- Email: [email protected]
Practice Trends
PHARMACY NEWS
MEDICAL HEADLINES
Continued from previous page
authors wrote. In Baltimore, where a threatened lawsuit against the local school system was widely publicized, the dnlg's use dropped 60% between 1986 and 1990. A survey of Baltimore school nurses found that an average of three medication-responsive children per elementary school and five per middle school were taken off Ritalin in 1988-89. About 36% of these developed major school maladjustment (grade failure, frequent suspensions) and 47% developed mild to moderate adjustment problems.
NIH to Study Alternative Medicine Alternative medical practices-long ignored and often scorned by traditional medicine-will soon get a
thorough probing by the National Institutes of Health. The new Office for the Study of Unconventional Medical Practices is now gearing up to investigate such practices as acupuncture, homeopathy, chiropractic, ayurveda, Chinese herbal remedies, naturopathy, and reflexology. "We want to determine which are quackery and which really have something to offer," said Laurel Chaconas, a staff person in the office. The project was initiated, Chaconas said, because "so many people have reported positive benefits from these therapies. And Western medicine, which is mostly surgery and administration of dnlgs, is becoming so expensive. " She noted that lllconventional medical practices are becoming more popular and available. "We need more information on them-but some of them will be very difficult to evaluate."
Acupuncture is one of several alternative medical practices that NIH will be researching. AMERICAN PHARMACY
PRACTICE TRENDS Pharmacists Again Rated Tops for Honesty For the fourth consecutive time, Americans have designated pharmacy as the profession with the highest ethical standards, according to a recent Gallup poll. Two-thirds of the 1,206 adults polled ranked pharmacists highest for "honesty and ethical standards." The clergy came next by a 12-point nlargin - the biggest gap in the poll's history. "It is evident that the clergy have never recovered from the ethical battering sustained during the Bakker and Swaggart televangelist scandals," noted an article from the Gallup Poll News Service. Following closely behind the clergy were phYSiCians, college teachers, dentists, and engineers. Lowest on the list of 25 professions were state officeholders, congressmen, advertising practitioners, insurance salesmen, and, at the very bottom, car salesmen. The report notes that pharmacists were "judged more rigorously" by respondents over age 65: only 58% of that group rated pharmacists highly, as compared with 72% of young adults. Because the poll was conducted before the news broke in late June about the "Operation Goldpill" investigation, it is unknown whether the widespread
publicity affected Americans' view of pharmacy. "Operation Goldpill" led to the arrests of 82 pharmacists across the country for Medicaid fraud and drug diversion.
Online Science Journal Launched Scientific publishing entered a new era in July with the arrival of The Online Journal of Current Clinical Trials, an electronic, peer-reviewed journal that publishes articles within 48 hours of acceptance. The journal is a joint venture of the American Association for the Advancenlent of Science CAAAS), publisher of Science magazine, and the OCLC Online Computer Library Center. The editor, Edward]. Huth, MD, was fornlerly editor of the Annals of Internal Medicine. Current Clinical Trials publishes only original, fulltext research fmdings. Subscribers must have a 286 or higher level IBM-compatible computer equipped with Windows 3.0 software, a modem, two megabytes of RAM, and a VGA monitor. A Macintosh-compatible release is expected in 1993. Subscribers can review the components of a research article-abstract, text, graphs, tables, footnotes, and author November 1992/870
Vol. NS32, No. 11
information-in any order they choose. They can also search and retrieve data quickly using key words, subjects, authors, titles, or captions. When subscribers access the journal, they are immediately alerted to new alticles published since the last time they checked. The journal stores all of its previously published articles, making it possible for readers to retrieve any article at any time. Subscribers who designate special areas of interest (up to 1,000 may be selected) will receive an alert by fax whenever an article pertaining to those areas is published. Articles can be downloaded and printed, or, for an additional fee , can be sent to subscribers by fax or mail. The annual subscription fee is $110. For more information, contact AAAS, 1333 H St., NW, Washington, DC 20005. (202) 3266440.
