare officials plan to begin providing coverage for noninvasive ultrasound stimulation for the treatment of nonunion bone fractures prior to a surgical intervention. Officials at the Centers for Medicare and Medicaid Services (CMS) plan to change the Medicare National Coverage Determinations Manual to remove the requirement that a patient fail at least one surgical intervention before the ultrasound stimulation can be used. The agency took up a review of those requirements at the request of Smith & Nephew Inc., the manufacturer of an ultrasound bone healing system. Based on the scientific literature and expert opinion, the agency determined that there was adequate evidence to support using the procedure prior to surgery; however, CMS plans to continue examining the overall net health benefits of the procedure.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Pay-for-Performance Shortfalls

The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Studies on Gender Differences Stall

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding, but they are encouraged that some NIH institutes have established mechanisms to foster this research.

Progress for Project 100

Officials at the U.S. Bone and Joint Decade are moving forward with their initiative to increase the amount of musculoskeletal course work required in medical schools. The effort, called Project 100, aims to get 100% of medical schools to incorporate musculoskeletal medicine into their core curricula. Officials at the Decade are working with the National Board of Medical Examiners to create a subject test in musculoskeletal medicine that would quiz students in broad areas of the discipline. The idea is that the creation of the test could make it easier for schools to offer courses in musculoskeletal medicine. The goal is to make the subject test happen this year, said Decade spokesman Toby King. In addition, the Association of American Medical Colleges Objectives Project Panel in Musculoskeletal Medicine is finalizing a white paper report on the best education objectives for the discipline.

Bone Fracture Coverage

Medicare officials plan to begin providing coverage for noninvasive ultrasound stimulation for the treatment of nonunion bone fractures prior to a surgical intervention. Officials at the Centers for Medicare and Medicaid Services (CMS) plan to change the Medicare National Coverage Determinations Manual to remove the requirement that a patient fail at least one surgical intervention before the ultrasound stimulation can be used. The agency took up a review of those requirements at the request of Smith & Nephew Inc., the manufacturer of an ultrasound bone healing system. Based on the scientific literature and expert opinion, the agency determined that there was adequate evidence to support using the procedure prior to surgery; however, CMS plans to continue examining the overall net health benefits of the procedure.

The Chosen Profession

“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.

Illinois Malpractice Bill

Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.

Pay-for-Performance Shortfalls

The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.

Studies on Gender Differences Stall

Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding, but they are encouraged that some NIH institutes have established mechanisms to foster this research.

Bill to Thwart Medicare Cuts

A bipartisan bill (H.R. 2356) introduced by Rep. Clay Shaw (R-Fla.) and Rep. Ben Cardin (D-Md.) seeks to halt impending cuts to Medicare physician payments and replace the flawed formula that determines those payments. Following up on a recommendation of the Medicare Payment Advisory Commission, the bill would increase payments by no less than 2.7% in 2006. It would also repeal the sustainable growth rate adjustment, replacing it with a method “that ensures adequate and appropriate payments as well as stable updates for Medicare providers,” Rep. Cardin said in a statement. Physicians face a 4.3% cut in Medicare payments in 2006 and subsequent cuts totaling 30% from 2007 to 2012 if the formula isn't fixed. The bill was referred to the House Ways and Means and Energy and Commerce committees. A similar bill introduced in the Senate (S. 1081) would provide a positive update to Medicare payments for 2 years.

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking the Centers for Medicare and Medicaid Services to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Obesity is significantly associated with 5 of the top 10 self-reported health conditions of Medicare beneficiaries, the group wrote in its request to CMS, which currently covers gastric bypass surgery if it is medically appropriate and if it is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking CMS to expand its coverage to include laparoscopic procedures. ASBS also pointed to the Medicare Coverage Advisory Committee's favorable vote on the safety and efficacy of bariatric surgery for severely obese patients.

Smoking Rates Decline

The percentage of U.S. adults who smoke cigarettes continues to decline, according to the Centers for Disease Control and Prevention. About 21.6% of U.S. adults are current smokers, which is a drop from the 22.5% who were smokers in 2002 and the 22.8% in 2001, according to data from the 2003 National Health Interview Survey. And for a second straight year, the number of people who have quit smoking—about 46 million—outnumber the 45 million who continue to smoke. The study, which was published in the Morbidity and Mortality Weekly Report, also noted that more interventions are needed to help address the remaining disparities in smoking by age, race and ethnicity, and educational levels.

Healthy Eating

Tweens can improve their eating habits if given the right education, according to a study in the June issue of Pediatrics. The study found that children aged 8–10 years who had attended a behavior-oriented nutrition education program and were taught to follow a specific diet adopted better eating habits over several years than children who received only general nutrition information. The results are based on a review of dietary recalls from 595 children aged 8–10 who had high blood cholesterol levels at the start of the study. “These new findings offer valuable lessons for finding effective ways to help children develop healthier eating habits—a critical need in light of the rising rates of obesity and related conditions among children,” said Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute, which sponsored the study.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Studies on Gender Differences Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, said the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of of NIH grants, and in 2000–2003, none of the NIH institutes had devoted more than 8% of its funded grants to such research. Also during that time, an average of just 3% of grants focused on gender differences, according to an SWHR report. SWHR officials said they had hoped to see increasing levels of funding into gender differences, but they are encouraged that some NIH institutes have established mechanisms to foster this research.

