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January 18, 2008

The Ultimate "Halo" Effect

by Peter Pitts

A US study by the Banner Good Samaritan Medical Center in Phoenix, Arizona has found surgical residents performed better during simulated surgery after playing on the Wii for an hour beforehand.

"The whole point about surgery is to execute small, finely controlled movements with your hands, and that is exactly what you get playing Wii," Kanav Kahol, who conducted the study with colleague Marshall Smith, told New Scientist magazine.

Professor John Quin, executive director of surgical affairs at the Royal Australasian College of Surgeons, said the study was interesting and showed promise, but it was still not clear whether better performance in simulated surgery translated into better performance in surgery on a live patient.

"What it shows at the moment is only that if you repeatedly play video games you get better at playing video games," he said, adding the RACS was conducting a Federal Government-aided study to determine the effectiveness of simulated surgery.

Professor Quin said he hoped high-tech tools like the Wii and simulated surgery proved useful because "it's getting more and more difficult to train the full experience of the surgical operation".

The study found only those games requiring precise movements, like Marble Mania in which a player guides a marble through a 3D obstacle course using the Wii's motion-sensitive remote, are effective.

"You don't gain a lot from swinging an imaginary tennis racket," Kahol said.

Past research by other academics has similarly found video games requiring fine control can help build the skills surgeons need for operations like keyhole surgery.

Kahol and Smith are now reportedly designing Wii software to accurately simulate surgical procedures. For developing countries unable to provide expensive professional training systems, the Wii could be used as a cheap and effective training tool.

In conducting their study, the pair called on eight trainee doctors to play the Wii for an hour before performing virtual surgery using a tool called ProMIS. The training tool provides a 3D simulation of a patient's body and tracks the surgeon's movements while they are "operating".

Movement data was then processed using an algorithm and the surgeons were given scores. Those who played the Wii scored 48 per cent higher on tool control and performance than those who didn't.

Posted by peterpitts at 08:29 AM
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January 15, 2008

Jonathan Swift, meet Werner van den Gobbledygook

by Peter Pitts

For those of you watching EU policy on information to patients (“ITP” in EU parlance), there are two documents worth discussing.

The first is “Communication from the Commission to the European Parliament and the Council Concerning the Report on Current Practice with Regard to Provisions of Information to Patients on Medicinal Products’

(I know, it sounds like the title of a Jonathan Swift essay)

I quote directly:

“The provision of information on medicinal products requires taking into consideration the needs of patients in the context of healthcare provision.”

Once you get past all the banal bureaucratic gobbledygook, there’s some pretty interesting bureaucratic gobbledygook.

(Is there someone somewhere in a secret, secure location in Brussels named Werner van den Gobbledygook who edits all these EU documents?)

“Most sources available point to the increasingly active role of patients in this regard; patients have a right to be informed and in this context they should be able to access information about their health, medical conditions and the availability of treatments.”

A crucial point – but if the delivery of information is placed in the hands of governments (aka "payors") – will “availability of treatments” be defined as “what will be reimbursed” or will the full panoply of options be presented to newly empowered European patients? This is not just a finesse question, but rather hits at the heart of the matter. He who controls the access to knowledge controls the knowledge.

“Patients are no longer simply taking what is prescribed for them, but are increasingly involved as manager of their health. They become intensely involved with their illness, show great interest in health issues and have a constantly growing need for information.”

This is an elliptical way of saying that, when patients learn that they are being denied treatment because of cost-based vs. patient-centric government care schemes, they get upset – very upset.

And finally, “Recent evidence indicates that patients are however often unsuccessful in playing a larger role in their health decisions.”

Even though government health care limits, by definition, many health care options, the lack of information adds to that dilemma. According to the report, “Although there is insufficient evidence published, an increase in the quality and appropriateness of information available to patients would be expected to contribute to achieve better health conditions and also to contribute to a more efficient use of resources. Better informed patients are expected to adhere better to treatments and to better understand clinical decisions. This should lead in the long term to social and economic benefits.”

That’s right. And, once you plod your way through all the conditional phrasing, the report is saying that more information results in better outcomes which reduces costs. Amen. But when they say there is “insufficient evidence,” what they’re really saying is that there’s actually a lot of solid research – except that it pertains to the positive benefits of direct to consumer advertising. But at least they’ve embraced the concept that more information is better.

Unfortunately the report also calls for the EU to “keep the ban on direct to consumer advertising on prescription-only medicines.” But that's another issue for another time.

Towards the end of the report, this refreshingly honest statement:

“Member States authorities may not be in a position to fully address patients’ needs in terms of the substance of information and the access via different means. In turn, the pharmaceutical industry possesses the key information on their medicines but this information can currently not be made available to patients and healthcare professionals throughout the EU.”

So much for Health Action International (HAI) who claims, “There is no health information gap in Europe.”

And then there’s the companion document, “Commission Staff Working Document: Background information supportive to the Communication from the Commission to the European Parliament and the Council concerning the Report on Current Practice with Regard to Provision of Information to Patients on Medicinal Products, in the form of different annexes”

(Indeed, the titles just keep getting sexier, pithier, and more lyrical).

Again, I quote directly:

“Pharmaceutical companies possess key information about their products which only in part (through leaflets and labels) is made available to the public. Consequently, the pharmaceutical industry has the potential to be an important source of information to respond to the growing demand for more and better information by patients and to help reduce the current information gap, provided that there will be adequate rules to ensure reliability, objectivity, and quality of information.”

