March 12, 2007

Editor's Column: Simple, Not More Sophisticated
What Makes Big Pharma So Special?
MSU Med School Seeks SE Michigan Campus
A Brief Message From Our MSMS Service Rep
Celebrating America's Women Physicians
Mind, Mood, Medicine
MSMS Accepting BOM Nominations

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Editor's Column:
Simple, Not More Sophisticated

By JOSEPH WEISS, MD
Now that our hospitals have changed to computer entry, the mantra has changed. Presently, hospital administration exhorts us to go onward and upward with their computer order entry “enhancements.”

The computer engineers introduce us to “input and output interactive flow sheets, integrated nursing and physician documentation views, enhanced medication reconciliation sheets with medication order sentence lock down.”

If the physician is not already irritated or excited enough the next iteration of order entry will include: “a major opportunity for optimized physician documentation including hot spot dictation and auto text completion. “The physician will have at his fingertips: “improved clinical decision support analytics including integrated discharge and meds reconciliation roll-out with advanced triggering rules.” Likely, most Wayne County Medial Society members have heard this hospital administration mantra or a similar one.

What do we really need? It is not a computer entry system that holds everything imaginable. We need the reverse. We need our hospital computers simpler, not more sophisticated. We need better coordination between emergency room order entry and what the ward receives, we need nurses notes we can read, rather than 10-15 forms requiring a scroll through, we need discharge orders that take minutes to enter rather than hours to complete. We need focus not fullness.

How do we get what we want? By protest and organization. We need to turn our staff meetings away from an hour set aside to listen to the sermon administration prepares for us. Instead, we must be willing to arrive on time to staff meetings and speak out on the issues of computer order entry. What we need first is to correct the disconnects and absurdities in the computer entry system we live with now. Next, we need streamlining of the same system. Then we can look for “enhancements.” The challenge we could give to the engineers is that for every new feature put into the system, something old be removed.

If we don’t act, we will face the experience of doctors so bereft of nursing information that they request that nurses write a line or even a few words on the patient’s condition in the doctors progress note tab in the paper chart. That is where state-of-the-art of computer order entry leads us to today.

What Makes Big Pharma So Special?

By PAUL NATINSKY
The ongoing debate about liability immunity for drug makers should prick up the ears of physicians as it is loaded with provocative elements including an enormous scope of protection when compared with similar protections sought by physicians and product manufacturers and an unsavory attempt to circumvent Congress and state legislatures.

It’s ironic that pharmaceutical giant Pfizer would cut 2,100 jobs from Michigan, the state that features the strongest immunity law for drug makers in the country. The law, passed in 1996 during the zeitgeist of liability reform that swept through Michigan, states that pharmaceutical manufacturers cannot be held liable for damages arising from drugs that meet federal Food and Drug Administration standards, are not “defective or unreasonable dangerous,” and haven’t been approved by bribed FDA officials.

If the timing of Pfizer’s pullout and worldwide job trimming is ironic, the movement of a bill through the Michigan House with the support of the governor seems to coincide perfectly with declarations that protection extended to big drug makers neither reduced prices nor created lasting jobs.

The bill now sits in the Republican-controlled Senate where it is likely to be ignored unless public pressure becomes unbearable.

As mentioned, Michigan’s law is viewed as a model for the federal government as well as other states by both pharmaceutical companies and the FDA. Movement on the federal level was much more likely before the Democratic resurgence last fall. Still, as early as January 2006, the FDA weighed in with a preamble to its rules on drug labeling by opining that state law actions “threaten FDA’s statutorily prescribed role as the federal agency responsible for evaluating and regulating drugs,” requiring lay persons to second-guess its expert assessments of a drug’s risk and benefits.

The preamble also states, “Pre-emption (which, if applied, would negate a lawsuit) would include not only claims against manufacturers, but also against healthcare practitioners for claims related to dissemination of risk information to patients beyond what is included in the labeling.”

So there’s the first nexus for physicians – some possible indirect liability protection. Pharmaceutical as well as product liability reform is anchored by many of the same arguments as medical liability reform. So, should physicians support the drug makers as kindred victims of greedy litigants? Well, in addition to the mitigating physician responsibility to act as a patient advocate, there are important differences in what the Michigan law provides pharmaceutical manufacturers.

Despite powerful medical liability reform law in Michigan, cases must be heard in court, with facts presented and evaluated, and ultimately decided by a jury or settlement between the parties. There is no absolute deference to a federal agency consisting of appointed officials. The closest physicians have come to pushing an alternate and more expert venue than the courts is the debate about setting up a medical court stocked with expert judges who solely handle medical liability cases. But even here, there is the due process and independent evaluation afforded by a court of law. It’s the difference between rule by law and rule by edict.

Physicians should be especially sensitive to this, given the amount of policy formation by fiat that occurs in places like the Center for Medicare and Medicaid Services.

Based on recent news accounts, it seems that in states without drug company immunity laws courts have disregarded the FDA’s humble opinion and let cases proceed on their merits. And it doesn’t seem as though Big Pharma and the FDA will get relief from federal legislation anytime soon. Still, that same political wind has the potential to blow sand into the gears of national medical liability reform. So where does that leave physicians?

Certainly in a less compromised position than the Daniel Troy, the FDA’s chief counsel at the time the 2006 rules were written. Troy, according to the Web site Countercurrents (www.countercurrents.org) , “in previous employment fought the FDA in court to allow drug companies to promote drugs to doctors for “off label” use. The Web site reports that Pfizer paid Troy’s law firm $358,000 the year before he became chief counsel at the FDA.