Bill to Thwart Medicare Cuts

A bipartisan bill (H.R. 2356) introduced by Rep. Clay Shaw (R-Fla.) and Rep. Ben Cardin (D-Md.) seeks to halt impending cuts to Medicare physician payments and replace the flawed formula that determines those payments. Following up on a recommendation of the Medicare Payment Advisory Commission, the bill would increase payments by no less than 2.7% in 2006. It would also repeal the sustainable growth rate adjustment, replacing it with a method “that ensures adequate and appropriate payments as well as stable updates for Medicare providers,” Rep. Cardin said in a statement. Physicians face a 4.3% cut in Medicare payments in 2006 and subsequent cuts totaling 30% from 2007 to 2012 if the formula isn't fixed. The bill was referred to the House Ways and Means and Energy and Commerce committees. A similar bill introduced in the Senate (S. 1081) would provide a positive update to Medicare payments for 2 years.

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking the Centers for Medicare and Medicaid Services to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Obesity is significantly associated with 5 of the top 10 self-reported health conditions of Medicare beneficiaries, the group wrote in its request to CMS, which currently covers gastric bypass surgery if it is medically appropriate and if it is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking CMS to expand its coverage to include laparoscopic procedures. ASBS also pointed to the Medicare Coverage Advisory Committee's favorable vote on the safety and efficacy of bariatric surgery for severely obese patients.

Smoking Rates Decline

The percentage of U.S. adults who smoke cigarettes continues to decline, according to the Centers for Disease Control and Prevention. About 21.6% of U.S. adults are current smokers, which is a drop from the 22.5% who were smokers in 2002 and the 22.8% in 2001, according to data from the 2003 National Health Interview Survey. And for a second straight year, the number of people who have quit smoking—about 46 million—outnumber the 45 million who continue to smoke. The study, which was published in the Morbidity and Mortality Weekly Report, also noted that more interventions are needed to help address the remaining disparities in smoking by age, race and ethnicity, and educational levels.

Healthy Eating

Tweens can improve their eating habits if given the right education, according to a study in the June issue of Pediatrics. The study found that children aged 8–10 years who had attended a behavior-oriented nutrition education program and were taught to follow a specific diet adopted better eating habits over several years than children who received only general nutrition information. The results are based on a review of dietary recalls from 595 children aged 8–10 who had high blood cholesterol levels at the start of the study. “These new findings offer valuable lessons for finding effective ways to help children develop healthier eating habits—a critical need in light of the rising rates of obesity and related conditions among children,” said Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute, which sponsored the study.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Studies on Gender Differences Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, said the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of of NIH grants, and in 2000–2003, none of the NIH institutes had devoted more than 8% of its funded grants to such research. Also during that time, an average of just 3% of grants focused on gender differences, according to an SWHR report. SWHR officials said they had hoped to see increasing levels of funding into gender differences, but they are encouraged that some NIH institutes have established mechanisms to foster this research.

Bill to Thwart Medicare Cuts

A bipartisan bill (H.R. 2356) introduced by Rep. Clay Shaw (R-Fla.) and Rep. Ben Cardin (D-Md.) seeks to halt impending cuts to Medicare physician payments and replace the flawed formula that determines those payments. Following up on a recommendation of the Medicare Payment Advisory Commission, the bill would increase payments by no less than 2.7% in 2006. It would also repeal the sustainable growth rate adjustment, replacing it with a method “that ensures adequate and appropriate payments as well as stable updates for Medicare providers,” Rep. Cardin said in a statement. Physicians face a 4.3% cut in Medicare payments in 2006 and subsequent cuts totaling 30% from 2007 to 2012 if the formula isn't fixed. The bill was referred to the House Ways and Means and Energy and Commerce committees. A similar bill introduced in the Senate (S. 1081) would provide a positive update to Medicare payments for 2 years.

Weight Loss Surgery Coverage

The American Society for Bariatric Surgery (ASBS) is asking the Centers for Medicare and Medicaid Services to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Obesity is significantly associated with 5 of the top 10 self-reported health conditions of Medicare beneficiaries, the group wrote in its request to CMS, which currently covers gastric bypass surgery if it is medically appropriate and if it is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking CMS to expand its coverage to include laparoscopic procedures. ASBS also pointed to the Medicare Coverage Advisory Committee's favorable vote on the safety and efficacy of bariatric surgery for severely obese patients.

Smoking Rates Decline

The percentage of U.S. adults who smoke cigarettes continues to decline, according to the Centers for Disease Control and Prevention. About 21.6% of U.S. adults are current smokers, which is a drop from the 22.5% who were smokers in 2002 and the 22.8% in 2001, according to data from the 2003 National Health Interview Survey. And for a second straight year, the number of people who have quit smoking—about 46 million—outnumber the 45 million who continue to smoke. The study, which was published in the Morbidity and Mortality Weekly Report, also noted that more interventions are needed to help address the remaining disparities in smoking by age, race and ethnicity, and educational levels.

