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33 posts from July 2009

July 30, 2009

Senate Aging Committee: Hearing on Education and Research: Higher Learning or Higher Earning – No More of Either

Hearing

Fair and balanced presentations which rely on evidenced based medicine are principles that for the most part are strictly adhered to in the delivery of continuing medical education (CME) activities across the country.  Unfortunately those same rules don’t apply to congressional hearings, as we saw firsthand yesterday at the Senate Aging Committee hearing titled Medical Research and Education Higher Learning or Higher Earning.

There is nothing good that could come out of commercially supported CME – that was the crux of the sentiment of first panel at a recent Senate Aging Committee hearing “.  Fortunately there were two panels and he second panel spoke of the advances in medicine and the benefits of CME and that we should not throw out the baby with the bathwater. 

By far the most outrageous statement at the hearing or any hearing that I have ever attended goes to Steve Nissen, MD who mused that ending commercial support for CME ($1 billion) would save $90 billion/year or $900 billion/ten years from the healthcare budget thus closing the trillion dollar ten year gap that the law makers have been looking for just by limiting the information physicians receive.

 

The hearing drew little attention with the national media, and was not covered in any of the national newspapers (Wall Street Journal, New York Times, Washington Post or Boston Globe….)

Details

Committee Chairman Herb Kohl (D-WI) outlined that “Providing ongoing training and access to the latest medical innovations is costly, to say nothing of the resources necessary to produce the research in the first place. Teaching hospitals and medical schools face rising costs as well. From that perspective, industry funding has fulfilled a real need. But as we know, large corporations do not typically spend these sums unless they think they will get something out of it.”

 

That’s not an indictment of the drug and device industries, it is just how business works. This brings us to the crux of today’s hearing. Are the drug and device industries getting a return on their annual billion dollar investment in medical education? Do the programs funded by industry stay true to their mission of providing unbiased education and research, or do they instead market the industry’s latest products? We are not suggesting that these financial relationships are rife with corruption, but it is clear to us that greater transparency, and perhaps stronger firewalls, should be considered.

 

Ranking Minority Member Mel Martinez (R-FL) Stated that Today, doctors and patients enjoy access to an abundance of information from numerous sources. Patients rely on doctors to sift through this information and use it to make sound judgments about the benefits and risks of certain medical procedures, drugs, and devices.

While off-label prescribing by doctors is legal and in many instances appropriate, promoting a drug for off-label purposes by the drug-maker is not.

 

Continuing medical education is essential for disseminating information that helps doctors make decisions about appropriate off-label use of a drug.

Sometimes the line between promotion and education can be blurred. This is why transparency and appropriate, commonsense safeguards, are necessary.

 

Lewis Morris, Chief Council, Office of Inspector General, Health and Human Services, stated that “Current environment favors the industries needs… almost exclusively covers topics that favor supporters products”  he outlined some practices such as directing honorarium that have since.

He threw out that elimination of commercial support would be a simple solution but probably not a practical one.

He suggested several measures that companies can take to mitigate the potential problems with commercial support including:

· Separate grant making function from CME from sales and marketing

· Establish objective criteria for making educational grants to CME providers

· Eliminate any control over speakers or content of the educational activity

For the most part these steps have been adopted by manufactures.  

The other major recommendation he suggested is to set up “Independent CME grant organizations” that would review and give out grants independently of the commercial supporter. 

 Later during questioning he used as an example that the American Academy of Orthopedic Surgeons has set up such an organization but admitted that companies declined their funding requests and the future of the program remains uncertain.

There is something about economics that is continually missing from the discussion.  At the end of his presentation he lamented that physicians should pay for their own CME, similar to lawyers, accountants and other professionals.  That this would improve the “quality” of the CME, I am not sure how less funds equals greater quality by any measure.  The hospitals in Michigan City Indiana would never get a speaker come from out of town and believe you me they need speakers from out of town to educate on important medical issues and breakthroughs.

Morris and the other speakers failed to mention to the senators that the FDA has existing guidance on CME which address many of the issues brought up by the panelist.

Steve Nissen, MD Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic,  former president of the American College of Cardiology and Prescription Project Advisory Board Member, showed his diversity in being an expert on absolutely everything.   Just days ago he was interviewed by CNBC leading the charge on health care reform, today an expert on CME.

