Diagnostic Errors—The Next Frontier for Patient Safety

Diagnostic Errors—The Next Frontier for Patient Safety: An estimated 40 000 to 80 000 US hospital deaths result
from misdiagnosis annually.4 -JAMA. 2009;301(10):1060-1062.

Harvard Medical School Ethics

Should you be concerned about how the next generation of medical doctors are taught?


Harvard Medical School students like Kirsten Austad, left; Lekshmi Santhosh, Kim Sue and David Tian, members of the American Medical Student Association, object to the influence of drug companies in the school’s educational curriculum.



http://www.nytimes.com/2009/03/03/business/03medschool.html

Harvard Medical School in Ethics Quandary

Jodi Hilton for The New York Times

Harvard Medical School students like Kirsten Austad, left; Lekshmi Santhosh, Kim Sue and David Tian, members of the American Medical Student Association, object to the influence of drug companies in the school’s educational curriculum.

By DUFF WILSON

Published: March 2, 2009

BOSTON — In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

“I felt really violated,” Mr. Zerden, now a fourth-year student, recently recalled. “Here we have 160 open minds trying to learn the basics in a protected space, and the information he was giving wasn’t as pure as I think it should be.”

Mr. Zerden’s minor stir four years ago has lately grown into a full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty, intent on exposing and curtailing the industry influence in their classrooms and laboratories, as well as in Harvard’s 17 affiliated teaching hospitals and institutes.

They say they are concerned that the same money that helped build the school’s world-class status may in fact be hurting its reputation and affecting its teaching.

The students argue, for example, that Harvard should be embarrassed by the F grade it recently received from the American Medical Student Association, a national group that rates how well medical schools monitor and control drug industry money.

Harvard Medical School’s peers received much higher grades, ranging from the A for the University of Pennsylvania, to B’s received by Stanford, Columbia and New York University, to the C for Yale.

Harvard has fallen behind, some faculty and administrators say, because its teaching hospitals are not owned by the university, complicating reform; because the dean is fairly new and his predecessor was such an industry booster that he served on a pharmaceutical company board; and because a crackdown, simply put, could cost it money or faculty.

Further, the potential embarrassments — a Senate investigation of several medical professors, the F grade, a new state law effective July 1 requiring Massachusetts doctors to disclose corporate gifts over $50 — are only now adding to pressure for change.

The dean, Dr. Jeffrey S. Flier, who says he wants Harvard to catch up with the best practices at other leading medical schools, recently announced a 19-member committee to re-examine his school’s conflict-of-interest policies. The group, which includes three students, is to meet in private on Thursday.

Advising the group will be Dr. David Korn, a former dean of the Stanford Medical School who started work at Harvard about four months ago as vice provost for research. Last year he helped the Association of American Medical Colleges draft a model conflict-of-interest policy for medical schools.

The Harvard students have already secured a requirement that all professors and lecturers disclose their industry ties in class — a blanket policy that has been adopted by no other leading medical school. (One Harvard professor’s disclosure in class listed 47 company affiliations.)

“Harvard needs to live up to its name,” said Kirsten Austad, 24, a first-year Harvard Medical student who is one of the movement’s leaders. “We are really being indoctrinated into a field of medicine that is becoming more and more commercialized.”

David Tian, 24, a first-year Harvard Medical student, said: “Before coming here, I had no idea how much influence companies had on medical education. And it’s something that’s purposely meant to be under the table, providing information under the guise of education when that information is also presented for marketing purposes.”

The students say they worry that pharmaceutical industry scandals in recent years — including some criminal convictions, billions of dollars in fines, proof of bias in research and publishing and false marketing claims — have cast a bad light on the medical profession. And they criticize Harvard as being less vigilant than other leading medical schools in monitoring potential financial conflicts by faculty members.

Dr. Flier says that the Harvard Medical faculty may lead the nation in receiving money from industry, as well as government and charities, and he does not want to tighten the spigot. “One entirely appropriate source, if done properly, is industrial funds,” Dr. Flier said in an interview.

And school officials see corporate support for their faculty as all the more crucial, as the university endowment has lost 22 percent of its value since last July and the recession has caused philanthropic contributors to retrench. The school said it was unable to provide annual measures of the money flow to its faculty, beyond the $8.6 million that pharmaceutical companies contributed last year for basic science research and the $3 million for continuing education classes on campus. Most of the money goes to professors at the Harvard-affiliated teaching hospitals, and the dean’s office does not keep track of the total.

But no one disputes that many individual Harvard Medical faculty members receive tens or even hundreds of thousands of dollars a year through industry consulting and speaking fees. Under the school’s disclosure rules, about 1,600 of 8,900 professors and lecturers have reported to the dean that they or a family member had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizer and 130 with Merck.

