AMERICAN MEDICAL NEWS (7/12/93)
ABLEnews MedNotes
AMERICAN MEDICAL NEWS (7/12/93)
CDC Offers New Guidance on Drug-Resistant TB (1)
In view of the proliferation of drug-resident tuberculosis, the Centers for Disease Control and Prevention (CDC) advise physicians to start all TB patients on a four-day regimen of isoniazid, rifampin, pyrazinamide, and either streptomycin or ethambutol. Strictly observed this treatment course can cure 95% if TB patients, according to the CDC.
Medicare Funding Still Uncertain (1)
"Even before the proposal [to cut an additional $19 billion] left the [Senate Finance] committee, Sen. Tom Harkin (D-IA) and Paul Wellstone (D-MN) were weighing the prospects...to restore about $9 billion...Joined by a small contingent of other party liberals, the two Midwesterners were given little chance of success. They stuck doggedly to their position nonetheless...As it became clear that the budget bill might be defeated without their backing, the rebels gained the upper hand. To stave off an embarrassing defeat of the president's once vaunted economic plan, Senate Majority Leader George Mitchell agreed to give the Harkin-Wellstone contingent the full $9 billion they had asked for.
Physicians Fighting Back as States Turn to Provider Taxes (1)
In June West Virginia became the first state to tax physicians' gross receipts. Kentucky followed suit this month. Next January Minnesota will tax physician revenues and other states are weighing the option. According to John Patchett, AMA director of state legislation, three things are pushing states to tax providers: 1) Medicaid has become one of the states' biggest budget items. 2) Problems arising from weak economies, high unemployment, and revenue shortfalls plague many states. 3.) The federal government has restricted states' ability to generate Medicaid matching funds by taxing providers.
Ready or Not, EDI Is coming (1)
At last month's Annual Meeting AMA delegates passed a resolution opposing mandatory electronic claims submission, but the Work Group for Electronic Data Interchange, a task force of government, insurance, hospital, and physician interests, is pushing federal legislation mandating EDI standards by the first quarter of 1994.
Judges Must Weigh Expert Testimony (2)
Supreme Court rules in Daubert et al v. Dow.
AIDS Commission Folds Up Shop (2)
Members decry lack of political will.
New AIDS Coordinator Named (2)
Kristine Gebbie served on President Reagan's AIDS commission.
Assisted-Suicide Ban Restore (2)
by Michigan Court of Appeals.
CDC Head Goes to Insurer (2)
William Roper, MD quits as director of the Centers for Disease Control and Prevention (CDC) to head Prudential Insurance Company's National Center for Health Care Research, a managed care think tank.
Still Pushing Single-Payer (2)
85 House members co-sponsor bill for government-financed health care system.
Prescription for Professionals (3)
"We need to acknowledge that everyone is going to make errors. Making them isn't the sin; it's recognizing them and not doing anything." --Lucian Leape, MD, director of Harvard study finding two-thirds of the 1.3 million annual iatrogenic injuries sustained in US hospitals could be averted. Better efforts by hospitals and physicians could save up to 100,000 lives and $10.1 billion annually.
ACGME Imposes Stiffer Standards for Subspecialties (3)
But leaders of the Accreditation Council for Graduate Medical Education (ACGME) claim the new guidelines for recognizing subspecialties are not an effort to cut back on specialization in order to boost primary care.
Abortion Providers Share Inner Conflicts (3)
"The notion that nurses, doctors, counselors, and others who work in the abortion field have qualms about the work they do is a well-kept secret. But among themselves--at work, or at meetings with other providers--they talk about how they really feel. About women who come in for 'repeat' abortions...And about the feelings they have towards the fetus...They wonder if the fetus feels pain. They talk about the soul and where it goes. And about their dreams, in which aborted fetuses stare at them with ancient eyes, and perfectly shaped hands and feet, asking, 'Why? Why did you do this to me?'"
California Blue Cross Is Using Its Market Power (4)
"When Arthur Wiscot, MD, went to his mail box in mid-May and opened a letter saying his premium for the preferred provider organization (ppo) he belonged to was rising 6%, he wasn't too surprised--after all, health care costs continue to soar. But when he opened a letter the next day saying the same PPO, Blue Cross of California's Prudent Buyer Plan, was cutting his fees on average about 6%, he felt sucker-punched." As Dr. Wiscot, a Torrance ob-gyn concludes, "What's guiding them is the profit motive, and not the relationship between insurer and physician." CURE Comment: Nevermind the ancient if anachronistic patient-physician relationship.
New HIV Guidelines Offer Flexibility on AZT (5)
In a key change, starting AZT (zidovudine) treatment is no longer routinely recommended for asymptomatic patients whose CD4 cell counts drop below 500. Instead, physicians may continue to monitor patients for signs of deterioration,, at which point drug treatment should be initiated.
New York Court Bars Release of Disciplinary Charges (5)
against physicians by state health department. "The decision is all to one side. It cloaks the entire disciplinary process in secrecy." --Mark Chassin, MD, NY Health Commissioner. The ruling by the NY Court of Appeals was described as "a tremendous step backward for the public" by Arthur Levin, the director of New York City's Center for Medical Consumers.
Insurers Study Drug Errors Leading to Suits (7)
According to the Physician Insurers Association of America (PIAA), prescribing errors and failure to monitor patients for side effects or addiction are among the medicinal mistakes most commonly cited in malpractice cases. Antibiotics, glucocorticoids, and narcotics are commonly named.
Tough Smoking ban Passes in California Assembly (8)
"If we can do this here, it will help set the stage for similar measures in many other states." --Richard Corlin, MD, immediate past president, California Medical Association. "It's best done at a local level. It's a mistake to introduce a statewide preemptive ban." --Stanton Glantz, PhD, founder, Americans for Nonsmokers Rights.
