Ronald Reagan once said "The nine most terrifying words in the English language are: 'I'm from the government and I'm here to help.' "

Cambridge doctors light years away on the political spectrum from the conservative president have written a paper that also casts the government as part of a problem. Drs. Karen Lasser, Steffie Woolhandler, and David Himmelstein of Cambridge Health Alliance plant blame for pay gaps between specialists and generalists squarely on the government, saying its policies help perpetuate a primary care physician shortage.

The doctors, who in other arenas have favored a government-funded single-payer system something like Canada's, analyzed payment data for outpatient visits and found that government sources, including Medicaid and Medicare, make up one-third of total physician income. They conclude that changes in how the government reimburses doctors could reduce gaps that in the case of geriatricians mean they are paid an average of $165,000 a year while hematologists get $504,000. Geriatricians provide primary care for elderly people while hematologists specialize in diseases of the blood, including cancer. For both geriatricians and hematologists, government payments make up more than half of their income.

Industry funding for research at Harvard is taking another hit today in a Bloomberg News report that says a leading psychology professor's work on gambling addiction was paid for by casinos.

The arrangement has come under fire before, as reported in this 2004 Globe story, but the climate may have chilled since then for such partnerships. Harvard is currently reviewing the cases of three psychiatrists who are the subjects of a Senate investigation into their failure to reveal all industry funding for their research into drugs for children.

Howard Shaffer, an associate professor of psychology in Harvard's Department of Psychiatry, heads the Institute for Research on Pathological Gambling and Related Disorders at Harvard. According to the Globe and Bloomberg stories, the institute was created in 2000 with funding from the Washington-based National Center for Responsible Gaming, which in turn, was created in 1996 by the American Gaming Association. Shaffer and the institute have received $9.1 million since 1996, the Bloomberg story says.

A prominent advocate of a single-payer national health system will make her case to a presidential commission later today.

Dr. Steffie Woolhandler (left, in file photo) of Cambridge Health Alliance and Harvard Medical School is scheduled to testify at 2 p.m. before the President’s Council on Bioethics, which is meeting today and tomorrow in Chicago. The group is weighing various approaches to reforming healthcare.

An internal medicine physician, Woolhandler has researched inequalities in health and health care, administrative costs in medicine, and national health insurance. She supports the idea of a national health insurance system, under which private insurers would be eliminated and the government -- the single payer -- would cover all Americans through an expanded version of Medicare.

Other experts scheduled to present plans include Len Nichols, director of the health policy program for the New America Foundation, and James Capretta, a fellow at the Ethics and Public Policy Center in Washington, DC.

Dale M. Lodge, president and chief executive officer of Winchester Hospital, took the gavel of the Massachusetts Hospital Association's board of trustees at its annual meeting today in Chatham.

He follows Robert G. Norton, head of North Shore Medical Center, as chairman. Ellen M. Zane, Tufts Medical Center president and CEO, was named chair elect; Dennis Keefe, Cambridge Health Alliance president and CEO, is treasurer; and Normand E. Deschene, Lowell General Hospital president and CEO, is secretary.

Somerville Hospital is curtailing some services as the healthcare system it belongs to faces financial problems.

Somerville's intensive care unit will be closed, surgery will be performed only between 7:30 a.m. and 4:30 p.m., and the Somerville Transitional Care Unit, which offers a bridge between surgery and home for recuperating patients who need skilled nursing, will be closed, according to an article in the Somerville Journal. Forty-one jobs will be cut, including 32 in transitional care.

Every three years, medical institutions are evaluated by a national nonprofit group that scrutinizes safety and quality, from medication record-keeping to hand-washing, before awarding accreditation.

Joint Commission inspections of hospitals and nursing homes are serious occasions, intense week-long visits to decide whether the institutions meet its roughly 250 standards. The timing of the inspections is supposed to be secret, after a chorus of criticism halted the announced visits that were the norm until 2006.

Minutes from a February meeting of the psychiatry department at Cambridge Health Alliance offer some insights into how hospitals prepare for those surprise visits, and just how much of a surprise they actually are.

