Medical students begin losing empathy after their first year in school, and the decline accelerates after clinical rotations, according to a study in Academic Medicine.

To reach these conclusions, Bruce Newton and colleagues followed 419 medical students from four consecutive classes from freshman through senior year at the University of Arkansas for Medical Sciences.

Researchers assessed vicarious empathy, which is a person’s emotional response to the perceived emotional experiences of others. Using a 9-point scale, they asked students to agree or disagree with statements like, “I cannot feel much sorrow for those who are responsible for their own misery.”

The scientists found that student empathy scores dropped after the first year of medical school and then again after the third year. Female students turned in higher empathy scores than their male counterparts, and students entering primary care showed more empathy than those entering pathology, radiology and surgery.

They attributed the early decline in empathy to stress and anxiety associated with students’ competitiveness and worry about exam scores. The late decline was assumed to be caused by the intensity of hospital practice. Teaching on the wards was likely to have been rushed, and students may not have received as much mentoring or bedside teaching as they wanted.

“We know that really good communication skills (helps) patients…to comply with the instructions of the physician,” said Newton. “A bond of trust is established, and if something unfortunately goes wrong, if you have this bond, you are less likely to be sued.”

“We start with students who are very caring but have no diagnostic skills and end up with physicians with great diagnostics skill but who don’t care,” summed up Richard Frankel a professor of medicine at Indiana University School of Medicine, for AMedNews.

Japanese women are getting skinnier, a lot skinnier. The phenomenon began 25 years ago, and it encompasses all body types. Thus, compared with the mid-80s Japan now has both more women who are thin (BMI of less than 18.5), and fewer women who are overweight (BMI > 25).  

The trend is most pronounced among women in their 20s. In the 80s, there were twice as many thin Japanese women in this age range as there were overweight women. Now, Japanese women are 4 times more likely to be thin. In this age group, average daily calorie consumption was found in recent government studies to be just two-thirds of recommended levels.

Japanese public health officials generally agree that young adult Japanese women have, as a group, become dangerously skinny. The average birth weight of their babies is falling for example, and their risk of death in instances serious illness is increasing.

The problem, it seems, is social pressure in the form of women looking critically at other women. “Japanese women are outstandingly tense and critical of each other,” said Hisako Watanabe, an assistant professor of pediatrics at Keio University and an expert in eating disorders.

“There is a pervasive habit among women to monitor each other with a serious sharp eye to see what kind of slimness they have. They want other people to be fatter than themselves. It is complicated, competitive and so subtle.”

(Meanwhile, Japanese men are gaining weight at a prodigious pace. In the mid-80s, 20% of men in their 50s were overweight; now, it’s 32%. The problem became so bad that the government imposed national waistline standards in 2007, and required employer-funded physical examinations including waistline measurements, along with focused education programs.)

The Food and Drug Administration will require Biotech giant Amgen to implement a risk management program designed to warn physicians and patients about the risks and benefits of using its blockbuster drugs, Epogen and Aranesp to treat chemotherapy-related anemia. 
 
The drugs, which are known as erythropoiesis-stimulating agents, help mitigate anemia in cancer patients by stimulating bone marrow production of red blood cells

The new FDA regs require Amgen to assure that physicians complete training designed to teach them how best to use ESAs in cancer patients. Amgen must also assure that patients get a medication guide about the drugs, and that both doctors and patients must sign a form indicating that risks and benefits of ESAs have been discussed prior to treatment.
 
“This new risk management program will help ensure that patients and health care professionals have fully considered the benefits and risks of using ESAs,” Richard Pazdur, director of the Office of Oncology Products in the FDA’s Center for Drug Evaluation and Research told BurrillReport.
 
Epogen and Aranesp netted $5.8 billion in sales for Amgen last year, which is down nearly 15% year over year. The sales falloff actually began in 2007, when the FDA first issued safety warnings about the ESAs. The warnings suggested that ESAs may accelerate tumor growth and increase the risk of cardiovascular complications like heart attacks and strokes.

ESAs are FDA-approved for anemia associated with kidney failure, but the new program does not apply to that patient population.

Scientists at UC Berkeley have found that an afternoon nap improves cognition later in the day, and posit that the beneficial effects of a nap have to do with letting a particular area of the brain clear out short-term memory “storage space” so it can absorb new information.

To reach these conclusions, Matthew Walker and colleagues randomized 39 healthy adult volunteers into a nap group and a no-nap group.

The groups performed equally well on a midday test which involved absorbing a lot of facts. After that, the nappers retired for a 1.5 hour respite, while unfortunate souls in the no-nap group toiled away. Then,  at 6 pm, both groups underwent further cognitive testing.

