The American Society for Surgery of the Hand (ASSH) Corporate Advisory Council recently gathered in Chicago to create the first ever, ethics guidelines, to be followed by hand surgeons. The ASSH has been an industry leader in developing standards to both embrace the support of industry partners, while also ensuring that such support is accepted without conditions or restrictions.

In 2008, the Corporate Relations Committee was formed by the ASSH Board of Directors (Council) as a means of monitoring and developing clean and ethical relationships. While serving as President of the ASSH at the time, Steven Z. Glickel, MD, conceived the initial concept of a “10 Commandments”. Dr. Glickel, Chair of the Hand Service at Roosevelt Hospital in New York City, believed it was necessary to develop a clearly defined standard to be followed by hand surgeons. In doing so, any appearance of impropriety or the perception that a physician’s ability to independently make decisions regarding the care of a patient, patient would be avoided. William Seitz, Jr., MD., served as the ASSH Commercial Support Chair when Dr. Glickel, conceived the idea. They worked together to make the initial idea, an actual reality. Dr. Seitz, who is at the Cleveland Clinic, is now Chair of the newly formed Corporate Advisory Council. Robert Szabo, MD, (UC Davis) is the current ASSH President and he continues the work to support the initiative. ASSH’s “10 Commandments” will be strictly adhered to by physicians and corporations. L. Andrew Koman, MD, Chair of the Department of Orthopaedics at Wake Forest, was also a key surgeon and President at the time the Corporate Advisory Council held its inaugural meeting.

The following guidelines are also part of the American Foundation for Surgery of the Hand’s (AFSH) commitment to having the highest ethical relationships with the industry in support of hand and upper extremity research. Fred Fakharzadeh, MD, current President of the AFSH, believes these “commandments” will help both industry leaders and surgeons have the kind of relationship that will ultimately benefit patients.

The following 10 Commandments are as follows:

It is the belief of the leadership of the ASSH, that a relationship between medical societies representing physicians and commercial corporations is necessary and beneficial for the future of medicine. It is essential for industry to consult with physicians for their medical expertise. It is also necessary for the medical professionals to rely on industry to support education in order to stay abreast of the latest technology within their chosen field.

In order to avoid any appearance of impropriety or perception that a physician’s ability to independently make decisions regarding the care of the patient has been compromised, we will henceforth strictly adhere to these following guidelines (“our ten commandments”):

• Industry is strongly encouraged to support educational activities to increase knowledge and the skills necessary to improve patient care through the American Society for Surgery of the Hand (ASSH).
• Industry is strongly encouraged to provide support for research through the American Foundation for Surgery of the Hand (AFSH). The subject and content of the research will be determined by the ASSH/AFSH. Corporations will not control the content of supported research.
• The ASSH/AFSH will clearly define research programs and methods of selection of topics and researchers receiving donated funds. The AFSH will provide annual updates to donors on the use of those funds.
• Physicians will be consulted and involved in the development and design of new products as deemed necessary by the device company following a comprehensive review of the specific project requirements as well as the physicians’ credentials, qualifications and expertise on the subject matter by the company.
• Consulting and design activities will be reimbursed by industry at a fair market value on a per-activity or per-time basis. No ASSH members will accept gifts, funding for companion travel, sponsorship of recreational activity, entertainment or sports events.
• ASSH Members and industry will be parties to explicit contracts regarding the scope of service and reimbursement for service.
• ASSH members will not demand or accept unreasonable reimbursement for travel, meals, and lodging, for being involved in an educational activity.
• All funding to support education and research will be controlled by the ASSH and the AFSH.
• Companies will not influence the control of educational or research activities.
• All relationships will be disclosed and readily available to the public.

With Plavix’s gurney on the golf course, Cialis’ twin bath tubs and Ambien’s rooster in the office, many drug commercials make for great water cooler conversations but do they translate into more conversations in the physician’s office? And if so, are those conversations positive or negative – improving disease awareness and brand requests, or raising concerns around fair balance statements and side effects?

As pharmas continue to make significant investment in DTC, a recent study from Verilogue revealed that the biggest DTC budgets don’t always result in positive pull-through – or pull-through at all – in the physician’s office. From this analysis, Verilogue derived three key recommendations for how pharmas can convert DTC investment into positive patient-physician interactions.

