Joyce Frieden

CRYSTAL CITY, VA. — The shortage of primary care physicians schooled in caring for elderly patients will continue to worsen, according to an analysis of federal physician data.

“Our nation is facing a growing shortage of physicians for the care of adults,” Dr. Jack Colwill said at the 2008 Physician Workforce Research Conference. “We potentially will have limited ability to provide the sort of comprehensive and coordinated care we're talking about for the growing aging population.”

In a recent study, Dr. Colwill, professor emeritus of family and community medicine at the University of Missouri-Columbia, and colleagues looked at data from the 2003–2005 National Ambulatory Medical Care Survey to project what physician workloads might be in the future. The researchers predicted that by 2025 there will be a 29% increase in demand for physician visits by adults, fueled in part by the aging of the population (Health Aff. [Millwood] 2008;27:w232-41 [Epub doi: 10.1377/hlthaff.27.3.w232]).

“There have been dramatic changes in internal medicine, with [a more than] one-third drop in the numbers entering general internal medicine from the peak in 1998,” Dr. Colwill said at the conference, which was jointly sponsored by the Association of American Medical Colleges and Harvard Medical School.

If this trend continues, by 2025 there will be an increase in generalists in adult care of 11% compared with 2005 levels, trying to respond to that 29% increase in workload, he continued. “That doesn't adjust for the fact that physician supply is getting older, and that the percentage of women [physicians] is going from 33% of physicians to 49%,” he said; women physicians may work fewer hours to accommodate lifestyle considerations. “With those adjustments, the increase is up only 7% from 2005. If you assume the continuing decline in generalists goes through 2008, then the increase in 2025 is only 2% above 2005 levels.”

“That's roughly 35,000–44,000 additional physicians we'd need to provide as many visits as we do today for adult care,” Dr. Colwill said. “That would require 2,800–3,600 additional medical graduates per year. [However], as we progressively find ourselves in primary care doing more and more management of patients with severe chronic illnesses, [even] today's benchmark may not be adequate.”

Medical specialists also “say they have overloads right now, and abundant data out there says medical specialists see themselves as medical specialists and primary care not as a major part” of their practice, he added.

Physician extenders such as nurse practitioners and physician assistants will definitely help take up some of the shortfall. But “physician assistant program output has been flat, and nurse practitioner programs have literally dropped from above 8,000 graduates per year to 6,000 per year between 1998 and 2005,” Dr. Colwill said.

This whole scenario paints “a pretty bleak picture,” he continued. “I think it's a serious problem we face.”

Dr. Colwill also mentioned the concept of a medical home for all patients, which he said “is the wave of the future. The question is, will we have the workforce to pull it off?”

CRYSTAL CITY, VA. — The shortage of primary care physicians schooled in caring for elderly patients will continue to worsen, according to an analysis of federal physician data.

“Our nation is facing a growing shortage of physicians for the care of adults,” Dr. Jack Colwill said at the 2008 Physician Workforce Research Conference. “We potentially will have limited ability to provide the sort of comprehensive and coordinated care we're talking about for the growing aging population.”

In a recent study, Dr. Colwill, professor emeritus of family and community medicine at the University of Missouri-Columbia, and colleagues looked at data from the 2003–2005 National Ambulatory Medical Care Survey to project what physician workloads might be in the future. The researchers predicted that by 2025 there will be a 29% increase in demand for physician visits by adults, fueled in part by the aging of the population (Health Aff. [Millwood] 2008;27:w232-41 [Epub doi: 10.1377/hlthaff.27.3.w232]).

“There have been dramatic changes in internal medicine, with [a more than] one-third drop in the numbers entering general internal medicine from the peak in 1998,” Dr. Colwill said at the conference, which was jointly sponsored by the Association of American Medical Colleges and Harvard Medical School.

If this trend continues, by 2025 there will be an increase in generalists in adult care of 11% compared with 2005 levels, trying to respond to that 29% increase in workload, he continued. “That doesn't adjust for the fact that physician supply is getting older, and that the percentage of women [physicians] is going from 33% of physicians to 49%,” he said; women physicians may work fewer hours to accommodate lifestyle considerations. “With those adjustments, the increase is up only 7% from 2005. If you assume the continuing decline in generalists goes through 2008, then the increase in 2025 is only 2% above 2005 levels.”

“That's roughly 35,000–44,000 additional physicians we'd need to provide as many visits as we do today for adult care,” Dr. Colwill said. “That would require 2,800–3,600 additional medical graduates per year. [However], as we progressively find ourselves in primary care doing more and more management of patients with severe chronic illnesses, [even] today's benchmark may not be adequate.”

Medical specialists also “say they have overloads right now, and abundant data out there says medical specialists see themselves as medical specialists and primary care not as a major part” of their practice, he added.

Physician extenders such as nurse practitioners and physician assistants will definitely help take up some of the shortfall. But “physician assistant program output has been flat, and nurse practitioner programs have literally dropped from above 8,000 graduates per year to 6,000 per year between 1998 and 2005,” Dr. Colwill said.

This whole scenario paints “a pretty bleak picture,” he continued. “I think it's a serious problem we face.”

Dr. Colwill also mentioned the concept of a medical home for all patients, which he said “is the wave of the future. The question is, will we have the workforce to pull it off?”

CRYSTAL CITY, VA. — The shortage of primary care physicians schooled in caring for elderly patients will continue to worsen, according to an analysis of federal physician data.

“Our nation is facing a growing shortage of physicians for the care of adults,” Dr. Jack Colwill said at the 2008 Physician Workforce Research Conference. “We potentially will have limited ability to provide the sort of comprehensive and coordinated care we're talking about for the growing aging population.”

In a recent study, Dr. Colwill, professor emeritus of family and community medicine at the University of Missouri-Columbia, and colleagues looked at data from the 2003–2005 National Ambulatory Medical Care Survey to project what physician workloads might be in the future. The researchers predicted that by 2025 there will be a 29% increase in demand for physician visits by adults, fueled in part by the aging of the population (Health Aff. [Millwood] 2008;27:w232-41 [Epub doi: 10.1377/hlthaff.27.3.w232]).

