Healthcare policy Archives - Page 5 of 6

The history behind the MOC®kery

Michel AccadMay 27, 2015December 13, 2016Healthcare policy, Medical practicecertification, licensingLeave a comment

For those affected or scandalized by the way MOC® programs are being foisted on doctors, the following Wikipedia entry may provide an explanatory frame of reference:

A union security agreement is a contractual agreement, usually part of a union collective bargaining agreement, in which an employer and a trade or labor union agree on the extent to which the union may compel employees to join the union, and/or whether the employer will collect dues, fees, and assessments on behalf of the union.

Of course, the American Board of Medical Specialties (ABMS) is not a physician union in the strict sense of the term. From the vantage point of ABMS executives, the situation is far better. ABMS bosses can impose enrollment into MOC® without needing to grant doctors membership—and therefore voting rights—in the organization.Continue reading “The history behind the MOC®kery”

COI in medicine: the pharisees exposed!

Michel AccadMay 21, 2015January 19, 2017Ethics, Healthcare policyconflict of interestLeave a comment

Irvine Page’s 1987 medical textbook Hypertension Mechanisms begins with the following acknowledgment:

My special thanks are due to the Ciba-Geigy Company, who not only has contributed generously to the financing of this book, but who–over the years and more than any corporation–has recognized and encouraged the development of research in hypertension

The famed Cleveland Clinic physician-scientist, who died 4 years after the book was published, would not live long enough to have to apologize publicly for this colossal evidence of conflict of interest (COI). It would take a few more years and a few scandals to set into motion the current phobia against industry influence. In fact, Page would undoubtedly be stupefied by the rituals we now go through to show that our research and opinions are unblemished by the taint of for-profit corporations.Continue reading “COI in medicine: the pharisees exposed!”

Are patient safety organizations losing the war on error?

Michel AccadMay 12, 2015December 13, 2016Healthcare policy5 Comments

The war on medical error was officially launched in 1999, when the Institute of Medicine (IOM) published its landmark report To Err is Human, alleging that up to 98,000 yearly deaths in US hospitals were due to human missteps.

Despite significant ambiguities in the definition of a medical error, numerous militias known as Patient Safety Organizations (PSO) sprung up almost overnight to help combat the terrible enemy.Continue reading “Are patient safety organizations losing the war on error?”

The apostles of “less is more”

Michel AccadApril 14, 2015December 19, 2017Articles, Healthcare policy5 Comments

Gnosticism in medicine

Gnosticism describes a religious movement flourishing at the beginning of the current era, as Roman paganism was foundering but before Christianity became firmly established.

The main belief of the Gnostic sects was a doctrine of “Salvation by Knowledge (gnosis),” the idea that a privileged class of human beings can, by special insight, obtain possession of the mysteries of the Universe.

Gnostics held a deprecating view of the material world, and favored instead the spiritual realm. Gnostic elites would profess a severely ascetic lifestyle as the path to enlightenment, although some have been accused of hypocrisy for shunning the austere discipline they would demand of their followers.

American medicine in the 21st century bears resemblance to the Gnostic movements of old.Continue reading “The apostles of “less is more””

Mark Cuban vs. guideline writers

Michel AccadApril 8, 2015December 13, 2016Healthcare policyLeave a comment

Who can do the most harm?

Celebrity Mark Cuban set off controversy a few days ago with a Tweet expressing his recommendation that people should get quarterly blood tests “for everything available.” If you have not followed the story, you can quickly get up to speed by reading a couple of posts on Forbes.com written specifically about this opinion firestorm.

Apart from their disagreement with Cuban’s specific recommendation, many physicians seemed particularly concerned that he and other celebrities who express medical opinions exert undue influence on the public. In my opinion, this concern is misplaced.Continue reading “Mark Cuban vs. guideline writers”

Is the government writing your next hypertension guidelines?

Michel AccadMarch 22, 2013December 13, 2016Healthcare policyLeave a comment

The release of the latest report from the Joint National Committee on Hypertension (JNC-8) has been delayed for several years. It’s already been a decade since the prior report was issued.

Until recently the reason for the delay was obscure, but in the March issue of Cardiology News inside information is provided by cardiologist Sidney Smith. The UNC professor of medicine, who has made a career out of writing practice guidelines for the American Heart Association, is a senior writer on the JNC-8 panel and this is what he had to say:

The delay has been due in large part to an unprecedented degree of prerelease review by numerous government agencies at a multitude of levels. This extensive and time-consuming advance scrutiny was instituted mainly because many health officials felt blindsided by the publication of the U.S. Preventive Health Services Task Force controversial mammography guidelines, which kicked up a hornet’s nest of criticism in the breast cancer and public health communities. Government officials don’t ever want to be caught by surprise like that again, explained Dr. Smith, professor of medicine at the University of North Carolina, Chapel Hill.

