Naseem S. Miller

WASHINGTON – While the use of magnetic resonance imaging as a screening tool for breast cancer has increased significantly over the past decade, there is still little evidence of its clinical benefits and cost-effectiveness, according to a panel of experts who addressed a capacity crowd at the annual clinical congress of the American College of Surgeons.

Patients at high risk of developing breast cancer (e.g., those with BRCA mutations or a greater than 20% risk of developing breast cancer during their lifetime) could benefit from breast MRI. The panel, however, pointed to a wide range of U.S., Canadian, and European studies showing that there is no evidence that MRI improves breast cancer survival, and it increases the rate of mastectomies. The panel members included Dr. Elisa R. Port and Dr. Monica Morrow, both of Memorial Sloan-Kettering Cancer Center in New York, Dr. Isabelle Bedrosian of MD Anderson Cancer Center in Houston, and Dr. Richard J. Bleicher of Fox Chase Cancer Center in Philadelphia.

The American Cancer Society and the National Comprehensive Cancer Network have developed MRI screening guidelines to distinguish which groups of patients should or should not be screened. However, there are very few data thus far to indicate just when to start or stop screening, or how often to perform screening, said Dr. Bedrosian.

“There are no data on the impact of MRI screening on survival outcomes,” she said, noting that the data to support MRI screening in terms of outcomes are based on disease stage migration, not survival.

She added that there are very few data about the cost-effectiveness of breast MRI screening. Patient age, BRCA gene mutations, breast density, and the cost of MRI must all be factored into the cost-effectiveness of MRI screening. The data show that MRI screening is more cost effective for higher-risk patients, but the panel wondered whether breast MRI screenings could be contributing to the nation’s rising health care costs.

There are currently 70 million women in the United States between the ages of 30 and 70. Of those, 1% are at high risk of developing breast cancer and are eligible for screening, which translates to a potential 1 million MRI screenings per year, said the panel.

“The most troubling finding is that it causes us to think about breast cancer the way we thought about it in the 1970s, the 1980s, and the early 1990s – that the disease burden in the breast is the sole or primary determinant of breast cancer outcome,” said Dr. Morrow. “The modern era tells us that’s really not true.”

In addition, she mentioned two retrospective studies (one in the United States and the other from the Netherlands Cancer Institute) that showed no decrease in unplanned mastectomy for patients who had preoperative MRI.

To answer the question of whether or not obtaining an MRI increases the likelihood of obtaining negative margins, Dr. Morrow summarized the results of four retrospective studies involving more than 2,500 patients. “The studies showed no statistically significant benefit in terms of reducing positive margins with MRI,” she said.

Another prospective randomized trial of 1,600 women showed that the net effect of MRI was a slightly higher rate of mastectomy in patients who had an MRI preoperatively, but no reduction in the need for further surgery.

Dr. Morrow added that in patients who have unifocal cancer, MRI can’t underestimate the extent of disease but instead overestimates the extent of disease in a third of the patients. In the case of multifocal or multicentric disease, MRI is accurate in a third of the patients, it overestimates the disease in another third, and it misses the disease a third of the time.

“There’s no possibility that MRI will improve breast cancer survival,” Dr. Morrow said. It takes a difference in local failure rates of greater than 10% at 5 years post treatment to see a survival difference in 15 years, she added. “Current rates of local recurrence at 10 years are less than 10%, and there should be no expectation that MRI will change survival.”

Medicare data show that the number of MRIs (all types) performed has increased over the past decade. While the total cost of treating breast cancer patients in the United States is increasing at 4% per year, the imaging costs are increasing at 10% a year, said Dr. Bleicher.

Although there are no national data showing what percentage of health care costs is attributable to breast MRIs, “one of the things that’s not in dispute [is that] breast MRI usage in breast cancer patients is increasing,” and its contribution to rising health care costs is “highly suggestive,” he added.

Furthermore, fear of lawsuits among surgeons and radiologists also influences the decision to order these tests.

“So what can we do?” asked Dr. Bleicher. “Always do what’s best for the patient, [and] you need to document your rationale. MRI is indeed a valuable tool, but we really do need to define its indications both to justify the cost involved and to clarify when not performing it is true breach of duty to the patient.”

The panel concluded that there is a need to establish evidence-based criteria for ordering MRIs in different clinical scenarios. “The potential research applications of MRI should not be confused with routine clinical practice,” said Dr. Morrow.

“MRI is not emerging – it has fully emerged – and in some respects, the train has already left the station,” said Dr. Port. “I think what we need to do at this point is really re-establish definitive guidelines for [MRI] use in women with newly diagnosed breast cancer for whom there are no clear-cut guidelines and for whom practice patterns range widely.”

The panel members reported no relevant conflicts of interest.

WASHINGTON – While the use of magnetic resonance imaging as a screening tool for breast cancer has increased significantly over the past decade, there is still little evidence of its clinical benefits and cost-effectiveness, according to a panel of experts who addressed a capacity crowd at the annual clinical congress of the American College of Surgeons.

Patients at high risk of developing breast cancer (e.g., those with BRCA mutations or a greater than 20% risk of developing breast cancer during their lifetime) could benefit from breast MRI. The panel, however, pointed to a wide range of U.S., Canadian, and European studies showing that there is no evidence that MRI improves breast cancer survival, and it increases the rate of mastectomies. The panel members included Dr. Elisa R. Port and Dr. Monica Morrow, both of Memorial Sloan-Kettering Cancer Center in New York, Dr. Isabelle Bedrosian of MD Anderson Cancer Center in Houston, and Dr. Richard J. Bleicher of Fox Chase Cancer Center in Philadelphia.

The American Cancer Society and the National Comprehensive Cancer Network have developed MRI screening guidelines to distinguish which groups of patients should or should not be screened. However, there are very few data thus far to indicate just when to start or stop screening, or how often to perform screening, said Dr. Bedrosian.

“There are no data on the impact of MRI screening on survival outcomes,” she said, noting that the data to support MRI screening in terms of outcomes are based on disease stage migration, not survival.

She added that there are very few data about the cost-effectiveness of breast MRI screening. Patient age, BRCA gene mutations, breast density, and the cost of MRI must all be factored into the cost-effectiveness of MRI screening. The data show that MRI screening is more cost effective for higher-risk patients, but the panel wondered whether breast MRI screenings could be contributing to the nation’s rising health care costs.

There are currently 70 million women in the United States between the ages of 30 and 70. Of those, 1% are at high risk of developing breast cancer and are eligible for screening, which translates to a potential 1 million MRI screenings per year, said the panel.

“The most troubling finding is that it causes us to think about breast cancer the way we thought about it in the 1970s, the 1980s, and the early 1990s – that the disease burden in the breast is the sole or primary determinant of breast cancer outcome,” said Dr. Morrow. “The modern era tells us that’s really not true.”

In addition, she mentioned two retrospective studies (one in the United States and the other from the Netherlands Cancer Institute) that showed no decrease in unplanned mastectomy for patients who had preoperative MRI.

To answer the question of whether or not obtaining an MRI increases the likelihood of obtaining negative margins, Dr. Morrow summarized the results of four retrospective studies involving more than 2,500 patients. “The studies showed no statistically significant benefit in terms of reducing positive margins with MRI,” she said.

Another prospective randomized trial of 1,600 women showed that the net effect of MRI was a slightly higher rate of mastectomy in patients who had an MRI preoperatively, but no reduction in the need for further surgery.

Dr. Morrow added that in patients who have unifocal cancer, MRI can’t underestimate the extent of disease but instead overestimates the extent of disease in a third of the patients. In the case of multifocal or multicentric disease, MRI is accurate in a third of the patients, it overestimates the disease in another third, and it misses the disease a third of the time.

“There’s no possibility that MRI will improve breast cancer survival,” Dr. Morrow said. It takes a difference in local failure rates of greater than 10% at 5 years post treatment to see a survival difference in 15 years, she added. “Current rates of local recurrence at 10 years are less than 10%, and there should be no expectation that MRI will change survival.”

Medicare data show that the number of MRIs (all types) performed has increased over the past decade. While the total cost of treating breast cancer patients in the United States is increasing at 4% per year, the imaging costs are increasing at 10% a year, said Dr. Bleicher.