And, “Like many patient organizations most pharmaceutical companies argue that information should be of high quality and not be judged by its source. These companies want to be able to produce non-promotional information for patients about their own medicines and diseases and make it public.”

EU Commission recognition that the pharmaceutical industry can be a valuable partner in the broader dissemination of timely and accurate health care information is an important step in the right direction.

And it’s about time because, as Julian Morris of the London-based International Policy Network quipped, “Europe is running out of failed alternatives.”

Posted by peterpitts at 10:27 AM
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January 10, 2008

The Cost of Co-Pays

by Peter Pitts

Offering lower drug co-payments to people with diabetes, high blood pressure and other chronic diseases could increase use of preventive medicines, suggests a new study led by University of Michigan and Harvard University researchers.

Higher co-payments that took effect Jan. 1 are designed to help American employers cope with the rising costs of health insurance by making workers and retirees pay more out of their own pockets. But does it help health care outcomes for patients? No.

The study, funded by GlaxoSmithKline and Pfizer Inc., suggests that some drug co-payments should be reduced for some people with chronic diseases. Reducing the amount of co-payments by a few dollars would increase the use of preventive drugs by these patients. And properly treated, these chronic conditions can be managed effectively and cost -efficiently -- keeping patients out of the hospital or other more, er, horizontal places.

The researchers looked at a major private employer that made some medications free to employees and slashed co-pays for other drugs by 50 percent. This led to a significant increase in employees' use of preventive medicines.

The study authors also looked at another employer that kept co-payments at the same levels and found it didn't show the same increase in employee use of preventive medicines.

The findings were published in the January/February issue of Health Affairs.

"All research to this point has shown that individuals will not buy important medical services even if there's a small financial barrier: $5 or even $2," senior study author Dr. Mark Fendrick, of the University of Michigan Medical School and School of Public Health, said in a prepared statement. "This study showed that when you remove those barriers, people started using these high-value services significantly more. These results bolster the idea that health insurance benefits should be designed in ways that produce the most health per dollar spent."

Treating chronic disease via appropriate pharmaceutical intervention saves both money and lives -- benefiting both the public purse and the public health. And isn't that what health care is all about.

Posted by peterpitts at 05:46 PM
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January 09, 2008

Mad Libs for Legislators

by Peter Pitts

Under the signature of Chairman Dingell and Mr. Stupak, the Energy and Commerce Committee is charging that Dr. Robert Jarvick isn’t qualified to speak on issues of cardiovascular disease since he’s not a "practicing physician with a valid license in any state."

As Peter Rost over at BrandweekNRX writes, “He's an M.D. but he never actually practiced medicine. Instead he changed the course of medicine, through his work."

Did Jonas Salk ever practice medicine -- or was he too busy saving mankind?

“In the ads, Dr. Jarvik appears to be giving medical advice, but apparently, he has never obtained a license to practice or prescribe medicine,” Mr. Dingell said in a press release.

Congress imitates the Colbert Report. Except their writers aren't on strike.

Rost writes. “This is grossly unfair. He clearly went through fire to get his medical degree and had more motivation than most. He then continued a career which led to one of the most notable breakthroughs in medicine. To get on his case and the fact that Pfizer is using him as a spokesperson is simply wrong.”

"Dr. Jarvik,” Pfizer responds, “ is a respected health care professional and heart expert. Dr. Jarvik, inventor of the Jarvik artificial heart, knows how imperative it is for patients to do everything they can to keep their heart working well."

It's Mad Libs for legislators. Insert NAME OF DRUG COMPANY. Insert NAME OF CEO. Insert ACCUSATION. Its fun for the whole family – and the media loves it!

Until it makes you look foolish.

Posted by peterpitts at 08:51 AM
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January 08, 2008

The Skittles Defense

by Peter Pitts

From the WSJ Health Blog ...

Claiming he popped Merck’s former painkiller “like it was Skittles” (sic), the pitcher expressed his concerns about the potential impact of the drug on his health. “Now these people who are supposedly regulating it tell me it’s bad for my heart. I don’t know what the future holds because of the medicine I’ve eaten, but I trusted that it was not harmful,” Clemens told Mike Wallace.

I may be wrong here, but I do not believe the FDA-approved label for Vioxx included any mention of either stupidity or hanging fastballs.

Posted by peterpitts at 11:07 AM
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January 07, 2008

Thanks Son

by Peter Pitts

Previously uninsured adults who received Medicare coverage reported improvements in health, especially those with cardiovascular disease or diabetes, according to a study in the JAMA.

Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes and use more health services as Medicare beneficiaries after age 65 years than insured near-elderly adults. Because chronic diseases are prevalent and insurance coverage is often unaffordable for older uninsured adults, the impact of near-universal Medicare coverage at age 65 years on the health of previously uninsured adults may be substantial, according to researchers at Brigham and Women’s Hospital and Harvard Medical School in Boston.

The researchers conclude that providing earlier health insurance coverage for uninsured adults, particularly those with cardiovascular disease or diabetes, may have considerable social and economic value for the United States by improving health outcomes.

Posted by peterpitts at 09:58 AM
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January 02, 2008

Thanks Mom

by Peter Pitts

My mother-in-law hates George W. Bush. That doesn't make her special -- but it has made her impossible to talk to about Part D. She thinks it's "Bush's thing" and has refused to even consider signing up for coverage.

Over the holidays, as she was complaining about her prescription medicine expenses, I went to the well one more time and advised her to check into signing up for Medicare drug coverage.

And you know what? She did.

She may still hate the President, but she sure loves her Part D.

Oh yes -- she lives in California.

Posted by peterpitts at 09:14 AM
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