“There have been dramatic changes in internal medicine, with [a more than] one-third drop in the numbers entering general internal medicine from the peak in 1998,” Dr. Colwill said at the conference, which was jointly sponsored by the Association of American Medical Colleges and Harvard Medical School.

If this trend continues, by 2025 there will be an increase in generalists in adult care of 11% compared with 2005 levels, trying to respond to that 29% increase in workload, he continued. “That doesn't adjust for the fact that physician supply is getting older, and that the percentage of women [physicians] is going from 33% of physicians to 49%,” he said; women physicians may work fewer hours to accommodate lifestyle considerations. “With those adjustments, the increase is up only 7% from 2005. If you assume the continuing decline in generalists goes through 2008, then the increase in 2025 is only 2% above 2005 levels.”

“That's roughly 35,000–44,000 additional physicians we'd need to provide as many visits as we do today for adult care,” Dr. Colwill said. “That would require 2,800–3,600 additional medical graduates per year. [However], as we progressively find ourselves in primary care doing more and more management of patients with severe chronic illnesses, [even] today's benchmark may not be adequate.”

Medical specialists also “say they have overloads right now, and abundant data out there says medical specialists see themselves as medical specialists and primary care not as a major part” of their practice, he added.

Physician extenders such as nurse practitioners and physician assistants will definitely help take up some of the shortfall. But “physician assistant program output has been flat, and nurse practitioner programs have literally dropped from above 8,000 graduates per year to 6,000 per year between 1998 and 2005,” Dr. Colwill said.

This whole scenario paints “a pretty bleak picture,” he continued. “I think it's a serious problem we face.”

Dr. Colwill also mentioned the concept of a medical home for all patients, which he said “is the wave of the future. The question is, will we have the workforce to pull it off?”

PHILADELPHIA — While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics. Opponents feared that women would be overwhelmingly the ones using the act, but 53% of the patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said—for instance, the fact that disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death—which would certainly be more controversial—“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, Mr. Schwartz said. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Of those using the act, 85% had been enrolled in a hospice program. MR. SCHWARTZ

PHILADELPHIA — While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics. Opponents feared that women would be overwhelmingly the ones using the act, but 53% of the patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said—for instance, the fact that disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death—which would certainly be more controversial—“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, Mr. Schwartz said. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Of those using the act, 85% had been enrolled in a hospice program. MR. SCHWARTZ

PHILADELPHIA — While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics. Opponents feared that women would be overwhelmingly the ones using the act, but 53% of the patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said—for instance, the fact that disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death—which would certainly be more controversial—“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, Mr. Schwartz said. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Of those using the act, 85% had been enrolled in a hospice program. MR. SCHWARTZ

Diabetes Programs Reauthorized

The House and Senate voted last month to reauthorize two diabetes programs through the end of fiscal year 2010: the Special Diabetes Program for Indians and the Special Statutory Funding Program for Type 1 Diabetes Research. The programs fund research in diabetes prevention and treatment, including TrialNet, an international clinical research network that receives half its funding from the statutory funding program. The two programs have each been receiving $150 million annually. “We applaud Congress for their vote to extend the Special Diabetes Programs,” R. Stewart Perry, chair of the board of the American Diabetes Association, said in a statement. “We know the value of these programs and the real difference they make in the quality of life for millions of people with diabetes.”

Statin Use Zooming

Americans spent $20 billion on statin medications in 2005, a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, 16 million people said they had purchased at least one statin. By 2005, almost twice as many (30 million) had purchased a statin. Outpatient prescriptions zoomed from 90 million to 174 million. Each individual who took a statin saw expenditures increase from $484 per year to $661 annually. The AHRQ did not determine how much of that was covered by insurers and how much was out-of-pocket cost to the individual. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details health services used by civilian, noninstitutionalized Americans.

Crocs OK'd by Medicare

Crocs, the well-known plastic clogs, have become the first molded shoe to be accepted into Medicare's shoe program for diabetes patients. Medicare's stamp of approval means that providers can fit Medicare beneficiaries for the company's Custom Cloud model; the cost of the shoes will be reimbursed by Medicare. The approved shoe comes with three pairs of heat-moldable orthotic insoles. “We are thrilled with the Center for Medicare and Medicaid Services' decision to include CrocsRx footwear in the Medicare program,” said Eddie Scott, director of CrocsRx. “CMS acceptance is an enormous accomplishment.”

Claims by Dead Doctors Paid

In the past 8 years, Medicare has paid more than $76.6 million in durable medical equipment claims that contained the Unique Physician Identification Numbers of dead physicians, according to a congressional subcommittee investigation. The probe, from the Senate Permanent Subcommittee on Investigations, found that from 2000 through 2007, Medicare paid for at least 478,500 claims that contained the UPINs of deceased doctors. Medicare was unable to stop the claims even though the CMS took steps in 2002 to reject claims using invalid or inactive UPINs, the report said. UPINs were replaced this year by National Provider Identifier numbers. The subcommittee recommended that the CMS strengthen procedures to deactivate NPIs after physician death, and initiate regular NPI registry and claim audits.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July 2007-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a group practice was more than $4,700, the CMS said. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services. Also, physicians and other health professionals can now access confidential feedback reports on their performance by registering with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/PQRI

Diabetes Programs Reauthorized

The House and Senate voted last month to reauthorize two diabetes programs through the end of fiscal year 2010: the Special Diabetes Program for Indians and the Special Statutory Funding Program for Type 1 Diabetes Research. The programs fund research in diabetes prevention and treatment, including TrialNet, an international clinical research network that receives half its funding from the statutory funding program. The two programs have each been receiving $150 million annually. “We applaud Congress for their vote to extend the Special Diabetes Programs,” R. Stewart Perry, chair of the board of the American Diabetes Association, said in a statement. “We know the value of these programs and the real difference they make in the quality of life for millions of people with diabetes.”

Statin Use Zooming

Americans spent $20 billion on statin medications in 2005, a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, 16 million people said they had purchased at least one statin. By 2005, almost twice as many (30 million) had purchased a statin. Outpatient prescriptions zoomed from 90 million to 174 million. Each individual who took a statin saw expenditures increase from $484 per year to $661 annually. The AHRQ did not determine how much of that was covered by insurers and how much was out-of-pocket cost to the individual. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details health services used by civilian, noninstitutionalized Americans.

