The US Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.
Based on the FDA’s review of new safety information, it is now requiring updates to the drug labels of all prescription NSAIDs.
The Supreme Court today voted to uphold the previous IRS ruling that the Affordable Care Act allows for tax subsidies in the 34 states that use federally funded health-care exchanges. The 6-3 decision preserves health-care coverage for millions of Americans who enrolled for health care on the federal exchange.
Gout, the most common inflammatory arthritis worldwide, is treatable but vastly undertreated, according to epidemiologic studies that now encompass three continents. The undertreatment problems previously reported in the United Kingdom and the United States also characterize gout in Taiwan, according to a nationwide population study.
Chang-Fu Kuo, MD, from the Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, United Kingdom, and the Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues report the study results in an article published online January 23 in Arthritis Research & Therapy. Dr Kuo was also the lead author on the UK study.
In the new article, Dr Kuo and colleagues report, although gout incidence in Taiwan decreased during the course of the study, prevalence remained high and stable and gout management remained poor, with only about one quarter of patients receiving potentially curative urate-lowering therapy.
Jasvinder A. Singh, MD, MPH, who led the US study and who was not involved in either the Taiwan or UK studies, told Medscape Medical News, “The rates of undertreatment of gout in the US are also quite high and have been widely published, and many of the observations published in this study have also been seen in many other countries. Undertreatment includes not only lower rate of use of urate-lowering drugs but also infrequent monitoring of the serum urate and a low proportion reaching the target serum urate of less than 6 mg/dL due to use of suboptimal dose of urate-lowering drugs.” Dr Singh is professor of medicine at the University of Alabama, Birmingham.
Dr Kuo and colleagues used data from the National Health Insurance Research Database for Taiwan, which covers the entire population of 23 million people, to identify gout patients, estimate prevalence and incidence for each year from 2005 to 2010, and examine patterns of gout treatment.
Gout prevalence was 1,458,569 (6.24%), and gout incidence was 56,595 (2.74/1000 person-years). Gout prevalence did not change significantly during the study, although gout incidence decreased 13.4% between 2005 and 2010 and 2.1% between 2007 and 2010. In comparison, estimates of annual incidence in US studies ranged from 0.45 to 1.73 per 1000 person-years.
Gout was most prevalent and had the highest incidence rates in eastern coast counties and offshore islets of Taiwan, which the authors note also have higher populations of indigenous Taiwanese. “However, genetic factors account for just one-third of phenotypic variation of gout in men and only one-fifth in women so environmental factors could also contribute to the variable geographical distribution of gout in Taiwan,” the authors write.
“To the best of our knowledge, our study is the first to report gout incidence in Asian populations. The incidence in Taiwan was much higher than other countries, suggesting significant racial and geographic variation in the aetiology of gout,” they add.
Dr Singh commented, “There are very few studies of gout risk in Asian patients in the US, so it’s not easy to say whether the problem is better, the same, or worse than Taiwan. There are no particular subgroups in the US that require particular attention, except that African-Americans have been shown to have poorer outcomes with gout compared to Caucasians, and lower rates of medication treatment.”
In the Taiwan study, in 2010, only about one third of patients with gout had contact with health services in relation to gout, and only one in five were prescribed urate-lowering therapy. Of those treated, 60.08% (95% confidence interval, 59.91% – 60.25%) received uricosuric agents alone, 28.54% (95% confidence interval, 28.39% – 28.69%) received a xanthine oxidase inhibitor, and 11.38% (95% confidence interval, 11.27% – 11.49%) received both. The authors add, “Unfortunately, this suboptimal care has not changed over the study period, despite the publication of national and international guidelines on gout management during this period.”
The authors have disclosed no relevant financial relationships. Dr Singh reported no financial conflicts related directly to this study but has received research and travel grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Allergan, and Novartis.
Source: Janis C. Kelly, Medscape
Cool article about how DPMs are helping to rebuild in Haiti, from the blog of Patrick DeHeer DPM written by Fairuz Parvez DPM:
When asked about my experience in Haiti, at first I did not know where to begin. If I were to sum it up in a word, it would be: shocking.
It was eye opening to say the least. I was at a loss for words when I first landed in Haiti. I knew there was some structural destruction but I did not truly understand at what level, the depth of the devastation, and why it was still so. I was as guilty as the next American assuming Haiti was not so bad off. Boy, did I get a crash course in the reality of things there.
