What's a rich media ad, anyway?

Since last year's DoubleClick acquisition, we've increased our focus on helping marketers and agencies use Google tools for all of their display advertising needs. DoubleClick Rich Media is the part of DoubleClick that provides the technology for the most technically advanced and engaging of these display ads, which are typically created by creative agencies for their brand-focused clients. To help make this process even easier and efficient, today we're launching <a href="http://studio.doubleclick.com/">DoubleClick Studio</a>, our new rich media production and development tool.<br /><br />To describe rich media, it helps to think about other ad formats that we're all familiar with, starting with the simplest: text ads. With just a few keystrokes, anyone can create simple messages in a standardized format, and place them on a site like Google.com in minutes. Then we have standard display ads, ads that usually include text with a visual such as a logo or a graphic. These can be in formats we're all familiar with like .jpg, .gif, .swf and more. Standard display ads can either be static or animated with tools like Flash. They typically have only one interaction, meaning that when you click on them, you'll be taken to a destination site. And then at the most complex level, from a design and interaction perspective, we have rich media ads. With rich media, you can have ads that expand when users click or roll over, for example, and there are extensive possibilities for interactive content, such as HD video or even the ability to click to make a phone call.<br /><br />But making a rich media ad possible requires much more complex technology to ensure that all of the ad behaviors function properly, that all of the interactions can be measured, and to serve the ads onto web pages. Every piece of the canvas, from the video play button to the button that allows for expansion, requires coding in Flash that's made possible by a rich media technology provider like DoubleClick Rich Media. With all of this complexity, there's also a lot of room for error. So in addition to enabling the development of the ads, tools like DoubleClick Studio provide quality analysis and preview functionalities to make sure that the ads work the way they should.<br /><br />Here is a graphic that represents some of the differences between types of online ads:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_7ZYqYi4xigk/SfnkNjBwa_I/AAAAAAAADsE/gUFcUCMLotk/s1600-h/0904_r3_GoogleBlogGC.GIF"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5330542555361733618" src="http://2.bp.blogspot.com/_7ZYqYi4xigk/SfnkNjBwa_I/AAAAAAAADsE/gUFcUCMLotk/s400/0904_r3_GoogleBlogGC.GIF" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 160px;" /></a>With DoubleClick Studio, we hope to make it easier for our existing users to produce rich media ads, and to expand the number of advertisers that can make these useful formats part of their marketing strategy. This is also a good thing for Internet users; rich media capabilities make advertising even more useful, letting a viewer interact with an ad and learn about a brand without having to leave the page they're on. And, advertisers have an expanded creative canvas within the ad itself, allowing for deeper, higher-quality content in the ad itself. At Google, we believe that ads at their best are useful information.<br /><br />To read more about DoubleClick Studio, visit the <a href="http://www.doubleclick.com/insight/blog/archives/doubleclick-rich-media-and-video/create-and-manage-rich-media-ads-more-efficiently-with-doubleclick-studio.html">DoubleClick blog</a>.<br /><br /><span class="byline-author">Posted by Shamim Samadi and Ari Paparo, DoubleClick Rich Media Team </span>

What's a rich media ad, anyway?

Since last year's DoubleClick acquisition, we've increased our focus on helping marketers and agencies use Google tools for all of t...

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BLOGSCAN - Accountable Academic Governance Under Threat

<span style="color:#006600;">On The Torch blog, hosted by FIRE (Foundation for Individual Rights in Education), </span><a href="http://www.thefire.org/index.php/article/10538.html"><span style="color:#006600;">this post </span></a><span style="color:#006600;">by Kyle Smeallie summarized the travails of "petition candidates" for the boards of trustees of two elite American universities (<a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">Dartmouth</a> and <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">Harvard</a>). As we have noted, at most universities, the boards of trustees, the bodies ultimately responsible for upholding the universities' missions, are closed shops. At most universities, the boards appoint new members to replace departing ones, without input from alumni, parents, students, faculty or anyone else who might be considered constituents. Thus, at most universities, even though the boards are ultimately responsible for the stewardship of the institutions, and upholding the institutions' missions, practically, they are accountable to no one. At very few universities, there may be contested elections for a few board seats, and an opportunity for those outside the board, usually alumni, to place candidates on the ballot. However, even at those somewhat more enlightened universities, those candidates face an uphill battle. Thus, while Dartmouth and Harvard have somewhat more transparent, accountable, and representative governance than do most academic institutions, even that is under threat. </span>

BLOGSCAN - Accountable Academic Governance Under Threat

On The Torch blog, hosted by FIRE (Foundation for Individual Rights in Education), this post by Kyle Smeallie summarized the travails of &qu...

