Alicia Ault

WASHINGTON—The topic of long-term care isn't making the cut as part of otherwise excited discussions of potential health care reform in the next administration, according to political observers, advocates, and insurance representatives.

Sen. Ron Wyden (D-Ore.) said that although he's certain there will be movement toward overhauling the health system, long-term care (LTC) is not on the radar screen. “All of us have to make sure that long-term care is not the afterthought, the forgotten stepchild in the debate.”

Rep. Jim McCrery (R-La.) agreed that LTC is in danger of being overlooked. He called for leadership to avoid that policy mistake. The lawmakers and other health care leaders spoke at a meeting sponsored by the Brookings Institution.

Currently, the debate over how to finance long-term care is being silenced, yet nursing home and home-care spending shows no sign of slowing down. Medicaid is the primary payer for these services—and states are grappling with how to manage Medicaid budgets in an environment of declining tax revenues.

According to several recent studies, about half of nursing home and home-care costs are covered by Medicaid, with Medicare covering another 20%−30% of the bills. The Government Accountability Office estimated in a recent report that LTC cost $193 billion in 2004. Only about 10% was covered by private insurance, the GAO said.

There's also a huge burden borne by Americans out of their own pockets. Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, said that caregivers spend an average of $5,500 annually out of pocket on assistance for elderly and disabled family members. “It's an expensive national pastime,” he said at the forum.

Long-term care is an insurable event, he said, and yet it has not been treated as such, which has made Medicaid a “$100 billion problem and growing,” he said. “It's time to solve the problem and look at the downstream effects on Medicaid,” Mr. Minnix said.

Very few Americans have purchased private LTC insurance. Buck Stinson, president of the LTC division at Genworth Financial, told attendees that an estimated 7 million people hold private LTC policies. Genworth is the largest LTC insurer in the United States. Mr. Stinson noted that policies were attracting younger buyers—currently, the average age of a purchaser is 57—which should help spread the industry's risk and bring premium prices down. The average claimant is 80, and the claim is generally open for 2 years, Mr. Stinson said. The company is paying out $2.5 million a day, with 40% of claims made for Alzheimer's disease.

Policy makers and others often approach LTC financing as a problem facing all 300 million Americans, which “paralyzes the discussion,” Mr. Stinson said. But about one-third of Americans can cover the costs of LTC through prudent financial planning, he said. Another third will be strictly Medicaid eligible due to their incomes.

The target market for LTC policies is only about 13 million people—those who are in an income bracket where they might tip into Medicaid, but could stay out of the program if they had an alternative, Mr. Stinson said.

Mr. Minnix suggested a pay-as-you-go system with all workers, starting at age 21, paying premiums to a quasi-governmental LTC program. “People are willing to pay their fair share—they already are,” he said.

Sen. Wyden said that a voluntary contribution system would make LTC financing more palatable to the American public and to Congress, which is required to fund only budget-neutral programs. A voluntary system would generate “huge waves of support from both sides of the aisle,” Sen. Wyden said.

'All of us have to make sure that long-term care is not the afterthought, the forgotten stepchild in the debate.' SEN. WYDEN

WASHINGTON—The topic of long-term care isn't making the cut as part of otherwise excited discussions of potential health care reform in the next administration, according to political observers, advocates, and insurance representatives.

Sen. Ron Wyden (D-Ore.) said that although he's certain there will be movement toward overhauling the health system, long-term care (LTC) is not on the radar screen. “All of us have to make sure that long-term care is not the afterthought, the forgotten stepchild in the debate.”

Rep. Jim McCrery (R-La.) agreed that LTC is in danger of being overlooked. He called for leadership to avoid that policy mistake. The lawmakers and other health care leaders spoke at a meeting sponsored by the Brookings Institution.

Currently, the debate over how to finance long-term care is being silenced, yet nursing home and home-care spending shows no sign of slowing down. Medicaid is the primary payer for these services—and states are grappling with how to manage Medicaid budgets in an environment of declining tax revenues.

According to several recent studies, about half of nursing home and home-care costs are covered by Medicaid, with Medicare covering another 20%−30% of the bills. The Government Accountability Office estimated in a recent report that LTC cost $193 billion in 2004. Only about 10% was covered by private insurance, the GAO said.

There's also a huge burden borne by Americans out of their own pockets. Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, said that caregivers spend an average of $5,500 annually out of pocket on assistance for elderly and disabled family members. “It's an expensive national pastime,” he said at the forum.

Long-term care is an insurable event, he said, and yet it has not been treated as such, which has made Medicaid a “$100 billion problem and growing,” he said. “It's time to solve the problem and look at the downstream effects on Medicaid,” Mr. Minnix said.

Very few Americans have purchased private LTC insurance. Buck Stinson, president of the LTC division at Genworth Financial, told attendees that an estimated 7 million people hold private LTC policies. Genworth is the largest LTC insurer in the United States. Mr. Stinson noted that policies were attracting younger buyers—currently, the average age of a purchaser is 57—which should help spread the industry's risk and bring premium prices down. The average claimant is 80, and the claim is generally open for 2 years, Mr. Stinson said. The company is paying out $2.5 million a day, with 40% of claims made for Alzheimer's disease.

Policy makers and others often approach LTC financing as a problem facing all 300 million Americans, which “paralyzes the discussion,” Mr. Stinson said. But about one-third of Americans can cover the costs of LTC through prudent financial planning, he said. Another third will be strictly Medicaid eligible due to their incomes.

The target market for LTC policies is only about 13 million people—those who are in an income bracket where they might tip into Medicaid, but could stay out of the program if they had an alternative, Mr. Stinson said.

Mr. Minnix suggested a pay-as-you-go system with all workers, starting at age 21, paying premiums to a quasi-governmental LTC program. “People are willing to pay their fair share—they already are,” he said.

Sen. Wyden said that a voluntary contribution system would make LTC financing more palatable to the American public and to Congress, which is required to fund only budget-neutral programs. A voluntary system would generate “huge waves of support from both sides of the aisle,” Sen. Wyden said.

'All of us have to make sure that long-term care is not the afterthought, the forgotten stepchild in the debate.' SEN. WYDEN

WASHINGTON—The topic of long-term care isn't making the cut as part of otherwise excited discussions of potential health care reform in the next administration, according to political observers, advocates, and insurance representatives.

Sen. Ron Wyden (D-Ore.) said that although he's certain there will be movement toward overhauling the health system, long-term care (LTC) is not on the radar screen. “All of us have to make sure that long-term care is not the afterthought, the forgotten stepchild in the debate.”

Rep. Jim McCrery (R-La.) agreed that LTC is in danger of being overlooked. He called for leadership to avoid that policy mistake. The lawmakers and other health care leaders spoke at a meeting sponsored by the Brookings Institution.

Currently, the debate over how to finance long-term care is being silenced, yet nursing home and home-care spending shows no sign of slowing down. Medicaid is the primary payer for these services—and states are grappling with how to manage Medicaid budgets in an environment of declining tax revenues.

According to several recent studies, about half of nursing home and home-care costs are covered by Medicaid, with Medicare covering another 20%−30% of the bills. The Government Accountability Office estimated in a recent report that LTC cost $193 billion in 2004. Only about 10% was covered by private insurance, the GAO said.

There's also a huge burden borne by Americans out of their own pockets. Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, said that caregivers spend an average of $5,500 annually out of pocket on assistance for elderly and disabled family members. “It's an expensive national pastime,” he said at the forum.

Long-term care is an insurable event, he said, and yet it has not been treated as such, which has made Medicaid a “$100 billion problem and growing,” he said. “It's time to solve the problem and look at the downstream effects on Medicaid,” Mr. Minnix said.

