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News From The Annals Of Family Medicine: July/August 2009
The Primary Care Paradox and the Need to Integrate Primary and Specialty Care to Improve the Quality of Healthcare
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Vermont Legislature Passes Law Regulating All Drug/Device Company Marketing, Requiring Disclosure Of Gifts To Doctors
The Vermont Legislature has passed legislation (S 48) that bans nearly all gifts from pharmaceutical and medical device companies to health care providers, administrators and facilities in the state, the New York Times reports. The legislation specifically would prohibit drug and device makers from giving providers no-cost meals. Vermont"s legislation would go further than similar laws in other states like Massachusetts and Minnesota by requiring drug and medical device manufacturers who give gifts to health providers to publicly disclose recipients" names and dollar amounts of payments and gifts. The measure would not require manufacturers to disclose payments for clinical research of products undergoing FDA review, the Times reports. The legislation also would eliminate a loophole that allows manufacturers to conceal certain expenses by claiming them as trade secrets. In a recent report, the Vermont Office of the Attorney General said that medical product makers spent about $2.9 million on promotional efforts to the state"s health care providers in fiscal year 2008 and that nearly half of the state"s 4,573 licensed providers had received some type of incentive from drugmakers in the same year. The report, which was developed prior to passage of the new legislation, offers only aggregate data, as 83% of the manufacturer-declared payments were deemed to be trade secrets, the Times reports.Gov. Jim Douglas (R) is expected to sign the law, which would take effect July 1. Several state medical groups -- including the Vermont Association for Mental Health and the Vermont Medical Society -- have indicated support for the legislation.Marjorie Powell, a senior lawyer for the Pharmaceutical Research and Manufacturers of America, said the requirements under the new law appear redundant with new voluntary guidelines the group has issued on physician gifting practices. She said, "We think this is unnecessary, and it is not going to improve patient care," adding, "It makes it onerous not only for the company but also for the physician in Vermont, because this is going to be on a Web site" (Singer, New York Times, 5/20).
News of the day
The Future Of Schizophrenia
22nd Congress of the European College of Neuropsychopharmacology (ECNP), 12 - 16 September 2009, Istanbul, Turkey
Oncology

Early Detection Of Osteoarthritis In Dogs Could Open Doors For A Cure

Osteoarthritis is commonly diagnosed in the late and irreversible stages, when treatment can only be expected to decrease pain and slow progression of disease. Because osteoarthritis is a widespread problem in dogs, horses and humans, doctors and veterinarians need a precise way to diagnose the disease early and accurately. Now, University of Missouri researchers are investigating potential biomarkers in dogs for early diagnosis of osteoarthritis, which could help identify patients at increased risk of developing osteoarthritis. "By developing methods for earlier diagnosis of osteoarthritis, prevention or even curative treatment strategies to manage the disease become more realistic," said James Cook, professor of veterinary medicine and surgery, and the William & Kathryn Allen Distinguished Professor in Orthopedic Surgery. "Biomarkers could detect the disease before pain and swelling occurs, and owners could take preventative measures, such as modifying activities or diet, helping their pets lose weight and strengthen their joints, to reduce the likelihood of their dogs developing osteoarthritis." In the study, researchers examined potential biomarkers in synovial fluid. Synovial fluid, which is fluid that lubricates the joints, is known to have sensitive and rapid responses to joint injury. Taking samples from dogs, researchers found that synovial fluid quantity and quality were altered in injured stifle joints (the joint in the hind limbs of dogs that is the equivalent joint to the human knee). "At the MU Comparative Orthopaedic Laboratory, we are particularly interested in identification and validation of biomarkers that can detect early stages of osteoarthritis to provide accurate diagnostic and prognostic information prior to the onset of clinical disease for people and for pets," Cook said. "Our team, led by Drs. Kuroki, Stoker and Garner, is making tremendous progress in developing simple tests on blood, urine and synovial fluid that show great promise for helping us diagnose impending osteoarthritis before it is too late to help the patient in the most effective manner." Osteoarthritis causes degradation of articular cartilage, leading to pain, inflammation and loss of motion in the joint. Veterinarians predict that 20 percent of middle-aged dogs and 90 percent of older dogs have osteoarthritis in one or more joints and the percentages are even higher for the human population. The study, "Examination of Synovial Fluid Hyaluronan Quantity and Quality in Stifle Joints of Dogs with Osteoarthritis," was published in the American Journal of Veterinary Research. It was coauthored by Cook; Rachel Venable, doctoral student; Aaron Stoker, research assistant professor; Cristi Cook, clinical assistant professor; and Mary Cockrell, research specialist. Kelsey Jackson University of Missouri-Columbia


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