Current Shareware 1994 January/SHAR194.ISO/homecook/amn9307.zip/AMN30712.MN

Text File | 1993-07-31 | 13KB | 255 lines

ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (7/12/93)

CDC Offers New Guidance on Drug-Resistant TB (1)
  In view of the proliferation of drug-resident tuberculosis, the
  Centers for Disease Control and Prevention (CDC) advise physicians
  to start all TB patients on a four-day regimen of isoniazid,
  rifampin, pyrazinamide, and either streptomycin or ethambutol.
  Strictly observed this treatment course can cure 95% if TB patients,
  according to the CDC.

Medicare Funding Still Uncertain (1)
  "Even before the proposal [to cut an additional $19 billion] left
  the [Senate Finance] committee, Sen. Tom Harkin (D-IA) and Paul
  Wellstone (D-MN) were weighing the prospects...to restore about $9
  billion...Joined by a small contingent of other party liberals, the
  two Midwesterners were given little chance of success. They stuck
  doggedly to their position nonetheless...As it became clear that the
  budget bill might be defeated without their backing, the rebels
  gained the upper hand. To stave off an embarrassing defeat of the
  president's once vaunted economic plan, Senate Majority Leader
  George Mitchell agreed to give the Harkin-Wellstone contingent the
  full $9 billion they had asked for.

Physicians Fighting Back as States Turn to Provider Taxes (1)
  In June West Virginia became the first state to tax physicians'
  gross receipts. Kentucky followed suit this month. Next January
  Minnesota will tax physician revenues and other states are weighing
  the option. According to John Patchett, AMA director of state
  legislation, three things are pushing states to tax providers: 1)
  Medicaid has become one of the states' biggest budget items. 2)
  Problems arising from weak economies, high unemployment, and revenue
  shortfalls plague many states. 3.) The federal government has
  restricted states' ability to generate Medicaid matching funds by
  taxing providers.

Ready or Not, EDI Is coming (1)
  At last month's Annual Meeting AMA delegates passed a resolution
  opposing mandatory electronic claims submission, but the Work Group
  for Electronic Data Interchange, a task force of government,
  insurance, hospital, and physician interests, is pushing federal
  legislation mandating EDI standards by the first quarter of 1994.

Judges Must Weigh Expert Testimony (2)
  Supreme Court rules in Daubert et al v. Dow.

AIDS Commission Folds Up Shop (2)
  Members decry lack of political will.

New AIDS Coordinator Named (2)
  Kristine Gebbie served on President Reagan's AIDS commission.

Assisted-Suicide Ban Restore (2)
  by Michigan Court of Appeals.

CDC Head Goes to Insurer (2)
  William Roper, MD quits as director of the Centers for Disease
  Control and Prevention (CDC) to head Prudential Insurance Company's
  National Center for Health Care Research, a managed care think tank.

Still Pushing Single-Payer (2)
  85 House members co-sponsor bill for government-financed health care
  system.

Prescription for Professionals (3)
  "We need to acknowledge that everyone is going to make errors.
  Making them isn't the sin; it's recognizing them and not doing
  anything." --Lucian Leape, MD, director of Harvard study finding
  two-thirds of the 1.3 million annual iatrogenic injuries sustained
  in US hospitals could be averted. Better efforts by hospitals and
  physicians could save up to 100,000 lives and $10.1 billion
  annually.

ACGME Imposes Stiffer Standards for Subspecialties (3)
  But leaders of the Accreditation Council for Graduate Medical
  Education (ACGME) claim the new guidelines for recognizing
  subspecialties are not an effort to cut back on specialization in
  order to boost primary care.

Abortion Providers Share Inner Conflicts (3)
  "The notion that nurses, doctors, counselors, and others who work in
  the abortion field have qualms about the work they do is a well-kept
  secret. But among themselves--at work, or at meetings with other
  providers--they talk about how they really feel. About women who
  come in for 'repeat' abortions...And about the feelings they have
  towards the fetus...They wonder if the fetus feels pain. They talk
  about the soul and where it goes. And about their dreams, in which
  aborted fetuses stare at them with ancient eyes, and perfectly
  shaped hands and feet, asking, 'Why? Why did you do this to me?'"

