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May 9, 2008  Download print version

U.N. suspends Myanmar aid after supplies seized by Junta

Physician compensation survey shows gender gap in earnings

Study in 7,000 men and women ties obesity, inflammatory proteins to heart failure risk

Research predicts hospital stays and measures effects of patient education among diabetics

C. difficile exacts heavy toll at Ontario hospital

Group urges F.D.A. to take Ortho-Evra contraceptive off market

Hard sell to Medicare insurance buyers would get softer under new rules

U.N. suspends Myanmar aid after supplies seized by Junta

BANGKOK — The United Nations suspended relief supplies to Myanmar on Friday after the military government seized the food and equipment it had already sent into the country. Earlier, in a statement, Myanmar’s military junta said it was willing to receive disaster relief from the outside world but would not welcome outside relief workers. Nearly one week after a devastating cyclone, supplies into the country were still being delayed and aid experts were being turned back as they arrived at the airport. In the statement, the government said it would distribute international relief supplies itself.

Paul Risley, a spokesman for the United Nations World Food Program, said, "all the food aid and equipment that we managed to get in has been confiscated." He said the World Food Program was suspending the few flights that the Myanmar authorities had so far allowed to enter the country until the matter was resolved.

Myanmar said it had turned back one relief flight because, in addition to disaster relief supplies, it carried disaster assessment experts and an unauthorized media group. "Myanmar is not in a position to receive rescue and information teams from foreign countries at the moment," the statement, from the Foreign Ministry, said. “But at present Myanmar is giving priority to receiving relief aid and distributing them to the storm-hit regions with its own resources."

The first of two major international aid shipments arrived Thursday by aircraft from the United Nations World Food Program, carrying high energy biscuits, water containers, food and plastic sheets. But two of four United Nations experts who flew in on Friday were turned back at the airport for unknown reasons, said John Holmes, a relief coordinator for the United Nations. Altogether, by one count, 11 chartered planes with relief supplies have landed in Myanmar, a tiny amount for a disaster that the United Nations said has affected 1.5 million people. By the government’s official count, 22,500 people have died, but Shari Villarosa, the top American diplomat in Myanmar, said the number could reach 100,000 if help was not prompt and the humanitarian situation worsened.

One United Nations official said he had never seen delays like this before in delivering relief supplies and aid officials. In Indonesia after the tsunami in 2004, he said, an air bridge of daily flights was established within 48 hours. "The frustration caused by what appears to be a paperwork delay is unprecedented in modern humanitarian relief efforts," said the official, Paul Risley, a spokesman for the United Nations World Food Program, in Bangkok. He said his agency alone had submitted 10 visa applications for relief workers but that none had been approved before consulates shut down for the weekend. "We strongly urge the government of Myanmar to process these visa applications as quickly as possible, including working over the weekend," he said.

In Thailand, in addition to aid workers United States Air Force transport aircraft and helicopters waited at an airport for permission to enter Myanmar with supplies. "We are in a long line of nations who are ready, willing and able to help, but also, of course, in a long line of nations the Burmese don’t trust," said United States Ambassador Eric John. He said that on Thursday Myanmar appeared to agree to accept American aid, but then said it would not accept the aid. He said it was not clear whether there had been a misunderstanding or a change of mind.

Also in Bangkok it appeared that Prime Minister Samak Sundaravej had changed his mind about visiting Myanmar to discuss the relief operation, canceling the trip because the leaders would not welcome aid workers. "After they said today they would not welcome foreign staff, there is no point of me going there," Samak said. In New York, United Nations officials all but demanded Thursday that the government open its doors. "The situation is profoundly worrying," said Holmes, the United Nations official in charge of the relief effort. "They have simply not facilitated access in the way we have a right to expect." Holmes’s predecessor in that job, Jan Egeland, said, "children are going to die from diarrhea because of this government’s inaction."

