- Academic medical centers provide major boost to national and local economies
Clinical news in the headlines
- AHA issues heart disease prevention guidelines for women
- FDA approves combination pill for treating hypertension, high cholesterol
- Provider group protests price hike for HIV drug
- Study links CRP levels to colon cancer
- More than 7% of senior office visits result in potentially inappropriate medications
- Physicians examine 'epidemic' of medical mistakes
- College releases new book on breast health
A study released last week by the Association of American Medical Colleges (AAMC) found that academic medical centers injected $326 billion into the U.S. economy in 2002, while providing 2.7 million fulltime and part-time jobs.
The study also found that academic medical centers deliver major economic gains to their home states. In 2002, academic centers contributed $14.7 billion in state tax revenue, in addition to sales taxes, corporate net income taxes, and capital stock and franchise fees.
Spending by visitors from other states to academic centers accounted for $14 billion of related revenue, according to a Feb. 4 AAMC press release. That included $11 billion generated by participants in events sponsored by academic medical institutions.
The AAMC release is at www.aamc.org/newsroom/pressrel/2004/040204.htm.
Clinical news in the headlines
The American Heart Association (AHA) last week released its first heart disease prevention guidelines for women, part of a campaign to highlight heart problems as a major health concern for women.
Cardiovascular disease is the leading cause of death for both women and men in this country, killing close to 500,000 American women every year. The guidelines were published in the Feb. 10 Circulation.
The guidelines recommend tailoring the aggressiveness of preventive treatment to whether women are at low, medium or high risk of developing heart disease in the next 10 years. Risk is based on Framingham risk scores.
According to the new guidelines, women at high risk should receive aspirin, ACE inhibitors and beta-blockers. They should also receive cholesterol-lowering drugs even if they have LDL cholesterol levels below 100 mg/dl.
The guidelines also divide interventions into different classes ranging from Class I interventions, which are "strongly recommended," to Class III interventions that are not effective or may even be harmful. For low-risk women, for example, the guidelines consider regular use of aspirin for cardiac care alone a Class III intervention because the risk of bleeding may outweigh any benefits, according to an AHA press release.
The release of the guidelines coincides with the launch of AHA's "Go Red for Women" media campaign to raise awareness of cardiovascular disease risk among women.
The AHA press release is online at: www.americanheart.org/presenter.jhtml?identifier=3018804.
The guidelines in Circulation are online at circ.ahajournals.org/cgi/content/full/109/5/672.
The FDA last week approved a new drug that combines medication for both high cholesterol and hypertension in one pill.
The new pill, called Caduet, combines Pfizer's atorvastatin (Lipitor) with its blood pressure medication, amlodipine (Norvasc). Sold separately in 2003, the two drugs had combined sales of more than $13 billion, according to the Feb. 2 Reuters.
The company hopes that patients will prefer the convenience and savings of taking only one pill a day to treat both conditions, while paying only one pharmacy co-pay. Pfizer estimates that 30 million Americans suffer from both conditions but that fewer than 10% have successfully reached target levels for either their blood pressure or cholesterol.
Analysts predict that sales of the new drug could reach $3.5 billion by 2007, Reuters said. Pfizer has another combination pill now in phase 3 trials that marries atorvastatin with the drug torcetrapib, which raises HDL cholesterol.
Reuters is online at story.news.yahoo.com/news?tmpl=story&u=/nm/20040202/hl_nm/health_pfizer_dc_1.
A national group of medical professionals who treat HIV patients has strongly objected to a steep rise in the cost of the HIV drug ritonavir by Abbott Laboratories, the drug's manufacturer.
In a letter sent last month to Abbott, the 1,600-member American Academy of HIV Medicine (AAHIVM) protested the recent 400% price increase for ritonavir, which is marketed under the name Norvir. The drug is a primary protease inhibitor frequently used to treat patients with HIV/AIDS.
According to the letter, the steep increase could have a "drastic effect" on the overall cost of antiretrovirals. With both private and public payers looking for ways to cut drug costs, the letter said, such an increase could potentially restrict patients' access to needed medications.
In response, Abbott executives defended their decision to raise prices. In at letter to AAHIVM, the drug company claimed that Norvir is now being used in lower doses in combination with other drugs, making it harder for Abbott to recoup its costs. In addition, Abbott's research revealed that most AIDS patients wouldn't be hurt by the increase because they receive assistance to purchase drugs.
