In the midst of the political excitement of the past week, you may have missed the most recent data from the US Census Bureau about the number of people without health insurance.

In 2007, there were 45.7 million people without health insurance, which represents a slight decline from 2006. Why the decline? Are we seeing the marketplace in action, where private entities fill a need in the economy?

No, not at all. In fact, the number of people with private insurance actually dropped. When you look closer at the numbers, the reason why more people are covered is because states like Massachusetts have started programs to cover the gaps and provided insurance to their citizens. This is a further indication that the “marketplace” fails the health insurance needs, and solutions come from when citizens find a way to ensure coverage through the government.

This change is happening on the local and state level because the Federal government has failed to address this issue in a meaningful way in nearly a generation. We need to demand more of our leaders: learn more about the National Physicians Alliance Campaign for Secure Health Care for All, and sign the petition to the candidates to ensure that health care is addressed during this Presidential Election.

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!

This piece from the BMJ editor, Dr Fiona Godlee, gives a couple of good links to stories on industry funding of CME:

Is the writing on the wall for the relationship between pharma and medical education? The authors of three articles on bmj.com certainly think so. Ray Moynihan describes the case of a small group of hospital based psychiatrists in Australia, who have become increasingly anxious about the industry’s influence over their education and have institued a ban on sponsored educational events. In the United States, academic Suzanne Fletcher recommends a five-year phase-out of commercial sponsorships and a shift to practice based – rather than lecture based -learning. And Alfredo Pisacane, director of CME at the University of Naples in Italy, proposes seven practical measures for limiting commercial support to continuing medical education. Ample food for thought – and we’d like to know what you think. We look forward to hearing from you via rapid responses.

Earlier this month, a contract surfaced between public hospitals in New York and a international medical school that detailed the payments that the medical school would make to the hospitals for the opportunity for its students to train in those facilities.

One of the many disturbing aspects of this arrangement was the fact that the off-shore medical school is a strictly for-profit entity. It does not focus on medical research; it does not have a charter to ensure that charity care is provided. It charges tuition to students (mostly Americans not accepted at schools in the US) in exchange for providing them the necessary education to pass the medical licensing exams.

This structure is partly driven by the fact that international medical schools are generally not eligible for NIH funding or other governmental support, so the only source of income is tuition.

But the schools also fill a market: there is more demand for entry into medical schools than there is supply.  From Econ 101, we know that when demand exceeds supply, the price increases. In this case, the price is paid tuition.
This contract is merely the most recent phase of a slow “marketization” process affecting medicine. There is a demand for places in teaching hospitals, so why not economize that demand and recoop the value of that training?

This is a further eroding of the concept that physicians are a public good — it is beneficial to society as a whole, especially to the next generation, to ensure that we have a supply of well-trained physicians. Yes, we could design a system that extracts every last dollar available from the system today, but what does that leave us with? A generation of physicians with extraordinarily high debts because they have had to “buy” the value of becoming a physician during the training process (which by the way, extracts a lot of other costs from those who go through it: 7-15 years, limited time for family, high-stress environments, etc).

Furthermore, this creates an belief in the next generation of doctors that the most important value is monetary – more important than caring for all who are sick, more important than a just and fair health care system. Do we treat patients because they are human beings with illnesses, or do we treat patients because they can pay for it?

Physicians are a public good. This is borne out when the public shares the cost of our training and our care to ensure that physicians will be prepared to take care of the next generation of people.

The opposite side of that coin is this: physicians have a responsibility to the public, to provide care to everyone; not just those that can pay, not just those with certain diseases, not just to those currently in power.

Physicians are currently at the risk of setting aside our obligation to the public. This is a reaction to the perception that the public is no longer supporting us: public funds for training are cut, public funds for research are cut, public funds for our professional services are cut. In their place, we are seeing (respectively) more dollars from the pockets of trainees, more dollars from drug companies and less dollars for our services overall.

But some physicians still believe that we do serve a public good; that we have a professional obligation to serve all people with integrity, and to advocate for the public good.

The National Physicians Alliance is launching the Secure Health Care for All Campaign because we believe physicians do have an obligation to provide the best health care to everyone.

We have an obligation to serve people because it is patients who have allowed us into their lives in the most intimate ways, understanding that we will do our best to heal them, and use what we learn from every encounter to improve our abilities to heal all patients that we treat.

We have an obligation to ensure that all members of our society have access to health care and can benefit from the public good that has been entrusted into us, the healing community. Physicians should remember that we are a public good, and we serve all of the communities that enabled us to become doctors.

One only needs to read a newspaper or watch television to see how frustrated patients are with their physicians and how little they trust them. As a fledgling physician, it’s very discouraging to know that the public perception of our chosen field is so dismal. Fortunately, one of the NPA’s goals is to promote integrity and trust in medicine.

We intend to regain our patients’ trust by earning it.  The NPA believes that patients should never have to doubt the motives of their doctors. For this reason, we have been actively working to help physicians to limit their marketing relationships with pharmaceutical companies. This is one of the many ways that we can restore integrity and trust in our profession.

Dr. Joseph Sokol, chair of the NPA’s ethics committee and associate professor of psychiatry at the University of Arkansas, recently spoke with the Prescription Project about Sentor Grassley’s investigation into the pharmaceutical industry’s payments to psychiatrists. At the end of his interview, he makes the following statement:

“At the NPA, we are fundamentally committed to strengthening the public’s trust in the integrity of medicine. This means actively addressing and sanctioning behaviors that undermine physicians’ fiduciary relationship with patients or give the impression of doing so. Because of this, we intend to set the highest possible standard. It is worth noting that the NPA does not get any of its funding from the pharmaceutical industry.”

For a link to this excellent interview, please go to the Precription Project Blog to read Psych’s Perfect Storm.

I work in a research clinic at an academic medical center where a significant minority of our funding (probably 10-15%) comes from the pharmaceutical industry. In fact, for the past few years approximately 15% of my salary has come directly from drug company funds for clinical trials. (The other 85% has come from public sources, mainly the National Institutes of Health.) As a liberal doc who took an unpopular stand during residency and spoke out against meals and gifts from Big Pharma, I’m not thrilled about having to take drug company salary support, but I also recognize that the NIH is unlikely to fund clinical trials of investigational drugs, and so pharma will continue to fund them. I also realize that this salary support, whether it had come from pharma or public sources, has helped me to launch a career as a clinical researcher. And, I think that doing research with pharma is qualitatively different than accepting gifts or attending CME talks at fancy venues. In the spirit of full disclosure, my position as medical director at our clinic does require me to attend “investigator meetings” where I am put up at fancy hotels and fed expensive buffet meals. This makes me a bit uncomfortable, but I spend the minimum amount of time possible at these meetings (usually one night and the meeting the next day), since I don’t wish to take anything from these companies other than the science I need to work on the trial. In any case, getting a bit “Pharmed Out” is a compromise I’ve had to make to move forward in my career, but a compromise I’ve been able to accept.

Boston.com: Leaders Nip Tuck Healthcare Policy

Governor Deval Patrick yesterday signed into law one of the nation’s strictest limits on gifts given to medical professionals by drug salespeople, the most contentious measure contained in a broad package intended to improve healthcare safety and curb skyrocketing costs.

Thanks to all of our coalition partners!