Judge approves physician- Aetna settlement

The 11th U.S. Circuit Court of Appeals cleared the way for insurance giant Aetna to go forward with a settlement agreement reached last year in a massive class-action lawsuit alleging the plan unfairly reimbursed doctors.

The Atlanta-based federal appeals court in late September affirmed the settlement that the company agreed to with the nation’s physicians and organized medicine. A handful of physicians challenged the settlement that U.S. District Judge Federico Moreno in Miami approved.

The settlement includes $100 million to be divided among physicians who are part of the class. Many physicians donated their portion to a foundation established under the agreement that will promote physician-directed improvements to the health care system. The agreement outlines the steps Aetna will take to improve business relations with doctors, including disclosing how the company determines what it pays for physicians’ services. Aetna estimates the business practice improvements will be worth about $300 million to physicians.

Some British med students justify sex with patients

A small, British sample study published recently in the Journal of Medical Ethics indicates that while most medical students say a sexual relationship with a patient is not justifiable, four out of 10 said they could justify having a relationship with someone who has been under their care.1 Researchers monitored the responses of 62 British medical students to a validated questionnaire on four separate occasions during the course of their training, and found the students’ views changed little as their training progressed.

The questionnaire asked students to imagine that they were general practitioners on a small, remote Scottish island, and were presented with the opportunity to initiate a romantic relationship with a patient who was coming to the end of a period of lengthy treatment.

Sixty percent of the students said they would refuse, mostly on the grounds that it was unethical or would compromise the doctor-patient relationship. Other reasons included abuse of power and a feeling that such behavior would be unprofessional. But four out of 10 students said they would pursue the relationship. The principal reasons given were the difficulties of meeting a future mate in such a setting, the belief that professional and private lives can be kept separate, and the feeling that this would be acceptable if the patient changed practice. These views remained fairly constant over time.

The authors cite international studies showing that sexual relationships between doctors and their patients, particularly in general practice, gynecology, and psychiatry, are relatively common. They cite U.S. research suggesting that one in 10 family doctors surveyed had had sexual contact with at least one patient, while an Australian study found that almost one-third of family doctors questioned knew of a colleague who had had sex with a patient.

"Particularly vulnerable are socially isolated, middle-age men experiencing a midlife crisis, who are eminent in their field," say the authors, pointing out that the risk of sexual misconduct increases with age, rising 44% with every decade. The authors conclude that far too little attention is paid to the issue of sexual or improper relationships in medical training, and that these issues need to be made more explicit.


1. Goldie J, et al. Sex and the surgery: Students’ attitudes and potential behavior as they pass through a modern medical curriculum. J Med Ethics 2004; 30:480-486.

Prosecution urged for flu vaccine price gouging

Department of Health and Human Services Secretary Tommy G. Thompson sent a letter to the Attorney General of each state in October, urging them to thoroughly investigate reports of price gouging involving the flu vaccine and to prosecute those found to be taking advantage of the vaccine shortage.

"It is extremely disturbing to learn of reports of price gouging by immoral individuals looking to make a quick buck off of a public health challenge," Secretary Thompson wrote in the letter. "I am encouraging the attorney general of each state to thoroughly investigate reports of price gouging and prosecute those engaging in this immoral and illegal activity to the full extent of the law."

Secretary Thompson said it will take the good faith and cooperation of all Americans — the public, doctors, nurses, and public health professionals — to ensure that the flu vaccine goes to those who truly need it most this flu season. Information on who is recommended to get the flu vaccine is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/flu/protect/whoshouldget.htm.

Health disparities persist between Hispanics, whites

Despite progress in combating health disparities, a significant gap persists between Hispanic Americans — the nation’s largest ethnic minority group — and whites in both access to care and prevalence of a leading chronic illness, according to the Centers for Disease Control and Prevention’s Oct. 15 Morbidity and Mortality Weekly Report. The country’s 35 million Hispanics are less likely than whites to have a regular health care provider (68.5% vs. 84.1% in 2001-2002) and to have health coverage (76.2% vs. 90%), the report shows. Hispanics also are less likely to receive important preventive care, including breast cancer and cholesterol screenings, and more likely to have diabetes.

In the key states studied, the overall prevalence of diabetes among Hispanics is twice that among whites (9.8% vs. 5%). "For society, these disparities translate into less than optimal productivity, higher health care costs, and social inequity," the report says, noting that Hispanics will comprise an estimated one-quarter of the population by 2050. The report urges "using culturally appropriate programs to advise Hispanics about the importance of screening, expanding access to health care, and targeting specific barriers to care, such as poverty and lack of knowledge among health care professionals about how best to encourage Hispanics to use preventive services."