The first thing that shook me to my core was just how impoverished the country really was. I have visited developing nations in the past and even there you can find modernized areas with better conditions and buildings that are comparable to those of the west. With Haiti, almost the entire country looks like the ghetto of a developing nation. High rises are almost nonexistent and modern buildings are truly in the minority. Most buildings are primarily plaster or poorly constructed one-floor concrete-ish structures. Then you have the tent cities and makeshift shacks that line the sides of the road.
Yes, I know, I know. You are probably thinking the same thing I was. “Well, what about those innumerable fundraising efforts for millions of dollars by members of Hollywood and various philanthropists? It has been five years since the earthquake. What’s been going on since then?”
The issues with Haiti are more complicated and deeper than just some physical damage to some buildings from the earthquake. If it were that simple, Haiti would have been “fixed” by now. Haiti has been in dire shape since long before the earthquake. If anything, the earthquake was sort of almost a service to the country. It forced the world to pay attention to a country that is so desperately impoverished and functionally broken at the most basic, fundamental levels. The country needs far more than a few well-meaning philanthropists throwing some money at it. That will not solve any problem. The country needs help to establish foundations and basic infrastructure in every field from healthcare to finance to education to agriculture and even to tourism. Without the right kind of help, Haiti will only fall deeper into despair.
As Dr. DeHeer so astutely put, “Haiti is devastatingly endearing.” It truly is. You see people in absolute, abject poverty along the streets in Haiti. Yet there they are, trying to carve out a meager existence, selling their wares. Somehow, they still push forward. Yes, invariably, with international efforts, a culture of dependency has also developed. Nonetheless, this has not completely taken over the psyche of the Haitians. There is great enthusiasm among them when they are afforded an opportunity to learn something new. However, things are still in a fragile state. After my week in Haiti, it us clear that our support is necessary more than ever.
Sure, coming to Haiti and doing a handful or even a large number of surgeries on a mission visit is satisfying, but useless nonetheless. I have always planned to do mission work, knowing it would be part of my practice in the future in some way. But after my visit to Haiti, my entire perspective shifted. Most of my concerns and thoughts seem so insignificant now. I realize I can’t just go to an impoverished country and provide treatment/perform surgeries, and expect to think it made some sort of difference. It is simply not enough.
That old adage “give a man a fish, you feed him for a day. Teach a man to fish and you feed him for a lifetime” rings true here. This is the only thing that will truly make a difference in Haiti. We really need give our Haitian colleagues the proper tools (be it medical equipment or medical training) so they can help themselves. Only then can they truly recover and grow.
Now before I give the impression that my trip to Haiti was a bust, let me clarify. It was a great success. The best part of my trip to Haiti was discovering that the organization, Step by Step Haiti, is doing all that and more. It was truly wonderful working alongside our Haitian colleagues. They took our direction and instructions so enthusiastically. They were exceptionally eager to learn what we had to offer. They asked insightful questions and truly try to apply their newfound knowledge to help their fellow citizens. There are real efforts now happening in the communities to educate and reach the average Haitian citizen. They see there is a chance and it is encouraging. It was quite enriching and exciting seeing our colleagues not only treat patients, but be able to demonstrate that they are actively sowing the seeds for preventative care in limb salvage as well.
There is still a long way to go but progress is surely happening. Once these clinics are fully established around the country with appropriate tools and protocols, we hope to establish a Haitian medical residency as a tradition for coming generations.
I am proud to say I have been consumed by my trip to Haiti. I am just getting started and am anxious to do more. All in all, my first trip to Haiti has been truly satisfying. With all of the wreckage I found, I also saw a silver lining. It is with this silver lining that hope springs eternal in the human breast. Hope for a better future for our Haitian brothers and sisters.
Source: Podiatry Today
The American Public Health Association (APHA) is creating awareness through their Get Ready Day campaign, which will be held on September 16, 2014. The campaign helps Americans prepare themselves, their families and their communities for all disasters and hazards, including the flu, infectious disease, natural disasters and other emergencies.
It’s certainly a good reminder to be aware of potentially dangerous situations and how they are safely handled. Here is a list of how to prepare for pretty much any emergency situation you can think of.
