Bioidentical Hormones Resolution
The American Medical Association has endorsed a resolution calling for tighter regulation of bioidentical hormones. The resolution, passed at the AMA's interim meeting of its House of Delegates last month, calls for the Food and Drug Administration to conduct surveys for purity and dosage accuracy of all bioidentical hormone formulations; require mandatory reporting by drug manufacturers, including compounding pharmacies, of adverse events related to using bioidentical hormones; create a registry of adverse events related to use of compounded bioidentical hormone preparations; require uniform patient information; and prohibit use of the term “bioidentical hormones” unless the preparation has been approved by the FDA. “The Endocrine Society applauds the AMA for helping to bring much-needed oversight to bioidentical hormones,” said Dr. Leonard Wartofsky, president of the society, which cosponsored the resolution along with the American Association of Clinical Endocrinologists and the American Society of Reproductive Medicine. “The inconsistencies and unknown risks of bioidentical hormones are of great concern. Without proper oversight and control, the public has no way of knowing precisely what they're getting or what effect it will have on an individual's body.”
Disparities in Medicare HMO Care
Black Medicare beneficiaries with diabetes fare worse than their white counterparts on four outcome measures of quality, according to a study published in the Oct. 25 issue of the Journal of the American Medical Association. Dr. Amal N. Trivedi, of Brown University and colleagues reviewed 431,000 patient observations from 151 Medicare health plans over a 3-year period. They looked at a combination of hemoglobin A1c (HbA1c) levels, low-density lipoprotein (LDL-C) levels, and blood pressure levels in three groups of patients: those with diabetes, those with hypertension, or those with a prior coronary event. They found that 80% of white patients had HbA1c levels below 9.5% or 9.0% (depending on the year being studied), compared with only 72% of black patients. Fewer black patients with diabetes than white patients had LDL-C levels less than 130 mg/dL (63% vs. 72%, respectively). Nearly three-fourths of the disparity in each outcome was due to disparities in outcomes among beneficiaries in the same plan, as opposed to differences between plans, according to the authors. “Effective measurement within health plans is one cornerstone of improving quality and reducing racial disparities in outcomes,” they wrote.
House Investigates CDC Finances
Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.
Health IT Gaps
The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report are from the HSC Community Tracking Study Physician survey. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available at