Psychiatry chief Dr. Jay Burke "reminded staff this is the second week of the period when we are actually vulnerable for a survey visit," according to the document obtained by the Globe.

A Brookline gynecologist whose patient died after an abortion has surrendered his license to practice medicine in Massachusetts, one of five disciplinary actions announced by a state regulatory agency yesterday.

Dr. Rapin Osathanondh, who has practiced in Massachusetts since 1974, voluntarily resigned, according to the state Board of Registration in Medicine. Board spokesman Russell Aims said the resignation -- a disciplinary action under which a physician is permanently removed from practice -- meant the board could not provide any more details, but according to a story in the Cape Cod Times, Laura Smith of Sandwich died in September while under anesthesia during an abortion at Osathanondh’s Hyannis clinic. She was 22.

The board also indefinitely suspended the license of Dr. Leon Josephs, chief of surgery at St. Vincent Hospital in Worcester. The board said that dating back to 1998 he had provided substandard care to three patients -- two of whom died after laparoscopic operations -- and failed to dictate notes about one of them in a timely fashion. The suspension was stayed yesterday when the doctor, who is also on the staff of Fallon Clinic in Worcester, agreed to five years of probation. Under the agreement, he will no longer perform laparoscopic procedures, he will be supervised by a monitor approved by the board, and he will undergo random chart review.

All patients are waiting longer to see doctors in emergency rooms, a study by Boston-area researchers says, but for people with serious conditions such as heart attacks, the time it takes has risen more rapidly.

Between 1997 and 2004, wait times went up an average of 4.1 percent per year for all patients, but for heart attack patients, the waits stretched 11.2 percent per year, researchers from Cambridge Health Alliance report in today’s issue of Health Affairs. Blacks, Hispanics, women, and patients in urban hospitals waited longer than other patients.

"The striking finding is that waits are increasing for all Americans, for people who are insured and for people who are uninsured," lead author Dr. Andrew Wilper, also a fellow in internal medicine at Harvard Medical School, said in an interview. “For patients with severe illnesses, it is troublesome.”

More than 250 Massachusetts doctors give the state's healthcare law a failing grade in an open letter released today.

Physicians for a National Health Progam, which favors a single-payer system of healthcare, contends that requiring almost all individuals to buy health insurance harms poor people, enriches insurance companies, and costs the state more than it can afford. Most but not all of the doctors who signed the letter are members of the group.

“It’s to tell people outside of Massachusetts, ‘Do something better than what we have done here,’ ” Dr. David Himmelstein, a primary care doctor at Cambridge Hospital and a member of the group, said in an interview. “The presidential candidates should be proposing something better.”

The full text of the letter follows:

Free drug samples are more likely to go to wealthy and insured people than to poor or uninsured Americans, according to a study by Boston-area doctors that conflicts with the view that giving away prescription medications forms a safety net for low-income patients.

Less than one-third of all people who received samples in a 32,000-person, nationally representative survey had low incomes, and less than one-fifth who got the free drugs were uninsured at any point in 2003, the year analyzed by researchers at Cambridge Health Alliance and Harvard Medical School. Low income was defined as less than 200 percent of the federal poverty line.

"Doctors are trying to target samples to needy patients, but their individual efforts failed to counteract society-wide factors that determine access to care," lead author Dr. Sarah L. Cutrona said in an interview today. The study appears in the February issue of the American Journal of Public Health.

About 1 in 7 teenagers in Massachusetts and Vermont might have a substance abuse problem, according to screening questionnaires filled out during routine doctors’ visits, a study has found. The adolescents' answers were more likely to indicate a problem during an appointment when they were sick or injured than when they were having a checkup.

“Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only,” wrote Dr. John R. Knight of Children’s Hospital Boston, lead author of the study in this month’s Archives of Pediatrics & Adolescent Medicine.

By Elizabeth Cooney, Globe Correspondent

Most Americans might think that veterans automatically have healthcare from the government, but one in eight working-age veterans is uninsured, a study from Cambridge Health Alliance reports.