Very few Americans have purchased private LTC insurance. Buck Stinson, president of the LTC division at Genworth Financial, told attendees that an estimated 7 million people hold private LTC policies. Genworth is the largest LTC insurer in the United States. Mr. Stinson noted that policies were attracting younger buyers—currently, the average age of a purchaser is 57—which should help spread the industry's risk and bring premium prices down. The average claimant is 80, and the claim is generally open for 2 years, Mr. Stinson said. The company is paying out $2.5 million a day, with 40% of claims made for Alzheimer's disease.

Policy makers and others often approach LTC financing as a problem facing all 300 million Americans, which “paralyzes the discussion,” Mr. Stinson said. But about one-third of Americans can cover the costs of LTC through prudent financial planning, he said. Another third will be strictly Medicaid eligible due to their incomes.

The target market for LTC policies is only about 13 million people—those who are in an income bracket where they might tip into Medicaid, but could stay out of the program if they had an alternative, Mr. Stinson said.

Mr. Minnix suggested a pay-as-you-go system with all workers, starting at age 21, paying premiums to a quasi-governmental LTC program. “People are willing to pay their fair share—they already are,” he said.

Sen. Wyden said that a voluntary contribution system would make LTC financing more palatable to the American public and to Congress, which is required to fund only budget-neutral programs. A voluntary system would generate “huge waves of support from both sides of the aisle,” Sen. Wyden said.

'All of us have to make sure that long-term care is not the afterthought, the forgotten stepchild in the debate.' SEN. WYDEN

WASHINGTON—More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the ONDCP, said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

Health insurer Aetna Inc. is aiming to have more of its participating primary care physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with primary care physicians to encourage screening. Aetna will offer training to physicians and office managers.

Some online training is available at www.mdalcoholtraining.orgwww.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON—More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the ONDCP, said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

Health insurer Aetna Inc. is aiming to have more of its participating primary care physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with primary care physicians to encourage screening. Aetna will offer training to physicians and office managers.

Some online training is available at www.mdalcoholtraining.orgwww.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON—More than $260 million in Medicaid funds set aside to pay physicians to conduct brief screening and interventions for substance abuse are practically untouched, according to federal experts in the White House Office of National Drug Control Policy.

In January, the Centers for Medicare and Medicaid Services designated the matching funds for states that adopt Medicaid codes for substance abuse Screening and Brief Intervention (SBI). But so far, only nine states (Iowa, Indiana, Maine, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Virginia) have begun using the codes, Bertha Madras, Ph.D., deputy director for demand reduction at the ONDCP, said at a meeting to discuss the program. Wisconsin and Washington are reimbursing for SBI in limited circumstances.

The CMS established G codes for SBI in 2006 and followed with H codes. Last year, the American Medical Association established current procedural terminology codes for SBI; they were published for the first time in the 2008 CPT manual.

For CPT 99408, which involves screening and a brief intervention of 15–30 minutes, the reimbursement is $33.41. For SBI longer than 30 minutes (CPT 99409), the rate is $65.51. (See box.)

Dr. Madras did not say how much money has been reimbursed by Medicaid and Medicare, but indicated that the codes are vastly underused.

The ONDCP has been seeking ways to encourage more physicians to conduct SBIs. At the meeting, Dr. Madras cited recently released figures from the Substance Abuse and Mental Health Services Administration showing that 19.9 million people abuse drugs in the United States, but that 93% of those who are addicted are not aware that they have a problem and do not seek treatment.

Dr. Madras said that so far, about 700,000 people have been screened. Almost a quarter were positive for alcohol or drug use; 70% needed a brief intervention and about 16% were referred to treatment, she said. According to self-reports 6 months later, at least a third of those who received treatment said their health status improved.

Citing several recent developments, she said that screening is gaining currency.

At the beginning of 2008, the Federal Employees Health Benefits Plan, which covers 8 million employees and dependents, notified its carriers that the CPT codes for screening and intervention were added and available for use.

In June, the Department of Veterans Affairs directed all VA medical centers to routinely screen for alcohol use and provide brief interventions.

Screening for alcohol intoxication is required at level I and II trauma centers; patients with positive screens should be offered interventions, according to criteria adopted by the American College of Surgeons' Committee on Trauma. The committee decided to institute SBI because alcohol use is the single most important risk factor associated with serious injury, said Dr. John Fildes, who represented the ACS committee at the meeting.

Screening and brief intervention protocols are also incorporated into the latest edition of the Advanced Trauma Life Support manual, said Dr. Fildes, professor of surgery at the University of Nevada, Las Vegas.

The ACS Committee on Trauma hopes to expand SBI to all level II and III trauma centers and have drug and alcohol intoxication data included in the National Trauma Data Bank, Dr. Fildes said.

Health insurer Aetna Inc. is aiming to have more of its participating primary care physicians offer screening and brief interventions, said Dr. Hyong Un, national medical director for behavioral health at the company. Dr. Un said Aetna has the systems in place to pay claims with the SBI codes and that its behavioral health specialists will work with primary care physicians to encourage screening. Aetna will offer training to physicians and office managers.

Some online training is available at www.mdalcoholtraining.orgwww.sbirt.samhsa.gov

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON—Sexually active women aged 15–25 years have little awareness about chlamydia or that there is a simple urine-based diagnostic test to detect the pathogen, according to a recent phone survey conducted by the Centers for Disease Control and Prevention.

The survey was conducted to help shape a national chlamydia screening campaign that the CDC is developing, said Allison L. Friedman, a health scientist at the agency who presented the results at the annual meeting of the Association for Reproductive Health Professionals.

In 2006, slightly more than 1 million cases of chlamydia infection were reported to the CDC, but that is probably an underestimate, said Ms. Friedman, noting that most men and women are unaware they might be infected and do not seek testing.

The CDC estimates that only about half of the eligible women were tested in 2006. The agency hopes the national campaign will lead to improved awareness and testing.

From October 2007 through January 2008, an agency contractor conducted 1-hour phone interviews with 80 women aged 15–25 years. The women were from 10 metropolitan areas and, to participate, had to speak English and have reported having had sex or having sought reproductive services. There was a good mix of blacks, Hispanics, and whites participating, Ms. Friedman said.

The survey found that, in general, knowledge of testing for sexually transmitted diseases was low. Most women thought that there was one test that covered all STDs and that it was done automatically during a Pap smear or was actually a part of the Pap smear. None of the women knew there was a urine-based test for chlamydia or that it was recommended that STD testing—including for chlamydia—be conducted annually, she said.

There also was low knowledge about chlamydia. The women who had heard of it were able to say that it's often asymptomatic and can be treated.

Most women said they would go to their physician for information about chlamydia and other STDs. After that, they said they would seek information on the Internet, primarily on Google and WebMD. For testing, most women said they would go to their physician, a gynecologist, or Planned Parenthood.

Women also were queried about what kept them from seeking chlamydia testing. The most commonly cited reason was fear: of being tested, of getting a positive test result, or that their parents would find out they were having sex. Many women said they worried that a friend would see them going for a test and assume they were at risk for an STD and then label them promiscuous. Some women feared getting a vaginal exam, and others said they were embarrassed to ask to be tested.

“Clearly, not all women are comfortable asking, which is important because they also had lots of questions about the test itself before they would be willing to get tested,” Ms. Friedman said, adding that they had questions about the accuracy and safety of the test, as well as how it is conducted.

For the older black and Hispanic women—18–25 years—access was cited as a barrier to testing.

When asked what would help, women said they wanted confidential, anonymous, fast, easy, safe, reliable, and cheap testing, Ms. Friedman said. Women also said they preferred a physician who was nice, supportive, and understanding, and wasn't rushed. They preferred to have the provider initiate the discussion about and the recommendation for testing, she said. They also said they would feel less stigmatized if the recommendation were routine.

After hearing a list of facts about chlamydia, most women said the most compelling motivator was the fact that more than 1 million people are infected each year.