The AAHIVM had acknowledged that patients may not feel an immediate financial impact, because they can use assistance programs. But the group pointed out that the price hike will sharply increase the administrative burdens on HIV clinics by increasing the number of patients who will now need patient assistance programs to cover drug costs.
The AAHIVM's members include physicians, nurse practitioners and physician assistants.
Associated Press on Feb. 8 reported that state investigators in New York and Illinois are investigating the price hikes, which raised the daily price of Norvir from $1.75 to $8.57.
The AAAHIVM's letters to Abbott and Abbott's responses are online at www.aahivm.org/new/index.html.
Associated Press is online at www.washingtonpost.com/wp-dyn/articles/A24319-2004Feb8.html.
A study released last week found that high blood levels of C-reactive protein (CRP) may be an indicator of colon cancer.
The 11-year study of more than 22,000 adults found that patients with the highest levels of CRP—which is produced in response to infection or inflammation—were more than twice as likely to develop colon cancer as those with low levels of the protein. The findings, which were published in the Feb. 4 Journal of the American Medical Association (JAMA), support past studies showing that chronic intestinal inflammation is associated with a higher risk of colon cancer.
According to the Feb. 3 Washington Post, the study's author suggested that high CRP levels might be a predictor of colon cancer, but claimed that findings were too premature to recommend testing to determine patients' risk. An accompanying JAMA editorial noted that the study did not settle the debate over whether high CRP levels are a symptom of colon cancer or a risk factor for developing it—the same controversy that continues over CRP's role in cardiovascular disease.
A JAMA abstract is online at jama.ama-assn.org/cgi/content/abstract/291/5/585. (Full text available only to subscribers.)
The Washington Post article is online at www.washingtonpost.com/ac2/wp-
For more on the debate over CRP's role in assessing cardiovascular risk, see "Testing for CRP: red flag or red herring?" in the March 2003 ACP Observer www.acponline.org/journals/news/mar03/crp.htm.
A study released this week found that more than 7% of office visits made by patients 65 and older in 2000 resulted in potentially inappropriate medications being prescribed.
The study, which was based on CDC data and published in the Feb. 9 Archives of Internal Medicine, defined inappropriate medications as those with risks for adverse outcomes that outweigh potential benefits for most senior patients.
Study authors identified several drugs that together account for much of the problem. They include diazepam, propoxyphene, hydroxyzine, amitriptyline and oxybutynin.
In 2000, the risk of being prescribed inappropriate drugs was greater when patients were prescribed multiple medications—and risk was double when patients were women, according to the study abstract.
A study abstract is online at archinte.ama-assn.org/cgi/content/abstract/164/3/305. (Full text available only to subscribers.)
A new book provides a dramatic look at medical errors in U.S. hospitals and clinics, and recommends changes in systems and policies to help prevent mistakes.
"Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes" was written by hospitalist Robert M. Wachter, FACP, and Kaveh G. Shojania, ACP Member. The authors present a series of case studies from around the country to illustrate why serious medical errors occur. Several of the cases first appeared in "Quality Grand Rounds," an Annals of Internal Medicine series co-edited by the authors.
They conclude that most errors result from systems problems and "mixed signals" rather than incompetent individuals, according to a press release from the University of California, San Francisco (UCSF), which published the book. Proposed solutions include creating systems to prevent "handoff" errors when patients are transferred; using computerized tools to eliminate medication errors; and creating a culture of teamwork at hospitals, as well as learning opportunities when errors and near-misses occur.
The UCSF press release is online at pub.ucsf.edu/today/cache/news/200402047.html.
The Annals "Quality Grand Rounds" series is online at www.acponline.org/journals/annals/series/quality/.
The ACP Books Program has released "Breast Health and Common Breast Problems: A Practical Approach," a valuable tool for assessing and managing common breast problems.
The reference book offers medical professionals a systematic approach to preventing and evaluating common breast problems, and to answering frequently encountered questions about breast health and cancer risk. The book includes algorithms for diagnosis, management, and referral, as well as recommendations for counseling women about breast cancer risk and screening options amid often contradictory evidence and guidelines.
It also offers a sensitive guide to understanding unanticipated perceptions and challenges when advising women about breast cancer risk, prevention and benign breast disease.
More information is online at www.acponline.org/catalog/books/breast_health.htm?ow. The 250-page, softcover book is available to members for $29. To order, call ACP Customer Service at 800-523-1546, ext. 2600, and refer to product #330300330.
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Copyright 2004 by the American College of Physicians.
A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. Following a physical exam and review of previously performed chest radiographs and pulmonary function testing, what is the most appropriate management?
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