Tami Flu

Social networking, once the domain of teenagers, is attracting physicians who want to connect with other people online for reasons from professional contact to dating.

Although Internet interactions can be freewheeling, certain rules of etiquette apply. As with most technology, early adopters tend to set the standards, and latecomers learn to adapt. So "netiquette" does vary, depending on the type of site -- general versus physician-specific, personal versus professional.

And there are a plethora of sites. Social networking no longer involves just a handful of general sites, such as Facebook and MySpace, but includes a network of sites specific to health care, physicians and even specialties.

The first step to social networking, experts say, is to decide what audiences you want to connect with, choose the most appropriate site for each purpose, and set clear boundaries between each one. But even if you opt for purely social networking, a stranger there potentially can become your employer, patient or colleague, and an etiquette blunder could be career-killing.

"There's no way people aren't going to Google a new contact," said Rusty Weston, chief blogger of the networking site My Global Career. "You have to be careful."

A recent survey conducted by Erika S. Fishman, director of research and client services for Manhattan Research, a marketing and research firm for health care and pharmaceutical companies, found nearly half of all physicians feel it is important to have a professional presence online.

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Direct-to-consumer marketing isn't only about enticing patients to ask for a specific prescription drug. It's also about pitching patients to ask their doctors how that prescription will be conveyed.

This patient-centered pitch on electronic prescribing is being made by SureScripts, the nation's largest provider of electronic prescribing services, joined by nearly all of the nation's largest pharmacy chains.

The hope is that patients who are educated about the benefits of e-prescribing will start to demand that their physicians use the technology.

SureScripts chief marketing officer and lead campaign organizer Tammy Lewis said the main objective is to let patients know that more than 70% of pharmacies have e-prescribing connectivity, and show how e-prescribing might benefit them.

Part of the campaign involves signage at more than 26,000 pharmacies saying, "ePrescriptions filled here." Other signs will direct consumers to a Web site where they can learn about the benefits of e-prescribing, find a doctor who has the technology, and print information to bring to physicians who don't (www.learnabouteprescriptions.com).

The printed materials include information about a Web site where physicians can assess their e-prescribing needs and learn about available systems. Five physician organizations and the Medical Group Management Assn started that site (www.getrxconnected.com).

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Kaiser Permanente and Health Net have agreed to offer coverage to hundreds of individuals whose policies the insurers had rescinded and to pay medical bills from before and after the rescissions.

The agreements between the state's Dept. of Managed Health Care and the insurers are the latest development in a crackdown on what authorities have called illegal policy rescissions.

"While it's obviously terrific for those particular patients, that this had to be done reflects that there is a pattern and practice of behavior from those big insurance companies, and it hurts people who need health care," said California Medical Assn. President Richard Frankenstein, MD, a pulmonologist from Garden Grove.

Dept. of Managed Health Care Director Cindy Ehnes said she expected the state's two largest insurers of individuals, Blue Cross of California and Blue Shield of California, to follow Kaiser and Health Net by agreeing to offer coverage to as many as 4,000 former members.

At a May 15 news conference announcing agreements with Kaiser and Health Net, Ehnes said doctors or hospitals who provided free or uncompensated care to the people regaining coverage have a right to collect from the health plans, but doctors and hospitals may have to go to the patient to ask for payment.

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Hospitals generally are well aware of what they have to do under the Health Insurance Portability and Accountability Act to ensure the security of patient data. They are also aware that their own employees might be the ones who breach that security.

However, hospitals generally underestimate the malicious intent and the financial damage involved in data breaches and are unaware they're being targeted by perpetrators wishing to commit identity theft or medical fraud.

That is the conclusion of a recent report by the Health Information and Management Systems Society. The report was based on responses to a January telephone survey from 263 hospital executives responsible for patient data.

"I think ... hospitals, they may stick their heads in the sand, and they don't want to acknowledge that people want to access people's data for personal gain," said Brian Lapidus, chief operating officer of Kroll Fraud Solutions. Kroll, which sells data protection and identity theft response solutions, commissioned the study by HIMSS.

The report did not look into breaches at physician practices. But some experts say physicians also underestimate their chances of being targeted.

Mike Spinney, spokesman for Ponemon Institute, a Traverse City, Mich.-based think tank that researches privacy and data security issues, said while breaches are commonly discovered at hospitals and large medical groups, too often physician practices adopt a mentality that they are too small to be targeted.

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A recent case of vaccine compensation in the US has been picked up by the UK media, notably the Daily Express, and is being touted as evidence that vaccines cause autism.

Paul Offit provides a commentary in The New England Journal of Medicine on the Hannah Poling case, and explains how the US vaccination compensation scheme has abandoned science over the years.

the VICP’s concession to Hannah Poling was poorly reasoned. First, whereas it is clear that natural infections can exacerbate symptoms of encephalopathy in patients with mitochondrial enzyme deficiencies, no clear evidence exists that vaccines cause similar exacerbations. Indeed, because children with such deficiencies are particularly susceptible to infections, it is recommended that they receive all vaccines.

Second, the belief that the administration of multiple vaccines can overwhelm or weaken the immune system of a susceptible child is at variance with the number of immunologic components contained in modern vaccines. A century ago, children received one vaccine, smallpox, which contained about 200 structural and nonstructural viral proteins. Today, thanks to advances in protein purification and recombinant DNA technology, the 14 vaccines given to young children contain a total of about 150 immunologic components.

Third, although experts testifying on behalf of the Polings could reasonably argue that development of fever and a varicella-vaccine rash after the administration of nine vaccines was enough to stress a child with mitochondrial enzyme deficiency, Hannah had other immunologic challenges that were not related to vaccines. She had frequent episodes of fever and otitis media, eventually necessitating placement of bilateral polyethylene tubes. Nor is such a medical history unusual. Children typically have four to six febrile illnesses each year during their first few years of life; vaccines are a minuscule contributor to this antigenic challenge.

Fourth, without data that clearly exonerate vaccines, it could be argued that children with mitochondrial enzyme deficiencies might have a lower risk of exacerbations if vaccines were withheld, delayed, or separated. But such changes would come at a price. Even spacing out vaccinations would increase the period during which children were susceptible to natural infections, giving a theoretical risk from vaccines priority over a known risk from vaccine-preventable diseases. These diseases aren’t merely historical: pneumococcus, varicella, and pertussis are still common in the United States. Recent measles outbreaks in California, Arizona, and Wisconsin among children whose parents had chosen not to vaccinate them show the real risks of public distrust of immunization.

Offit believes that the US vaccine compensatory scheme should be more stringent.

Going forward, the VICP should more rigorously define the criteria by which it determines that a vaccine has caused harm. Otherwise, the message that the program inadvertently sends to the public will further erode confidence in vaccines and hurt those whom it is charged with protecting.