Policy & Practice


In the Dark on the Plan B Plan

Despite the controversy surrounding the proposal to provide Plan B emergency contraception without a prescription, only about one-quarter of Americans in a recent survey said they had heard a lot about the debate. And nearly an equal number said they had heard nothing about the politically charged issue. The survey was commissioned by the Pew Research Center for the People & the Press and the Pew Forum on Religion & Public Life. The survey also found that about 48% of those surveyed favored selling emergency contraception without a prescription, whereas about 41% opposed the idea. The national telephone survey was conducted in July among more than 2,000 U.S. adults.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut will be at least 4.6%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to perform a study on the question of whether imaging saves money. The American College of Obstetricians and Gynecologists has backed the bill. “Elimination of the SGR is necessary to move forward on reporting on performance indicators and we thank you for recognizing this important link in your legislation,” said Dr. Douglas W. Laube, ACOG president, in a statement.

HIV Treatment Adherence

Educational programs can be effective at improving adherence to HIV drug regimens when the programs are one-on-one and provide practical medication management strategies, according to a review of 19 randomized controlled trials. The literature review, which was published in the Cochrane Library in July, also noted that interventions tended to be successful if they were conducted for longer periods of time, usually 12 weeks or more. Interventions that were performed on a one-on-one basis were successful in improving adherence to medication in 10 out of 15 such studies (67%). Comparatively, in the four studies conducted in group settings, none were successful in improving adherence. The 19 studies reviewed included 2,159 patients. The reviewers did not find evidence to support the use of more “complex psychological constructs” such as self-efficacy, stress management, and motivation. These interventions may be ineffective or take longer to produce an effect, the reviewers wrote.

Screening Knowledge Gap

Most women are unaware of when to receive screening tests such as mammograms and Pap tests, according to the results of a 2005 government survey. But despite the lack of knowledge about when screening is required, women are receiving recommended screening care anyway, the survey found. The Health Information National Trends Survey, developed by the National Cancer Institute, is a nationally representative telephone survey of the general U.S. population conducted in 2002–2003 and 2005. An analysis of the 2005 data showed that 57% of U.S. women were unaware that they should have a mammogram to screen for breast cancer starting at age 40 years. However, 74% said they had received a mammogram within the recommended time period. When it came to Pap smears, most women didn't know they only needed to be screened at least once every 3 years. Instead, 87% of women who had ever received a Pap test said they received it annually as part of their regular exam. “We must significantly increase our efforts to inform all Americans of what cancer screening tests are available so that we can catch cancer in its earliest stages when it is most treatable,” Dr. John E. Niederhuber, acting director of the National Cancer Institute, said in a statement.

Regulating Nanotechnology

The Food and Drug Administration has launched an internal nanotechnology task force aimed at figuring out new regulatory approaches for pharmaceutical products and devices that use nanotechnology materials. Nanotechnology materials measure about 1–100 nm and often have different chemical and physical properties—such as altered magnetic properties and increased chemical and biological activity—than do larger materials, according to the FDA. The agency will kick off its efforts with a public meeting scheduled for Oct. 10.

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