Amid the 250 reports and resolutions being debated at the American Medical Association's annual meeting last week in Chicago-mostly collegial discussions of mundane topics such as breastfeeding rates and influenza immunization-was one that ventured into some politically treacherous terrain.
The 534-member House of Delegates took up a resolution calling for an end to a section of the USA Patriot Act that would allow the federal government to order physicians to produce confidential health records on demand without notifying the patients involved.
A political hot potato that stirred some impassioned arguments, the debate was kicked off by Rick Lentz, a physician from Daytona Beach, Fla., who declared his unwavering support for the government, suggesting that the AMA shouldn't be taking a "passionate position" on such a highly charged issue. "We are all at war with terrorists," he said. "We must take strong, strident steps to protect the citizenry. We do need, at times, to take these extreme measures. I don't believe the AMA will benefit itself by being activists. Let's not take the AMA into the press."
On the opposite side of the ideological spectrum was Baltimore neurosurgeon Michael Williams, who said, "There's an important ethical principle that's been around for a long time, and it says that the AMA will speak on issues that are important to our patients. Suggesting this is political is incorrect. And to use it as some sort of a bargaining ploy is worrisome."
The AMA ultimately affirmed its support for patient confidentiality by calling for that section of the Patriot Act to expire this year.
Freedom of the (fake) press
Douglas Farrago, a family physician in Auburn, Maine, has spent the past few years poking fun at all aspects of healthcare in his parody magazine, Placebo Journal. Most of the jokes are about doctors, but an item about HMOs has ruffled some very big feathers.
In a past issue of the small journal-once profiled in Outliers (July 28, 2003, p. 36)-included a physician satisfaction survey by an HMO called "SICKNA Healthcare." The logo attached to the survey is similar to one used by Cigna Corp. The survey was signed "W.E. Sucque" of SICKNA's "Medical Thievery and Health Policy Division."
In the most recent edition, Farrago's editorial reveals that he has been warned by Cigna through his employer, Sisters of Charity Health System in Lewiston, Maine, to "cease and desist" from such activities.
Lindsay Shearer, a Cigna spokeswoman in Hooksett, N.H., says the item likely offended Cigna employees and it's possible that someone contacted him. "Our employees work very hard to provide very high quality service to our members, our clients, our providers. And when they see stuff like that it upsets them," she says.
But she adds that there has been no formal cease-and-desist letter, and she thinks some material in Placebo is "hilarious."
Farrago says parody is a legally protected form of free speech. The item was targeted at all HMOs, not just Cigna, he writes. "Lastly, the most important thing to me is that the parody was funny!"
Clearly, Farrago isn't backing down. His latest issue also includes "A day in the life of an HMO medical director" and a fake advertisement for a video game called "Grand Theft HMO III: Medical Request Denied."
Penelope, the world's newest robot, had her coming-out party earlier this month, when she assisted a surgical team at New York-Presbyterian Hospital's Allen Pavilion in removing a benign tumor on a forearm.
Acting as a scrub nurse, Penelope handed and retrieved surgical instruments for Spencer Amory, director of surgery at the New York hospital. Voice recognition software works as her ears, and she has a specially designed robotic gripper that places the requested tools into the surgeon's hand. For her eyes, she uses digital cameras and advanced image-processing software to recognize instruments that the surgeon lays back down, returning them to their proper position.
Penelope is the brainchild of Michael Treat, founder of Robotic Surgical Tech of New York and an attending surgeon at the Allen Pavilion. Treat, who has a master's degree in physics in addition to a medical degree, says he designed Penelope to help scrub nurses, not to replace them. Robots abound to help doctors, he says, so he figured it was about time someone tried to take the tedium out of operating-room nursing. Treat says Penelope will help nurses perform their jobs more productively, saving time and increasing efficiency in the operating room.
Penelope was funded in part by a grant from the National Science Foundation. Treat was delighted to see last week that she was featured on the foundation's Web page.
At one point during the procedure Penelope handed an instrument to Amory that he hadn't yet asked for but was about to, Treat says. At the end of the procedure, she says, "That was a lot of fun, let's do it again sometime." Will surgeons some day be saying, "Open the pod door, Penelope"?
"It's a tele-operator," Treat says defensively. "She's not that smart. It's not like that. She's a nice robot."