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Teaching Hospital Update September 26-30, 2011


 Email Alert
September 30, 2011
By Sarah Kitchell*

Many Physicians Feel They're Delivering Too Much Care

A survey of primary care doctors conducted in 2009 finds that 42% of the 627 respondents believed the patients in their own practice were getting too much care. Just 6% of doctors believed their patients were getting too little care. (The rest thought the level of care was just right.) Furthermore, 28% of the doctors thought they themselves were practicing more aggressively than they would prefer to.

The response rate to the mailed survey was 70%, suggesting that this is a topic of interest for doctors--as well as for a healthcare system struggling to control costs while helping to improve people's health.

The survey, the results of which were published in the latest Archives of Internal Medicine, found that 76% of doctors blamed malpractice worries for their over-aggressive care. Some 52% of physicians cited clinical performance measures, which gauge how closely doctors or institutions adhere to recommended protocols for a certain disease or condition, as a reason for excessive care.

Forty percent of doctors surveyed said inadequate time to spend with patients led them to order tests or refer patients to specialists rather than use other, less-aggressive ways of addressing patients' issues.

Financial incentives were also cited, but "most thought they affected other physicians," the study found. Only 3% said financial considerations influenced their own care decisions while 39% said they affected other primary care doctors and 62% thought they affected sub-specialist physicians.

Katherine Hobson, Many Physicians Feel They're Delivering Too Much Care, Wall Street Journal (Sept. 26, 2011).

Study: Brenda E. Sirovich et al., Too Little? Too Much? Primary Care Physicians' Views on U.S. Healthcare, 171 Arch Intern Med. 1582-1585 (2011).

Some Hospitalized Patients at Higher Risk for Readmission, Consumer Reports Finds

Hospitalized patients with a diagnosis of heart attack, heart failure, or pneumonia have a 20% chance on average of being readmitted within thirty days of their discharge, according to data released September 27, 2011, by the Consumer Reports.

The magazine reported that nearly 70% of the 2,432 hospitals in its analysis received its lowest or second-lowest rating for hospital readmissions.

Hospitals showed no improvement in the readmissions rate from last year's survey, the magazine said. Hospitals also failed to provide adequate information to patients upon discharge, it added.

The ratings are based on Medicare data provided by the Centers for Medicare & Medicaid Services. The magazine said that researchers have determined that hospitals can take several steps to reduce readmissions, such as ensuring that patients schedule follow-up appointments with a medical professional, or home visits.

Consumer Reports hospital ratings are available online.

Some Hospitalized Patients at Higher Risk for Readmission, Consumer Reports Finds, BNA Health Care Daily Repport (Sept. 28, 2011) (note: subscription required to view this content).

Drug Companies Pay $25 Million to Illinois Doctors

Doctors in Illinois received about $25 million in all from the companies for travel, meals, research, consulting, speaking engagements, data shows. Nationally, the eight companies that provided a full year's worth of payment information doled out more than $220 million in 2010 to promotional speakers for their products.

The database of drug company disclosures was compiled by ProPublica, a national investigative news organization, and allows the public to search for individual physicians to see whether they've been on a drug company's payroll.

The data provide a preview of what the public can expect to see in 2013, when all drug and medical device companies--potentially hundreds--must report such figures to the federal government. As more information becomes available, a more complete picture is emerging of the perks and payments made to physicians.

Until 2009, pharmaceutical company payments to health professionals were closely held trade secrets. But several companies began reporting the information publicly under pressure from lawmakers or as a condition of settling federal whistleblower lawsuits.

ProPublica published a database called Dollars for Docs in October 2010 that included information from those companies, and it recently updated the database to include twelve companies in all. Eight provided data for all of 2010: Eli Lilly and Co., GlaxoSmithKline, Pfizer, Merck, Cephalon, Johnson & Johnson, ViiV Healthcare, and AstraZeneca.

Deborah Shelton, Drug Companies Pay $25 million to Illinois Doctors, Chicago Tribune (Sept. 27, 2011).

Cancer Drug Trials and Company Stock Go Up (and Down) Hand in Hand

When is the exchange of scientific data a possible case of insider trading? When the safety and effectiveness of cancer drugs are tested in advanced clinical trials, says a study published on September 21, 2011, in the Journal of the National Cancer Institute.

In an unusual study that merged the worlds of medicine and finance, Canadian researchers have turned up an ethical and legal quandary for those who conduct and publish biomedical research: while scientific inquiry demands openness, fortunes ride on its findings, especially for those who can get those findings early.

The study looked at fifty-nine clinical trials completed from 2000-2009 that involved drugs still considered experimental for the uses for which they were tested. In all cases, the medications were proposed--but not yet approved by the U.S. Food and Drug Administration (FDA)--for the treatment of certain cancers. The study's authors also tracked the fluctuations in the stock price of the company sponsoring each trial in the months preceding the public release of a trial's findings and the sixty trading days after those findings were made public.