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Another Key Opinion Leader Confesses

The Milwaukee Journal-Sentinel published <a href="http://www.jsonline.com/features/health/43933562.html">another story </a>in their series on physicians' entanglements with health care corporations. This one tells the story of a single university faculty member who was seduced by pharmaceutical companies, then eventually became disillusioned.<br /><br /><blockquote><br />[Dr James] Stein, now a professor at the University of Wisconsin School of Medicine and Public Health, was a 29-year-old cardiology fellow in Chicago in 1994 when his faculty mentor asked him to fill in for him at a drug company-funded lecture to a large group of doctors.<br /><br />It would be his first taste of life as a drug company speaker and consultant.<br /><br />Stein got first-class airfare to Dallas. A limousine took him to a luxury hotel for the talk.<br /><br />He walked off the stage, and a doctor from the conference handed him an envelope containing a $500 check.<br /><br />'I got a pat on the back and he said, 'There's more where that came from, son.' I had no idea what that meant, but I went home and paid off part of my student loans,' Stein said in a presentation at UW this month.<br /><br />Stein's first drug company talk led to more than a decade of work for drug companies before he gave it up for ethical reasons. Now he is speaking out.<br /><br />Over the years, many of the big names in the drug industry would hire Stein to give speeches or serve as a consultant, eventually leading to fees of $2,000 to $3,000 per talk.<br /><br />About a month after his first talk in 1994, Stein was asked by another drug company to give a lecture on cholesterol at a small hospital in Chicago, just as blockbuster statin drugs were coming on the market.<br /><br />'I was really flattered because <em><strong>over and over again I was told that I was a future thought leader</strong></em>,' he said. 'I did my talk. I got a $750 honorarium and I was hooked.'<br /><br />Stein said he now realizes that the speech at the hospital was just an audition.<br /><br />'They wanted to know what I would say and how I would deliver,' he said. 'And I think <em>they also wanted to know what I would say about their product</em>.'<br /><br />He joined speakers bureaus for several drug companies. It was a kind of badge of honor, he said. The more companies a doctor spoke for, the more highly he or she was regarded.<br /><br />Stein, now 44, came to UW in 1996. Over the years, he would give talks and do other work for many of the top names in the pharmaceutical industry.<br /><br />For instance, in 2005 Stein did work for six drug makers, according to a disclosure form filed with UW. That year, Pfizer paid him between $10,000 and $20,000 for four days of work as a speaker and advisory board member.<br /><br />LipoScience, a firm that markets a cholesterol test, paid him $10,000 to $20,000 for four days of similar work.<br /><br />Another firm, Schering-Plough, paid him about $12,000 for two days as a lecturer.<br /><br />Although he said he had concerns about the propriety of his work, Stein said <em>he was assured by his superiors there was nothing wrong with it as long as he did it on his own time. Indeed, they said it <strong>enhanced the reputation of the university</strong>. </em><br /><br />And, he said, he considered himself an educator, not a salesman.<br /><br />He said he tried to manage any conflicts of interest by disclosing who paid him, controlling the content of what he said and doing the work on personal time.<br /><br />Things started to change rapidly beginning several years ago.<br /><br /><em>Drug companies began referring to the talks as promotional. They wanted him to use their slides; he refused</em>. Then, medical journals and the lay press began printing articles questioning the ethics of the relationships.<br /><br />A 2006 article in a Madison newspaper listed Stein as being among the UW doctors who reported the most money from the drug industry. Stein said he was embarrassed.<br /><br />But, he said, he continued to try to manage his relationships with drug companies. He sent letters to patients disclosing his ties to industry. As of December 2006, he donated all the money from his talks to charity.