January 2007

NEWS FROM ATTORNEYS GENERAL OFFICES

  1. According to an article in Lexington, Kentucky, Herald-Leader, Kentucky Attorney General Greg Stumbo is advocating legislation that would require people to have face-to-face examinations by a licensed medical practitioner before ordering prescription drugs over the Internet. General Stumbo is also recommending that any pharmacy during business in Kentucky must use the address on file with the Kentucky Board of Pharmacy as the return address on the labels of any package shipped into or within the state. He is also suggesting that the legislature make forging a medical record to obtain prescription drugs a felony.
  2. New Jersey Attorney General Stuart Rabner announced the arrests of five alleged top members of a Newark-based narcotics ring that distributed millions of dollars a year in illegal prescription painkillers. General Rabner also announced this month that an Atlantic City pharmacist was indicted for her role in Medicaid and Health Insurance Fraud for illegally dispensing painkillers.

LEGISLATIVE/REGULATORY DEVELOPMENTS

  1. In December, Congress passed and the President signed an amendment to the Drug Abuse Treatment Act, H.R. 6344, which allows an increase in the number of patients to whom a doctor can prescribe buprehorphine. The amendment allows a certified physician to prescribe for up to 100 patients. Buprerhorphine has proven to be an effective method to treat heroin dependence.
  2. Pennsylvania has new legislation that clarifies terminal patients’ rights and health-care decision protocols. A key part of the law requires the state Health Department to name a commission to enact rules for physician orders for life-sustaining treatment. For those without an appointed health care agent, the law prioritizes representatives, beginning with a spouse or adult child of another relationship and concluding with a close friend.
  3. A South Dakota senate panel has approved SB74 that would provide that a doctor may consult with a close friend regarding end-of-life care if an incapacitated patient has no available relative to consult. SB75 and SB76 were also approved. They seek to clarify and simply state laws dealing with living wills and decisions on whether to provide artificial food and water to an incapacitated patient who is terminally ill.
  4. Virginia has begun a program that monitors narcotics prescriptions written by doctors that will send out notices when it appears a patient of theirs may be “doctor shopping.” The unsolicited notices will be used for information only and cannot be shared with law enforcement unless there is already an active state police investigation under way. The Virginia Prescription Monitoring database is available to physicians, pharmacists, and patients older than 18.
  5. A bill to allow emergency responders to comply with do-not-resuscitate orders has been filed in the Missouri legislature. An additional provision states that a do-not-resuscitate order is not effective during pregnancy.

PAIN MANAGEMENT

  1. The National Insitutes of Health and the National Institute on Drug Abuse will hold a two-day conference on March 5 and 6th titled “Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients.” According to the news release, the goal of the two-day meeting is to inform researchers and practitioners about the state of the science of the intersection of addiction and pain management. The meeting is co-sponsored by the American Medical Association and the NIH Pain Consortium.
  2. On Christmas Day, the New York Times published a lengthy article revealing the saga of pioneering heart surgeon Dr. Michael E. Debakey. Surgery was performed on him to correct a dissecting aortic aneurysm despite a concern that surgery would counter the wishes earlier expressed by Dr. Debakey when he became aware of his situation. Despite his advanced years (97), Dr. Debakey has recovered from the surgery and now believes that doctors should be able to make decisions that they feel are in the best interest of the patient. A Medpage Today on-line article notes that the extensive and expensive care afforded Dr. Debakey raises questions about end of life care, patient rights, and the use of limited medical resources.
  3. A survey, conducted in October 2006 on behalf of the Institute of Health Productivity Management and discussed in PR Newswire, found that one-third of adults have at least one bad headache per month. About half of those reporting headaches also said that their condition made them work less effectively or decreased their productivity. Nonetheless, fewer than one in five sought medical attention for their headaches. Many of those surveyed described symptoms consistent with migraine. Headache sufferers are encouraged to take an on-line quiz and discuss the results with their doctor.
  4. An article in Boston.com discusses the partnership between Tufts University School of Medicine and the New England School of Acupuncture. According to the article, the focus of this partnership is to widen the approaches for fighting pain by providing acupuncturists with a grounding in conventional diagnostic and treatment techniques while exposing Tufts medical students to the use of acupuncture as an approach to treating pain.
  5. The December 2006 issue of the journal Neurological Focus featured an article discussing the use of motor cortex stimulation (MCS) for treating intractable pain. Written by Dr. Richard Osenbach of Duke University Medical Center, the article noted that the use of MCS shows promise for treating patients suffering from central deafferentation pain.
  6. In the January 16 issue of the Annals of Internal Medicine, Dr. Bridget A. Martell reported on her work in examining the use of opioids for chronic back pain. She found that there was no statistical evidence that opioids worked better than a placebo for long-term treatment. She also found that prescribing opioids was more common if a patient went to a specialty treatment center than if he or she went to a primary care center. “Suspicious” medication-taking behaviors among the patients studied occurred in up to 24 percent of cases.
  7. The on-line Psychiatric Times carried an article by Penelope Ziegler, M.D., titled “Safe Treatment of Pain in the Patient with a Substance Use Disorder.
  8. An article in Warren, Ohio’s, Tribune-Chronicle discussed a technique for pain management developed by Raymond J. Petras, Ph.D. Called TAP for “taking away pain,” the technique uses four steps in treating a patient’s pain. He has successfully used the technique on patients as diverse as athletes suffering from injury to those dealing with cancer.
  9. The National Committee for Quality Assurance, a private, not-for-profit organization that assesses and reports on the quality of managed care plans has initiated a program that will recognize practitioners who give superior care to those who suffer from back pain. The organization will use 16 evidence-based criteria to identify these practitioners.
  10. In an advanced online edition of the journal Nature, an article appeared reporting a study conducted by a group of scientists at the Scripps Research Institute. They identified a mechanism that enables certain compounds to activate a pain sensing protein. It is hoped that this development will yield new therapies for managing acute and chronic pain.
  11. The newspaper at the University of Kansas in Lawrence featured in article titled “For Pain or for Party.” The article noted the dangers in prescription drug abuse, particularly when “pill popping” is mixed with alcohol intake. It also noted that the 2005 National Household Survey on Drug Abuse revealed that 6.9 million young adults between the ages of 18 and 25 had abused prescription drugs at least once.
  12. The Cambridge Valley Rescue Squad in rural New York has been certified by the New York State Department of Health to administer pain medication to patients it is transporting to area hospitals. Sometimes these trips can take up to one hour.
  13. A recent issue of the Journal of the American Medical Association contained an article concerning the increase in legitimate use as well as abuse of opioid prescriptions.