Crocs OK'd by Medicare

Crocs, the well-known plastic clogs, have become the first molded shoe to be accepted into Medicare's shoe program for diabetes patients. Medicare's stamp of approval means that providers can fit Medicare beneficiaries for the company's Custom Cloud model; the cost of the shoes will be reimbursed by Medicare. The approved shoe comes with three pairs of heat-moldable orthotic insoles. “We are thrilled with the Center for Medicare and Medicaid Services' decision to include CrocsRx footwear in the Medicare program,” said Eddie Scott, director of CrocsRx. “CMS acceptance is an enormous accomplishment.”

Claims by Dead Doctors Paid

In the past 8 years, Medicare has paid more than $76.6 million in durable medical equipment claims that contained the Unique Physician Identification Numbers of dead physicians, according to a congressional subcommittee investigation. The probe, from the Senate Permanent Subcommittee on Investigations, found that from 2000 through 2007, Medicare paid for at least 478,500 claims that contained the UPINs of deceased doctors. Medicare was unable to stop the claims even though the CMS took steps in 2002 to reject claims using invalid or inactive UPINs, the report said. UPINs were replaced this year by National Provider Identifier numbers. The subcommittee recommended that the CMS strengthen procedures to deactivate NPIs after physician death, and initiate regular NPI registry and claim audits.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July 2007-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a group practice was more than $4,700, the CMS said. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services. Also, physicians and other health professionals can now access confidential feedback reports on their performance by registering with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/PQRI

Diabetes Programs Reauthorized

The House and Senate voted last month to reauthorize two diabetes programs through the end of fiscal year 2010: the Special Diabetes Program for Indians and the Special Statutory Funding Program for Type 1 Diabetes Research. The programs fund research in diabetes prevention and treatment, including TrialNet, an international clinical research network that receives half its funding from the statutory funding program. The two programs have each been receiving $150 million annually. “We applaud Congress for their vote to extend the Special Diabetes Programs,” R. Stewart Perry, chair of the board of the American Diabetes Association, said in a statement. “We know the value of these programs and the real difference they make in the quality of life for millions of people with diabetes.”

Statin Use Zooming

Americans spent $20 billion on statin medications in 2005, a massive rise from just 5 years earlier, when that tally was about $8 billion, according to the Agency for Healthcare Research and Quality. The 156% increase in spending went toward well-known drugs such as Lipitor, Lescol, Pravachol, and Zocor, the agency reported. In 2000, 16 million people said they had purchased at least one statin. By 2005, almost twice as many (30 million) had purchased a statin. Outpatient prescriptions zoomed from 90 million to 174 million. Each individual who took a statin saw expenditures increase from $484 per year to $661 annually. The AHRQ did not determine how much of that was covered by insurers and how much was out-of-pocket cost to the individual. The AHRQ data are drawn from the Medical Expenditure Panel Survey, which details health services used by civilian, noninstitutionalized Americans.

Crocs OK'd by Medicare

Crocs, the well-known plastic clogs, have become the first molded shoe to be accepted into Medicare's shoe program for diabetes patients. Medicare's stamp of approval means that providers can fit Medicare beneficiaries for the company's Custom Cloud model; the cost of the shoes will be reimbursed by Medicare. The approved shoe comes with three pairs of heat-moldable orthotic insoles. “We are thrilled with the Center for Medicare and Medicaid Services' decision to include CrocsRx footwear in the Medicare program,” said Eddie Scott, director of CrocsRx. “CMS acceptance is an enormous accomplishment.”

Claims by Dead Doctors Paid

In the past 8 years, Medicare has paid more than $76.6 million in durable medical equipment claims that contained the Unique Physician Identification Numbers of dead physicians, according to a congressional subcommittee investigation. The probe, from the Senate Permanent Subcommittee on Investigations, found that from 2000 through 2007, Medicare paid for at least 478,500 claims that contained the UPINs of deceased doctors. Medicare was unable to stop the claims even though the CMS took steps in 2002 to reject claims using invalid or inactive UPINs, the report said. UPINs were replaced this year by National Provider Identifier numbers. The subcommittee recommended that the CMS strengthen procedures to deactivate NPIs after physician death, and initiate regular NPI registry and claim audits.

CMS Issues PQRI Payments

Physicians who successfully reported quality measures to Medicare in 2007 as part of the Physician Quality Reporting Initiative should be receiving their bonus payments this month Officials at the Centers for Medicare and Medicaid Services announced that they had paid out more than $36 million in bonuses to physicians and other health professionals as part of the PQRI. Of the approximately 109,000 health professionals who reported data on Medicare services provided during July 2007-December 2007, more than 56,700 met the reporting requirements and will be receiving bonus checks. The average bonus paid to an individual provider was more than $600, and the average bonus for a group practice was more than $4,700, the CMS said. “These payments to physicians for participating in the PQRI are a first step toward improving how Medicare pays for health care services,” Kerry Weems, acting administrator, said in a statement. Under the PQRI, physicians could earn bonus payments of up to 1.5% of their total allowed Medicare charges by successfully reporting quality data for Medicare services. Also, physicians and other health professionals can now access confidential feedback reports on their performance by registering with the Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC). More information on the program is available at

www.cms.hhs.gov/PQRI

PHILADELPHIA — While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics.

Opponents feared that women would be overwhelmingly the ones using the act, but 53% of patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said—disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death—which would certainly be more controversial—“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, said Mr. Schwartz. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Some feared that women would be the ones using the act most, but 53% of patients have been men. MR. SCHWARTZ

PHILADELPHIA — While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics.

Opponents feared that women would be overwhelmingly the ones using the act, but 53% of patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said—disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death—which would certainly be more controversial—“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, said Mr. Schwartz. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Some feared that women would be the ones using the act most, but 53% of patients have been men. MR. SCHWARTZ

PHILADELPHIA — While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics.