Healthy Eating

Tweens can improve their eating habits if given the right education, according to a study in the June issue of Pediatrics. The study found that children aged 8–10 years who had attended a behavior-oriented nutrition education program and were taught to follow a specific diet adopted better eating habits over several years than children who received only general nutrition information. The results are based on a review of dietary recalls from 595 children aged 8–10 who had high blood cholesterol levels at the start of the study. “These new findings offer valuable lessons for finding effective ways to help children develop healthier eating habits—a critical need in light of the rising rates of obesity and related conditions among children,” said Elizabeth G. Nabel, M.D., director of the National Heart, Lung, and Blood Institute, which sponsored the study.

Medicaid Commission

To strengthen Medicaid, the Department of Health and Human Services established an advisory commission to identify reforms necessary to stabilize the program. The commission must submit two reports to HHS Secretary Mike Leavitt. The first, due Sept. 1, will outline recommendations for Medicaid to save $10 billion over the next 5 years, targeting potential long-term enhancements and performance goals. The second, due Dec. 31, 2006, will make recommendations to help ensure Medicaid's long-term sustainability. Secretary Leavitt plans to appoint up to 15 voting members to the commission with expertise in health care policy, finance, or administration.

Studies on Gender Differences Stalled

Research into gender differences is receiving limited funding at the National Institutes of Health, said the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of of NIH grants, and in 2000–2003, none of the NIH institutes had devoted more than 8% of its funded grants to such research. Also during that time, an average of just 3% of grants focused on gender differences, according to an SWHR report. SWHR officials said they had hoped to see increasing levels of funding into gender differences, but they are encouraged that some NIH institutes have established mechanisms to foster this research.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

“Paper is still the dominant mode of data collection,” William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a Webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper. “We're seeing a steady movement toward a paperless office,” Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

The private industry is working to create a voluntary certification process for electronic health record products.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

“Paper is still the dominant mode of data collection,” William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a Webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper. “We're seeing a steady movement toward a paperless office,” Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

The private industry is working to create a voluntary certification process for electronic health record products.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

Most group practices are still using paper medical records and charts, according to preliminary results from a survey by the Medical Group Management Association.

“Paper is still the dominant mode of data collection,” William F. Jessee, M.D., president and CEO of the Medical Group Management Association (MGMA) said in a Webcast sponsored by the group.

But the scale is tipping, he said. About 20% of group practices report that they have an electronic health record of some kind. In addition, 8% have a dictation and transcription system for physician notes, combined with a document imaging management system for information received on paper. “We're seeing a steady movement toward a paperless office,” Dr. Jessee said.

The preliminary findings are based on responses from about 1,000 group practices that responded to an electronic questionnaire. The second stage of the survey will include mailing more than 16,000 printed questionnaires to a sample of group practices across the country. Complete results from the survey are expected this spring.

The survey is part of a contract from the Agency for Healthcare Research and Quality to MGMA's Center for Research and the University of Minnesota. The purpose of the contract is to provide a baseline that describes the use of new information technologies in medical groups.

Some of the challenges physicians face in making the transition to an electronic health record include knowing which product to buy, how to go about buying it, and how to implement the system, said David Brailer, M.D., national health information technology coordinator for the Department of Health and Human Services.

The private industry is working to create a voluntary certification process for electronic health record products.

Dr. Brailer also plans to explore interoperability issues. It's not enough to have every practice using an electronic health record, he said, they also have to be able to share data with other providers and institutions.

ALBANY, N.Y. — The New York State Academy of Family Physicians' Congress of Delegates last month staked out positions on managed care reform and a range of controversial topics in medicine, including abortion and access to emergency contraception.

The Congress of Delegates also voiced frustration over the numerous administrative requirements from managed care companies and the lack of reimbursement for those tasks.

“We feel that we're kind of drowning here,” said Raymond Ebarb, M.D., of West Sayville.

The delegates voted that the state academy should partner with other state medical societies to lobby the government to encourage health insurance carriers to compensate family physicians for all work they perform for patients.

The delegates cited referrals to specialists, processing appeals for patients who have been declined coverage, preauthorization for pharmaceuticals, and diagnostic tests as examples.

They also voted to ask the American Academy of Family Physicians to advocate for the same relief at the federal level.

Paul Salizberg, M.D., who practices in Callicoon, said that he spends 1–2 hours a day on paperwork and he even had to hire more staff to keep up with the requirements from insurers. “We're not getting reimbursed for this,” he said.

Lawmakers need to at least be made aware of the problem, Dr. Ebarb said, so that they can put pressure on payers to make changes.

The delegates also called for the creation of a confidential national clearinghouse for collection of information regarding undesirable practices by health care insurers in an effort to identify trends and support the development of effective policy.

And the delegates voted to support the establishment of a formal advocacy process to support any family physician who is threatened with the restriction of his or her practice, reduction in compensation, termination, or exclusion from a health care organization. The state academy will present these ideas to the AAFP's national Congress of Delegates this fall in San Francisco.

“We desperately need some intervention and some support,” said Linda Prine, M.D., of New York City.

The state academy also went on record opposing measures that interfere with the prompt dispensing of emergency contraception. The delegates voted to recommend that the state academy collaborate with pharmacists to eliminate barriers to prompt access to all types of contraceptives.

And the delegates voted to refer the issue to the AAFP congress for national action.

