WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.

Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.

The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.

The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.

Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system.”

The administration does not try to define the difference between proper and improper payments. It says simply that public reporting of the financial ties between doctors and drug and device companies “will permit patients to make better-informed decisions when choosing health care professionals and making treatment decisions.”

The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul.

“The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.

Christopher L. White, executive vice president of the Advanced Medical Technology Association, which represents makers of medical devices, said the payment data could be used by federal law enforcement agencies, plaintiffs’ lawyers and whistleblowers.

“Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation,” Mr. White said.

Matthew D. Bennett, a senior vice president of the Pharmaceutical Research and Manufacturers of America, said the industry “supported transparency of physician payment information.” However, he said, it is important that payment data be presented in a proper context, emphasizing that interactions between doctors and drug companies played a critical role in improving care, educating doctors and fostering appropriate use of medicines.

Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.

Although the Congressional Budget Office does not predict immediate savings, it has said that, “over time, disclosure has the potential to reduce spending,” by reducing instances of overprescribing.

The law also requires drug and device companies to report the amount of “any ownership or investment interest” held by doctors or their immediate family members, other than holdings of publicly traded stocks.

The administration intends to apply the same disclosure requirements to doctor-owned companies that distribute medical devices. Such companies allow doctors to benefit financially from sales of devices they use in surgery.

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NYTIMES.COM

http://www.nytimes.com/2012/01/17/health/policy/us-to-tell-drug-makers-to-disclose-payments-to-doctors.html?pagewanted=2&_r=1

The eldest son of North Korea's late leader Kim Jong-il has predicted the regime would soon fail, with or without reforms, according to a new book that the author says is based on emails and interviews with Kim Jong-nam.

The book says that Kim Jong-nam – who has never met the new leader, his half-brother Kim Jong-un – described the dynastic succession as "a joke to the outside world", and said even his father had originally opposed the hereditary transfer of power.

"The Kim Jong-un regime will not last long," Kim Jong-nam is said to have written, forecasting a power struggle. "Without reforms, North Korea will collapse, and when such changes take place, the regime will collapse."

He added: "I think we will see valuable time lost as the regime sits idle fretting over whether it should pursue reforms or stick to the present political structure."

The claims emerge in a book by Yoji Gomi, a journalist with Tokyo Shimbun, who said he exchanged emails with Kim Jong-nam over seven years. The date of the remarks on the regime is unclear.

Gomi, who lived for years in Seoul and Beijing, said he met Kim three times in total, once in 2004 and twice in 2011.

"He gave me a very good impression. He's very gentle and friendly," Gomi said.

"We exchanged emails over some time and when I suggested compiling our exchanges as a book, he agreed. At first he wanted publication to be delayed, but when I said we ought to go ahead because of everything that is happening in North Korea right now, he said that was OK. I don't feel that he has any ambition to become leader of North Korea, but he wants to contribute to improving the situation in the country. He travels a great deal, but his base is in Macau."

A publicist for the Bungei Shunju publishing company said the book would be published shortly.

Kim Jong-nam has previously offered relatively outspoken if brief remarks on the North to journalists who have tracked him down, but these reported messages go much further. Experts on North Korea cautioned that it was impossible to verify the details unless or until Kim Jong-nam confirmed he had written the emails.

In one message, Kim Jong-nam remarked: "I'm concerned how Jong-un, who merely resembles my grandfather [former North Korean leader Kim Il-sung], will be able to satisfy the needs of North Koreans.

"Kim Jong-un is still just a nominal figure and the members of the power elite will be the ones in actual power."

He said his father had not wanted to pass power to a third generation, but decided the bloodline was needed to maintain the regime's stability.

He also said his father felt lonely after sending him to study abroad, growing close to his siblings instead, and displeased his father by calling for reform and market-opening and "was eventually viewed with suspicion". His views meant that the overseas education of his brothers and sister was shortened.

He also claimed to have told Kim Jong-il how concerned the international community was about the nuclear tests and missile launches.

He noted the North's hardline stance was based on the political system's determination to survive. Of the deadly shelling of Yeonpyeong island in 2010, he added: "It was a provocation by North Korea's military to justify their status and existence and the possession of nuclear weapons."

Asked about the new leader, he reportedly replied: "I'm his half brother, but I've never met him so I don't know."

But he said he had seen their middle brother Jong-chol a few times and was also on good terms with their aunt and uncle. Kim Kyong-hui and Jang Song-taek have become increasingly prominent in North Korean media and appear to be guiding the new leader as he assumes power, although some suggest Jang could become a potential rival.

Kim Jong-nam, who is believed to divide his time between Beijing and Macau, said of his arrangements: "The Chinese government is protecting me, but it is also monitoring me too. It's my inevitable fate. If you can't avoid it, it's better to enjoy it."

Reports have previously suggested Kim fell from favour with his father when Japanese authorities caught him trying to enter the country with a forged passport from the Dominican Republic, hoping to visit Tokyo Disneyland.

Kim said it was common for the North's elite to travel with forged documents, claiming Kim Jong also went to Japan with a fake Brazilian passport.