Many women said they had not talked to their physicians about STDs or testing for them—even those who had gone in specifically to seek birth control. This was a surprise, Ms. Friedman said. Some women assumed that they were automatically tested for STDs and thus never brought it up. Others said testing had been offered but they'd declined, thinking they weren't at risk.

“This is reassuring because it speaks to the influence of providers, but also puts the onus on providers,” she said.

WASHINGTON—Sexually active women aged 15–25 years have little awareness about chlamydia or that there is a simple urine-based diagnostic test to detect the pathogen, according to a recent phone survey conducted by the Centers for Disease Control and Prevention.

The survey was conducted to help shape a national chlamydia screening campaign that the CDC is developing, said Allison L. Friedman, a health scientist at the agency who presented the results at the annual meeting of the Association for Reproductive Health Professionals.

In 2006, slightly more than 1 million cases of chlamydia infection were reported to the CDC, but that is probably an underestimate, said Ms. Friedman, noting that most men and women are unaware they might be infected and do not seek testing.

The CDC estimates that only about half of the eligible women were tested in 2006. The agency hopes the national campaign will lead to improved awareness and testing.

From October 2007 through January 2008, an agency contractor conducted 1-hour phone interviews with 80 women aged 15–25 years. The women were from 10 metropolitan areas and, to participate, had to speak English and have reported having had sex or having sought reproductive services. There was a good mix of blacks, Hispanics, and whites participating, Ms. Friedman said.

The survey found that, in general, knowledge of testing for sexually transmitted diseases was low. Most women thought that there was one test that covered all STDs and that it was done automatically during a Pap smear or was actually a part of the Pap smear. None of the women knew there was a urine-based test for chlamydia or that it was recommended that STD testing—including for chlamydia—be conducted annually, she said.

There also was low knowledge about chlamydia. The women who had heard of it were able to say that it's often asymptomatic and can be treated.

Most women said they would go to their physician for information about chlamydia and other STDs. After that, they said they would seek information on the Internet, primarily on Google and WebMD. For testing, most women said they would go to their physician, a gynecologist, or Planned Parenthood.

Women also were queried about what kept them from seeking chlamydia testing. The most commonly cited reason was fear: of being tested, of getting a positive test result, or that their parents would find out they were having sex. Many women said they worried that a friend would see them going for a test and assume they were at risk for an STD and then label them promiscuous. Some women feared getting a vaginal exam, and others said they were embarrassed to ask to be tested.

“Clearly, not all women are comfortable asking, which is important because they also had lots of questions about the test itself before they would be willing to get tested,” Ms. Friedman said, adding that they had questions about the accuracy and safety of the test, as well as how it is conducted.

For the older black and Hispanic women—18–25 years—access was cited as a barrier to testing.

When asked what would help, women said they wanted confidential, anonymous, fast, easy, safe, reliable, and cheap testing, Ms. Friedman said. Women also said they preferred a physician who was nice, supportive, and understanding, and wasn't rushed. They preferred to have the provider initiate the discussion about and the recommendation for testing, she said. They also said they would feel less stigmatized if the recommendation were routine.

After hearing a list of facts about chlamydia, most women said the most compelling motivator was the fact that more than 1 million people are infected each year.

Many women said they had not talked to their physicians about STDs or testing for them—even those who had gone in specifically to seek birth control. This was a surprise, Ms. Friedman said. Some women assumed that they were automatically tested for STDs and thus never brought it up. Others said testing had been offered but they'd declined, thinking they weren't at risk.

“This is reassuring because it speaks to the influence of providers, but also puts the onus on providers,” she said.

WASHINGTON—Sexually active women aged 15–25 years have little awareness about chlamydia or that there is a simple urine-based diagnostic test to detect the pathogen, according to a recent phone survey conducted by the Centers for Disease Control and Prevention.

The survey was conducted to help shape a national chlamydia screening campaign that the CDC is developing, said Allison L. Friedman, a health scientist at the agency who presented the results at the annual meeting of the Association for Reproductive Health Professionals.

In 2006, slightly more than 1 million cases of chlamydia infection were reported to the CDC, but that is probably an underestimate, said Ms. Friedman, noting that most men and women are unaware they might be infected and do not seek testing.

The CDC estimates that only about half of the eligible women were tested in 2006. The agency hopes the national campaign will lead to improved awareness and testing.

From October 2007 through January 2008, an agency contractor conducted 1-hour phone interviews with 80 women aged 15–25 years. The women were from 10 metropolitan areas and, to participate, had to speak English and have reported having had sex or having sought reproductive services. There was a good mix of blacks, Hispanics, and whites participating, Ms. Friedman said.

The survey found that, in general, knowledge of testing for sexually transmitted diseases was low. Most women thought that there was one test that covered all STDs and that it was done automatically during a Pap smear or was actually a part of the Pap smear. None of the women knew there was a urine-based test for chlamydia or that it was recommended that STD testing—including for chlamydia—be conducted annually, she said.

There also was low knowledge about chlamydia. The women who had heard of it were able to say that it's often asymptomatic and can be treated.

Most women said they would go to their physician for information about chlamydia and other STDs. After that, they said they would seek information on the Internet, primarily on Google and WebMD. For testing, most women said they would go to their physician, a gynecologist, or Planned Parenthood.

Women also were queried about what kept them from seeking chlamydia testing. The most commonly cited reason was fear: of being tested, of getting a positive test result, or that their parents would find out they were having sex. Many women said they worried that a friend would see them going for a test and assume they were at risk for an STD and then label them promiscuous. Some women feared getting a vaginal exam, and others said they were embarrassed to ask to be tested.

“Clearly, not all women are comfortable asking, which is important because they also had lots of questions about the test itself before they would be willing to get tested,” Ms. Friedman said, adding that they had questions about the accuracy and safety of the test, as well as how it is conducted.

For the older black and Hispanic women—18–25 years—access was cited as a barrier to testing.

When asked what would help, women said they wanted confidential, anonymous, fast, easy, safe, reliable, and cheap testing, Ms. Friedman said. Women also said they preferred a physician who was nice, supportive, and understanding, and wasn't rushed. They preferred to have the provider initiate the discussion about and the recommendation for testing, she said. They also said they would feel less stigmatized if the recommendation were routine.

After hearing a list of facts about chlamydia, most women said the most compelling motivator was the fact that more than 1 million people are infected each year.

Many women said they had not talked to their physicians about STDs or testing for them—even those who had gone in specifically to seek birth control. This was a surprise, Ms. Friedman said. Some women assumed that they were automatically tested for STDs and thus never brought it up. Others said testing had been offered but they'd declined, thinking they weren't at risk.

“This is reassuring because it speaks to the influence of providers, but also puts the onus on providers,” she said.

CU Seeks Sunscreen Probe

Consumers Union has urged the Food and Drug Administration to review sunscreens for safety, saying that tests it conducted found that four of five products contained nanoparticles, despite claims to the contrary by the manufacturers. Nanoparticles make clear sunscreens, which consumers prefer, but there are unanswered safety questions, said Consumers Union, which publishes Consumer Reports. "The widespread use of nanoparticles of titanium dioxide and zinc oxide in sunscreen is involving consumers in a vast experiment as to the safety of these products," CU senior scientist Michael Hansen, Ph.D., said in a statement. Even if the Food and Drug Administration does not conduct a review, it should require manufacturers to reveal the presence of nanoparticles, according to the organization.

Lasers Effective for Leg Hair

A small study has found that both Nd:YAG and alexandrite lasers are effective for long-term removal of leg hair, but that combining the two did not confer additional benefit, just more side effects such as pain and hyperpigmentation. There was no significant difference between the two lasers, according to a study published in Archives of Dermatology. The trial included 20 patients aged 16–50 years with Fitzpatrick skin types III and IV. Eighteen months after the last treatment, the mean hair reduction for the 12-mm spot-size alexandrite laser was 76%. For the 18-mm spot-size alexandrite laser it was 84%, and for the Nd:YAG laser, it was 78%.

