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[GCTMT]

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In House, Many Spoke With One Voice: Lobbyists'

WASHINGTON-In the official record of the historic House debate on overhauling health care, the speeches of many lawmakers echo with similarities. Often, that was no accident.

Statements by more than a dozen lawmakers were ghostwritten, in whole or in part, by Washington lobbyists working for Genentech, one of the world's largest biotechnology companies.

E-mail messages obtained by The New York Times show that the lobbyists drafted one statement for Democrats and another for Republicans.

[SilentMind]

Call it what you may, it's not a solution to health care, and delays reform of the pathetic excuse for a health care delivery system. It's just a gold mine that insurance. pharmacy, physician, DME, etc. companies have in place today, at the expense (literally and figuratively) of suffering Americans. Why do you think the FDA wouldn't allow approval of GlaxoSmithKline's H1N1 vaccine in time to prevent dozens of deaths, most of them pregnant women and babies?

There has to be a starting place to create a solution, and I believe that the bill facing the senate today, is a way to have that. When you agree with me, please let your government representatives know that you want them to support the bill.

"Plants" for the opposition come to allnurses because we have so many thousands of "hits" an hour, hoping to sway some to the demise of health care reform. Let it happen in our lifetime, please!

Truly, your wisdom knows no bounds.

[MaxAttack, BSN, RN]

It's just a gold mine that insurance. pharmacy, physician, DME, etc. companies have in place today, at the expense (literally and figuratively) of suffering Americans. Why do you think the FDA wouldn't allow approval of GlaxoSmithKline's H1N1 vaccine in time to prevent dozens of deaths, most of them pregnant women and babies?

You're not truly suggesting that the FDA prolonged the approval of GSK's vaccine so they, somehow, would make money off of people dying? I didn't realize you knew the entire approval process that their vaccine underwent, and could prove that their vaccine didn't get a late start or suffer any setbacks during the process. Because without that information, you're suffering from something called wild, unfounded, conspiracy-theory speculation. Besides, wouldn't drug manufacturers want their product to be approved so they could sell it? Wouldn't doctors want it as well so their patients would schedule visits and get their shot? Wouldn't insurance companies want it so they didn't shell out the money for sick, possibly hospitalized, patients? You're contradicting your own, misguided logic.

Maybe next time the FDA should just rush through whatever drug they're testing at the time, because apparently being thorough and doing things right just isn't good enough. I'd write a letter if I were you.

[lamazeteacher]

you're not truly suggesting that the fda prolonged the approval of gsk's vaccine so they, somehow, would make money off of people dying? i doubt that they were thinking of making money, rather they politicise giving approval to one company, over another. gsk was already in use in canada, having obtasined delivery of 34 million doses of vaccine, without there being any untoward effect of their vaccine. the usa ordered only 11 million doses of gsk's vaccine, which was available earlier. obviuously there's big money for companies whose products receive approval. i didn't realize you knew the entire approval process that their vaccine underwent, and could prove that their vaccine didn't get a late start or suffer any setbacks during the process. because without that information, you're suffering from something called wild, unfounded, conspiracy-theory speculation. your accusation is unfounded, as gsk's vaccine was available, did not suffer setbacks; and your assumption indicates that you didn't research your opinions before hurling them at me. besides, wouldn't drug manufacturers want their product to be approved so they could sell it? they did. wouldn't doctors want it as well so their patients would schedule visits and get their shot? that's another mystery in regard to the distribution of the vaccinbe. doctors ordered it, but weren't getting it. public health departments, hospitals and bankers as well as stock brokers had it first! that's a fact! wouldn't insurance companies want it what would they do with it? so they didn't shell out the money for sick, possibly hospitalized, patients? you're contradicting your own, misguided logic.

maybe next time the fda should just rush through whatever drug they're testing at the time, because apparently being thorough and doing things right just isn't good enough. i'd write a letter if i were you.

what the fda did, was not authorize distribution of a proven, available vaccine that hadn't been ordered by the usa in sufficient quantity, while waiting for another one to reach production, that hadn't been used on millions of people already. sorry to burst the bubble on the fda's trustworthiness, but that's been done many times already.

what really caused you to go off at me?:smiley_abi have facts before making accusations, you should too.