The rules, though, do not require them to report specific amounts received for speaking or consulting, other than broad indications like “more than $30,000.” Some faculty who conduct research have limits of $30,000 in stock and $20,000 a year in fees. But there are no limits on companies’ making outright gifts to faculty — free meals, tickets, trips or the like.

Other blandishments include industry-endowed chairs like the three Harvard created with $8 million from sleep research companies; faculty prizes like the $50,000 award named after Bristol-Myers Squibb, and sponsorships like Pfizer’s $1 million annual subsidy for 20 new M.D.’s in a two-year program to learn clinical investigation and pursue Harvard Master of Medical Science degrees, including classes taught by Pfizer scientists.

Dr. Flier, who became dean 17 months ago, previously received a $500,000 research grant from Bristol-Myers Squibb. He also consulted for three Cambridge biotechnology companies, but says that those relationships have ended and that he has accepted no new industry affiliations.

That is in contrast to his predecessor as dean, Dr. Joseph B. Martin. Harvard’s rules allowed Dr. Martin to sit on the board of the medical products company Baxter International for 5 of the 10 years he led the medical school, supplementing his university salary with up to $197,000 a year from Baxter, according to company filings.

Dr. Martin is still on the medical faculty and is founder and co-chairman of the Harvard NeuroDiscovery Center, which researches degenerative diseases, and actively solicits industry money to do so. Dr. Martin declined any comment.

A smaller rival faction among Harvard’s 750 medical students has circulated a petition signed by about 100 people that calls for “continued interaction between medicine and industry at Harvard Medical School.”

A leader of the group, Vijay Yanamadala, 22, said, “To say that because these industry sources are inherently biased, physicians should never listen to them, is wrong.”

Encouraging them is Dr. Thomas P. Stossel, a Harvard Medical professor who has served on advisory boards for Merck, Biogen Idec and Dyax, and has written widely on academic-industry ties. “I think if you look at it with intellectual honesty, you see industry interaction has produced far more good than harm,” Dr. Stossel said. “Harvard absolutely could get more from industry but I think they’re very skittish. There’s a huge opportunity we ought to mine.”

Brian Fuchs, 26, a second-year student from Queens, credited drug companies with great medical discoveries. “It’s not a problem,” he said, pointing out a classroom window to a 12-story building nearby. “In fact, Merck is right there.”

Merck built a corporate research center in 2004 across the street from Harvard’s own big new medical research and class building. And Merck underwrites plenty of work on the Harvard campus, including the immunology lab run by Dr. Laurie H. Glimcher — a professor who also sits on the board of the drug maker Bristol-Myers Squibb, which paid her nearly $270,000 in 2007.

Dr. Glimcher says industry money is not only appropriate but necessary. “Without the support of the private sector, we would not have been able to develop what I call our ‘bone team’ in our lab,” she said at a recent student and faculty forum to discuss industry relationships. Merck is counting on her team to help come up with a successor to Fosamax, the formerly $3 billion-a-year bone drug that went generic last year. But Dr. Marcia Angell, a faculty member and former editor in chief of The New England Journal of Medicine, is among the professors who argue that industry profit motives do not correspond to the scientific aims of academic medicine and that much of the financing needs to be not only disclosed, but banned. Too many medical schools, she says, have struck a “Faustian bargain” with pharmaceutical companies.

“If a school like Harvard can’t behave itself,” Dr. Angell said, “who can?”

"Save Some Good People from Bankruptcy..."

One thing that really irks me are those guys that wear black socks and Bermuda shorts on the beach. But, that’s not really important.

What is important are the billions of dollars wasted every year for expensive medical care that doesn’t work. What bugs me even more is that the medics know (or should know) that the right choice for many patients is chiropractic. They are often bound, however, by the secret rules of the medical cartels in every town.

More people go through bankruptcy because of medical bills than any other reason. So, shouldn’t we be spreading the word about how to save money with chiropractic?

Yes, we should.

Within the realm of conditions we usually see people for, medical care is almost always more expensive, and often ineffective. People are often put through the medical mill, being referred from one doctor to another, leading to the specialist that says, “there’s nothing wrong with you”.

Consumers and insurance companies pay millions every day for expensive medical diagnostic testing designed to figure out what the hell is wrong with a patient with typical musculoskeletal complains. Usually, they come up empty, when a good chiropractor could easily figure it out (with his bare hands) that the patient has a vertebral subluxation.

How many people wind up in the ER every day for just migraines headaches? How much do consumers and government entitlement programs pay daily for the MRI and CAT scans just for migraines?