Elston Honored By Dermpaths

The American Society of Dermatopathology honored Dr. Dirk M. Elston with its Walter R. Nickel Award for Excellence in Teaching of Dermatopathology at the society's annual meeting in San Francisco. Dr. Elston is director of dermatology at Geisinger Medical Center, Danville, Pa., and is on the advisory board of SKIN AND ALLERGY NEWS. He has authored hundreds of peer-reviewed articles and is editor-in-chief of the Requisites in Dermatology series of textbooks and of eMedicine Dermatology. An active participant in the American Academy of Dermatology's mentorship and leadership programs, Dr. Elston is the recipient of numerous teaching awards including the Darl Vanderplueg Excellence in Teaching Award, the Brooke and Wilford Hall Medical Center Department of Medicine Outstanding Teacher Award, and the Brooke Army Medical Center Department of Pathology Outstanding Teacher Award.

Etanercept, Infliximab Lead Injuries

An analysis of adverse drug reactions reported to the FDA in the first quarter of 2008 has found that etanercept and infliximab were among the top 10 drugs accounting for serious injuries. The analysis was conducted by the Institute for Safe Medicine Practices. Varenicline (Chantix) was the leading source of serious injuries with reports of 1,001 injuries and 50 deaths, including 226 reports of self-injury or suicide. In response, the FDA said in a statement that it has been "carefully evaluating" the varenicline reports. The ISMP said that overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Heparin—specifically a tainted version tied to Chinese suppliers—accounted for the second-highest number of serious reactions. The FDA received reports of 779 serious adverse reactions and 102 deaths. The ISMP noted that only a small number of drugs accounted for a large volume of reports. After varenicline and heparin, the top 10 associated with injuries included fentanyl, interferon-β, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Practice Costs Outstrip Revenues

Operating costs rose faster than did revenues in most group practices in 2007, according to the Medical Group Management Association's annual cost survey. From 1997 to 2007, operating costs rose from 58 cents per dollar of revenue to 61 cents. For multispecialty groups, median total revenue increased 5.5% from 2006 to 2007, while median operating costs increased by 6.5%. The cost survey data are based on reports that were submitted by practices representing 30,000 physicians, said the MGMA.

Poor Marks for PQRI

Most of the physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback reports. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey conducted by the Medical Group Management Association reported similar problems in accessing feedback reports.

GAO: FDA Needed Broader Pool

FDA officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

CU Seeks Sunscreen Probe

Consumers Union has urged the Food and Drug Administration to review sunscreens for safety, saying that tests it conducted found that four of five products contained nanoparticles, despite claims to the contrary by the manufacturers. Nanoparticles make clear sunscreens, which consumers prefer, but there are unanswered safety questions, said Consumers Union, which publishes Consumer Reports. "The widespread use of nanoparticles of titanium dioxide and zinc oxide in sunscreen is involving consumers in a vast experiment as to the safety of these products," CU senior scientist Michael Hansen, Ph.D., said in a statement. Even if the Food and Drug Administration does not conduct a review, it should require manufacturers to reveal the presence of nanoparticles, according to the organization.

Lasers Effective for Leg Hair

A small study has found that both Nd:YAG and alexandrite lasers are effective for long-term removal of leg hair, but that combining the two did not confer additional benefit, just more side effects such as pain and hyperpigmentation. There was no significant difference between the two lasers, according to a study published in Archives of Dermatology. The trial included 20 patients aged 16–50 years with Fitzpatrick skin types III and IV. Eighteen months after the last treatment, the mean hair reduction for the 12-mm spot-size alexandrite laser was 76%. For the 18-mm spot-size alexandrite laser it was 84%, and for the Nd:YAG laser, it was 78%.

Elston Honored By Dermpaths

The American Society of Dermatopathology honored Dr. Dirk M. Elston with its Walter R. Nickel Award for Excellence in Teaching of Dermatopathology at the society's annual meeting in San Francisco. Dr. Elston is director of dermatology at Geisinger Medical Center, Danville, Pa., and is on the advisory board of SKIN AND ALLERGY NEWS. He has authored hundreds of peer-reviewed articles and is editor-in-chief of the Requisites in Dermatology series of textbooks and of eMedicine Dermatology. An active participant in the American Academy of Dermatology's mentorship and leadership programs, Dr. Elston is the recipient of numerous teaching awards including the Darl Vanderplueg Excellence in Teaching Award, the Brooke and Wilford Hall Medical Center Department of Medicine Outstanding Teacher Award, and the Brooke Army Medical Center Department of Pathology Outstanding Teacher Award.

Etanercept, Infliximab Lead Injuries

An analysis of adverse drug reactions reported to the FDA in the first quarter of 2008 has found that etanercept and infliximab were among the top 10 drugs accounting for serious injuries. The analysis was conducted by the Institute for Safe Medicine Practices. Varenicline (Chantix) was the leading source of serious injuries with reports of 1,001 injuries and 50 deaths, including 226 reports of self-injury or suicide. In response, the FDA said in a statement that it has been "carefully evaluating" the varenicline reports. The ISMP said that overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Heparin—specifically a tainted version tied to Chinese suppliers—accounted for the second-highest number of serious reactions. The FDA received reports of 779 serious adverse reactions and 102 deaths. The ISMP noted that only a small number of drugs accounted for a large volume of reports. After varenicline and heparin, the top 10 associated with injuries included fentanyl, interferon-β, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Practice Costs Outstrip Revenues

Operating costs rose faster than did revenues in most group practices in 2007, according to the Medical Group Management Association's annual cost survey. From 1997 to 2007, operating costs rose from 58 cents per dollar of revenue to 61 cents. For multispecialty groups, median total revenue increased 5.5% from 2006 to 2007, while median operating costs increased by 6.5%. The cost survey data are based on reports that were submitted by practices representing 30,000 physicians, said the MGMA.

Poor Marks for PQRI

Most of the physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback reports. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey conducted by the Medical Group Management Association reported similar problems in accessing feedback reports.

GAO: FDA Needed Broader Pool

FDA officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

CU Seeks Sunscreen Probe

Consumers Union has urged the Food and Drug Administration to review sunscreens for safety, saying that tests it conducted found that four of five products contained nanoparticles, despite claims to the contrary by the manufacturers. Nanoparticles make clear sunscreens, which consumers prefer, but there are unanswered safety questions, said Consumers Union, which publishes Consumer Reports. "The widespread use of nanoparticles of titanium dioxide and zinc oxide in sunscreen is involving consumers in a vast experiment as to the safety of these products," CU senior scientist Michael Hansen, Ph.D., said in a statement. Even if the Food and Drug Administration does not conduct a review, it should require manufacturers to reveal the presence of nanoparticles, according to the organization.

Lasers Effective for Leg Hair

A small study has found that both Nd:YAG and alexandrite lasers are effective for long-term removal of leg hair, but that combining the two did not confer additional benefit, just more side effects such as pain and hyperpigmentation. There was no significant difference between the two lasers, according to a study published in Archives of Dermatology. The trial included 20 patients aged 16–50 years with Fitzpatrick skin types III and IV. Eighteen months after the last treatment, the mean hair reduction for the 12-mm spot-size alexandrite laser was 76%. For the 18-mm spot-size alexandrite laser it was 84%, and for the Nd:YAG laser, it was 78%.

Elston Honored By Dermpaths

The American Society of Dermatopathology honored Dr. Dirk M. Elston with its Walter R. Nickel Award for Excellence in Teaching of Dermatopathology at the society's annual meeting in San Francisco. Dr. Elston is director of dermatology at Geisinger Medical Center, Danville, Pa., and is on the advisory board of SKIN AND ALLERGY NEWS. He has authored hundreds of peer-reviewed articles and is editor-in-chief of the Requisites in Dermatology series of textbooks and of eMedicine Dermatology. An active participant in the American Academy of Dermatology's mentorship and leadership programs, Dr. Elston is the recipient of numerous teaching awards including the Darl Vanderplueg Excellence in Teaching Award, the Brooke and Wilford Hall Medical Center Department of Medicine Outstanding Teacher Award, and the Brooke Army Medical Center Department of Pathology Outstanding Teacher Award.

