An article today discussed the measure of Americans’ confidence in reform of our current health care system – confidence is down just in case you were wondering. Much of what was cited in the article was fear of change. That fear was found to be based on mistaken beliefs about the current proposals – a government take-over of health care, covering all ‘illegal immigrants’ etc.

On a daily basis, whether practicing medicine in the clinic or the hospital, we as physicians counsel patients on their diagnoses and best choices of therapies. Recently, I talked to a mother about getting a spinal tap done to rule out meningitis in her young son with fever. She had significant fears about what this meant and what the risks were. I listened, tried to address those fears and any questions she had while advocating that this was the best therapeutic choice. We are all trained in this, either formally or informally, and it is essential to practicing good medicine.

In discussing the health care reform process, some of us seem to be forgetting some of the basic tools that we use to encourage patients to follow what we see as the best choice of therapy. Listening, addressing questions and concerns in plain language and taking into account where the person is coming from while advocating for what we see as the best option are things we should consider applying to our engagement in the current debate.

There are significant fears in people’s minds about health care reform as the article pointed out. I think a lot of that fear can be assuaged through using language that is neutral yet accurate – others have proposed talking about ‘a family doctor for every family’ or a ‘pediatrician for every child’ instead of ‘universal health care.’ Specifically asking what is it about government-run health care that people are afraid of and then addressing whatever fear that is – bureaucrats will not be taking the place of your doctor.

As physicians, we counsel patients on a daily basis to take medications and undergo procedures that have inherent risks, that they have fears about but that we think are the best option. We have the training to do so. While this is nothing new, this study I think serves as a good reminder that we should use the training that we have to advocate for the health care reform that we see as best for our patients and try not to fall back on political rhetoric (even if instigated by the ‘opposing side’), confusing terminology or brush off people’s concerns and fears. I believe that the current proposal with a public health insurance option is the best for my patients, but the patients have to want it too.

Alex Foster, MD, MPH

So the DNC was over yesterday and everyone is enjoying the moment of Barack Obama accepting the nomination for president.  During the DNC there was much hope laid out for ensuring health care for all, including a valiant speech by Ted Kennedy that he looks forward to Universal Health Care in his life, and many moving stories about citizens facing health care crisis.  Some citizens in despair have left the Republicans to support Barack this year.

Yet in no way has Health Care been a top 3 priority issue for either McCain or Obama.  In addition we have heard each campaign say that it wants to ensure coverage for every American, however in digging deeper neither plan ensures that every American will get coverage.

Check out the National Physicians Alliance’s Report Card on the candidates

Obama’s plan is quickly summarized in having a mandate for all children to have insurance, offering the “Exchange” where Obama will not allow for patients to be denied insurance and opens up the Federal Employee Benefit Health Program, and offers federal subsidies of undisclosed amounts.  He also supports Mental Health parity.

McCain is summarized in wanting to increase choice in private health insurance, offering tax credits and expanding Health Savings Accounts.  He also suggests that increasing retail based clinics will increase access.

Without picking apart either plan, let me just say that neither is Universal.  The plans may be intended for everyone, but they certainly do not ensure health care for everyone.  Universal means Everyone In, Nobody Out.  America recognizes the crisis that we face in health care, and wants health care to stop being a privilege.  Consumer groups are uniting to make sure health care stays on the agenda:  AARP’s Divided We Fail, Health Care for America Now, Families USA and SEIU head coalitions.

The NPA also wants to make sure that Health Care stays on the national agenda and has its own campaign to ensure that either candidate can be helped to bring about Guarenteed, Affordable, Quality, Accessible health care for All.

And remember to be wary of the words you hear at the Republican National Convention next week.  Check it out and make sure that others know to make Health Care Voting a priority and to push the candidates after the election to ensure Everyone In, Nobody Out!

Last week, Minnesota became the latest state to have legislation introduced that would ban the practice of prescription datamining. SF 3699 will prevent the sale of prescriber-specific prescription information for commercial purposes.

I had the opportunity represent the NPA at the hearing in favor of the legislation. In addition to my testimony, the Prescription Project and the Minnesota Seniors Federation also spoke in support of the legislation.

The discussion was lively, and quickly moved into the more general topic of gifts and drug detailing. At several intervals, several of the state Senators expressed their personal experiences. I never expected to have many of my arguments presented by a legislator, but one described working in a psychiatry office that has weekly lunches sponsored by drug companies.

The opposition also testified, including PhRMA and a prescription benefits manager (PBM). They argued the same lines: that physicians need detailing to learn about new drugs, that the data is used for research, and that existing legislation is under court review in New Hampshire.

Let’s take those apart:

Physicians need detailing to stay current – Of course not. There are plenty of unbiased, evidenced-based sources of information about new drugs.

