America has shortage of 40,000 doctors
with millions of newly insured patients, there will be a shortage of 40,000 doctors in the next five years. 15 years from now, that number will approach a shortage of 63,000 doctors. the shortage approaches 15% of the doctor workforce. We need to add 7000 new doctors every year over the next 10 years. Association of American medical colleges, October 1, 2010
ERS CROWDED WITH UNINSURED
Researchers look at emergency room visits and whether uninsured people are driving overcrowding. Turns out, they're not. Uninsured patients are less likely to visit the ER for non-urgent care than insured patients. And insured patients are fueling most of the rise in visits to the ER
because they find it Difficult to get an appointment with their own doctors .
Source: JAMA oct, 2008
more grants to train health care workers
the US Department of health is giving $320 million in grants to train more physicians assistants, primary care nurse practitioners, and nurse midwives. Over 1300 students will get $22,000 each per year for up to two years, leading to 600 newly trained nurse practitioners and nurse midwives in the next five years. Another $15 million is granted to start 10 nurse managed health clinics providing I married their to underserved populations. Another $4 million will be spent to train 5100 home care aides. $67 million will be granted to train the low income individuals to become pharmacy technicians, dental assistants, licensed vocational nurses, health information technicians and registered nurses. HHS Website
The safety of exposure to strong magnetic fields with MRI scans is debatable. There are risks of physical injury from magnetic objects and magnetic fields in conjunction with implanted medical devices. No one has addressed the significant biological or neurocognitive risks of MRIs. Because of the low magnetic susceptibility of biological tissues exposure to static magnetic fields don’t produce long-term effects. Despite studies of epidemiological studies, there is no sufficient evidence to draw any conclusions about the health effect of the static magnetic field exposures. The FDA published guidelines recommending static magnetic field exposure to be below 8T, and radiofrequency fields below 6T to protect tissues from heating.
Proving the absence of harm, scientists are now using MRI as a tool to study brain development and healthy children. They must pause to consider these implications and risks. Just because no study to date has shown to CAT scan has increased cancer risks drawing such parallels between MRIs is inappropriate. Many feel long-term exposures take 10 to 20 years for cells to develop demonstrable changes. Science July 30.2010
FDA needs more money
FDA needs more money to update its scientific tools for reviewing medical devices, prescription drugs, and tracking food safety. The FDA oversees over 25% of goods sold in the United States, including foods, cosmetics, and prescription drugs. The evolving science has made the FDA struggle to keep up with the latest drugs, devices, and foods. To help their budgets, drug makers and medical device makers help pay user fees for reviewing their products. This provides $25 million to the agency. However the agency is asking for $4 billion budget for next year, but the legislature yhe 2010 budget has its limits for the next year.
Drug companies cutting down on research and drug development
everyone is getting concerned about drug companies pulling back on drug discoveries, especially in pain and the oppression areas. Glaxo Smith Kline, closed plants in England and Italy and the other big drug company, Astra Zeneca, are closing their United States and European drug discovery programs for work on schizophrenia, bipolar disorders, depression, and anxiety. These top two drug companies with their cutbacks have shown that the industry is pulling away from this area. There is very little being actually done in psychiatric drug development at this time. Very few novel ideas are presented and hese disorders currently have no truly effective treatments.
Many of the drugs in clinical trials have been approved long time ago, and now are being retested for new indications. There is a lack of ideas, and a lot of attempts to extend the current drug company patents, as they search for new indications for old drugs that they own. The drug companies know they can make billions of dollars a year off drugs, that they slightly modify, from already approved medications ,particularly antidepressants like Prozac. A lot of money can be made from old repeat me too drugs.
Companies will soon lose billions of dollars in revenue as their patents expire on dozens of blockbuster drugs. The cost of research and development also are rising. Companies are having a cash flow crunch and are beoming more conservative. They don’t want to throw money at something that might not pay off.
Most of these neurological disorders are quite complex, intermittent, and their symptoms are hard to objectively measure. This makes development these fields significantly risky.
As safer bets, many companies now look at oncology and autoimmune diseases as safer bets for their money. They see psychiatric drugs as a big gamble along with drugs for neurological conditions. The old model for drug companies to develop and assume are all the risks and costs of researching for new drugs and shepherding them from the test tube to the clinic, it is no longer viable. They would rather have internal research groups doing some of the basic research for them that might help lead to new targets.
Companies are also trying to reduce their costs by outsourcing their research and development. Three years ago, they opened research and development centers in China, focusing on treatments for multiple sclerosis, Parkinsonism and Alzheimer’s. They are also outsourcing, by contracting with biotech companies and academic researchers to do the early drug discovery work that they previously did in-house
Typically, a company now funds a research project in exchange for the rights to license and any resulting compounds that might be potential. The NIH has authorized up to $500 million a year for a curious acceleration network to speed drug development. Congress would like to see the NIH more involved in drug discovery and development. Science July 30, 2010
more papers published, the higher university rankings
Researchers now cut down their manuscripts into small least publishable units and rushed them to publication before they can be evaluated. Articles and journals have increased 300% over the last 30 years. It’s all a number game. Monetary rewards occur for articles published in top journals. We are now at number three in total number of articles produced by following China and number one Europe.
To change things, researchers are now evaluating a researcher’s impact in discipline. They have created indices to evaluate the impact of their papers, rather than count the annual number of articles they write. Researchers now,however, publish more articles to raise their own citations, and ask their colleagues for citations to then return the favor. Top journals are flooded beyond capacity, and are seeking reviewers to scrutinize research proposals, government reports, as well as manuscripts. Academic institutions don’t want to get involved in such peer reviewing and good journal reviewers are now at a premium.
In the past, the number of articles published per year was used as a criterion to promotion, tenure, and academic ranking. 25 years ago, researchers proposed to include no more than three publications a year in activity reports, and research proposals to be limited at 10 papers. It got nowhere.
University administrators are being pressured to consider peer reviewing as a legitimate important way to contribute to scholarship and should reward it in that way. Journals should demand that authors provide three peer reviews of other manuscripts. for every paper they submitted. If authors knew their papers would be reviewed, they t they would craft better and fewer papers. Science September 17.2010