This is also probably the cutest video you’ll ever see about emergency situations…Get Ready Video
Office visits in the United States for diabetes rose 20% from 2005 to 2010, with the largest increase in adults in their mid-20s to mid-40s, according to a new data brief from the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS).
Nearly 29 million people in the United States have diabetes, putting them at risk for other chronic conditions, such as heart disease, eye disease, and stroke, Jill J. Ashman, PhD, and colleagues from the NCHS note in the brief.
On an annual basis, the cost of diabetes in the United States approaches $245 billion, and patients with diabetes have medical expenditures 2.3 times those of patients without diabetes.
The researchers analyzed recent trends in office visits by patients with diabetes using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal office-based physicians (excluding anesthesiologists, radiologists, and pathologists).
They found that office-based physician visits by patients with diabetes rose from 94.4 million in 2005 to 113.3 million in 2010 (a 20% increase). Visits by patients with diabetes made up about 11% of all office-based physician visits in 2010.
The number of office visits increased during the study period for all age groups except for those younger than 25 years. The largest percentage increase (34%) occurred in people in the 25- to 44-year age range.
However, the volume of visits was higher for older adults; individuals aged 65 and older made 53.7 million visits in 2010 compared with 2.6 million visits made by those younger than 25.
The researchers did not see any marked change in the rate of office visits by patients with diabetes in any age group during the study period. The highest rate in 2010 was among those aged 65 and older (1380 visits per 1000 persons) and lowest in those younger than 25 (20 visits per 1000).
“Diabetes is not the only health concern for the majority of patients who have it, with 87% of visits being made by patients who have additional chronic conditions,” Dr. Ashman and colleagues say.
Regardless of age, they found that patients with diabetes use “extensive health resources,” making frequent trips to the doctor and often receiving multiple prescriptions.
One of the federal Healthy People 2020 goals is to reduce the disease and economic burden of diabetes. “Continuing to examine office-based physician visits by patients with diabetes is especially important given changes in standards of care that may influence such visits,” Dr. Ashman and colleagues say.
Source: Medscape
As its name insists, the Affordable Care Act (ACA) is supposed to give more American access to reasonably-price healthcare, but this affordability would prove fruitless if the number of primary care physicians in the United States continues to decrease.
Recent findings from the likes of SERMO, the largest online community of physicians, show that amongst all provider specialties family and internal medicine are two of three unhappiest groups of physicians, 62 percent and 60 percent, respectively. Only obstetricians and gynecologists come in lower at 59 percent. For internists and family physicians, dissatisfaction with lifestyle was a common factor leading many to rethink their choice of specialty, 25 and 23 percent, respectively.
“These are the doctors on the front lines in medicine who are seeing the increase pressure and in particular now with the ACA in play and a higher stream of patients coming in,” SERMO CEO Peter Kirk tells EHRIntelligence.com. “It is still a challenging work environment and they are at the lower end of the pay scale. Those are the ones looking to change whereas those on the higher end of the pay scale — orthopedists, physiatrists, oncologists, etc. — are happiest with their professions.”
Although these physicians admit to dissatisfaction with their choice of specialty, it does not mean that they are leaving it for another. So then why is this problematic? The answer to that question is seen in the choices made by the next waves of physicians, residents, who are opting more lucrative and less stressful professional positions.
“Based on some of the conversations on the site, you can build a sense of how much there is a drive toward specialty right off,” Kirk explains. “Having your own private practice as a primary care physician is not the dream anymore. It doesn’t pay the bills. There’s too much complexity, too much involved in running a business. This is driving residents into searching for the best-paid specialties in order to help pay of their debt and have a nice head start moving forward.”
Here lies the basis on predictions that physician shortages are only a matter of time. The ACA and increase of insured Americans should only serve to exacerbate the stresses associated with primary care.
“There will not be enough real doctors at the front lines of primary care to handle the workload, especially with the ACA adding 30 million additional patients to the system,” maintains SERMO’s CEO. “More pressure and more of the primary care are being assigned to non-physicians. The NPs and PAs are likely to do more of the work. That’s going to play out over the next five to ten years.”
A solution to the problem?
The physician shortage problem is real, but what can be done about it? Both the Association of American Medical Colleges (AAMC) and American Medical Association (AMA) believe the solution to be found in graduate medical education.