Opponents feared that women would be overwhelmingly the ones using the act, but 53% of patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said—disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death—which would certainly be more controversial—“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, said Mr. Schwartz. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Some feared that women would be the ones using the act most, but 53% of patients have been men. MR. SCHWARTZ

ARLINGTON, VA. — International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

“Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas” as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr.P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and included information from 2,390 physicians in office-based practices. Surveyors performed a face-to-face interview and abstracted medical records for about 30 office visits. Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older that U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States. The racial and ethnic differences were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians—57% vs. 46%—a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians—87% vs. 79%. And IMGs more often saw patients during evening and weekend hours than their U.S.-trained counterparts. IMGs also were more likely to accept new patients and to accept Medicaid—nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

“This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care,” Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School. “The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming [medical graduates]. This is an important consideration for policy makers.”

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. — International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

“Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas” as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr.P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and included information from 2,390 physicians in office-based practices. Surveyors performed a face-to-face interview and abstracted medical records for about 30 office visits. Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older that U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States. The racial and ethnic differences were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians—57% vs. 46%—a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians—87% vs. 79%. And IMGs more often saw patients during evening and weekend hours than their U.S.-trained counterparts. IMGs also were more likely to accept new patients and to accept Medicaid—nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

“This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care,” Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School. “The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming [medical graduates]. This is an important consideration for policy makers.”

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. — International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

“Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas” as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr.P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and included information from 2,390 physicians in office-based practices. Surveyors performed a face-to-face interview and abstracted medical records for about 30 office visits. Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older that U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States. The racial and ethnic differences were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians—57% vs. 46%—a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians—87% vs. 79%. And IMGs more often saw patients during evening and weekend hours than their U.S.-trained counterparts. IMGs also were more likely to accept new patients and to accept Medicaid—nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

“This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care,” Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School. “The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming [medical graduates]. This is an important consideration for policy makers.”

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. – International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

“Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas” as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr.P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and the data used by the researchers included information from 2,390 physicians in office-based practices. Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older that U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States. The racial and ethnic differences were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians–57% vs. 46%–a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians–87% vs. 79%. IMGs also were more likely to accept new patients and to accept Medicaid–nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

“This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care,” Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School.

“The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming” medical graduates, she said.

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. – International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

“Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas” as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr.P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and the data used by the researchers included information from 2,390 physicians in office-based practices. Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older that U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States. The racial and ethnic differences were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians–57% vs. 46%–a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians–87% vs. 79%. IMGs also were more likely to accept new patients and to accept Medicaid–nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

“This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care,” Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School.

“The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming” medical graduates, she said.

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. – International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

“Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas” as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr.P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and the data used by the researchers included information from 2,390 physicians in office-based practices. Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older that U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States. The racial and ethnic differences were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians–57% vs. 46%–a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians–87% vs. 79%. IMGs also were more likely to accept new patients and to accept Medicaid–nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

“This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care,” Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School.

“The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming” medical graduates, she said.

ELSEVIER GLOBAL MEDICAL NEWS

PHILADELPHIA – While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics.

Opponents feared that women would be overwhelmingly the ones using the act, but 53% of patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said–disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death–which would certainly be more controversial–“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, said Mr. Schwartz. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Eighty-five percent of those using the act had been enrolled in a hospice program. MR. SCHWARTZ

PHILADELPHIA – While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics.

Opponents feared that women would be overwhelmingly the ones using the act, but 53% of patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said–disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death–which would certainly be more controversial–“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, said Mr. Schwartz. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Eighty-five percent of those using the act had been enrolled in a hospice program. MR. SCHWARTZ

PHILADELPHIA – While physicians in much of the United States struggle with issues surrounding end-of-life care, those in Oregon may help their terminally ill patients end their lives because of the state's groundbreaking, 10-year-old Death With Dignity Act.

Under the law, terminally ill patients may obtain prescriptions for lethal doses of medication that they can self-administer, explained Robert L. Schwartz, a professor of law at the University of New Mexico, Albuquerque, who teaches and writes about bioethics. The law was passed in 1997, and the Oregon Department of Health recently issued a 10-year report on its use.

So far, 341 patients have made use of the law. The number of prescriptions (85) written under the law last year was much higher than in any previous year, “and maybe most significantly, the number of doctors willing to write those prescriptions in Oregon was considerably higher [in 2007] than in any year in the past,” Mr. Schwartz said. Of those 85 patients, 46 took the medications, 26 died of their underlying disease, and 13 were alive at the end of 2007.

Many of the concerns expressed about the act when it was first passed don't seem to have occurred, Mr. Schwartz said at a meeting of the American Society of Law, Medicine, and Ethics.

Opponents feared that women would be overwhelmingly the ones using the act, but 53% of patients have been men. In addition, although opponents feared that uninsured patients who couldn't afford health care would be forced into using the act, the percentage of uninsured patients who have availed themselves of it is lower than the percentage of uninsured patients in the state, he noted.

Another fear was that the act would “short-circuit” the hospice system, but that also hasn't come to pass: 85% of those using the act were enrolled in a hospice program. And for those who were concerned that disenfranchised groups such as ethnic minorities would be forced into using it, not a single African American patient has used the act, although there has been significant use by Asian Americans, he said.

On the other hand, opponents of the statute might feel justified by some of the other statistics, he said–disproportionate numbers of people who make use of the statute are divorced, suggesting that it may be those with a looser social network who end up choosing physician-assisted death. In addition, the statute calls for patients who seek the prescriptions to be referred for psychiatric evaluation, but fewer than 10% have been referred, Mr. Schwartz said. And although 90% of the patients availing themselves of physician-assisted death cited “loss of autonomy” as one reason for their choice, 40% also said that becoming a burden on their families and others played a part in the decision, “which might be a reason to give us some concern,” he added.

But the most surprising thing about the statute, according to Mr. Schwartz, is that other states have not adopted similar measures, although several have tried. One bill now being considered in the California legislature would allow terminally ill patients to request information on the options available to them, including hospice care, palliative care, and refusal or withdrawal of life-sustaining treatment. Physicians who do not want to provide patients with this information are required to refer the patient elsewhere for it or tell the patient how to find another provider. The bill has passed the California state assembly but is still being considered in the state senate.

By floating this bill rather than one that allows for physician-assisted death–which would certainly be more controversial–“the supporters have taken a page from the right-to-life movement” with the idea that if people at least have access to the information, they will end up doing the right thing, said Mr. Schwartz. Opponents of the bill call it the “Kill the Ill Bill,” he added.