Emefre Udo, M.D., of Brooklyn, said she introduced the resolution because of news reports that pharmacists across the country had refused to dispense both emergency contraception and birth control.

The delegates also debated scope of practice and residency training issues related to abortion.

There was widespread agreement among the delegates to recommend that New York family medicine residencies provide residents with annual up-to-date lectures in evidence-based contraception and pregnancy options counseling.

However, there was extensive debate prior to the vote to approve a resolution recommending that family medicine residencies make available, when possible, abortion training for those residents desiring it.

“The residents want this education,” said Dr. Prine.

However, she said, most residency programs don't have an existing arrangement with another program that allows residents to get abortion training off site. In fact, residents often go through a lot of barriers to get abortion training, Dr. Udo said.

Supporters also pointed out the resolution was a recommendation only, not a requirement that programs include abortion training. But opponents said the recommendation would not be received well within the state's many Catholic teaching hospitals.

Philip Kaplan, M.D., of Manlius, said the resolution would only serve to make enemies out of institutions opposed to abortion. “It will change nothing in a tangible way. We will simply raise a flag of divisiveness.”

The delegates also staked a claim that reproductive health care, including abortions, is part of the scope of practice in family medicine.

The group voted to ask the AAFP to encourage state chapters to work with local professional liability insurers and regulators for fair rates for family physicians who provide contraceptive care, maternity care, medical and early aspiration termination of pregnancy care, and other services.

They also urged the AAFP to encourage state chapters to work with local payers to ensure fair and equitable reimbursement for these services.

The resolutions are needed, according to Dr. Prine, because some liability insurers are charging prohibitively high premiums for family physicians who perform abortions or refusing to provide coverage for those procedures. “This continues to plague us,” she said.

ALBANY, N.Y. — The New York State Academy of Family Physicians' Congress of Delegates last month staked out positions on managed care reform and a range of controversial topics in medicine, including abortion and access to emergency contraception.

The Congress of Delegates also voiced frustration over the numerous administrative requirements from managed care companies and the lack of reimbursement for those tasks.

“We feel that we're kind of drowning here,” said Raymond Ebarb, M.D., of West Sayville.

The delegates voted that the state academy should partner with other state medical societies to lobby the government to encourage health insurance carriers to compensate family physicians for all work they perform for patients.

The delegates cited referrals to specialists, processing appeals for patients who have been declined coverage, preauthorization for pharmaceuticals, and diagnostic tests as examples.

They also voted to ask the American Academy of Family Physicians to advocate for the same relief at the federal level.

Paul Salizberg, M.D., who practices in Callicoon, said that he spends 1–2 hours a day on paperwork and he even had to hire more staff to keep up with the requirements from insurers. “We're not getting reimbursed for this,” he said.

Lawmakers need to at least be made aware of the problem, Dr. Ebarb said, so that they can put pressure on payers to make changes.

The delegates also called for the creation of a confidential national clearinghouse for collection of information regarding undesirable practices by health care insurers in an effort to identify trends and support the development of effective policy.

And the delegates voted to support the establishment of a formal advocacy process to support any family physician who is threatened with the restriction of his or her practice, reduction in compensation, termination, or exclusion from a health care organization. The state academy will present these ideas to the AAFP's national Congress of Delegates this fall in San Francisco.

“We desperately need some intervention and some support,” said Linda Prine, M.D., of New York City.

The state academy also went on record opposing measures that interfere with the prompt dispensing of emergency contraception. The delegates voted to recommend that the state academy collaborate with pharmacists to eliminate barriers to prompt access to all types of contraceptives.

And the delegates voted to refer the issue to the AAFP congress for national action.

Emefre Udo, M.D., of Brooklyn, said she introduced the resolution because of news reports that pharmacists across the country had refused to dispense both emergency contraception and birth control.

The delegates also debated scope of practice and residency training issues related to abortion.

There was widespread agreement among the delegates to recommend that New York family medicine residencies provide residents with annual up-to-date lectures in evidence-based contraception and pregnancy options counseling.

However, there was extensive debate prior to the vote to approve a resolution recommending that family medicine residencies make available, when possible, abortion training for those residents desiring it.

“The residents want this education,” said Dr. Prine.

However, she said, most residency programs don't have an existing arrangement with another program that allows residents to get abortion training off site. In fact, residents often go through a lot of barriers to get abortion training, Dr. Udo said.

Supporters also pointed out the resolution was a recommendation only, not a requirement that programs include abortion training. But opponents said the recommendation would not be received well within the state's many Catholic teaching hospitals.

Philip Kaplan, M.D., of Manlius, said the resolution would only serve to make enemies out of institutions opposed to abortion. “It will change nothing in a tangible way. We will simply raise a flag of divisiveness.”

The delegates also staked a claim that reproductive health care, including abortions, is part of the scope of practice in family medicine.

The group voted to ask the AAFP to encourage state chapters to work with local professional liability insurers and regulators for fair rates for family physicians who provide contraceptive care, maternity care, medical and early aspiration termination of pregnancy care, and other services.

They also urged the AAFP to encourage state chapters to work with local payers to ensure fair and equitable reimbursement for these services.