<br /><br />Why didn't he just stop doing the work?<br /><br />He said he believed he could save more lives lecturing than by working in the emergency room. Stein said he saw no harm in being paid. But <em><strong>he admitted that giving the talks also made him feel important.<br /></strong></em><br />At the same time, new scientific articles suggested that it is impossible for doctors to be unbiased when they receive gifts or payments from drug companies.<br /><br /><em>'I have learned that human beings, physicians included, are incapable of recognizing bias in themselves, and even when you try not to be biased it is impossible to avoid it, especially when money is involved</em>,' he said.<br /><br />He said he came to realize that drug and medical device firms were no longer trustworthy partners in medical education.<br /><br />He also said it has become obvious that patients have the least power and drug companies have the most power.<br /><br />'I was wrong,' he said.<br /><br />Stein said he stands by what he taught.<br /><br />But, he added, <em>'I was naïve to think I was not influenced by the money and power of the drug and device companies</em>.'<br /><br />As of last December, he said, he stopped all drug company speaking and consulting other than bona fide research.<br /></blockquote><br />It is nice that a few commercially paid "key opinion leaders" have realized what they were really doing. Maybe, Dr Stein will follow in the footsteps of Dr Daniel Carlat, and try to atone for his previous role in drug marketing disguised as education. (See Dr Carlat's excellent blog <a href="http://carlatpsychiatry.blogspot.com/">here</a>, and his now classic article, "<a href="http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html">Dr Drug Rep</a>.")<br /><br />This compelling narrative reinforces some points about relationships among physicians and health care corporations.<br /><br />Health care corporations do not pay for nothing, and are not charitable organizations. If a company pays a physician to give talks, it is almost certainly because those talks will help market company products or services.<br /><br />Pharmaceutical and device companies have argued that they only pay the best and the brightest physicians as speakers and consultants. But this story (and others, e.g. <a href="http://hcrenewal.blogspot.com/2008/06/key-opinion-leaders-were-sales-people.html">here</a>) suggest that they recruit young physicians who seem to be malleable and likely to go along with the company line, and groom them to do marketing in the guise of education.<br /><br />The company's money thus helps mold "key opinion leaders." Worse, at many medical schools, being a commercially supported speaker or consult was a badge of honor. Thus, faculty chosen by commercial firms as most tractable and sympathetic to the companies' viewpoints, came to be regarded as the best and the brightest.<br /><br />Why getting money from commercial firms was regarded as indicative of honor and intelligence, rather than gullibility, naivete, or worse, is not clear. I wonder whether it correlated with increasing alignment of the leadership of medical schools with commercial interests, and domination of the very top leadership, that is, the universities' board of directors, by those formerly regarded as Masters of the Universe (but now often seen as stupid, arrogant, greedy, or even corrupt. See posts about how the boards of <a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">Dartmouth</a>, <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">Harvard</a>, and <a href="http://hcrenewal.blogspot.com/2009/04/hedge-fund-u.html">Yeshiva</a> were disproportionately populated by leaders of [faux] finance).<br /><br />At any rate, this is truly a cautionary tale of seduction of academia into hucksterism.<br /><br />Hat tip to Margaret Soltan <a href="http://www.margaretsoltan.com/?p=12236">at University Diaries</a>.<br /><br />ADDENDUM (30 April, 2009) - See also the <a href="http://carlatpsychiatry.blogspot.com/2009/04/another-hired-gun-repents-this-time.html">comments</a> by Dr Daniel Carlat on the Carlat Psychiatry Blog.