California Blue Cross Is Using Its Market Power (4)
  "When Arthur Wiscot, MD, went to his mail box in mid-May and opened
  a letter saying his premium for the preferred provider organization
  (ppo) he belonged to was rising 6%, he wasn't too surprised--after
  all, health care costs continue to soar. But when he opened a letter
  the next day saying the same PPO, Blue Cross of California's Prudent
  Buyer Plan, was cutting his fees on average about 6%, he felt
  sucker-punched." As Dr. Wiscot, a Torrance ob-gyn concludes, "What's
  guiding them is the profit motive, and not the relationship between
  insurer and physician." CURE Comment: Nevermind the ancient if
  anachronistic patient-physician relationship.

New HIV Guidelines Offer Flexibility on AZT (5)
  In a key change, starting AZT (zidovudine) treatment is no longer
  routinely recommended for asymptomatic patients whose CD4 cell
  counts drop below 500. Instead, physicians may continue to monitor
  patients for signs of deterioration,, at which point drug treatment
  should be initiated.

New York Court Bars Release of Disciplinary Charges (5)
  against physicians by state health department. "The decision is all
  to one side. It cloaks the entire disciplinary process in secrecy."
  --Mark Chassin, MD, NY Health Commissioner. The ruling by the NY
  Court of Appeals was described as "a tremendous step backward for
  the public" by Arthur Levin, the director of New York City's Center
  for Medical Consumers.

Insurers Study Drug Errors Leading to Suits (7)
  According to the Physician Insurers Association of America (PIAA),
  prescribing errors and failure to monitor patients for side effects
  or addiction are among the medicinal mistakes most commonly cited in
  malpractice cases. Antibiotics, glucocorticoids, and narcotics are
  commonly named.

Tough Smoking ban Passes in California Assembly (8)
  "If we can do this here, it will help set the stage for similar
  measures in many other states." --Richard Corlin, MD, immediate past
  president, California Medical Association. "It's best done at a
  local level. It's a mistake to introduce a statewide preemptive
  ban." --Stanton Glantz, PhD, founder, Americans for Nonsmokers
  Rights.

Needles-Exchange Programs Spreading (8)
  to 33 US cities.

EPA's Lead Balloon (9)
  The Environmental Protection Agency (EPA) placed Aspen's Smuggler's
  Mountain neighborhood on the Superfund list of hazardous waste sites
  in 1986 due to high lead concentrations in the soil. They proposed
  replaced a foot-deep layer of soil with clean fill at a cost of $12
  million, but the affluent tourist mecca, backed by local physicians,
  persuaded the federal government there was no public health problem.

Presidential Hopeful Promised a Really New Beginning (12)
  "My patient, Roger, was...a highly functioning paranoid
  schizophrenic. His characteristic 'flight of ideas' and 'loose
  associations' were always creative...Roger also heard voices...He
  told me they gave him his best ideas...He wrote Margaret Tutweiler
  notifying her of his intention to be a write-in candidate for
  president of the United States."

Burroughs Sues Over Patent Rights to AIDS Drug (14)
  Pharmaceutical giant Burroughs Wellcome Company is trying to
  preserve its exclusive patent rights to produce the drug it sells as
  Retrovir. The company contends its researchers developed AZT and
  that the patents give it a monopoly until 2005. The generic
  producers are supported by the National Institutes for Health (NIH)
  and AIDS activists.

Meeting in Touch with the Times (editorial) (15)
  "The [AMA] House of Delegates was cautious at times, defiant at
  others. It was willing to face change, but unwilling to abandon what
  works simply for the sake of change. The doctors listened
  attentively to Hillary Rodham Clinton, the nation's chief health
  system reformer. But they reserved the right to question whatever
  reform plan is put on the table."