The resolutions are needed, according to Dr. Prine, because some liability insurers are charging prohibitively high premiums for family physicians who perform abortions or refusing to provide coverage for those procedures. “This continues to plague us,” she said.

ALBANY, N.Y. — The New York State Academy of Family Physicians' Congress of Delegates last month staked out positions on managed care reform and a range of controversial topics in medicine, including abortion and access to emergency contraception.

The Congress of Delegates also voiced frustration over the numerous administrative requirements from managed care companies and the lack of reimbursement for those tasks.

“We feel that we're kind of drowning here,” said Raymond Ebarb, M.D., of West Sayville.

The delegates voted that the state academy should partner with other state medical societies to lobby the government to encourage health insurance carriers to compensate family physicians for all work they perform for patients.

The delegates cited referrals to specialists, processing appeals for patients who have been declined coverage, preauthorization for pharmaceuticals, and diagnostic tests as examples.

They also voted to ask the American Academy of Family Physicians to advocate for the same relief at the federal level.

Paul Salizberg, M.D., who practices in Callicoon, said that he spends 1–2 hours a day on paperwork and he even had to hire more staff to keep up with the requirements from insurers. “We're not getting reimbursed for this,” he said.

Lawmakers need to at least be made aware of the problem, Dr. Ebarb said, so that they can put pressure on payers to make changes.

The delegates also called for the creation of a confidential national clearinghouse for collection of information regarding undesirable practices by health care insurers in an effort to identify trends and support the development of effective policy.

And the delegates voted to support the establishment of a formal advocacy process to support any family physician who is threatened with the restriction of his or her practice, reduction in compensation, termination, or exclusion from a health care organization. The state academy will present these ideas to the AAFP's national Congress of Delegates this fall in San Francisco.

“We desperately need some intervention and some support,” said Linda Prine, M.D., of New York City.

The state academy also went on record opposing measures that interfere with the prompt dispensing of emergency contraception. The delegates voted to recommend that the state academy collaborate with pharmacists to eliminate barriers to prompt access to all types of contraceptives.

And the delegates voted to refer the issue to the AAFP congress for national action.

Emefre Udo, M.D., of Brooklyn, said she introduced the resolution because of news reports that pharmacists across the country had refused to dispense both emergency contraception and birth control.

The delegates also debated scope of practice and residency training issues related to abortion.

There was widespread agreement among the delegates to recommend that New York family medicine residencies provide residents with annual up-to-date lectures in evidence-based contraception and pregnancy options counseling.

However, there was extensive debate prior to the vote to approve a resolution recommending that family medicine residencies make available, when possible, abortion training for those residents desiring it.

“The residents want this education,” said Dr. Prine.

However, she said, most residency programs don't have an existing arrangement with another program that allows residents to get abortion training off site. In fact, residents often go through a lot of barriers to get abortion training, Dr. Udo said.

Supporters also pointed out the resolution was a recommendation only, not a requirement that programs include abortion training. But opponents said the recommendation would not be received well within the state's many Catholic teaching hospitals.

Philip Kaplan, M.D., of Manlius, said the resolution would only serve to make enemies out of institutions opposed to abortion. “It will change nothing in a tangible way. We will simply raise a flag of divisiveness.”

The delegates also staked a claim that reproductive health care, including abortions, is part of the scope of practice in family medicine.

The group voted to ask the AAFP to encourage state chapters to work with local professional liability insurers and regulators for fair rates for family physicians who provide contraceptive care, maternity care, medical and early aspiration termination of pregnancy care, and other services.

They also urged the AAFP to encourage state chapters to work with local payers to ensure fair and equitable reimbursement for these services.

The resolutions are needed, according to Dr. Prine, because some liability insurers are charging prohibitively high premiums for family physicians who perform abortions or refusing to provide coverage for those procedures. “This continues to plague us,” she said.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

“Nothing is more important to me than preserving the trust of the public in NIH,” Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. “It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries.”

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

“This new policy is an extension of a profession-wide examination of physicians' relationships to industry,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

The new policy was praised by the Association of American Medical Colleges. “The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists,” AAMC President Jordan J. Cohen, M.D., said in statement.

“We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary,” he said.

Officials at NIH also announced a new policy aimed at speeding the public's access to scientific articles that result from NIH-funded research. Under the policy, the agency is calling on scientists to voluntarily release manuscripts supported by NIH to the public within a year of peer-reviewed publication.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

“Nothing is more important to me than preserving the trust of the public in NIH,” Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. “It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries.”

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

“This new policy is an extension of a profession-wide examination of physicians' relationships to industry,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

The new policy was praised by the Association of American Medical Colleges. “The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists,” AAMC President Jordan J. Cohen, M.D., said in statement.

“We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary,” he said.

Officials at NIH also announced a new policy aimed at speeding the public's access to scientific articles that result from NIH-funded research. Under the policy, the agency is calling on scientists to voluntarily release manuscripts supported by NIH to the public within a year of peer-reviewed publication.

Officials at the National Institutes of Health are tightening restrictions on outside consulting arrangements with industry after more than a year of investigations turned up potential conflicts of interest.

