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ByLindseyTanner TheAssociatedPress CHICAGO Should old doc- tors be forced to retire? That question is the fo- cus of a new report by an American Medical Associ- ation council that says doc- tors themselves should help decide when one of their own needs to stop working. Unlike U.S. pilots, mil- itary personnel and a few other professions where mistakes can be deadly, doctors have no man- datory retirement age. All doctors must meet state licensing require- ments, and some hospi- tals require age-based screening. But there are no national mandates or guidelines on how to make sure older physi- cians can still do their jobs safely. It's time to change that, the report suggests, noting that the number of U.S. phy- sicians aged 65 and older has quadrupled since 1975 and now numbers 240,000 — one-fourth of all U.S. doc- tors — although not all still see patients. The report asks the AMA to spearhead a doctor-led effort to develop national guidelines and screening methods. It's among more than 250 reports and resolutions prepared for the AMA's an- nual policy-making meet- ing in Chicago. AMA dele- gates vote Monday through Wednesday on which pro- posals become official AMA policy. The AMA's Council on Medical Education wrote the report and says "physi- cians should be allowed to remain in practice as long as patient safety is not en- dangered." But physicians should develop guidelines and standards for monitoring and assessing both their own and their colleagues' competency. Doing so "may head off a call for manda- tory retirement ages or im- position of guidelines by others," the council's re- port says. Typical age-related changes in hearing, vision, memory and motor skills all could potentially affect physicians' competence, the report says, but notes there is no evidence that directly links these changes to worse outcomes for pa- tients. While some physicians think they will know when it's time to hang up the stethoscope, the report says evidence disputes that. It's a touchy topic for older doctors, and not all welcome the prospect of ex- tra scrutiny. "I don't myself have any doubts about my compe- tency and I don't need the AMA or anybody else to test me," said Dr. William Ny- han, an 89-year-old pedia- trician, genetics researcher, runner and tennis player who works with the Uni- versity of California, San Diego and a children's hos- pital there. "There are a lot of peo- ple overlooking my activi- ties" already, he said. "This is a litigious society — if we were making mistakes, we'd be sued." Dr. Jack Lewis of Omaha, Nebraska, turns 81 this week and has worked as an internal medicine special- ist for half a century — first with his dad, who worked until age 83, and now with his 41-year-old physician son. "My dad always told me to watch to see if he was making mistakes or losing it, and my son is watching me the same way," Lewis said. Lewis sees 25-30 patients daily. While his "hands aren't as good as they used to be" and he sometimes forgets patients' names, he doesn't think anyone should make him leave the work he loves. He agrees that some sort of age-based assessment for physicians is probably a good idea, but said, "If I made a mistake, I'd be the first one to quit here." Dr. Louis Borgenicht, a Salt Lake City pediatrician, was forced by a hospital to take a computer-based men- tal assessment test last year before he turned 72. He de- cided recently to stop doing circumcisions because of a mild tremor in his hands, but otherwise said his age doesn't affect his work. "I was hoping to fail the test so I could go to the American Civil Liberties Union and say this is age- ism," Borgenicht said. He said the test was based on one given to air- plane pilots and wasn't relevant to his medical skills. Borgenicht said he would support the AMA's involvement in developing screening assessments, "but it's got to be based on something that makes sense." U.S. physicians must be licensed to practice in the state where they work and requirements generally in- clude an evaluation of med- ical education and train- ing, malpractice and disci- pline history. Licenses must be renewed yearly or every two years, but no compe- tency exams are required after initial licensure, re- gardless of the doctor's age. The Joint Commission, a private accrediting group, requires U.S. hospitals to periodically evaluate phy- sicians' performance. Most hospitals do these evalua- tions every nine months for physicians of all ages, said Dr. Ana McKee, the com- mission's chief medical of- ficer. The University of Vir- ginia Health System and Stanford Health Care, at Stanford University, are among institutions that re- quire additional scrutiny of older doctors. Stanford's policy began last year for physicians aged 75 or older and requires a special assessment every two years. It includes a per- formance evaluation and a comprehensive medical history and physical exam, said Dr. Ann Weinacker, a Stanford quality improve- ment specialist. "It is not a pass-fail type of screening. However, if concerns are raised, we re- quire the person to have further evaluation," she said. The University of Vir- ginia's screening began in 2011 for doctors and some other medical staff starting at age 70 and involves phys- ical and cognitive exams ev- ery two years. "The vast majority of them score very well," said Dr. Scott Syverud, chair of the university medical cen- ter's credentials committee. AMA