Vol. NS32, No. 11 November 1992/ 871
More HMO Members, More Hybrids, Report Finds The number of health maintenance organizations (HMOs) in the United States dropped to 581 by the end of 1991, down from 610 a year earlier, but HMO membership grew 7.6% during the same period-to 40,388,285 enrollees, according to the 1992 Marion Merrell Dow Managed Care Digest, HMO Edition.
The report, based on surveys conducted between January and April 1992, notes that the biggest growth in the HMO industry over the . past year is in the area known as "hybrid" HMO plans. These plans, which allow individuals to
physicians and hospitals both within and outside of the HMO network, are now offered by 256 HMOs, up from 123 in 1990. "Employers have signaled that they are more comfortable signing up with an HMO ...when these hybrid plans are offered, " the repolt says. Spending for drugs was one of the fastest growing expenses for HMOs in 1991 , reaching an average of $103.29 per member. In 1990, the average was $89.34 per member. The number of prescriptions filled per HMO member rose slightly in 1991 to 5.8 per year, from 5.7 the year before. To deal with rising costs, HMOs turned to the use of dnlg formularies in increasing numbers-49% of all plans, up from 44% in 1990. Also, 70% of HMOs had generic substitution poliCies in 1991 , as compared with 63% in 1990. Other fmdings in the report: • Only 14% of HMOs provided coverage for over-thecounter medications in 1991 , down from 18% in 1990. • All but 7% of HMOs refused to pay for experimental drugs and cosmetic drugs in 1991 , continuing a trend from 1989 and 1990. Other drugs commonly excluded from cover-
age were fertility dnlgs, injectables, and anorexiants. • HMOs requiring dnlg use review (DUR) increased to 48% in 1991, up from 47% in 1990 and 46% in 1989. Most HMOs employ retrospective DUR, using past medical records to evaluate physician practices. • Seven percent of HMOs used in-house pharmacies exclusively to fill prescriptions in 1991. Nearly nine out of lOused contract pharmacies; most of the contract pharmacies (85%) were chains. HMOs in operation at least 10 years were the ones most likely to rely exclusively on in-house pharmacies. • The percentage of HMOs using mail-order pharmacies rose significantly to 12% in 1991 from 9% in 1990. The HMOs most likely to use mail order plans were those affiliated with corporations.
Medicine Grapples vvith Gaps in Primary Care The health care system in the United States has too nlany specialists-causing spiraling costs and lack of access to basic care, according to experts who met recently in Washington, D.C., for a conference on primary care, sponsored by the Department of Health and Human Services. From 1982 to 1991, the number of medical students choosing primary care practice declined more than AMERICAN PHARMACY
PHARMACY NEWS
PRA<:TI<:E TRENDS
Continued from previous page
60%, according to Steven Schroeder, MD, president of the Robert Wood Johnson FOlmdation. In 1989 only 30% of all physicians in the United States were general practitioners, he said, a drop from 43% in 1962. In most other developed nations, primary care providers make up more than half of physicians, noted Stuart Altman, dean of Brandeis University. A major reason cited for the high numbers of specialists is the high monetary rewards that await them and the large debt -averaging $50,000-that physicians must incur to pay for medical school. Speakers urged fmancial incentives for choosing primary practice, such as interest-free tuition loans and educational programs that allow work-study. A series of reports in the September 2 issue ofJAMA lmderscores the problem. A survey of graduate medical education in the United States points out that 25 physician specialties and 56 subspecialties now have accredited training programs-and 35 of the subspecialties were recognized within the past five years. In an attempt to curb this proliferation, the Accreditation Council for Graduate Medical Education voted in June for a one-year moratorium on recognizing any new specialties or subspecialties. A report from the AmeriAMERICAN PHARMACY
can Medical Association's Primary Care Task Force recommends that medical schools increase their commitment to producing primary care graduates and that the availability of residency positions be tied to national needs. Also needed are incentives to attract generalists to nlral and inner-city areas, where their availability has decreased markedly over the past three decades. In the meantime, while the medical establishment searches for solutions, an increasing number of "physician extenders" are stepping in to fill gaps in primary care, according to an article in the August 5 issue of the Wall StreetJournal. Physician extenders are mid-level practitioners, such as physician assistants, nurse practitioners, and nurse midwives, who perform physical exams, treat a limited range of problems, and admit patients to hospitals. According to the article, there are around 27,000 physician assistants in the United States today, up from 11 ,000 in 1980. Advanced nurse specialists total some 30,000, compared with about 13,000 in 1980.