Tweet this: Verilogue study: Does higher DTC mean better patient pull through? http://bit.ly/1Ns2tk

Verilogue’s analysis tracked brand requests coupled with a reference to specific promotional campaigns across 12,500 doctor-patient conversations from 2008 and covered 20 disease states and 46 different branded prescription medications. Overall, DTC pull-through in conversations in the doctor’s office is low – 3% (n=392) – and specific patient requests for advertised medications are even lower – .002% (n=23). Most significantly, the most frequently pulled-through brands from Verilogue’s database fail to align with the brands with the biggest DTC ad spend:

Brand analysis: How does DTC come up in patient-physician conversations?

Most of the time, DTC is referenced by the physician to try to increase patient acceptance for already-chosen medicines. Unaided (spontaneous) patient mentions or actual patient requests for medication are rarer. Regarding five of the top DTC brand spenders of 2008, here is how their DTC campaigns influenced the doctor-patient conversation:

1) Advair
Patients most often brought up side effect concerns arising from fair balance statements in Advair TV commercials; for instance: “I saw on TV that Advair can cause pneumonia in some patients.”

2) Plavix
Although frequently mentioned and discussed by physicians, Plavix’s DTC campaign was not mentioned by patients in Verilogue’s database.

3) Cymbalta
This is the most mentioned DTC campaign out of the five top spenders. Approximately half of the patients expressed positive sentiment about the ad (e.g. they reflected on other depression symptoms, for instance: “That commercial they have out showing depression and how it affects everything else. It’s not just that person that feels that way. Your whole family that’s around you.”), while the other half expressed negative sentiments (e.g. “No, I don’t want to take Cymbalta. And I don’t like the commercials, and plus I’m on Zoloft and that’s it. I don’t want any more of those drugs.”)

4) Lyrica
The main outcome of the campaign was increased awareness about fibromyalgia in addition to the brand. (e.g. “Do you do a lot of patients with fibromyalgia? That’s how I found about a neurologist when I seen it on TV for that Lyrica. And they sent me some stuff in the mail.”)

5) Ambien
This is the most likely to be requested out of the top five spenders. However, like Advair, patients commonly expressed side effect concerns arising from fair balance statements in Ambien TV commercials, both positive (e.g. “But I saw where it is Ambien that helps you get to sleep and stay asleep. I saw the commercial for it. You think that’s a good one for me?”) and negative (e.g. “Yeah, I saw the commercial. I think it’s, uh, Ambien that says you might go out and eat and not remember. I thought great all I need.”)

DTC Recommendations: How can pharmas get the most bang for their buck?

Verilogue’s study revealed three key recommendations for every pharma in creating effective DTC ads:

1) Validate patient experiences
In order to drive greater patient awareness and more robust, meaningful discussions about a disease, akin to Cymbalta DTC pull-through, pharmas should structure DTC to validate patient experiences with health conditions. Use DTC as a tool to engage patients in constructing the meaning of – rather than simply mirroring experiences with – a health condition. Tactics to support such a strategy might go beyond traditional TV spot advertising to include embedded marketing where health conditions and treatments are woven into the lives of television/film characters, among other relevant tactics.

2) Better prepare physicians for the fair balance fight
While there’s no way around the regulatory mandate for fair balance statements, pharmas can better prepare physicians to address patient side effect concerns arising from DTC promotion. This might include providing physicians with tools (visual aids, stories/narratives, etc.) to put side effects into perspective by couching potential side effects in incidence scales/descriptions or in risk-benefit scenarios.

3) Connect meaningfully with patients
The most frequently pulled-through DTC campaign was Boniva’s “Rally with Sally,” which employed a well-known and trusted “friend” to deliver messages to the targeted middle-aged woman audience. This tactic was markedly different from tactics in other campaigns where messages are delivered by physicians and actors portraying patient family members, for example,“I know [Boniva]. Yes. Sally’s on the commercial.”

Science now offers us ever more advanced ways to understand and control pain. But with those new treatments come new questions about the use (and misuse) of state-of-the-art technology and how far pain management can and should go. Is pain a symptom or a disease? How much pain should be relieved? Can reducing pain be inappropriate or detrimental? Can technologies capable of scanning the brain tell us whether a patient is really experiencing pain? And what questions arise in confronting (and treating) pain in animals and other non-human beings?

On November 13, the Center for Neurotechnology Studies at the Potomac Institute for Policy Studies will present the lecture “From a Neuroscience of Pain to a Neuroethics of Care” by Prof. James Giordano, internationally known for his work on the neuroscience and neuroethics of pain. The program will address the neuroscientific progress achieved during the Congressionally-designated Decade of Pain Control and Research, and discuss the ethical implications of this knowledge for medicine, and society at large. Researchers are now looking ahead to a Decade of the Mind, and this lecture raises questions about whether what we know about pain will both guide and be guided by what we seek to learn about the mind, and the nature of self and others.