Another Key Opinion Leader Confesses

The Milwaukee Journal-Sentinel published another story in their series on physicians' entanglements with health care corporations. This ...

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11 short films about a browser

<span style="font-size:85%;"><span style="font-style: italic;">(Cross-posted from the <a href="http://chrome.blogspot.com/2009/04/11-short-films-about-browser.html">Google Chrome Blog</a>)</span></span><br /><br />For those of us who live and work on the web, the browser is an unsung hero. It's become the most important piece of software on our computer, but rarely is it given proper recognition, let alone fêted.<br /><br />We invited some creative friends to make short movies about our own browser, <a href="http://www.google.com/chrome/index.html?brand=CHNT&utm_campaign=en&utm_source=en-et-ogb&utm_medium=et">Google Chrome</a>, and then watched as they came back with dozens of interesting ways to portray the browser. After finishing his <a href="http://www.youtube.com/watch?v=5535Ts-iOP0">video</a>, artist and illustrator <a href="http://www.christophniemann.com/">Christoph Niemann</a> wrote to us about his approach:<br /><br /><span style="font-style: italic;">"Instead of thinking of what I wanted to show, I tried to think about what I did NOT want to show. I realized that when I use a computer or browse the web these days, the one thing I do NOT think about is... a computer.</span><br /><br /><span style="font-style: italic;"> There was a time when I knew the meaning of every single item in my system folder and had to wisely allocate RAM to an application before burdening it with a complex task. Dealing with a computer has become much simpler these days (if everything works), but much more difficult and complex (especially if it doesn't behave) — almost like dealing with a living creature.</span><br /><br /><span style="font-style: italic;"> I wanted to find a simple metaphor that explains what a browser does, without showing a screen, a keyboard, the letters WWW, pixels, zeroes or ones.</span><br /><br /><span style="font-style: italic;"> Initially I thought of my mom (the browser) who brings me (the user) a plate of spaghetti bolognese (the Internet). But since spaghetti bolognese is not a rewarding thing to draw, let alone animate, I went for the next best metaphor, which can be seen in the animation."</span><br /><br />Along with Christoph's video, there are great shorts by <a href="http://www.motiontheory.com/">Motion Theory</a>, <a href="http://parkpictures.com/">Steve Mottershead</a>, <a href="http://www.gorobot.com/">Go Robot</a>, <a href="http://notclosed.com/">Open</a>, <a href="http://www.defaultbkk.org/">Default Office</a>, <a href="http://www.huntergatherer.net/">Hunter Gatherer</a>, <a href="http://www.lifelongfriendshipsociety.com/site2/flash.php#/">Lifelong Friendship Society</a>, <a href="http://www.superfad.com/">SuperFad</a>, <a href="http://www.thecollaborativeworksofjeffandpaul.com/">Jeff&Paul</a>, and <a href="http://www.pangra.net/">Pantograph</a>. You can view the individual Chrome Shorts on our <a href="http://youtube.com/googlechrome">YouTube channel</a> as well as a quick compilation below.<br /><br /><object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/xj8tD_XFV3g&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/xj8tD_XFV3g&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object><br /><br />We're really excited about the imagination and range of their ideas, and we hope you enjoy them.<br /><br /><span class="byline-author">Posted by Ji Lee, Creative Lab</span>

11 short films about a browser

(Cross-posted from the Google Chrome Blog ) For those of us who live and work on the web, the browser is an unsung hero. It's become the...

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Experimental Flu Trends for Mexico

<span style="font-style: italic;font-size:85%;" >(Cross-posted on the <a href="http://blog.google.org/2009/04/experimental-flu-trends-for-mexico.html">Google.org Blog</a>)</span><br /><br />In November 2008, we launched <a href="http://www.google.org/flutrends/">Google Flu Trends</a> after finding a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Google Flu Trends may be able to detect influenza outbreaks earlier than other systems because it estimates flu activity in near real time.<br /><br />In response to recent inquiries from public health officials, we've been attempting to use Google search activity in Mexico to help track human swine flu levels. <a href="http://www.google.org/flutrends/intl/en_mx/index.html"> Experimental Flu Trends for Mexico</a> is, as you might have guessed, very experimental. But the system has detected increases in flu-related searches in Mexico City (Distrito Federal) and a few other Mexican states in recent days, beginning early in the week of April 19-25.<br /><br />In the United States, we were able to validate our estimates using data from a surveillance system managed by the U.S. Centers for Disease Control and Prevention (CDC). We have not verified our data for Mexico in the same manner, but we've seen that Google users in Mexico (and around the world) also search for many flu-related topics when they have flu-like symptoms. Given the tremendous recent attention to swine flu, our model tries to filter out search queries that are more likely associated with topical searches rather than searches by those who may be experiencing symptoms.<br /><br />While we would prefer to validate this data and improve its accuracy, we decided to release an early version today so that it might help public health officials and concerned individuals get an up-to-date picture of the ongoing swine flu outbreak. As with our existing Flu Trends system, estimates are provided across many of Mexico's states and updated every day. Our current estimates of flu activity in the U.S. are still generally low as would be expected given the relatively low confirmed swine flu case count. However, we'll be keeping an eye on the data to look for any spike in activity.<br /><br />We're keenly aware of the trust our users place in us and our responsibility to protect their privacy. Experimental Flu Trends for Mexico -- like Google Flu Trends -- cannot be used to identify individual users. The patterns we observe are only meaningful across large populations of Google searchers. We hope that this experimental release provides useful information.<br /><br />For updates on swine flu and information on how to stay healthy during a disease outbreak, visit the<a href="http://www.cdc.gov/swineflu/"> CDC's swine flu site</a>.<br /><br /><span class="byline-author">Posted by Jeremy Ginsberg and Matt Mohebbi, Software Engineers</span>

