Is your drug database leading you astray?
Researchers estimate that more than 1 million people are injured by medication errors every year. While the causes for those errors are many — from poor handwriting on prescriptions to mistakes by pharmacists filling the prescriptions to patients taking the wrong doses — one research team says one of the tools physicians use in choosing and prescribing drugs may be leading to errors.
Scott Strayer, MD, assistant professor of family medicine at the University of Virginia Health System, suggests, in a study published in the July issue of Journal of the American Medical Informatics Association (www.jamia.org), that drug databases could be partly to blame for medication errors. He cites as an example that only two of 15 popular databases reported the recall of a popular painkiller on the same day the recall was announced — a fact he says could indicate the likelihood that the databases are missing updates on contraindications and adverse reactions.
The report states that several prominent drug reference databases took an average of more than three months to update the withdrawal of valdecoxib (Bextra) from the market.
Women's hearts less well-tended than men's?
A study conducted by University of Michigan researchers and funded by the American College of Cardiology found a significant difference between the treatment received by female heart attack patients and that received by men. The study, which appears in Archive of Internal Medicine, shows that despite hospitals' efforts to improve care for all patients immediately after a heart attack, women were less likely than men to benefit from hospitals' quality improvement measures and were less likely to receive the full spectrum of medications, testing, and education that has been shown to improve survival and longevity in heart attack patients.
The study, led by Kim Eagle, MD, co-director of the university's cardiovascular center, examined records from nearly 4,000 Medicare-insured heart attack survivors treated at 33 Michigan hospitals. The difference in care, the authors write, may explain why women in the study had a higher likelihood of dying within a year of their heart attacks than men.
Both men and women in the study had a better chance of surviving a year after their hospitalization if their hospitalization occurred after the hospital had begun quality improvement efforts, compared to those hospitalized before quality efforts were undertaken. The improved survival rate was smaller in women.
Eagle writes that the different may be due to the fact that female patients were less likely than men to have one-on-one instruction in how to understand and manage the medications and lifestyle changes needed to improve their health. Both men and women who signed a discharge contract with their doctors and nurses that included a pledge to stick to treatment and follow-up appointments had a 54% lower risk of dying within a year than those who did not, the authors wrote.
While the reasons behind the persistent differences are unclear, Eagle and colleagues speculate that it may have something to do with the fact that women heart attack patients tend to be older, and as a result doctors may not feel that women patients can derive as much benefit from post-heart attack treatments and lifestyle changes.
AMA statement against MD participation in executions
The American Medical Association (AMA) mostly reserved comment on physician participation in executions as several states and their courts wrestled with the ethics and obligations surrounding lethal injections, issuing statements only about specific rulings. But in late July the association's president issued a statement that leaves no question about where the AMA stands on the issue.
"The American Medical Association is troubled by continuous refusal of many state courts and legislatures to acknowledge the ethical obligations of physicians, which strictly prohibit physician involvement in a legally authorized execution," AMA President William G. Plested III, MD, said in the statement. "The AMA's policy is clear and unambiguous — requiring physicians to participate in executions violates their oath to protect lives and erodes public confidence in the medical profession."
The AMA defines physician participation in executions as actions that fall into one or more of the following categories:
- it would directly cause the death of the condemned;
- it would assist, supervise or contribute to the ability of another individual to directly cause the death of the condemned; and/or
- it could automatically cause an execution to be carried out on a condemned prisoner.
The AMA says the following do not constitute physician participation:
- testifying as to the medical history and diagnoses or mental state as they relate to competence to stand trial; testifying as to relevant medical evidence during trial; testifying as to medical aspects of aggravating or mitigating circumstances during the penalty phase of a capital case; or testifying as to medical diagnoses as they relate to the legal assessment of competence for execution;
- certifying death, provided that the condemned has been declared dead by another person;
- witnessing an execution in a nonprofessional capacity;
- witnessing an execution at the specific voluntary request of the condemned person, provided that the physician observes the execution in a nonprofessional capacity; and
- relieving the acute suffering of a condemned person awaiting execution, including providing tranquilizers at the specific voluntary request of the condemned person to help relieve pain or anxiety in anticipation of the execution.
Each of the 38 states that have a death penalty use the lethal injection method, and 17 of those states require physician participation. The AMA opposes physician participation on the grounds that physicians are healers, not executioners. No physicians who participate in the administration of lethal injections thus far have been sanctioned or lost their licenses for ethics code violations. The Society of Correctional Physicians and the American Nurses Association have both banned members from participating in or facilitating executions.
'Older, artier' students make better doctors
Older, artier, and better-rounded applicants who have at least a year's work experience make better medical students and happier doctors. That's what a British medical school researcher says he discovered in setting out to establish admission criteria that would identify the best candidates for medical careers.
Christopher Cowley, MD, of the school of medicine, health policy, and practice at the University of East Anglia in Norwich, UK, writes in the Journal of Medical Ethics in July that being older, more experienced in the arts, having work experience in health care or related fields, and a background in social sciences and literature would ensure that new medical students are not only technically proficient, but also more capable of understanding themselves and their patients.
Cowley says that medical schools have come a long way in improving curriculum content, but it is not clear what further improvements can be made with "the raw materials [students] at hand."