Two recent health care research articles and their accompanying editorials once again question the premises which undergird the currently fashionable pay-for-performance (P4P) movement.

We have posted skeptically here, here, and here about P4P. Briefly, our concerns were that P4P could lead to perverse incentives (by rewarding apparently better rates of good outcomes which could be created by avoiding the sickest patients, or emphasizing a few measured processes and thus distracting physicians from doing anything else, or being based on inaccurate or irrelevant data), could emphasize cost cutting over quality, and could emphasize processes which have been better studied, potentially penalizing the specialties that did the most research about quality.

Rapid Antibiotic Treatment for Patients with Pneumonia

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Want to know about MRIs for breast cancer detection or anti-choice Eric Keroack resigning his position in charge of family planning? Head on over to Women's Health News's new digs at WordPress.

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The pain at the University of Medicine and Dentistry of New Jersey (UMDNJ) just goes on and on. We have previously discussed, seemingly ad infinitum, the troubles there. The university now is operating under a federal deferred prosecution agreement with the supervision of a federal monitor (see most recent posts here, here, here, here and here.) We had previously discussed allegations that UMDNJ had offered no-bid contracts, at times requiring no work, to the politically connected; had paid for lobbyists and made political contributions, even though UMDNJ is a state institution; and seemed to be run by political bosses rather than health care professionals. (See posts here, and here, with links to previous posts.) A recent development (see post here with links to previous posts) was that UMDNJ apparently gave paid part-time faculty positions to some community cardiologists in exchange for their referrals to the University's cardiac surgery program, but not in exchange for any major academic responsibilities. Another was some amazingly wasteful decisions by UMDNJ managers leading to spending millions of dollars for real-estate that now stands vacant (see post here).

This just in, via Bloomberg News,

New Jersey Senator Wayne Bryant, once one of the state's most powerful Democrats, was indicted today on corruption charges and accused of trading his political influence for a job at the state's medical university.

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In "Pharma Goes to the Laundry," Carl Elliott described Wyeth's marketing campaign for fenfluramine, the fen in the diet drug combination fen-phen. It included a stealth marketing effort, including strategically placed ghost-written articles on behalf of obesity as a public health problem. When reports of heart valve damage afflicting patients on fen-phen began to come out, the company allegedly tried to conceal the evidence it had supporting a causative role for the drug combination. [Elliot C. Pharma goes to the laundry. Hasting Center Report 2004: 34: 18-23, link here.] (See our post here.)

A few days ago, the New York Times reported how patients who developed valvular heart disease after taking fen-phen allegedly were then ripped off by their own lawyers.

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As Sean Braisted is reporting from the hill, and this vote tally page seems to confirm, HB1580 has been voted down by the Health and Human Resources Committee. The bill, covered in this previous post, would have taken authority to require vaccines away from the Commissioner of Health and given it to the General Assembly when the disease is sexually transmitted. Lawmakers made a grab for this authority in reaction to the new HPV vaccine.

Sean says:

The Christian Conservatives oppose this because they want to have cervical cancer as a threat to hang over their daughters heads so that they don't have sex; the state is looking out for the best interest of the girls whose parents are over-confident in their ability to control their daughter's sex life.

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Again with the thinking that women having knowledge is dangerous or scary or just plain bad.

Birth control prices going up on college campuses.

South Carolina wants to force women to look at ultrasounds before having an abortion. Thoughts on that at Aunt B's and in this previous post. Also, the underlying assumption that these silly women just haven't *thought* about it is especially offensive.

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Every time the issue of conflicts of interest affecting the US Food and Drug Administration (FDA) comes up, one is sure to see at least one opinion piece decrying how excess concern with such conflicts will stifle innovation and keep wonder drugs off the market. There seems to be a whole raft of economists, lawyers, and policy-wonks out there who believe that any slowdown in drug approvals or any excess concern about drug side-effects will lead to unmitigated disaster.

Recently, the FDA announced it would restrict physicians and scientists with major conflicts of interest from participating on its advisory boards. To summarize quickly (with quotes from a Washington Post article),

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The condom amulet to the left was made for me by the blogger at a little red hen, knitting activist and fellow Oberlin alum Naomi Bloom, complete with NYC Condoms for my collection. Visit the Safe Sex section of her blog for more about her condom amulet and condom distribution work - Naomi is especially passionate about HIV/AIDS prevention work in women over 50, and is generally a kick-ass, impressive, and generous woman. Go visit her site.

Naomi - I apologize for the quality of the photo - I had to take it on my cell because the regular digital camera is on the fritz. Thanks so much.

Everybody else - The photo doesn't do it justice, but the amulet is styled in Oberlin colors with a knitted loop to make it wearable around the neck.

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The FDA has an update on the recent peanut butter recall. It appears that the Salmonella contamination took place at ConAgra's processing plant.

As a follow-up to the recent Salmonella outbreak linked to peanut butter, the U.S. Food and Drug Administration (FDA) is conducting an extensive inspection of ConAgra's Sylvester, Georgia processing plant. Samples collected by the FDA revealed the presence of Salmonella. The fact that FDA found Salmonella in the plant environment further suggests that the contamination likely took place prior to the product reaching consumers. Last week, tests by several states identified Salmonella in many open jars of Peter Pan and Great Value peanut butter recovered from consumers. In these instances, the Salmonella found in the plant and in the open jars matched the outbreak strain recovered from consumers who became ill.

The recall included Peter Pan peanut butter which was pulled from store shelves. There are also some peanut butter toppings that could contain salmonella. These products are listed in the FDA's update. Here are the symptoms of Salmonella. Read the rest of this entry »

There may still be some outstanding data but it is already clear that West Nile Virus was a bigger problem in 2006 than it was in 2005 and 2004. Just when it looked like WNV may be fading away the number of cases and deaths climbed again. Here is a comparison of 2006 and previous years.

2006: 4219 cases, 161 fatalities (not final)

2005: 3000 cases, 119 fatalities

2004: 2539 cases, 100 fatalities

2003: 9862 cases, 262 fatalities

2002: 4156 cases, 284 fatalities

2001: 66 cases, 9 fatalities

2000: 21 cases, 2 fatalities

1999: 62 cases, 7 fatalities

According to the CDC's data for 2006 Iowa was by far the state hit with the most cases with 984 - nearly 1,000 cases. Texas had the most fatalities with 29 deaths. Hopefully this isn't a new trend and 2007 will be another down year for WNV. West Nile Virus usually peaks in the late Summer and early Fall periods. It won't be something to worry about until the mosquitoes start to come out again. That's not too far away for people living in the southern U.S. states.

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