There are tons of studies showing the cost effectiveness of chiropractic care. One study tells us that ”a new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 83% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic non-surgical non-pharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.”

Shocking Statistics About Our Food Supply

Want to hear something that's intense? I have
some statistics that will amaze you. What if I
show you serious numbers, and I'm talking serious,
that prove today's fruits, vegetables, grains,
eggs, even the milk and meats we eat are not
even close to what they were a few generations
ago?
What if I were to say that “no man of today can
eat enough fruits and vegetables to supply his
system with the mineral salts he requires for
perfect health”? Big deal you say. I’ve heard
that statement more than once. What if I were to
tell you that this statement was made at the 74th
Congress of the United States way back in 1936
and that this is an excerpt of a testimony pertaining
to the problem of “soil mineral depletion”?
You see, back in
1936 some astute
scientists were
blowing the
whistle that commercial
fertilizers
were not adding back into the soil the nutrients
and trace minerals necessary for healthy plants.
Fast forward to the 21st century and most industrial
farmers have still not learned this lesson.
So, year after year soil minerals are depleted.
For example, in 1914 an apple contained almost
half the minimum daily requirement of iron, but
today you would have to eat 26 apples to get the
same amount. Iron is not the only nutrient depleted.
In 80 years apples have declined in the
following minerals: the amount of calcium in
apples has dropped 48%; phosphorous 84%; iron
96%; and magnesium, the famous heart nutrient,
has dropped 82%.
Paul Bergner in his book “The Healing Power of
Minerals, Special Nutrients and Trace Elements”
quotes US Government statistics as he drives
home the point that we cannot live healthy lives
on the food of today. Before I go further I want
to make sure you understand we are talking
about RAW food here. We all know that
cooking and processing further depletes the minerals.
Paul Stitt, author and whole food activist, says
we lose 90% of the mineral content of our food
from garden to
gullet. So, we start
with depleted nutrients
in our food.
Then we process
them to remove the
enzymes to make sure they stay on the shelf
longer. Then we cook or microwave them which
further inactivate many of the nutrients and food
factors. One of the things that make food taste
good is the minerals in the soil. It’s not just a
HCL or zinc deficiency when food loses its
flavor.
Today’s plants are not as healthy and don’t have
that vibrancy that well mineralized plants do.
One of the tastes many of us are familiar with is
the first bite of a vine ripened tomato grown in
one’s own garden. I'm not just trying to
impress you with statistics, but unless you are
convinced that food doesn’t contain the nutrients
we need, you won’t be confident in directing
your patients to get the high quality
supplements they need to achieve the level of
wellness that they desire.
The Journal of the American Medical Association
in 2002 volume states “Most people do not
consume an optimal amount of all vitamins or
minerals by diet alone. Pending evidence of
effectiveness from randomized trials, it appears
prudent for all adults to take vitamin supplements”.
For the Journal of the American
Medical Association to say “it appears prudent
for all adults to take vitamin supplements” after
years of prejudice against the supplement industry
is a landmark statement.
Look at these statistics focusing on the mineral
calcium in a few common foods. In the last 80
years the amount of calcium has declined
81% in cabbage, 92% in lettuce, 56% in
spinach, and 48% in apples. These are absolutely
massive drops in the mineral levels in
our foods.
During the same time period magnesium levels
have dropped by 77% in cabbage, 91% in lettuce,
35% in spinach, and as I said earlier, 82%
in apples. Iron levels dropped from 60% to
99% in the same vegetables.
These huge drops in mineral levels are occurring
in all our fresh foods. It’s not just fruits
and vegetables; the same types of things are
happening with chicken, beef, rice etc. We see
not only mineral depletions but vitamin reductions
as well.
Everyone wants to feel healthy, but how can
we feel good when we’re not getting the
basic nutrients our bodies need? The point is
that we are eating nutrient depleted foods in
the most stressful time in human history.
One researcher quoted our stress levels as
100 times greater than our grandparents. As
you know stress depletes nutrient levels
faster than those who are not under pressure
or stress.

Remember the double blind 7 study with
10,000 participants in France. The National
Institute of Health in Paris funded the
SUVIMAX study which found a 37% reduction
in heart disease and death in men 45-60
and a 33% reduction in cancer from taking a
low dose antioxidant with just beta carotene,
zinc, selenium, Vitamin E, and Vitamin C.
Think of the reductions if the formula would
have been a full spectrum product.
This subject needs to be foundational in your
approach to nutrition for one great reason,
because foundational multivitamin/mineral
products not only save lives but improve
your quality of life. The science is
solid. Check it out.