Etanercept, Infliximab Lead Injuries

An analysis of adverse drug reactions reported to the FDA in the first quarter of 2008 has found that etanercept and infliximab were among the top 10 drugs accounting for serious injuries. The analysis was conducted by the Institute for Safe Medicine Practices. Varenicline (Chantix) was the leading source of serious injuries with reports of 1,001 injuries and 50 deaths, including 226 reports of self-injury or suicide. In response, the FDA said in a statement that it has been "carefully evaluating" the varenicline reports. The ISMP said that overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Heparin—specifically a tainted version tied to Chinese suppliers—accounted for the second-highest number of serious reactions. The FDA received reports of 779 serious adverse reactions and 102 deaths. The ISMP noted that only a small number of drugs accounted for a large volume of reports. After varenicline and heparin, the top 10 associated with injuries included fentanyl, interferon-β, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Practice Costs Outstrip Revenues

Operating costs rose faster than did revenues in most group practices in 2007, according to the Medical Group Management Association's annual cost survey. From 1997 to 2007, operating costs rose from 58 cents per dollar of revenue to 61 cents. For multispecialty groups, median total revenue increased 5.5% from 2006 to 2007, while median operating costs increased by 6.5%. The cost survey data are based on reports that were submitted by practices representing 30,000 physicians, said the MGMA.

Poor Marks for PQRI

Most of the physicians who participated in Medicare's 2007 Physician Quality Reporting Initiative found the program at least moderately difficult, according to a survey conducted by the American Medical Association. Only 22% of respondents to the online survey were able to successfully download their feedback reports. Of those who downloaded the report, less than half found it helpful. In an open-ended question about their experience with the program, nearly all the responses were negatives, according to the AMA. The results are based on responses from 408 physicians. The AMA plans to work with Congress and the administration to alter the program to provide physicians with interim feedback reports and an appeals process. A recent survey conducted by the Medical Group Management Association reported similar problems in accessing feedback reports.

GAO: FDA Needed Broader Pool

FDA officials might have avoided some conflicts of interest on their scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a report from the Government Accountability Office. The report, released last month, analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum sponsored by the Center for Medicine in the Public Interest.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. “CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” The manufacturers have a responsibility to educate clinicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000-$3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum sponsored by the Center for Medicine in the Public Interest.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. “CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” The manufacturers have a responsibility to educate clinicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000-$3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum sponsored by the Center for Medicine in the Public Interest.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. “CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” The manufacturers have a responsibility to educate clinicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000-$3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

CMS Rules Out Carotid Expansion

The Centers for Medicare and Medicaid Services (CMS) will not expand coverage for carotid artery percutaneous transluminal angioplasty with stenting, according to a final decision memo issued by the agency last month. The American College of Cardiology, the Society for Vascular Medicine, and the Society of Vascular and Interventional Neurology had asked the agency in December 2007 to add coverage for patients at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%–90% or greater or asymptomatic carotid artery stenosis of at least 80%. However, the CMS ruled there was not enough evidence to support coverage, adding that the agency was “aware of other data that has yet to be published,” and that once it was available, it would “determine the need for an expedited review and reconsideration.”

Pfizer Settles Bextra Claims

Pfizer Inc. has struck a multimillion-dollar agreement to resolve most of the pending claims involving Bextra (valdecoxib), which was withdrawn from the market in 2005. The company agreed to pay $60 million to attorneys general in 33 states and the District of Columbia and to adopt certain compliance practices in response to suits alleging that the company violated state laws in its promotion and marketing of Bextra. Pfizer also said it was setting aside $745 million in anticipation of a final settlement of pending personal injury claims involving it's other COX-2 inhibitor, Celebrex (celecoxib). That amount should resolve more than 90% of the suits alleging that Celebrex caused heart attack, stroke, or other injury in those who took the drug. Several courts have ruled that the plaintiffs had failed to prove that the drug led to these effects. Pfizer settled to remove the cloud over the drug, it said in a statement.

Heparin a Top Cause for Injuries

Heparin—specifically a tainted version tied to Chinese suppliers—accounted for the second-highest number of serious drug reactions in the first quarter of 2008, according to an analysis of Food and Drug Administration data by the Institute for Safe Medicine Practices. The FDA received reports of 779 cases of serious adverse reactions and 102 deaths possibly related to the tainted heparin during the first 3 months of this year. The product associated with the most reports was varenicline (Chantix); there were 1,001 cases and 50 deaths potentially related to use of the smoking cessation therapy. An earlier warning about varenicline from ISMP was followed by an FDA warning about its psychiatric side effects. Overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Most drugs are relatively safe; a small number of drugs accounted for a large volume of reports, said ISMP. For injuries, that list included fentanyl, interferon-beta, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Imaging Cuts Reduce Costs

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office (GAO). Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect on Jan. 1, 2007. As a result, Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computer tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which did the analysis at the request of Congress. The GAO concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated that the payments cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of equipment and personnel in physician offices and developing appropriateness criteria would be a better approach to curb high imaging expenses, according to AdvaMed.

CMS Rules Out Carotid Expansion

The Centers for Medicare and Medicaid Services (CMS) will not expand coverage for carotid artery percutaneous transluminal angioplasty with stenting, according to a final decision memo issued by the agency last month. The American College of Cardiology, the Society for Vascular Medicine, and the Society of Vascular and Interventional Neurology had asked the agency in December 2007 to add coverage for patients at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%–90% or greater or asymptomatic carotid artery stenosis of at least 80%. However, the CMS ruled there was not enough evidence to support coverage, adding that the agency was “aware of other data that has yet to be published,” and that once it was available, it would “determine the need for an expedited review and reconsideration.”

Pfizer Settles Bextra Claims

Pfizer Inc. has struck a multimillion-dollar agreement to resolve most of the pending claims involving Bextra (valdecoxib), which was withdrawn from the market in 2005. The company agreed to pay $60 million to attorneys general in 33 states and the District of Columbia and to adopt certain compliance practices in response to suits alleging that the company violated state laws in its promotion and marketing of Bextra. Pfizer also said it was setting aside $745 million in anticipation of a final settlement of pending personal injury claims involving it's other COX-2 inhibitor, Celebrex (celecoxib). That amount should resolve more than 90% of the suits alleging that Celebrex caused heart attack, stroke, or other injury in those who took the drug. Several courts have ruled that the plaintiffs had failed to prove that the drug led to these effects. Pfizer settled to remove the cloud over the drug, it said in a statement.

Heparin a Top Cause for Injuries

Heparin—specifically a tainted version tied to Chinese suppliers—accounted for the second-highest number of serious drug reactions in the first quarter of 2008, according to an analysis of Food and Drug Administration data by the Institute for Safe Medicine Practices. The FDA received reports of 779 cases of serious adverse reactions and 102 deaths possibly related to the tainted heparin during the first 3 months of this year. The product associated with the most reports was varenicline (Chantix); there were 1,001 cases and 50 deaths potentially related to use of the smoking cessation therapy. An earlier warning about varenicline from ISMP was followed by an FDA warning about its psychiatric side effects. Overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Most drugs are relatively safe; a small number of drugs accounted for a large volume of reports, said ISMP. For injuries, that list included fentanyl, interferon-beta, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Imaging Cuts Reduce Costs

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office (GAO). Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect on Jan. 1, 2007. As a result, Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computer tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which did the analysis at the request of Congress. The GAO concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated that the payments cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of equipment and personnel in physician offices and developing appropriateness criteria would be a better approach to curb high imaging expenses, according to AdvaMed.