Troy, in a March 21, 2006 paper titled “State-Level Protection for Good-Faith Pharmaceutical Manufacturers,” states that several states have laws in place that restrict punitive damages in prescription drug cases, but “(t)he Michigan statute is more effective at reducing the negative consequences of the current pharmaceutical-liability regime because it provides protection from compensatory as well as punitive damages.” He further states that even with only an allowance for compensatory damages that excludes punitive damages, “mass tort claims would be exceedingly expensive to defend.” Presumably, the costs to which he refers would fall to the pharmaceutical industry. The same industry that records record profits each year and has enough surplus to spend massively on advertising as well as research.

This stands in stark contrast to medical liability reform which caps but doesn’t eliminate punitive damage awards and allows economic awards covering medical and living expenses.

So, irresistible ironies aside, tort reform for drug makers is simply a different slice of cake than what’s being served to the rest of us.

MSU Med School Seeks SE Michigan Campus

Discussions on a satellite campus for Michigan State University’s College of Osteopathic Medicine arose about a year and a half ago and were borne of concern for the impending physician shortage, according to a report on the Detroit Free Press March 7.

The campus would initially host about 50 students expand to 100. To the surprise of Dr. William Strampel, Dean of the MSU Osteopathic school, the satellite campus idea has drawn tremendous interest from area hospitals and universities.

DMC CEO Mike Duggan is making a bid for Hutzel Hospital to become home for the program, despite the objections of Wayne State University Medical School, which partners on residency and medical student programs with DMC. WSU told the Free Press that quarters are already cramped for medical students who utilize DMC hospitals.

St. John Health System told the newspaper that it has offered up Riverview Hospital in Detroit to the MSU program. The move would bring in a reported $14 million in Medicaid dollars.

The MSU Board of Trustees will make the final decision. A vote scheduled for last month was postponed because the board needed more time to consider the proposals.

A Brief Message From Our MSMS Service Rep

I wanted to introduce myself as your Member Service Representative from Michigan State Medical Society. My job is to make sure that you get the most of your MSMS membership.

I'm available to answer any questions that you and your staff may have about the large menu of MSMS benefits and services. My services are free, and meetings can be scheduled at your convenience.

Thank You

Rob Beattie
Member Service Representative
Chief, Member Services
Michigan State Medical Society

Celebrating America's Women Physicians

Changing the Face of Medicine
Celebrating America's Women Physicians
Exhibit at the Main Library, 5201 Woodward Ave. Hours: Tuesday & Wednesday, Noon-8 p.m. and Thursday, Friday, Saturday, 10 a.m.-6 p.m.. To schedule tours, please contact: Mary Kordyban, Assistant Manager, Business, Science & Technology Department (313) 833-1450 or (313) 833-1420. The activities listed below are open to the public and free of charge. Pre-registration is required for the March 24 event.

Book Talk: Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist
Ngozi Osuagwu, MD, FACOG

WEDNESDAY, MARCH 14, NOON
Skillman Branch Library
121 Gratiot at Library

WEDNESDAY, MARCH 14, 6 P.M.
Hubbard Branch Library
12929 W. McNichols

A Fireside Chat with Local Women Physicians

WEDNESDAY, MARCH 21, 6-8 P.M.
Main Library - Old Browsing
Hear local women doctors discuss their careers and how women have changed the face of medicine.

Girl Talk Luncheon: Everything You Always Wanted to Know About Medical School and Being a Physician
SATURDAY, MARCH 24, 11 A.M.-2:30 P.M.
Main Library - Explorers Room

Mind, Mood, Medicine

2007 Retreat for Women Physicians - "Mind, Mood and Medicine"
Friday-Sunday, April 13-15, Kalamazoo

The MSMS Foundation is proud to announce that the 2007 Retreat for Women Physicians will take place Friday-Sunday, April 13-15, at the Kalamazoo Radisson. This year’s event, titled "Mood, Mind and Medicine," will focus on the needs and interests unique to women physicians, including life transitions for women, scope of practice, epilepsy in women, sexual dysfunction, depression, and more.

Now in its fourth year, the Retreat for Women Physicians will provide attendees with the opportunity to network with colleagues while learning about topics that affect their personal and professional lives. Breakout sessions covering a wide array of topics will allow attendees to choose which sessions best suit their needs and interests.

The weekend also will include a number of recreational/non-medical opportunities, such as spa services and a Saturday evening showing of "The Women," by Clare Boothe Luce, at the Kalamazoo Civic Theatre.

Registration begins at 8:30 a.m. and the daily program will run from 9:00 a.m. to 2:00 p.m. Cost is $200 for MSMS & MMGMA members, $275 for non-members.

For more information or to register, visit www.msms.org/events or contact the MSMS Registrar at (517) 336-5784 or abatten@msms.org.

MSMS Accepting BOM Nominations

The MSMS Committee on Licensure & Discipline has begun the process of soliciting candidates who wish to receive the recommendation of MSMS for appointment to the Michigan Board of Medicine. On Dec. 31, 2007, the terms of five Board of Medicine members will expire. Of those five, four are eligible to be reappointed to a second four-year term. One position will be vacant and require an appointment by the governor. The Committee considers many key factors (peer review experience, board certification, and involvement in organized medicine) when selecting a candidate it believes to be qualified to serve in this capacity. The Committee will begin accepting candidates this month and will continue to do so through the end of April so that the recommendations may be brought to the July MSMS Board of Directors meeting for final approval.

For more information or to obtain a nomination application, visit www.msms.org/advocacy. Or contact Colin Ford at MSMS at (517) 336-5737 or cford@msms.org.

This publication brought to you by Natinsky Publishing Network.

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