[MaxAttack, BSN, RN]

what the fda did, was not authorize distribution of a proven, available vaccine that hadn't been ordered by the usa in sufficient quantity, while waiting for another one to reach production, that hadn't been used on millions of people already. sorry to burst the bubble on the fda's trustworthiness, but that's been done many times already.

what really caused you to go off at me?:smiley_abi have facts before making accusations, you should too.

every country has their own version of the fda, simply saying it was approved elsewhere doesn't show or prove anything about the process in the united states. as for canada, id biomedical, the subsidiary of gsk that produces the h1n1 vaccine, wasn't approved until october 21st. we approved it less than 30 days later. since we're comparing the united states to canada, we had three vaccines over a month before they even had one and had shipped millions before the first one was even approved there, but i'm not accusing the canadian government of wrongdoing.

that hadn't been used on millions of people already.

that makes it sound like csl, novartis, sanofi pasteur, and medimmune (astrazeneca) are inferior to gsk. but since they were out first, how was gsk's vaccine tested on millions and theirs weren't?

anyways, it wasn't meant as an attack so much as a rebuttal.

[elkpark]

I'm amused by the brouhaha over the USPSTF mammogram recommendations. A big part of the problem with healthcare costs in this country is that we operate largely on emotion and assumptions rather than evidence. The USPSTF doesn't need to have oncology experts on the panel to make recommendations about cancer screenings because they're working with the results of the studies that have been done -- they don't need to know about cancer, they need to know about statistics and epidemiology (which they do). It's easy to find out about the USPSTF if you're sincerely curious, rather than just looking for a rationale to discount their recommendations. They're not just some self-appointed bunch of kooks and crackpots -- the group has been around since 1984, a panel of independent experts tasked by the government with determining best, most effective preventive/screenings services, based on the available evidence.

"The United States Preventive Services Task Force (USPSTF) is an independent panel of experts that is convened and supported by the Agency for Healthcare Research and Quality (AHRQ). The U.S. Congress has charged it to review the scientific evidence for clinical preventive services and develop evidence-based recommendations about their delivery. In its recommendations, the USPSTF seeks to maximize population health benefits while simultaneously minimizing harms. The primary care clinician is the target audience for USPSTF recommendations, but the recommendations are widely used by others." http://www.ahrq.gov/clinic/uspstf09/methods/inevidup.htm

The United States Preventive Services Task Force (USPSTF) is the most evidence-based and authoritative organization making recommendations on preventive services in the US. http://www.jfponline.com/Pages.asp?AID=4117&issue=May_2006&UID=

"The U.S. Preventive Services Task Force is a prominent example of evidence-based medicine put to work. The Guide to Clinical Preventive Services and its Canadian counterpart distill thousands of articles into easily understood guidelines for the busy clinician. Rather than dictating practice, it provides the scientific base for prevention services." http://www.ncbi.nlm.nih.gov/pubmed/9646965?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

"US Preventive Services Task Force: The gold standard of evidence-based prevention

The United States Preventive Services Task Force (USPSTF) was first formed in 1984 to assist physicians in making decisions about which preventive services to offer patients. It consists of a 15-member panel of independent scientists picked for their expertise in primary care, clinical prevention, and evidence-based methodology. The first set of recommendations was published in 1989 as the Guide to Clinical Preventive Services, and was revised in 1996 in the second edition. Recommendations are now published on the USPSTF web site (http://www.ahrq.gov/ clinic/uspstfix.htm)."

http://www.jfponline.com/Pages.asp?AID=1963&issue=June_2005

(Bolding mine)

[MaxAttack, BSN, RN]

Why can't the media pick out quotes like this to use instead of fueling hysteria? It seems like anyone that presents evidence contrary to common belief is commiting a crime. Let's see if I can remember the word...cognitive dissonance. Yes, that does it.

You'd think we were asking people to hang themselves.