Although there are no national data showing what percentage of health care costs is attributable to breast MRIs, “one of the things that’s not in dispute [is that] breast MRI usage in breast cancer patients is increasing,” and its contribution to rising health care costs is “highly suggestive,” he added.

Furthermore, fear of lawsuits among surgeons and radiologists also influences the decision to order these tests.

“So what can we do?” asked Dr. Bleicher. “Always do what’s best for the patient, [and] you need to document your rationale. MRI is indeed a valuable tool, but we really do need to define its indications both to justify the cost involved and to clarify when not performing it is true breach of duty to the patient.”

The panel concluded that there is a need to establish evidence-based criteria for ordering MRIs in different clinical scenarios. “The potential research applications of MRI should not be confused with routine clinical practice,” said Dr. Morrow.

“MRI is not emerging – it has fully emerged – and in some respects, the train has already left the station,” said Dr. Port. “I think what we need to do at this point is really re-establish definitive guidelines for [MRI] use in women with newly diagnosed breast cancer for whom there are no clear-cut guidelines and for whom practice patterns range widely.”

The panel members reported no relevant conflicts of interest.

WASHINGTON – While the use of magnetic resonance imaging as a screening tool for breast cancer has increased significantly over the past decade, there is still little evidence of its clinical benefits and cost-effectiveness, according to a panel of experts who addressed a capacity crowd at the annual clinical congress of the American College of Surgeons.

Patients at high risk of developing breast cancer (e.g., those with BRCA mutations or a greater than 20% risk of developing breast cancer during their lifetime) could benefit from breast MRI. The panel, however, pointed to a wide range of U.S., Canadian, and European studies showing that there is no evidence that MRI improves breast cancer survival, and it increases the rate of mastectomies. The panel members included Dr. Elisa R. Port and Dr. Monica Morrow, both of Memorial Sloan-Kettering Cancer Center in New York, Dr. Isabelle Bedrosian of MD Anderson Cancer Center in Houston, and Dr. Richard J. Bleicher of Fox Chase Cancer Center in Philadelphia.

The American Cancer Society and the National Comprehensive Cancer Network have developed MRI screening guidelines to distinguish which groups of patients should or should not be screened. However, there are very few data thus far to indicate just when to start or stop screening, or how often to perform screening, said Dr. Bedrosian.

“There are no data on the impact of MRI screening on survival outcomes,” she said, noting that the data to support MRI screening in terms of outcomes are based on disease stage migration, not survival.

She added that there are very few data about the cost-effectiveness of breast MRI screening. Patient age, BRCA gene mutations, breast density, and the cost of MRI must all be factored into the cost-effectiveness of MRI screening. The data show that MRI screening is more cost effective for higher-risk patients, but the panel wondered whether breast MRI screenings could be contributing to the nation’s rising health care costs.

There are currently 70 million women in the United States between the ages of 30 and 70. Of those, 1% are at high risk of developing breast cancer and are eligible for screening, which translates to a potential 1 million MRI screenings per year, said the panel.

“The most troubling finding is that it causes us to think about breast cancer the way we thought about it in the 1970s, the 1980s, and the early 1990s – that the disease burden in the breast is the sole or primary determinant of breast cancer outcome,” said Dr. Morrow. “The modern era tells us that’s really not true.”

In addition, she mentioned two retrospective studies (one in the United States and the other from the Netherlands Cancer Institute) that showed no decrease in unplanned mastectomy for patients who had preoperative MRI.

To answer the question of whether or not obtaining an MRI increases the likelihood of obtaining negative margins, Dr. Morrow summarized the results of four retrospective studies involving more than 2,500 patients. “The studies showed no statistically significant benefit in terms of reducing positive margins with MRI,” she said.

Another prospective randomized trial of 1,600 women showed that the net effect of MRI was a slightly higher rate of mastectomy in patients who had an MRI preoperatively, but no reduction in the need for further surgery.

Dr. Morrow added that in patients who have unifocal cancer, MRI can’t underestimate the extent of disease but instead overestimates the extent of disease in a third of the patients. In the case of multifocal or multicentric disease, MRI is accurate in a third of the patients, it overestimates the disease in another third, and it misses the disease a third of the time.

“There’s no possibility that MRI will improve breast cancer survival,” Dr. Morrow said. It takes a difference in local failure rates of greater than 10% at 5 years post treatment to see a survival difference in 15 years, she added. “Current rates of local recurrence at 10 years are less than 10%, and there should be no expectation that MRI will change survival.”

Medicare data show that the number of MRIs (all types) performed has increased over the past decade. While the total cost of treating breast cancer patients in the United States is increasing at 4% per year, the imaging costs are increasing at 10% a year, said Dr. Bleicher.

Although there are no national data showing what percentage of health care costs is attributable to breast MRIs, “one of the things that’s not in dispute [is that] breast MRI usage in breast cancer patients is increasing,” and its contribution to rising health care costs is “highly suggestive,” he added.

Furthermore, fear of lawsuits among surgeons and radiologists also influences the decision to order these tests.

“So what can we do?” asked Dr. Bleicher. “Always do what’s best for the patient, [and] you need to document your rationale. MRI is indeed a valuable tool, but we really do need to define its indications both to justify the cost involved and to clarify when not performing it is true breach of duty to the patient.”

The panel concluded that there is a need to establish evidence-based criteria for ordering MRIs in different clinical scenarios. “The potential research applications of MRI should not be confused with routine clinical practice,” said Dr. Morrow.

“MRI is not emerging – it has fully emerged – and in some respects, the train has already left the station,” said Dr. Port. “I think what we need to do at this point is really re-establish definitive guidelines for [MRI] use in women with newly diagnosed breast cancer for whom there are no clear-cut guidelines and for whom practice patterns range widely.”

The panel members reported no relevant conflicts of interest.

WASHINGTON – Natural orifice myotomy significantly improved dysphasia symptoms and significantly reduced lower esophageal sphincter pressure in achalasia patients in a prospective study.

The short-term outcome for the procedure, called peroral endoscopic myotomy (POEM), was excellent, although further study is needed to determine the procedure’s long-term efficacy and to compare it with other interventional therapies, said lead author Dr. Haruhiro (Haru) Inoue at the annual clinical congress of the American College of Surgeons.

To conduct the study, the investigators performed POEM in 17 consecutive patients (7 women, 10 men) with a mean age of 41 years, between September 2008 and December 2009. All had confirmed achalasia, including 12 nonsigmoid and 5 sigmoid cases.

The procedure was successful in all 17 patients. Mean dysphagia symptom scores dropped significantly from 10 to 1.3, while mean resting lower esophageal sphincter pressure also dropped significantly from 52.4 to 19.8. No serious related complications were encountered (Endoscopy 2010;42:265-71).

During a mean follow-up of 5 months, additional treatment or medication was necessary in one patient who developed mild reflux esophagitis, said Dr. Inoue of the Digestive Disease Center at Showa University Northern Yokohama Hospital, Japan.

POEM was done under general anesthesia with positive pressure ventilation at a higher pressure than is usually used, by endoscopic CO2 insufflation.

The surgeons created a submucosal tunnel, starting with a submucosal injection at the level of the mid esophagus. Then, using the triangle-tip knife, they dissected the circular muscle bundle. After confirming the status of the gastroesophageal junction, they closed the mucosal entry site with about five hemostatic clips.

The procedure was performed successfully on patients who had previously undergone balloon dilation or Botox injection, Dr. Inoue said.

Current common treatments for achalasia are medication, Botox injection, balloon dilation, and esophagomyotomy (which requires at least five abdominal incisions for trocar placement).

Most systematic studies of current treatments have found laparoscopic myotomy with fundoplication to be the most effective surgical technique, followed by endoscopic balloon dilation and endoscopic botulin toxin injection.

Dr. Inoue noted that endoscopic myotomy for the treatment of achalasia previously was reported in a case series published in 1980, in which a modified needle knife was used to dissect the muscle layer directly through the mucosal layer.

Since reporting the study, Dr. Inoue and his team have performed POEM in about 30 additional patients, and have not seen any recurrence of dysphasia. Of the treated patients, less than 10% have developed mild cases of gastroesophageal reflux disease (GERD), which has been treated with proton pump inhibitors.

The investigators reported no relevant conflicts of interest.