Healthcare at Veterans Health Administration hospitals and clinics is limited to veterans who have service-related conditions or who have incomes of less than about $30,000 a year, depending on where they live. That leaves many middle-income veterans under 65 without coverage of any kind, mirroring the situation of other uninsured groups, Dr. Steffie Woolhandler, author of the study in the American Journal of Public Health, said in an interview.

“I and I think a majority of Americans had assumed that all veterans were automatically eligible for healthcare, and this in fact was true in the late 1990s,” she said. Now “the majority of middle-income veterans are excluded.”

A Boston group is sharing genetic information from families affected by autism with other researchers to promote understanding of the developmental disorder.

The Autism Consortium, whose members include hospitals, medical schools and universities in the Boston area, will transfer profiles of 500,000 genetic variations found across the genomes of 700 families with two or more children who have autism. The data will be held by the Autism Genetic Resource Exchange, a program of the advocacy organization Autism Speaks. Scientists can apply to the exchange, which gathered DNA from the families. The samples have been scanned for sequences where there are deletions or extra copies of DNA segments. The consortium is sharing the genetic variations it found.

"We returned all of the raw data to AGRE so they can distribute it to any other investigtors who want to begin exploring what may be the genetic underpinnings of autism," Mark Daly, a consortium member from Massachusetts General Hospital and the Broad Institute of MIT and Harvard, said in an interview. "Understanding the genetics underlying a complex disease is not an easy problem to solve. So there's no excuse for hoarding your data when much more can be learned by sharing."

Cambridge Health Alliance will accept an award today from the National Association of Public Hospitals and Health Systems for its role in medical school curriculum change.

CHA developed a program for third-year Harvard Medical School students to follow patients for a year at one hospital instead of traditional rotations in different settings. The hospital was chosen for the 2007 Chair Award from 64 submissions, NAPH said in a statement.

Dr. Samantha L. Rosman, a third-year resident in pediatrics in Boston, has been re-elected to the American Medical Association's board of trustees. She is a 2004 graduate of Columbia University College of Physicians and Surgeons. After completing her residency, she will begin a fellowship in pediatric emergency medicine at Boston Medical Center.

Dr. Karen Shedlack (left), medical adviser for the mental retardation division of Vinfen, has won a 2007 Distinguished Fellowship from the American Psychiatric Association.

Before joining Vinfen, a private, nonprofit human services organization based in Cambridge, Shedlack was medical director for the adult developmental disabilities program at McLean Hospital and worked in the department of psychology and brain science at the Massachusetts Institute of Technology.

Virgin Life Care has named three Boston academics to its science advisory board.

A subsidiary of the Virgin group headed by Sir Richard Branson, the Boston company develops activity-based health rewards programs.

The board members are Dr. I-Min Lee of Harvard Medical School and the Harvard School of Public Health, Kyle McInnis of UMass-Boston and Jessica Whitely of UMass-Boston and Brown Medical School.

Children's Hospital Boston has honored five doctors with Community Physician Awards for the care they give in pediatric practices and community health centers.

They are Dr. Anthony Compagnone of Hyde Park Pediatrics, Dr. Debra Ann Gfeller of Holliston Pediatrics, Dr. David Holder of the Martha Eliot Health Center, Dr. Richard Marshall of Harvard Vanguard Associates at Copley and Dr. Robert Michaels of Longwood Pediatrics.

Robert G. Norton, president and CEO of North Shore Medical Center in Salem, became chairman of the Massachusetts Hospital Association's board of trustees today, the group said.

Norton came to the Partners HealthCare hospital from Shands Jacksonville Medical Center in Florida after being executive vice president at Beth Israel Deaconess Medical Center.

Other MHA officers are Winchester Hospital president and CEO Dale M. Lodge, chairman elect; Tufts-New England Medical Center president and CEO Ellen M. Zane, treasurer; and Cambridge Health Alliance president and CEO Dennis Keefe, secretary.

Louis Kunkel, director of the program in genomics at Children's Hospital Boston, has won a one-year $100,000 distinguished investigator award from the Mental Health Research Association to study gene expression in autistic children.

