Quattro! More from the DOG Patch.

Some more offerings in our fourth effort in these pages to get rid of this damned dander. It's still up! Here in the DOG Patch, D is for Dander, and the dander, in spite of smatterings of good new lately, has still got itself up.

Vive le Québec! Nodbody's taking sides in Canadian separatism, if it's still brewing north of the border. But a certain sense of fairness surely prevails, and we have to give them a rousing "jolly good" (whoops) among Canadian physicians. At least in the one province.  As reported by the WaPo, a large group of doctors there have produced a petition (interesting to read here) asking that their proposed recent salary increases be rolled back. They're concerned about the sorry state of care and salary support throughout their province and nation. Pretty astonishing. It remains for those of us suffering from DTs (dander-toting) to investigate how it's being received in places like Ontario, or even moreso, Alberta and Saskatchewan. It's also intriguing that the signatories include almost half subspecialists--not just a bunch of lefty primary-care types. Ah, but there are 700 or so signatories here. And Quebec has over 17,000 physicians. 'Nuff said. Let's take back that explanation point above. Make it a question mark, and nonetheless hats-off to those young and resident physicians who signed the petition.

Should Textbook Authors Declare Conflict of Interest? Have to admit, this hadn't exactly been uppermost in our minds--I've no recollection that we at HCRenewal ever really discussed it at meetings--but now a scholarly journal has reported out some fascinating findings on COI among the authors of Harrison's venerable textbook of internal medicine, and several others. (Hell, some of us even knew Dr. Harrison: what would he say, and does it even matter?) In any case, this was reported recently in one of the STAT newsletters. They found an important piece in the journal AJOB Empirical Bioethics about potential COI problems with over a quarter of authors on patents, and almost a third on up to 800,000 dollars per author in pharmaceutical company payments. Seems that journal editors, especially in the top tier, do better than this in requiring declarations from submitting authors. After all, quite a few years ago the editors all got together and created a COI policy that many of us know first-hand when we try to publish. But tetbook editors seem to have, still, a sort of noblesse oblige about their solicited authors. When Harrison's successors anoint a certain individual as her resident expert on a given disorder, it's almost as though that expert is automatically considered above reproach. Or, is it the case, for example in the instance of McGraw-Hill and Harrison's, that the publishers haven't gotten to the same point of transparency as the journal editors did years ago? Either way, it needs to change.

Two Trump HHS Secretaries: the Doc and the Pharma Exec. Who's Choosing Wiselier?  In that order. Dr. Price first, and now Mr. Azar. What does it mean when, pitting them head-to-head for decision-making and general comportment, the latter looks a damn sight better than the former? Says something about the ethics of a lot of physicians in our country, and especially so about those those who choose to run for elective office. On the one side we have Dr. Price, the orthopedist whose wife (herself a physician and state representative) inquired a few months ago whether HIV patients could be quarantined. And who himself did everything he could to weaken Obamacare, according to Politico and others. Comes now Azar, and remarkably, he's made some very adequate middle-of-the-road decisions. First that comes to mind: backing away from the radioactive attempts in Idaho (see an earlier DOG Patch Report on this) to gut the Affordable Care Act by skewering its structuring of insurance. It's all technical and full of legalese, but the eight-page letter Azar had Seema Verma write to Governor "Butch" Otter is a master stroke. And long. And canny. (Shows why Azar is where he is--wonder whether any ultra-right plants from the White House are in HHS as they are in the VA, undermining their own secretary. Time will tell.) In essence, despite its Vermoid verbosity, we can boil it down to this: Verma says, and by proxy Azar says to old Butch, and in part we quote: "As you know ... ACA is failing to deliver quality health care options to the American people and has damaged health insurance markets across the nation." This must have felt good to read for those in Idaho afflicted with Trumpist ideology. But Butch, (s)he goes on to say, the law is the law. We're going to enforce it.