The scientists found that the nappers outperformed the non-nappers. In fact, the nappers performed better than they did on the first test, which occurred before their nap.

The results supported earlier research which showed that that the hippocampus temporarily stores fact-based memories before relaying them to the brain’s prefrontal cortex, and that the hippocampus has a relatively limited storage capacity.

They also supported earlier research showing that students who work through the night reduce their capacity to absorb new facts by 40% by the following morning.

According to Walker, “Sleep not only rights the wrong of prolonged wakefulness but, at a neurocognitive level, it moves you beyond where you were before you took a nap.”

Walker’s group also demonstrated using EEGs that the memory-refreshing process occurs during stage 2 non-REM sleep (non Rapid Eye Movement sleep). This is why, Walker suggests, humans spend nearly half their nap time in this stage of sleep.

Walker presented these preliminary findings at last month’s annual meeting of the American Association of the Advancement of Science (AAAS) in San Diego.

Jon Basso, owner of the Heart Attack Grill in Chandler, Florida and proud creator of the quadruple bypass burger (see picture) is suing his counterpart, who recently started a similarly-themed establishment, the Heart Stoppers Sports Grill, in nearby Delray Beach.

The Heart Attack Grill has been around for years. Heart Stoppers began serving it’s artery-clogging, stomach-expanding fare in the past few months.

Both establishments feature Hooter’s-like “nurses” as waitresses and a cardiovascular-catastrophe themed ambiance, which prompted the lawyer representing the Heart Attack Grill to plead his case thusly to the South Florida Sun Sentinel:

“Heart Attack Grill is the originator of the medically themed hamburger grill and restaurant. … It sells high-calorie food products and we have had very extensive media coverage, including numerous shows on the Travel Channel and the Food Network. In my mind, we are just as well known as McDonald’s.”

According to the WSJ Health Blog, the Heart Stoppers folks were negotiating for a Heart Attack Grill franchise before cutting and running. The Heart Stoppers theme “is completely different,” says the lawyer for the upstart. “They didn’t steal the same trademarked Single Bypass, Double Bypass burger”

And Heart Stoppers offers food for vegetarians as well, claimed Iggy Lena, the owner.

Diabetic patients treated by physicians who received pay-for-performance incentives received better care and had better clinical outcomes than those whose physicians were not involved in the program, according to researchers at IMS Health.

To reach these conclusions, Judy Chen and colleagues looked at the records of diabetic patients who received care from the Hawaii Medical Services Association, a large PPO between 1999 and 2006. HMSA had 19,600 diabetic at study onset and about 32,000 by 2006.

HMSA offered its physicians the opportunity to earn bonuses ranging between 1.5% and 7.5% of their base fees if they met quality-of-care targets including the use of HbA1c and LDL cholesterol testing for their diabetic patients. Beginning in 2001, participating physicians could earn nearly $6,000 in bonuses if their adherence to specified care requirements improved versus the previous year.

The provider organization defined high-quality care as receiving at least 2 tests for HbA1c and one test for LDL cholesterol in a given year.

Chen’s group found that physicians who were enrolled in the P4P program delivered high quality care 16% more frequently than physicians who were not so enrolled. The patients of physicians who participated in P4P for at least 3 consecutive years were also found to be 25% less likely to be hospitalized.

“This study showed a robust, consistent, significant, and positive association between increased receipt of appropriate laboratory monitoring of A1c and LDL cholesterol levels and decreased hospitalization rates,” Chen’s group wrote.

The proportion of diabetic patients seen by physicians enrolled in the P4P plan jumped from 79% in 1999 to 95% in 2006.

The write up is in the American Journal of Managed Care.

Patient risk factors like advanced age increase the likelihood of some so-called “never events” in hospitals, according to a report in last month’s Archives of Surgery. The findings do not support Medicare’s current policy of denying payments associated with treatments for such events.

To reach this conclusion, Donald Fry and colleagues analyzed 890,000 surgeries in 1,368 hospitals using the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. They studied abdominal hysterectomy, aorto-femoral bypass, colon resection, coronary artery bypass grafting and total hip replacement.

The researchers looked for associations between patient factors like comorbidities, age and gender and 8 “never event” complications, including C. difficile, MRSA, and surgical site infections, catheter-associated vascular and urinary tract infections, mediastinitis after CABG, decubitus ulcers and post-operative pneumonia.

They found that patient age and comorbid conditions like renal failure and weight loss were associated with a much higher risk of many of these “never event” complications.

The odds ratios ranged from 1.8 for unscheduled admission as a predictor for C. difficile enterocolitis to 16.4 for malnutrition and weight loss as a risk factor for intravascular device infection.

