Interactions of doctors with the pharmaceutical industry.

OBJECTIVE: To assess the opinions and practice patterns of obstetrician-gynaecologists on acceptance and use of free drug samples and other incentive items from pharmaceutical representatives. METHODS: A questionnaire was mailed in March 2003 to 397 members of the American College of Obstetricians and Gynecologists who participate in the Collaborative Ambulatory Research Network. RESULTS: The response rate was 55%. Most respondents thought it proper to accept drug samples (92%), an informational lunch (77%), an anatomical model (75%) or a well-paid consultantship (53%) from pharmaceutical representatives. A third (33%) of the respondents thought that their own decision to prescribe a drug would probably be influenced by accepting drug samples. Respondents were more likely to think the average doctor's prescribing would be influenced by acceptance of the items than theirs would be (p<0.002). Respondents who distributed drug samples to patients indicated doing so because of patients' financial need (94%) and for their convenience (76%) and less so as a result of knowledge of the efficacy of the sample product (63%). A third (34%) of respondents agreed that interactions with industry should be more strictly regulated. CONCLUSION: Obstetrician-gynaecologists largely indicated that they would act in accordance with what they think is proper regarding accepting incentive items from pharmaceutical representatives. Although accepting free drug samples was considered to be appropriate more often than any other item, samples were most commonly judged to be influential on prescribing practices. The widely accepted practice of receiving and distributing free drug samples needs to be examined more carefully.

Intravenous nitroglycerin for uterine relaxation of an inverted uterus.

Intravenous nitroglycerin has recently come to the attention of obstetricians as a potent uterine relaxant. In the case presented, it was used to permit replacement of a tightly contracted, inverted uterus. Relaxation was rapid, effective, and associated with no adverse side effects.

Stratification and standards: a quality assurance perspective. Presidential address.

A diminished public respect for physicians, a decrease in professional autonomy, and an increased regulatory presence have led to extensive changes in medical practice in the past 25 years. Along with rising costs of medical care, there has been a resurgence in interest in the quality of health care, and a considerable body of literature on the monitoring and evaluation of health services has been produced. Quality assurance programs frequently evoke negative and skeptical responses from many physicians for a variety of reasons. Crucial to the potential effectiveness of quality assessment methods is the setting of standards. Physician clinicians should be strongly encouraged to participate directly and seriously in the development of standards. The quality assurance process should be viewed by physicians as an opportunity to recapture the control of the profession and to demonstrate to patients, in an objective manner, the legitimate high quality of care rendered.

A personal experience in comparing three nonoperative techniques for treating internal hemorrhoids.

Infrared photocoagulation therapy was used on a total of 302 patients. Approximately 20% of the patients experienced minor bleeding; however, two required surgery, and 30% of the patients experienced discomfort during a 14-day period following the procedure. Good results were obtained in patients with first- and second-degree hemorrhoids. Heater probe coagulation therapy was conducted in a total of 264 patients. Good results were achieved in 90% of patients with first- and second-degree hemorrhoids, minor pain and bleeding occurred in approximately 10% of these patients, and one patient with third-degree hemorrhoids who was treated with this technique failed to respond and required surgery. Ultroid d.c. current therapy was utilized in 192 patients, and follow-up results were good in 95% of these cases. Minor bleeding occurred in four patients. It is concluded that all three techniques, performed on an outpatient basis with little or no sedation, are effective modalities for first- and second-degree hemorrhoids, but that Ultroid d.c. current therapy is associated with less discomfort and fewer complications and that Ultroid therapy may yield good results in some patients with third- or even fourth-degree hemorrhoids.

alpha-Thalassemia hydrops fetalis: clinical and ultrasonographic considerations.

Five pregnant Southeast Asian women presenting during a 14-month period with microcytic anemia, preeclampsia, and size-date discrepancies were all ultimately diagnosed as carrying fetuses with homozygous alpha-thalassemia hydrops fetalis. The perinatal complications of this hemoglobin disorder are unique to persons of this ethnic background and include uniform fatality for the affected infant, maternal preeclamptic morbidity, and retained placenta. In this report the obstetric ultrasound findings are presented and the clinical manifestations are discussed, with recommendations made to reduce this emerging public health problem in the United States.