WASHINGTON – Natural orifice myotomy significantly improved dysphasia symptoms and significantly reduced lower esophageal sphincter pressure in achalasia patients in a prospective study.

The short-term outcome for the procedure, called peroral endoscopic myotomy (POEM), was excellent, although further study is needed to determine the procedure’s long-term efficacy and to compare it with other interventional therapies, said lead author Dr. Haruhiro (Haru) Inoue at the annual clinical congress of the American College of Surgeons.

To conduct the study, the investigators performed POEM in 17 consecutive patients (7 women, 10 men) with a mean age of 41 years, between September 2008 and December 2009. All had confirmed achalasia, including 12 nonsigmoid and 5 sigmoid cases.

The procedure was successful in all 17 patients. Mean dysphagia symptom scores dropped significantly from 10 to 1.3, while mean resting lower esophageal sphincter pressure also dropped significantly from 52.4 to 19.8. No serious related complications were encountered (Endoscopy 2010;42:265-71).

During a mean follow-up of 5 months, additional treatment or medication was necessary in one patient who developed mild reflux esophagitis, said Dr. Inoue of the Digestive Disease Center at Showa University Northern Yokohama Hospital, Japan.

POEM was done under general anesthesia with positive pressure ventilation at a higher pressure than is usually used, by endoscopic CO2 insufflation.

The surgeons created a submucosal tunnel, starting with a submucosal injection at the level of the mid esophagus. Then, using the triangle-tip knife, they dissected the circular muscle bundle. After confirming the status of the gastroesophageal junction, they closed the mucosal entry site with about five hemostatic clips.

The procedure was performed successfully on patients who had previously undergone balloon dilation or Botox injection, Dr. Inoue said.

Current common treatments for achalasia are medication, Botox injection, balloon dilation, and esophagomyotomy (which requires at least five abdominal incisions for trocar placement).

Most systematic studies of current treatments have found laparoscopic myotomy with fundoplication to be the most effective surgical technique, followed by endoscopic balloon dilation and endoscopic botulin toxin injection.

Dr. Inoue noted that endoscopic myotomy for the treatment of achalasia previously was reported in a case series published in 1980, in which a modified needle knife was used to dissect the muscle layer directly through the mucosal layer.

Since reporting the study, Dr. Inoue and his team have performed POEM in about 30 additional patients, and have not seen any recurrence of dysphasia. Of the treated patients, less than 10% have developed mild cases of gastroesophageal reflux disease (GERD), which has been treated with proton pump inhibitors.

The investigators reported no relevant conflicts of interest.

WASHINGTON – Natural orifice myotomy significantly improved dysphasia symptoms and significantly reduced lower esophageal sphincter pressure in achalasia patients in a prospective study.

The short-term outcome for the procedure, called peroral endoscopic myotomy (POEM), was excellent, although further study is needed to determine the procedure’s long-term efficacy and to compare it with other interventional therapies, said lead author Dr. Haruhiro (Haru) Inoue at the annual clinical congress of the American College of Surgeons.

To conduct the study, the investigators performed POEM in 17 consecutive patients (7 women, 10 men) with a mean age of 41 years, between September 2008 and December 2009. All had confirmed achalasia, including 12 nonsigmoid and 5 sigmoid cases.

The procedure was successful in all 17 patients. Mean dysphagia symptom scores dropped significantly from 10 to 1.3, while mean resting lower esophageal sphincter pressure also dropped significantly from 52.4 to 19.8. No serious related complications were encountered (Endoscopy 2010;42:265-71).

During a mean follow-up of 5 months, additional treatment or medication was necessary in one patient who developed mild reflux esophagitis, said Dr. Inoue of the Digestive Disease Center at Showa University Northern Yokohama Hospital, Japan.

POEM was done under general anesthesia with positive pressure ventilation at a higher pressure than is usually used, by endoscopic CO2 insufflation.

The surgeons created a submucosal tunnel, starting with a submucosal injection at the level of the mid esophagus. Then, using the triangle-tip knife, they dissected the circular muscle bundle. After confirming the status of the gastroesophageal junction, they closed the mucosal entry site with about five hemostatic clips.

The procedure was performed successfully on patients who had previously undergone balloon dilation or Botox injection, Dr. Inoue said.

Current common treatments for achalasia are medication, Botox injection, balloon dilation, and esophagomyotomy (which requires at least five abdominal incisions for trocar placement).

Most systematic studies of current treatments have found laparoscopic myotomy with fundoplication to be the most effective surgical technique, followed by endoscopic balloon dilation and endoscopic botulin toxin injection.

Dr. Inoue noted that endoscopic myotomy for the treatment of achalasia previously was reported in a case series published in 1980, in which a modified needle knife was used to dissect the muscle layer directly through the mucosal layer.

Since reporting the study, Dr. Inoue and his team have performed POEM in about 30 additional patients, and have not seen any recurrence of dysphasia. Of the treated patients, less than 10% have developed mild cases of gastroesophageal reflux disease (GERD), which has been treated with proton pump inhibitors.

The investigators reported no relevant conflicts of interest.

WASHINGTON – Natural orifice myotomy significantly improved dysphasia symptoms and significantly reduced lower esophageal sphincter pressure in achalasia patients in a prospective study.

The short-term outcome for the procedure, called peroral endoscopic myotomy (POEM), was excellent, although further study is needed to determine the procedure’s long-term efficacy and to compare it with other interventional therapies, said lead author Dr. Haruhiro (Haru) Inoue at the annual clinical congress of the American College of Surgeons.

To conduct the study, the investigators performed POEM in 17 consecutive patients (7 women, 10 men) with a mean age of 41 years, between September 2008 and December 2009. All had confirmed achalasia, including 12 nonsigmoid and 5 sigmoid cases.

The procedure was successful in all 17 patients. Mean dysphagia symptom scores dropped significantly from 10 to 1.3, while mean resting lower esophageal sphincter pressure also dropped significantly from 52.4 to 19.8. No serious related complications were encountered (Endoscopy 2010;42:265-71).

During a mean follow-up of 5 months, additional treatment or medication was necessary in one patient who developed mild reflux esophagitis, said Dr. Inoue of the Digestive Disease Center at Showa University Northern Yokohama Hospital, Japan.

POEM was done under general anesthesia with positive pressure ventilation at a higher pressure than is usually used, by endoscopic CO2 insufflation.

The surgeons created a submucosal tunnel, starting with a submucosal injection at the level of the mid esophagus. Then, using the triangle-tip knife, they dissected the circular muscle bundle. After confirming the status of the gastroesophageal junction, they closed the mucosal entry site with about five hemostatic clips.

The procedure was performed successfully on patients who had previously undergone balloon dilation or Botox injection, Dr. Inoue said.

Current common treatments for achalasia are medication, Botox injection, balloon dilation, and esophagomyotomy (which requires at least five abdominal incisions for trocar placement).

Most systematic studies of current treatments have found laparoscopic myotomy with fundoplication to be the most effective surgical technique, followed by endoscopic balloon dilation and endoscopic botulin toxin injection.

Dr. Inoue noted that endoscopic myotomy for the treatment of achalasia previously was reported in a case series published in 1980, in which a modified needle knife was used to dissect the muscle layer directly through the mucosal layer.

Since reporting the study, Dr. Inoue and his team have performed POEM in about 30 additional patients, and have not seen any recurrence of dysphasia. Of the treated patients, less than 10% have developed mild cases of gastroesophageal reflux disease (GERD), which has been treated with proton pump inhibitors.

The investigators reported no relevant conflicts of interest.

WASHINGTON – Natural orifice myotomy significantly improved dysphasia symptoms and significantly reduced lower esophageal sphincter pressure in achalasia patients in a prospective study.

The short-term outcome for the procedure, called peroral endoscopic myotomy (POEM), was excellent, although further study is needed to determine the procedure’s long-term efficacy and to compare it with other interventional therapies, said lead author Dr. Haruhiro (Haru) Inoue at the annual clinical congress of the American College of Surgeons.

To conduct the study, the investigators performed POEM in 17 consecutive patients (7 women, 10 men) with a mean age of 41 years, between September 2008 and December 2009. All had confirmed achalasia, including 12 nonsigmoid and 5 sigmoid cases.

