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Regulatory Issues

Reaping Royalties, Medicare Bounty

This article from the Wall Street Journal is important in a number of ways: Implant surgery is both highly expensive as well as hotly debated as to efficacy and indications. The article suggests that not only are the surgeons profiled therein highly compensated for their expertise in the operating room (and are not compensated nearly as well for declining to perform a procedure), but they appear to be receiving incentives from the device manufacturer for their relationship – one that is more than likely contingent upon continued use of and promotion of the devices.

The article discloses relationships of the sort that in the past were unreported but significant. Spine surgery is often suggested in workers’ compensation cases as well as auto accidents. The indications and cost of such procedures is highly relevant to those overseeing such claims.

Beyond continued scrutiny and perhaps regulation, what other suggestions are in order? One is that any patient should ask and have the right to know if their prospective surgeon is receiving compensation of any sort from device and pharmaceutical manufacturers, including the amount and the rationale behind the royalties. If surgery is proposed and a device by a company compensating the physician is to be used, it would be reasonable to get a second opinion from a physician who has no such interests.

Service Dog Expansion Stretches Credibility

I have long had an interest in the expanded definition and use of service-dogs in US society. Historically these animals were used to extend capability to individuals with sensory deficits, primarily sight. Appropriate access laws and policies have been in place for some time with respect to these dogs.

The January 15 “Psychiatric News” of the American Psychiatric Association had a sympathetic article on the topic. I wrote a letter to the editor that was published on April 16 in response to this article.

I have been chagrined to see a trend towards creating a special class of animals to provide for the subjective comfort of their owners, to the degree that this imposes duties upon others to provide access and rights to the dog and their owners. For example right to be in workplaces, on public transportation, restaurants and other public accommodations that do not permit pets. At this point to my knowledge the issue has been addressed in the regulatory and not judicial sphere. A test case or two in the Federal courts would be illuminating and may soon be overdue.

While I can’t dispute the strongly held positions and  passions of others who feel the need for such accomodations for emotional issues, society at large has an equally compelling right to set limits on the obligations of others to participate or endorse these views.

It should also be noted that there is no meaningful credentialing of such service dogs or the claims of those who wish to use them. A web search will find any number of sites that will provide credentials for the animals and endorsement for their owners based upon self-report of need. See: http://www.servicedogsamerica.org/ and http://www.psychdog.org/index.html as a small sample of the many sites on the topic.

See http://www.pawnation.com/2009/05/21/service-animals-pets-helping-people/ and click on the slide show showing a number of ‘service animals’. Based upon the criteria that the animal do something and perform a service, which of them do you feel are legitimate in their function, and warrant the definition and rights of a service dog?

By the way, I have two dogs (King Charles Spaniels) and am rather fond of them, but they are pets, not therapists – regardless of he companionship and comfort that they may provide.

Benefit for Uninsured May Still Pose Hurtle

With the passage of health reform, we are now seeing frequent reports of its shortcomings. The new legislation still relies upon a private insurance market and the expectation that individuals will buy insurance or suffer penalty. People, especially those with lower incomes, will behave rationally and in what they perceive to be their economic interests. This many for some include preserving scarce cash today, and not focusing on an uncertain and expensive need for future health care. Rather than argue that people should behave responsibly and address future health issues with insurance, this article, from April 20 in the NY Times, and the individuals describes speaks for itself.

A Remedy for Troubled Doctors

Physicians from time to time have issues impacting their ability to practice. Many of these issues are temporary, relating to health or substance abuse, skill deficiencies and other matters. Others may become permanent. At MCN in the course of credentialing consultants, we review cases where regulatory action has taken place. This Wall Street Journal article describes one program’s approach to assessment and remediation of physicians who have practice issues leading to regulatory action in California.