[herring_RN, ASN, BSN]

"Evidence based" information must be used as a resource only. It must not be allowed to substitute for the clinical judgment of a physician or registered nurse.

The physician must be able to override the suggestion regarding medical orders and diagnoses.

[lamazeteacher]

why can't the media pick out quotes like this to use instead of fueling hysteria? it seems like anyone that presents evidence contrary to common belief is commiting a crime. let's see if i can remember the word...cognitive dissonance. yes, that does it.

the media is looking for news, so they accentuate certain bits of information according to its use at the timer. in the case of the preventive (not preventative) task force, its membership has been drastically changed sonce 1982, and has few scientists. the member who appeared on cnn was the director of a nursing school in georgia, whose statistics course must have been in the pre-computer age......

[color=#48d1cc]i don't know what her "axe to grind" was, but the news she conveyed certainly added "grist to the mill" for conservatives who are happily throwing out billions of dollars into the current medical/health care scheme of things. it seemed to me that insurance companies' lobbyists could have grabbed some obtuse mammography info, knowing the outcry that would result against anything that harked of mismanagment by government if that was heeded, and could have seen that the panel examined those statistics...... who knows?????

you'd think we were asking people to hang themselves.

if that type of guideline were to have been in effect when i had breast cancer, it would have been tantamount to hanging myself. women traditionally cling to life tighter than do men, and i'm guessing you're a guy, max - although you could be maxine......

[MaxAttack, BSN, RN]

"Evidence based" information must be used as a resource only. It must not be allowed to substitute for the clinical judgment of a physician or registered nurse.

The physician must be able to override the suggestion regarding medical orders and diagnoses.

Completely agree, and they even mention that the clinician should take into account the individual.

The media is looking for news, so they accentuate certain bits of information according to its use at the timer.

I was being facetious; they're looking out for theirs and they make money on controversy, of course.

In the case of the Preventive (not Preventative) Task Force, its membership has been drastically changed sonce 1982, and has few scientists. The member who appeared on CNN was the Director of a Nursing School in Georgia, whose statistics course must have been in the pre-computer age......

http://www.ahrq.gov/clinic/uspstfab.htm#Members

So they're all not qualified? And come on, how much have the basics of statistics changed?

Either way, I'm truly sorry to hear about your personal experience, and I'm glad to hear you refer to in the past tense. It's a nasty thing to a degree I don't want to imagine.

[elkpark]

"Evidence based" information must be used as a resource only. It must not be allowed to substitute for the clinical judgment of a physician or registered nurse.

The physician must be able to override the suggestion regarding medical orders and diagnoses.

The task force's recommendations are just that, recommendations, and are based on epidemiology and the general population -- they're not intended to apply equally to every single individual; they don't take into account individual risk factors, family histories, etc. Of course the astute clinician must carefully consider the unique situation of each individual.

[lamazeteacher]

The task force's recommendations are just that, recommendations, and are based on epidemiology and the general population -- they're not intended to apply equally to every single individual; they don't take into account individual risk factors, family histories, etc. Of course the astute clinician must carefully consider the unique situation of each individual.

However, the panel determined the recommendations they made re: mammography, on a study of barely over 1,000 women, without a double blind process..... Hardly a sufficient # or recognized method upon which decisions for the whole country's women should be based.

[elkpark]

However, the panel determined the recommendations they made re: mammography, on a study of barely over 1,000 women, without a double blind process..... Hardly a sufficient # or recognized method upon which decisions for the whole country's women should be based.

Do you have a source for that info?? This is from the (extensive) supporting documentation posted by the USPSTF along with the announcement of the new screening guidelines on the AHRQ website. There is a ton of further information, if one just cares to look for it.

"... We obtained data from 600,830 women aged 40 years or older undergoing routine mammography screening from 2000 to 2005 at the BCSC sites from the BCSC Statistical Coordinating Center and stratified the data by age in decades. Routine screening was defined as having at least 1 mammogram within the previous 2 years, which is consistent with current USPSTF recommendations ..."

http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanup.htm