In the News for the Week of 6-8-04
Clinical news in the headlines
- Discount cards go live but many seniors not signed up
Business of medicine
- Male physicians earn considerably more than female colleagues
- Conference call will target disseminating patient safety research
- College offers savings on full MKSAP 13
- ACP issues updated editions of popular practice and screening guides
- SGIM honors College Regent Chair
- New forum links members of carrier advisory committees
Clinical news in the headlines
The first large study to compare psychotherapy with drug treatment for depressed teens found that fluoxetine (Prozac) works better than psychotherapy. The study also found, however, that combining the two therapies may be the best treatment approach.
Results from the landmark study, sponsored by the National Institute of Mental Health, indicated that sessions with a therapist were no more effective than placebo, according to the June 2 New York Times. However, drug treatment combined with psychotherapy produced better outcomes and reduced patients' risk of suicide.
The findings, presented at a meeting last week of psychiatric drug researchers, should reassure physicians and patients worried about recent reports that selective serotonin reuptake inhibitors (SSRIs) may cause suicidal tendencies in teens, the New York Times reported.
However, the study--which involved more than 430 adolescents age 12 to 17--collected data on only fluoxetine, which is the only SSRI approved by the FDA for use in adolescents. Britain recently banned prescribing other SSRIs to adolescents, and the FDA is now reviewing clinical trial data from U.S. drug companies to see if there is an association between SSRI use in teens and suicide.
While most studies on SSRI use in teenagers have been small trials sponsored by drug companies, the study released last week was funded entirely by the government.
The New York Times is online.
Contrary to some recent findings, a new study suggests that structured interruption of treatment may harm, not help, patients with multidrug-resistant HIV infection.
Those findings, abstracted in the May-June ACP Journal Club, are from a study of 270 mostly male patients with HIV. Patients in the intervention group received four months of structured interruption of treatment followed by an optimized antiretroviral regimen. Drug treatment was resumed if the disease progressed or there was a 50% decrease in the CD4 count before four months.
Results showed that 16% of the patients in the intervention group experienced progression of disease or death compared to 9% of the patients in the control group, with this difference due to progression, rather than increased mortality during the course of the study.
Reviewers noted that some studies have found that structured interruption of treatment can produce better immunologic and virologic responses. However, they pointed out that physicians should take note of mounting evidence that structured interruptions before the initiation of salvage therapy can have harmful clinical consequences for patients.
The ACP Journal Club is online.
While Medicare beneficiaries were able to use drug discount cards for the first time last week, administration officials said that many low-income seniors still have not enrolled in the card program.
Most of the almost 3 million Medicare beneficiaries already signed up in the discount card program were automatically enrolled by their Medicare managed care plans, according to the June 1 Washington Post.
Only a half million beneficiaries from Medicare's fee-for-service program have enrolled. HHS secretary Tommy Thompson was quoted as saying he is particularly concerned that the 4.7 million low-income seniors who are eligible this year and in 2005 for an additional $600 credit to purchase prescriptions are not enrolling.
Up to 7.3 million of the 41 million Medicare recipients were expected to sign up this year for the cards, which provide discounts of up to 18% on brand-name prescriptions for an annual fee of about $30.
CMS administrator Mark McClellan, ACP Member, has said that the agency will consider automatically signing up low-income beneficiaries if large numbers of that group don't enroll. According to Mr. Thompson in the Washington Post, the administration will make a concerted effort to sign more low-income beneficiaries in the drug discount program.
More information about the card program is at the CMS Web site.
The Washington Post is online.
Business of medicine
Female physicians in 1999 earned only 63 cents for every dollar earned by male physicians.
The findings were part of a recently released report from the Census Bureau, using data collected in 1999. The report claimed that physicians and surgeons still have the highest-earning occupation, with a median salary of $120,000. However, the report found that the median salary for female physicians was $88,000 while the median salary for male physicians was $140,000.
According to the June 3 Philadelphia Inquirer, the report claimed that pay differences between male and female physicians can be attributed to factors other than discrimination. Those factors include female physicians choosing different specialties or leaving the labor force for longer periods than men.
The Census Bureau report, which looks at male and female earnings for several occupations, is online.
The Philadelphia Inquirer is online.
A College staff member will help lead an upcoming conference call on ways to publicize results of research into patient safety. Physicians are invited to participate.
The conference call, which is set for June 16, is sponsored by the Agency for Healthcare Research and Quality (AHRQ). The focus of the discussion will be what works--and what doesn't--with dissemination strategies for research results.
