Maybe it was pure coincidence that David Kessler, M.D., announced he would resign as Food and Drug Administration commissioner just in time for Christmas.
Whatever his reasons, Kessler has boys and girls throughout corporate America-and the consumer watchdogs who nip at their heels-drawing up lists for the White House, if not Santa, of what they want in a new FDA chief.
Foremost among the next commissioner's traits, his or her background should "inspire confidence and trust," the Pharmaceutical Research and Manufacturers of America wrote in a recent letter to President Clinton.
And for drugmakers that means a commissioner who will "consider cooperation with industry and international regulatory bodies the preferred approach to fulfilling the FDA's mission," the letter said.
The PhRMA stopped short of naming candidates but pledged to help locate the right man or woman to replace Kessler, who said he won't depart until a successor is named.
A frequent drug company foe agreed with the manufacturers group on one point: The Clinton administration needs someone who can effectively manage a 9,200-employee agency that's often caught in the public spotlight.
"The best commissioners are the ones (such as Kessler) who've had previous management experience," said Sidney Wolfe, M.D., director of Public Citizen's Health Research Group, Washington. But it must be the right kind of experience, Wolfe quickly added. The new commissioner, he said, had best not come from company ranks: "It's nearly the 21st century, and we should have left the notion of industry self-regulation behind in the 19th or early 20th century."
But business interests seem unlikely to stand by idly. After all, by its own estimate the FDA's authority touches products or services that make up a quarter of the American economy. And under Kessler, the FDA boldly expanded into new areas, such as tobacco.
Perhaps fearing it might be counted as naughty rather than nice this year, cigarette maker Philip Morris Cos. declined to comment on its Christmas wishes for a new FDA chief.
Time for a fire sale?The American Hospital Association is pouring $750,000 a year in upkeep into its vacant former headquarters in Chicago, the result of an inability to sell the historic two-building complex, according to AHA chief spokesman Richard Wade.
That's 50% more than the association said it would cost when it was disclosed that the AHA's original deal to sell the building fell through (Sept. 4, 1995, p. 2).
Wade says the initial figure didn't include land rent paid to Northwestern University, which owns the Near North property on which the building complex sits. Wade also now says the association always expected it would take up to five years to unload the old headquarters.
As far as staying in Chicago goes, Wade says, "We have no plan in mind to not have a presence in Chicago." The AHA's lease on its new downtown Chicago office space expires in 2004, although the association has an option to automatically renew for another five years. The AHA's Chicago work force is down to 264 full-time employees from 628 in 1991.
Pumping iron.Grandma may need a bench press more than a new pair of mittens this holiday season.
In recent years, both the New England Journal of Medicine and the Journal of the American Medical Association have published studies that support the use of high-resistance weight training to improve the mobility of the elderly.
As a result of the positive findings, NovaCare, a rehabilitation services provider, began bringing the same philosophy it applies to the rehabilitation of football players to help frail nursing home residents walk on their own again.
NovaCare has contracted with 14 nursing homes to supply therapists who rely on weights rather than traditional postural supports or other exercises to help patients. The nursing homes must supply the weight-training equipment, which ranges in price from $17,000 to $30,000.
The costs of the services and the equipment are typically reimbursed under Medicare as ancillary therapy-related expenses.
Jim Mertz, administrator of Boulder (Colo.) Good Samaritan Center, has contracted with NovaCare therapists and leases weight-training equipment for $1,200 a month for his residents in a 60-bed nursing home, a 13-unit assisted-living facility and a 66-unit apartment building.
"I can hardly imagine that what we did before did any good," he said.
The new equipment has replaced parallel bars and mat tables in his rec center. "The emphasis has to be on prevention," he said. "We can save Medicare money by strengthening people and getting them rehabbed quicker."
Literary triage.Fans addicted to NBC's No. 1-ranked show "ER" have more to rejoice about this holiday season. A new book, The Medicine of ER: Or, How We Almost Die, is in bookstores, providing the kind of data "ER" freaks are known to crave.
The book is written by Harlan Gibbs, M.D., an emergency room physician at Glendale Adventist Medical Center in Los Angeles, and Alan Duncan Ross, a television writer and producer and former administrator at a large urban medical center. Both are fans of "ER," and they set out a feast of the show's lore, from explanations of its fast-paced lingo (such as the exact meaning of "Bag 'em") to medical critiques of favorite "ER" episodes.
For example, a chapter titled "A Little Too Greene" dissects the Emmy Award-winning episode in the show's first season where the character Mark Greene, M.D., mistakenly discharges a pregnant woman with preeclampsia, who later dies after a Caesarean section performed by Greene.
The authors show why this episode, which "scared the dickens out of many a pregnant woman," is "unlikely at the very least in a major city hospital in the 1990s."
Fans also will learn why the likable young character John Carter, M.D., would have been thrown out of any emergency room in the country by now and why real pediatricians would never emulate Doug Ross, M.D., on the job.
Besides giving technical information about the show, the book provides details that might actually precipitate a healthcare administrator's visit to the emergency room, such as what an itemized bill would look like for some ER rescues, and how a lot of what the show's characters do would invite malpractice suits.