Wayne County Medical Society of Southeast Michigan

February 16, 2009

Editor's Column: Pharmaceutical Influence: To Be Or Not To Be?
In My Opinion: Real Change
WSUSOM, DMC Break Payment Logjam
Governor Urges Legislators To Push Smoking Ban...Again
Immunization Not Harmful To Infants, Says IOM, Court
St. John Hospital Names Pediatric Surgery Chief
Dr. Kleerekoper Wins Endocrinology Award
This Week's Sign Of The Apocalypse: Smokers Quit For Pets' Sake

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Editor's Column: Pharmaceutical Influence: To Be Or Not To Be?

By JOSEPH WEISS, MD
In the first article in the New England Journal of Medicine of Feb 5^th, Dr. Robert Steinbrook reviews the revised code of ethics of the Pharmaceutical Research and Manufacturers of America (PhRMA). He notes that the new code states that members of the Association, which includes every drug manufacturer in America, will no longer provide coffee mugs, pens, notepaper, stethoscopes, lunches, gifts, tickets or entertainment to physicians or physicians in training.

Dr. Steinbrook goes on to describe other limits on PhRMA contacts with physicians and concludes by predicting the change in gift giving will just shift the approach to marketing the medical community.

He had only to go to the last article in the same Feb 5^th issue of the New England Journal of Medicine to learn he was correct. The article, Limits On Medicare’s Ability to Control Rising Spending on Cancer Drugs, by P.B. Bach, details how legislation passed by Congress allows oncologists to use non- FDA-approved drugs for which Medicare must pay the market price. The legislation allows oncologists, but no other physicians, to purchase non-FDA approved anti-cancer drugs at discounted prices, but forbids Medicare to apply policies in place that lead to least costly payments in reimbursing oncologists who use these medications. Thus the effect of these laws and regulation are to allow oncologists a good profit on their cancer drug investment.

Such specific and detailed law and regulations mandating coverage of anti-cancer chemotherapeutic regimens necessitated the coordinated efforts of the pharmaceutical industry and the American Society of Clinical Oncologists. The lobbying likely required years of advocacy and possibly millions of dollars.

If such pharmacy-specialty physician coalitions become profitable enough for the drug companies, we may see new biological drugs not made to bind to cell receptors, but created to fit both the contours of the law and the specialty physician’s balance sheet.

The medical community can expect to see increasing growth of the “pharmaceutical-medical complex.” These marketing ventures will influence physician buying habits in ways the pen-and-lunch gift givers never dreamed possible. Eventually another round of prohibitions will stop such raids on the health care purse but in the meantime, family physicians, internists, general surgeons, and obstetricians/gynecologists will fall further behind in their efforts for financial equality. At the same time, the public will find that the rhetoric for cost containment will turn deafening as the cost of health care soars as never before.

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In My Opinion: Real Change

By ALLAN DOBZYNIAK, MD
Government controlled universal health care will define the end of capitalism. This will allow government to tax without restraint since it can always be ascribed to maintaining your access to the precious entity of personal health care.

The 2.4 trillion dollar health care industry is greater than the GDP of France. Government will be in control of the largest segment of the United States economy. Remember what the Nobel Prize winning economist Milton Friedman said, controlling both politics and the economy is the road to tyranny.

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WSUSOM, DMC Break Payment Logjam

According to published reports last week, Wayne State University and Detroit Medical Center, after negotiating for over a year, have agreed on a revised contract that resolves a $12.3 million physician payment dispute.

The new contract, which is not regarded as a settlement, requires the university to provide additional services, which include physician recruitment, to DMC after which it will receive the disputed funds over time, said Mary Zuckerman, DMC’s chief of business operations, reported Crain’s Detroit Business.

Under an agreement brokered by a state-appointed mediator in 2006, DMC was supposed to pay WSU $1.6 million per month for Medicaid and specified other services. However, on Feb. 1, 2008, DMC notified the university that it was going to hold $12 million in payments because it regarded the money as double payment for services that were already reimbursed directly by the Medicaid program.

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Governor Urges Legislature To Push Smoking Ban...Again

During her State of the State address, Gov. Jennifer Granholm, once again, strongly urged Michigan lawmakers to pass comprehensive smokefree workplace legislation.