Steve prided himself on his JAMA editorial which Senator Kohl lauded as a “research” paper calling for Zero ($0) funding from industry to medical specialty societies.    He outlined a fictional world in where “CME has become an insidious vehicle for aggressive promotion of drugs and medical devices”   the problem is for the most part he could not be further from the truth.

He complained that “on several occasions I have written the ACCME to complain about inappropriate CME-accredited activities. My letters were never even acknowledged.”  In his written comments his proposals include

  • Passing the physician payment sunshine act
  • Legislation requiring drug and device companies to be held liable if false or misleading claims are made at CME programs (so much for independence)
  • Replacing the ACCME with an IOM commission to regulate CME
  • For non-profit professional societies eliminating the tax exempt status of CME support

Perhaps the next time company CME departments get grant requests from the Cleveland Clinic, they are sent back with Dr. Nissen’s comments attached for clarification.

Eric Campbell, PhD Director of Research at the Institute of Health Policy at Harvard (who’s carrier has been doing anti-industry studies) Discussed the Institute of Medicine Report on Conflicts of Interest in Medical Education, Research and Practice.  He discussed the frequency of industry relationships (considers all relationships ubiquitous) he sees risk of undue influence everywhere.    He stated the IOM report called for disclosure of all types of payments.    Outlined that system is far too reliant on industry funding, admitted that though they lacked tools to measure the committee saw significant opportunity for bias (i.e. we know it is there) goal of IOM is funding system free of all influences of industry.  He called for stronger enforcement measures (ie government intervention).

The final panelist was Jack Russly a medical school student from Brown University and national leader of American Medical Students Association (who told Tom Stossel he signed up a as member of the Association of Clinical Researchers and Educators ACRE) spoke about the Pharm Free Score Card which is now supported by the Prescription Project which rates universities on their conflict of interest policies.  For the most part young Jack was clueless.

During the discussion it was clear that the two Senators Martinez (R-FL) and Frankel (D-MN)  who participated in the hearing with Senator Kohl, were completely unfamiliar with current continuing medical education practices and were in shock as would anyone who had no understanding of CME after they had they heard the first group of speakers with no contextual framework.  The Kohl staff by the selection of the first group of speakers did a great job in putting CME practices in the worst possible light essentially blaming CME for all the problems in the healthcare system.  

When the first group was asked by Senator Kohl if there was anything good about commercial support of CME the first group unanimously stated there was nothing good to come from commercial support of CME. 

The second panel was designed to bring some balance to the hearing by the time they got to that panel the room had cleared out significantly.

 

Thomas Stossel, MD, who is the American Cancer Society Professor of Medicine at Harvard Medical School and in the leadership of the Association of Clinical Researchers and Educators (ACRE), identified significant healthcare advancements made possible through physician-industry collaboration. Industry support of independent medical education and research has helped increase life expectancy, lessens the need for major surgery and cardiovascular disease deaths have fallen by 50% over the past 30 years, and cancer deaths are at an all time low.” Stossel said.

 

While some individuals are calling for the elimination of industry support for research and education, due to alleged conflict of interest, Stossel urged Congress to rely on facts instead of accusations and anecdotes. Past isolated examples of unethical behavior should not be used to taint an improved system that enables productive, ethical collaboration for the advancement of research and education which ultimately improves patient health.

 

“We had better have pretty good evidence to tamper with a system of innovation and education that has done so much good,” Stossel said. “What passes for evidence is the relentless reiteration of inevitable, sometimes egregious, but vanishingly uncommon adverse events – these events are without reference to the tens of thousands of actions that have led to highly valuable products and much better patient outcomes.  The plural of anecdote is never data.”

 

Stossel addressed the fact that medical advancements and improved patient health requires increases in research and independent medical education funding. Without industry funding for education and research, physicians will have an even more difficult time keeping up with the new science and information related to novel drugs and improved practices. Despite significant changes and regulatory improvements in the continuing medical education (CME) arena, unfounded accusations about conflicts of interest have pushed pharmaceutical and medical device manufacturers to reduce education funding by 20% in the past year alone. If these trends continue, patient benefit will diminish along with other positive outcomes stemming from physician-industry collaboration.  

Unfortunately the information he was sent by the committee he was asked to address issues in research, education in both medical school training and continuing medical education, so his talk was broader than the other speakers.