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THEGUARDIAN.COM

http://www.guardian.co.uk/world/2012/jan/17/north-korea-leader-not-long?newsfeed=true

NEW YORK – In celebration of the 2012 Lunar New Year, American Express today announced a new Gift Card design for the Year of the Dragon. The limited edition Lunar New Year Gift Card, exclusively from American Express, is available for purchase online with a free-shipping offer until January 31, 2012, at americanexpress.com/gift.

“For the third year in a row we have collaborated with the internal Asian Network at American Express to bring to life a unique gift card that celebrates the rich culture of several segments of the Asian community,” said Simran Kalra, Vice President and General Manager, E-Commerce with American Express’ Global Payment Options business. “American Express is excited for what the New Year will bring and we are proud to recognize Asian tradition through the release of this Gift Card.”

The Lunar New Year Gift Card features an intricate dragon image and traditional flower pattern background. The Lunar New Year Gift Card offers the perfect gift option which can serve as an exciting and special alternative to cash. The Gift Card offers the following benefits including:

Available in denominations of $25, $50, $100, and $200
• Accepted wherever American Express® Cards are accepted in the United States*
Funds on the Card do not expire and there are no monthly fees
Gift Card is replaceable at no fee if lost or stolen

Unlike some other gift cards, American Express® Gift Cards have no fees after purchase for activation, checking a balance, maintenance, or card replacement.  The online purchase price is $3.95 for all available denominations of this Gift Card.

for a special lunar new year giveaway.  Five lucky readers will each a receive a $50 gift card. To enter submit a lunar new year haiku to This e-mail address is being protected from spambots. You need JavaScript enabled to view it by Jan. 17  at noon. In the email subject heading write: Haiku. Winners will be notified via email.

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ASIANWEEK.COM

http://www.asianweek.com/2012/01/11/american-express-unveils-the-2012-lunar-new-year-gift-card/

 

 

 

(GLOBE NEWSWIRE) -- Care for Asian-American heart attack patients treated in hospitals in the American Heart Association's Get With The Guidelines (R)-Coronary Artery Disease program improved between 2003-08 and, with few exceptions, is comparable to care for whites. The research is reported in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

The findings are similar to other studies on blacks and Hispanics that found participation in the Get With The Guidelines quality improvement program reduced care gaps due to racial and ethnic disparities.

"Equitable quality care is possible across racial and ethnic groups, through quality improvement programs such as Get With The Guidelines," said Feng Qian, M.D., Ph.D., the study's lead author and a research assistant professor in the Department of Anesthesiology at the University of Rochester Medical Center in New York. "This improved care is more significant and sustainable the longer hospitals participate in the program."

Qian said Asian-Americans represent an important minority population and are one of the fastest growing racial/ethnic groups in the United States. However, very little was previously known about the clinical experience and outcomes of Asian-American heart attack patients.

Researchers analyzed data on 107,403 Asian-American and white heart attack patients from the Get With The Guidelines--Coronary Artery Disease database. Asian-Americans accounted for 4.1 percent of the patients in the study who were treated at 382 hospitals from 2003-08.

Care for Asian-Americans and whites improved in all measures over the five years. Only three measures were significantly different between the groups:

        
          --  Asian-Americans were less likely than whites to receive aspirin after
              discharge (93.9 percent vs. 96.9 percent)
          --  Asian-Americans were less likely than whites to receive smoking
              cessation counseling (83.1 percent vs. 93.1 percent).
          --  Asian-Americans were more likely than whites to receive lipid-lowering
              therapy (90.5 percent vs.89.3 percent).
        
    
    

Measures of care include:

        
          --  Prescribing aspirin within 24 hours of arrival
          --  Prescribing aspirin at discharge
          --  Prescribing ACE inhibitors or ARBs at discharge to relax and open
              arteries to lower blood pressure
          --  Prescribing beta blockers at discharge to reduce the heart's rate and
              workload to lower blood pressure
          --  Offering smoking cessation counseling
          --  Prescribing lipid-lowering therapy
          --  Improving door-to-balloon time to opening up clogged heart arteries
        
  
    

Asian-Americans were also more likely than whites to die in the hospital after a heart attack (11.5 percent vs. 5.8 percent), though that may partly be the result of patient characteristics rather than the quality of care received, researchers said.

Compared to whites, Asian-American patients were significantly older (average age 71 for Asian-Americans, 67 for whites) and were more likely to have cardiovascular risk factors and conditions including diabetes, hypertension, heart failure and smoking. After adjusting for these, the difference in death rates was reduced but still present.

Some differences in treatment could be due to language barriers, different ways of communicating with healthcare providers or differences in health-seeking behavior influenced by culture, Qian said.

"Health disparities are a serious public health concern in the United States and we've seen that different racial and ethnic groups often receive unequal treatment for the same diagnosis," Qian said. "For that reason, different ethnic and racial groups may have different outcomes. Future studies should look more specifically at differences in care among racial subgroups as well as at more long-term outcomes."

The Get With The Guidelines(R)--Coronary Artery Disease (GWTG-CAD) program was provided by the American Heart Association. The GWTG-CAD program was supported in part through the American Heart Association Pharmaceutical Roundtable and an unrestricted educational grant from Merck.

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MARKETWATCH.COM

http://www.marketwatch.com/story/care-for-asian-american-heart-attack-patients-improves-comparable-to-whites-in-get-with-the-guidelines-hospitals-2012-01-10