The procedure was successful in all 17 patients. Mean dysphagia symptom scores dropped significantly from 10 to 1.3, while mean resting lower esophageal sphincter pressure also dropped significantly from 52.4 to 19.8. No serious related complications were encountered (Endoscopy 2010;42:265-71).

During a mean follow-up of 5 months, additional treatment or medication was necessary in one patient who developed mild reflux esophagitis, said Dr. Inoue of the Digestive Disease Center at Showa University Northern Yokohama Hospital, Japan.

POEM was done under general anesthesia with positive pressure ventilation at a higher pressure than is usually used, by endoscopic CO2 insufflation.

The surgeons created a submucosal tunnel, starting with a submucosal injection at the level of the mid esophagus. Then, using the triangle-tip knife, they dissected the circular muscle bundle. After confirming the status of the gastroesophageal junction, they closed the mucosal entry site with about five hemostatic clips.

The procedure was performed successfully on patients who had previously undergone balloon dilation or Botox injection, Dr. Inoue said.

Current common treatments for achalasia are medication, Botox injection, balloon dilation, and esophagomyotomy (which requires at least five abdominal incisions for trocar placement).

Most systematic studies of current treatments have found laparoscopic myotomy with fundoplication to be the most effective surgical technique, followed by endoscopic balloon dilation and endoscopic botulin toxin injection.

Dr. Inoue noted that endoscopic myotomy for the treatment of achalasia previously was reported in a case series published in 1980, in which a modified needle knife was used to dissect the muscle layer directly through the mucosal layer.

Since reporting the study, Dr. Inoue and his team have performed POEM in about 30 additional patients, and have not seen any recurrence of dysphasia. Of the treated patients, less than 10% have developed mild cases of gastroesophageal reflux disease (GERD), which has been treated with proton pump inhibitors.

The investigators reported no relevant conflicts of interest.

WASHINGTON – Natural orifice myotomy significantly improved dysphasia symptoms and significantly reduced lower esophageal sphincter pressure in achalasia patients in a prospective study.

The short-term outcome for the procedure, called peroral endoscopic myotomy (POEM), was excellent, although further study is needed to determine the procedure’s long-term efficacy and to compare it with other interventional therapies, said lead author Dr. Haruhiro (Haru) Inoue at the annual clinical congress of the American College of Surgeons.

To conduct the study, the investigators performed POEM in 17 consecutive patients (7 women, 10 men) with a mean age of 41 years, between September 2008 and December 2009. All had confirmed achalasia, including 12 nonsigmoid and 5 sigmoid cases.

The procedure was successful in all 17 patients. Mean dysphagia symptom scores dropped significantly from 10 to 1.3, while mean resting lower esophageal sphincter pressure also dropped significantly from 52.4 to 19.8. No serious related complications were encountered (Endoscopy 2010;42:265-71).

During a mean follow-up of 5 months, additional treatment or medication was necessary in one patient who developed mild reflux esophagitis, said Dr. Inoue of the Digestive Disease Center at Showa University Northern Yokohama Hospital, Japan.

POEM was done under general anesthesia with positive pressure ventilation at a higher pressure than is usually used, by endoscopic CO2 insufflation.

The surgeons created a submucosal tunnel, starting with a submucosal injection at the level of the mid esophagus. Then, using the triangle-tip knife, they dissected the circular muscle bundle. After confirming the status of the gastroesophageal junction, they closed the mucosal entry site with about five hemostatic clips.

The procedure was performed successfully on patients who had previously undergone balloon dilation or Botox injection, Dr. Inoue said.

Current common treatments for achalasia are medication, Botox injection, balloon dilation, and esophagomyotomy (which requires at least five abdominal incisions for trocar placement).

Most systematic studies of current treatments have found laparoscopic myotomy with fundoplication to be the most effective surgical technique, followed by endoscopic balloon dilation and endoscopic botulin toxin injection.

Dr. Inoue noted that endoscopic myotomy for the treatment of achalasia previously was reported in a case series published in 1980, in which a modified needle knife was used to dissect the muscle layer directly through the mucosal layer.

Since reporting the study, Dr. Inoue and his team have performed POEM in about 30 additional patients, and have not seen any recurrence of dysphasia. Of the treated patients, less than 10% have developed mild cases of gastroesophageal reflux disease (GERD), which has been treated with proton pump inhibitors.

The investigators reported no relevant conflicts of interest.

WASHINGTON – Over the past 2 decades, women's mortality from cardiovascular disease and breast and cervical cancer has declined, thanks to research focused on women's health; however, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to an Institute of Medicine committee.

“We are pleased with how much progress has been made, but there are some caveats,” Nancy E. Adler, Ph.D., chair of the IOM Committee on Women's Health Research and director of the Center for Health and Community at the University of California, San Francisco, said at a press briefing on Sept. 23 to release the report.

Based on the report, “Women's Health Research: Progress, Pitfalls, and Promise,” the committee recommended:

▸ Undertaking initiatives that increase research in high-risk populations of women;

▸ Ensuring adequate participation of women in research and analysis of data by sex; and

▸ Creation of a task force to communicate health messages about research results to women and prevent them from receiving conflicting messages from various venues.

Communication is one area in which office-based physicians can play an important role, translating research into their practices, said committee member Alina Salganicoff, Ph.D., vice president and director of women's health policy at the Kaiser Family Foundation. “Their recommendations hold a lot of weight” with their patients, she said.

The report comes 20 years after the creation of the Office of Research on Women's Health at the National Institutes of Health and 25 years after a Public Health Service task force concluded that excluding women from medical research had compromised women's health care.

Before those landmark events, women were not included in research studies as often as men were because of concerns about fetal exposure to potentially harmful substances, the “flux” of hormones, and the assumption that research findings in men would translate to women, according to the report.

The committee found that requiring researchers to enroll women in clinical trials had resulted in advances, yet the benefit of increased participation by women has not yet reached its full potential because researchers usually don't separate the results by sex.

Committee members could not pinpoint why progress was made in some conditions and not others, according to the report, which offered possible explanations such as the extent of attention from government agencies, interest from researchers, understanding of the condition, and political and social barriers.

In addition to major progress in cardiovascular diseases and breast and cervical cancers, the report noted that some progress had been made in reducing the burden of conditions such as depression, HIV/AIDS, and osteoporosis in women.

However, there has been little progress in research having an impact on conditions such as unintended pregnancy, maternal morbidity and mortality, autoimmune diseases, addiction, lung cancer, gynecologic cancers other than cervical cancer, and Alzheimer's disease, according to the report.

“Knowledge about differences in manifestation of diseases is crucial for further studies to identify the underlying biology of disease in women vs. men and to develop appropriate prevention, diagnosis, and treatment strategies for women,” wrote the committee members.

WASHINGTON – Over the past 2 decades, women's mortality from cardiovascular disease and breast and cervical cancer has declined, thanks to research focused on women's health; however, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to an Institute of Medicine committee.

“We are pleased with how much progress has been made, but there are some caveats,” Nancy E. Adler, Ph.D., chair of the IOM Committee on Women's Health Research and director of the Center for Health and Community at the University of California, San Francisco, said at a press briefing on Sept. 23 to release the report.

Based on the report, “Women's Health Research: Progress, Pitfalls, and Promise,” the committee recommended:

▸ Undertaking initiatives that increase research in high-risk populations of women;

▸ Ensuring adequate participation of women in research and analysis of data by sex; and

▸ Creation of a task force to communicate health messages about research results to women and prevent them from receiving conflicting messages from various venues.

Communication is one area in which office-based physicians can play an important role, translating research into their practices, said committee member Alina Salganicoff, Ph.D., vice president and director of women's health policy at the Kaiser Family Foundation. “Their recommendations hold a lot of weight” with their patients, she said.

The report comes 20 years after the creation of the Office of Research on Women's Health at the National Institutes of Health and 25 years after a Public Health Service task force concluded that excluding women from medical research had compromised women's health care.

Before those landmark events, women were not included in research studies as often as men were because of concerns about fetal exposure to potentially harmful substances, the “flux” of hormones, and the assumption that research findings in men would translate to women, according to the report.

The committee found that requiring researchers to enroll women in clinical trials had resulted in advances, yet the benefit of increased participation by women has not yet reached its full potential because researchers usually don't separate the results by sex.

Committee members could not pinpoint why progress was made in some conditions and not others, according to the report, which offered possible explanations such as the extent of attention from government agencies, interest from researchers, understanding of the condition, and political and social barriers.