The cyclone struck a country particularly ill-equipped to deal with a public health catastrophe, said Dr. Chris Beyrer, an epidemiologist at Johns Hopkins who has worked extensively in Myanmar. Under the military government, the public health infrastructure has been crumbling for decades, he said. Malaria is already endemic, and many people with AIDS and tuberculosis are going untreated, he said. "We don’t think the blood supply is safe or adequately screened," Dr. Beyrer said, adding that people injured in the storm and in need of transfusions face the risk of infection and blood-borne diseases. In Geneva on Friday, a United Nations spokeswoman said the United Nations was putting together an urgent appeal for funding that would cover its relief efforts in Myanmar over the next six months. (The New York Times) See THIS LINK.

Physician compensation survey shows gender gap in earnings

A compensation survey was sent to thousands of physicians practicing in major medical specialties throughout the United States by Jackson & Coker is a physician-staffing firm headquartered in Alpharetta, GA. The 943 respondents serve in private practice, prominent hospitals, single- and multi-specialty groups, and with large integrated health systems. Participants answered 24 key questions related to trends in physician compensation, their satisfaction with current earnings and reimbursement levels, and other aspects of the practice of medicine that have a bearing on their financial situation.

The majority of all survey respondents were board certified (84%) and in practice ten years or longer (64%). The gender ratio of respondents: males (78%) and females (22%).The survey revealed stark differences in compensation related to medical specialty. Respondents were asked to state their current compensation. Unlike most physician compensation surveys, Jackson & Coker's 2008 Physician Compensation Survey differentiated between responses of males versus females, leading to some interesting observations.

Family Practice, which has always attracted females, showed a notable gender gap in earnings. In the lowest earnings category, most females (49%) and males (40%) indicated earning from $101,001 to $150,000. Both genders were even (23%) with regard to compensation in the $150,001 to $200,000 category. However, 6% of males (and no females) reported income at or above $300,001. OB/GYN is a medical specialty that is attracting female physicians, according to recent studies. Fifty-three percent of female physicians earn from $100,001 to $200,000. On the other end, 55% of male OB/GYN doctors earn between $150,001 and $250,000.

Dermatologists' compensation also showed a general difference. Female Dermatologists topped out at $250,000, whereas 17% of their male counterparts reported earnings in the range of $500,001 to $550,000. Female Anesthesiologists (43%) stated compensation in the $300,001 to $350,000 range, but not higher. Most male Anesthesiologists (14%) were in this earning category; yet nearly 20% indicated earnings in the $400,001 to $450,000 range. Nearly two percent of male MD's reported earnings approaching $750,000.

The surgical specialties attract more males and offer them greater compensation, by and large. A sizeable percentage of female Thoracic Surgeons reported earnings between $200,001 and $350,000. By contrast, 43% of their male counterparts reported earnings in excess of $450,000 to $1,000,000. Compensation disparity is also associated with Orthopedic Surgery. Fifty percent of female Orthopedists earn between $400,000 and $500,000. Only 15% of males fall into this category. However, almost one fourth of male Orthopedists earn between $500,000 and $1,000,000.

One of the most interesting findings concerns General Radiology. The majority of females placed themselves in the compensation range of $300,001 to $350,000. Male Radiologists' compensation ranged from almost 5% earning $150,000 or less, to an equal percentage earning over $700,000. The highest percentage of earnings for males (24%) was in the category of $350,001 to $400,000.

In addition to base compensation, many physicians receive some sort of extra financial incentives (bonus, equity participation, etc.) that increase their overall earnings. Just over 35% of males and 70% of females receive additional financial benefits of $25,000 or less. Approximately 17% of females and almost 30% of males report added income in the $25,001 to $50,000 range. Twice as many male physicians (17% to 8%) indicated additional income in the category of $50,001 to $100,000. In the $200,001 to $250,000 range, no females reported extra earnings, compared with 2% of male physicians.

Enjoying earned vacation is important to most physicians. Ten percent of both males and females are entitled to 1-2 weeks of vacation. Female doctors lead their male counterparts 25% to 16% with respect to 3 weeks of earned vacation. An equal amount (34%) reported 4 weeks. Females also take the lead (15% to 10%) regarding five weeks of vacation. Beyond that, male physicians clearly have the most vacation time. Thirteen percent of males (versus 10% of females) have six weeks. Three percent of males (versus 2%) have seven weeks of vacation. And 12% of males (versus 4%) have over eight weeks of time off.