Eighty-five percent of those using the act had been enrolled in a hospice program. MR. SCHWARTZ

PHILADELPHIA – Two new ways of dealing with end-of-life issues–default surrogates and physician-ordered life-sustaining treatment orders–are becoming more common in hospitals, according to several legal experts.

So far, 37 states have passed default surrogate regulations, aimed at naming a person who can act on behalf of an incapacitated hospital patient who does not have an advance directive, said Nina Kohn of Syracuse (N.Y.) University's College of Law. The vast majority of Americans–especially minorities, those with lower education levels, and younger patients–do not have an advance directive, noted Ms. Kohn, who spoke at a meeting of the American Society of Law, Medicine, and Ethics.

The states that have passed the default surrogate statutes “create a priority list saying if there is not an appointed surrogate, first the spouse does it, then the parent, then an adult sibling, and so on,” she explained. “The common justification is the idea that the statutes help protect wishes of the incapacitated person.”

But does that really work? Ms. Kohn and her associate Jeremy Blumenthal, also of Syracuse University, have been studying whether the laws result in the selection of the surrogates that incapacitated patients would have selected for themselves, and whether those surrogates made the decisions that those patients would have made.

They found that Americans tend to favor close family members as surrogates, which is consistent with most of the state laws. On the other hand, said Ms. Kohn, “The priority lists don't account for a number of factors predictive of surrogate selection, such as surrogate gender. Women are disproportionately selected as surrogates.” In addition, the statutes “don't do a good job of accounting for nontraditional family structures such as same-sex couples, or [situations] where people have more inclusive or more intergenerational notions of families.” This is particularly true of African Americans, who are less likely than are members of other racial groups to select a spouse or adult child as a surrogate, according to studies, she said.

As to whether the surrogates are deciding things the same way the patients would have, “we can't know for sure … because the patient is incapacitated,” she said. “But I think we can confidently say that there's real reason to be skeptical about the congruence levels being obtained.”

The literature on the subject shows that surrogates are very bad at predicting patient wishes; in addition, surrogates are not always willing to do what they know the patients would want them to do, Ms. Kohn continued.

Ms. Kohn had two suggestions for improving decision making by surrogates: First, move away from selecting surrogates based on familial relations and toward surrogates whose values are more consistent with those of the patient. And second, provide surrogates with information to better inform their decisions–for example, what a typical patient would do in a particular situation.

Another emerging tool for hospital-based end-of-life care is the physician orders for life-sustaining treatment (POLST) form, said Robert Schwartz, J.D., professor of law at the University of New Mexico, Albuquerque. These orders also go by other names: medical orders on life-sustaining treatment, medical orders on scope of treatment, or physician orders on scope of treatment.

“This is the next step from the advance directive,” he explained. 'These are physician orders that go in the patient's chart and provide information about the kind of patient care that should be provided.”

Usually, a POLST form addresses resuscitation issues, the extent of appropriate medical intervention, use of antibiotics, provision of nutrition and hydration, desired place of treatment, and the identity of the authorized health care provider, Mr. Schwartz said. The forms all have a place for the physician's signature, and many have a place for the patient's or surrogate decision maker's signature.

He has some reservations about the concept. “My problem with all these documents is that it seems like it's a step backwards [because] doctors are deciding these things in the hospital [rather than] patients having the authority to make these decisions. On the other hand, if patients make these decisions and they're never honored, we haven't achieved a whole lot.”

PHILADELPHIA – Two new ways of dealing with end-of-life issues–default surrogates and physician-ordered life-sustaining treatment orders–are becoming more common in hospitals, according to several legal experts.

So far, 37 states have passed default surrogate regulations, aimed at naming a person who can act on behalf of an incapacitated hospital patient who does not have an advance directive, said Nina Kohn of Syracuse (N.Y.) University's College of Law. The vast majority of Americans–especially minorities, those with lower education levels, and younger patients–do not have an advance directive, noted Ms. Kohn, who spoke at a meeting of the American Society of Law, Medicine, and Ethics.

The states that have passed the default surrogate statutes “create a priority list saying if there is not an appointed surrogate, first the spouse does it, then the parent, then an adult sibling, and so on,” she explained. “The common justification is the idea that the statutes help protect wishes of the incapacitated person.”

But does that really work? Ms. Kohn and her associate Jeremy Blumenthal, also of Syracuse University, have been studying whether the laws result in the selection of the surrogates that incapacitated patients would have selected for themselves, and whether those surrogates made the decisions that those patients would have made.

They found that Americans tend to favor close family members as surrogates, which is consistent with most of the state laws. On the other hand, said Ms. Kohn, “The priority lists don't account for a number of factors predictive of surrogate selection, such as surrogate gender. Women are disproportionately selected as surrogates.” In addition, the statutes “don't do a good job of accounting for nontraditional family structures such as same-sex couples, or [situations] where people have more inclusive or more intergenerational notions of families.” This is particularly true of African Americans, who are less likely than are members of other racial groups to select a spouse or adult child as a surrogate, according to studies, she said.

As to whether the surrogates are deciding things the same way the patients would have, “we can't know for sure … because the patient is incapacitated,” she said. “But I think we can confidently say that there's real reason to be skeptical about the congruence levels being obtained.”

The literature on the subject shows that surrogates are very bad at predicting patient wishes; in addition, surrogates are not always willing to do what they know the patients would want them to do, Ms. Kohn continued.

Ms. Kohn had two suggestions for improving decision making by surrogates: First, move away from selecting surrogates based on familial relations and toward surrogates whose values are more consistent with those of the patient. And second, provide surrogates with information to better inform their decisions–for example, what a typical patient would do in a particular situation.

Another emerging tool for hospital-based end-of-life care is the physician orders for life-sustaining treatment (POLST) form, said Robert Schwartz, J.D., professor of law at the University of New Mexico, Albuquerque. These orders also go by other names: medical orders on life-sustaining treatment, medical orders on scope of treatment, or physician orders on scope of treatment.

“This is the next step from the advance directive,” he explained. 'These are physician orders that go in the patient's chart and provide information about the kind of patient care that should be provided.”

Usually, a POLST form addresses resuscitation issues, the extent of appropriate medical intervention, use of antibiotics, provision of nutrition and hydration, desired place of treatment, and the identity of the authorized health care provider, Mr. Schwartz said. The forms all have a place for the physician's signature, and many have a place for the patient's or surrogate decision maker's signature.