Panelists will include Christel Mottur-Pilson, PhD, the College's Director of Scientific Policy, and Peter J. Pronovost, MD, an associate professor at Johns Hopkins University.
In promoting patient safety research, Dr. Mottur-Pilson said the College has engaged more than 7,000 physicians and trained over 75 chapter members in research on ways to improve patient safety. Those physicians have passed on those lessons during hospital rounds or in presentations to local medical societies, said Dr. Mottur-Pilson. Her own work at the College has focused on several patient safety ambulatory care issues, such as reducing medication errors.
To participate in the conference call, which is June 16 from 1-2 p.m. EST, call 1-800-549-8229. International callers should dial 1-630-691-2740. The passcode is "AHRQ Dissemination."
To help guide the discussion, please e-mail questions by June 9 to and write "Dissemination" in the subject line.
The full version of MKSAP 13, including parts A and B, is now available.
Part B features five completely revised books, covering Endocrinology and Metabolism, Gastroenterology and Hepatology, Neurology, Pulmonary Medicine and Critical Care, and Rheumatology. Physicians who complete Part B can receive 64 CME credits, in addition to the 76 credits available by completing Part A, for a total of 140 credits.
The new MKSAP 13 provides the latest developments in internal medicine and its subspecialties. It covers 14 areas in internal medicine and includes 10 books containing more than 1,500 pages. The program also includes answers to and critiques of the 1,000 multiple-choice questions contained in the syllabus books.
The program is available in print and on CD-ROM. A special combination package offers members a $100 discount when they purchase both the print and CD-ROM versions together.
More information is available online.
The College recently issued updated editions of popular College publications geared to improving practice management for young physicians and to identifying key preventive and screening services.
The fifth edition of the "Young Physician Practice Management Survival Handbook" provides information on setting up and managing a practice, including practice management resources the College offers. Updated every year, the "Handbook" is sponsored by ACP's Young Physicians Subcommittee, a College advisory group that represents physicians under the age of 40.
And the "Pocket Guide to Selected Preventive Services for Adults," now in its second edition, lists screening services, clinical guidelines and preventive measures. Developed in conjunction with ACP's Practice Management Center and Scientific Policy staff, the publication covers screening services, including counseling and preventive measures such as adult immunizations. For a free copy of either booklet, contact LuzSelenia Salas, Administrative Representative, at 800-523-1546, ext. 2714, or 215-351-2714; by fax at 215-351-2759; or via e-mail.
The Society of General Internal Medicine (SGIM) last month bestowed its highest honor on Eric B. Larson, FACP, MPH, Chair of the College's Board of Regents.
At SGIM's annual meeting, Dr. Larson received the society's annual Robert J. Glaser Award, which recognizes excellence in research and/or education in generalism in medicine.
In a nomination letter signed by 34 colleagues, Dr. Larson was hailed for his pioneering studies of dementia. He was also commended for his sustained interest in integrating technology with medicine and for consistently anticipating future trends. Colleagues noted, for example, that Dr. Larson 20 years ago was exploring errors related to inpatient medical orders.
In addition to being a Regent, Dr. Larson has served as a JCAHO commissioner and as a SGIM council member. He is director of the Seattle-based Group Health Cooperative's Center for Health Studies and is professor of medicine and health services at the University of Washington.
More information about the Glaser Award is online.
ACP has launched an electronic forum for College members who serve on their local Medicare carrier advisory committee (CAC).
Each state maintains a CAC, which includes a representative of each of the major physician specialties. CACs provide input on state-specific Medicare policies proposed by local Medicare carriers.
The new forum features a newsgroup that lets ACP members who serve on their local CAC talk to members who serve on CACs in other states. The forum also features a list of resources such as Medicare coverage decisions, ICD-9 codes and information on Medicare's correct coding initiative.
The forum is the result of a resolution from ACP's Kentucky Chapter, which requested a way for CAC members around the country to communicate with each other.
ACP has already given College members who serve on a CAC access to the forum. If you serve on a CAC, visit the forum at www.acponline.org/cac/. If you have problems accessing the forum, e-mail Carol McKenzie.
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Copyright 2004 by the American College of Physicians.
A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has severe COPD, previously with minimal exertional symptoms, but now notes activity-limiting shortness of breath when walking short distances. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratropium metered-dose inhaler. He has a 55-pack-year smoking history but quit when COPD was diagnosed. Following a physical exam, chest radiograph, and transthoracic echocardiogram, what is the most appropriate diagnostic test to perform next?
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