Experimental Flu Trends for Mexico

(Cross-posted on the Google.org Blog ) In November 2008, we launched Google Flu Trends after finding a close relationship between how many ...

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Live stream on YouTube: the President's First 100 Days News Conference

<span style="font-style: italic;font-size:85%;" >(Cross-posted from the <a href="http://www.youtube.com/blog?entry=KnCjVcOtSsM">YouTube Blog</a>)</span><br /><br />The first three months of the Obama Administration have brought the new American President unprecedented challenges. Back in November, when he was elected, everyone knew the economy and the Middle East would be critical issues for Obama to attack early on. But like every president before him, he's had to deal with the unexpected as well: who could have predicted pirates off the Somali Coast or swine flu?<br /><br />As citizens and pundits from all political perspectives analyze the President's first 100 days in office today, Obama himself will address the nation tonight on the 100-day anniversary of his inauguration -- and we're going to carry a live stream of the conference from the <a href="http://www.youtube.com/whitehouse">White House YouTube channel</a>. Be sure to tune in at 8pm EDT to watch it live.<br /><br />We're also featuring commentary and analysis from top news organizations on our homepage today. <a href="http://www.youtube.com/watch?v=NZKlUIjQ4kM">Hear Karl Rove</a> grade the President on Fox News. Get <a href="http://www.youtube.com/watch?v=hCv3JFdAcTc">a re-cap</a> from Al-Jazeera on what Obama has accomplished in his opening act. Watch the Washington Post <a href="http://www.youtube.com/watch?v=vhqOFGWRUXY">talk with Americans</a> in DC about their early impressions of the new President.<br /><br />You can join in the conversation by making a video: How is the Obama Administration doing, and what advice would you give the President moving forward? Upload your thoughts to YouTube and add them as a video response to this <a href="http://www.youtube.com/watch?v=geljx1wXdnY">Citizentube video</a>, and we'll feature some of them on our News page tomorrow.<br /><br />Finally, don't forget to come to <a href="http://www.youtube.com/whitehouse">youtube.com/whitehouse</a> at 8pm EDT to watch President Obama address the nation.<br /><br /><span class="byline-author">Posted by Steve Grove, YouTube News & Politics</span>

Live stream on YouTube: the President's First 100 Days News Conference

(Cross-posted from the YouTube Blog ) The first three months of the Obama Administration have brought the new American President unprecedent...

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UPMC as "Proving Ground" for IT Tests On Children: Pioneers in Health IT, or Pioneers in Ignoring the Past?