In addition to major progress in cardiovascular diseases and breast and cervical cancers, the report noted that some progress had been made in reducing the burden of conditions such as depression, HIV/AIDS, and osteoporosis in women.

However, there has been little progress in research having an impact on conditions such as unintended pregnancy, maternal morbidity and mortality, autoimmune diseases, addiction, lung cancer, gynecologic cancers other than cervical cancer, and Alzheimer's disease, according to the report.

“Knowledge about differences in manifestation of diseases is crucial for further studies to identify the underlying biology of disease in women vs. men and to develop appropriate prevention, diagnosis, and treatment strategies for women,” wrote the committee members.

WASHINGTON – Over the past 2 decades, women's mortality from cardiovascular disease and breast and cervical cancer has declined, thanks to research focused on women's health; however, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to an Institute of Medicine committee.

“We are pleased with how much progress has been made, but there are some caveats,” Nancy E. Adler, Ph.D., chair of the IOM Committee on Women's Health Research and director of the Center for Health and Community at the University of California, San Francisco, said at a press briefing on Sept. 23 to release the report.

Based on the report, “Women's Health Research: Progress, Pitfalls, and Promise,” the committee recommended:

▸ Undertaking initiatives that increase research in high-risk populations of women;

▸ Ensuring adequate participation of women in research and analysis of data by sex; and

▸ Creation of a task force to communicate health messages about research results to women and prevent them from receiving conflicting messages from various venues.

Communication is one area in which office-based physicians can play an important role, translating research into their practices, said committee member Alina Salganicoff, Ph.D., vice president and director of women's health policy at the Kaiser Family Foundation. “Their recommendations hold a lot of weight” with their patients, she said.

The report comes 20 years after the creation of the Office of Research on Women's Health at the National Institutes of Health and 25 years after a Public Health Service task force concluded that excluding women from medical research had compromised women's health care.

Before those landmark events, women were not included in research studies as often as men were because of concerns about fetal exposure to potentially harmful substances, the “flux” of hormones, and the assumption that research findings in men would translate to women, according to the report.

The committee found that requiring researchers to enroll women in clinical trials had resulted in advances, yet the benefit of increased participation by women has not yet reached its full potential because researchers usually don't separate the results by sex.

Committee members could not pinpoint why progress was made in some conditions and not others, according to the report, which offered possible explanations such as the extent of attention from government agencies, interest from researchers, understanding of the condition, and political and social barriers.

In addition to major progress in cardiovascular diseases and breast and cervical cancers, the report noted that some progress had been made in reducing the burden of conditions such as depression, HIV/AIDS, and osteoporosis in women.

However, there has been little progress in research having an impact on conditions such as unintended pregnancy, maternal morbidity and mortality, autoimmune diseases, addiction, lung cancer, gynecologic cancers other than cervical cancer, and Alzheimer's disease, according to the report.

“Knowledge about differences in manifestation of diseases is crucial for further studies to identify the underlying biology of disease in women vs. men and to develop appropriate prevention, diagnosis, and treatment strategies for women,” wrote the committee members.

When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.

Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?

What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.

“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.

So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.

Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.

Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.

Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.

“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”

The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).

ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.

“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.

As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.

The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.

A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.

“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”

Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.

“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”

It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.

One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.

CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.

Professional organizations, such as the American Medical Informatics Association, now hold training sessions and boot camps for CMIOs to help them position their institutions for stimulus funding.

“These findings underscore the fact that the transition to a digital health care system is likely to be a long one,” the survey authors wrote.

Another survey, conducted by the College of Health Information Management Executives, found that many IT executives were cautiously optimistic about meeting the “meaningful use” requirements and qualifying for subsidies in the next 2 years. About 10% of CHIME members surveyed said that they believed their organizations wouldn’t qualify for stimulus payments until fiscal years 2013 or 2014.

“At the end of the day, it’s an exciting time,” said Dr. Reynolds of Children’s. “It’s an opportunity to make a major impact on the whole population vs. one patient at a time.”

When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.

Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?

What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.

“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.

So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.

Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.

Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.

Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.

“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”

The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).

ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.

“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.

As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.

The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.

A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.

“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”

Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.

“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”

It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.

One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.

CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.

Professional organizations, such as the American Medical Informatics Association, now hold training sessions and boot camps for CMIOs to help them position their institutions for stimulus funding.

“These findings underscore the fact that the transition to a digital health care system is likely to be a long one,” the survey authors wrote.

Another survey, conducted by the College of Health Information Management Executives, found that many IT executives were cautiously optimistic about meeting the “meaningful use” requirements and qualifying for subsidies in the next 2 years. About 10% of CHIME members surveyed said that they believed their organizations wouldn’t qualify for stimulus payments until fiscal years 2013 or 2014.

“At the end of the day, it’s an exciting time,” said Dr. Reynolds of Children’s. “It’s an opportunity to make a major impact on the whole population vs. one patient at a time.”

When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.

Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?

What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.

“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.

So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.

Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.

Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.

Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.

“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”

The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).

ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.

“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.

As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.

The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.

A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.

“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”

Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.

“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”

It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.

One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.

CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.

Professional organizations, such as the American Medical Informatics Association, now hold training sessions and boot camps for CMIOs to help them position their institutions for stimulus funding.

“These findings underscore the fact that the transition to a digital health care system is likely to be a long one,” the survey authors wrote.

Another survey, conducted by the College of Health Information Management Executives, found that many IT executives were cautiously optimistic about meeting the “meaningful use” requirements and qualifying for subsidies in the next 2 years. About 10% of CHIME members surveyed said that they believed their organizations wouldn’t qualify for stimulus payments until fiscal years 2013 or 2014.

“At the end of the day, it’s an exciting time,” said Dr. Reynolds of Children’s. “It’s an opportunity to make a major impact on the whole population vs. one patient at a time.”

When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.

Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?

What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.

“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.

So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.

Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.

Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.

Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.

“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”

The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).

ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.

“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.

As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.

The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.

A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.

“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”

Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.

“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”

It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.

One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.

CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.

Professional organizations, such as the American Medical Informatics Association, now hold training sessions and boot camps for CMIOs to help them position their institutions for stimulus funding.

“These findings underscore the fact that the transition to a digital health care system is likely to be a long one,” the survey authors wrote.

Another survey, conducted by the College of Health Information Management Executives, found that many IT executives were cautiously optimistic about meeting the “meaningful use” requirements and qualifying for subsidies in the next 2 years. About 10% of CHIME members surveyed said that they believed their organizations wouldn’t qualify for stimulus payments until fiscal years 2013 or 2014.

“At the end of the day, it’s an exciting time,” said Dr. Reynolds of Children’s. “It’s an opportunity to make a major impact on the whole population vs. one patient at a time.”

When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.

Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?

What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.

“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.

So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.

Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.

Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.

Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.

“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”

The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).

ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.

“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.

As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.

The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.

A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.

“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”

Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.

“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”

It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.

One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.

CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.

Professional organizations, such as the American Medical Informatics Association, now hold training sessions and boot camps for CMIOs to help them position their institutions for stimulus funding.

“These findings underscore the fact that the transition to a digital health care system is likely to be a long one,” the survey authors wrote.

Another survey, conducted by the College of Health Information Management Executives, found that many IT executives were cautiously optimistic about meeting the “meaningful use” requirements and qualifying for subsidies in the next 2 years. About 10% of CHIME members surveyed said that they believed their organizations wouldn’t qualify for stimulus payments until fiscal years 2013 or 2014.

“At the end of the day, it’s an exciting time,” said Dr. Reynolds of Children’s. “It’s an opportunity to make a major impact on the whole population vs. one patient at a time.”

When Dr. Ferdinand Velasco became the first CMIO at Texas Health Resources 8 years ago, he didn’t have many peers at hospitals around the nation.

Sure, there were chief medical officers, chief operating officers, and chief information officers. But a chief medical information officer?

What was also missing at Texas Health, which serves 16 counties and more than 6 million patients in the north central portion of the state, was physician involvement in the selection of IT systems, Dr. Velasco said in an interview.

“My concern was that until we got them really engaged in [the IT selection process], it would be very difficult to get them to buy into the system. They were going to see it as a top-down approach,” he said.

