Complaints about “pharmascolds” in NEJM, over-screening for breast cancer, & empowering paramedics to avoid ER visits

May 21, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Over the last three weeks, the New England Journal of Medicine has published a series of commentaries (Part 1Part 2Part 3) by Lisa Rosenbaum, MD, discussing whether conflict of interest regulations have been become a barrier to innovation and productive collaborations between physicians and industry. She calls out “pharmascolds” for creating an environment in which physicians feel constrained from working with pharmaceutical companies, for fear that they will be unable to publish or serve on guideline panels where their expertise will help patients. ​We must point out that guideline and government advisory panels remain full of conflicted panelists. More importantly, Rosenbaum ignores the deleterious effects on medical science that come from widespread industry-funded trials and conflicts of interest. The fact that ​a prominent journal like ​the NEJM​ is devoting so much space to ​rebutting COI regulations​ may indicate the beginning of a backlash against the movement to reduce ​the influence of money in medicine. Larry Husten’s excellent response was posted at Forbes, and others have been posted at Health Care Renewal and HealthNewsReview. We will respond to the series more fully next week.


Americans are screened for cancers too often, and recommendations issued this month by two organizations are underscoring that less can be more when it comes to screenings and treatments. The United States Preventive Services Task Force (USPSTF), in its latest draft report, recommends mammograms once every two years between ages 50 and 74. In the LA Times, Karen Kaplan highlights new screening recommendations from the American College of Physicians relating to five cancers, among them breast cancer. The ACP’s recommendations for mammography mirror those of the USPSTF.  In their blog in Health Affairs, Lisa Simpson, MD, head of Academy Health and Shannon Brownlee, MSc, senior vice president at the Lown Institute, back the USPSTF, citing the multiple studies used by the panel in making their recommendation. Most important, the authors stress the harms of over-screening, including overtreatment. “Between one in five and one in three breast cancers detected by mammograms did not need to be treated, or could have been treated successfully at a later time in the woman’s life,” the authors concluded. Cries of foul are forthcoming from such groups as the American College of Radiology, which has taken a forceful stand against the USPSTF’s mammography recommendations, insisting the new guidelines will lead to thousands of unnecessary breast cancer deaths.


In Kaiser Health News, in an effort to better connect patients with the medical and social needs, states like Nevada have launched programs training paramedics to practice “community paramedicine,”or in-home care. They are providing care closer to home, steering patients away from unnecessary ER visits, coordinating patient services and reducing costs, all while improving health outcomes. In spite of their success, demonstrated in Reno and elsewhere, expansion is hindered by current reimbursement schedules, as Politico reports. The Field EMS Bill, expected to be reintroduced this month, would require the first federal evaluation of these programs and consolidate EMS oversight within HHS, which would greatly improve the programs’ visibility and hopefully, its expansion.



  • Save the Date: Tuesday, June 2, 12 – 1 PM Eastern Time, join us for our second webinar to learn about implementing a RightCare Rounds at your institution. Our presenters are David Bor, MD; Brandon Combs, MD, FACP and Hyung (Harry) Cho, MD.  Learn more and register.


  • PharmedOut’s CME conference, The Real Risks of Rx Drugs, will be held June 11-12 at Georgetown University, Washington, DC. For information, see here.



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