“Nothing is more important to me than preserving the trust of the public in NIH,” Elias A. Zerhouni, M.D., NIH director, said in a statement announcing the new ethics rules. “It is unfortunate that the activities of a few employees have tainted the stellar reputation of the many thousands of NIH scientists who have never compromised their integrity and have selflessly served the nation with great distinction through their discoveries.”

The new policy bars all NIH employees from engaging in compensated or uncompensated employment or consulting relationships with those organizations that are substantially affected by NIH decisions. Such organizations include pharmaceutical manufacturers, biotechnology companies, support research institutions, health care providers and insurers, and related trade and professional associations.

The policy also prohibits NIH employees from participating in compensated teaching, speaking, writing, or editing with these affected organizations.

Further, NIH employees are prohibited from self-employment activities that involve the sale or promotion of services or products from these organizations.

However, employees are allowed to teach courses that require multiple presentations and are part of an established curriculum at a university or college. They can also teach, speak, or write as part of a continuing education program. However, if the funding for the program comes from a substantially affected organization, like a drug company, it must be funded by an unrestricted grant.

NIH employees can also author articles, chapters, and textbooks that are subject to peer review provided that funding from affected organizations is in the form of unrestricted contributions.

Under the new policy, NIH employees are also allowed to continue clinical care to individual patients.

The new regulation also takes aim at stock ownership. NIH employees who are required to file financial disclosure statements are prohibited from acquiring or holding financial interests in affected organizations including biotechnology, pharmaceutical, and medical device companies. All other NIH employees are subject to a $15,000 cap on such holdings.

“This new policy is an extension of a profession-wide examination of physicians' relationships to industry,” said William E. Golden, M.D., professor of medicine and public health at the University of Arkansas in Little Rock.

Medical schools are likely to be the next major institutions to seek out greater transparency in the relationships between their faculty members and industry, Dr. Golden predicted.

The interim final regulation was developed by the Department of Health and Human Services with the Office of Government Ethics and went into effect immediately.

The new policy comes after about a year of internal NIH investigations as well as congressional inquiries into consulting arrangements between NIH employees and outside companies. NIH officials had previously proposed a 1-year moratorium on all outside consulting arrangements.

The new policy was praised by the Association of American Medical Colleges. “The rules are clear and unambiguous and will enhance the public's confidence in the integrity and dedication of NIH employees and scientists,” AAMC President Jordan J. Cohen, M.D., said in statement.

“We also firmly support NIH's plan to assess the impact of these new rules within 1 year. Given the sweeping changes being made and the possibility of unintended consequences, it is prudent for the agency to undertake a thorough review after full implementation so that appropriate modifications can be made, if necessary,” he said.

Officials at NIH also announced a new policy aimed at speeding the public's access to scientific articles that result from NIH-funded research. Under the policy, the agency is calling on scientists to voluntarily release manuscripts supported by NIH to the public within a year of peer-reviewed publication.

ATLANTA – American psychiatry is facing a “crisis of credibility,” said Steven S. Sharfstein, M.D., the new president of the American Psychiatric Association.

Dr. Sharfstein vowed at the APA's annual meeting to restore that credibility by advocating for patients and creating and enforcing ethical standards.

“Our profession is seen, by many, as an interest group, a trade association. And too often we have behaved like one,” said Dr. Sharfstein, who has served as president and chief executive officer of the Sheppard Pratt Health System, a nonprofit psychiatric hospital system in Baltimore, since 1992.

Psychiatrists are failing to lead when it comes to problems such as lack of access, high costs, and unmeasured quality in health care. The problem, he said, is not a lack of sound policy proposals, but the profession's lack of credibility and leverage.

“When we speak, too few listen,” he said. “And to a large extent, we have only ourselves to blame.”

Dr. Sharfstein pointed to an erratic and inconsistent system of self-discipline, an unacceptable rate of medical errors, and gross disparities in health care. As a profession, psychiatry has frequently allowed itself to be corrupted by industry and has compromised the core value of patient confidentiality in an effort to guarantee payment and stay on managed care contracts.

“We must earn back our moral authority,” said Dr. Sharfstein, who succeeds Michelle B. Riba, M.D., in the 1-year presidential term. “We must regain the public's trust.”

The first step is to recommit the profession to advocating for patients. Patients with mental illness still face stigma, and they are often ignored and mistreated. Psychiatrists should advocate for better care with insurers and policymakers, Dr. Sharfstein said. He also encouraged psychiatrists to form “creative alliances” with groups such as the National Alliance for the Mentally Ill and the National Mental Health Association.

In addition, he urged psychiatrists to push for the restoration of funding recently cut from the federal portion of the Medicaid program. And that advocacy should also extend beyond the boundaries of the doctor-patient relationship to broader issues of public health.

For example, thousands of young people are incarcerated unnecessarily each night because community mental health services are not available. And adults with mental illness are shot and killed by police who have little or no training to deal with such situations. “This, too, must be psychiatry's concern,” he said.

Next, psychiatry needs to create and enforce ethical standards. Dr. Sharfstein singled out the need to address the relationship between psychiatry and the pharmaceutical industry.

“It is my view that these relationships have been rife with the appearance of conflict of interest and frankly, with conflict of interest itself,” he commented.

Finally, Dr. Sharfstein said psychiatrists can help earn back their credibility by defending their core professional values, including confidentiality, academic inquiry, and scientific integrity.

