What Do Medical Researchers and Legislators Have in Common? Conflict of Interest, for One

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

LiebermanProtestIn a not-so-old blog post I did last month, I reported on a conference I attended in Vancouver.  There, editors from JAMA presented a study revealing that ghostwriting was a major problem for the leading medical journals. Articles were being drafted by writers other than the researchers. In some cases, the writers didn’t have access to all the data, which meant that analyses, conclusions, and—in some cases—recommendations for treatment were based on incomplete or misinterpreted findings.  As described in a New York Times article on the issue, medical product and pharmaceutical companies have much to gain if the safety and efficacy of their products are reported in a positive light.

Conflict of interest is a major concern whenever someone who stands to personally benefit can influence a decision. The National Institutes of Health, which is the leading medical and health research agency in this country, has imposed strict rules for employees limiting consulting and speaking fees involving outside companies and institutions that may have a stake in research outcomes. Most government agencies, research or not, impose rules to avoid conflicts of interest.

Last week, NBC News reported that protestors staged a sit-in at the Hartford, Connecticut, offices of Senator Joe Lieberman, demanding that he stop taking campaign contributions from insurance companies. 

2016-11-21T13:21:04-05:00November 16th, 2009|Ethics, health care policy|0 Comments
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Are Domestic Violence and Pregnancy Preexisting Conditions?

By Peggy McDaniel, BSN, RN

Kaiser Health News recently ran a story about an attorney who was denied private insurance coverage based on a “preexisting condition”—that is, treatment she’d received following a domestic abuse incident. A majority of states have passed laws prohibiting insurers from denying coverage based on treatment for domestic violence, but  eight states as well as the District of Columbia have no such legislation. It is a challenge to track the occurrence of such denials. Insurers often use alternative ways to find out about a history of domestic abuse. They have been known to search for protective orders at local courthouses, which is public information, and search through medical records for documentation of treatment related to such incidents. 

A bitter irony is that nurses are expected to be aware of and directly question patients about suspected abuse, yet in doing so we could be setting up patients for future loss or denial of coverage. 

Pregnancy, likewise defined as a preexisting condition, can also be used to deny coverage. Health reform bills under consideration would disallow the practice of basing insurance rates on gender, a practice which has in effect discriminated against women, particularly those of child-bearing age. 

The practice of denying private health insurance coverage based on these and other preexisting conditions must stop. As a nurse and a consumer, I believe that everyone should be able to buy health care at a reasonable price. A rate such as $1,000 per month for a family is not affordable. In the end we all pay if people do not have some […]

2016-11-21T13:21:15-05:00November 6th, 2009|health care policy, nursing perspective|2 Comments
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Why Don’t Drug Labels Make the Actual Harms and Benefits Clear?

By Jacob Molyneux, blog editor/senior editor

How can we know if a drug really works? Gary Schwitzer, publisher of HealthNewsReview.org (an incisive Website that grades the quality of health news reporting) addresses this question on his blog this week by drawing attention to a recent perspective piece published in the New England Journal of Medicine (NEJM). It’s called “Lost in Transmission — FDA Drug Information That Never Reaches Clinicians” and it states the problem clearly:

The 2009 federal stimulus package included $1.1 billion to support comparative-effectiveness research about medical treatments. No money has been allocated — and relatively little would be needed — to disseminate existing but practically inaccessible information about the benefits and harms of prescription drugs. Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.

The most direct way that the FDA communicates the prescribing information that clinicians need is through the drug label. Labels, the package inserts that come with medications, are reprinted in the Physicians’ Desk Reference and excerpted in electronic references. To ensure that labels do not exaggerate benefits or play down harms, Congress might have required that the FDA or another disinterested party write them. But it did not. Drug labels are written by drug companies, then negotiated and approved by the FDA.

One example given in the NEJM article is the sleeping pill Lunesta:

Clinicians who are interested in (Lunesta’s) efficacy cannot find efficacy information in […]

2016-11-21T13:21:34-05:00October 22nd, 2009|health care policy|0 Comments
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Mid-October Rainy Thursday Web Roundup

By Jacob Molyneux, blog editor/senior editor

The nursosphere is thriving and Change of Shift, the always interesting compendium of what’s new on nursing blogs, is up over at Emergiblog.

The health care reform process creeps slowly but surely toward an end someone somewhere can surely envision. One crucial question many are still asking is whether insurance companies might serve consumers a bit more readily and agreeably if they were forced to face a little competition from a public option. After all, isn’t competition supposed to be a good thing?

Most experts don’t expect the H1N1 vaccine to pose any more danger than the seasonal flu vaccine; even so, many Americans (and nurses commenting here, or taking our poll about the mandatory vaccine) continue to be wary, prompting public health officials to engage in especially aggressive surveillance measures in order to quickly detect any possible negative reactions to the vaccine: “Government Keeps Close Eye on Swine Flu Vaccine.”

AJN clinical editor Christine Moffa posted here a while back about how meditation might help cranky or exhausted or overworked nurses stay focused on what matters during the workday. Today the NY Times has a related piece on “doctor burnout” and meditation.

The role of social media in health care is constantly evolving as we all find our way. Its use by hospital workers is at issue in a recent post at Running a Hospital, about one hospital’s decision to ban social media from all its computers. And here’s something else on this: blogger Not Nurse Ratched wonders if social media policies in […]

2016-11-21T13:21:43-05:00October 15th, 2009|health care policy, nursing perspective|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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