Going on vacation. Will resume blogging either Sunday or Monday. Playing golf and giving health care thoughts a rest.

Have a great weekend!!!

Ephedra ban takes effect nationwide after judge rejects supplement makers' request.

The supplement makers' lawyers tried!

Unlike medications, which must be proven safe and effective before they are allowed to be sold, federal law allows dietary supplements to be marketed without any such proof. To curb a supplement, the FDA must show it poses a significant health threat.

NVE maintains that the FDA failed to prove such a threat if the supplement is taken correctly, and was swayed by the outcry over ephedra deaths.

"The FDA chose to ignore valid science that showed that there wasn't a problem," said Walter Timpone, a lawyer for NVE. "In 1999, (there were) 104 deaths as a result of aspirin ingestion. Are we going to ban aspirin now?"

I guess this judge is not impressed with sophistry.

Ordering Treatments à la Carte

Many patients reject the idea of deciding on their own treatments. Overwhelmed by a confusing array of alternatives, they do not want the added stress of being forced to make hard decisions. They turn to their physicians for guidance.

Many doctors are also uncomfortable ceding decision making authority to their patients. The BMJ, a medical journal in Britain, recently published a study showing that men differ significantly in the importance they place on trying to cure prostate cancer versus avoiding the side effects of treatment. In response to this article, angry doctors wrote into Internet sites complaining that the researchers were taking decision making authority away from physicians.

Taken to an extreme, the new way of doing things clearly goes beyond what most patients and physicians want. Still, that does not justify a return to old-fashioned paternalism. Instead, a model of shared decision making gives physicians an opportunity to practice the art of medicine in ways that help patients make choices, often by exploring patients' values enough to make individualized recommendations.

As I have struggled to communicate better with patients (dropping my television analogy, for starters), I have learned that the distinction between letting patients make decisions and making decisions for them is often very subtle.

Paternalism is not dead. Nor should we kill it. Perhaps we should develop a new category, patient directed paternalism!

Medicare Web Site to Provide Comparative Data on Prescription Medicines

Residencies pinpoint work-hour hurdles

According to an Internet survey of resident program administrators, the specialty facing the biggest compliance hurdles was surgery, with 67.7% of 105 surgical programs represented in the survey saying they were greatly challenged by the new work hours. This was followed by neurological surgery, internal medicine, ob-gyn and thoracic surgery.

The survey was conducted Jan. 28 through Feb. 17 and 117 responses were collected.

Respondents said the most difficult rule to implement was the 24-hour call period, which also allows for six additional hours for patient transfers and educational activities.

Common obstacles were adjusting residents' schedules (reported by 56% of respondents), followed by uncooperative residents (31%), lack of funding to hire more staff (29%), difficulties managing transitions from one rotation to the next (27%) and uncooperative faculty (25%).

Respondents noted other barriers, such as getting residents to accurately record their hours in a timely fashion and collecting the data necessary to verify compliance.

Acceptance by faculty and program directors was an ongoing battle for some, who found they had to continually remind all involved of the rules.

Some programs noted positive effects, such as better organization of their residency programs overall, more streamlined patient care and improved resident morale.

Those who have not gone through residencies (non-physicians) have a difficult time understanding the difficulties that these new regulations bring. The regulations conflict with long traditions. I still do not understand how and why new, seemingly arbitrary regulations were adopted without testing.

Perhaps residencies will improve. Perhaps our trainees will become better doctors. But we do not know what the long term effect of these rules.

We continue to work to improve our residency while meeting the regulations. We hope for positive results.

Alert warns of Medicare conflict for concierge practices

Those who start concierge practices (I prefer the term retainer practice) must carefully examine Medicare billing rules. One can still bill Medicare, however, one must be very careful not to claim that the retainer fee covers any service for which the provider also bills Medicare.