The amount of vacation earned and taken are two different matters. Males who take one week outnumber females two to one. Females who take 2 weeks have a slight edge over males who take the same amount (19% to 17%). The largest difference concerns 3 weeks (31% of females versus 21% of males). In the four week category, females outnumber males 29% to 26%. A conclusion that can be drawn from these results is that female physicians are generally entitled to less vacation time, but they take more of the amount of vacation they have earned. One reasonable explanation is that female doctors have more household and child-rearing responsibilities that prompt them to take full advantage of their earned vacation time.

What physicians actually earn and what they perceive as adequate compensation are two different matters, according to the survey results. A key question of the survey asked: "Do you feel that when consumer healthcare insurance premiums have increased that your reimbursements have increased proportionately?" Overall, 5% of the respondents mentioned yes, whereas nearly 20 percent believed that reimbursement levels have stayed about the same. On the other hand, 76% of females and males felt that their reimbursement level has actually decreased in the recent past.

A related question: "To what extent are current earnings in line with your skills, efforts and workload?" Only 8% indicated "very well," and only 31% believed they are "fairly" compensated or reimbursed. By contrast, 60% of all participants believed that they are underpaid by a significant amount. In sum, 77% of physicians believed that their compensation / reimbursement levels are at least 30% below their expected earnings.

The survey indicated that 22% of physicians plan on seeking another position within the next six months. Thirteen percent foresee switching jobs from six months to one year. Fourteen percent expect to make a career move within a 2-4 year timeframe. Interestingly, 44% have no such plans at the present time.

The entire survey results are available in the Jackson & Coker Industry Report at THIS LINK.

Study in 7,000 men and women ties obesity, inflammatory proteins to heart failure risk

Heart specialists at Johns Hopkins and elsewhere report what is believed to be the first wide-scale evidence linking severe overweight to prolonged inflammation of heart tissue and the subsequent damage leading to failure of the body’s blood-pumping organ. The latest findings from the Multiethnic Study of Atherosclerosis (MESA), published in the May 6 issue of the Journal of the American College of Cardiology, appear to nail down yet one more reason for the estimated 72 million obese American adults to be concerned about their health, say scientists who conducted the research.

“The biological effects of obesity on the heart are quite profound,” says senior study investigator João Lima, M.D. “Even if obese people feel otherwise healthy, there are measurable and early chemical signs of damage to their heart, beyond the well-known implications for diabetes and high blood pressure.” He adds that there is “now even more reason for them to lose weight, increase their physical activity and improve their eating habits.”

In the latest study, researchers conducted tests and tracked the development of heart failure in an ethnically diverse group of nearly 7,000 men and women, age 45 to 84, who were enrolled in the MESA study, starting in 2000. Of the 79 who have developed congestive heart failure so far, 35 (44 percent) were physically obese, having a body mass index, or BMI, of 30 or greater. And on average, obese participants were found to have higher blood levels of interleukin 6, C-reactive protein and fibrinogen, key immune system proteins involved in inflammation, than non-obese adults. A near doubling of average interleukin 6 levels alone accounted for an 84 percent greater risk of developing heart failure in the study population.

The researchers from five universities across the United States also found alarming links between inflammation and the dangerous mix of heart disease risk factors known as the metabolic syndrome. Its combined risk factors for heart disease and diabetes, high blood pressure, elevated blood glucose levels, excess abdominal fat and abnormal cholesterol levels, and particularly obesity, double a person’s chances of developing heart failure. “More practically, physicians need to monitor their obese patients for early signs of inflammation in the heart and to use this information in determining how aggressively to treat the condition,” says Lima, a professor of medicine and radiology at the Johns Hopkins University School of Medicine and its Heart Institute.

