Headlines: May 10, 2011
by Meg Larkin
This week there is a new development in the ongoing legal battle over last year’s health reform law. Starting Tuesday, courts of appeals will begin to hear challenges to the law’s constitutionality. The Fourth Circuit Court of Appeals will consider two contradictory lower court rulings, one upholding the law, and one finding it unconstitutional. If the Court reaches a decision quickly, the case may reach the Supreme Court during it’s next session, which begins in October. Since the Patient Protection and Affordable Care Act was passed, 31 lawsuits have been filed challenging the law. Of those, 31, nine are waiting to be heard in Courts of Appeals and nine are in Federal District Courts. The remainder have been dismissed. So far, the rulings at the district court level have split largely along party lines, with judges appointed by Democratic presidents ruling in favor of the law’s constitutionality and judges appointed by Republicans ruling against. The law is being defended by the Obama Administration’s acting solicitor general Neal K. Katyal.
Turning to the topic of medical education, the MCAT is about to undergo its fifth revision. The MCAT is used to assess the aptitude of medical school applicants, and over the years since its adoption, it has contributed to a dramatic decrease in the number of people who drop out of medical school. The latest revision, however, is aimed in part at covering area not previously tested on the MCAT: personality. The New York Times reported that the MCAT advisory panel has recommended, “lengthening the four-and-a-half hour exam by 90 minutes and adding questions on disciplines like sociology and psychology. The new exam would also test analytical and reasoning skills in areas like ethics, philosophy and cross-cultural studies.” Some medical educators have expressed concern over tampering with a test that has been so successful at predicting medical school success, while others are concerned that a personality scoring mechanism might risk branding applicants with a numerical personality score at an early stage. The MCAT advisory committee is accepting suggestions for how to redesign the test on its website until February.
In regulatory news, a recent review by the federal government has found that over half of antipsychotics paid for by Medicare are improperly prescribed. According to the New York Times, “Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments.” The audit found that improper prescription of antipsychotic medications to treat dementia in the elderly cost the Medicare program $116 million in the first half of 2007 alone. The Inspector General for the Department of Health and Human Services has suggested that the federal government should collect information on the diagnoses given to Medicare patients in order to ensure appropriate prescribing practices, but such a move is likely to be vigorously opposed by doctors’ groups and some members of congress. Although the dangers of using antipsychotic medications in the elderly have been known for some years, a lack of other options and aggressive marketing by the pharmaceutical industry have contributed to their continuing use in that population.
In other pharmaceutical company news, many large drug makers are using digital tools to replace sales reps. Where, formerly, pharmaceutical companies employed large armies of sales representatives to pay visits to doctors’ offices, many are now downsizing the sales force and increasing reliance on websites and marketing tools designed for handheld electronic devices. The Wall St. Journal reported that, “The changes are designed to cut costs and to reach doctors in ways other than the traditional office visit, which many busy physicians say they find intrusive and annoying.” The tools enable physicians to get more information about a company’s products and have the option of reaching a trained sales representative without having to make time to see the reps during office hours. Although digital marketing may not be as effective for sales as having a trained sales rep pay a visit to a doctor, the digital tools can result in substantial cost savings for the drug companies.
Finally, in global public health news, a study done in South Korea has found a much higher rate of autism than previous studies done in the United States. Unlike previous studies, which used medical records to determine autism rates in the general population, the South Korean study surveyed children in the mainstream education system. Researchers found an autism rate of 2.6 percent compared with 1.0 percent in the United States. According to the Boston Globe researchers, “don't think South Korea has more children with autism than the United States, but instead that autism often goes undiagnosed in many nations. U.S. estimates are based on education and medical records, not the more time-consuming survey conducted in South Korea.” Two thirds of the children identified as autistic in the South Korean study were in the mainstream school population and had milder forms of autism. It is unclear which of those children may benefit from additional medical interventions.
Meg Larkin is a third year law student at Boston University. Please feel free to email her with any questions, comments, suggestions or concerns.