CMS Rules Out Carotid Expansion

The Centers for Medicare and Medicaid Services (CMS) will not expand coverage for carotid artery percutaneous transluminal angioplasty with stenting, according to a final decision memo issued by the agency last month. The American College of Cardiology, the Society for Vascular Medicine, and the Society of Vascular and Interventional Neurology had asked the agency in December 2007 to add coverage for patients at high risk for carotid endarterectomy because of defined anatomic factors, and who have symptomatic carotid artery stenosis of 50%–90% or greater or asymptomatic carotid artery stenosis of at least 80%. However, the CMS ruled there was not enough evidence to support coverage, adding that the agency was “aware of other data that has yet to be published,” and that once it was available, it would “determine the need for an expedited review and reconsideration.”

Pfizer Settles Bextra Claims

Pfizer Inc. has struck a multimillion-dollar agreement to resolve most of the pending claims involving Bextra (valdecoxib), which was withdrawn from the market in 2005. The company agreed to pay $60 million to attorneys general in 33 states and the District of Columbia and to adopt certain compliance practices in response to suits alleging that the company violated state laws in its promotion and marketing of Bextra. Pfizer also said it was setting aside $745 million in anticipation of a final settlement of pending personal injury claims involving it's other COX-2 inhibitor, Celebrex (celecoxib). That amount should resolve more than 90% of the suits alleging that Celebrex caused heart attack, stroke, or other injury in those who took the drug. Several courts have ruled that the plaintiffs had failed to prove that the drug led to these effects. Pfizer settled to remove the cloud over the drug, it said in a statement.

Heparin a Top Cause for Injuries

Heparin—specifically a tainted version tied to Chinese suppliers—accounted for the second-highest number of serious drug reactions in the first quarter of 2008, according to an analysis of Food and Drug Administration data by the Institute for Safe Medicine Practices. The FDA received reports of 779 cases of serious adverse reactions and 102 deaths possibly related to the tainted heparin during the first 3 months of this year. The product associated with the most reports was varenicline (Chantix); there were 1,001 cases and 50 deaths potentially related to use of the smoking cessation therapy. An earlier warning about varenicline from ISMP was followed by an FDA warning about its psychiatric side effects. Overall, there were a record number of serious injuries reported in the first quarter: 20,745 cases. The 4,824 deaths recorded was the highest total since 2004, according to the ISMP. Most drugs are relatively safe; a small number of drugs accounted for a large volume of reports, said ISMP. For injuries, that list included fentanyl, interferon-beta, infliximab, etanercept, clopidogrel, pregabalin, acetaminophen, and oxycodone.

Imaging Cuts Reduce Costs

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office (GAO). Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect on Jan. 1, 2007. As a result, Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computer tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which did the analysis at the request of Congress. The GAO concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated that the payments cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of equipment and personnel in physician offices and developing appropriateness criteria would be a better approach to curb high imaging expenses, according to AdvaMed.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. “CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” The manufacturers have a responsibility to educate clinicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000-$3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.” Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers to Disclose Physician Pay

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that beginning this month, it will disclose the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. “CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” The manufacturers have a responsibility to educate clinicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000-$3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.” Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers to Disclose Physician Pay

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that beginning this month, it will disclose the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, said a group of CME providers, several physicians, and a medical journal editor at a forum.

The forum—designed to educate Capitol Hill staffers—was sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers.

The meeting was called in response to numerous efforts from senators, House members, and accrediting organizations for greater accountability for CME funding. In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

Panelists at the CMPI forum warned that withdrawing such funding would undermine a well-run and much-liked enterprise. “CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape. CME changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” The manufacturers have a responsibility to educate clinicians on how to use their products, he said. The pressure for transparency is leading to what Dr. Weber called censorship. He said that he has had to alter presentations at the request of meeting leaders in this country, whereas a recent appearance at the European Society of Cardiology was completely within his control.

Another cardiologist speaking at the forum, Dr. Jack Lewin, said he had “serious, serious concerns about the recent attacks” on CME. Dr. Lewin, CEO of the American College of Cardiology, said that without industry funding, it would cost the ACC an additional $2,000-$3,000 per attendee at its annual meeting, for instance. The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said. And, said Dr. Lewin, the ACC discloses its industry funding on its Web site.

About a third of that organization's $97 million annual budget comes from outside sources ($35 million), and 21% of that is from charitable contributions, he said.

Dr. Lewin said there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover, he said.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent Sept. 12 to the ACCME on its proposal to limit or ban industry support of CME, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.” Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers to Disclose Physician Pay

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that beginning this month, it will disclose the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

After a 12-year fight led by mental health advocates, patients, families, clinicians, and a handful of members of Congress, some 113 million Americans will soon have equality of coverage between their benefits for physical health care and those for mental or behavioral health care.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was tucked into the massive financial rescue package passed by the House of Representatives on Oct. 3 and signed into law that day by President Bush.

The biggest victory in the law's passage is “the recognition by the government of the United States that mental illnesses are real illnesses,” said Dr. Nada Stotland, president of the American Psychiatric Association, in an interview.

The law also ensures that substance abuse treatment is specifically subject to the parity requirements.

The law will take effect Oct. 3, 2009, which means that benefit changes should be seen in health insurance policies that take effect in January 2010.

Essentially, the newly enacted law requires companies with more than 50 employees to offer equal coverage for physical and mental health. Theoretically, if the plan offers 30 days of inpatient coverage for cardiac care, then it must offer 30 days of inpatient coverage for a mental health diagnosis. Also, if a plan offers out-of-network coverage for physical health care, it must do the same for mental health care.

However, the law does not outline specifics, such as which mental illnesses or how many visits or how many days should be covered.

That decision is left in the hands of the health plan or benefits administrator—often a self-insured employer.

The law will eliminate the discriminatory copayments, deductibles, and coverage restrictions that previously were used to reduce coverage for mental illness.

The banishing of higher payments will make a big financial difference for patients and families, said APA's Dr. Stotland.

The federal law does not preempt state mandates. The National Alliance on Mental Illness (NAMI) supported that provision, because state mandates often ensure at least basic coverage for the major mental illnesses, Andrew Sperling, director of legislative advocacy for NAMI, said in an interview.

But NAMI expects insurers, health plans, and self-insured employers to continue closely managing mental health care. The law “doesn't mean you get everything you want all the time,” cautioned Mr. Sperling.

Plans also can refuse to pay for care that they deem not “medically necessary,” but they must disclose how they make that determination.

After a 12-year fight led by mental health advocates, patients, families, clinicians, and a handful of members of Congress, some 113 million Americans will soon have equality of coverage between their benefits for physical health care and those for mental or behavioral health care.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was tucked into the massive financial rescue package passed by the House of Representatives on Oct. 3 and signed into law that day by President Bush.

The biggest victory in the law's passage is “the recognition by the government of the United States that mental illnesses are real illnesses,” said Dr. Nada Stotland, president of the American Psychiatric Association, in an interview.

The law also ensures that substance abuse treatment is specifically subject to the parity requirements.

The law will take effect Oct. 3, 2009, which means that benefit changes should be seen in health insurance policies that take effect in January 2010.

Essentially, the newly enacted law requires companies with more than 50 employees to offer equal coverage for physical and mental health. Theoretically, if the plan offers 30 days of inpatient coverage for cardiac care, then it must offer 30 days of inpatient coverage for a mental health diagnosis. Also, if a plan offers out-of-network coverage for physical health care, it must do the same for mental health care.

However, the law does not outline specifics, such as which mental illnesses or how many visits or how many days should be covered.

That decision is left in the hands of the health plan or benefits administrator—often a self-insured employer.

The law will eliminate the discriminatory copayments, deductibles, and coverage restrictions that previously were used to reduce coverage for mental illness.

The banishing of higher payments will make a big financial difference for patients and families, said APA's Dr. Stotland.