What: CCNELSI Lecture: “From a Neuroscience of Pain to a Neuroethics of Care”

Who: James Giordano, Ph.D.

Where: Potomac Institute for Policy Studies, 901 North Stuart Street, Suite 200, Arlington, VA, 22203

When: November 13, 2009, 3:30 – 6:00 pm

More info: www.ccnelsi.com

Autumn has arrived in the northern hemisphere and with shades of yellow and orange comes a less-welcome visitor: cold and flu season. Made worse this year by the H1N1 (swine flu) pandemic, people around the world are flocking to drugstores and supermarkets to stock up on over-the-counter (OTC) medicine, says market research firm Mintel.

Mintel’s Global Market Navigator (GMN) predicts Americans will cough up a total $3.6 billion on cold, cough and throat remedies this year, 1.7% more than during 2008. In Britain, people could fork over an eye-watering £428 million by year’s end, a 4.2% increase over 2008.

Diana Nhan, senior market analyst for Mintel GMN, comments on how swine flu could impact OTC medicine sales this year:

“The US cold, cough and throat remedy market saw a 13.4% spike in sales during 2005, when the avian flu dominated media stories. Already, swine flu has received equivalent media exposure, and many Americans are worried about the virus. I wouldn’t be surprised to see a similar trend-busting increase in US cold, cough and throat remedy sales for 2009 and the early part of 2010.”

In total, Americans will spend more than $32 billion on OTC pharmaceuticals this year, while Britons dedicate £2.6 billion towards alleviating symptoms. The Chinese are expected to spend over ¥58 billion, while Russians bear out cold weather in the name of $3.4 billion. Mintel GMN expects all four countries to see sales increases for OTC medication in 2010.

Americans dedicate more funds towards treating the sniffles than people in the UK, China or Russia. In the US, OTC medicine sales account for 0.22% of GDP, compared to 0.20% in Russia and approximately 0.17% in the UK and China.

As we head into a flu season where the 2009 H1N1 swine flu is expected to cause increased sickness, hospitalization and deaths across the U.S., something as simple as inaccurate body temperature measurements may lead to social and economic turmoil – and may cause many more deaths.

At the same time that reports estimate that half the U.S. population, or greater than 150 million people, may be affected by the flu this season and the Centers for Disease Control (CDC) recommends that people with influenza remains at home until at least 24 hours after they are free of fever, other reports have shown that approximately 40% of thermometer readings overestimate and 20% underestimate body temperature. The result is a perfect storm with 60% of Americans — or 90 million people – receiving the wrong temperature readings during the flu season.

The consequences of these errors in temperature readings could have severe results. It can cause people who are sick to be falsely diagnosed as healthy, further spreading the flu virus. At the same time, healthy individuals can be falsely diagnosed as having fever and “forced” to remain at home. This can have a serious detrimental effect on our entire health care system and the economy as companies face shortages of healthy workers and consumer spending is curtailed.

Just sorting out which patients to treat and which to send home, for example, could strain our healthcare system. A recent report from the nonprofit Trust for America’s Health noted that if 33% of the population caught swine flu, 15 states could run out of hospital beds at the peak of the outbreak.

Businesses can be affected in two ways. Overall productivity will be reduced simply because there are fewer workers, and businesses that rely on customers, such as restaurants, movie theaters, malls and the travel industry, will be affected if more people, possibly millions, are not able – or willing, due to false fever readings – to go out. This will cause a ripple effect throughout the economy.

Children are particularly at risk because of their parent’s dependence on the only objective emergency warning sign, which is fever, according to the CDC. The other signs are subjective and difficult to interpret, such as fast breathing, not drinking enough fluids, bluish color or irritability. Therefore, wrong thermometry jeopardizes children in two ways — lack of detection, which can lead to complications and possibly death; and false fever, which can expose them to the dangers of infections in a medical setting.

In addition, the military could be one of the greatest casualties of incorrect temperature measurements because they live in close quarters where disease can be easily transmitted. This was the case almost 100 years ago when the first wave of what became known as the 1918 flu pandemic appeared in military camps causing an enormous number of deaths.

The NavigateCancer Foundation (NCF), a nonprofit staffed by oncology professionals, provides patient advocacy tools and services for cancer patients and families, is filling an especially vital role as the ranks of the unemployed and uninsured steadily swell. Since launching in 2008, NCF’s experienced and credentialed clinical staff has helped hundreds of adult cancer patients and families understand and improve their cancer care. The personalized services allow patients to learn about their specific disease and navigate their way through diagnosis, treatment and survivorship to make it easy for them to create a plan of action and ensure that the best medical decisions are made.

