Preventing breast cancer

We suspected this, but confirmation is great. Drug cuts breast cancer risk

Scientists say they now have conclusive proof that tamoxifen can prevent breast cancer in healthy high-risk women. An international team led by Professor Jack Cuzick, of the charity Cancer Research UK, conducted an extensive review of the drug’s track record in prevention trials.

The findings show the drug reduced the incidence of breast cancer by 38% in healthy women with a high chance of developing the disease.
Researchers say the next challenge is to minimise the side-effects of tamoxifen so that it can fulfil its potential as a frontline preventative drug.

Professor Cuzick said: “In our analysis we combined all the available evidence from studies using tamoxifen for breast cancer prevention collectively involving over 40,000 women – and it is clear to us now that the drug can reduce the chance of high-risk women developing the disease.”

Washington Post on concierge medicine

Retainer medicine continues to grow. Doctors on Call — for a Hefty Retainer

In a few weeks, more than 4,800 people who have been patients of two Bethesda physicians will have to find new doctors — all because they aren’t willing to pay an annual membership fee of $1,500 to continue seeing their internists.

The membership program, described as a way to promote wellness and preventive care, has been adopted by 19 doctors nationwide who have retooled their practices to cater to a select group of patients willing to pay the retainer. In addition to the annual fee, the doctors will collect all the usual fees from patients’ health insurance plans.

The roster of doctors signing up with the Florida-based MDVIP program includes a Fairfax County physician and two in Severna Park.

The smaller patient load gives doctors time to see patients on short notice and allows them to pledge round-the-clock telephone availability. Michael A. Hattwick, 61, of Fairfax, who switched his practice in October, said that instead of seeing 24 patients on a busy day, he sees 10 or 11.

This new brand of “concierge care” has intrigued patients including Alvin J. Brooks of Potomac and Martin Fine of Bethesda. They intend to pay and stay with the Bethesda physicians, Alan R. Sheff, 49, and his partner, Lee R. Pennington, 51.
But it has provoked criticism in Congress and warnings that more doctoring does not equal better health care. “This just gives the rich the illusion of comfort and good care,” said Meri Kolbrener, a physician who treats low-income patients at a District clinic. “Not only do you not necessarily get better outcomes, you can, in fact, get worse outcomes.”

Others worry that if MDVIP gets large enough, shifting patients will only increase the stresses on their new caregivers’ offices.

We continue to have a vigorous debate on this issue. Detractors worry about equality of care. Supporters have a very different opinion.

Sheff said he knew it was time for a change when his patients starting asking him if he was feeling all right. Seeing a crush of 24 patients a day in the office, navigating health plan bureaucracies, watching insurers cut his fees — the toll on him was obvious, he said.

Sheff and Pennington signed up with the MDVIP program, they said, because they want more time to ponder their patients’ health problems, and the annual fee includes an annual physical exam and personalized wellness planning.

Those who have signed up with MDVIP include Hattwick and two doctors in Severna Park who joined in December, Marsha Y. Blakeslee, 39, and Maryrose F. Eichelberger, 42. There are eight member physicians in Florida, two each in New York and Massachusetts, and one each in New Jersey and California, company officials say.

Of why he changed, Sheff said, “It wasn’t one episode — it was a thousand cuts.” He said: “It was being here late into the evening, struggling to return phone calls, apologizing daily about non-timely test results, apologizing to my family for not being around. Patients were asking me if I was okay, because I looked tired. This was not healthy for me, my practice or my patients.”
So next month, Sheff and Pennington will begin providing care to a smaller group of patients — up to 1,200 who are willing to pay.

Like the average primary care physician nationwide, Sheff and Pennington each had about 3,000 patients. Soon each will limit his practice to 600. A physician with a full MDVIP enrollment would collect $600,000 a year and send $300,000 to MDVIP for its continuing oversight.

“If this does as well as we hope it will, then Lee and I will be able to earn a more comfortable living with less stress and strain to our personal lives than before,” Sheff said. “It will not make either one of us rich.”

But it will benefit their (the physicians’) health! I believe that we should not reject this concept quickly. Rather we need to see this as an expression of ongoing physician dissatisfaction.

Public guidelines for managed care

Large H.M.O. to Make Treatment Guidelines Public. This is a very important advance in managed care.

Kaiser Permanente, the nation’s largest nonprofit health maintenance organization, said yesterday that it would publish on its Web site the guidelines developed and used by Kaiser’s doctors for treatment of hundreds of diseases, “from asthma to visual impairment.” Kaiser also agreed to share with the public information about the way it pays doctors, including financial incentives.

The new guidelines, which are being published as part of a settlement of two lawsuits brought by consumer groups over patient care, are not compulsory, according to people familiar with them, so doctors will still be free to deviate from them without penalty. But Kaiser patients ? and the public ? will now have access to information they can use to assess the treatment they receive and discuss it with their doctors. Patients will have to look up the information themselves on Kaiser’s Web site.

Consumer advocates said the moves by Kaiser would push other managed care companies and medical groups to make similar disclosures regarding both treatments and doctors’ compensation.

The actions by Kaiser are the latest example of efforts to help consumers have more informed discussions with their doctors. Health policy experts say the disclosures may also help narrow the gaps in the treatments offered for identical diseases by doctors and health plans across the country.

“This sets a new standard for the competition and the doctors,” said Dr. John Wennberg, a health policy scholar who has studied disparities in care and is an advocate for medical practices with clear evidence of effectiveness. “Patients seeking information on the standards of care will have a new place to go. They could use it in negotiating with their own physician.”

This represents an advance, a very important advance. Hopefully, such disclosures will improve the doctor patient relationship, and make physicians more comfortable in discussing these issues.

Medscape discovers blogs

Medical blogs are starting to hit the big time. Medscape Enters the Blogosphere and Medscape.