News in brief - June 21, 2004

PRN joins new partners - Doctors feel undertrained to care for chronically ill - Stem cell initiative on Calif. ballot - Calif. board addresses medical marijuana

PRN joins new partners

Physicians for Responsible Negotiation, the physician collective bargaining organization the American Medical Association House of Delegates created in 1999, officially teamed up with the Service Employees International Union June 1.

In March, PRN announced that it would operate "as an entirely independent organization with no connection to the AMA." Both sides said the split was amicable.

SEIU is the nation's largest health care union, and PRN becomes the third doctor affiliate for the organization. PRN joins the Committee of Interns and Residents, which represents resident physicians, and the Doctors Council, which represents salaried physicians, as part of SEIU's National Doctor Alliance. The three unions represent 20,000 physicians, according to the SEIU.

"This new alliance will create a stronger and more united voice on critical professional and patient care issues," SEIU President Andrew Stern said in a statement.

PRN will reach out to non-salaried and private practice physicians.

"Together we can build on our own accomplishments, reach out to physicians around the country and help provide a more effective voice for doctors facing a rapidly changing medical system," said PRN President Mark Fox, MD, an otolaryngologist.

Doctors feel undertrained to care for chronically ill

Physicians don't feel as prepared as they would like when it comes to treating patients with chronic disease, according to a study in the June issue of Academic Medicine.

Two-thirds of doctors in the study felt undertrained in skills tied to care for the chronically ill. But family physicians and younger physicians reported more confidence in these areas than other physicians.

Co-author Eric Bass, MD, MPH, said this is a reflection of how health care in the United States is primarily organized around acute illness, though chronic disease is increasingly pervasive.

"As a result, current delivery systems are poorly adapted to the needs of patients with chronic conditions," Dr. Bass said.

More than 80% of people age 65 and older have one or more chronic diseases, while more than 10% of children have a chronic condition, the authors noted.

Researchers asked a random sample of U.S. physicians about their perceived adequacy in skills related to caring for patients with chronic illness. The authors of "More Training Needed in Chronic Care: A Survey of U.S. Physicians," divided these into 10 areas: management of geriatric syndromes, chronic pain management, nutrition, assessment of developmental milestones in chronically ill children, end-of-life care, management of psychosocial issues related to chronic illness, approaches to patient education, assessment of caregiver needs, coordination of in-home and community services, and interdisciplinary teamwork with nonphysician providers for the chronically ill.

Overall, 60% to 65% of physicians reported that their chronic disease training was less than adequate in all 10 areas. Family physicians were more likely to report adequate training in seven of these areas, and physicians who had trained in the 10 years before the survey also were less likely to report inadequate training.

Stem cell initiative on Calif. ballot

A referendum asking California voters to approve a $3 billion plan to fund stem cell research will be on the November ballot, California Secretary of State Kevin Shelley announced June 2 after certifying that initiative supporters had collected more than enough petition signatures.

The plan calls for establishing a California Institute for Regenerative Medicine and making $295 million available to stem cell researchers every year for 10 years. To fund the research, the state would borrow $3 billion, which would be paid off over 30 years.

New Jersey, the only other state to specifically approve embryonic stem cell research, recently allocated $6.5 million to establish a stem cell research institute in New Brunswick. Other states reportedly interested in approving stem cell research include Illinois, Maryland, Massachusetts, New York, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont and Washington.

In fiscal 2003, the federal government -- through the National Institutes of Health -- supported $24.8 million in human embryonic stem cell research. NIH also supported $190.7 million in human non-embryonic stem cell research in fiscal 2003.

Calif. board addresses medical marijuana

The Medical Board of California recently adopted a statement clarifying that the recommendation of medical marijuana by physicians will not have any effect against their license if they follow good medical practice.

In November 1996, California voters passed Proposition 215, the Compassionate Use Act of 1996, to "ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where the medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana."

In January 1997, the medical board published standards for physicians when recommending medical marijuana. According to the board's new statement, consultation should include: a history and good-faith examination of the patient; development of a treatment plan with objectives; provision of informed consent including discussion of side effects; periodic review of the treatment's efficacy; and proper record keeping that supports the decision to recommend the use of medical marijuana.