“Calling these complications never events and refusing to pay for their treatment may advantage high-quality caregivers, but it also will penalize providers that care for the most vulnerable patients or that perform procedures with higher-than-average risk,” Fry’s group wrote.

Medicare’s “never events” list was implemented 2 years ago. It includes obvious mistakes like transfusing the wrong blood type and wrong-site surgeries.

But the list also features complications that may not be preventable. In addition to those mentioned above, the list includes falls in the hospital, inadequate blood glucose control, pulmonary embolism and drug-induced delerium.

A person’s birth date may affect his or her odds of becoming a pro athlete, according to new study by Australian scientists.

Adrian Barnett, a research fellow at Queensland University of Technology examined the birthdays of Australian Football League (AFL) players and observed that a disproportionate share of them were born in the first 3 months of the year, while much fewer than expected were born in the last 3 months.

The Australian school year begins in January, Barnett noted.

“Children who are taller have an obvious advantage when playing [Australian rules football]. If you were born in January, you have almost 12 months’ growth ahead of your classmates born late in the year, so whether you were born on December 31st or January 1st could have a huge effect on your life,” Barnett told MSN.com.

Barnett found that 33% more AFL players had January birthdays than expected, and there were 25% fewer December birthdays than expected.

Barnett’s observations are similar to those of other scientists who found associations between birthdays early in the year and the chances of becoming a professional basketball, football, ice hockey, football or volleyball player.

“Research in the UK shows those born at the start of the school year also do better academically and have more confidence,” Barnett said. “And with physical activity being so important, it could also mean smaller children get disheartened and play less sport. If smaller children are missing out on sporting activity then this has potentially serious consequences for their health in adulthood.”

His study appears in a recently published book called Analyzing Seasonal Health Data.

Physicians must follow certain protocols should they wish to dismiss a patient in their practice.

Physicians can ask chronically disruptive or drug-seeking patients to leave their practice. They can do the same for patients who miss appointments or fail to pay bills, but generally they can’t fire patients for simple failure to follow their advice.

Recently, some pediatricians began refusing to care for the children of parents who don’t let them be vaccinated based on fears of a link between vaccines and autism.

The American Academy of Pediatrics frowns on this, Douglas Diekema, a former chairman of its bio-ethics committee told the Wall Street Journal, “because it gives you the opportunity to continue the discussion. Two years later, if the child gets whooping cough, the parents may change their mind.”

State laws on the subject are variable, but in general they require that doctors document the reason for withdrawing care, inform the patient about the problem, give him or her time to find a new physician and then send a certified letter ending the relationship.

The right of doctors to refuse to treat patients was reaffirmed by the Fifth Circuit Court of Appeals, in a case involving John Bower, the director of a kidney dialysis program in Jackson, Mississippi.

Bowers’ patient frequently missed appointments for dialysis, drank excessively and ended up needing emergency care all the time.

Bower eventually told the patient he was ending the relationship, but an advocacy group sued. Bower argued that forcing physicians to treat patients violated the 13th amendment, which outlawed slavery.

He won the case, but ended up treating the patient anyway because his hospital received funds under provisions requiring its physicians to treat anyone that needed care.

The patient died in a car accident 4 years later.

More than 75% of kids have at least one ear infection before age 5 and earaches are among the most common reasons why kids visit pediatricians. But doctors don’t agree how earaches should be treated.

Guidelines promulgated by the American Academy of Pediatrics and the American Academy of Family suggest that many kids will get better without antibiotics.

A recent study in the British Medical Journal even hinted that kids who receive antibiotics might be at greater risk for recurrent infections.

Nevertheless, US doctors prescribe them for more than 80% of the children they diagnose with earaches, according to a study in Pediatrics.

“I’m not looking at a study, I’m looking at a patient,” William Corporon a Kansas-based family practitioner told the Wall Street Journal. Corporan prescribes antibiotics when he diagnoses a bacterial ear infection.

Antibiotic-prescribing doctors believe the drugs help kids recover faster, though they admit the marginal gain is a day or less, at best. They also doubt the veracity of clinical trials on the subject, because they include kids that don’t have bacterial ear infections.

Meanwhile, many parents are not comfortable leaving an ear infection untreated, and others want the quickest possible recovery so their kids can get back to school or day care. In a survey of PCPs for example, 65% said parents’ requests for antibiotics was the most important factor leading to the prescription.

Allan Lieberthal, a pediatrician at Kaiser and chairman of an AAP group tasked to update guidelines on the subject says 80% of children will improve within a few days without antibiotics, while 90% will get better with the antibiotic. Lieberthal typically gives parents a prescription they can fill after 48 hours if the kid still has a fever or pain.