The federal law does not preempt state mandates. The National Alliance on Mental Illness (NAMI) supported that provision, because state mandates often ensure at least basic coverage for the major mental illnesses, Andrew Sperling, director of legislative advocacy for NAMI, said in an interview.

But NAMI expects insurers, health plans, and self-insured employers to continue closely managing mental health care. The law “doesn't mean you get everything you want all the time,” cautioned Mr. Sperling.

Plans also can refuse to pay for care that they deem not “medically necessary,” but they must disclose how they make that determination.

After a 12-year fight led by mental health advocates, patients, families, clinicians, and a handful of members of Congress, some 113 million Americans will soon have equality of coverage between their benefits for physical health care and those for mental or behavioral health care.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was tucked into the massive financial rescue package passed by the House of Representatives on Oct. 3 and signed into law that day by President Bush.

The biggest victory in the law's passage is “the recognition by the government of the United States that mental illnesses are real illnesses,” said Dr. Nada Stotland, president of the American Psychiatric Association, in an interview.

The law also ensures that substance abuse treatment is specifically subject to the parity requirements.

The law will take effect Oct. 3, 2009, which means that benefit changes should be seen in health insurance policies that take effect in January 2010.

Essentially, the newly enacted law requires companies with more than 50 employees to offer equal coverage for physical and mental health. Theoretically, if the plan offers 30 days of inpatient coverage for cardiac care, then it must offer 30 days of inpatient coverage for a mental health diagnosis. Also, if a plan offers out-of-network coverage for physical health care, it must do the same for mental health care.

However, the law does not outline specifics, such as which mental illnesses or how many visits or how many days should be covered.

That decision is left in the hands of the health plan or benefits administrator—often a self-insured employer.

The law will eliminate the discriminatory copayments, deductibles, and coverage restrictions that previously were used to reduce coverage for mental illness.

The banishing of higher payments will make a big financial difference for patients and families, said APA's Dr. Stotland.

The federal law does not preempt state mandates. The National Alliance on Mental Illness (NAMI) supported that provision, because state mandates often ensure at least basic coverage for the major mental illnesses, Andrew Sperling, director of legislative advocacy for NAMI, said in an interview.

But NAMI expects insurers, health plans, and self-insured employers to continue closely managing mental health care. The law “doesn't mean you get everything you want all the time,” cautioned Mr. Sperling.

Plans also can refuse to pay for care that they deem not “medically necessary,” but they must disclose how they make that determination.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, panelists emphasized at a forum aimed at educating Capitol Hill staffers on CME funding.

The forum, sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers, was called in response to efforts from senators, House members, and accrediting organizations for greater accountability for CME funding.

In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

But the panelists, who included a group of CME providers, several physicians, and a medical journal editor, warned that withdrawing such funding would undermine a well-run and much-liked enterprise.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

It changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” Manufacturers have a responsibility to educate providers on how to use their products, he said.

The pressure for transparency is leading to what Dr. Weber called censorship. He said he has had to alter presentations at the request of meeting leaders in the United States, whereas a recent presentation at the European Society of Cardiology was completely within his control.

Dr. Jack Lewin, CEO of the American College of Cardiology, said he had “serious, serious concerns about the recent attacks” on CME.

The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said, adding that in addition, it discloses its industry funding on its Web site.

Dr. Lewin said that there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent in September to the ACCME on its proposal to limit or ban industry support of continuing medical education, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers Set to Disclose Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that beginning this month, it will disclose the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, panelists emphasized at a forum aimed at educating Capitol Hill staffers on CME funding.

The forum, sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers, was called in response to efforts from senators, House members, and accrediting organizations for greater accountability for CME funding.

In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

But the panelists, who included a group of CME providers, several physicians, and a medical journal editor, warned that withdrawing such funding would undermine a well-run and much-liked enterprise.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

It changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” Manufacturers have a responsibility to educate providers on how to use their products, he said.

The pressure for transparency is leading to what Dr. Weber called censorship. He said he has had to alter presentations at the request of meeting leaders in the United States, whereas a recent presentation at the European Society of Cardiology was completely within his control.

Dr. Jack Lewin, CEO of the American College of Cardiology, said he had “serious, serious concerns about the recent attacks” on CME.

The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said, adding that in addition, it discloses its industry funding on its Web site.

Dr. Lewin said that there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent in September to the ACCME on its proposal to limit or ban industry support of continuing medical education, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers Set to Disclose Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that beginning this month, it will disclose the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Without pharmaceutical industry funding, continuing medical education is in danger of faltering, panelists emphasized at a forum aimed at educating Capitol Hill staffers on CME funding.

The forum, sponsored by the Center for Medicine in the Public Interest, a New York-based nonprofit organization, and the Coalition for Healthcare Communication, an umbrella group for advertising agencies and medical journal publishers, was called in response to efforts from senators, House members, and accrediting organizations for greater accountability for CME funding.

In July, a task force of the Association of American Medical Colleges said that academic medical centers should discourage faculty participation in industry-sponsored speakers bureaus. A month earlier, the Accreditation Council for Continuing Medical Education proposed tightening restrictions on commercial support of CME, and possibly even banning industry funding.

But the panelists, who included a group of CME providers, several physicians, and a medical journal editor, warned that withdrawing such funding would undermine a well-run and much-liked enterprise.

“CME in the U.S. is a great success story,” said Dr. George Lundberg, a former editor of JAMA and currently editor-in-chief at Medscape.

It changes knowledge, skills, and patient outcomes, he said, adding that surveys have shown that physicians are in favor of industry support.

Dr. Michael Weber, a professor of medicine at the State University of New York, Brooklyn, said that he views pharmaceutical company funding of CME as a mandate, “not a luxury.” Manufacturers have a responsibility to educate providers on how to use their products, he said.

The pressure for transparency is leading to what Dr. Weber called censorship. He said he has had to alter presentations at the request of meeting leaders in the United States, whereas a recent presentation at the European Society of Cardiology was completely within his control.

Dr. Jack Lewin, CEO of the American College of Cardiology, said he had “serious, serious concerns about the recent attacks” on CME.

The ACC has multiple steps to remove conflicts of interest from its professional and educational programs, he said, adding that in addition, it discloses its industry funding on its Web site.

Dr. Lewin said that there had been abuses in the CME arena, but that the move to clamp down on those bad actors had professional societies and pharmaceutical companies running for cover.

There is evidence to support his claim. Public Citizen's Health Research Group, in comments sent in September to the ACCME on its proposal to limit or ban industry support of continuing medical education, said that, “Despite a quadrupling of commercial support for CME over the past 10 years, in 2007, the percentage of CME income provided by commercial interests actually decreased to 2002 levels.”

Public Citizen advocates an end to commercially funded CME. Because CME is a condition of licensure, demand will remain, according to the group. “Shifting the burden of funding toward physicians (not exactly a group occupying the lower rungs of the earning ladder) would attenuate the effect of lost revenue.”

Drugmakers Set to Disclose Payments

Two pharmaceutical companies will begin publicly disclosing how much each pays physicians.

Eli Lilly & Co. was the first company to step forward, followed a day later by Merck & Co.

Lilly is starting a registry that will compile payments to physicians who have served as speakers or advisers for the company. It will be available to the public on the company's Web site as early as the second half of 2009, Lilly officials said in a statement. The registry will be updated each year to reflect the previous year's payments.

The company said that by 2011, it aims to report whatever is required under the proposed Physician Payments Sunshine Act. That bill (S. 2029) was introduced by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.) in November 2007. As currently written, it would require manufacturers of pharmaceuticals, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, and travel. Product samples for patients would be excluded.

The bill was endorsed by several major drug companies, including Lilly and Merck, by the Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, and by the Association of American Medical Colleges, among others. But it has not had any movement since its introduction.

In a statement, Sen. Kohl congratulated Lilly, saying the company was “fulfilling the obligations of the Physician Payments Sunshine Act before it has been enacted.”