MEETING Aging MDs prompt call for competency tests THEASSOCIATEDPRESS Eighty-year-old Dr. Jack Lewis has worked as an internal medicine specialist for half a century — first with his dad, who worked until age 83, and now with his 41-year-old physician son. By Matthew Perrone The Associated Press WASHINGTON Federal health regulators said Mon- day a highly-anticipated, experimental drug from Amgen significantly low- ers bad cholesterol. But of- ficials have questions about who should take the drug and whether to approve it based on currently avail- able data. The Food and Drug Ad- ministration posted its re- view of Amgen's Repatha ahead of a public meeting to consider its approval. Re- patha is the part of a new class of injectable, choles- terol-lowing drugs that work differently than older, statin drugs. The new drugs are considered the first ma- jor advance in lowering bad, or LDL, cholesterol in more than 20 years, and an- alysts expect them to gener- ate billions in sales But the prospect of ap- proving a pricey new class of drugs for one of the most common medical condi- tions in America is already drawing concerns from health insurers, provid- ers and pharmacy benefits managers. More than 73 million U.S. adults, or nearly one-third, have high LDL cholesterol, according to the Centers for Disease Control and Prevention. Those patients have twice the risk of heart disease. The FDA is consider- ing which patients should receive a prescription for drugs like Repatha. Amgen Inc., based in Thousand Oaks, studied the drug in several differ- ent patient groups, includ- ing those already taking statins, those who cannot take statins due to side ef- fects, and patients with a rare genetic disorder that causes extremely high cho- lesterol levels. On Wednesday the FDA will ask a panel of outside experts which patients are most likely to benefit from the drug, considering po- tential risks seen in stud- ies, including higher rates of pancreatitis and kidney problems. The same panel of experts will review a sim- ilar drug from Sanofi on Tuesday. Both drugs block a sub- stance called PCSK9, which interferes with the liver's ability to remove choles- terol from the blood. Key to FDA's consid- eration of both drugs is whether they ultimately reduce heart attacks and death in patients. For the last 20 years, the FDA has approved cholesterol drugs based on their abil- ity to lower levels of the wax-like substance found in the bloodstream. Stud- ies in older statin drugs have shown this reduc- tion results in fewer heart problems. But several drug cases in the last decade have shown that lowering cholesterol does not always translate into real benefits for patients. Amgen is conducting a 27,500-patient study to de- termine whether Repatha reduces heart attacks, but the results aren't expected before 2017. The FDA's ex- perts will vote on whether Repatha should be ap- proved despite the lack of cardiovascular data. The agency is not required to follow the group's recom- mendation, though it often does. Companies that would pay out on those costs, like insurers, have pointed out the lack of long-term safety data as a reason to go slowly. "We've seen lots of drugs that were touted as wonder- ful pulled from the market after large numbers of peo- ple got on them and it be- came clear there were side effects not seen in the ini- tial trials," said Steve Miller, chief medical officer with Express Scripts, the nation's largest pharmacy benefit manager. Express Scripts, a phar- macy benefits manager, has been one of the most vocal critics of escalating prices for specialty drugs, an is- sue that recently came to a head with the $1,000-a- pill price tag for Gilead Science's hepatitis C drug, Sovaldi. While Amgen will not discuss pricing plans for Repatha — and the FDA is barred from consider- ing cost when reviewing drugs — Express Scripts and other companies are already raising concerns about the impact on health care budgets. Some analysts estimate new PCSK9 drugs could cost about $10,000 per year, far more than currently- used statins, which usually run several hundred dol- lars per year. If 10 million U.S. patients took the new drugs, that could result in approximately $100 million in new drug spending, ac- cording to Express Scripts. "That's why there's so much anxiety about these coming products," Miller said. Pharmacy benefit man- agers like Express Scripts are paid by insurers and employers to manage drug costs. Express Scripts ulti- mately lowered its hepati- tis C drug bill by refusing to cover Gilead Science's medications and cutting a deal on competitor Abbvie's medications. Miller said the company would take a sim- ilar strategy with new cho- lesterol drugs. MEDICINE FDA weighs target population for Amgen cholesterol drug The Associated Press ELMAU, GERMANY Presi- dent Barack Obama says the U.S. Supreme Court proba- bly shouldn't have taken up the latest challenges to his signature health care law. Obama says there was no reason for the health pro- gram to end up in court, maintaining that "it's work- ing." The high court is ex- pected to decide soon whether Congress autho- rized federal subsidy pay- ments regardless of where people live, or only for resi- dents of states that created their own insurance mar- ketplaces. Obama says it has been well-documented that Congress never in- tended to exclude people who went through the fed- eral exchange. 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