“We again applaud the governor’s comments tonight and her support for smokefree air,” said Susan Schechter, CSA spokesperson and director of advocacy at the American Lung Association of Michigan. “Many lawmakers have done their research and know that in 2006 US Surgeon General Richard H. Carmona released a report stating the only way to protect Americans from secondhand smoke is through comprehensive smoke-free workplace legislation and policies. It’s time for lawmakers to stop dancing around the issue and finally listen to the state’s leader as well as their constituents and pass comprehensive smoke-free air legislation this year.”

With a new term beginning, there has been a groundswell of support from lawmakers, evident by the four bills that have been introduced thus far from both chambers. In addition to the bills, a Smokefree Air Caucus, led by long-time smoke-free air supporter Sen. Ray Basham (D-Taylor), Rep. Joan Bauer (D-Lansing), Sen. Roger Kahn (R-Saginaw Twp.) and Rep. Paul Scott (R-Grand Blanc) is being developed within the legislature. The caucus will be bicameral and bipartisan and will ask lawmakers to sign a pledge to work on smoke-free air legislation.

The governor once again made a call to action on smoke-free legislation during her annual speech. The governor also called for lawmakers to act in 2007. For more information about the Campaign for Smokefree Air, please visit www.MakeMIAirSmokefree.org.

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Immunization Not Shown To Be Harmful To Infants, Says IOM, Courts

Although most people realize the benefits of vaccinations, a recent survey showed that approximately one-quarter of parents believe that infants get more vaccines than are good for them, and that too many immunizations could overwhelm an infant's immune system.

On Feb. 20, 2002, the Institue of Medicine (IOM) released its latest report in a series on vaccine safety, "Immunization Safety Review: Multiple Immunizations and Immune Dysfunction."

The IOM's Immunization Safety Committee reviewed eight studies of the relationship between multiple vaccinations and Type 1 diabetes, the autoimmune form of the disease. All eight studies consistently demonstrated that multiple immunizations had no effect on the incidence of Type 1 diabetes, leading the committee to reject the notion that multiple vaccinations cause an increased risk of the disease.

The IOM also looked at the results of seven studies, which, despite some variations and limitations, consistently showed that multiple vaccinations either had no effect on the risk of infection or provided some degree of protection against infection. The IOM concluded that multiple immunizations do not increase the risk of young children developing various infections, ranging from colds and ear infections to pneumonia and meningitis.

The IOM also examined five studies looking at multiple vaccinations and their potential to cause allergic diseases, which reflect a hypersensitivity of the immune system to relatively harmless agents in the environment, like pollens, dust mites, insect venom, and specific foods. Some, but not all, of these studies suggested that certain vaccines increase the risk of developing allergic disorders. However, methodological weaknesses and inconsistent findings among the studies, led the committee to conclude that there is inadequate evidence to either accept or reject a causal relationship between multiple immunizations and increased risk of allergic diseases, particularly asthma.

Finally, the IOM recommended that the U.S. Department of Health and Human Services convene an expert panel to examine parents' perceptions of vaccine risks and benefits in order to develop better communication tools for them and their doctors.

The IOM Immunization Safety Review Committee's most important conclusions were:

1. A review of the available scientific evidence does not support the hypothesis that the infant immune system is inherently incapable of handling the number of antigens that children are exposed to during routine immunizations,

2. The epidemiologic evidence (i.e., from studies of vaccine-exposed populations and their control groups) favors rejection of a causal relationship between multiple immunizations and increased risk for infections or for type 1 diabetes mellitus,

3. The epidemiologic evidence regarding increased risk for allergic disease, particularly asthma, was inadequate to accept or reject a causal relationship.

The US Supreme Court also weighed in on the issue, prompting AMA Board Chairman Joseph Heyman, MD, to comment: “Three recent rulings by the Special Masters of the U.S. Court of Federal Claims provides even more overwhelming evidence that there is no association between vaccines and autism or related disorders. Vaccines are one of the best public health accomplishments of all time and have proven time and time again their ability to keep horrific diseases at bay. Measles, rubella, and polio are among the success stories of diseases eliminated in the United States, but are still active in other countries and could rebound here.

“Autism is a heart-wrenching condition, and the upheaval felt by parents whose children suffer with autism is understandable – as is their search for answers. We need ongoing research into the causes of autism, but cannot let unfounded myths keep us from giving our children the proven protection they need against infectious diseases.”

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St. John Hospital Names Pediatric Surgery Chief

Marc L. Cullen, MD, has been named division chief of Pediatric Surgery at St. John Hospital and Medical Center. He comes to SJH&MC with 24 years of expertise in skin and soft tissue disorders, congenital anomalies, vascular anomalies, burns, and trauma.