Although it isn't proper in an age of terrorism to insist on total confidentiality of records, it's appalling that the Patriot Act allows the government to not only view patient records but to prevent psychiatrists from telling patients of such breaches. “Speaking up for confidentiality, even if we have a lone voice, is absolutely essential to our credibility and our professionalism,” Dr. Sharfstein said.

Academic inquiry is another area that must be defended. That means refusing to let drug companies withhold clinically important information from physicians and patients. The APA has made progress in obtaining access to data, and the group will continue to push for federal legislation aimed at establishing a registry of all clinical trials, he noted.

Psychiatrists also need to work to protect the scientific integrity of the field from attacks, including those from government officials. Dr. Sharfstein cited comments made by Rep. Ron Paul (R-Tex.), who is opposed to psychiatric care for children. Rep. Paul, an ob.gyn., has said that psychiatric diagnosis is inherently subjective and that mental health screening in schools has “no place in a free and decent society.”

Dr. Sharfstein fired back, calling Rep. Paul's comments “ignorant attacks.”

Dr. Sharfstein warned that threats to scientific integrity have also come from government agencies. For example, Bush administration officials recently instructed researchers presenting a study on suicidality among gay, lesbian, bisexual, and transgender individuals to not use the words gay, lesbian, bisexual, and transgender.

Telling researchers to delete those words is an insult to science and human rights, Dr. Sharfstein said, and psychiatrists cannot sit back and let that happen.

“If we abandon our core principles, then we lose our moral and professional authority–which is the light we must use to lead,” he said.

Dr. Sharfstein, whose research interests include the financing of psychiatric care, will focus on issues such as psychologists' prescribing, malpractice, and parity during his term as APA president. But his top goal will be to set examples for American medicine by transforming psychiatry. “It is the only goal worthy of our profession,” he said.

ATLANTA – American psychiatry is facing a “crisis of credibility,” said Steven S. Sharfstein, M.D., the new president of the American Psychiatric Association.

Dr. Sharfstein vowed at the APA's annual meeting to restore that credibility by advocating for patients and creating and enforcing ethical standards.

“Our profession is seen, by many, as an interest group, a trade association. And too often we have behaved like one,” said Dr. Sharfstein, who has served as president and chief executive officer of the Sheppard Pratt Health System, a nonprofit psychiatric hospital system in Baltimore, since 1992.

Psychiatrists are failing to lead when it comes to problems such as lack of access, high costs, and unmeasured quality in health care. The problem, he said, is not a lack of sound policy proposals, but the profession's lack of credibility and leverage.

“When we speak, too few listen,” he said. “And to a large extent, we have only ourselves to blame.”

Dr. Sharfstein pointed to an erratic and inconsistent system of self-discipline, an unacceptable rate of medical errors, and gross disparities in health care. As a profession, psychiatry has frequently allowed itself to be corrupted by industry and has compromised the core value of patient confidentiality in an effort to guarantee payment and stay on managed care contracts.

“We must earn back our moral authority,” said Dr. Sharfstein, who succeeds Michelle B. Riba, M.D., in the 1-year presidential term. “We must regain the public's trust.”

The first step is to recommit the profession to advocating for patients. Patients with mental illness still face stigma, and they are often ignored and mistreated. Psychiatrists should advocate for better care with insurers and policymakers, Dr. Sharfstein said. He also encouraged psychiatrists to form “creative alliances” with groups such as the National Alliance for the Mentally Ill and the National Mental Health Association.

In addition, he urged psychiatrists to push for the restoration of funding recently cut from the federal portion of the Medicaid program. And that advocacy should also extend beyond the boundaries of the doctor-patient relationship to broader issues of public health.

For example, thousands of young people are incarcerated unnecessarily each night because community mental health services are not available. And adults with mental illness are shot and killed by police who have little or no training to deal with such situations. “This, too, must be psychiatry's concern,” he said.

Next, psychiatry needs to create and enforce ethical standards. Dr. Sharfstein singled out the need to address the relationship between psychiatry and the pharmaceutical industry.

“It is my view that these relationships have been rife with the appearance of conflict of interest and frankly, with conflict of interest itself,” he commented.

Finally, Dr. Sharfstein said psychiatrists can help earn back their credibility by defending their core professional values, including confidentiality, academic inquiry, and scientific integrity.

Although it isn't proper in an age of terrorism to insist on total confidentiality of records, it's appalling that the Patriot Act allows the government to not only view patient records but to prevent psychiatrists from telling patients of such breaches. “Speaking up for confidentiality, even if we have a lone voice, is absolutely essential to our credibility and our professionalism,” Dr. Sharfstein said.

Academic inquiry is another area that must be defended. That means refusing to let drug companies withhold clinically important information from physicians and patients. The APA has made progress in obtaining access to data, and the group will continue to push for federal legislation aimed at establishing a registry of all clinical trials, he noted.

Psychiatrists also need to work to protect the scientific integrity of the field from attacks, including those from government officials. Dr. Sharfstein cited comments made by Rep. Ron Paul (R-Tex.), who is opposed to psychiatric care for children. Rep. Paul, an ob.gyn., has said that psychiatric diagnosis is inherently subjective and that mental health screening in schools has “no place in a free and decent society.”