Dr. Mary Jane England, president of Regis College, has been honored as this year's outstanding psychiatrist for lifetime achievement by the Massachusetts Psychiatric Society.

Dr. Suzanne A. Bird, medical director of Cambridge Health Alliance's psychiatric emergency service, has received the annual Irma Bland Award for Excellence in Teaching Residents from the American Psychiatric Association.

Maureen Walsh, a nurse and health teacher at St. Francis Xavier School in South Weymouth, was one of 13 people to receive national recognition from the Food Allergy & Anaphylaxis Network for service to children with food allergies.

US Representative Patrick Kennedy of Rhode Island will be honored with fellow Congressman Jim Ramstad of Minnesota for their Campaign to Insure Mental Health and Addiction Equity at Mental Health America's annual meeting June 6 through 9 in Washington.

Cambridge has named Claude-Alix Jacob (left) chief public health officer for the city and director of the Cambridge Public Health Department.

Jacob had been deputy director of the Office of Health Promotion at the Illinois Department of Public Health and before that he was chief of the Bureau of Disease Prevention and Control at the Baltimore City Health Department. He earned a master’s degree in public health from the University of Illinois at Chicago.

Jacob will take over from interim health director Dr. Karen Hacker, who was appointed in July after Harold D. Cox stepped down to become associate dean for public health practice at Boston University's School of Public Health.

The Cambridge Public Health Department is a municipal health agency operated by Cambridge Health Alliance through a contract with the City of Cambridge.

Three Massachusetts hospitals have been named among the country's top 100 integrated health networks -- hospital systems that operate as a unified group.

Baystate Health System in Springfield was ranked 31st, Cambridge Health Alliance came in 49th and Lahey Clinic in Burlington finished 85th in the ratings released by Verispan. There were 587 hospital networks considered.

The healthcare information company said it surveyed health systems about patient access, clinical quality, physicians and the use of technology.

People addicted to opioids such as methadone or oxycodone can be treated in their primary care doctor's office as safely and effectively as at specialized clinics, authors from Cambridge Health Alliance and Harvard Medical School report in the Annals of Family Medicine.

Dr. Ira L. Mintzer and his colleagues studied 99 patients who received the drug buprenorphine-naloxone to treat their opioid dependence at two urban primary care practices: one in a hospital clinic and the other in a neighborhood health center. After six months 54 percent of patients were sober.

Where the patients received their treatment made no significant difference in sobriety, the authors said.

"We hope that our findings will encourage other primary care physicians to consider providing this efficacious form of care," they wrote.

By Elizabeth Cooney, Globe Correspondent

Heart disease has long been known to be the leading cause of death among firefighters, but a new study in tomorrow's New England Journal of Medicine reports that putting out fires raises a firefighter's risk of having a heart attack up to 100 times more than doing other, non-emergency duties.

Dr. Stefanos N. Kales of Cambridge Health Alliance and Harvard School of Public Healthled the study that looked at the types of tasks firefighters did -- responding to a fire, putting it out, returning from a call, training, etc. -- to see how these tasks were associated with death. They reviewed data on deaths from 1994 through 2004, excluding the 344 firefighters who died from the Sept. 11 terrorist attacks.

"This provides the strongest evidence to date that specific firefighting duties can precipitate coronary events," Kales said.

Firefighters don't have a higher risk of heart disease compared to the general population, but the sudden exertion of their work can trigger a heart attack in the same way shoveling snow can lead to a heart attack in someone else.

Dr. Luis F. Lobón has been named chief of emergency medicine at The Cambridge Hospital campus of Cambridge Health Alliance. Lobón comes to CHA from Caritas Carney Hospital in Dorchester, where he was chief of emergency medicine.

Lobón received his MD from the University of Cantabria Faculty of Medicine in Spain and performed his internship and residencies in emergency medicine in New York City at Albert Einstein College of Medicine, Mount Sinai Medical Center, Beth Israel Medical Center and Elmhurst Hospital Center. He received a master’s degree in health management and finance from New York University’s Robert F. Wagner Graduate School of Public Service.

