RxInformatics.com

The Los Angeles Times(3/9, Roan) "Booster Shots" blog reported that, according to a studypublished in the Journal of the American Medical Association (JAMA), "only 32% of medication studies published in top medical journals compared the effectiveness of existing treatments." The analysis of "328 medication studies in six leading journals" showed that "most compared medications against an inactive substance (a placebo) or involved unapproved therapies that are not currently available to doctors."

        In fact, the Boston Globe(3/9, Cooney) "White Coat Notes" blog reported that "only about a third" of the studies "met the definition of comparative effectiveness," meaning that "they directly compared drugs against other treatments to see which worked best." Notably, "comparative effectiveness studies were less likely than the other studies the authors reviewed to be funded by drug companies."

        Researchers found that "nearly 90% of such studies were funded by noncommercial institutions, such as not-for-profit foundations or government agencies," Modern Healthcare(3/9, Rhea, subscription required) reported. The authors noted that most studies failed to address "fundamental questions such as: How can we use this medication more effectively."

        HealthDay(3/9, Mundell) reported, "Relatively few studies (11 percent) compared an existing drug to non-pharmacological interventions (for example, exercise/diet or surgery) and less than one-third focused on different medication approaches (for example, achieving an optimal blood sugar level in patients with diabetes)." Meanwhile, "only 19 percent of the studies reviewed focused on drug safety." MedPage Today(3/9, Gever) and Reuters(3/10, Fox) also covered the story.

        Physicians Push For More Comparative Effectiveness Research.In an op-ed in the Los Angeles Times(3/10), the JAMA study's authors, Michael Hochman, MD, assistant professor of clinical medicine at ...

A Primary Care Physician Survey

Stephen D. Persell, MD, MPH; Charles Zei; Kenzie A. Cameron, PhD, MPH; Michael Zielinski, MD; Donald M. Lloyd-Jones, MD, ScM

Arch Intern Med. 2010;170(5):470-477.

Background  Data are sparse regarding how physicians use coronary risk information for prescribing decisions.

Methods  We presented 5 primary prevention scenarios to primary care physicians affiliated with an academic center and surveyed their responses after they were provided with (1) patient risk factor information, (2) 10-year estimated coronary disease risk information, and (3) 10-year and lifetime risk estimates. We asked about aspirin prescribing, lipid testing, and lipid-lowering drug prescribing.

Results  Of 202 physicians surveyed, 99 (49%) responded. The physicians made guideline-concordant aspirin decisions 51% to 91% of the time using risk factor information alone. Providing 10-year risk estimates increased concordant aspirin prescribing when the 10-year coronary risk was moderately high (15%) and decreased guideline-discordant prescribing when the 10-year risk was low (2 of 4 cases). Providing the lifetime risk information sometimes increased guideline-discordant aspirin prescribing. The physicians selected guideline-concordant thresholds for initiating treatment with lipid-lowering drugs 44% to 75% of the time using risk factor information alone. Selecting too low or too high low-density lipoprotein cholesterol thresholds was common. Ten-year risk information improved concordance when the 10-year risk was moderately high. Providing lifetime risk information increased willingness to initiate pharmacotherapy at low-density lipoprotein cholesterol levels that were lower than those recommended by guidelines when the 10-year risk was low but the lifetime risk was high.

Conclusions  Providing 10-year coronary risk information improved some hypothetical aspi...

Non-Compete Agreements

Non-compete agreements (NCAs) are designed to prevent individuals from leaving a company with valuable information and then using that information in a new job with a competitor of the company to the detriment of that original company/employer.

Sounds reasonable on its face. On the other side, what if you are the employee that with no malicious intent whatsoever, elects to change jobs and move on to bigger and better things? You should be free to do so, right? If on exiting your current job you are presented with the NCA that you signed when starting (and may have forgotten or misplaced) and you are a valuable developer, your soon-to-be former employer may be dropping more than a subtle hint in your lap.

So what is fair and reasonable in light of the two justifiable yet opposing positions?

This is the essence of the determination that courts must make in cases involving NCAs. In general terms, in order for an NCA to be “reasonable” it must protect an employer’s legitimate business interests while not unduly restricting the employee’s ability to work elsewhere. Other key considerations are length of time and geographical area (historically). The first part, protecting legitimate business interests, is satisfied if the employee involved had access to trade secrets of the former employer. Further, if the employer uses NCAs for only certain employees that have access to confidential material or trade secrets, they strengthen greatly their likelihood of support from the courts. As for length of time, six months to two years depending on the situation, is usually found to be acceptable. Anything longer than that would require a stiffer business reason for the restriction. Finally, geographic scope is considered. In the technology industry however, geographical area could include the entire US market. There has been some relaxing of the geographical scope restriction, which is why I used the parenthetical “historically” above.

Note that the NCA is a contract. All contracts must have “consideration...

Leroy Hood has been at the center of a number of paradigm shifts in biology. He helped to invent the first automated DNA sequencing machine in the 1980s, along with several other technologies that have changed the face of molecular biology. And in 2000, he founded the Institute for Systems Biology, a multidisciplinary institute in Seattle dedicated to examining the interactions between biological information at many different levels, and to moving forward a new perspective for studying biology. The next revolution he plans to help shape is in medicine, using new technologies and new knowledge in biology and informatics to make its practice more predictive, preventative and personal.

Hood says that with each of the major transitions he's been a part of, he has faced skepticism. The human genome project, for example, had many naysayers. But he says the best way to overcome doubts is with results. To that end, Hood has founded a startup called Integrated Diagnostics, which is developing cheap diagnostics that could be used to detect diseases at earlier, more treatable stages. He has also developed a partnership between the Institute for Systems Biology and Ohio State Medical School, where he hopes to show how combining existing medical and genomics technologies can affect the practice of health care today.

Hood contends that digitizing medical records--the health-care industry's major push at the moment--is just one small part of the informatics overhaul the field needs to undergo. And pharmacogenomics--the practice of using an individual's genetic makeup to choose drugs --provides only a limited example of the potential power of personalized medicine.

TR: How do you see the future of personalized medicine?

LH: I think personalized medicine is too narrow a view of what's coming. I think we'll see a shift from reactive medicine to pro...

Class Schedule

The inaugural semester of NHIN University will feature a series of webinars intended to provide stakeholders with foundational knowledge about what the NHIN is, how it works, and the vital trust fabric that underpins the safe and secure exchange of health information over the Internet.

Questions? Aaron Seib, NHIN Project Manager or Meryt McGindley, Acting Communications Director