James Scully, Jr. MD Medical Director and CEO of the American Psychiatric Association  described some of the steps they have taken to manage conflicts of interest and respond to congressional inquiries.  A telling part of his presentation was the revelation that the APA has more attorneys on staff than physicians.    He also stated that the changes in their policies are costing the association $1.5 million/year.  He thinks that the new focus on real and perceived conflicts of interest is a good thing….

Murray Kopelow, MD , MS the Chief Executive Officer of the Accreditation Council for Continuing Medical Education (ACCME) outlined that CME has valid content

He strongly stated that CME is currently independent of influence of commercial support.

The relative portion of CME supported by commercial entities continued a decline that began in 2003.   In real portions commercial support dropped by $200 million in 2008.

15% of provider receive 80% of the commercial support, the policy that excludes any entity that produces programs that promote products.

He discussed the proposals that are on the table at the ACCME including:

  • Complete elimination of commercial support
  • Allowing commercial support when:
    • Educational needs are indentified and verified by an organization that is free of commercial support
    • CME addresses a gap in professional practice corroborated by bona fide performance measures
    • CME content is from a curriculum specified by a bone fide organization
    • CME is verified free of commercial bias
    • Accredited providers must not receive communication from commercial interest related to specific content that would be preferred.
    • Persons paid to create or present promotional materials on behalf of commercial interest cannot control the content of accredited CME
  • The use of designations like “Promotional Speaker Free”
  • Creation of a pooled funding entity

Overall the ACCME has instituted policies for monitoring and surveillance of activities to look for any CME violations.  He explained that as many as 10% of the accreditation decisions result in probation.

He explained the ACCME’s strict enforcement of accreditation policies and the changes that the ACCME has made in the areas of transparency and enforcement.

Summary

At the end of the hearing the Senators were much more open to commercial support than after the first panel.  Senator Martinez brought up that we should not stop free enterprise from taking place.

We have to consider that the issue of commercial support of CME is just a pawn in a wide chess game going on between drug and device manufactures and politicians.     We can’t take this personally; there is no responsibility on the increased cost of healthcare assigned to the government, hospitals or insurance companies yesterday the entire blame was laid on the feet of CME.

One positive note the committee blew up and printed a large poster of the Coalition for Healthcare Communications Ad that medical communications including CME constitutes free speech and in America, we don’t censor free speech….

Commercial support of CME took a beating, but in the end with the advances in medicine and the improvement in patient care that CME contributes to, it will live to see another day.

Webcast

 Webcast of Hearing

Statements

Witness Testimony

Lewis Morris,, Chief Counsel to the Inspector Geneal, US Department of Health and Human Services, Washington, DC

Steven Nissen, MD, Chairman, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH

Eric Campbell, Ph.D., Associate Professor, Director of Research, Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Jack Rusley, Chairman, Culture of Medicine Action Committee, American Medical Student Association; Student, Brown University, Alpert School of Medicine, Providence, RI

Thomas Stossel, MD, Translation Medicine Division and Senior Physician, Hematology Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA

James Scully, MD, Medical Director and CEO, American Psychiatric Association, Arlington, VA

Murray Kopelow, MD, MS, FRCPC, Chief Executive, Accreditation Council for Continuing Medical Education, Chicago, IL

Written Testimony

 University of Wisconsin

Georgetown University  

PhRMA

AdvaMed  

Merck

Council for Medical Specialty Societies

Dr. Danny Carlat, Tufts School of Medicine 

 

July 28, 2009

Health Care Reform: CBO on House Bill (No Savings Here)

With the media predicting the downfall of healthcare reform before the August Recess, and prominent politicians setting new deadlines, the recent reports from the Congressional Budget Office (CBO) seem to put one more nail in the coffin.

 

CBO and the staff of the Joint Committee on Taxation (JCT) recently completed a report on the America’s Affordable Health Choices Act, which was released by the House Committee on Ways and Means on July 14, 2009.

 

One of their conclusions is that “the proposal, as drafted, would yield savings of $2 billion over the 2010–2019 period with a high probability that no savings would be realized. President Obama said this plan would save $10 billion. According to their report, the legislation would induce some people to move in and out of employment-based coverage. Several factors contribute to that conclusion:

 

  • Workers who get insurance through their employer receive a significant subsidy because the cost of that insurance is not treated as taxable earnings for the worker and thus avoids both income and payroll taxes.

  • On average, that tax exclusion gives workers a subsidy of roughly 30 percent for purchasing insurance through their employer—a subsidy that would be forgone if the employer chose not to offer coverage and the workers instead obtained coverage in the new insurance exchanges.