“At times like this, it’s hard enough for many people to simply get by, much less deal with the devastating diagnosis of cancer,” said NCF co-founder Sharon M. Bigelow, an advanced oncology certified nurse practitioner. “We strive to be the one place that someone can go – no matter what their economic, geographic or social situation – to get free, unbiased, caring and confidential help in all aspects and duration of their disease and treatment.”

Statistics show that the uninsured, underinsured and those patients with low income or education levels are more likely to die from cancer than those with adequate resources and education. Also included in this category are patients who live far from healthcare services. The lack of available resources affects the quality of treatment they receive. The foundation was formed to mitigate the impact of shrinking health-care resources. While everyone has access to some type of care and assistance, NCF is the only organization of its kind that offers 100 percent professional help, and will help patients advocate for themselves regardless of their circumstances.

“The NavigateCancer Foundation is filling a critical gap for the underserved and vulnerable populations,” said Dr. Paul Godley, a Professor in the Division of Hematology and Oncology at The University of North Carolina at Chapel Hill School of Medicine and Director of the UNC Program on Ethnicity, Culture and Health Outcomes (ECHO) “The health disparities that continue to exist among the less-educated, uninsured and in rural and minority populations are alarming and those affected need access to state-of-the-art cancer services to help break down these barriers.”

Formerly conjoined twins Ahmed and Mohamed Ibrahim of Egypt returned to Dallas this week for follow up diagnostic testing and to help celebrate the launch of a new Reconstructive Surgery Institute at Texas Hospital for Advanced Medicine. The twin boys, who were born joined at the top of their heads, were separated during a groundbreaking 34-hour surgery in October 2003. Kenneth E. Salyer, M.D., who directed their care, is a founder of the new Institute.

“These boys are a symbol of the possibilities for help, hope and healing to all who suffer with craniofacial abnormalities,” said Dr. Salyer. “Our goal is to build an Institute where every child can be brought out of the darkness of deformity and into the light of a normal life.”

Ira Korman, Ph.D., President and CEO of Texas Hospital for Advanced Medicine, is developing the Institute with Dr. Salyer. He explains, “The Reconstructive Surgery Institute will be truly a world-class facility. We have assembled an unparalleled team of experts lead by Dr. Salyer. These are among the top physicians in the world in craniofacial surgery, and because of our VisionShare Partners, they will have the latest technology available to them.”

According to the most recent Hospital Value Index results, a study that analyzed data from more than 4,500 hospitals across the United States, hospitals in the largest U.S. cities generally offer a low value of patient care compared to elsewhere in the country.

“Our findings conclude that these urban areas offer less affordable and less efficient care, which affected the overall performance of the market,” said Hal Andrews, Chief Executive Officer of Data Advantage, the company that developed and maintains the Hospital Value Index.

“Ironically, we found that the hospitals with which the White House and its advisers are most intimately familiar deliver low healthcare value against every benchmark – city, state, CMS Region, and the U.S.”

For example, the Chicago market ranked 88th out of the 100 largest markets, just one spot behind McAllen, Texas and one spot ahead of Honolulu. Other than Fort Myers and Las Vegas, the lowest-ranking large markets were all in California. The top five states in delivering value were North Dakota, Iowa, Montana, South Dakota, and Maine. The bottom five states were New Mexico, Arkansas, California, Hawaii, and Nevada.

“Like every other good and service, price is an essential part of healthcare value,” said Andrews. “For California, prices are relatively high, even after adjusting for national wage variances. The uninsured, underinsured and health savings account members are disproportionately harmed by the high prices, without receiving superior quality, outcomes or patient experience in exchange.”

“The rules have changed — whether because of the economy, health reform or Value-Based purchasing, and quality alone is not a sustainable strategy for the U.S. hospital industry,” said John Morrow, one of the authors of the study. “These organizations will need to be accountable to their communities for their performance on value and be transparent about doing so. The Hospital Value Index is a means toward that end.”

The latest study from the Hospital Value Index used the most current and comprehensive set of publicly available data, including Hospital Compare data released by CMS in July 2009, to analyze more than 4,500 U.S. hospitals to discover where patients can find the best value of care in their community. The Hospital Value Index researchers analyzed a variety of public data on hospital quality, price, efficiency, and patient satisfaction. The Hospital Value Index is updated frequently to reflect the dynamic impact of change occurring in the hospital industry.

