Archive for September 12th, 2008

Colon Cancer Care: Not Good Enough

September 12th, 2008 | No Comments | Source: Reuters, WebMD

Proper treatment for colorectal cancer includes excising the tumor, surrounding tissue and nearby lymph nodes, and then checking the nodes for metastatic spread. Oncologists decide whether to give adjuvant therapy based on the lymph node analysis. If the tumor has spread but the lymph node analysis fails to pick this up, then the patient does not receive appropriately aggressive adjuvant therapy.

Twelve years ago, oncologists established a guideline to measure the quality of colorectal cancer care. The guideline calls for pathologists to examine at least 12 lymph nodes for metastatic spread in 75% of all tissue blocks received from presumed colorectal cancer surgeries. Back then, only 15% of hospitals met the guideline.

Now we have new data. The results are better, but far from adequate. Only 38% of hospitals meet the guideline, according to data soon to be released in the Journal of the National Cancer Institute. Community hospitals meet the guideline only 34% of the time, whereas comprehensive cancer centers meet it 78% of the time.

Why the poor results? Perhaps doctors don’t know they should check so many nodes. Perhaps they don’t understand the importance of lymph node analysis in determining adjuvant therapy. Perhaps surgeons don’t provide enough nodes to the pathologists, or pathologists don’t have time to analyze that many nodes. Maybe tissue preparation and storage techniques are inadequate.

Providers that are serious about improving care will embrace the new findings and start exploring these hypotheses one by one.


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Bogus UA Bankruptcy Report

September 12th, 2008 | No Comments | Source: NY Times

Steve Jobs got a chuckle this week when he addressed recent speculation about his health by borrowing an old Mark Twain line. “Reports of my death are greatly exaggerated,” he said.

Perhaps United Airlines should post something similar on its web site after a series of errors led investors to believe the airline had tanked again and the subsequent sell-off wiped out $1 billion in UA’s market cap before things got sorted out.

What actually happened is a matter of dispute right now. One story is that a reporter with Income Securities Advisers was doing a routine Google search for bankruptcy filings in 2008 when he came across a link on the web site of the South Florida Sun-Sentinel. The link had a fresh date on it, but connected to a 2002 Chicago Tribune article describing UA’s bankruptcy filing in that year. The reporter included the link in a post to Bloomberg News, which in turn released a headline citing the article.

The bogus news caused UA shares to tumble 25% in less than an hour before UA officials figured out what happened. Thereafter, NASDAQ temporarily halted trading, Income Securities and Bloomberg issued corrections and the frenzy settled down quickly although UA stock closed down 12% for the day.

The Sun-Sentinel denies ever posting the story on its web site and its parent, Tribune Co. provides an equally plausible account that blames Google.


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Got PCPs?

September 12th, 2008 | No Comments | Source: Associated Press, JAMA

Twenty years ago, we were aware that US medical school graduates tended to enter disciplines having the highest earning potential. Since then, income disparity between specialists and primary care physicians has widened, and medical student debt has ballooned to an astounding median of $140,000 per graduating senior.

So there is no reason to be surprised by the results of a recently published survey of graduating students from 11 US medical schools. Only 2% of respondents to this survey indicated that they planned to work in primary care internal medicine. That’s down from 9% in 1990. This year, 2,600 fewer US doctors enrolled in primary care training programs than did so just 6 years ago. 

The survey revealed that low income is just one reason why US medical students steer clear of general internal medicine. They are turned off by heavy workloads, continuous hassling with insurance companies and inadequate ancillary support as well.



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