Association for Sales Reps Established The Association of Pharmaceutical Sales Representatives (APSR) was recently established to "foster the profeSSionalism" of the nation's 42,000 pharmaceuti-
cal sales representatives, according to an APSR press release. The group offers conferences and educational programs, as well as a journal and newsletter. APSR president Timothy A. Margraf, a former sales representative and manager for Marion Merrell Dow, notes that "APSR provides resources that help the pharmaceutical sales representative build relationships with the health care community based on mutual integrity and respect. " For more information call (800) 548-APSR.
New Magazine Focuses on Careers in Pharmacy This month Aster Publishing Company is launching a
new magazine that focuses on careers in the pharmaceutical industry.
Pharmaceutical Careers will be published once a year and will include profiles of professionals in key industry positions, guides to internships and profeSSional associations, data from employment surveys, and other information. The magazine will focus on these job functions: quality assurance, research and development, manufacturing, product management, marketing, and sales. It will also provide information on careers in the United States Patent Office, the Food and Dnlg Administration, and higher education. For more information, contact Aster Publishing Corporation, 195 Main St. , Metuchen, NJ 08840. (908) 549-3000.
DRUG RESEARCH Could Antihistamines Help Prevent Retinopathy? A six-month pilot study at the Milton S. Hershey Medical Center at Pennsylvania State University suggests that antihistamines may be a possible pharmacological approach to treating diabetic retinopathy, the most common type of blindness in people under 65. In diabetic retinopathy, blood vessels on the retina
leak fluid into the vitreous humor, leading to retinal scarring and eventual loss of vision. More than a million working-age Americans are afflicted by the disorder. At present, the only effective treatment is applying laser beams to the leaking blood vessels, sometimes followed by replacement of the vitreous humor with an artificial substance. Preliminary fmdings from the placebo-controlled study were presented at the annual Novembe r 1992/ 872
Vol. NS32, No . 11
MEDICAL HEADLINES
Continued from previous page
authors wrote. In Baltimore, where a threatened lawsuit against the local school system was widely publicized, the dnlg's use dropped 60% between 1986 and 1990. A survey of Baltimore school nurses found that an average of three medication-responsive children per elementary school and five per middle school were taken off Ritalin in 1988-89. About 36% of these developed major school maladjustment (grade failure, frequent suspensions) and 47% developed mild to moderate adjustment problems.
NIH to Study Alternative Medicine Alternative medical practices-long ignored and often scorned by traditional medicine-will soon get a
thorough probing by the National Institutes of Health. The new Office for the Study of Unconventional Medical Practices is now gearing up to investigate such practices as acupuncture, homeopathy, chiropractic, ayurveda, Chinese herbal remedies, naturopathy, and reflexology. "We want to determine which are quackery and which really have something to offer," said Laurel Chaconas, a staff person in the office. The project was initiated, Chaconas said, because "so many people have reported positive benefits from these therapies. And Western medicine, which is mostly surgery and administration of dnlgs, is becoming so expensive. " She noted that lllconventional medical practices are becoming more popular and available. "We need more information on them-but some of them will be very difficult to evaluate."
Acupuncture is one of several alternative medical practices that NIH will be researching. AMERICAN PHARMACY
PRACTICE TRENDS Pharmacists Again Rated Tops for Honesty For the fourth consecutive time, Americans have designated pharmacy as the profession with the highest ethical standards, according to a recent Gallup poll. Two-thirds of the 1,206 adults polled ranked pharmacists highest for "honesty and ethical standards." The clergy came next by a 12-point nlargin - the biggest gap in the poll's history. "It is evident that the clergy have never recovered from the ethical battering sustained during the Bakker and Swaggart televangelist scandals," noted an article from the Gallup Poll News Service. Following closely behind the clergy were phYSiCians, college teachers, dentists, and engineers. Lowest on the list of 25 professions were state officeholders, congressmen, advertising practitioners, insurance salesmen, and, at the very bottom, car salesmen. The report notes that pharmacists were "judged more rigorously" by respondents over age 65: only 58% of that group rated pharmacists highly, as compared with 72% of young adults. Because the poll was conducted before the news broke in late June about the "Operation Goldpill" investigation, it is unknown whether the widespread
publicity affected Americans' view of pharmacy. "Operation Goldpill" led to the arrests of 82 pharmacists across the country for Medicaid fraud and drug diversion.