He has some reservations about the concept. “My problem with all these documents is that it seems like it's a step backwards [because] doctors are deciding these things in the hospital [rather than] patients having the authority to make these decisions. On the other hand, if patients make these decisions and they're never honored, we haven't achieved a whole lot.”

PHILADELPHIA – Two new ways of dealing with end-of-life issues–default surrogates and physician-ordered life-sustaining treatment orders–are becoming more common in hospitals, according to several legal experts.

So far, 37 states have passed default surrogate regulations, aimed at naming a person who can act on behalf of an incapacitated hospital patient who does not have an advance directive, said Nina Kohn of Syracuse (N.Y.) University's College of Law. The vast majority of Americans–especially minorities, those with lower education levels, and younger patients–do not have an advance directive, noted Ms. Kohn, who spoke at a meeting of the American Society of Law, Medicine, and Ethics.

The states that have passed the default surrogate statutes “create a priority list saying if there is not an appointed surrogate, first the spouse does it, then the parent, then an adult sibling, and so on,” she explained. “The common justification is the idea that the statutes help protect wishes of the incapacitated person.”

But does that really work? Ms. Kohn and her associate Jeremy Blumenthal, also of Syracuse University, have been studying whether the laws result in the selection of the surrogates that incapacitated patients would have selected for themselves, and whether those surrogates made the decisions that those patients would have made.

They found that Americans tend to favor close family members as surrogates, which is consistent with most of the state laws. On the other hand, said Ms. Kohn, “The priority lists don't account for a number of factors predictive of surrogate selection, such as surrogate gender. Women are disproportionately selected as surrogates.” In addition, the statutes “don't do a good job of accounting for nontraditional family structures such as same-sex couples, or [situations] where people have more inclusive or more intergenerational notions of families.” This is particularly true of African Americans, who are less likely than are members of other racial groups to select a spouse or adult child as a surrogate, according to studies, she said.

As to whether the surrogates are deciding things the same way the patients would have, “we can't know for sure … because the patient is incapacitated,” she said. “But I think we can confidently say that there's real reason to be skeptical about the congruence levels being obtained.”

The literature on the subject shows that surrogates are very bad at predicting patient wishes; in addition, surrogates are not always willing to do what they know the patients would want them to do, Ms. Kohn continued.

Ms. Kohn had two suggestions for improving decision making by surrogates: First, move away from selecting surrogates based on familial relations and toward surrogates whose values are more consistent with those of the patient. And second, provide surrogates with information to better inform their decisions–for example, what a typical patient would do in a particular situation.

Another emerging tool for hospital-based end-of-life care is the physician orders for life-sustaining treatment (POLST) form, said Robert Schwartz, J.D., professor of law at the University of New Mexico, Albuquerque. These orders also go by other names: medical orders on life-sustaining treatment, medical orders on scope of treatment, or physician orders on scope of treatment.

“This is the next step from the advance directive,” he explained. 'These are physician orders that go in the patient's chart and provide information about the kind of patient care that should be provided.”

Usually, a POLST form addresses resuscitation issues, the extent of appropriate medical intervention, use of antibiotics, provision of nutrition and hydration, desired place of treatment, and the identity of the authorized health care provider, Mr. Schwartz said. The forms all have a place for the physician's signature, and many have a place for the patient's or surrogate decision maker's signature.

He has some reservations about the concept. “My problem with all these documents is that it seems like it's a step backwards [because] doctors are deciding these things in the hospital [rather than] patients having the authority to make these decisions. On the other hand, if patients make these decisions and they're never honored, we haven't achieved a whole lot.”

ARLINGTON, VA. — International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

"Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas" as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr. P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and the data used by the researchers included information from 2,390 physicians in office-based practices.

Surveyors performed a face-to-face interview and abstracted medical records for about 30 office visits.

Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older than U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States.

The racial and ethnic differences between U.S.-trained doctors and IMGs were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians—57% vs. 46%—a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians—87% vs. 79%. And IMGs more often saw patients during evening and weekend hours than their U.S.-trained counterparts.

IMGs also were more likely to accept new patients and to accept Medicaid—nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

"This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care," Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School.

"The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming [medical graduates]," she said.

"This is an important consideration for policy makers."

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. — International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

"Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas" as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr. P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and the data used by the researchers included information from 2,390 physicians in office-based practices.

Surveyors performed a face-to-face interview and abstracted medical records for about 30 office visits.

Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older than U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States.

The racial and ethnic differences between U.S.-trained doctors and IMGs were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians—57% vs. 46%—a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians—87% vs. 79%. And IMGs more often saw patients during evening and weekend hours than their U.S.-trained counterparts.

IMGs also were more likely to accept new patients and to accept Medicaid—nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

"This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care," Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School.

"The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming [medical graduates]," she said.

"This is an important consideration for policy makers."

ELSEVIER GLOBAL MEDICAL NEWS

ARLINGTON, VA. — International medical graduates have become an integral part of providing medical care in federally designated physician shortage areas, according to results from a recent study.

"Compared to U.S.-trained physicians, IMGs provide more primary care and more [overall] medical care to populations living in primary care shortage areas" as well as to minorities, immigrants, patients in poor areas, and Medicaid recipients, said Esther Hing of the National Center for Health Statistics, in Hyattsville, Md.

Ms. Hing and her colleague Susan Lin, Dr. P.H., studied 2005-2006 data from the National Ambulatory Medical Care Survey. The survey was nationally representative, and the data used by the researchers included information from 2,390 physicians in office-based practices.

Surveyors performed a face-to-face interview and abstracted medical records for about 30 office visits.

Ms. Hing presented the survey results at the 2008 Physician Workforce Research Conference.

The survey showed that IMGs make up 25% of office-based physicians. They also tend to be a little older than U.S.-trained doctors, with an average age of 52 years, compared with 50 years for physicians trained in the United States.

The racial and ethnic differences between U.S.-trained doctors and IMGs were more pronounced: 71% of U.S. medical graduates were non-Hispanic white, compared with 26% of IMGs. Asian/Pacific Islanders made up 32% of IMGs, compared with 5% of U.S. medical graduates. Hispanic and Latino physicians accounted for 7% of IMGs, compared with 2% of U.S. graduates.

