American College of Physicians, April 19-21, 2012
The annual meeting of the American College of Physicians (ACP) was held from April 19 to 21 in New Orleans and attracted approximately 7,000 participants from around the world, including internists, adult medicine specialists, sub-specialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults. Over 250 scientific sessions were presented by over 300 faculty members, covering a variety of topics, including updates in neurology, oncology, infectious diseases, endocrinology, and cardiology. The entire program focused on the advancement of clinical medicine and related sciences.
During the meeting, the ACP, in collaboration with Consumer Reports, announced an initiative to aid patients and physicians in understanding the costs, advantages, and disadvantages associated with tests and treatments used for the most common clinical issues.
"The High Value, Cost-Conscious Care Initiative was developed to help contain increasing costs associated with health care. We are currently looking at over $200 billion in wasted health care dollars on services that were not needed and provided patients with no benefit. Most of these wasted services are under the control of the physician, including X-rays and lab testing," Patrick Alguire, M.D., Senior Vice President for Medical Education at the ACP said. "The ACP initiative is not about rationing health care, as we are not promoting withholding appropriate care and testing. However, we are talking about withholding inappropriate health care, which is not helping patients and may actually bring more harm to the patient."
The ACP had presenters weave this theme into their educational activities during the meeting to help guide physicians in making appropriate decisions. The organization will continue to provide recommendations to physicians through publications in the Annals of Internal Medicine.
"The ACP is excited to take on this leadership role in helping physicians become better stewards of health care resources by providing patient care that is beneficial to patients and avoiding waste through provision of care that does not improve patient health or well-being," Alguire added.
During one presentation, Sammy Saab, M.D., M.P.H., of the David Geffen School of Medicine at the University of California Los Angeles, discussed screening, diagnosis, and treatment of hepatitis B and C in clinical practice.
"Early diagnosis of hepatitis B and C can have a huge impact on a patient's long term care, in terms of education, preventing complications, as well as improving a patient's quality of life. Treatment exists for both chronic hepatitis B and C," Saab said. "Screening for viral hepatitis B and C is good primary care. Screening should be performed based on risk factors and for medical consequences and not just for elevated liver enzymes."
Overall, screening for hepatitis B and C is easy to perform, interpret, and employ, and Saab recommends it being incorporated into daily clinical practice.
Saab disclosed financial ties to multiple hepatitis C drug development companies and other pharmaceutical organizations.
In another presentation, Raymond R. Townsend, M.D., of the University of Pennsylvania in Philadelphia, discussed different classes of drugs used to treat hypertension.
"A reasonable working knowledge of how blood pressure is regulated is very useful in managing blood pressure. There are four key regulatory systems for blood pressure, which can be shoe-horned into the popular 'DASH' acronym," Townsend said. "D is for direct -- autoregulatory, the things that happen to a blood vessel's ability to respond by dilating or constricting, even when it is outside the body; A is for autonomic or sympathetic nervous system activity; S is for salt/sodium; and H is for humors -- things that circulate (like hormones) and have the ability to constrict (or dilate) an arterial vessel, such as angiotensin-II."
Most of the drugs used for the treatment of blood pressure management impact one of the mechanisms of action stated by Townsend. However, choosing the appropriate medication for a patient can depend on age, ethnicity, and/or presence of other comorbid conditions.
"When looking at patients, some systems (like the renin system, an 'H' system) are more active in younger, Caucasian patients, and drugs blocking that system (angiotensin-converting-enzyme inhibitors [ACE-I], angiotensin receptor blockers [ARB], and beta-blockers [which suppress renin]) tend to be more effective. Older patients and African-Americans are more likely to be low renin, and these individuals have more initial responsiveness to a diuretic or a calcium channel blocker," Townsend said. "In addition, some comorbidities help to direct therapies (use of an ARB in a type 2 diabetes patient with hypertension and proteinuria), and some comorbidities (like a borderline glucose elevation or low high-density lipoprotein cholesterol) might lead one to use something other than a diuretic or a beta-blocker, which can affect insulin resistance adversely."
In terms of dosing hypertension medications, Townsend recommends adding a new medication in the mid-range dose, about half of the manufacturer's recommended maximum dosage, since that leverages the better efficacy at the expense of fewer side effects. Furthermore, in some cases the addition of a second agent can offset some of the adverse effects of the first one; for example, an ACE-I reducing the potassium losses with a diuretic.
Townsend disclosed financial ties to Novartis, Merck, and GlaxoSmithKline.