Off the Cuff:
Guilty Until Proven Guilty
In a country where even vile criminals
are innocent until proven guilty, our legislators have started convicting
the healthcare industry and its providers of dishonesty and unethical behavior
without so much as a fair hearing. Our organizations are too scared of appearing
self-serving to say a word about it. Right now, the NY State Legislature
is considering a bill that vilifies healthcare providers. The proposed legislation
specifically includes ODs. Rather than paraphrase, let me share some of the
The legislature makes the following findings with respect to improper influences exerted on prescribing decisions. . . .
1. The pharmaceutical, biological product and medical device industries spend billions of dollars annually to attempt to influence prescribers' decisions about which drugs or other treatment to prescribe to their patients, including more than half of all formal continuing medical education programs. Legislation is necessary to prohibit drug and device manufacturers from making payments to prescribers in an attempt to influence their prescribing decisions and further to require prescribers and manufacturers to disclose the things of value that are legitimately transferred from drug and device manufacturers to prescribers.
2. There is compelling evidence that the vast majority of physicians accept some type of gift or payment from pharmaceutical and medical device manufacturers, and often such gifts and payments, even when of little value, influence physicians to prescribe treatments that are more expensive and no more effective or safe, and are sometimes less effective and more dangerous, than other available treatments.
3. Legislation is necessary to prohibit presenters at continuing professional education programs from providing false or misleading information to prescribers and to require all potential conflicts of interest be disclosed to attendees of such programs.
Personally, I find these allegations and insinuations baseless and offensive. I have yet to hear of a colleague being paid for prescriptions or influenced by the inexpensive meals or cheap tokens the industry "gifts" for the personal time we take from our families for sponsored dinner CE meetings.
Why should the pharmaceutical industry be castigated for trying to influence prescribing habits? After all, this is America, and they are for-profit businesses. I believe that sponsored CE is an important source of scientific and clinical information, and that limiting it will adversely affect patient care. The doctors I know put patients' needs ahead of financial concern, and all are capable of separating valid scientific data from marketing spam.
It is perverse that lawyers and legislators benefit from elaborate systems of perks and benefits that would cost us our licenses, yet they accuse us of being so untrustworthy that we would put a few dollars ahead of our patients. Maybe the real problem here is that they are ascribing their motives and ethics to us?
Want to share your perspective? Write
to Dr. Epstein at email@example.com.
Please indicate if you would like your thoughts shared on
OP-Blog and if they should be attributed or
Watch for new posts on the OP Blog this week!
The views expressed in this editorial are solely those of the
author and do not necessarily represent the opinions of the
editorial board, Jobson Publishing or any other entities or
Associations with Intraocular Pressure in Latinos
A total of 5,958 Latinos 40 years and older from the Los Angeles Latino Eye Study without a history of ocular hypertensive treatment underwent an interviewer-administered questionnaire and a complete ocular and clinical examination to evaluate biologic factors associated with intraocular pressure (IOP) in a Latino population. IOP was obtained by applanation tonometry and was based on the mean of three measurements per participant.
Higher systolic blood pressure, higher central corneal thickness and diabetes were the major factors associated with elevated IOP. Other positively correlated variables included age, female gender, higher diastolic blood pressure, larger body mass index, darker colored irides and nuclear sclerosis. Axial length and family history of glaucoma had no association with IOP.
Several systemic and ocular characteristics are associated with elevated IOP in Latinos. By identifying and recognizing these risk factors, it's possible to define subgroups of the population that may be most at risk of having elevated IOP.
SOURCE: Memarzadeh F, Ying-Lai M, Azen SP, Varma R (Los Angeles Latino Eye Study Group). Associations with intraocular pressure in Latinos: The Los Angeles Latino Eye Study. Am J Ophthalmol 2008; May 15 [Epub ahead of print].
Oral and Ocular Dryness with Rheumatoid Arthritis
This study attempted to determine, primarily in rheumatoid arthritis (RA) patients, the prevalence, relative risk and risk factors for oral and ocular dryness. The study included 9,921 patients with RA and 2,851 with a non-inflammatory rheumatic disorder (NIRD; not fibromyalgia: FM) presenting with self-reported persistent ocular and oral dryness (PD) at two consecutive observations, and sporadic dryness at one of two consecutive observations during semiannual assessments. Prevalence was also evaluated in 2,867 patients with FM.
In RA, PD was noted in 11.6 percent and SD in 17.5 percent. Compared with NIRD, the age- and sex-adjusted relative risk for PD was 1.34 and the severity- and treatment-adjusted relative risk was 1.46. The adjusted relative risk for FM compared with RA and NIRD was 2.02. Dryness prevalence increased 10 percent to 13 percent every 10 years and was associated with therapy. The risk attributable to treatment was 27.5 percent. Fatigue and body pain (Symptom Intensity Scale) was more strongly associated with dryness than was any other clinical scale, including Health Assessment Questionnaire, pain and Medical Outcomes Study Short Form-36 Health Survey. Sporadic dryness was associated with a decrease in quality of life of 0.020 utility units.