  • Firms that decide to stop sponsoring insurance coverage for their workers would not be able to reduce their operating costs because, they would have to offer higher wages and other forms of compensation instead.

Under the proposal, nearly 90 percent of workers would be employed by firms that would either have to offer qualified coverage and contribute a significant share toward the premium or pay a tax equal to 8 percent of their total payroll.

 

That “play-or-pay” penalty would constitute a substantial portion of the average cost of providing insurance coverage, which has been estimated at about 12 percent of payroll currently (but which would rise over time). In dollar terms, the penalty would vary depending on a firm’s payroll, and would make no direct contribution to those workers’ insurance costs; they would then need to obtain coverage from another source in order to fulfill the individual mandate.

 

As a result, only a distinct minority of would be better off if their employer stopped offering coverage. Therefore, CBO noted that “employer-offered coverage would be the best option for the workforce overall, even with the new insurance exchanges.” Furthermore, the combination of the subsidy from the current tax exclusion and the penalty for firms that did not offer qualified coverage provides a strong financial reason for employers to continue offering coverage to their workers.  

 

In addition, firms with lower-wage workers would probably decide not to offer coverage—both because the play-or-pay penalty for not offering coverage would be smaller in dollar terms and because their workers would be eligible for larger subsidies in the insurance exchanges (or through Medicaid).

 

Smaller firms (those with an annual payroll of less than $400,000) would either be exempt from the play-or-pay penalty or would pay a lower tax rate. However, small employers with low-wage workers would be eligible for a tax credit covering up to 50 percent of the employer’s contribution toward health insurance premiums. Consequently, CBO estimates that in 2016, about 3 million people (including spouses and dependents of workers) who would be covered by an employment-based plan would not have an offer of coverage under the proposal.

 

Approximately another 3 million people (including part-time workers) in 2016 would obtain coverage in the exchanges because the employer’s offer would be unaffordable and they would therefore be eligible to receive subsidies through the exchanges. In sum, CBO estimates that by 2016, about 9 million people who would otherwise have had employer coverage would not be enrolled in an employment-based plan under the proposal.

In addition, CBO estimates that about 12 million new people would be covered by an employer plan in 2016 because the mandate for individuals to be insured would increase workers’ demand for insurance coverage through their employer.

 

Under the proposal, firms with 20 or fewer workers would be given the option to let their workers buy coverage through the insurance exchanges starting in 2014, and larger employers would begin in 2015. It is estimated that only firms with 50 or fewer employees would be permitted to buy coverage through the exchanges, and about 6 million workers and their dependents would obtain coverage in that way. About one third of those enrollees would choose the public plan.

 

Analysts at the Lewin Group recently estimated that if all employers were given access to the insurance exchanges, more than 100 million people would end up enrolling in the public plan.

 

CBO predicted a much smaller total because:

 

  • large employers would generally have lower administrative costs for health insurance than would plans offered in the exchanges,
  • employees of large firms are less likely than those of small firms to find the option of purchasing coverage through the exchange attractive
  • the public plan would probably have to incur much of the same cost in order to attract and retain members.
  • the public plan’s premium would, on average, be about 10 percent lower than that of a typical private plan offered in the insurance exchanges.

Interestingly, the CBO uses these estimates on premiums from the Medicare Advantage. We wonder if they included in that estimate the millions of dollars that are lost to fraud and abuse claims each year, did CBO account for that.

 

Interestingly, offering more firms the option of letting their workers purchase insurance through the exchanges “would probably have a limited effect on the proposal’s net budgetary impact.” Basically, the only way for money to be generated from the public plan is if employers purchase a large amount of plans, which would increase their workers’ taxable compensation and thereby would generate slightly higher tax revenues.

 

Greater enrollment in the public plan would also increase the plan’s outlays and premium collections, which would be included in the federal budget, but as long as the public plan charged premiums that covered its costs (as it is supposed to do under the proposal), those amounts would be offsetting.

 

The report estimates that about 1 million people will switch from employment-based insurance or individually purchased coverage to Medicaid in 2016, with about 10 million new people in Medicaid under the proposal. This proposal would impose a considerable penalty on employers that did not offer qualified insurance and contribute a substantial share of the premium.

 

Accordingly, by 2012, all newly issued policies purchased by individuals would have to be bought through the insurance exchanges; as a result, the proposal’s effects on premiums outside the exchanges would be seen in premiums for coverage provided by or through employers. The magnitude of the effect on average premiums would probably be modest.