Cambridge Health Alliance has received a two-year, $599,999 grant from the Robert Wood Johnson Foundation to study the quality of depression treatment for ethnic and racial minorities, the hospital said today.

Margarita Alegría, director of the Center for Multicultural Mental Health Research at CHA and a professor of psychiatry at Harvard Medical School, will lead the study.

Cambridge Health Alliance is the first hospital system to report communicable disease information electronically to the Massachusetts Department of Public Health, CHA said today.

Data from Cambridge Hospital, Somerville Hospital and Whidden Memorial Hospital will be sent to the DPH's secure server, giving state epidemiologists information about patient demographics, test type, specimen source, results and antibiotic susceptibilities the same day they become available.

Results now come to DPH by phone, fax or email, spokeswoman Donna E. Rheaume said in an e-mail.

Three Cambridge Health Alliance physicians have earned academic promotions from Harvard Medical School.

Dr. Jean A. Frazier, director of the Child and Adolescent Neuropsychiatric Research Program at CHA and co-director of CHA’s Center for Child and Adolescent Development, has been named associate professor of psychiatry at the medical school.

Dr. Elizabeth H. Gaufberg, an internist and a psychiatrist at CHA, has been named assistant professor of medicine and assistant professor of psychiatry.

Dr. Cynthia J. Telingator, training director of CHA’s Division of Child and Adolescent Psychiatry, has been named assistant professor of psychiatry.

By Liz Kowalczyk, Globe staff

Doctors from Cambridge Health Alliance, which includes Cambridge Hospital, and Harvard Medical School tout a new way of training medical students in tomorrow's New England Journal of Medicine.

Third-year medical students who spend the entire year following the same patients as they are treated by various doctors throughout the health care system see patients more frequently and are supervised more often by experienced faculty, than students trained the traditional way, write Dr. David Hirsh and Dr. Barbara Ogur, both physicians at the hospital; and HMS professors Dr. George Thibault, an executive with Partners HealthCare, and Dr. Malcolm Cox of the federal Veteran's Health Administration. Students normally go from hospital to hospital for one- to three-month stints in specific specialties.

Students in the Cambridge pilot program, which began in July 2004, also score as well or better on tests of clinical skill and knowledge than their peers, the authors report, although results are preliminary.

Cox, who helped Hirsh and Ogur develop the program, gets revenge of sorts in the article. Many doctors at Harvard's other teaching hospitals considered the Cambridge approach too radical, and felt Cox was not building a consensus as leader of a curriculum reform initiative at Harvard Medical School. He resigned after 18 months, saying in an interview with the Globe last year that he had "deep philosophical differences" with many Harvard faculty who believed that students learn better the traditional way.

The Tufts University Family Medicine Residency Program at Cambridge Health Alliance is one of 14 programs in the country to be chosen for an initiative to improve how doctors are trained to practice family medicine.

The Preparing the Personal Physician for Practice program is a $1.75 million, five-year project funded by the Association of Family Medicine Residency Directors and the American Board of Family Physicians.

"The goal here is to create graduates of family medicine residency programs who are expert clinical decision makers, who use the best technology available and who are able to apply this in a very individualized process to provide personalized care," said Dr. Randy Wertheimer, chief of family medicine at CHA.

The 24 residents in the Tufts-CHA program will be based in a new CHA-Malden Family Medicine Center, reflecting the emphasis on outpatient care, said Dr. Lyle Bohlmann, associate director of the Family Medicine Residency Program.

Registered nurse Louise Yvette Charles of Cambridge Health Alliance has won the 2007 Excellence in Nursing Award from the New England Regional Black Nurses Association Inc.

Louise Yvette Charles

Charles, a native of Haiti, graduated from nursing school in Port-au-Prince in 1977, immigrated to the United States in 1989, and earned her bachelor of science degree at Emmanuel College in 2004. She joined CHA in 1997 at the Zinberg Clinic, a multidisciplinary AIDS center at the Cambridge Hospital campus. Charles is currently a public health nurse with the Cambridge Public Health Department.