So the first thing he did was establish a steering committee of physicians to help with strategic decisions like the selection of health IT systems. And 4 year later, when Texas Health launched a new electronic health record system, there was a nearly universal adoption by physicians, he said.

Dr. Velasco, a cardiothoracic surgeon, attributes that success to partnership. “It’s necessary to get the physicians on board, because they will have a sense of ownership,” he said.

Dr. Velasco’s role in Texas Health’s adoption of an EHR system is one example of the increasingly important role that CMIOs play as the health care system embraces technology.

Although the CMIO position still isn’t the standard, experts say that it is gaining prominence and is expected to grow even more as federal Recovery Act provisions drive health IT spending. Under the Recovery Act, the federal government is set to pay more than $40 billion over the next decade to providers who make “meaningful use” of EHRs.

“The CMIO role will become essential because of meaningful use,” said Dr. Velasco. “You need physicians using the systems. It’s not enough to invest in electronic health records.” Many health organizations that tried but didn’t get physician adoption might have had success, he believes, if they had had “somebody – a physician – helping with that change management.”

The position of CMIO goes back to the 1990s, when a few organizations began to place physicians in positions with titles like medical director of information systems, said Rich Rydell, CEO of the Association of Medical Directors of Information Systems (AMDIS).

ADMIS was formed at about the same time (13 years ago, to be exact) with 300 members. Today, the association has more than 2,000 members, half of whom consider themselves CMIOs, Mr. Rydell said.

“In the past 3-4 years, we’ve seen a significant increase. Many of our new members are CMIOs,” he added.

As the position has evolved over the years, so has its responsibilities. There are wide variations in day-to-day responsibilities, but there are some overall trends.

The position began as an advisory role, but today many CMIOs have clinical and operational responsibilities. And although the position generally used to be a part-time job in the IT department, increasingly CMIOs are full time and report to the CMO or CEO instead.

A few, like Dr. George Reynolds of Children’s Hospital and Medical Center in Omaha, Neb., are both the CIO and the CMIO of their organizations.

“There aren’t too many of us,” he said jokingly, referring to his double duty. “It’s a rare situation.”

Dr. Reynolds, a pediatric intensivist, has been at Children’s for 14 years, has been a CMIO for the past 5 years, and took on the CMIO/CIO position in March. He became interested in information technology from the quality standpoint, he said. His interest and involvement eventually evolved to his current full-time position.

“The reality is that physicians are critical to the success of the hospital,” he said. “So anybody who speaks representing physicians is someone who carries influence with the hospital administration.”

It is difficult to estimate what percentage of U.S. hospitals have CMIOs. And because CMIOs are an emerging group, there are not many studies or surveys about them.

One survey, the 2010 Top Health IT Survey and CMIO Census by TriMed Media Group, shows that a majority of the 212 qualified, responding CMIOs were men in their early 50s who practiced internal medicine, pediatrics, or emergency medicine. More than half had the CMIO title, with others having titles such as director or manager of clinical information systems. More than half practiced in large hospital systems, and almost half said they spent less than 10% of their time seeing patients.

CMIO practice and hiring trends somewhat reflect the trend in EHR implementation among U.S. hospitals. A recent Health Affairs survey shows that only 2% of U.S. hospitals reported having EHRs that would allow them to meet the “meaningful use” criteria. Meanwhile, nearly 12% of hospitals reported adopting either basic or comprehensive EHRs.

Professional organizations, such as the American Medical Informatics Association, now hold training sessions and boot camps for CMIOs to help them position their institutions for stimulus funding.

“These findings underscore the fact that the transition to a digital health care system is likely to be a long one,” the survey authors wrote.

Another survey, conducted by the College of Health Information Management Executives, found that many IT executives were cautiously optimistic about meeting the “meaningful use” requirements and qualifying for subsidies in the next 2 years. About 10% of CHIME members surveyed said that they believed their organizations wouldn’t qualify for stimulus payments until fiscal years 2013 or 2014.

“At the end of the day, it’s an exciting time,” said Dr. Reynolds of Children’s. “It’s an opportunity to make a major impact on the whole population vs. one patient at a time.”

BETHESDA, MD. – The next decade worth of research in women’s health should focus on increasing understanding of role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women’s Health at the National Institutes of Health.

“We need to continue the research that will help us better understand the health of women and of men,” said Dr. Vivian W. Pinn, director of the

Office of Research on Womens Health (ORWH). “We need to continue to expand the scientific base and make sure we have better ... and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research.”

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

• Increase sex differences research in basic science studies.

• Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

• Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

• Create strategic alliances and partnerships to maximize the domestic and global impact of women’s health research.

• Develop and implement new communication and social networking technologies to increase understanding and appreciation of women’s health and wellness research.

• Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women’s health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

“Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics,” the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

“There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they’re important,” she said. “That’s something that leaves me very concerned. We don’t have the power to change it. We just have to make pleas.”

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women’s health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women’s health, because that’s one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: “We’ve saved lives. A million at a time.”

Women’s health goes beyond just women, Dr. Pinn said. “We don’t see women’s health research as for being just for women but really for the broader community.”

Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women’s health is “really about the future, not just the past.” To see an interview with Dr. Healy click here.

There have been three women’s suffrage movements, according to Dr. Healy. “First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we’re in the midst of it. It’s been primed for the past 20 years and it’s going to continue. It’s about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership.”

BETHESDA, MD. – The next decade worth of research in women’s health should focus on increasing understanding of role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women’s Health at the National Institutes of Health.

“We need to continue the research that will help us better understand the health of women and of men,” said Dr. Vivian W. Pinn, director of the

Office of Research on Womens Health (ORWH). “We need to continue to expand the scientific base and make sure we have better ... and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research.”

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

• Increase sex differences research in basic science studies.

• Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

• Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

• Create strategic alliances and partnerships to maximize the domestic and global impact of women’s health research.

• Develop and implement new communication and social networking technologies to increase understanding and appreciation of women’s health and wellness research.

• Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women’s health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

“Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics,” the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

“There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they’re important,” she said. “That’s something that leaves me very concerned. We don’t have the power to change it. We just have to make pleas.”

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women’s health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women’s health, because that’s one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: “We’ve saved lives. A million at a time.”

Women’s health goes beyond just women, Dr. Pinn said. “We don’t see women’s health research as for being just for women but really for the broader community.”

Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women’s health is “really about the future, not just the past.” To see an interview with Dr. Healy click here.

There have been three women’s suffrage movements, according to Dr. Healy. “First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we’re in the midst of it. It’s been primed for the past 20 years and it’s going to continue. It’s about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership.”

BETHESDA, MD. – The next decade worth of research in women’s health should focus on increasing understanding of role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women’s Health at the National Institutes of Health.

“We need to continue the research that will help us better understand the health of women and of men,” said Dr. Vivian W. Pinn, director of the

Office of Research on Womens Health (ORWH). “We need to continue to expand the scientific base and make sure we have better ... and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research.”

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

• Increase sex differences research in basic science studies.

• Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

• Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

• Create strategic alliances and partnerships to maximize the domestic and global impact of women’s health research.

• Develop and implement new communication and social networking technologies to increase understanding and appreciation of women’s health and wellness research.

• Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women’s health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

“Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics,” the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

“There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they’re important,” she said. “That’s something that leaves me very concerned. We don’t have the power to change it. We just have to make pleas.”

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women’s health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women’s health, because that’s one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: “We’ve saved lives. A million at a time.”

Women’s health goes beyond just women, Dr. Pinn said. “We don’t see women’s health research as for being just for women but really for the broader community.”

Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women’s health is “really about the future, not just the past.” To see an interview with Dr. Healy click here.

There have been three women’s suffrage movements, according to Dr. Healy. “First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we’re in the midst of it. It’s been primed for the past 20 years and it’s going to continue. It’s about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership.”

BETHESDA, MD. - The next decade worth of research in women's health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women's Health at the National Institutes of Health.

"We need to continue the research that will help us better understand the health of women and of men," said Dr. Vivian W. Pinn, director of the Office of Research on Women's Health (ORWH). "We need to continue to expand the scientific base and make sure we have better … and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research."

The plan, "A Vision for 2020 for Women's Health Research: Moving Into the Future With New Dimensions and Strategies," was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women's Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

Increase sex differences research in basic science studies.

Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

Create strategic alliances and partnerships to maximize the domestic and global impact of women's health research.

