Dying in NYC, open peer review at The BMJ, and yes, conflicts of interest still matter: RightCare Weekly

September 11, 2014

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.

Join the conversation: Post your comments on our new section found at the bottom of this page.



On the eve of the release of the Sunshine Act findings, Aaron Carroll reminds us in The Upshot how widespread and common conflicts of interest still are, as he points to a just published study by Genevieve Pham-Kanter in The Milbank Quarterly.  In it, the study’s author reviews the voting behaviors and financial interests of 1,400 FDA advisory committee members who were involved in decision-making for the Center for Drug and Evaluation research from 1997-2011. She found that over all, committee members had a 52 percent chance of voting in favor of a sponsor of a drug, while members who had financial interests in only the company whose product was under deliberation were more likely to vote for its approval, with a probability of 63 percent. (Conflicts of interest are also common, and just as concerning, on panels that write clinical guidelines.) Carroll surmises that conflicts of interest are surely real and influence decisions even today; while they can’t be totally eliminated, discussions about them might minimize impacts.


The BMJ has announced that it will post reviewers’ signed comments, editors’ reports, and other pre-publication documents for all new research articles and some opinion pieces. The move is part of The BMJ’s ongoing response to the controversy over two articles on the adverse effects of statin drugs for lowering cholesterol, which we wrote about here. In addition to giving active peer reviewers more credit for their work (which is essential to producing high-quality medical research and often goes unrecognized), the open peer review and pre-publication history should be useful for readers wondering how valid a trial might be, whether a paper was sufficiently scrutinized by reviewers, or why an unusual methodological choice might be appropriate.


A new series by WNYC covers end-of-life care in the New York City area. Data from the Dartmouth Atlas show that the region has much higher levels of spending and more intense end-of-life treatment than most other parts of the country. But that extra treatment isn’t necessarily better for patients and might be the opposite of what they want. However, many physicians find it difficult to accept and communicate the value of palliative care or other forms of lower-intensity care. Similarly, New York has been slow to expand the use of hospice care, which can provide patients a more supportive and less medicalized environment. The first story in the series quotes David Goodman, MD, and Diane Meier, MD, members of Lown Institute’s Clinical Advisory Council.



Don’t forget: The deadline to submit applications for the RightCare Alliance Young Innovator Grants is midnight Pacific time tomorrow, Friday, September 12! Take advantage of this opportunity to transform medical education and combat the culture of overuse. Apply today!


Conference of interest: “Price, Profit, & Reward: Winners and Losers in Healthcare Transformation” Registration is open for the National Physicians Alliance Annual Conference and Healthcare Summit, to be held October 24 & 25, 2014 at the Consumer Reports National Research and Testing Center in Yonkers, New York, on the Hudson. More information here.



Humanism and caring in medicine

  1. Caring 101: A Simple Lesson For The First Days Of Medical School – Michael F. Collins, MD, WBUR Cognoscenti blog
  2. How do we tell the stories of medicine? – Louise Aronson, The Lancet
  3. A Modern Hippocratic Oath – Paul Levy, Not Running A Hospital


End-of-life care

  1. Encouraging End-of-Life Talks – Editorial, New York Times
  2. When It’s the Doctor Who Can’t Let Go – Theresa Brown, New York Times Opinionator
  3. Doctors cannot speak about the reality of death and dying – Monica Williams-Murphy, MD, KevinMD
  4. Is one hospice the same as any other? No. Why it’s important to choose carefully. – Peter Whoriskey, Washington Post


PARADIGM-HF: The debate continues…

  1. Perspectives on PARADIGM-HF – Editors, NEJM’s CardioExchange
  2. Logical Fallacies in Defense of the PARADIGM – HF Trial of Valsartan – Sacubitril, Suppsedly the “Game Changer” for Heart Failure – Roy Poses, MD, Health Care Renewal
  3. Richard Lehman’s journal review – 8 September 2014 – Richard Lehman, The BMJ blogs


Healthcare spending

  1. The 125 percent solution for American health care – Ezra Klein, Vox
  2. A Comparison Of Hospital Administrative Costs In Eight Nations: US Costs Exceed All Others By Far – David Himmelstein, et al., Health Affairs


Patient safety

  1. Feds reverse course, will release hospital mistake data – Jayne O’Donnell, USA Today
  2. Uninformed breast cancer patients more apt to consider removing the other breast, too – Megan Brooks, Reuters


Healthcare system

  1. Replacing An Ambulance With A Station Wagon – Eric Whitney, Kaiser Health News
  2. Rural Doctor Shortage Worsens As Newly Insured Washington Residents Seek Care – Lisa Stiffler, Seattle Times
  3. It Ain’t Necessarily So: Why Much of the Medical Literature Is Wrong – Christopher Labos, MD CM, MSc, FRCPC, Medscape
  4. A Vaccine Mystery Hits Older Americans – Virginia Postrel, Bloomberg News
  5. Surgeon looks at ‘The Cost of Cutting’ in new bookThe Herald News


The Right Care Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.