Want to be sure you are spending your healthcare dollars wisely? Fortunately, the latest version of the Hospital Value Index reveals that informed healthcare consumers can find high-value healthcare in every corner of the United States. In fact, the study of more than 4,500 U.S. hospitals finds communities with hospitals with fewer than 300 beds consistently rank among those with the best value in the nation, according to Hal Andrews, CEO of Data Advantage, the company behind the Hospital Value Index.

“Our findings show that the best value of care often exists in smaller markets where patients access community-based hospitals, not just in large academic medical centers,” said Andrews. “For consumers, it is encouraging to know that the healthcare providers in communities like Dothan, Alabama, Billings, Montana or Dubuque, Iowa deliver some of the best value in the nation.”

These findings are among a number of interesting results in the 2009-2010 Hospital Value Index, the most comprehensive and current examination of the value of hospital care available today.

Communities with hospitals delivering America’s best value of hospital care include:

• Dothan, Alabama
• Minden, Louisiana
• Tawas City, Michigan
• Clarksburg, West Virginia
• Billings, Montana
• Dubuque, Iowa
• Charlotte, North Carolina
• Amsterdam, New York
• Bangor, Maine
• Pittsburgh, Pennsylvania

“In light of the ongoing discussion of healthcare reform in Washington, D.C., we were curious to identify markets where value is easy to find, as well as markets where value is a precious commodity,” said John Morrow, one of the authors of the study. “We were surprised to find that California has only two hospitals among the top 100 Best in Value™ hospitals. In contrast, states as diverse as New York, Alabama and Iowa each have at least six hospitals in the top 100.”

The latest study from the Hospital Value Index used the most current and comprehensive set of publicly available data, including Hospital Compare data released in July 2009, to survey more than 4,500 U.S. hospitals to discover where patients can find the best value of care in their community. The Hospital Value Index researchers analyzed a variety of public data on hospital quality, price, efficiency, and patient satisfaction for the study.

“The Hospital Value Index includes more data points from more hospitals than any other study,” said Morrow. “As a result, our findings point us to a broader spectrum of markets that will help consumers and might help reformers in D.C. better understand the healthcare delivery system.”

A new American Health Care Association (AHCA) analysis of the pending House health reform bill, combined with the impact of a recently-enacted Medicare regulation cutting Medicare-funded nursing home care by $12 billion over ten years, finds seniors in Ohio requiring nursing and rehabilitative care will face total funding cuts of more than $2.5 billion over that same time period, which equals the fifth highest state cut across the 50 states. Nationally, the study finds, seniors’ Medicare cuts will total $44 billion over ten years, prompting Ohio’s long term care community to warn that seniors’ care needs are endangered by the House bill, as are the jobs of more than 3,100 caregivers in Ohio alone.

This is on top of state cuts of $184 million to skilled nursing facilities imposed through the recently passed Ohio biennium budget process.

“We are greatly concerned about the impact proposed cuts will have on Ohio seniors’ Medicare-funded nursing care. We urge lawmakers to consider how cuts of this size will affect senior care and ask that Congress revise its plan to ensure seniors are helped by reform measures,” said Peter Van Runkle, Executive Director of the Ohio Health Care Association (OHCA). “Arguments being made that seniors’ benefits will not be reduced by the House bill do not recognize that cuts would force providers to cut staff because labor expenses make up 70 percent of facility costs. Cutting staff within a facility has a direct impact on patients and their care.”

The new analysis of the House bill’s Medicare funding reductions over ten years (combined with the $12 billion ten year Medicare cuts just put into effect by the Centers for Medicare and Medicaid Services (CMS), is computed by the AHCA Reimbursement and Research Department using the Congressional Budget Office (CBO) score of both HR 3200 and the recent CMS funding rule, along with Medicare Skilled Nursing Facility (SNF) utilization data.

Other states with cuts exceeding $1 billion over ten years include California, Florida, New York, Texas, Pennsylvania, Illinois, New Jersey, Massachusetts, Michigan, Indiana, North Carolina, Virginia, Connecticut and Tennessee.

In crafting a final bill, Van Runkle also urged lawmakers to take into account the fact the Medicaid program already under funds the cost of providing care by at least $281 million in Ohio according to Eljay, LLC, thereby already placing enormous stress on facilities and staff before federal Medicare cuts even enter the picture. “We believe Congress should preserve, protect and defend seniors’ Medicare-funded nursing home care, and we respectfully ask lawmakers to do so when Congress reconvenes in September.”