Crediting medical schools for increasing enrollments and students for responding with an increasing number of applications, the AAMC is placing the onus on lawmakers:
Now Congress must do its part by lifting the cap on the number of federally supported residency training positions. Lawmakers have responded with proposals in the House and Senate to increase the number of residency positions. But they must act now in order to ensure that there are enough physicians for our growing and aging population.
Meanwhile, the AMA has developed a new policy to encourage state and federal legislators and private payers help fund residents in training with an emphasis on promoting the teaching of team-based and patient-centered care models by accrediting associations.
Through its Accelerating Change in Medical Education initiative, the AMA has convened nearly a dozen medical schools to decrease disparities in medical education. “As more patients continue to receive health care coverage, it is essential that the next generation of physicians is sufficiently trained,” said AMA Board Member Stephen Permut, MD.
Health information technology (IT) has a role to play in easing the burdens on providers if developed, implemented, and used properly. But it is still only a support and no substitute for the skill and expertise of physicians using it.
Source:
Kyle Murphy, PhD
EHR Intelligence
WASHINGTON—The American Podiatric Medical Association (APMA) today voiced its concern over the short-term solution known as the “doc fix” legislation passed by voice vote in the House of Representatives. APMA calls on Congress to discontinue use of these temporary fixes, and instead focus efforts on continuing bipartisan negotiations, working toward a permanent SGR replacement package that includes provisions of the APMA-sponsored HELLPP Act.
The one-year “doc fix” keeps Medicare payment levels at their current level and averts the 24-percent payment cut scheduled to take effect April 1. Instead, providers would see a 0.5-percent increase in payments through December 31, 2014. Payments would then revert to their current levels through April 15, 2015. The bill would also delay the ICD-10 transition until October 2015. While the delay does allow for additional time for preparation, it poses a significant financial and resource impact on entities that were heavily invested in the transition.
“APMA continues to work with members of Congress to replace the flawed sustainable growth rate formula as well as any burdensome requirements that adversely affect our members, including our collaborative goal of an orderly ICD-10 transition,” said APMA President Frank Spinosa, DPM. “APMA urges its members and all physician organizations to push for permanent Medicare payment reform.”
Contact APMA’s Legislative Advocacy department at advocacy@apma.org.
During the battle to reopen the government, a pot
With that in mind, here are some frequently asked questions about the tax.
Q: What is the medical device tax?
A: Since the beginning of this year, medical device manufacturers and importers have paid a 2.3 percent tax on the sale of any taxable medical device. The tax applies to devices like artificial hips or pacemakers, not to devices sold over-the-the counter, like eyeglasses or contact lenses.
Q: Why did Congress put the tax into the health law?
A: The law created a package of new taxes and fees to finance the cost of the health law’s subsidies to help purchase coverage on the online marketplaces, or exchanges, and the law’s Medicaid expansion. In addition to the tax on medical devices, an annual fee for health insurers is expected to raise more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion. In 2018, the law also will impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. That has been dubbed a “Cadillac” tax because it hits the most generous plans.
Q: Why do proponents of the repeal suggest the medical device manufacturers should get a break over those other industries?
A: Medical device makers say the tax will cost 43,000 jobs over the next decade and will increase healthcare costs. In a September letter to lawmakers, device manufacturers said if the tax were not repealed, “it will continue to force affected companies to cut manufacturing operations, research and development, and employment levels to recoup the lost earnings due to the tax.”
The device makers also assert that, unlike other health industry groups that are being taxed through the health law, they will not see increased sales because of the millions of people who will be getting insurance through the overhaul. “Unlike other industries that may benefit from expanded coverage, the majority of device-intensive medical procedures are performed on patients that are older and already have private insurance or Medicare coverage. Where states have dramatically extended health coverage, such as in Massachusetts where they added 400,000 new covered lives, there is no evidence of a device ‘windfall,'” the group’s letter to Congress stated.
The left-leaning Center for Budget and Policy Priorities has challenged industry assertions that the tax will lead medical device manufacturers to shift operations overseas and that it will reduce industry innovation. Since the tax applies to imported and as well as domestically produced devices, sales of medical devices in the U.S. will be subject to the tax whether they are produced here or abroad, the center’s analysis notes. Innovation in the medical device industry has slowed for reasons unrelated to the tax, the center said, noting that the health law may spur medical-device innovation by promoting more cost-effective ways to deliver care.
