Pearls from last week

St. Mary's Glacier

The pearl I experienced in person was the 14th annual Rocky Mountain Workshop on Evidence-Based Health Care, held last week in Steamboat Springs, Colorado.  It was the most intensive training in the evaluation of evidence that I’ve participated in.  The organizers planned excellent plenary sessions on topics such as bias in research and making policy decisions based on research.  And for several hours each day, participants broke up into small group sessions.  I was assigned to a lively group:

  • Andrew D. Oxman, MD, MSc
    Workshop Co?Director
    Director, Informed Choice Research Department
    Norwegian Knowledge Centre for the Health Services
  • Virginia Moyer, MD, MPH
    Chair, US Preventive Services Task Force
    Professor, Pediatrics
    University of Texas, Baylor College of Medicine
  • James B. Becker, MD
    Physician Director
    West Virginia Offices of the Insurance Commissioner
  • Christopher Koller
    Health Insurance Commissioner
    State of Rhode Island
  • Josh Morse, MPH
    Program Director, Health Technology Assessment Program
    Health Care Authority, State of Washington
  • Sheeba Ibidunni, MHSA
    Medicaid Policy Specialist, Medicaid Benefits Management
    Colorado Department of Health Care Policy & Financing
  • Miriam Falco
    Managing Editor, CNN Medical News
  • Sean Swint
    Executive Editor, Editorial, WebMD
  • Eve Harris
    Freelance writer, blogger, contributor to KQED “State of Health” blog
  • Sarah Rosenbaum, PhD
    Designer and researcher, communications unit, Norwegian Knowledge Centre for the Health Services
  • Lynne Fox, AMLS, MA, AHIP
    Health Sciences Library
    University of Colorado Denver

There was no time during that week to blog or assign story reviews, but here are some of the pearls I wanted to draw attention to from a busy week on health and health care issues in the media:

  • Aftermath of the Aurora, Colorado movie theater shootings and journalism about the tragedy:

The rate of early prostate cancers among older Americans dropped suddenly following a change in screening advice from government-backed experts in 2008, new research shows.

The findings are another sign that the tide could be turning against routine prostate cancer screening, which a growing number of medical groups worry could do more harm than good. …

The Archives of Internal Medicine, which published (the) results, welcomed the findings in a note entitled “Time to Stop Screening for Prostate Cancer.”

“Given that the harms of screening… outweigh the benefits for younger men as well,” editor Dr. Mitchell Katz wrote, “we hope to see a similar decrease in early prostate cancer incidence in young men.”

Would constant checking for disease be reassuring, or would it interfere with the actual business of living? The empowerment of patients with information, where possible from appropriate physical tests, is to be encouraged: but striving after a technology-driven, purely biomedical model of perfect physical health is no form of empowerment at all.

  • News coverage of the innovative shared decision-making program at UC-San Francisco:
    • Eve Harris on the KQED “State of Health” blog wrote: “What Do Engaged Patients Do?”  She not only featured the UCSF program, but profiled a woman who received a diagnosis of ductal carcinoma in situ (DCIS) and who chose active surveillance rather than immediate aggressive intervention rather than bilateral prophylactic mastectomy as some had recommended for her.

While a greater number of physicians in more diverse settings are now engaged in pharmaceutical research than were 20 years ago, our data have potentially troubling implications for drug development. We found that the private-sector physicians interviewed identify primarily with the business rather than the science of contract research. In addition, our findings indicate that the private-sector PIs aligned their sense of research ethics with industry—ensuring the responsible conduct of research—rather than foregrounding the interests of research participants. Because these private-sector PIs are largely motivated by financial gain as opposed to making a contribution to science, we suggest that the professional identity of private-sector PIs may inadvertently offer pharmaceutical companies the ability to exert more control over their proprietary information and clinical trial data.

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