All MESA study participants, who will be followed through to 2012, had no pre-existing symptoms of heart disease. Upon enrollment, they all underwent a physical exam, including weight and body measurements, blood analysis and an MRI scan to assess heart function. “Our results showed that when the effects of other known disease risk factors - including race, age, sex, diabetes, high blood pressure, smoking, family history and blood cholesterol levels - were statistically removed from the analysis, inflammatory chemicals in the blood of obese participants stood out as key predictors of who got heart failure,” says Lima.

C-reactive protein levels are widely known to rise dramatically and speed up the early stages of inflammation when cells swell up with fluid, leading to widespread arterial damage. One-fifth higher than average blood levels of fibrinogen, best known for its role in blood clotting but also a major player in muscle scarring, bumped up the risk of heart failure by 37 percent. When the inflammatory protein levels were included in the scientists’ statistical analysis, the heightened risk from obesity disappeared.

“What this tells us is that both obesity and the inflammatory markers are closely tied to each other and to heart failure,” says lead researcher Hossein Bahrami, M.D., M.P.H. Bahrami says study results also point to inflammation as a possible catalyst in metabolic syndrome. Increased blood levels of albuminuria, a chemical more known for its association with impaired kidney function and metabolic syndrome boosted risk of a progressively weakening heart nearly tenfold among MESA participants. Bahrami, a senior cardiology research fellow at Hopkins, said “the basic evidence is building the case that inflammation may be the chemical route by which obesity targets the heart, and that inflammation may play an important role in the increased risk of heart failure in obese people, especially those with the metabolic syndrome.” He notes that previous studies, also done at Hopkins, have shown that even moderate exercise to lose abdominal fat dramatically offsets the harmful effects of metabolic syndrome on heart function.

Bahrami said the team’s next steps are to determine how, over a longer timeframe, heart function changes with levels of inflammatory markers, and to see if alterations to the immune system proteins halts or speeds up disease. For additional information, go to: http://www.hopkinsheart.org/ or http://content.onlinejacc.org/

Research predicts hospital stays and measures effects of patient education among diabetics

MedImpact unveiled a model that predicts the probability of inpatient hospital utilization among Medicaid recipients who suffer from diabetes. Modeling results showed that improving compliance with medications that control diabetes, along with encouraging the use of statins, may be associated with a reduction in inpatient hospitalizations. In a separate but related study, MedImpact demonstrated that education-based interventions are effective in promoting the continued use of statin therapy among diabetics.

Both studies were part of a collection of poster presentations at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 13^th Annual International Conference held in Toronto, Canada this week. The event drew more than 1,600 researchers and other representatives from the health care community. ISPOR is a vital organization that supports those who study health care economics and the effects of health care interventions on patient well-being.

“Research that can help identify specific predictors of undesirable outcomes, such as future hospitalizations, is very important,” said Dr. Louis Brunetti, senior vice president and chief medical officer for MedImpact. “When the health care community has a greater understanding of the factors that contribute to adverse events, we can work together to identify and implement strategies that successfully address them.”

In the first MedImpact study presented at ISPOR, “Predictive Modeling for Medicaid Diabetes Patients,” MedImpact researchers demonstrated that diabetics who do not take insulin or other oral medications as prescribed by their physician are up to 57 percent more likely to be hospitalized. Similarly, diabetics who do not use a statin to help control cardiovascular complications that are often associated with diabetes are 72 percent more likely to require hospitalization. Previous inpatient history was also found to be a significant predictor.

In the second study, “The Effectiveness of a Patient and Physician Educational Program in Initiating Statin Therapy among Diabetics,” MedImpact found that letter-based educational programs directed to physicians and patients are effective in promoting the use of statin therapy among diabetics. In this study, researchers from MedImpact demonstrated that among diabetics who were not taking a statin, as many as 22 percent added a statin to their drug regimen after the first phase of the intervention.

“These two studies really go hand-in-hand and demonstrate our commitment and direct application to leverage MedImpact research,” said Dr. Brunetti. “Our first study showed us where we needed to focus our attention to reduce the likelihood of inpatient hospitalizations among diabetics. Our second study validated the effectiveness of an educational program we designed and implemented to address the factors that contribute the need for those hospitalizations. Our solution was successful, easy and inexpensive. These are just a few examples of how MedImpact clinical research and clinical programs ultimately help our clients achieve lower net cost, higher quality of care, and increased customer satisfaction.”