 

Effects on the Risk Pool

 

Under the proposal, however, full-time workers with an offer of coverage from their employer would generally be prohibited from receiving subsidies through the exchanges—a restriction known as a “firewall,” which CBO believes would be largely effective. Moreover, the proposal would allow premiums in the insurance exchanges to vary only by age and then only to a limited degree.

 

The main reason some people would be paying less for their coverage is because newly enrolled people would be making premium payments they would not otherwise have made—so the changes in premiums would largely represent a transfer among workers rather than an improvement in the efficiency of employment-based insurance plans.

 

The proposal would prohibit insurers from varying the premiums charged to employers to reflect differences in the health status or likely costs of their employees. That change would not apply to employers who chose to bear the financial risk of providing health insurance to their workers, but it would affect employers who purchased such coverage from an insurer. Those limits might not have a substantial effect on the average premium paid by employers, but they would tend to increase premiums for firms with relatively healthy workers and decrease them for firms with relatively unhealthy workers.

 

Effects of Cost Shifting

 

A less direct way in which the proposal could cause private-sector premiums to change is by affecting the extent of “cost shifting”—a phenomenon in which lower rates paid to health care providers for some patients (such as uninsured people or enrollees in government insurance programs) can lead to higher payment rates for others (privately insured individuals).

 

On the one hand, the proposal’s expansion of eligibility for Medicaid and other provisions would substantially increase enrollment in that program (by an estimated 10 million to 11 million people in the latter part of the 2010–2019 period). In addition, many provisions of the proposal would reduce payments to hospitals and other providers.

On the other hand, we estimate that the proposal would ultimately reduce the uninsured population by roughly two-thirds, which would greatly attenuate the pressure to shift costs that arises today when uncompensated or undercompensated care is provided to people who lack health insurance. One recent estimate indicates that hospitals provided about $35 billion in such care in 2008—an amount that would grow under current law but would be expected to decline considerably under the proposal.

 

The adverse effects on hospital finances stemming from greater enrollment in Medicaid, cuts in Medicare payment rates, and enrollment in the public plan would also have to be substantial to offset those savings for hospitals as a group. Overall, therefore, the effect the proposal would have on private-sector premiums via cost shifting is unclear.

 

Changes in Payment Methods

The proposal would also alter some of Medicare’s payment methods such as a demonstration project to examine the use of “accountable care organizations” and would make other modifications that could encourage reductions in health care spending. Some of these benefits could “spill over” to the private sector. However, such effects would probably represent a small fraction of privately insured medical costs over the next 10 years.

 

Impact on the Labor Market

Requiring employers to offer health insurance—or pay a fee if they do not—would be likely to reduce employment. Under the proposal, employers with annual payroll above specified levels would be required to offer health insurance to their workers and contribute a significant share toward the premium or pay a tax equal to as much as 8 percent of their total payroll. For the firms that chose not to offer qualified insurance, that penalty would increase the cost of employing each worker by somewhat less than 8 percent.

 

Through the insurance exchanges and expanded eligibility for Medicaid, the proposal would enhance access to health insurance for people who are not employed and would provide subsidies for insurance to people with income below 400 percent of the federal poverty level who do not have employment-based coverage.

 

Those provisions could encourage more people to retire before age 65, and they might lead some people to choose not to work at younger ages. The provisions might also lead to better matches between workers and jobs, because workers would not have to stay in less desirable jobs solely to maintain their health insurance.

 

Longer-Term Costs of the Proposal

 

The CBO estimates that the proposal as a whole would increase federal deficits by $239 billion over the 2010–2019 period. In sum, relative to current law, the proposal would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.

 

Allocation of the Net Budgetary Impact Between Outlays and Revenues

 

Under the proposal, firms with relatively few employees and relatively low average wages would also be eligible for tax credits to cover up to half of their contributions toward health insurance premiums, which would reduce revenues by an estimated $53 billion over 10 years.

 

The Proposed Independent Medicare Advisory Council

 

The Administration’s proposal calls for an Independent Medicare Advisory

Council (IMAC) consisting of 5 members.

