Fitness Blog

Alternatives: Stuart Browning and Kaiser Permanente respond to Michael Moore.

Influence: Congress wants to start a registry of drug company gifts to doctors. One Senator had the inside scoop:

Senator Claire McCaskill mentioned that she had a brother who runs a restaurant.

“And he said that the most lucrative part of his business was the private room that is used mostly by drug companies” to entertain doctors, said Ms. McCaskill, Democrat of Missouri. “He said that you wouldn’t believe how much expensive wine these guys buy.” The tab often totals thousands of dollars, she said later.

Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, assured Ms. McCaskill that major drug makers no longer offer doctors expensive dinners. The industry’s code of ethics mandates that free meals be modest — pizza, for instance, Ms. Powell said.

“I would, with all due respect, suggest that there has been a change in your brother’s restaurant in recent years,” she said.

Ms. McCaskill pressed, “Are they allowed to buy alcohol?”

Ms. Powell responded, “Our code does not go into that level of detail.”

Do lobbyists buy senators' meals? Or are they limited to campaign financing? They can give them meals, though according to the Senator, Congress is thinking about putting a stop to that. Registries for both politicians and doctors and their respective lobbyists may not be a bad idea. I'm game if they are.

The drug industry, of course, isn't so keen on the idea:

Asked whether the drug industry would support a mandatory national registry of payments and gifts to doctors, Ms. Powell told the committee that similar state efforts had become enmeshed in difficult details — like deciding whether free drug samples should be classified as gifts.

“There are those kinds of complexities that would make a registry very difficult,” she said.

After the hearing, Ms. Powell’s trade association released a statement criticizing the state registries, saying they “disarm doctors by inhibiting access to critical scientific information about the benefits and risks of treatment options that help patients win their battle against disease.”

Registries don't "disarm" doctors. They disarm the drug industry.

But it isn't the wine and food and nice resort get-aways that are the real problem. It's this kind of influence that's the problem:

Now, nearly two-thirds of the cost of continuing education courses sponsored by medical schools, popular for their prestige, are paid for by drug and medical device companies and other commercial interests, figures show. Overall, commercial sponsors pick up about half of the $2.25 billion annual cost of the courses doctors must attend to keep their licenses.

"Most of what doctors know about drugs comes from the industry, and that's not healthy," said Jerry Avorn, a Harvard Medical School professor and critic of the sponsorships. "Academic organizations lend their names to courses that are nothing more than infomercials."

It has become very difficult to get good, reliable, independent information. Even when a doctor is able to find good information, he may find it difficult to apply to his practice if he's obligated to hold to a local community standard of practice. What if everyone else in the community has based their standard on the drug company lectures and lobbying?

Smokers Need Not Apply: The Cleveland Clinic, leader in health mandates, has announced it will no longer hire smokers. How long before they announce they won't hire fat people?

Wonderful: An intern with the State of Ohio had a computer disc stolen from his car with more information on it than anyone should be carrying around. That includes bank account numbers of doctors who accept Medicaid. One more reason to be wary of Medicaid.

Aftermath: A new study says that mortality in post-Katrina New Orleans is higher than before the hurricane, though they had to rely on newspaper obituaries to make the determination:

Kevin U. Stephens Sr., MD, JD, Director of the New Orleans Health Department, and colleagues used monthly totals from the New Orleans Times-Picayune to obtain the frequency and proportion of deaths from January to June 2006. They compared these figures with deaths notices from 2002 to 2003. They also compared death notice figures with data from the state Health Statistics Center on the top ten causes of death in the greater New Orleans area from 2002 to 2003.

"The post-Katrina mortality rate for the first six months of 2006 was approximately 91.37 deaths per 100,000 population. Compared to the pre-Katrina population mortality rate of 62.17 deaths per 100,000 population, this represents an average 47 percent increase from the baseline mortality, suggesting a marked increase in indirect (excess) deaths post-disaster, the authors report.

It shouldn't be too surprising that mortality is higher in the aftermath of such an extensive disaster. On top of the loss of infrastructure and people, those left behind are more likely to be the sicker and older - people who would have more difficulty picking up and moving to a new place after the deluge.

The press notice goes on to argue that this is a reason for electronic record system, but it seems that electronic records, but wouldn't electronic records be even more vulnerable to a disaster?