In a national study that measured the conflict of interest between medical schools and the drug industry, Dallas' UT Southwestern Medical School received the state's highest score. Texas A&M Health Science Center College of Medicine in College Station, the University of Texas Medical Branch at Galveston and the University of Texas Health Science Center at San Antonio received Fs, the last two because they did not respond to the survey. Officials at Texas A&M, the only school that received an F after submitting the required material, did not comment. The study, commissioned by the American Medical Student Association, said the school's conflict of interest policy does not address gifts from the pharmaceutical companies, among other things.
Connecticut House Majority Leader Christopher G. Donovan has called on Gov. M. Jodi Rell to delay the implementation of her new Charter Oak health plan for uninsured adults. The Rell administration intends to merge Charter Oak with the HUSKY health plan for 320,000 low-income children and adults who are eligible for Medicaid. Child advocates complain that Rell's plan may disrupt coverage for needy children. The advocates are also concerned that covering uninsured adults may be too expensive, weakening HUSKY.
A broad coalition of corporations, consumer groups, and pharmaceutical providers has moved closer to compelling millions of doctors to file prescriptions electronically. Supporters such as AARP and AT&T have touted electronic prescriptions as an easy, effective way to avoid deadly medication errors and save healthcare providers billions. Under a proposal before the Senate, Doctors in the government's Medicare program would receive bonuses when they use online prescribing software, beginning with 2% increases in 2009. Those who don't adopt the technology by 2011 would see their pay cut 1%, growing to 2% by 2013.
Wall Street Journal columnist Benjamin Brewer, MD, says that despite the monetary rewards of choosing high paying specialties, many of these docs are missing out on the best parts of medicine. In family medicine, Brewer says their is a feeling of importance in the work and the satisfaction of seeing patients get well and the kids grow up.
During a hearing before the New York City Landmarks Preservation Commission, St. Vincent's Hospital Manhattan representatives said the facility will have to close if it cannot build a medical tower in Greenwich Village. The hospital presented several consultants and healthcare experts that supported its case for a $1.6 billion development plan, which also involves demolishing several structures. Commissioners had objected to the hospital's original plan to demolish nine buildings in the Greenwich Village Historic District to permit the construction of a 329-foot-tall medical building. The commissioners did not rule on the hospital's application, more hearings are planned.
Many patients with the worst type of heart disease think they will live longer than their doctors tell them they will, according to Duke University researchers. Cardiologists at Duke began telling people being treated for heart failure that the condition would shorten their lives. The doctors weren't believed and instead, many patients preferred to believe that they would have the normal life span expected of men their age, according to a report on the research.
Johns Hopkins Healthcare LLC is suing CareFirst of Maryland Inc. for $2 million, claiming the insurer owes it that much for claims made since October 2004. In a lawsuit, Johns Hopkins says CareFirst denied or underpaid nearly 15,000 claims for healthcare services performed through April 30. Johns Hopkins also claims that CareFirst reduced some negotiated Medicare reimbursement rates without disclosing the changes, used outdated fee schedules and made mathematical computing mistakes, among other processing errors.
University of North Carolina Hospitals is seeking state funding to help build a 321-bed tower on its old helipad site in front of NC Memorial Hospital. The $732 million project would increase the total number of patient beds to 1,009 by 2014. The tower also would have 38 operating and procedure rooms, and UNC Health Care is requesting $325.5 million from the state over several years to help fund the project.
At leading medical centers, patients in intensive care units are often managed by doctors specially trained to provide that care—but a new study raises questions about the benefits of that treatment. Patients managed by critical care physicians were at greater risk of dying than patients managed by doctors who lacked that training, according to researchers who examined data from 123 U.S. intensive care units. The results were immediately challenged by the Society of Critical Care Medicine, and researchers acknowledged that more study is needed.
