A shift in dying children's care

Excerpts from the Globe's blog on the Boston-area medical community.

Children dying of cancer are suffering less as their care focuses more on easing their symptoms than aggressively treating their disease, a Harvard study has found.

Writing in the Journal of Clinical Oncology, Dr. Joanne Wolfe (below) of the Dana-Farber Cancer Institute and Children's Hospital Boston, reports that better communication and better pain control have contributed to improved quality of care at the end of life.

The study compares 119 children who died between 1997 and 2004 at Dana-Farber or Children's to 102 children who died there between 1990 and 1997 whose parents were part of an earlier survey. Parents in the later group said their children suffered less from pain and trouble breathing and more said they were prepared for death in the child's last month of life compared with the earlier group.

Stung by revelations that authors of a paper failed to reveal a potential conflict of interest and support for their lung cancer research from a tobacco company, the New England Journal of Medicine published a correction, a clarification, and an editorial on full disclosure.

The case involves Dr. Claudia Henschke and Dr. David Yankelevitz, both of Cornell University's medical school and authors of an October 2006 article that said screening with CT scanners was effective in detecting early lung cancer among smokers and former smokers.

In the correction, the researchers said they should have disclosed that they received royalty payments from licensing patents to General Electric, the makers of the CT scanners in the study. And Henschke said in a letter to the journal that a foundation that helped to fund the study was largely supported by the parent company of Liggett Tobacco.

"As funding mechanisms grow increasingly complex, . . . it has become ever more challenging for editors to ensure the complete reporting of all sources of financial support," the editorial says. The journal relies on researchers to disclose their funding sources.

Requiring doctors to get prior authorization before prescribing certain drugs to their schizophrenic patients leads to greater disruption in treatment and delivers no cost savings, a Harvard study has found.

Stephen B. Soumerai, a professor of ambulatory care and prevention at Harvard Medical School, and his co-authors compared how patients fared under a prior-authorization policy in Maine with how similar patients did without such a plan in New Hampshire. They found that schizophrenic patients who received treatment through Maine's programs had a 29 percent greater risk of gaps in treatment than the group in New Hampshire. The costs in both programs were about the same, they report.

Two of the nine authors of the article published online in Health Affairs work for the drug company Eli Lilly and Co., which provided some of the funding for the study.

Massachusetts comes in 14th in the country in federal funding to prevent disease and injury, a national health-advocacy organization reports.

Trust for America's Health calculated how much the US Centers for Disease Control and Prevention spent in fiscal 2007 per person on public health programs in the 50 states. In Massachusetts that came to $25.42 per person. The national average is $19.74 per person. Alaska took in the most CDC dollars ($69.76) and Kansas got the least ($13.61).

CDC funds programs to prevent such diseases as cancer, diabetes, and HIV, as well as on environmental health, immunizations, and bioterrorism preparedness.

Massachusetts doctors are doing a good job screening patients and following treatment guidelines for chronic diseases, according to a new, statewide report on primary care. But, while screening rates are good, outcomes still lag, the report shows, with too many patients still suffering from uncontrolled diabetes and heart disease.

"Looking at screening versus outcome rates, there's an important gap there," said Barbra G. Rabson, executive director of the Massachusetts Health Quality Partners, which produces the annual report. "Let's raise the bar and really focus on outcomes for a healthier population."

Scores for doctors' groups are available on the group's website, mhqp.org.

Dr. Edward J. Wing (left) has been named dean of medicine and biological sciences at Brown University in Providence. Chairman of the department of medicine at Brown, he will step into his new role as dean of the Warren Alpert Medical School on July 1, the university announced.

Wing is physician-in-chief at Rhode Island Hospital and the Miriam Hospital and executive physician-in-chief at the Memorial Hospital of Rhode Island, the Veterans Affairs Medical Center, and Women & Infants Hospital. He will succeed Dr. Eli Y. Adashi, who has been dean since January 2005.

ELIZABETH COONEY