Dryness is increased in RA and is contributed to by severity and therapy. The combination of body pain and fatigue is the strongest clinical correlate of dryness, and is independent of diagnosis of FM. Any factor that increases illness severity or distress results in an increase in dryness.
SOURCE: Wolfe F, Michaud K. Prevalence, risk, and risk factors for oral and ocular dryness with particular emphasis on rheumatoid arthritis. J Rheumatol 2008; May 15. [Epub ahead of print].
Visual Acuity After Cataract Surgery in Patients with AMD
This retrospective case control study included all patients who had consecutively undergone phacoemulsification from January 2000 to February 2006, had a pre-existing diagnosis of early age-related macular degeneration (AMD) and were followed up for at least one year postoperatively (1,152 eyes of 696 patients) to analyze changes in visual acuity after cataract surgery in patients suffering from age-related maculopathy.
The control group comprised phakic patients diagnosed with early AMD from January 2000 to February 2006 who did not undergo eye surgery and were followed up for at least one year (334 eyes of 202 patients). In 62.1 percent of operated eyes, the best-corrected visual acuity was at least two logMAR units better than before surgery, and in 26.7 percent it was at least four logMAR units better. Deterioration of visual acuity of more than four logMAR units occurred in 1.3 percent of operated eyes and 1.5 percent of control eyes.
Cataract surgery can markedly improve visual acuity in patients with age-related maculopathy.
SOURCE: Baatz H, Darawsha R, Scharioth G, et al. Visual acuity after cataract surgery in patients with age-related macular degeneration. Ophthalmologe 2008; May 18. [Epub ahead of print].
NEWS & NOTES
ARGENTIS LICENSES THIRD DRY EYE TREATMENT. ArGentis Pharmaceuticals, LLC has licensed a third treatment for dry eye syndrome, designated ARG103, in a continuance of the licensing partnership the company has with the Southern College of Optometry (SCO). The treatment is the third prospective therapy for dry eye syndrome that uses transdermal delivery of an active pharmaceutical ingredient to affected glands via cream or gel applied to eyelids. ARG103 incorporates a combination of testosterone and progesterone, which may help treat a larger number of postmenopausal women who may experience dry eye syndrome as a result of waning androgen levels. The progesterone added to testosterone for dry eye treatment provides extra anti-inflammatory power and may enhance meibomian gland secretion. ARG103 will broaden the reach of arGentis' transdermal ocular technology, which includes ARG101 for use in menopausal women and ARG102, a progesterone-based formulation that treats dry eye syndrome in younger women and men. For more information, go to www.argentisrx.com.
PIONEERING EYE SURGERY NETWORK RECEIVES 2008 GATES AWARD FOR GLOBAL HEALTH. The Aravind Eye Care System of Tamil Nadu, India, has won the 2008 Gates Award for Global Health in recognition of its work to prevent blindness and provide affordable, world-class eyecare to the poor. The $1 million Gates Award, the world's largest prize for international health, honors extraordinary efforts to improve health in developing countries. Founded by Dr. G. Venkataswamy in 1976, Aravind has saved millions of people in India from blindness. In the past year, Aravind provided outpatient care to approximately 2.4 million patients and performed more than 280,000 surgeries. Thanks in part to Aravind's efforts, the estimated number of blind people in India dropped 25 percent between 1990 and 2002. Outreach teams from Aravind hospitals coordinate with local leaders and service groups across India to organize "eye camps" where free exams are provided. Since 2004, Aravind has used high-speed broadband access to link these camps directly to on-call doctors in central hospitals. The doctors can diagnose and refer patients in real time, so that only those who require surgery need to visit the hospital. The Gates Award was presented on May 29 at the Global Health Council's 35th Annual International Conference in Washington, DC. For more information, go to www.aravind.org or www.gatesfoundation.org/GlobalHealth.
TWO MILLION-DOLLAR GRANT ANNOUNCED FOR INNOVATIVE GLAUCOMA RESEARCH. Frank Stein and Paul S. May have established "The Frank Stein and Paul S. May Grant for Innovative Glaucoma Research" for the Glaucoma Research Foundation. The terms of the grant are restricted to support research, with principal and income used over a period of ten years from receipt to fund grants. It is expected that each $1 million bequest will make possible a significant grant for glaucoma research of approximately $100,000 annually for ten years, after receipt of funds. The scientist-recipient of the "Frank Stein and Paul S. May Grant for Innovative Glaucoma Research" will be selected by GRF's Scientific Advisory Committee in consultation with the GRF Board and will be announced each year at GRF's Annual Meeting. For more information on the GRF, go to www.glaucoma.org.