Bitter Lesson on Living Wills (letter-editor) (15)
  "How true the living will is open to misinterpretation (AMNews, May
  17). I'm a professional working in the field of aging and employed
  by our local medical society foundation. Until recently I was a
  strong supporter of the living will. Now I know that to many
  professionals, a patient who has a living will 'wants to die.' All
  the fine point eludes them...How do I feel now about living wills? I
  wouldn't sign one." --Phyllis Rob, Ft. Wayne, IN. ABLEnews Editor's
  Note: For the complete text of this letter see "Bitter Lesson" on
  the ABLEnews echo or watch for it in the July ABLEnews Review.

Better Training Needed (letter-editor) (15)
  "Some patients are ready to look intelligently at their mortality
  and to discuss their expectations, but many others have given the
  matter no thought or have such negative feelings about death that
  they refuse to consider it. The idea that Congress could pass a law
  that would solve the problem is absurd on its face." --Robert
  Gillette, MD, Youngstown, OH. CURE Comment: Because of our "negative
  feelings about death," particularly premature death, CURE has
  considered it carefully and, looking at it intelligently, created
  our mandatory treatment directive--the Life Support Directive. If
  you're negative about untimely death request your copy from CURE.

Ophthalmology Unfairly Targeted (letter-editor) (16)
  "From the letters I have seen in American Medical News, one would
  believe that ophthalmologists dump their [cataract] patients out of
  the operating room door and never see them again. The fact is, 120
  days of free care is given during the postoperative period." --Scott
  Geller, MD, Naples, FL.

Drifting to Socialism (letter-editor) (16)
  "I can see why the AMA has lost members and been criticized for
  drifting into the socialist camp. Your headline: 'Too much free
  choice could undermine reforms,' and its first sentence: 'In the
  great national tradition of unfettered pursuit of self-interest,
  Americans...' indicate a destructive attitude and a lack of
  understanding." --Robert Eckert, MD, Athens, TX.

Match Deeds with Words [sic] About Native Americans (let-ed) (16)
  "In the rush to deal with the everyday crises which confront us as
  physicians, we tend to ignore...the muted cries and whispers of
  desperate Native Americans. One gets painful reminders of our
  neglect when we visit an Indian reservation." --Randall Bloomfield,
  MD, chair, AMA Advisory Committee on Minority Physicians.

'Doctor, Heal Thy Children' (letter-editor) (16)
  "Love and nurture them and you will grow as a person and as a
  physician and your patients will also reap the benefits. Time off is
  not a sin." --Barbara Field, RN, Wauwatosa, WI.

Open AMA Voting to All Members (letter-editor) (16)
  "It's hard for me to work up much interest in these 'elections'
  though since, as a lowly member of the due-paying, rank-and-file AMA
  membership, I am not entrusted with the power to choose who will
  lead organized medicine." --Tim Gorski, MD, Arlington, TX.

Dump 'Reform' (letter-editor) (16)
  "Why do you support President Clinton's and Hillary's abominable
  proposals for medicine by repeating the term 'health system reform.'
  The word reform implies improvement. It would be better to refer to
  it as something like bureaucratic restructuring or calling it what
  it actually is socialized medicine." --John Krafchuk, MD, Hempstead,
  Long Island, NY.

Salary vs. Solo (17)
  "The business community is also diminishing another advantage of
  private practice: freedom to practice medicine as one wishes.
  Physicians in private practice are increasingly burdened by Medicare
  and Medicaid regulations, as well as restrictions from private
  third-party payers...Sooner or later, a lot of doctors will have to
  ask if they would be better off in a salaried position. And a
  growing number will answer 'yes.'"

Will You Get Hit with Retirement-Plan Success Tax? (20)
  "Physicians who receive too much from retirement plans or accumulate
  too much in them can be hit with excise penalty taxes. These taxes
  are in addition to the regular income tax on distributions and
  applicable estate tax on remaining pension accumulations after you
  die." --William Howard, Jr., president, Memphis Society of the ICPF.

[The above listing, prepared for ABLEnews by CURE, includes all major
articles in the cited issue and a representative selection of the
rest.]

...For further information, contact CURE, 812 Stephen Street, Berkeley
Springs, West Virginia 25411 (304-258-LIFE/258-5433).