That’s right. There is nothing more frustrating for a government official than to be caught by surprise by a body of medical experts sifting through scientific data for the benefit of practitioners. The report must first be approved by the authorities!

We suppose that when the government pays for so much of health care and medical research, it’s only natural it would try to ensure that scientists have the national interest in mind, No?

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The purges have begun

Michel AccadDecember 17, 2011January 30, 2019Healthcare policy1 Comment

In 1793, Georges-Francois Danton led a Committee of Public Safety to ensure application of the revolutionary ideals of Liberté, Egalité, Fraternité. In the months that followed, the so-called Reign of Terror, the committee sent to the guillotine thousands of individuals deemed to be a threat to the French Revolution.

The bulk of the offenders were initially identified from among the aristocracy and the clergy, but it soon became necessary to also purify the revolutionary ranks from the less ardent supporters of rhetoric. Soon enough, Danton himself was condemned to the same end that so many before him had met.

The heart.org issued a news report about Dr. John Wang, a Maryland doctor who was part of a safety committee, the Technical Advisory group on Oversight of Percutaneous Coronary Intervention, tasked by the Maryland Health care Commission (MHCC) with “stopping improper stenting in Maryland.”

According to the report, Wang himself is accused of “improper stenting in his own practice,” and the Society of Cardiac Angiography and Intervention (SCAI) and the Maryland Chapter of the American College of Cardiology (ACC) criticized Wang’s committee for “not going far enough” in ensuring that “all citizens of Maryland are afforded equal, high quality healthcare.”

The MHCC, ACC, SCAI and countless committees, commissions, and task forces around the country are fervently working to ensure application of the modern medical ideals of Quality, Equality, and Appropriateness.

May the just God protect us all from the zeal coming out of utopian ideologies.

Update 2015: A couple of years ago, the New Yorker magazine published a terrific piece by cardiologist Lisa Rosenbaum on the very topic of improper stenting. It can be found here.

A brief history of official dietary recommendations

Michel AccadOctober 19, 2011April 14, 2015Healthcare policy, Medical science1 Comment

1992

The USDA introduces its food guide pyramid

2005

The USDA modifies its food guide pyramid to more accurately reflect knowledge in nutrition science….Continue reading “A brief history of official dietary recommendations”

The problem with transparency

Michel AccadAugust 26, 2011December 13, 2016Healthcare policyconflict of interestLeave a comment

While the NIH is tightening its rules concerning what financial ties university researchers must disclose before getting public grants, the FDA may be loosening its own criteria for excluding potential advisors based on their industry connections. It seems that as a consequence of the disclosure business, the only experts who would pass muster were no experts after all…

Meanwhile a story in Cardiology News this month tags yet again Dr. Paul Ridker with the issue of conflict of interest. It seems the inflammatologist felt obligated to elaborate once more on his “lengthy disclosure slide” before giving a lecture at a scientific meeting. But Ridker is now taking a more offensive stance and arguesContinue reading “The problem with transparency”

“Intolerable” laissez-faire in medicine: the early years of the Mayo Clinic

Michel AccadAugust 18, 2011September 10, 2021Healthcare economics, Healthcare policyeconomic history, Flexnerian medicine, history of medicine, information asymmetry, licensingLeave a comment

[Shortly after its initial posting on this site, this article was also cross-posted on the website the Ludwig von Mises Institute under the title “The Mayo Clinic and the Free Market.” I have made some very minor edits since then. MA. April 18, 2015.]

Neoclassical economists such as Kenneth Arrow and Joseph Stiglitz tell us that the health care market is imperfect (or “Pareto inefficient”), meaning that the allocation of services is not optimal from the standpoint of social welfare. They point to information asymmetry as an important cause of this imperfection: patients cannot distinguish on their own the physician from the charlatan, the surgeon from the butcher, the remedy from the snake oil, the hospital from the coop. This may lead to moral hazard where the party with the most knowledge can provide inferior service with impunity.

To provide the necessary counterbalance for this “knowledge gap,” experts must be in charge of social institutions that tell patients where to go, who to see, how to be treated, and how much it should cost. This has been a principal and virtually unchallenged argument underpinning health care legislation in the last 100 years. In a famous paper he wrote on the subject in 1963, Arrow declared that “It is the general social consensus, clearly, that the laissez-faire solution for medicine is intolerable.”

But for those who wonder how intolerable the “laissez-faire solution” really is, a short booklet published in 1926 may prove instructive. Continue reading ““Intolerable” laissez-faire in medicine: the early years of the Mayo Clinic”