News in brief - Nov. 6, 2000

Former AMA leaders die

Two former presidents of the American Medical Association died less than 24 hours apart in October.

Malcolm C. Todd, MD, president in 1974-75, died of a stroke on Oct. 1 at age 87. Frank J. Jirka Jr., MD, president of the AMA in 1983-84, died of cancer on the same day. He was 78 years old.

Both men had wide-ranging careers, and both were particularly concerned with the affairs of the nation's military and veterans.

Dr. Todd, a Long Beach, Calif., surgeon, was a leader in the development of the original Medicare program (now CHAMPUS) that provided care for military dependents after World War II. He was President Nixon's personal physician and traveled with him during his three presidential campaigns. He also served as an adviser to Presidents Kennedy, Johnson, Ford and Reagan. Dr. Todd was a past president of the California Medical Assn. and the International College of Surgeons. He was the chief of staff and chief of surgery at Long Beach Memorial Medical Center.

Catholic managed care plans are better than their hospital counterparts at ensuring patients access to reproductive services, according to a Catholics for a Free Choice report released recently.

Among the 48 Catholic HMOs surveyed, 52% cover at least one form of contraception and 48% cover tubal ligations. All the plans have procedures that eliminate themselves from direct provision of this care. That's done either by contracting with non-Catholic providers to provide the services, directing money for reproductive health care to a third-party administrator or arranging for another insurer to handle provision and payment for reproductive services.

But Catholic HMOs' provision for reproductive health care falls below that of the industry in general. Nationally, 93% of HMOs and 51% of PPOs provide contraception coverage.

An Indiana University School of Medicine study on tube feeding further questions the benefits of this therapy for older adults with progressive neurological disease or terminal illnesses.

The researchers, led by Christopher M. Callahan, MD, found that percutaneous endoscopic gastrostomy "failed to achieve any clinically meaningful improvement on common measures of functional status, nutritional status or subjective health status" in 70% of the 72 patients who survived 60 days or more. Further, "most patients experienced symptomatic problems that they attributed to the enteral tube feeding," according to the article in the September Journal of the American Geriatrics Society.

Although the money amounts to only about one-eighth of the cost to train pediatric residents, 56 freestanding children's hospitals now have checks totaling $38 million from the federal government to subsidize graduate medical education programs.

Unlike teaching hospitals, which are paid direct costs to train residents, children's hospitals aren't eligible for similar funding from Medicare because few Medicare-eligible services are performed at the facilities.

"Children's hospitals train about one-third [2,500] of all pediatric residents in the country. This money will help these hospitals cope with declining managed care reimbursements and the rising costs of the uninsured," said Claude Earl Fox, MD, administrator of the Health Resources and Services Administration.

President Clinton has requested $80 million for the Children's Hospitals Graduate Medical Education program. But direct medical education costs at children's hospitals total about $285 million, Dr. Fox said.