Merck said that beginning this month, it will disclose the grants to patient organizations, professional societies, and others for “independent professional education initiatives,” which would include continuing medical education. Next year, it will include other grants made by the Merck Company Foundation and the Merck Office of Corporate Contributions. The information will be posted on its Web site.

Beginning in 2009, the company will also start disclosing payments to physicians on its speakers bureau.

WASHINGTON — Geisinger Health System has used a medical home model to slash inpatient costs in a demonstration program that it is now expanding to more of its practice sites, Dr. Glenn Steele Jr., CEO, said at a press briefing.

The pilot was conducted at Geisinger's practice sites in Lewistown and Lewisburg, Pa. Dr. Steele said that the multicomponent medical home program reduced all-cause inpatient admissions by 20% at Lewistown and 14% at Lewisburg during the pilot period of January-October 2007.

Readmissions during the same period were reduced from 19% in the 9-month period before the program started to 16% after the medical home was implemented, Dr. Steele said. At Lewisburg, readmissions dropped from 15% to 8% (Health Affairs 2008;27:1235-45).

Dr. Steele acknowledged that the Geisinger program might be hard to replicate. Geisinger is an integrated delivery system serving 2.6 million people across 43 counties in central and northeastern Pennsylvania. It has 700 employed physicians in 55 practice sites, three acute-care hospitals, specialty hospitals, ambulatory surgery centers, home care, and a 215,000-member health plan.

The medical home program offers 24-hour access to primary care and, through the primary care physician, consultation with a specialist; a nurse-coordinator at each practice site; a personal care navigator to respond to patient inquiries about health and where to get care; home-based monitoring; and support ranging from virtual care management to electronic health records for all participants.

Physicians were paid $1,800 per month to participate. Each practice site received $5,000 for every 1,000 Medicare members enrolled, as support for infrastructure changes, additional staff, and extra practice hours. Bonus payments were provided if physicians met targets for 10 quality indicators. Each practice received monthly performance reports.

Geisinger also has a coordinated program to manage patients with chronic disease such as diabetes, heart failure, chronic kidney disease, coronary artery disease, and hypertension. This has become somewhat of an extension of the medical home program, with a new focus on prevention.

And the health system continues to build on its ProvenCare program, which addresses hospitalizations as episodes of care guided by best practices and risk-based pricing.

Although it may not be possible to exactly replicate the Geisinger experience, there are implications to be considered by policy makers, physicians, and others interested in the medical home, Dr. Steele said. Geisinger can more easily align incentives for physicians and for all patients; it's not clear that Medicare or commercial payers could do that across their physician and patient populations. The use of an electronic health record system has enabled Geisinger to start leveraging its benefits, but that was after a long transformation period, according to Dr. Steele.

Geisinger, however, is not looking back. It has expanded the medical home to 32 of its 55 sites and expects to be publishing those results soon, Dr. Steele said.

WASHINGTON — Geisinger Health System has used a medical home model to slash inpatient costs in a demonstration program that it is now expanding to more of its practice sites, Dr. Glenn Steele Jr., CEO, said at a press briefing.

The pilot was conducted at Geisinger's practice sites in Lewistown and Lewisburg, Pa. Dr. Steele said that the multicomponent medical home program reduced all-cause inpatient admissions by 20% at Lewistown and 14% at Lewisburg during the pilot period of January-October 2007.

Readmissions during the same period were reduced from 19% in the 9-month period before the program started to 16% after the medical home was implemented, Dr. Steele said. At Lewisburg, readmissions dropped from 15% to 8% (Health Affairs 2008;27:1235-45).

Dr. Steele acknowledged that the Geisinger program might be hard to replicate. Geisinger is an integrated delivery system serving 2.6 million people across 43 counties in central and northeastern Pennsylvania. It has 700 employed physicians in 55 practice sites, three acute-care hospitals, specialty hospitals, ambulatory surgery centers, home care, and a 215,000-member health plan.

The medical home program offers 24-hour access to primary care and, through the primary care physician, consultation with a specialist; a nurse-coordinator at each practice site; a personal care navigator to respond to patient inquiries about health and where to get care; home-based monitoring; and support ranging from virtual care management to electronic health records for all participants.

Physicians were paid $1,800 per month to participate. Each practice site received $5,000 for every 1,000 Medicare members enrolled, as support for infrastructure changes, additional staff, and extra practice hours. Bonus payments were provided if physicians met targets for 10 quality indicators. Each practice received monthly performance reports.

Geisinger also has a coordinated program to manage patients with chronic disease such as diabetes, heart failure, chronic kidney disease, coronary artery disease, and hypertension. This has become somewhat of an extension of the medical home program, with a new focus on prevention.

And the health system continues to build on its ProvenCare program, which addresses hospitalizations as episodes of care guided by best practices and risk-based pricing.

Although it may not be possible to exactly replicate the Geisinger experience, there are implications to be considered by policy makers, physicians, and others interested in the medical home, Dr. Steele said. Geisinger can more easily align incentives for physicians and for all patients; it's not clear that Medicare or commercial payers could do that across their physician and patient populations. The use of an electronic health record system has enabled Geisinger to start leveraging its benefits, but that was after a long transformation period, according to Dr. Steele.

Geisinger, however, is not looking back. It has expanded the medical home to 32 of its 55 sites and expects to be publishing those results soon, Dr. Steele said.

WASHINGTON — Geisinger Health System has used a medical home model to slash inpatient costs in a demonstration program that it is now expanding to more of its practice sites, Dr. Glenn Steele Jr., CEO, said at a press briefing.

The pilot was conducted at Geisinger's practice sites in Lewistown and Lewisburg, Pa. Dr. Steele said that the multicomponent medical home program reduced all-cause inpatient admissions by 20% at Lewistown and 14% at Lewisburg during the pilot period of January-October 2007.

Readmissions during the same period were reduced from 19% in the 9-month period before the program started to 16% after the medical home was implemented, Dr. Steele said. At Lewisburg, readmissions dropped from 15% to 8% (Health Affairs 2008;27:1235-45).

Dr. Steele acknowledged that the Geisinger program might be hard to replicate. Geisinger is an integrated delivery system serving 2.6 million people across 43 counties in central and northeastern Pennsylvania. It has 700 employed physicians in 55 practice sites, three acute-care hospitals, specialty hospitals, ambulatory surgery centers, home care, and a 215,000-member health plan.

The medical home program offers 24-hour access to primary care and, through the primary care physician, consultation with a specialist; a nurse-coordinator at each practice site; a personal care navigator to respond to patient inquiries about health and where to get care; home-based monitoring; and support ranging from virtual care management to electronic health records for all participants.

Physicians were paid $1,800 per month to participate. Each practice site received $5,000 for every 1,000 Medicare members enrolled, as support for infrastructure changes, additional staff, and extra practice hours. Bonus payments were provided if physicians met targets for 10 quality indicators. Each practice received monthly performance reports.

Geisinger also has a coordinated program to manage patients with chronic disease such as diabetes, heart failure, chronic kidney disease, coronary artery disease, and hypertension. This has become somewhat of an extension of the medical home program, with a new focus on prevention.

And the health system continues to build on its ProvenCare program, which addresses hospitalizations as episodes of care guided by best practices and risk-based pricing.

Although it may not be possible to exactly replicate the Geisinger experience, there are implications to be considered by policy makers, physicians, and others interested in the medical home, Dr. Steele said. Geisinger can more easily align incentives for physicians and for all patients; it's not clear that Medicare or commercial payers could do that across their physician and patient populations. The use of an electronic health record system has enabled Geisinger to start leveraging its benefits, but that was after a long transformation period, according to Dr. Steele.

Geisinger, however, is not looking back. It has expanded the medical home to 32 of its 55 sites and expects to be publishing those results soon, Dr. Steele said.