Dr. Sharfstein fired back, calling Rep. Paul's comments “ignorant attacks.”

Dr. Sharfstein warned that threats to scientific integrity have also come from government agencies. For example, Bush administration officials recently instructed researchers presenting a study on suicidality among gay, lesbian, bisexual, and transgender individuals to not use the words gay, lesbian, bisexual, and transgender.

Telling researchers to delete those words is an insult to science and human rights, Dr. Sharfstein said, and psychiatrists cannot sit back and let that happen.

“If we abandon our core principles, then we lose our moral and professional authority–which is the light we must use to lead,” he said.

Dr. Sharfstein, whose research interests include the financing of psychiatric care, will focus on issues such as psychologists' prescribing, malpractice, and parity during his term as APA president. But his top goal will be to set examples for American medicine by transforming psychiatry. “It is the only goal worthy of our profession,” he said.

ATLANTA – American psychiatry is facing a “crisis of credibility,” said Steven S. Sharfstein, M.D., the new president of the American Psychiatric Association.

Dr. Sharfstein vowed at the APA's annual meeting to restore that credibility by advocating for patients and creating and enforcing ethical standards.

“Our profession is seen, by many, as an interest group, a trade association. And too often we have behaved like one,” said Dr. Sharfstein, who has served as president and chief executive officer of the Sheppard Pratt Health System, a nonprofit psychiatric hospital system in Baltimore, since 1992.

Psychiatrists are failing to lead when it comes to problems such as lack of access, high costs, and unmeasured quality in health care. The problem, he said, is not a lack of sound policy proposals, but the profession's lack of credibility and leverage.

“When we speak, too few listen,” he said. “And to a large extent, we have only ourselves to blame.”

Dr. Sharfstein pointed to an erratic and inconsistent system of self-discipline, an unacceptable rate of medical errors, and gross disparities in health care. As a profession, psychiatry has frequently allowed itself to be corrupted by industry and has compromised the core value of patient confidentiality in an effort to guarantee payment and stay on managed care contracts.

“We must earn back our moral authority,” said Dr. Sharfstein, who succeeds Michelle B. Riba, M.D., in the 1-year presidential term. “We must regain the public's trust.”

The first step is to recommit the profession to advocating for patients. Patients with mental illness still face stigma, and they are often ignored and mistreated. Psychiatrists should advocate for better care with insurers and policymakers, Dr. Sharfstein said. He also encouraged psychiatrists to form “creative alliances” with groups such as the National Alliance for the Mentally Ill and the National Mental Health Association.

In addition, he urged psychiatrists to push for the restoration of funding recently cut from the federal portion of the Medicaid program. And that advocacy should also extend beyond the boundaries of the doctor-patient relationship to broader issues of public health.

For example, thousands of young people are incarcerated unnecessarily each night because community mental health services are not available. And adults with mental illness are shot and killed by police who have little or no training to deal with such situations. “This, too, must be psychiatry's concern,” he said.

Next, psychiatry needs to create and enforce ethical standards. Dr. Sharfstein singled out the need to address the relationship between psychiatry and the pharmaceutical industry.

“It is my view that these relationships have been rife with the appearance of conflict of interest and frankly, with conflict of interest itself,” he commented.

Finally, Dr. Sharfstein said psychiatrists can help earn back their credibility by defending their core professional values, including confidentiality, academic inquiry, and scientific integrity.

Although it isn't proper in an age of terrorism to insist on total confidentiality of records, it's appalling that the Patriot Act allows the government to not only view patient records but to prevent psychiatrists from telling patients of such breaches. “Speaking up for confidentiality, even if we have a lone voice, is absolutely essential to our credibility and our professionalism,” Dr. Sharfstein said.

Academic inquiry is another area that must be defended. That means refusing to let drug companies withhold clinically important information from physicians and patients. The APA has made progress in obtaining access to data, and the group will continue to push for federal legislation aimed at establishing a registry of all clinical trials, he noted.

Psychiatrists also need to work to protect the scientific integrity of the field from attacks, including those from government officials. Dr. Sharfstein cited comments made by Rep. Ron Paul (R-Tex.), who is opposed to psychiatric care for children. Rep. Paul, an ob.gyn., has said that psychiatric diagnosis is inherently subjective and that mental health screening in schools has “no place in a free and decent society.”

Dr. Sharfstein fired back, calling Rep. Paul's comments “ignorant attacks.”

Dr. Sharfstein warned that threats to scientific integrity have also come from government agencies. For example, Bush administration officials recently instructed researchers presenting a study on suicidality among gay, lesbian, bisexual, and transgender individuals to not use the words gay, lesbian, bisexual, and transgender.

Telling researchers to delete those words is an insult to science and human rights, Dr. Sharfstein said, and psychiatrists cannot sit back and let that happen.

“If we abandon our core principles, then we lose our moral and professional authority–which is the light we must use to lead,” he said.

Dr. Sharfstein, whose research interests include the financing of psychiatric care, will focus on issues such as psychologists' prescribing, malpractice, and parity during his term as APA president. But his top goal will be to set examples for American medicine by transforming psychiatry. “It is the only goal worthy of our profession,” he said.