More of the IMGs than U.S. medical graduates were working as primary care physicians—57% vs. 46%—a statistically significant difference, Ms. Hing noted.

IMGs also practiced more often in counties that included primary care shortage areas than did U.S.-trained physicians—87% vs. 79%. And IMGs more often saw patients during evening and weekend hours than their U.S.-trained counterparts.

IMGs also were more likely to accept new patients and to accept Medicaid—nearly one-third of IMGs surveyed derived 20% or more of their incomes from Medicaid, compared with less than one-fourth of U.S.-trained physicians.

"This study illustrates how the U.S. health care system continues to rely on IMGs to address shortages in primary care," Ms. Hing said at the conference, which was sponsored by the Association of American Medical Colleges and Harvard Medical School.

"The U.S. health care system faces challenges if the future supply and use of IMGs is constrained by recent changes in visa policy that reduce the number of incoming [medical graduates]," she said.

"This is an important consideration for policy makers."

ELSEVIER GLOBAL MEDICAL NEWS

Number of Diabetics on the Rise

The number of people with diabetes in the United States now stands at 24 million, an increase of more than 3 million from about 2 years ago, according to new data from the Centers for Disease Control and Prevention. Another 57 million are thought to have prediabetes, with 25% unaware that they have it, a decrease of 5 percentage points from 2 years ago. The data “have both good news and bad news,” Dr. Ann Albright, director of the agency's Division of Diabetes Translation, said in a statement. “It is concerning to know that we have more people developing diabetes, and these data are a reminder of the importance of increasing awareness of this condition, especially among people who are at high risk. On the other hand, it is good to see that more people are aware that they have diabetes. That is an indication that our efforts to increase awareness are working, and more importantly, that more people are better prepared to manage this disease and its complications.” The data show that diabetes continues to disproportionately affect the elderly; almost 25% of those aged 60 years and older had diabetes in 2007. And disparities among ethnic groups continue to persist: After adjustment for population age differences between groups, the rate of diagnosed diabetes was highest among Native Americans and Alaska Natives at 17%, followed by blacks with 12%, and Hispanics at 10%, Asian Americans at 8%, and whites at 7%.

Pesticide Exposure and Diabetes

Long-term pesticide exposure may increase the risk of diabetes, according to a study published in the American Journal of Epidemiology. Researchers at the National Institute of Environmental Health Sciences studied more than 30,000 pesticide applicators who used chlorinated pesticides on more than 100 days over their lifetime; specific pesticides increased diabetes risk anywhere from 20% to 200%, the study found. A total of 1,171 applicators developed diabetes after enrollment; researchers compared their pesticide use and other potential risk factors with those from applicators who did not develop diabetes and adjusted for age, body mass index, and smoking. Among the 50 different pesticides studied, 7—aldrin, chlordane, heptachlor, dichlorvos, trichlorfon, alachlor, and cynazine—increased the likelihood of diabetes among study participants who had ever been exposed to any of these pesticides. “The results suggest that pesticides may be a contributing factor for diabetes along with known risk factors such as obesity, lack of exercise, and having a family history of diabetes,” said Dale Sandler, Ph.D., chief of the institute's epidemiology branch and a study coauthor. “Although the amount of diabetes explained by pesticides is small, these new findings may extend beyond the pesticide applicators in the study.”

Feds Seek Help in Bone Campaign

The federal government is reaching out to organizations that promote bone health and girls' health to help to increase national awareness of behaviors that contribute to good bone health in girls. The Office of Women's Health at the Department of Health and Human Services recently issued a request for groups to offer advice on the development and dissemination of campaign materials related to the National Bone Health Campaign. The campaign is aimed at helping girls increase their consumption of calcium and of vitamin D and weight-bearing physical activity with the goal of building strong bones. The national social marketing campaign will target girls, parents, and health care providers.

Performance-Enhancing Drug Bill

Rep. Elton Gallegly (R-Calif.) has introduced a measure to help eliminate the use of performance-enhancing drugs by high school athletes. The High School Sports Anti-Drug Act would require the secretary of Education to award grants to states to pilot random drug-testing programs. It would require a parent's written consent before a student could be tested for drugs, and grantees would have to provide recovery, counseling, and treatment programs for students who test positive for performance-enhancing agents. The proposed legislation also would require grantees to spend at least 10% of their grant funds on drug abuse prevention. Rep. Gallegly recommends funding for the act of $10 million in 2009 and $20 million in 2010 and in 2011. “The recent Major League Baseball steroids scandal and Marion Jones' being stripped of her Olympic medals show how prevalent the use of performance-enhancing drugs is in amateur and professional sports,” Rep. Gallegly said. “Our high school athletes look up to these athletes and are under tremendous pressure to succeed. It's important … to give them the opportunity to resist the pressure to use steroids and other dangerous performance-enhancing drugs.”

Number of Diabetics on the Rise

The number of people with diabetes in the United States now stands at 24 million, an increase of more than 3 million from about 2 years ago, according to new data from the Centers for Disease Control and Prevention. Another 57 million are thought to have prediabetes, with 25% unaware that they have it, a decrease of 5 percentage points from 2 years ago. The data “have both good news and bad news,” Dr. Ann Albright, director of the agency's Division of Diabetes Translation, said in a statement. “It is concerning to know that we have more people developing diabetes, and these data are a reminder of the importance of increasing awareness of this condition, especially among people who are at high risk. On the other hand, it is good to see that more people are aware that they have diabetes. That is an indication that our efforts to increase awareness are working, and more importantly, that more people are better prepared to manage this disease and its complications.” The data show that diabetes continues to disproportionately affect the elderly; almost 25% of those aged 60 years and older had diabetes in 2007. And disparities among ethnic groups continue to persist: After adjustment for population age differences between groups, the rate of diagnosed diabetes was highest among Native Americans and Alaska Natives at 17%, followed by blacks with 12%, and Hispanics at 10%, Asian Americans at 8%, and whites at 7%.

