- Email: [email protected]
Transparency rules at the Cleveland Clinic
Editorial
Science Photo Library
Quality? No, the cattle-market of NHS care
For the King’s Fund report see http://www.kingsfund.org.uk/ publications/kings_fund_ publications/the_point_of_ care.html
Go into one leading London teaching hospital. In a full waiting room a patient will sit, perhaps anxious about what is to come. A nurse begins discussing the details of a case in front of other patients and relatives. The rest of the waiting room looks away, embarrassed and anxious too. In a nearby day-care treatment centre, patients sit next to one another in chairs in two circles. Room for relatives is scarce. There are no curtains. No privacy. Nurses come to talk to patients about their diagnoses, surgical histories, biopsy details, treatments, and home situations. Private details are exposed to the whole room. The job gets done. Drugs are administered. Efficient, effective, no nonsense. The NHS. Small additional infelicities. The consultant does not introduce the medical student to the patient. It is the student who introduces herself and asks if students can sit in. A referral to a pharmacist is greeted by a receptionist with incredulity. The pharmacist does not see patients before 10·30 am. At the end of the
treatment, the patient is sent home. The only nod to any kind of concern for the patient’s psychic state are offers of reflexology and Reikii classes on nearby notice boards. Last week, the King’s Fund published a report pointing out how difficult it is to make generalisations about the NHS from individual patients’ experiences. But the authors of the report, Joanna Goodrich and Jocelyn Cornwell, also concluded that the evidence from patients’ stories emphasised “the importance of seeing the person in the patient and bringing patients’ experience alive.” How does it feel to be an NHS patient in 2008? Not good, sometimes. The job gets done. Treatment is given. But if there is a lack of dignity and sensitivity, an absence of compassion or kindness, a failure to comfort or reassure, treatment is not synonymous with care. The NHS is getting better at treatment and that is welcome. It has a long way to go before it is good at care. ■ The Lancet
The Cleveland Clinic
Transparency rules at the Cleveland Clinic
The Cleveland Clinic
For the Cleveland Clinic’s directory of doctors see http://my.clevelandclinic.org/ staff_directory/default.aspx
2002
In a move believed to be the first of its kind by a major US medical centre, the Cleveland Clinic, Cleveland, OH, USA, announced last week that it has begun to list the industry ties of its doctors and scientists in a searchable directory on its website. For each of these staff, the clinic will “list the names of companies with which they have collaborations, further identifying whether they have equity, the right to royalties, a fiduciary position or a consulting relationship that pays US$5000 or more per year”. Physicians and scientists at the Clinic are required to submit details of any industry relations to an internal committee for review at least once a year. The process therefore relies on self-reporting. And, as yet, the clinic’s website does not list the amount of money staff receive. Whether the $5000 threshold for disclosure is too high is also debatable. Still, the Clinic’s push for transparency is to be applauded. It has been hailed as part of a growing movement in the USA to address doctors’ links with industry. Positive changes are certainly afoot. For example, Senator Charles Grassley, Republican of Iowa, is
promoting a bill called the Physician Payment Sunshine Act that would require pharmaceutical companies and manufacturers of medical devices to disclose all payments over $500 that they give to physicians. Eli Lilly and Merck have said they will start making such disclosures next year even if Grassley’s bill is not enacted. However, individual failures to disclose links with industry are still rife in US medicine. In October, a Congressional investigation found that a leading psychiatrist at Emory University, Atlanta, GA, USA, allegedly failed to disclose $1 million in consulting fees from drug manufacturers. Even the Cleveland Clinic’s attempt to clamp down on conflicts of interest comes after the media revealed the financial ties of some of its doctors. Such revelations continue to taint the integrity of medical research. Other medical centres should use and develop the Cleveland Clinic’s initiative to manage conflicts of interest of their employees, preferably before they become the subject of any media scandal. ■ The Lancet www.thelancet.com Vol 372 December 13, 2008
Science Photo Library
Quality? No, the cattle-market of NHS care
For the King’s Fund report see http://www.kingsfund.org.uk/ publications/kings_fund_ publications/the_point_of_ care.html
Go into one leading London teaching hospital. In a full waiting room a patient will sit, perhaps anxious about what is to come. A nurse begins discussing the details of a case in front of other patients and relatives. The rest of the waiting room looks away, embarrassed and anxious too. In a nearby day-care treatment centre, patients sit next to one another in chairs in two circles. Room for relatives is scarce. There are no curtains. No privacy. Nurses come to talk to patients about their diagnoses, surgical histories, biopsy details, treatments, and home situations. Private details are exposed to the whole room. The job gets done. Drugs are administered. Efficient, effective, no nonsense. The NHS. Small additional infelicities. The consultant does not introduce the medical student to the patient. It is the student who introduces herself and asks if students can sit in. A referral to a pharmacist is greeted by a receptionist with incredulity. The pharmacist does not see patients before 10·30 am. At the end of the
treatment, the patient is sent home. The only nod to any kind of concern for the patient’s psychic state are offers of reflexology and Reikii classes on nearby notice boards. Last week, the King’s Fund published a report pointing out how difficult it is to make generalisations about the NHS from individual patients’ experiences. But the authors of the report, Joanna Goodrich and Jocelyn Cornwell, also concluded that the evidence from patients’ stories emphasised “the importance of seeing the person in the patient and bringing patients’ experience alive.” How does it feel to be an NHS patient in 2008? Not good, sometimes. The job gets done. Treatment is given. But if there is a lack of dignity and sensitivity, an absence of compassion or kindness, a failure to comfort or reassure, treatment is not synonymous with care. The NHS is getting better at treatment and that is welcome. It has a long way to go before it is good at care. ■ The Lancet
The Cleveland Clinic
Transparency rules at the Cleveland Clinic
The Cleveland Clinic
For the Cleveland Clinic’s directory of doctors see http://my.clevelandclinic.org/ staff_directory/default.aspx
2002
In a move believed to be the first of its kind by a major US medical centre, the Cleveland Clinic, Cleveland, OH, USA, announced last week that it has begun to list the industry ties of its doctors and scientists in a searchable directory on its website. For each of these staff, the clinic will “list the names of companies with which they have collaborations, further identifying whether they have equity, the right to royalties, a fiduciary position or a consulting relationship that pays US$5000 or more per year”. Physicians and scientists at the Clinic are required to submit details of any industry relations to an internal committee for review at least once a year. The process therefore relies on self-reporting. And, as yet, the clinic’s website does not list the amount of money staff receive. Whether the $5000 threshold for disclosure is too high is also debatable. Still, the Clinic’s push for transparency is to be applauded. It has been hailed as part of a growing movement in the USA to address doctors’ links with industry. Positive changes are certainly afoot. For example, Senator Charles Grassley, Republican of Iowa, is
promoting a bill called the Physician Payment Sunshine Act that would require pharmaceutical companies and manufacturers of medical devices to disclose all payments over $500 that they give to physicians. Eli Lilly and Merck have said they will start making such disclosures next year even if Grassley’s bill is not enacted. However, individual failures to disclose links with industry are still rife in US medicine. In October, a Congressional investigation found that a leading psychiatrist at Emory University, Atlanta, GA, USA, allegedly failed to disclose $1 million in consulting fees from drug manufacturers. Even the Cleveland Clinic’s attempt to clamp down on conflicts of interest comes after the media revealed the financial ties of some of its doctors. Such revelations continue to taint the integrity of medical research. Other medical centres should use and develop the Cleveland Clinic’s initiative to manage conflicts of interest of their employees, preferably before they become the subject of any media scandal. ■ The Lancet www.thelancet.com Vol 372 December 13, 2008