Rethinking Shared Decision-Making in Prostate Cancer Screening

Kenneth Lin

Posted 2/28/12 on Common Sense Family Doctor 

Last October, the U.S. Preventive Services Task Force provisionally recommended against screening for prostate cancerusing the prostate-specific antigen (PSA) test, eliciting a variety of reactions from medical and patient advocacy groups. The New England Journal of Medicine published one of the most thoughtful responses by Mary McNaughton-Collins and Michael Barry, two physicians who have done a great deal of research on the psychological and physical harms related to false-positive tests, an all-too-common occurrence in men who receive periodic PSA testing. They respectfully disagreed with the USPSTF’s “D” (don’t do) rating for this preventive service, arguing that the rating should have instead been a “C” (don’t do routinely):

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The War on Health Care Fraud Needs a Champion

Merrill Goozner

Posted 1/09/12 on Gooz News

My regular readers know how much importance I attach to the war on waste, fraud and abuse in the Medicare and Medicaid programs (see posts here and here). Anyone who cares deeply about providing health care for all our citizens needs to make this a high priority, since taxpayers won’t long support those in need if the programs that deliver services aren’t protected from theft. That’s why Roy Poses over at the Health Care Renewal blog has done us a big favor by digging up this report from a 2007 Boston Globe profile on Mitt Romney.

Bain Capital’s 1989 purchase of Damon Corp., a Needham medical testing firm that later pleaded guilty to defrauding the federal government of $25 million and paid a record $119 million fine.

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Tougher NIH Rules About Financial Conflicts in Danger of Being Watered Down

Alison Bass

First posted 7/20/11 on Alison Bass

I realize this is the dead of summer and every journalist who isn’t on vacation is captivated by the Murdoch phone-hacking scandal. But while everyone is looking the other way, the National Institute of Health’s proposed new rules about the disclosure of financial conflicts of interest may be watered down.

The sticking point, according to the Project on Government Oversight (POGO), is a proposed rule that would require government-funded researchers to publicly disclose potential conflicts of interest to consumers. POGO officials say that the Office of Management and Budget (OMB), which has been reviewing the proposed changes for months, may weaken or eliminate the public disclosure requirement due to pressure from industry and university officials. In a letter to OMB July 11, POGO’s executive director Danielle Brian and staff scientist Ned Feder called on the OMB to make sure that requirement remains in the new guidelines.

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How To Find Good Health Information Online

Kenneth Lin

First published 6/10/11 on the Healthcare Headaches Blog at US News

recent survey found that 60 percent of adults have gone online at least once to look up health information. Unfortunately, finding high-quality health websites is a challenge. Several years ago, a review of 79 studies published in the Journal of the American Medical Association concluded that online health information for consumers is frequently flawed, inaccurate, or biased. Based on my experience, the situation isn’t any better today.

Why do some health websites contain misleading information? One reason is that the group or organization running the site may have a hidden agenda. Drug companies often create consumer demand for expensive new drugs by financing groups that promote awareness of a previously unrecognized health condition, a sales tactic known as “disease mongering.” (For example, Dartmouth Medical School researchers have argued that restless leg syndrome became a disease only when a drug was developed to treat it.) Unfortunately, a study published earlier this year in theAmerican Journal of Public Health found that most health advocacy groups that receive drug-company funding don’t disclose that on their websites.

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Let’s Fix Medicaid’s Perverse Financial Incentives Before Hacking Its Budget

Alison Bass

First published 4/15/11 on Alison Bass

Medicaid and Medicare are in the news of late, as Congressional Republicans spar with President Obama and the Democrats on how best to rein in the ballooning costs of these entitlement programs, which make up a growing share of federal and state budgets. But what few policy makers seem to be talking about — at least in public — are the perverse financial incentives built into the system that allow the companies who manage Medicaid contracts on a statewide basis to make profits at the expense of quality health care for Medicaid recipients. As a result of these perverse incentives, many Medicaid patients, particularly those being treated for mental health problems, are either terribly under-served or in some cases, badly over-treated. The upshot, in many cases, is poorer health outcomes and higher Medicaid costs.

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Doctors Without Borders

A Special Weekend Article!

Why you can’t trust medical journals anymore.


Brian’s Note: This article was published nearly 7 years ago, in 2004, in the Washington Journal. While transparency and disclosure rules have arguably improved since then, the larger problems associated with financial conflict still pervade all medicine and health care. A spate of recent stories has detailed device manufacturers paying off surgeons. Community oncologists and adolescent psychiatrists are still permitted to profit on the drugs they prescribe. And on and on.

So Ms. Brownlee’s article remains relevant, shocking and very engaging. Enjoy.

With financial ties to nearly two dozen drug and biotech companies, Dr. Charles B. Nemeroff may hold some sort of record among academic clinicians for the most conflicts of interest. A psychiatrist, a prominent researcher, and chairman of the department of psychiatry and behavioral science at Emory University in Atlanta, Nemeroff receives funding for his academic research from Eli Lilly, AstraZeneca, Pfizer, Wyeth-Ayerst–indeed from virtually every pharmaceutical house that manufactures a drug to treat mental illness. He also serves as a consultant to drug and biotech companies, owns their stocks, and is a member of several speakers’ bureaus, delivering talks–for a fee–to other physicians on behalf of the companies’ products.

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