Needles-Exchange Programs Spreading (8)
to 33 US cities.
EPA's Lead Balloon (9)
The Environmental Protection Agency (EPA) placed Aspen's Smuggler's Mountain neighborhood on the Superfund list of hazardous waste sites in 1986 due to high lead concentrations in the soil. They proposed replaced a foot-deep layer of soil with clean fill at a cost of $12 million, but the affluent tourist mecca, backed by local physicians, persuaded the federal government there was no public health problem.
Presidential Hopeful Promised a Really New Beginning (12)
"My patient, Roger, was...a highly functioning paranoid schizophrenic. His characteristic 'flight of ideas' and 'loose associations' were always creative...Roger also heard voices...He told me they gave him his best ideas...He wrote Margaret Tutweiler notifying her of his intention to be a write-in candidate for president of the United States."
Burroughs Sues Over Patent Rights to AIDS Drug (14)
Pharmaceutical giant Burroughs Wellcome Company is trying to preserve its exclusive patent rights to produce the drug it sells as Retrovir. The company contends its researchers developed AZT and that the patents give it a monopoly until 2005. The generic producers are supported by the National Institutes for Health (NIH) and AIDS activists.
Meeting in Touch with the Times (editorial) (15)
"The [AMA] House of Delegates was cautious at times, defiant at others. It was willing to face change, but unwilling to abandon what works simply for the sake of change. The doctors listened attentively to Hillary Rodham Clinton, the nation's chief health system reformer. But they reserved the right to question whatever reform plan is put on the table."
Bitter Lesson on Living Wills (letter-editor) (15)
"How true the living will is open to misinterpretation (AMNews, May 17). I'm a professional working in the field of aging and employed by our local medical society foundation. Until recently I was a strong supporter of the living will. Now I know that to many professionals, a patient who has a living will 'wants to die.' All the fine point eludes them...How do I feel now about living wills? I wouldn't sign one." --Phyllis Rob, Ft. Wayne, IN. ABLEnews Editor's Note: For the complete text of this letter see "Bitter Lesson" on the ABLEnews echo or watch for it in the July ABLEnews Review.
Better Training Needed (letter-editor) (15)
"Some patients are ready to look intelligently at their mortality and to discuss their expectations, but many others have given the matter no thought or have such negative feelings about death that they refuse to consider it. The idea that Congress could pass a law that would solve the problem is absurd on its face." --Robert Gillette, MD, Youngstown, OH. CURE Comment: Because of our "negative feelings about death," particularly premature death, CURE has considered it carefully and, looking at it intelligently, created our mandatory treatment directive--the Life Support Directive. If you're negative about untimely death request your copy from CURE.
Ophthalmology Unfairly Targeted (letter-editor) (16)
"From the letters I have seen in American Medical News, one would believe that ophthalmologists dump their [cataract] patients out of the operating room door and never see them again. The fact is, 120 days of free care is given during the postoperative period." --Scott Geller, MD, Naples, FL.
Drifting to Socialism (letter-editor) (16)
"I can see why the AMA has lost members and been criticized for drifting into the socialist camp. Your headline: 'Too much free choice could undermine reforms,' and its first sentence: 'In the great national tradition of unfettered pursuit of self-interest, Americans...' indicate a destructive attitude and a lack of understanding." --Robert Eckert, MD, Athens, TX.
Match Deeds with Words [sic] About Native Americans (let-ed) (16)
"In the rush to deal with the everyday crises which confront us as physicians, we tend to ignore...the muted cries and whispers of desperate Native Americans. One gets painful reminders of our neglect when we visit an Indian reservation." --Randall Bloomfield, MD, chair, AMA Advisory Committee on Minority Physicians.
'Doctor, Heal Thy Children' (letter-editor) (16)
"Love and nurture them and you will grow as a person and as a physician and your patients will also reap the benefits. Time off is not a sin." --Barbara Field, RN, Wauwatosa, WI.
Open AMA Voting to All Members (letter-editor) (16)
"It's hard for me to work up much interest in these 'elections' though since, as a lowly member of the due-paying, rank-and-file AMA membership, I am not entrusted with the power to choose who will lead organized medicine." --Tim Gorski, MD, Arlington, TX.
Dump 'Reform' (letter-editor) (16)
"Why do you support President Clinton's and Hillary's abominable proposals for medicine by repeating the term 'health system reform.' The word reform implies improvement. It would be better to refer to it as something like bureaucratic restructuring or calling it what it actually is socialized medicine." --John Krafchuk, MD, Hempstead, Long Island, NY.
Salary vs. Solo (17)
"The business community is also diminishing another advantage of private practice: freedom to practice medicine as one wishes. Physicians in private practice are increasingly burdened by Medicare and Medicaid regulations, as well as restrictions from private third-party payers...Sooner or later, a lot of doctors will have to ask if they would be better off in a salaried position. And a growing number will answer 'yes.'"
Will You Get Hit with Retirement-Plan Success Tax? (20)
"Physicians who receive too much from retirement plans or accumulate too much in them can be hit with excise penalty taxes. These taxes are in addition to the regular income tax on distributions and applicable estate tax on remaining pension accumulations after you die." --William Howard, Jr., president, Memphis Society of the ICPF.
[The above listing, prepared for ABLEnews by CURE, includes all major articles in the cited issue and a representative selection of the rest.]
...For further information, contact CURE, 812 Stephen Street, Berkeley Springs, West Virginia 25411 (304-258-LIFE/258-5433).