All of the clinical trials were considered "Phase III," which is the final step before a candidate-drug goes before an FDA advisory panel, and then before FDA regulators, for approval. A good showing in a Phase III trial usually, though not always, clears the way for FDA to approve the marketing of the drug for a specific use in the United States. A negative result can, at this very late stage in a drug's development, doom its bid for FDA approval and represent a major financial setback for the sponsoring company.

Some twenty-three of the Phase III drug trials showed positive results--they shrank tumors, stabilized cancer progression, forestalled death or in some way, showed some clinical benefit to patients that was not offset by its risks. An additional thirty-six of the drug trials considered in the study failed to meet the expectations of researchers. When the study authors looked at fluctuations of stock prices in the months before and after clinical trial results were revealed, they found a disturbing pattern: in the 120 trading days before the public announcement of a positive trial result, the sponsoring company's stock surged in value 13.7% on average. During that same period, the company that would soon publicly declare its drug's failure saw the price of its stock shares slump, losing on average .7% of their value.

That difference was found to fall short of statistical significance--it could have been the result of chance. But the difference became stronger--and statistically significant--when the researchers averaged stock prices over a crucial sixty-day period that preceded the announcement of findings (a period during which speculation would likely be most intense).

Melissa Healy, Cancer Drug Trials and Company Stock Go Up (and Down) Hand in Hand, Los Angeles Times (Sept. 27, 2011).

Study: Jeffrey M. Rothenstein et al., Company Stock Prices Before and After Public Announcements Related to Oncology Drugs, 103 J Natl Cancer Inst.

DOJ, States Ask Supreme Court to Hear Health Law Fight

The U.S. Department of Justice asked the U.S. Supreme Court on September 28, 2011, to review an Eleventh Circuit ruling finding a government mandate that individuals buy health insurance unconstitutional, the same day twenty-six states fighting the law also petitioned for high Court review.

"The department has consistently and successfully defended this law in several courts of appeals, and only the Eleventh Circuit . . . has ruled it unconstitutional," the government said. "We believe the question is appropriate for review by the Supreme Court."

The Eleventh Circuit struck down the Patient Protection and Affordable Care Act's mandate that individuals buy health insurance or pay a penalty as unconstitutional in August, but found the provision could be severed from the rest of the law.

That ruling conflicted with other appeals courts' rulings upholding the law, leading many legal observers to view a Supreme Court challenge as a forgone conclusion.

In its petition for review, the United States argued that Congress has the authority to regulate health insurance because Americans who choose not to buy it have a major impact on interstate commerce by shifting billions in costs to other citizens.

Meanwhile, the twenty-six states and a small business trade group that are also fighting the law filed separate petitions asking the Supreme Court to reconsider the appeals court's ruling that the mandate could be severed from the law at the same time that it weighs in on whether the overhaul violates the constitution.

Erin Fuchs, DOJ, States Ask Supreme Court to Hear Health Law Fight, (Sept. 28, 2011) (note: subscription required to view this content).

Study: Whites No Healthier Than Blacks in Canada

Black people in Canada are at least as healthy as whites, hints a study that is a stark contrast to U.S. statistics.

From health surveys, researchers found that blacks born in Canada had lower rates of high blood pressure, diabetes, heart disease, and cancer than their white compatriots.

By contrast, high blood pressure and diabetes were more common among blacks than whites in the U.S. One possible explanation is that African-Americans have a long history as second-class citizens, said study author Thomas LaVeist, who directs the Hopkins Center for Health Disparities Solutions in Baltimore. While he called the findings surprising, noting that they contradict earlier data from Canada, he also cautioned that they have significant limitations.

The Canadian health survey, for instance, included only 729 blacks, compared with more than 280,000 whites. That makes the comparisons between the two groups much less trustworthy.

LaVeist and a colleague found that 9% of blacks born in Canada had high blood pressure, while 21% of their white compatriots did. Two percent of African-Canadians had diabetes, compared to 6% of whites.

In the U.S., 35% of blacks had high blood pressure and 28% of whites did. The figures for diabetes were 11% and 8%, respectively.

However, the rates of heart disease and cancer were lower among African-Americans than whites.

Frederik Joelving, Whites No Healthier than Blacks in Canada: Study, Reuters (Sept. 27, 2011).

Study: Lydie A. Lebrun and Thomas A. LaVeist, Black/White Racial Disparities in Health: A Cross-Country Comparison of Canada and the United States, 171 Arch Intern Med. 1591 (2011).

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.

*We would like to thank Sarah Kitchell, Esquire (McDermott Will & Emery LLP, Boston, MA), for providing this week's update.

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