Viewpoints: Docs On Drugmakers' Payrolls; No Comparison Shopping In Health Care

USA Today: Is Your Doctor On A Drug Maker’s Payroll? Our View
Doctors have long gotten small favors from drug makers: pads with logos, a deli tray sent to the office, tickets to sporting events and free drug samples. But in recent years, those trinkets have evolved into big money for doctors paid to speak to other doctors about new drugs, often using canned scripts provided by the pharmaceutical companies. Some of the paid speakers have become high-volume prescribers of the drugs. ... Taken as a whole, the practice has begun to look less like education and more like legalized bribery (2/20). 

USA Today: Doctors Learn From Other M.D.s: Opposing View
Change in medicine is relentless. New drugs and devices, new indications for old ones and newly recognized safety issues are hard for busy M.D.s to keep up with. One way to manage all this innovation has been for medical product companies to pay physicians to speak to their colleagues about products, usually at evening events in restaurants (Dr. Thomas Stossel, 2/20). 

Los Angeles Times: A Costly Pain In The Neck, And What It Says About Health Care In The U.S.
After a weeklong stay, the Barrow Neurological Institute in Phoenix sent me on my way on Jan. 5 with five stitches, a titanium alloy plate in my neck and a hard plastic Össur Miami J cervical collar that will remain on my neck until late March. A few weeks later, I learned what I'd been charged for the Miami J: $447. Had I been given the chance, I could have purchased the brace online for less than $100. Allowing that sort of comparison shopping is one small thing policymakers could do to slow the growth of health care spending. But like seemingly everything related to health care, it wouldn't be that simple (Jon Healey, 2/21).

The Star Tribune: In The Long Run, MNsure Is Important For Minnesota
Every once in a while a tough issue comes along that has the potential to split a community. Today's issue is health care reform, and more specifically, MNsure -- Minnesota's state health care exchange. In a break from conventional wisdom, and putting myself at risk for significant criticism, I believe that MNsure should and will be an important part of health care reform in Minnesota. That isn't to say the launch of MNsure has been smooth. Far from it. It is expensive, complicated and over engineered. We now know that we tried to do too much too fast, when simplicity would have been the better path (Kenneth H. Paulus, 2/20).

Des Moines Register: Iowa View: Let's Repair Health Care
Recently, President Obama delayed the full enforcement of the Affordable Care Act's employer mandate provision until 2016. Yet, the administration still insists on enforcing the individual mandate, which began earlier this year. Arguments surrounding the policy implications of these mandates are complex, but easing the employer mandate and enforcing the individual mandate illustrates the federal government's favoritism toward corporations over individuals. Our government is forgetting the intrinsic value of the individual (David Young, 2/19).

The New England Journal of Medicine: Informed Consent, Comparative Effectiveness, And Learning Health Care
Interest in learning health care systems and in comparative-effectiveness research (CER) is exploding. One major question is whether informed consent should always be required for randomized comparative-effectiveness studies, particularly studies conducted in a learning health care system. Our answer to this question is no. It will often be unethical to go forward with CER in which patients are randomly assigned to different interventions without their written, prospective, informed consent. However, in a mature learning health care system with ethically robust oversight policies and practices, some randomized CER studies may justifiably proceed with a streamlined consent process and others may not require patient consent at all (Ruth R. Faden, Tom L. Beauchamp and Nancy E. Kass, 2/20).

The New England Journal of Medicine: Informed Consent For Pragmatic Trials -- The Integrated Consent Model
In some pragmatic, randomized clinical trials comparing two commonly prescribed medications for an outpatient condition such as hypertension, the only material departure from clinical practice may be replacing the physician selection of treatment with a randomized selection. It seems unlikely that such a study can be seamlessly "embedded" in routine clinical care delivery if the traditional informed-consent process for research participation (with the usual complex, lengthy document) is required. But what are the alternatives? (Dr. Scott Y.H. Kim and Franklin G. Miller, 2/20).

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