C. difficile exacts heavy toll at Ontario hospital

TORONTO — A deadly outbreak of a highly contagious superbug at an Ontario hospital claimed the lives of one-third of the patients afflicted with the disease, a far greater toll than previously believed. Joseph Brant Memorial Hospital in Burlington announced yesterday that 91 of the 177 patients diagnosed with Clostridium difficile, commonly known as C. difficile, over a 20-month period ending last December died in the institution. It blamed the disease for 62 of the deaths.

Joseph Brant is among a handful of hospitals in Ontario that have been hit with a severe outbreak of the so-called Quebec strain of C. difficile, a particularly virulent form that caused 2,000 deaths in that province. But in Ontario, the scope of the problem is not known, because hospitals are not required to release statistics on hospital-acquired infections to the public.

Only a small number of the province's 154 hospitals, including Joseph Brant, voluntarily release such statistics. As a result, the public is in the dark about the extent of the problem even though Ontario is believed to have the highest rates of the superbug in Canada, said Michael Gardam, director of infection prevention and control for the University Health Network, who performed the mortality study on patients at Joseph Brant. He said the disease tends to afflict the elderly but also often goes undetected because it is easily misdiagnosed.

The results of the study were sobering for everyone involved. It found that the outbreak of C. difficile began in May of 2006 - nine months earlier than hospital officials initially thought. The number of fatalities was also much higher than a previous estimate of 15 deaths and well above the rate experienced at other hospitals that have "come clean" in fighting the disease, Dr. Gardam said.

Ontario Health Minister George Smitherman described the number of deaths as "very, very startling." He vowed yesterday that the province will make public reporting of such infections mandatory by the end of the year. "We have an obligation for transparency and to apprise people of information that's important to them, to know what risks are out there," Smitherman told reporters. (The Globe and Mail) See THIS LINK.

Group urges F.D.A. to take Ortho-Evra contraceptive off market

A consumer advocacy group petitioned the government Thursday to pull the birth control patch off the market, calling it far riskier than the pill. Warnings about the Ortho-Evra weekly patch have escalated since a 2005 investigation by The Associated Press found that patch users had higher rates of life-threatening blood clots than did women who took birth control pills.

Blood clots are a rare side effect for estrogen-related products. Some studies of the risk suggest that patch users have twice the risk of clots in the legs and lungs as do women who swallow the pill because patients absorb up to 60 percent more estrogen with the patch. The Food and Drug Administration updated the patch’s label in 2005, 2006 and earlier this year with clot warnings.

Demand has dropped, to 2.7 million prescriptions filled in 2007 from the 9.9 million filled in 2004, Dr. Wolfe wrote. But he argued that the patch offered no better contraception in return for the extra risk. And he said lawsuits by women who claim they were harmed by the patch had unearthed two previously unpublished studies from Johnson & Johnson researchers who found higher estrogen exposure from the patch even before it won federal approval in 2001.

A spokeswoman for the patch’s maker, Ortho Women’s Health & Urology, a Johnson & Johnson company, said, “Ortho-Evra is a safe and effective hormonal birth control option when used according to its labeling.” (The Associated Press)

See THIS LINK.

Hard sell to Medicare insurance buyers would get softer under new rules

The Bush administration proposed on Thursday to crack down on the aggressive marketing of private Medicare insurance plans by outlawing unsolicited visits and telephone calls to beneficiaries, regulating commissions paid to sales agents and increasing the fines that could be imposed on insurers. Medicare “should not be undermined by the actions of a limited number of unscrupulous sales agents,” said Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services.

