CME is an acronym for Continuing medical education. It is a type of continuing education that serves to maintain, develop, or increase the knowledge, skills, and professional performance of a physician after they leave medical school. CME activities are usually educational interventions that rely on evidence based medicine to provide unbiased direction to medical practitioners to meet educational needs and ultimately improve patient care. In April, a Senate Finance Committee study found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, does not scrutinize course materials for accuracy or evidence of bias toward sponsors’ products. At times, sponsors have been able to select topics, and presenters have discussed off-label uses for drugs, the report found.
Recently, pharmaceutical companies have become the biggest sponsors of CME courses, even at the nation’s top medical schools, a development that critics say raises health-care costs, skews doctors’ treatment decisions and allows the industry to skirt laws against advertising “off-label” uses for its products. The trend toward pharmaceutical industry sponsorship accelerated after the government backed off a plan to limit commercial sponsorships in 2002 at the urging of the industry.
Now, nearly two-thirds of the cost of continuing education courses sponsored by medical schools, popular for their prestige, are paid for by drug and medical device companies and other commercial interests, figures show. Overall, commercial sponsors pick up about half of the $2.25 billion annual cost of the courses doctors must attend to keep their licenses.
Scott Lassman of the Pharmaceutical Research and Manufacturers of America state the following for the practice of pharma funding:
• a way to educate physicians about the latest medical and scientific research.
• are viewed as running independently of the pharmaceutical company. The company may be providing the funding for it, but they are not directing the content.”
• Allows for physicians to learn about “off-label” uses of drugs since “A lot of times, the regulatory process lags behind the science,” Thus “[he] think it’s a benefit for physicians, as long as it’s independent and as long as the scientific information is solid.”
J. Gregory Rosenthal, of Physicians for Clinical Responsibility For doctors and others states the following against the practice:
• “[Pharma] makes it very difficult [for a physician] to know what research to believe”
• “[a physician] can’t go onto a CME Web site without being confronted by sponsorship logos.”
• the drug industry does hold some sway over which topics are covered in the courses.
• “[CME] are promotional activities disguised as education.”
Read more: Conflict Alleged in Drug Firms’ Education Role, Elizabeth Williamson and Christopher Lee, Washington Post Wednesday, June 27, 2007; Page A03 .
Only since 1986 was Emergency room physicians mandated to provide care to all patients – regardless of their medical condition, age, or ability to pay. Before 1986, some hospitals participated in a practice called “patient dumping” as a solution to address emergency department overcrowding. Patient dumping is the denial of care by hospital emergency departments despite being capable of providing the needed medical care. Patient dumping is defined as the transfer of patients from one hospital to another based on the patient’s inability to pay for care. Schiff (1986) reported that 250,000 inappropriate transfers of medically unstable patients occurred, resulting in increased patient morbidity and mortality. The reason this is import behavior to critique, is that it was the founding action of a federal law that eventually became a contributor to the emergency department overcrowding situation.
Congress created and passed the Emergency Medical Treatment and Active Labor Act (“EMTALA”) as a response to “patient dumping”, EMTALA was written so that federally funded hospitals were required to give emergency aid in order to “stabilize” a patient suffering from an “emergency medical condition” or “active labor” before discharging or transferring that patient to another facility (Fosmire, 2003). An “emergency medical condition” is defined by Section (e)(1) of EMTALA as a condition with “acute symptoms” of a “sufficient severity” such that the absence of “immediate medical attention” could reasonably be expected to result in serious health risks and/or disability. The courts have interpreted the phrase “emergency medical condition” to mean a condition which puts the patient in imminent danger of death or serious disability. Unfortunally hospitals still do practice patient dumping.
In order to combat “patient dumping” hospital must fulfill six duties. They include providing a medical screening examination to all patients that present themselves ED premises regardless of ability to pay; providing stabilizing care; not transferring patients who are potentially unstable if the hospital has the capabilities to treat the patient (Patients may only be transferred under EMTALA for medical necessity such as burn patients who need a Burn Unit); providing medically appropriate transfers where the patient is transferred for medically necessity; maintaining an on-call system for physicians to provide coverage to be available to assist stabilizing patients; and accepting requests for in-coming transfer if the hospital has the specialized capabilities needed by the patient, and the transferring hospital is relatively less able to care for the patient (Fosmire, 2003).
Federal government penalties under EMTALA may be against hospitals and or individual physicians if they negligently dump a patient. They may face civil penalties up to $50,000/violation and or exclusion from participation in the Medicare and Medicaid reimbursement programs. In addition, EMTALA allows for civil actions for individual who experience personal harm. Interestingly, enforcement of EMTALA remains a patient complaint-driven process. In other words, the investigation of a hospital’s practices, are initiated only by a patient or public complaint. Thus, there is no federal “EMTALA Police” performing undercover hospital inspections. However, as patients become more consumer-oriented and informed about their patient rights, it is probable that dissenting hospitals and physicians will be identified and curtailed.
I nominate Andrew Speaker as the poster boy for the “Me Generation”. Generation Me is a term that describes people that don’t know how to put duty before self; people that believe that the needs of the individual should come first; people who take it for granted that the self comes first and feel no responsibility for their actions; people who feel entitled. Here are my arguments for your consideration.
Tuberculosis is caused by germs that are spread from person to person through the air. It affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide. Multidrug-resistant” TB can withstand the mainline antibiotics isoniazid and rifampin. The man at the center of the current case was infected with something even worse — “extensively drug-resistant” TB, also called XDR-TB, which resists many drugs used to treat the infection.
A few points to ponder after listening to Andrew Speaker interview. If Speaker truly believed that he was harmless then why was his father compelled to secretly tape record the conversation? I think there are two reasons for this (a) if the CDC quarantined him, the tape would have been used to sue the CDC and health officials for denying his civil liberties by detaining and confining him against his will, or (b) suing the CDC and health officials for not properly warning him if he had actually infected someone else. Either way, it does show that he or at least the father knew that he was in a high risk situation and that he was more concerned about his own wedding happiness and any potential legal fallout then with the actual fact that he might actually cause pain and suffering in another human being.
Point 2. Somewhere around the time when Speaker was notified that he had XDR-TB he found out that he was put on the no-fly list and that he was asked to check himself into a hospital. By his actions I can only assume his only thoughts were “How can I get the best treatment for myself regardless of who I come in contact with”. Once again this shows his utter disregard for his fellow man.
Point 3. In Atlanta on May 10th Speaker admitted that “They said I was multi-drug resistant. I wanted to stay in Atlanta for treatment but they convinced me that with all the toxicity of the drugs and since there weren’t that many drugs left for me I should go to Denver, that it was my best chance of living through this.” Why wasn’t he in fear for his life at this time? Then in Europe on May 18th, Speaker said officials wanted him to check into a treatment center in Rome indefinitely. But he feared that if he did, he might not make it to Denver. “It is a very real threat that I could have died” in
Italy, he said.
Speaker’s attorneys will likely paint him as a “victim” despite the fact that he himself created hundreds of potential victims when he exposed them to one of the deadliest strains of TB via his reckless globe-trotting. So why should he be a victim? And one more thing, who is going to pay for testing all these people?