Develop and implement new communication and social networking technologies to increase understanding and appreciation of women's health and wellness research.

Employ innovative strategies to build a well-trained, diverse, and vigorous women's health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women's health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

"Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology-enabled fields such as genomic, proteomics and metabolomics," the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

"There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they're important," she said. "That's something that leaves me very concerned. We don't have the power to change it. We just have to make pleas."

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women's health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women's health, because that's one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: "We've saved lives. A million at a time."

Women's health goes beyond just women, Dr. Pinn said. "We don't see women's health research as for being just for women but really for the broader community."
Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women's health is "really about the future, not just the past."

There have been three women's suffrage movements, according to Dr. Healy. "First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we're in the midst of it. It's been primed for the past 20 years and it's going to continue. It's about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership."

Read Related Story:

Reports Shows Progress, Pitfalls in Women's Health Research

BETHESDA, MD. - The next decade worth of research in women's health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women's Health at the National Institutes of Health.

"We need to continue the research that will help us better understand the health of women and of men," said Dr. Vivian W. Pinn, director of the Office of Research on Women's Health (ORWH). "We need to continue to expand the scientific base and make sure we have better … and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research."

The plan, "A Vision for 2020 for Women's Health Research: Moving Into the Future With New Dimensions and Strategies," was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women's Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

Increase sex differences research in basic science studies.

Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

Create strategic alliances and partnerships to maximize the domestic and global impact of women's health research.

Develop and implement new communication and social networking technologies to increase understanding and appreciation of women's health and wellness research.

Employ innovative strategies to build a well-trained, diverse, and vigorous women's health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women's health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

"Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology-enabled fields such as genomic, proteomics and metabolomics," the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

"There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they're important," she said. "That's something that leaves me very concerned. We don't have the power to change it. We just have to make pleas."

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women's health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women's health, because that's one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: "We've saved lives. A million at a time."

Women's health goes beyond just women, Dr. Pinn said. "We don't see women's health research as for being just for women but really for the broader community."
Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women's health is "really about the future, not just the past."

There have been three women's suffrage movements, according to Dr. Healy. "First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we're in the midst of it. It's been primed for the past 20 years and it's going to continue. It's about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership."

Read Related Story:

Reports Shows Progress, Pitfalls in Women's Health Research

BETHESDA, MD. - The next decade worth of research in women's health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women's Health at the National Institutes of Health.

"We need to continue the research that will help us better understand the health of women and of men," said Dr. Vivian W. Pinn, director of the Office of Research on Women's Health (ORWH). "We need to continue to expand the scientific base and make sure we have better … and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research."

The plan, "A Vision for 2020 for Women's Health Research: Moving Into the Future With New Dimensions and Strategies," was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women's Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

Increase sex differences research in basic science studies.

Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

Create strategic alliances and partnerships to maximize the domestic and global impact of women's health research.

Develop and implement new communication and social networking technologies to increase understanding and appreciation of women's health and wellness research.

Employ innovative strategies to build a well-trained, diverse, and vigorous women's health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women's health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

"Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology-enabled fields such as genomic, proteomics and metabolomics," the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

"There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they're important," she said. "That's something that leaves me very concerned. We don't have the power to change it. We just have to make pleas."

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women's health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women's health, because that's one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: "We've saved lives. A million at a time."

Women's health goes beyond just women, Dr. Pinn said. "We don't see women's health research as for being just for women but really for the broader community."
Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women's health is "really about the future, not just the past."

There have been three women's suffrage movements, according to Dr. Healy. "First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we're in the midst of it. It's been primed for the past 20 years and it's going to continue. It's about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership."

Read Related Story:

Reports Shows Progress, Pitfalls in Women's Health Research

Major Finding: U.S. health care spending is projected to rise to about $4.6 trillion by 2019, growing at an average rate of 6.3% a year.

Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary.

Disclosures: The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (Health Affairs 2010 Sept. 9 [doi:10.1377/hlthaff.2010.0788]).

The projections update an analysis done in February. This time, they take into account the impact of the ACA and changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a subsequent blog post, “Today's report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report's data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients' out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is slated to comprise 32% of national health spending; Medicaid and the Children's Health Insurance Program are to account for 20%. Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

Major Finding: U.S. health care spending is projected to rise to about $4.6 trillion by 2019, growing at an average rate of 6.3% a year.

Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary.

Disclosures: The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (Health Affairs 2010 Sept. 9 [doi:10.1377/hlthaff.2010.0788]).

The projections update an analysis done in February. This time, they take into account the impact of the ACA and changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a subsequent blog post, “Today's report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report's data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients' out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is slated to comprise 32% of national health spending; Medicaid and the Children's Health Insurance Program are to account for 20%. Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

Major Finding: U.S. health care spending is projected to rise to about $4.6 trillion by 2019, growing at an average rate of 6.3% a year.

Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary.

Disclosures: The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (Health Affairs 2010 Sept. 9 [doi:10.1377/hlthaff.2010.0788]).

The projections update an analysis done in February. This time, they take into account the impact of the ACA and changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a subsequent blog post, “Today's report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report's data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients' out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is slated to comprise 32% of national health spending; Medicaid and the Children's Health Insurance Program are to account for 20%. Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

More C-Sections at For Profits

California women who gave birth at for-profit hospitals were 17% more likely to have a C-section than women who went to nonprofit hospitals, according to an analysis by California Watch. “This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate,” Desirre Andrews, president of the International Cesarean Awareness Network, told the watchdog group. The analysis was based on state birthing records. Data and charts from the report are available at

http://projects.californiawatch.org/c-sections

Morning Sickness Doubts

A review of drugs and alternative therapies for morning sickness showed a lack of high-quality evidence to support advice on which treatment to use. Published by the Cochrane Library, the findings were based on an examination of 27 randomized controlled trials that included data on 4,041 women in early pregnancy. The review found that most of the studies had a high risk of bias and that they measured symptoms in several different ways. “Given the high prevalence of nausea and vomiting in early pregnancy,” health professionals need systematically reviewed evidence by which to guide women, the authors said. However, they found “very little information on the effectiveness of treatments for improving women's quality of life.”

Breastfeeding Rates Vary

Nearly 75% of babies born in the United States in 2007 were breastfed, according to the Centers for Disease Control and Prevention's 2010 Breastfeeding Report Card. However, that rate dropped to 43% by the time babies reached 6 months of age. Although the rate of women initiating breastfeeding in newborns has risen steadily, the proportion of babies being breastfed at 6 and 12 months remained stagnant for the third straight year, according to the report. Only 43% (1.8 million) of U.S. mothers were breastfeeding at 6 months and only 22% (fewer than 1 million) at 12 months, the researchers found. “We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces, and communities to continue breastfeeding beyond the first few days of life,” Dr. William Dietz, director of the CDC's division of nutrition, physical activity, and obesity, said in a statement.

Alternative Birthing Rooms Safe

Homelike birthing rooms within hospitals, including bed-free rooms, are as safe for healthy women in labor as are rooms with traditional hospital beds, according to another Cochrane Library report. After reviewing nine studies of more than 10,000 women, researchers found that alternative birthing rooms reduced use of epidural and other anesthesia by 18% and the need for oxytocin by 22%. The probability of mothers breastfeeding at 6-8 weeks increased by 4% among those using the alternative rooms. “Birth environment affects not only the women who are laboring but also the behavior of care providers,” said lead author and registered nurse Ellen Hodnett, Ph.D., chair of perinatal nursing research at the University of Toronto, in a statement. “Providers should think creatively about how to use the environment that they have to promote the message that they want to send, and, hopefully, that message is that birth is a normal experience.”

AMA Opposes Tax Change

The American Medical Association and 90 medical organizations, including the American Congress of Obstetricians and Gynecologists, have written to the Department of the Treasury urging it not to allow trial lawyers to deduct court costs and other expenses. Making such a change to tax law could encourage trial lawyers to file more claims, the organizations claimed. “Even though a substantial majority of claims are dropped or decided in favor of physicians, the cost of defending against meritless claims averages over $22,000,” their letter said. The organizations urged the Treasury Department to reconsider rumored plans to change current policy, which does not allow such tax deductions.