Research would be harmed without this information – Very rarely do health policy and public health researchers need data specific to prescribers. But if they did want the data, few researchers would be able to afford it, nor would want to submit their research proposals for approval by the companies, which can be a requirement. Luckily, similar data sets are available from Medicare and other public programs.

Existing law is tied up in court – The New Hampshire law is currently under review in the District court. The drug companies argued that this is a commercial speech issue. (Curious how what physicians prescribe to their patients should be available, but what drug companies pay to physicians is “proprietary information” …) But judges have found that the State has an interest in regulating this area in the public interest. We expect the court to rule in the coming months.

But wait, there’s more! This week, legislation banning gifts to physicians in Minnesota may be introduced. Minnesota already forbids gifts over $50, but the ban is poorly enforced. The NPA will hopefully have an opportunity to testify in support of this legislation as well.

What a meeting. It was a bit of an geographical, meteorological and figurative journey for me: from Downeast Maine to Houston, TX. Let’s just say I did not need my jacket. I did not need good spirits either, since everybody brought plenty! A 3 day intense, fun and educational 3rd annual meeting. Among others, there were great speakers/bloggers like Howard Brody and Merril Goozner, as well as Marcia Hams (from the Prescription Project) and last but not least, former Surgeon General Joycelyn Elders, who was keynote speaker at the joint AMSA/NPA event. She is hilarious, but clearly not in tune with the Washington establishment, especially the born again kind. Here is just one of her priceless – and true – quotes:

“Condoms will break, but I can assure you that vows of abstinence will break more easily than condoms.”

For the ‘Pharma Taskforce’, the meeting was a success. First of all, it is now called the “Unbranded Doctor” campaign, expanding its original scope of advocating for prescription privacy, to the broader issue of pharma-physicians interaction. It will have its own website, unbrandeddoctor.org, where health care providers can learn about more the campaign and find networking opportunities as well as resources, most importantly the “Unbranded Doctor Toolkit”. There is also an online store where I encourage y’all to buy unbranded T-shirts, mugs, stickers etc.

Missing from the meeting? Pharma Money – it was almost entirely supported by the membership!

Online registration for the Physicians Leadership Institute: Building Coalitions for Patient Advocacy (March 14th-17th in Houston, TX) continues until March 8th! Don’t miss the opportunity to spend a solid weekend with like-minded physicians, those who care passionately about integrity in medicine, health access issues, and creative collaboration in moving forward towards a healthier America. This will truly be an inspiring meeting of the minds (and that means you!)

We are even sponsoring CME credit for an unprecedented leadership institute called The Unbranded Doctor! (separate registration is required for this course)

Check out the agenda, post the flyers at your institution or clinic, talk to your friends, register ASAP!

And for you social networking butterflies, join the National Physicians Alliance group on Facebook.

“We are one. If we don’t know it, we will learn it the hard way.”
– Bayard Rustin, Civil Rights Activist, Organizer of the 1963 March on Washington

Now is the time to join the National Physicians Alliance at its meeting in Houston, TX. If you have never been to an NPA event, you are truly missing out. Missing out on energy. You may arrive tired and disheartened, but you leave energized and full of momentum to make a difference. Whether you would like to join in NPA’s efforts to ensure the availability of quality health care to all in the US or to explore how big business looks to compromise your practice as a physician and the health of your patients, you can find it with this group.

Certainly, one of the best things about a National Physicians Alliance meeting is finding like minded physicians who are in the struggle to maintain the integrity of our profession, and who strive daily to put their patients first. That is what excites me. It is an exciting time in our country and everyone is talking about change. Now is the time for physicians like us to make a stand and be heard.

When I leave an NPA meeting I truly get what Bayard Rustin was saying. We are truly one!

(link to register for the NPA meeting)

The NPA is a terrific idea. Here is an idea for the next meeting.

Lets invite IPPNW, PHR, PSR, PNHP, No Free Lunch, AMSA, et al to all come to have a joint meeting with the NPA.

The purpose of this meeting would be:

1. to discuss our common interests which do overlap in that all of us are at least receptive to what the other organizations are doing.
2. to have a forum for discussing future collaborative endeavors or perhaps subsequent joint meetings.
3. to recruit members, network, and discuss organization building techniques.
4. to perhaps agree to discuss forming a consortium, association, or merged organization.

It would be important that the meeting be jointly sponsored even though each sponsoring organization would retain its separate idenity and would have opportunities to meet separately on their distinctive agendas. Mutual engagement only comes from shared ownership.

I have some experience with this kind of meeting when the American Association of Bioethics, the Society for Health and Human Values, and Society for Bioethics Consultation met jointly for three years. We set up a conference fee splitting arrangement with each constituent organization that brought members to the meeting. After three years, the 3 groups merged to create the American Society of Bioethics and Humanities.

We need a real alliance.

I am willing to help try to arrange such a meeting.

Steve Miles