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2 September 2008 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit Past highlights are accessible as well.

1. Intermittent HIV Treatment Increases Risk for HIV-Related Infections and Death Even After Resuming Continuous Treatment

A recent trial showed that continuous treatment of HIV infection is better than stopping treatment when the patient’s immune status is good and restarting it when immune status deteriorates (interrupted treatment). At the end of this trial, patients assigned to intermittent treatment were begun on continuous treatment and observed for 18 months. When persons assigned to interrupted treatment resumed continuous treatment, their risk for HIV related infections and death declined but was still slightly higher than those who had been receiving continuous treatment from the beginning.

2. Large-scale Survey Links “Burnout” to Suicidal Thoughts in Medical Students

Death by suicide is a major occupational hazard for physicians. Male and female physicians have a 40 percent and 130 percent higher suicide rate, respectively, than the general population. This survey of 4,287 students at seven medical schools revealed that many U.S. medical students think about suicide, suggesting that physicians’ increased risk for suicide may begin in medical school. Both personal distress and professional distress, or “burnout” were linked to thinking about suicide. While the relationship between depression and suicide is well-recognized, the association between burnout and thinking about suicide has not been previously reported. Burnout is common among medical students, and is associated with a two- to three-fold increased risk of thinking about suicide. In the study, 26 percent of burned out students recovered within the following year, indicating that burnout is reversible. Their risk for suicidal thoughts returned to normal.

3. Study Documents a Decade of Whistleblower-Initiated Legal Action Against Medicare Fraud

In the 1990s, the U.S. Department of Justice (DOJ) increased efforts to combat health care fraud, focusing on false claims made to Medicare and Medicaid programs in particular. The volume of litigation and financial recoveries related to health care grew quickly, especially among qui tam actions. Qui tam actions are enforcement actions initiated by whistleblowers who are private citizens with inside knowledge of the alleged fraud. By 2005, 90 percent of new health care fraud enforcement actions were initiated by whistleblowers. From 1996 to 2005, the DOJ closed 379 health care fraud cases and recovered $9.3 billion from defendants. Of those cases, the most common targets were provider organizations and billing practices. Although pharmaceutical manufacturers accounted for only 13 of the 379 cases, they accounted for nearly 40 percent of the total recovery because of the very large awards. Researchers concluded that fraud and abuse may increase during periods of rapid market expansion, but closer government oversight may also be a factor.

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