Dr. Cullen has been caring for children’s surgical needs since 1984 and is one of the region’s most respected pediatric surgeons. He completed his medical degree at Brown University in Providence, R.I., followed by a residency in general surgery at Rush Presbyterian St. Luke’s Medical Center in Chicago.

He completed fellowships in surgical research, pediatric surgery, and burns. During his fellowship at Shriners Hospital in Boston, he cared for children with burns involving 90 percent of their body. At Children’s Hospital of Michigan, he ran a burn program that achieved nationwide recognition.

Dr. Cullen has a strong belief in providing parents with comprehensive information about their child’s surgical needs in an efficient timeframe. He is committed to seeing patients within approximately one day of their parent’s call to the office. Focusing on a strong collaboration with parents, he alleviates their anxiety and concerns through compassionate support, education, and excellent follow-through after surgery.

He is a fellow of the Academy of the American College of Surgeons, and is board certified by the American Board of Surgery in General Surgery, Pediatric Surgery, and Surgical Critical Care.

“Dr. Cullen has a passion for pediatric surgery that is evident to all who know him,” said Jim Orosz, M.D., chief medical officer at SJH&MC. “We are delighted that he has brought his surgical expertise in children's surgery and skills in treating burns to our hospital and its patients.”

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Dr. Kleerekoper Wins Endocrinology Award

Michael Kleerekoper, MD, a professor at the Wayne State University School of Medicine, will receive a prestigious teaching award from the American Association of Clinical Endocrinologists.

Dr. Kleerekoper will receive the association’s H. Jack Baskin, MD, Endocrine Teaching Award at the organization’s annual meeting in Houston in May. The award is presented to a member “who has made a profound impact in teaching fellows-in-training and who is actively involved in teaching either in a university or through AACE."

This is only the second year the association has presented the award.

"This award came as a major surprise since I did not know I had been nominated and there are many outstanding teachers in endocrinology," Dr. Kleerekoper said. “In all walks of life the knowledge base is expanding rapidly, and medicine is no exception. It is now not possible to retain all the information we have learned, nor all the new information needed for day-to-day patient care. As clinicians, we need to become comfortable saying ‘I don't know, I will have to look that up and get back to you,’ whether the inquiry comes from a patient or a colleague. As teachers we need to change our approach from information transfer to get our students through an upcoming exam to a more basic understanding of the material that will allow for better assimilation of new knowledge as it becomes available."

Dr. Kleerekoper served the School of Medicine as a tenured faculty member from 1992 to 2006. He is currently a clinical professor in the Departments of Internal Medicine, and Obstetrics and Gynecology.

AACE is a professional medical organization with more than 6,200 members in the United States and 92 other countries. The association is dedicated to the optimal care of patients with endocrine problems. AACE clinical endocrinologists’ specialized training enables them to be experts in the care of endocrine disease such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

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This Week's Sign Of The Apocalypse: Smokers Quit For Pets' Sake

A study, published recently in the British Medical Journal Tobacco Control, represents the first time researchers looked at the smoking behaviors of people who own or live with a pet. Participants were either smokers or non-smokers who lived with a dog, cat or bird.

"We hope smokers realize that the health of their pets is affected by their smoking habit, and that secondhand smoke's impact is not limited just to human beings," says Sharon Milberger, Sc. D, the study's lead author interim director of the Center for Health Promotion and Disease Prevention at Henry Ford Health System in Detroit. "Exposure to second-hand smoke has been linked to cancer, allergies, eye and skin diseases and respiratory problems in dogs and cats."

Nearly 3,300 people responded to an online survey available through the Michigan Humane Society, Pet Supplies Plus pet stores and Henry Ford Health System. The survey posed questions about the animals living in the home, smoking behaviors for themselves and of the people with whom they live, interest in quitting smoking and smoking rules in the home.

Henry Ford researchers reported that:

28.4 percent of smokers said knowing that smoking was bad for their pets' health would motivate them to kick the habit.
8.7 percent of smokers said knowing that smoking was bad for their pets' health would motivate them to ask their smoking partners to quit.
14 percent of smokers said they would tell their partner to smoke outdoors.
Among non-smokers, more than 16 percent said they would ask their partner to quit and 24 percent said they would tell their partner to smoke outdoors.

The study was funded by the Flight Attendant Medical Research Institute in Miami, Fla.

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