In the last two years, Medicare beneficiaries and state officials have often complained that high-pressure sales tactics led some people to sign up for unsuitable policies. After reviewing comments from the public, federal officials intend to issue final rules before the marketing of plans for 2009 begins this October. The proposed rules respond to pleas by consumers, Congress and state officials, but do not go as far as they wanted. In particular, the proposal affirms the Bush administration’s view that “states do not have the authority to regulate the marketing” of private Medicare plans.

The Bush proposal would prohibit door-to-door marketing of private Medicare plans. Agents could not accost beneficiaries in the parking lot of a center for the elderly, a clinic or an apartment building. Agents could respond to telephone inquiries, but they could not make “cold calls” to beneficiaries. The rules would set a $15 limit on the value of gifts and promotional items offered to potential customers. Insurance companies could offer coffee, soft drinks, snacks, pill dispensers and water bottles worth less than $15. But insurers could not offer free meals, whatever their value. This proposal would end a common practice. Insurers like Humana have signed up many beneficiaries at family restaurants where the companies provide sales presentations and meals.

The proposed rules would also prohibit agents from offering annuities, life insurance and other “non-health care related products” while selling private Medicare plans. Under current rules, the government can impose a civil fine up to $25,000 for each serious violation. The proposed rule would allow larger fines, up to $25,000 for each beneficiary who was “directly adversely affected.”

The Bush administration also wants to regulate sales commissions, to discourage agents from switching people inappropriately from one Medicare plan to another. Under the proposal, the commission paid for the initial sale and first year of coverage could not exceed the commission paid for renewal of coverage in a subsequent year. Many carriers now pay higher commissions in the first year. Some pay only for the first year, with no commission in later years. This creates a “financial incentive for agents to encourage beneficiaries to change plans each year,” the administration said.

Of the 44 million Medicare beneficiaries, at least 25 million are in some type of private plan, either a Medicare Advantage plan, which provides a wide range of health services, or a free-standing prescription drug plan, which covers just medicines. Under the proposal, an insurer would have to pay the same commission for all its Medicare Advantage plans and a uniform amount for all its drug plans. An insurer could still encourage sales of the more profitable products by paying higher commissions, $200 a year for sale of a Medicare Advantage plan and $50 a year for a drug plan, for example. (The New York Times) See THIS LINK.

New CDC study finds arthritis can be a barrier for adults seeking to manage diabetes

More than half of adults with diagnosed diabetes also have arthritis, a painful condition that can be a barrier to physical activity, an important health strategy for managing diabetes, according to a study released by the Centers for Disease Control and Prevention in today′s Morbidity and Mortality Weekly Report.

Nationwide, 46.4 million adults have arthritis and 20.6 million adults have diabetes, with nearly 7 in 10 having had diabetes diagnosed by a health professional. Research shows that engaging in joint-friendly activities such as walking, swimming, biking can help manage both conditions.

The study, “Arthritis as a Potential Barrier to Physical Activity among Adults with Diabetes: United States, 2005 and 2007,” analyzed data on the prevalence of physical inactivity among adults with arthritis and diabetes in all 50 states, the District of Columbia, and U.S. territories.

The study suggests that the presence of arthritis acts as an additional barrier to physical activity among those with diabetes. The study found that 29.8 percent of adults with arthritis and diabetes were inactive, compared with 21.0 percent of people with diabetes alone, 17.3 percent of those with arthritis alone, and 10.9 percent of adults with neither condition.

The study also found that the percentage of adults with diabetes and arthritis who are physically inactive varied among states, ranging from 20.2 percent in California to 46.4 percent in Tennessee.

Adults with arthritis and diabetes have unique barriers to being physically active such as concerns about pain, aggravating or worsening joint damage, and not knowing how much or what types of physical activity are safe for them. These concerns must be addressed for adults with both conditions to become more physically active.

Disease self-management classes, including exercise programs that address arthritis-specific barriers, may help adults with arthritis and diabetes better manage their disease. Programs proven to be effective in managing arthritis, such as the Chronic Disease Self-Management Program, the Arthritis Foundation′s Exercise Program, and Enhance Fitness, are available in many local communities nationwide. For more information, visit CDC′s Arthritis Web site at http://www.cdc.gov/arthritis/intervention.