 

Recommendations for savings include:

 

  • Setting quantitative goals for reducing outlays in the Medicare program.
  • Broad changes in coverage benefit design, and payment and delivery systems.
  • A fall-back mechanism if goals for cost reduction are not met.
  • Independent verification of the expected reduction in program spending
  • Work with HHS, CMS and other similar agencies

In the end this report found very little to get excited about in the current house version of healthcare reform.   They looked all over for the “savings” but there were virtually none to be found. 

 

The Blue Dog coalition in the Democratic Party (conservative democrats), are currently holding up this legislation in the Energy and Finance committee until they get compromises from Congressman Waxman so the bill won’t bankrupt the country and small business owners at the same time. 

July 27, 2009

Senate Aging Committee: Hearing – Higher Learning or Higher Earning

The Senate Aging Committee is hosting a hearing this Wednesday July 29th at 2:00pm in Room 562 Dirksen Senate Office Building, Washington DC titled: Medical Research and Education: Higher Learning or Higher Earning. 

According to the Senators Press Release and other sources panelist include:

· Dr. Eric Campbell, Associate Professor and Director of Research, Institute of Health Policy, Massachusetts General Hospital, Harvard Medical School.  To talk from the IOM perspectives (IOM Report on Conflicts of Interest in Medical Education, Research and Practice).  Eric has made his carrier on publishing anti collaboration articles and stated to me late last year at an IOM meeting  “I will find bias in CME” 

· Jack Rusley, Chair, Culture of Medicine Action Committee, American Medical Student Association; Student, Brown University Alpert School of Medicine to talk from the perspective of their “Pharm Free” brand.  (Not sure what they expect to hear from in a group of medical students who’s only life experience includes going to school, but hey college students are always going to be radical about something.

Panel Two:

  • Dr. Thomas Stossel, Director, Translational Medicine Division and Senior Physician, Hematology Division, Harvard University, and Brigham & Women’s Hospital; Leadership, Association of Clinical Researchers and Educators (ACRE).
  • Dr. Murray Kopelow, President, Accreditation Council for Continuing Medical Education (ACCME) to explain ACCME Policy and Enforcement

According to the Senators Press Release:

The focus will be on conflicts of interest in the fields of Continuing Medical Education (CME) and other medical research.  As with many professions, physicians are required to participate in CME in order to maintain their license.  In recent years, the pharmaceutical and medical device industries have increased their funding of CME, as well as other medical education programs, medical schools, and professional medical associations.  The industries also pay physicians directly for their service as educational consultants.  According to the Institute of Medicine, industry funding for accredited CME quadrupled from $302 million to $1.2 billion between 1998 and 2006.

This influx of funding has raised concerns that CME and other medical research and educational activities, meant to keep doctors updated on the latest scientific advances and best practices in medicine, could be unduly influenced by the pharmaceutical and device industries.  The Aging Committee will hear from a number of well-respected witnesses on the topic and consider recommendations for reform of the CME delivery system.  The hearing will also highlight the ways in which some organizations are mitigating industry influence, while also enabling legitimate physician-industry relationships to flourish.

Senator Kohl, along with Senator Chuck Grassley (R-IA), is cosponsor of the Physician Payments Sunshine Act (S. 301), which would require the pharmaceutical and medical device industries to publicly report payments and gifts to doctors.  Recently, identical provisions to those in S.301 were included in the health care reform discussion documents released by the Senate Finance Committee.  Similar provisions were also included in the House tri-committee health reform bill, which also includes disclosure of industry payments to medical schools, sponsors of continuing medical education programs, and organizations of health care professionals.

Staff of Members of Congress, often pride themselves on coming up with cutie titles for hearings. 

In the case of Senator Herb Kohl of Wisconsin, Chairman of the Senate Aging Committee and his staff pride themselves on real winners.  In their eyes you are either a villain or hero, at least in one case last sessions hero (Reverse Mortgages: Polishing not Tarnishing the Golden Years  ) became this year’s villain (Reverse Mortgages: Leaving Seniors and Taxpayers on the Hook?).  So when he titled this weeks hearing on Medical Education and Research it was not surprising that his punch line was Higher Learning or Higher Earning.    

How fair and balanced that hearing will be?   Do you think his goal is to show the value those physicians who work with industry to develop life saving medication?   Given the title do you think there is a certain amount of jealousy simply because those physicians who work with industry earn more than those who don’t?

The CME industry saw a $200 million drop in revenue last year, just when funds are need to keep vital educational programs going, Senator Kohl seems to be working to even further reduce this figure.

The hearing promises to be a lively one.  Let the Games begin….

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