Is there a physician union in your future?

Physician unions are in the news. Patient management and patient care decisions are increasingly being taken out of the hands of physicians and put into the hands of "The Suits." To take their case for a return to physician-driven patient care to the people, some physicians are joining unions. Some are even collectively bargaining for salary and other issues that are historically more closely associated with unions. The simple fact is that physician unions exist and the number of physicians joining them is expected to increase. What are the pros and cons of unionization? What motivates physicians to join unions, and what potential negative and positive factors are associated with physician unionization? This article reviews the pros and cons and the issues related to physician unions, for physicians attempting to answer the question, "Is there a union in my future?"

Doctors must review referral and business relationships.

Ten safe harbors describe referral relationships and other business arrangements exempt from prosecution under federal anti-kickback law. As the statute's prohibitions are broad and the safe harbors narrow, physicians should review--carefully--their practice relationships.

Testing of insulin hexamer-stabilizing ligands using theoretical binding, microcalorimetry, and nuclear magnetic resonance (NMR) line broadening techniques.

In a study aimed at the development of a long-acting insulin preparation, Manallack and co-workers (5) reported on the design of small organic molecules which have the potential to bind to insulin and stabilize its hexameric aggregate. Two of the molecules that were designed with their computer graphics program were thought to be particularly promising as ligands: benzene-p-disulfonate and benzene-p-diphosphonate. In the present work, the insulin binding abilities of these molecules have been thoroughly tested. A theoretical binding program, GRID, was used to calculate the binding energetics of the molecules and to predict the most probable site of their binding. Microcalorimetry and NMR line broadening techniques were used to measure the actual binding reactions of the ligands. For both compounds, no evidence of binding to insulin was ever observed in either the microcalorimetry or the NMR studies. In contrast, a series of phenolic ligands commonly used as preservatives for insulin showed evidence of substantial binding using either method. An explanation has been proposed for this apparent discrepancy between computer predictions and actual experimental data: The theoretical programs do not take solvation effects of the aqueous medium into account. Solvation effects would tend to inhibit binding of the ionized ligand molecules due to charge delocalization and steric crowding.

The use of microcalorimetry to measure thermodynamic parameters of the binding of ligands to insulin.

Flow microcalorimetry was used to measure the free energies, enthalpies, and entropies of interactions between the hormone insulin and small ligand molecules or ions. Measurable amounts of heat were obtained for binding of four phenolic preservative molecules--phenol, meta-cresol, resorcinol, and methylparaben--to both two-zinc and zinc-free insulin and for binding of zinc ions to zinc-free insulin. All of the reactions were spontaneous, but the phenolic binding was driven by enthalpy, while that of zinc was entropy-driven. A combination of van der Waals interactions, hydrophobic effects, and protein conformational changes appeared to be involved in binding of the phenolic ligands. Zinc ions displayed two types of binding to insulin, both involving ion-dipole interactions.