With all the attention it gets, medical tourism might seem like an entirely new concept. Although the idea of U.S. residents seeking services outside the States is relatively novel, destination hospitals have long received patients from places like Latin America, the Middle East, Europe, and more recently Asia.
As medical travel has gained acceptance and the industry begins to take off, the debate over its ethics also gains momentum. In my last column, I discuss whether U.S. healthcare organizations will explore ways to collaborate or compete with global destination hospitals. In a public comment, one reader appears to take offense to the notions I forwarded in the story, and in this online posting the reader raises many of the ethical dilemmas associated with medical travel.
With 150,000 Americans traveling abroad for medical care last year, according to Josef Woodman, author of Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism, the global healthcare industry should consider ethical matters with care as it seeks to further develop inroads into first-world countries.
Woodman joined three others from the medical travel industry for a panel discussion at Harvard Medical School on the ethical issues of medical tourism. The conversation was wide-ranging and focused more on medically necessary procedures rather than cosmetic procedures that account for more than half of the industry's services.
Maggi Grace, a consultant with BestMed Journeys and author of State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India, put a human face on the issue by telling her first-hand account of traveling with her partner, Howard Staab, to India to repair a mitral valve in his heart. Grace made the case that the U.S. health system doesn't provide enough for the uninsured and has in effect forced people like Staab to seek alternatives outside the States.
At the same time, Grace questioned whether the citizens of India are receiving "compromised care" because healthcare resources are being diverted to medical travelers. This is perhaps the toughest ethical issue for the medical travel industry.
Another panelist, I. Glenn Cohen, JD, assistant professor at Harvard Law School, said that he considered "brain drain," a term for the practice of developed countries recruiting clinicians from underdeveloped countries, as a greater ethical dilemma for global healthcare than private hospitals providing medical travel services.
David Boucher, president and chief operating officer for South Carolina-based Companion Global Healthcare, was also on hand to outline how U.S. insurers are entering into global healthcare. The idea that insurers are working with employers to explore cost-savings options through medical travel didn't sit well with some of the Harvard faculty in attendance.
During the Q&A session, Arnold Relman, MD, professor emeritus of medicine and of social medicine at Harvard Medical School and the former editor of the New England Journal of Medicine, was on hand to question why American providers should support the expansion of medical tourism at the cost of neglecting problems within the U.S. healthcare system. He described the need for Americans to access medical travel as a failure of the U.S. system and suggested that by accommodating the middle-class, who can afford access to procedures abroad, the medical tourism industry is reducing the political pressure on policy makers.
In sum, the panelists responded that they believe medical travel will continue to expand and shouldn't be ignored by U.S. healthcare providers and organizations. Woodman pointed out that he didn't think it possible to stop the trend of medical travel and global healthcare and said that as a component of overall healthcare, medical travel could force changes to the healthcare system.
Other topics—such as medical travel's influence on the continuum of care, destination hospitals providing services that are illegal in home countries, and malpractice mitigation—were touched upon. It's no surprise that global healthcare faces numerous ethical issues.
At the same time it's unreasonable to expect any industry to solve all possible ethical issues on the front-end of globalization. In the history of globalization, what industry has indisputably succeeded navigating the minefield of multicultural ethical considerations? Unlike some other industries, global healthcare seems to have at least a solid understanding of the potential impacts of its expansion. I'm not saying all have been overcome, but they have been identified and can now be addressed.
But more ethical problems that we have yet to imagine will be discovered along the way. What will be telling is the willingness of industry players to engage in candid public dialog about these issues.
With the industry is still in its infancy, I believe that as global healthcare evolves, it will find ways over time to resolve ethical concerns, provide more healthcare options to those in need, and help to further develop emerging countries. I'm sure we'll also uncover unethical medical practices—just as we do in developed nations—but I hope these will be the rare exceptions.
Time will tell, but perhaps more readers could enlighten us with their thoughts. As always, feel free to leave a public comment using the tool below or send me an e-mail.
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