Pesticide Exposure and Diabetes

Long-term pesticide exposure may increase the risk of diabetes, according to a study published in the American Journal of Epidemiology. Researchers at the National Institute of Environmental Health Sciences studied more than 30,000 pesticide applicators who used chlorinated pesticides on more than 100 days over their lifetime; specific pesticides increased diabetes risk anywhere from 20% to 200%, the study found. A total of 1,171 applicators developed diabetes after enrollment; researchers compared their pesticide use and other potential risk factors with those from applicators who did not develop diabetes and adjusted for age, body mass index, and smoking. Among the 50 different pesticides studied, 7—aldrin, chlordane, heptachlor, dichlorvos, trichlorfon, alachlor, and cynazine—increased the likelihood of diabetes among study participants who had ever been exposed to any of these pesticides. “The results suggest that pesticides may be a contributing factor for diabetes along with known risk factors such as obesity, lack of exercise, and having a family history of diabetes,” said Dale Sandler, Ph.D., chief of the institute's epidemiology branch and a study coauthor. “Although the amount of diabetes explained by pesticides is small, these new findings may extend beyond the pesticide applicators in the study.”

Feds Seek Help in Bone Campaign

The federal government is reaching out to organizations that promote bone health and girls' health to help to increase national awareness of behaviors that contribute to good bone health in girls. The Office of Women's Health at the Department of Health and Human Services recently issued a request for groups to offer advice on the development and dissemination of campaign materials related to the National Bone Health Campaign. The campaign is aimed at helping girls increase their consumption of calcium and of vitamin D and weight-bearing physical activity with the goal of building strong bones. The national social marketing campaign will target girls, parents, and health care providers.

Performance-Enhancing Drug Bill

Rep. Elton Gallegly (R-Calif.) has introduced a measure to help eliminate the use of performance-enhancing drugs by high school athletes. The High School Sports Anti-Drug Act would require the secretary of Education to award grants to states to pilot random drug-testing programs. It would require a parent's written consent before a student could be tested for drugs, and grantees would have to provide recovery, counseling, and treatment programs for students who test positive for performance-enhancing agents. The proposed legislation also would require grantees to spend at least 10% of their grant funds on drug abuse prevention. Rep. Gallegly recommends funding for the act of $10 million in 2009 and $20 million in 2010 and in 2011. “The recent Major League Baseball steroids scandal and Marion Jones' being stripped of her Olympic medals show how prevalent the use of performance-enhancing drugs is in amateur and professional sports,” Rep. Gallegly said. “Our high school athletes look up to these athletes and are under tremendous pressure to succeed. It's important … to give them the opportunity to resist the pressure to use steroids and other dangerous performance-enhancing drugs.”

Number of Diabetics on the Rise

The number of people with diabetes in the United States now stands at 24 million, an increase of more than 3 million from about 2 years ago, according to new data from the Centers for Disease Control and Prevention. Another 57 million are thought to have prediabetes, with 25% unaware that they have it, a decrease of 5 percentage points from 2 years ago. The data “have both good news and bad news,” Dr. Ann Albright, director of the agency's Division of Diabetes Translation, said in a statement. “It is concerning to know that we have more people developing diabetes, and these data are a reminder of the importance of increasing awareness of this condition, especially among people who are at high risk. On the other hand, it is good to see that more people are aware that they have diabetes. That is an indication that our efforts to increase awareness are working, and more importantly, that more people are better prepared to manage this disease and its complications.” The data show that diabetes continues to disproportionately affect the elderly; almost 25% of those aged 60 years and older had diabetes in 2007. And disparities among ethnic groups continue to persist: After adjustment for population age differences between groups, the rate of diagnosed diabetes was highest among Native Americans and Alaska Natives at 17%, followed by blacks with 12%, and Hispanics at 10%, Asian Americans at 8%, and whites at 7%.

Pesticide Exposure and Diabetes

Long-term pesticide exposure may increase the risk of diabetes, according to a study published in the American Journal of Epidemiology. Researchers at the National Institute of Environmental Health Sciences studied more than 30,000 pesticide applicators who used chlorinated pesticides on more than 100 days over their lifetime; specific pesticides increased diabetes risk anywhere from 20% to 200%, the study found. A total of 1,171 applicators developed diabetes after enrollment; researchers compared their pesticide use and other potential risk factors with those from applicators who did not develop diabetes and adjusted for age, body mass index, and smoking. Among the 50 different pesticides studied, 7—aldrin, chlordane, heptachlor, dichlorvos, trichlorfon, alachlor, and cynazine—increased the likelihood of diabetes among study participants who had ever been exposed to any of these pesticides. “The results suggest that pesticides may be a contributing factor for diabetes along with known risk factors such as obesity, lack of exercise, and having a family history of diabetes,” said Dale Sandler, Ph.D., chief of the institute's epidemiology branch and a study coauthor. “Although the amount of diabetes explained by pesticides is small, these new findings may extend beyond the pesticide applicators in the study.”

Feds Seek Help in Bone Campaign

The federal government is reaching out to organizations that promote bone health and girls' health to help to increase national awareness of behaviors that contribute to good bone health in girls. The Office of Women's Health at the Department of Health and Human Services recently issued a request for groups to offer advice on the development and dissemination of campaign materials related to the National Bone Health Campaign. The campaign is aimed at helping girls increase their consumption of calcium and of vitamin D and weight-bearing physical activity with the goal of building strong bones. The national social marketing campaign will target girls, parents, and health care providers.

Performance-Enhancing Drug Bill

Rep. Elton Gallegly (R-Calif.) has introduced a measure to help eliminate the use of performance-enhancing drugs by high school athletes. The High School Sports Anti-Drug Act would require the secretary of Education to award grants to states to pilot random drug-testing programs. It would require a parent's written consent before a student could be tested for drugs, and grantees would have to provide recovery, counseling, and treatment programs for students who test positive for performance-enhancing agents. The proposed legislation also would require grantees to spend at least 10% of their grant funds on drug abuse prevention. Rep. Gallegly recommends funding for the act of $10 million in 2009 and $20 million in 2010 and in 2011. “The recent Major League Baseball steroids scandal and Marion Jones' being stripped of her Olympic medals show how prevalent the use of performance-enhancing drugs is in amateur and professional sports,” Rep. Gallegly said. “Our high school athletes look up to these athletes and are under tremendous pressure to succeed. It's important … to give them the opportunity to resist the pressure to use steroids and other dangerous performance-enhancing drugs.”