Q: Who else is pushing for a repeal?
A: Republicans and Democrats in both chambers – in particular those who hail from states with many device manufactures, such as Minnesota, Massachusetts and New York — have sought to repeal the medical device tax. Most recently, Sen. Susan Collins, R-Maine, has pushed for a repeal as part of larger legislation to lift the debt ceiling and reopen the government.
The Republican-controlled House has twice passed legislation to scrap the tax, including a recent measure that would have also delayed implementation of the health law by a year. In the Senate, 33 Democrats and Maine Independent Angus King voted earlier this year to repeal the tax, although the vote was a symbolic one, taken as part of a non-binding budget resolution.
Q. Who opposes the repeal?
The White House in the past has said the president would not support such a measure, although it has not commented about the issue in the current negotiations. In a statement issued last year about a congressional effort to get rid of the tax, the White House said, “The medical device industry, like others, will benefit from an additional 30 million potential consumers who will gain health coverage under the Affordable Care Act starting in 2014. This excise tax is one of several designed so that industries that gain from the coverage expansion will help offset the cost of that expansion.”
Senate Majority Leader Harry Reid, D-Nev., has said that the Senate will reject any attempts by Republicans to delay implementation of the law or to repeal the medical device tax as part of reopening the government or lifting the federal debt ceiling. But it is unclear if he would still oppose the effort if it was part of a major bipartisan compromise on the health law and budget issues.
Meanwhile, other health care providers are watching closely. In a recent blog post, Chip Kahn, president and chief executive officer of the Federation of American Hospitals, an association of for-profit institutions, wrote that if Congress reopens the heath law “to reconsider the contributions of any one health care sector that benefits from ACA’s coverage expansion, it should simultaneously address the changed circumstances of hospitals and provide similar relief.”
Source: Mary Agnes Carey, Kaiser Health News/Healthcare Finance News
During his lecture entitled “Righting the Wrong: Exploding Myths in Podiatric Medicine” last month, Bradley W. Bakotic, DPM, DO, Bako Pathology Services in Alpharetta, GA called out some myths which have inexplicably become part of the modus operandi of the modern podiatrist.
“Podiatry is a little bit incestuous,” Dr. Bakotic said. “If you go to MD school, you’re taught dermatology by a dermatologist. In podiatry, you’re often taught dermatology by a podiatrist who has an interest in dermatology. It’s incestuous in the sense that we don’t get out into other disciplines like we should. We pass on ideas, and sometimes they’re frankly wrong.”
The first myth Bakotic tackled was “Soft tissue mass? Just cut it out!” school of thought.
“That’s a big one” he continued, “It’s profession-wide and can actually end up in frank negligence. I think this came from the fact that 70 percent of pedal soft tissue masses are ganglia, which are pseudo cysts. The problem is other neoplasms happen.”
“If you just cut it out blindly, you almost never have appropriate margins, so you’re going to have a higher recurrence rate,” he said. “It almost doubles. Distant metastasis also almost doubles.”
Bakotic went on to state the potential litigative repercussions of this; “When you go in and cut out soft tissue mass with positive margins, you cannot do limb-sparing surgery in the aftermath,” he said. “It has big repercussions.”
His conclusion on the myth was strong; “Cutting out soft tissue mass is something that should be left behind in this profession, we shouldn’t be doing it. We hurt people.”
Dr. Bakotic continued to dispel another myth – that acral dermatitis should be seen as tinea pedis until proven otherwise.
“When I was practicing podiatry, I wrote [a prescription] for one corticosteroid in seven years,” he said. “That’s incompetence. I was led to believe every time you saw a rash on the foot, it was tinea.”
Like many podiatric physicians, Dr. Bakotic said, he commonly writes prescriptions for antifungals.
“If you get the prescription data, you’ll see it’s an absolute fact. Only 25 percent of podiatrists prescribe a topical corticosteroid at least once a month. That’s ridiculous.”
After sharing results of studies that show nearly two-thirds of skin biopsies thought to be tinea pedis are not, Dr. Bakotic shared 10 photos with the audience, asking them to identify how many were cases of tinea pedis.
The answer? None.
“Many of us were just taught to assume everything’s a fungal infection,” Dr. Bakotic said. “When I was a student, if someone came in with dermatitis I was already running to the cabinet with the Spectazole samples.”
Source:
APMA