Online Science Journal Launched Scientific publishing entered a new era in July with the arrival of The Online Journal of Current Clinical Trials, an electronic, peer-reviewed journal that publishes articles within 48 hours of acceptance. The journal is a joint venture of the American Association for the Advancenlent of Science CAAAS), publisher of Science magazine, and the OCLC Online Computer Library Center. The editor, Edward]. Huth, MD, was fornlerly editor of the Annals of Internal Medicine. Current Clinical Trials publishes only original, fulltext research fmdings. Subscribers must have a 286 or higher level IBM-compatible computer equipped with Windows 3.0 software, a modem, two megabytes of RAM, and a VGA monitor. A Macintosh-compatible release is expected in 1993. Subscribers can review the components of a research article-abstract, text, graphs, tables, footnotes, and author November 1992/870
Vol. NS32, No. 11
information-in any order they choose. They can also search and retrieve data quickly using key words, subjects, authors, titles, or captions. When subscribers access the journal, they are immediately alerted to new alticles published since the last time they checked. The journal stores all of its previously published articles, making it possible for readers to retrieve any article at any time. Subscribers who designate special areas of interest (up to 1,000 may be selected) will receive an alert by fax whenever an article pertaining to those areas is published. Articles can be downloaded and printed, or, for an additional fee , can be sent to subscribers by fax or mail. The annual subscription fee is $110. For more information, contact AAAS, 1333 H St., NW, Washington, DC 20005. (202) 3266440.
Vol. NS32, No. 11 November 1992/ 871
More HMO Members, More Hybrids, Report Finds The number of health maintenance organizations (HMOs) in the United States dropped to 581 by the end of 1991, down from 610 a year earlier, but HMO membership grew 7.6% during the same period-to 40,388,285 enrollees, according to the 1992 Marion Merrell Dow Managed Care Digest, HMO Edition.
The report, based on surveys conducted between January and April 1992, notes that the biggest growth in the HMO industry over the . past year is in the area known as "hybrid" HMO plans. These plans, which allow individuals to
physicians and hospitals both within and outside of the HMO network, are now offered by 256 HMOs, up from 123 in 1990. "Employers have signaled that they are more comfortable signing up with an HMO ...when these hybrid plans are offered, " the repolt says. Spending for drugs was one of the fastest growing expenses for HMOs in 1991 , reaching an average of $103.29 per member. In 1990, the average was $89.34 per member. The number of prescriptions filled per HMO member rose slightly in 1991 to 5.8 per year, from 5.7 the year before. To deal with rising costs, HMOs turned to the use of dnlg formularies in increasing numbers-49% of all plans, up from 44% in 1990. Also, 70% of HMOs had generic substitution poliCies in 1991 , as compared with 63% in 1990. Other fmdings in the report: • Only 14% of HMOs provided coverage for over-thecounter medications in 1991 , down from 18% in 1990. • All but 7% of HMOs refused to pay for experimental drugs and cosmetic drugs in 1991 , continuing a trend from 1989 and 1990. Other drugs commonly excluded from cover-
age were fertility dnlgs, injectables, and anorexiants. • HMOs requiring dnlg use review (DUR) increased to 48% in 1991, up from 47% in 1990 and 46% in 1989. Most HMOs employ retrospective DUR, using past medical records to evaluate physician practices. • Seven percent of HMOs used in-house pharmacies exclusively to fill prescriptions in 1991. Nearly nine out of lOused contract pharmacies; most of the contract pharmacies (85%) were chains. HMOs in operation at least 10 years were the ones most likely to rely exclusively on in-house pharmacies. • The percentage of HMOs using mail-order pharmacies rose significantly to 12% in 1991 from 9% in 1990. The HMOs most likely to use mail order plans were those affiliated with corporations.