Alaskans Vote for Prenotification

On the day Alaskan Republicans turned out incumbent Sen. Lisa Murkowski for Tea Party candidate Joe Miller, more than half of the primary voters said “yes” to a ballot measure that would require notification of parents or guardians before minors can receive an abortion. The 69,012 votes in favor of Ballot Measure 2 made up 56% of the turnout on the state's primary day, according to the National Partnership for Women and Families. The law would take effect 90 days after the election is certified, or about mid-December. If so, doctors who fail to comply could face felony charges and prison sentences of up to 5 years, according to the advocacy group. In a statement, it added that teens can circumvent the parental notification requirements if they appear before a judge or provide the abortion provider with a notarized statement attesting to abuse at home. Currently, 34 states require parental consent or notification before minors can obtain abortion services, according to the partnership.

More C-Sections at For Profits

California women who gave birth at for-profit hospitals were 17% more likely to have a C-section than women who went to nonprofit hospitals, according to an analysis by California Watch. “This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate,” Desirre Andrews, president of the International Cesarean Awareness Network, told the watchdog group. The analysis was based on state birthing records. Data and charts from the report are available at

http://projects.californiawatch.org/c-sections

Morning Sickness Doubts

A review of drugs and alternative therapies for morning sickness showed a lack of high-quality evidence to support advice on which treatment to use. Published by the Cochrane Library, the findings were based on an examination of 27 randomized controlled trials that included data on 4,041 women in early pregnancy. The review found that most of the studies had a high risk of bias and that they measured symptoms in several different ways. “Given the high prevalence of nausea and vomiting in early pregnancy,” health professionals need systematically reviewed evidence by which to guide women, the authors said. However, they found “very little information on the effectiveness of treatments for improving women's quality of life.”

Breastfeeding Rates Vary

Nearly 75% of babies born in the United States in 2007 were breastfed, according to the Centers for Disease Control and Prevention's 2010 Breastfeeding Report Card. However, that rate dropped to 43% by the time babies reached 6 months of age. Although the rate of women initiating breastfeeding in newborns has risen steadily, the proportion of babies being breastfed at 6 and 12 months remained stagnant for the third straight year, according to the report. Only 43% (1.8 million) of U.S. mothers were breastfeeding at 6 months and only 22% (fewer than 1 million) at 12 months, the researchers found. “We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces, and communities to continue breastfeeding beyond the first few days of life,” Dr. William Dietz, director of the CDC's division of nutrition, physical activity, and obesity, said in a statement.

Alternative Birthing Rooms Safe

Homelike birthing rooms within hospitals, including bed-free rooms, are as safe for healthy women in labor as are rooms with traditional hospital beds, according to another Cochrane Library report. After reviewing nine studies of more than 10,000 women, researchers found that alternative birthing rooms reduced use of epidural and other anesthesia by 18% and the need for oxytocin by 22%. The probability of mothers breastfeeding at 6-8 weeks increased by 4% among those using the alternative rooms. “Birth environment affects not only the women who are laboring but also the behavior of care providers,” said lead author and registered nurse Ellen Hodnett, Ph.D., chair of perinatal nursing research at the University of Toronto, in a statement. “Providers should think creatively about how to use the environment that they have to promote the message that they want to send, and, hopefully, that message is that birth is a normal experience.”

AMA Opposes Tax Change

The American Medical Association and 90 medical organizations, including the American Congress of Obstetricians and Gynecologists, have written to the Department of the Treasury urging it not to allow trial lawyers to deduct court costs and other expenses. Making such a change to tax law could encourage trial lawyers to file more claims, the organizations claimed. “Even though a substantial majority of claims are dropped or decided in favor of physicians, the cost of defending against meritless claims averages over $22,000,” their letter said. The organizations urged the Treasury Department to reconsider rumored plans to change current policy, which does not allow such tax deductions.

Alaskans Vote for Prenotification

On the day Alaskan Republicans turned out incumbent Sen. Lisa Murkowski for Tea Party candidate Joe Miller, more than half of the primary voters said “yes” to a ballot measure that would require notification of parents or guardians before minors can receive an abortion. The 69,012 votes in favor of Ballot Measure 2 made up 56% of the turnout on the state's primary day, according to the National Partnership for Women and Families. The law would take effect 90 days after the election is certified, or about mid-December. If so, doctors who fail to comply could face felony charges and prison sentences of up to 5 years, according to the advocacy group. In a statement, it added that teens can circumvent the parental notification requirements if they appear before a judge or provide the abortion provider with a notarized statement attesting to abuse at home. Currently, 34 states require parental consent or notification before minors can obtain abortion services, according to the partnership.

More C-Sections at For Profits

California women who gave birth at for-profit hospitals were 17% more likely to have a C-section than women who went to nonprofit hospitals, according to an analysis by California Watch. “This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate,” Desirre Andrews, president of the International Cesarean Awareness Network, told the watchdog group. The analysis was based on state birthing records. Data and charts from the report are available at

http://projects.californiawatch.org/c-sections

Morning Sickness Doubts

A review of drugs and alternative therapies for morning sickness showed a lack of high-quality evidence to support advice on which treatment to use. Published by the Cochrane Library, the findings were based on an examination of 27 randomized controlled trials that included data on 4,041 women in early pregnancy. The review found that most of the studies had a high risk of bias and that they measured symptoms in several different ways. “Given the high prevalence of nausea and vomiting in early pregnancy,” health professionals need systematically reviewed evidence by which to guide women, the authors said. However, they found “very little information on the effectiveness of treatments for improving women's quality of life.”

Breastfeeding Rates Vary

Nearly 75% of babies born in the United States in 2007 were breastfed, according to the Centers for Disease Control and Prevention's 2010 Breastfeeding Report Card. However, that rate dropped to 43% by the time babies reached 6 months of age. Although the rate of women initiating breastfeeding in newborns has risen steadily, the proportion of babies being breastfed at 6 and 12 months remained stagnant for the third straight year, according to the report. Only 43% (1.8 million) of U.S. mothers were breastfeeding at 6 months and only 22% (fewer than 1 million) at 12 months, the researchers found. “We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces, and communities to continue breastfeeding beyond the first few days of life,” Dr. William Dietz, director of the CDC's division of nutrition, physical activity, and obesity, said in a statement.

Alternative Birthing Rooms Safe

Homelike birthing rooms within hospitals, including bed-free rooms, are as safe for healthy women in labor as are rooms with traditional hospital beds, according to another Cochrane Library report. After reviewing nine studies of more than 10,000 women, researchers found that alternative birthing rooms reduced use of epidural and other anesthesia by 18% and the need for oxytocin by 22%. The probability of mothers breastfeeding at 6-8 weeks increased by 4% among those using the alternative rooms. “Birth environment affects not only the women who are laboring but also the behavior of care providers,” said lead author and registered nurse Ellen Hodnett, Ph.D., chair of perinatal nursing research at the University of Toronto, in a statement. “Providers should think creatively about how to use the environment that they have to promote the message that they want to send, and, hopefully, that message is that birth is a normal experience.”

AMA Opposes Tax Change

The American Medical Association and 90 medical organizations, including the American Congress of Obstetricians and Gynecologists, have written to the Department of the Treasury urging it not to allow trial lawyers to deduct court costs and other expenses. Making such a change to tax law could encourage trial lawyers to file more claims, the organizations claimed. “Even though a substantial majority of claims are dropped or decided in favor of physicians, the cost of defending against meritless claims averages over $22,000,” their letter said. The organizations urged the Treasury Department to reconsider rumored plans to change current policy, which does not allow such tax deductions.

Alaskans Vote for Prenotification

On the day Alaskan Republicans turned out incumbent Sen. Lisa Murkowski for Tea Party candidate Joe Miller, more than half of the primary voters said “yes” to a ballot measure that would require notification of parents or guardians before minors can receive an abortion. The 69,012 votes in favor of Ballot Measure 2 made up 56% of the turnout on the state's primary day, according to the National Partnership for Women and Families. The law would take effect 90 days after the election is certified, or about mid-December. If so, doctors who fail to comply could face felony charges and prison sentences of up to 5 years, according to the advocacy group. In a statement, it added that teens can circumvent the parental notification requirements if they appear before a judge or provide the abortion provider with a notarized statement attesting to abuse at home. Currently, 34 states require parental consent or notification before minors can obtain abortion services, according to the partnership.