Internal Medicine 2010, the annual meeting of the American College of Physicians, provides a comprehensive overview of the major clinical and policy issues in adult medicine today. ConsultantLive brings you the highlights of the meeting with reports on key presentations and interviews with leading experts.

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Featuring Joseph A. Lieberman III, MD, MPH, Associate Editor of the Delaware Medical Journal and Professor of Family Medicine at Jefferson Medical College.

Phillip arrived at the appointment for his first psychiatric outpatient session, filled out the paperwork, told me he was depressed, shed a tear, and became completely silent. No amount of coaxing from me could get him to talk. He looked down or into space, avoiding my eyes, and just sat there for the entire 50-minute session.

The pharmaceutical industry aggressively supported efforts to pass health care reform, even pledging to trim drug costs by $80 billion.1 In addition, it pumped millions of dollars into lobbying and ad campaigns to push the legislation to a successful conclusion, even joining with groups such as Families USA, which ironically spent years attacking drug makers in the early part of the decade.2

The recent signing of health reform legislation signals a watershed event in the delivery of health care in our country. It is the culmination of a tangled legislative battle, but it ignores 3 of the 4 pillars of health reform. In this article, I describe these pillars, and then outline where recent legislation falls short.

The sweeping health care reform bill signed into law in March will eventually provide coverage to 32 million more Americans, but the Congressional Budget Office has estimated that about 23 million will still be without health care by 2019.1 Even those with insurance may continue to have high out-of-pocket (OOP) expenses, because coverage premiums and medical services outpace household incomes.

Connecticut Attorney General Richard Blumenthal has backed a bill that will require hospitals in Connecticut to disclose publicly all adverse events that occur in their facilities. Previously, hospital errors were reported but specifics of the errors, including where they occurred, were never disclosed because of a confidentiality provision enacted in 2004 that allowed the health department to list the overall medical errors without naming a hospital.1

A group of 18 senators have proposed to reverse a policy that imposes a lifetime ban on donating blood for men who have had any gay sex since 1977. In writing to the FDA Commissioner Margaret Hamburg, the lawmakers stressed that the science has dramatically changed since the ban was established in 1983 at the emergence of the HIV/AIDS crisis.1

Thimerosal, the organomercurial compound commonly used as a preservative in vaccines, does not cause autism, ruled the so-called vaccine court, a special branch of the US Court of Federal Claims that was established to handle claims of injury caused by vaccines. In this case, a group of parents who are convinced that there is a connection between the additive and autism were told that they had failed to prove their belief.1

Three years after the FDA’s authority was broadened to allow it to require pharmaceutical manufacturers to conduct additional clinical studies or change medication labels (among other new powers), the FDA still has concerns about medication risks. Drug safety has always been an issue for the FDA, but given the recent high-profile troubles with the recalled painkiller Vioxx (rofecoxib), the contaminated blood-thinner heparin, and the sometimes fatal cardiac effects of the diabetes drug Avandia (rosiglitazone), it is clear to the FDA that it needs to have better oversight when it comes to medication safety.

Schizophrenia, a devastating mental illness that affects nearly 2.2 million Americans, is associated with high rates of morbidity and mortality.1 Persons with schizophrenia have a 20% shorter life expectancy than the general population.1,2 Furthermore, among persons with schizophrenia, there is an increased prevalence of metabolic syndrome characterized by a constellation of risk factors, including insulin resistance, abdominal obesity, dyslipidemia, hyperglycemia, and hypertension,3

As publicly funded health care payment programs have grown over decades because of demographic shifts and expansion of coverage, comparative effectiveness research (CER) has emerged to address value in health care. The American Recovery and Reinvestment Act of 2008 (ARRA) included $1.1 billion for CER initiatives, and the new health care legislation created the Patient-Centered Outcomes Research Institute, which will be funded with $500 million or more annually. In these efforts exist the promise to create informed decisions that will improve health care at both the individual and population levels.

In the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1

A 20-month-old boy brought to the emergency department with swelling on the right side of the neck and fever (temperature, 39.3°C [102.7°F]) of 1 day’s duration. The parents reported that the child had had intermittent fevers and poor weight gain for the past 3 months but no vomiting, diarrhea, rash, drooling, or difficulty in swallowing.

A 14-year-old girl is seen because of long-standing nasal itch, intermittent nasal congestion, and clear nasal discharge. Allergies to house dust mites and to cats shown on prior skin testing. Often has marked eye swelling when exposed to cats. Receives antihistamines when in flare-up and prior to cat exposure. The consumption of dairy products exacerbates all of the above.