OTHER DEVELOPMENTS OF INTEREST

  1. The American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association will hold its annual assembly in Salt Lake City, Utah, on February 14 through 17. Among the scheduled sessions includes a talk by Harvey Chochinov, M.D., from the University of Manitoba on “Dying with Dignity: A Contemporary Challenge in Palliative Care.”
  2. Starting in 2008, family physicians, internists, and doctors in eight other specialties will be able to be board certified in hospice and palliative medicine, according to an article in amednews.com.
  3. Brooklyn Law School will host an End-of-Life Care Symposium on February 8, which will focus on appropriate medical treatment at the end of life and the resolution of conflicts among the patient, family members, and physicians.
  4. The November 2006 issue of the Journal of the American Geriatrics Society contained an article by Elizabeth Vig, MD, and her colleagues that studied how surrogates make medical decisions for others. The data indicate that many surrogates rely on factors other than the patient’s best interests in making their decisions.
  5. The Center to Advance Palliative Care has launched a new website where doctors, patients, family caregivers, and policymakers can obtain information about palliative care, where it can be obtained, and help in making decisions regarding palliative care.
  6. The on-line Psychjourney Podcasts contains an interview with Dr. David Kuhl, author of What Dying People Want: Practical Wisdom for the End of Life.
  7. An article in the January 8, 2007, issue of Archives of Internal Medicine reports on the findings of Jennifer L. Wolff, PhD, and her colleagues at the John Hopkins Bloomberg School of Health regarding end-of-life care. They found that nearly three quarters of disabled older people receive care from a friend or family member during their last year of life.
  8. The January 14 issue of Boston.com featured an article about Dr. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center in New Hampshire. According to the article, he intends to make end-of-life care a central issue when presidential candidates visit New Hampshire this year. The article noted that only 25 percent of United States hospitals have palliative care programs.
  9. The U.S. Department of State’s on-line publication USInfo carried an article about Children’s Hospice International (CHI). The article notes that CHI collaborates with the U.S. Department of Health and Human Services and health care providers in the United States to find better ways to care for terminally ill pediatric patients. Internationally, CHI has sent specialists to 42 countries to provide training.
  10. The website of the National Hospice and Palliative Care Organization contains the full report of the U.K.-based International Observatory on End of Life Care which found that an estimated half of the world’s 234 countries have no palliative care services available to their populations. The report was produced for the World Wide Palliative Care Alliance.
  11. The first palliative care center at Walter Reed Army Medical Center has opened for patients diagnosed with terminal cancer and their families. The bulk of the money for the center came from contributions from active duty men and women.
  12. A new book, End-of-Life Decision Making, contains a series of essays written by experts from twelve countries that analyze their respective nations’ policies regarding health care costs, advance directives, and pain management, and explores cultural, social, and religious factors. The countries include Brazil, China, Germany, India, Israel, Japan, Kenya, the Netherlands, Taiwan, Turkey, the United Kingdom and the United States.
  13. The Journal of Clinical Oncology’s December 1 issue included an article discussing the difficult issue of parents’ disagreeing with cancer specialists about the care of their children. Dr. Jeffrey J. Hord and colleagues explored the fallout from such decisions made in the cases of six children. When the parents in these cases determined that they were going to refuse standard therapy treatments and pursue alternative interventions, doctors took the parents to court. In two of the six cases, the courts upheld the parents’ position.
  14. The January 17 issue of the Journal of the American Medical Association has an article titled “Palliative Management of Fatigue at the Close of Life.” The authors discuss the clinical approach to assess and treat fatigue in patients who are close to the end of their lives.

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