Medicine Grapples vvith Gaps in Primary Care The health care system in the United States has too nlany specialists-causing spiraling costs and lack of access to basic care, according to experts who met recently in Washington, D.C., for a conference on primary care, sponsored by the Department of Health and Human Services. From 1982 to 1991, the number of medical students choosing primary care practice declined more than AMERICAN PHARMACY
PHARMACY NEWS
PRA<:TI<:E TRENDS
Continued from previous page
60%, according to Steven Schroeder, MD, president of the Robert Wood Johnson FOlmdation. In 1989 only 30% of all physicians in the United States were general practitioners, he said, a drop from 43% in 1962. In most other developed nations, primary care providers make up more than half of physicians, noted Stuart Altman, dean of Brandeis University. A major reason cited for the high numbers of specialists is the high monetary rewards that await them and the large debt -averaging $50,000-that physicians must incur to pay for medical school. Speakers urged fmancial incentives for choosing primary practice, such as interest-free tuition loans and educational programs that allow work-study. A series of reports in the September 2 issue ofJAMA lmderscores the problem. A survey of graduate medical education in the United States points out that 25 physician specialties and 56 subspecialties now have accredited training programs-and 35 of the subspecialties were recognized within the past five years. In an attempt to curb this proliferation, the Accreditation Council for Graduate Medical Education voted in June for a one-year moratorium on recognizing any new specialties or subspecialties. A report from the AmeriAMERICAN PHARMACY
can Medical Association's Primary Care Task Force recommends that medical schools increase their commitment to producing primary care graduates and that the availability of residency positions be tied to national needs. Also needed are incentives to attract generalists to nlral and inner-city areas, where their availability has decreased markedly over the past three decades. In the meantime, while the medical establishment searches for solutions, an increasing number of "physician extenders" are stepping in to fill gaps in primary care, according to an article in the August 5 issue of the Wall StreetJournal. Physician extenders are mid-level practitioners, such as physician assistants, nurse practitioners, and nurse midwives, who perform physical exams, treat a limited range of problems, and admit patients to hospitals. According to the article, there are around 27,000 physician assistants in the United States today, up from 11 ,000 in 1980. Advanced nurse specialists total some 30,000, compared with about 13,000 in 1980.
Association for Sales Reps Established The Association of Pharmaceutical Sales Representatives (APSR) was recently established to "foster the profeSSionalism" of the nation's 42,000 pharmaceuti-
cal sales representatives, according to an APSR press release. The group offers conferences and educational programs, as well as a journal and newsletter. APSR president Timothy A. Margraf, a former sales representative and manager for Marion Merrell Dow, notes that "APSR provides resources that help the pharmaceutical sales representative build relationships with the health care community based on mutual integrity and respect. " For more information call (800) 548-APSR.
New Magazine Focuses on Careers in Pharmacy This month Aster Publishing Company is launching a
new magazine that focuses on careers in the pharmaceutical industry.
Pharmaceutical Careers will be published once a year and will include profiles of professionals in key industry positions, guides to internships and profeSSional associations, data from employment surveys, and other information. The magazine will focus on these job functions: quality assurance, research and development, manufacturing, product management, marketing, and sales. It will also provide information on careers in the United States Patent Office, the Food and Dnlg Administration, and higher education. For more information, contact Aster Publishing Corporation, 195 Main St. , Metuchen, NJ 08840. (908) 549-3000.
DRUG RESEARCH Could Antihistamines Help Prevent Retinopathy? A six-month pilot study at the Milton S. Hershey Medical Center at Pennsylvania State University suggests that antihistamines may be a possible pharmacological approach to treating diabetic retinopathy, the most common type of blindness in people under 65. In diabetic retinopathy, blood vessels on the retina
leak fluid into the vitreous humor, leading to retinal scarring and eventual loss of vision. More than a million working-age Americans are afflicted by the disorder. At present, the only effective treatment is applying laser beams to the leaking blood vessels, sometimes followed by replacement of the vitreous humor with an artificial substance. Preliminary fmdings from the placebo-controlled study were presented at the annual Novembe r 1992/ 872
Vol. NS32, No . 11