Hospitals as a "Proving Ground" for tests of unproven health IT - upon <span style="font-weight: bold;">children?</span><br /><br />At my post "<a href="http://hcrenewal.blogspot.com/2009/04/business-week-on-health-it-dubious.html">BusinessWeek on Health IT: The Dubious Promise of Digital Medicine</a>" I began to discuss the responses made by health IT vendors and organizations regarding HIT problems and defects, raised in a very serious April 23, 2009 <a href="http://www.businessweek.com/magazine/content/09_18/b4129030606214.htm?campaign_id=rss_daily">BusinessWeek article</a> on these issues.<br /><br />In this post I address the following claims regarding UMPC and a controversial Dec. 2005 article by a UPMC physician in the journal <span style="font-weight: bold;">Pediatrics</span> ("<a href="http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1506">Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System</a>", <strong style="font-weight: normal;">Yong Y. Han et al. -- </strong>my comments on this paper at that time were <a href="http://hcrenewal.blogspot.com/2005/12/upi-picks-up-on-pitfalls-of-bad.html">at this link</a>).<br /><br />BusinessWeek wrote:<br /><p></p><blockquote><p>... [HIT vendor Cerner] faced more questions over its technology at the University of Pittsburgh Medical Center (UPMC). In 2005 researchers there <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[i.e., Han et al. - ed.]</span> found that at the university's Children's Hospital <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[note that this is a Children's Hospital - ed.]</span>, <span style="font-weight: bold;">patient deaths more than doubled</span>, to 6.6% of intensive-care admissions, in the five months following the installation of a computerized order-entry system. The research on child patient deaths at the University of Pittsburgh found a "direct association between [computerized records] and increased mortality," according to an article published in December 2005 in the medical journal <cite>Pediatrics</cite>. Digital technology slowed treatment in several ways, the researchers concluded. One example: Doctors and nurses in the intensive-care unit were accustomed to ordering medications and tests while a sick child was en route to the hospital.<br /></p><p><span style="font-weight: bold;">The Cerner system required that orders be submitted only when the patient arrived, costing crucial time.</span> The authors of the <cite>Pediatrics</cite> article acknowledged that their work clashed with other studies showing that digitization decreases errors and shortens hospital stays <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[but also is consistent with another body of literature </span><span style="font-style: italic; color: rgb(255, 0, 0);">(<a href="http://hcrenewal.blogspot.com/2009/03/reader-on-why-we-have-busywork.html">examples here</a>)</span><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"> that Health IT vendors and others with conflicts of interest simply ignore, as per my numerous HC Renewal posts on the issue. Pharma should only have it as good - ed.]</span> </p> <p> G. Daniel Martich, chief medical information officer at UPMC, says the <cite>Pediatrics</cite> study <span style="font-weight: bold;">was flawed</span>. <span style="font-weight: bold;">Factors other than the installation of computers</span>, such as the centralization of pharmacy services, <span style="font-weight: bold;">also disrupted care</span>, he emphasizes. <span style="font-weight: bold;">The problems identified in the 2005 paper have all been resolved</span>, Martich adds. "There were workflow issues," he says. "<span style="font-weight: bold;">We learned the hard way because we were pioneers.</span>" Over the long run, he says, technology has helped decrease mortality rates and cut medication errors in half at Children's Hospital since 2003 .</p></blockquote><p> </p><br />Again, I emphasize we are considering the healthcare of <span style="font-weight: bold;">children</span> in this matter.<br /><br />Here are my observations and questions:<br /><br /><ul><li>Why is the 2005 paper simply being dismissed? This is not a scientific approach to the peer reviewed literature, especially where the <span style="font-weight: bold;">deaths of children</span> are concerned. I believed in 2005 and believe now that the red flags raised by this paper may have been "brushed under the carpet" too rapidly. See my <a href="http://hcrenewal.blogspot.com/2005/12/upi-picks-up-on-pitfalls-of-bad.html">2005 post</a> on the matter.</li></ul><ul><li>The implication that the Cerner CPOE was uninvolved in the increased mortality would itself require a very careful observational study to ferret out the exact contributions of its deficits and that of the "centralization" of pharmacy services and other factors. Has such a study been performed and peer reviewed, and has a rebuttal been posted by the original study's authors? Can such a prospective study even be performed after the fact?<br /></li></ul><ul><li>While CMIO G. Daniel Martich claims "the problems in the 2005 paper have all been resolved" <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[wait - I thought the paper was flawed, yet it illustrated problems now resolved? - ed.]</span>, how can patients be assured of this? Where are the studies that show the issues have all been resolved?</li></ul><ul><li>Does the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=granger_speaks_out">damning commentary</a> by the UK's former NHS HIT Director Richard Granger, stories such as patients going untreated for months at a time related to Cerner Millennium Care Records Service ("<a href="http://www.computerweekly.com/blogs/tony_collins/2009/04/if-the-npfit-were-a-jumbo-heav.html">If NPfiT were a jumbo jet heaven help 747 flyers</a>"), an equally damning report in Jan. 2009 on Cerner's EHR products (i.e., "Millenium") as reported by the <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">UK House of Commons Public Accounts Committee</a>, and the impact on the UK's £12.7 billion national Health IT project suggest a systemic problem needing investigation?</li></ul>Martich also makes the fantastic claim that "we learned the hard way because we were pioneers."<br /><br /><span style="font-weight: bold;">Pioneers?</span><br /><br />Pioneers in what, exactly?<br /><br />As a former NIH informatics fellow and then former CMIO myself more than a decade ago, it seems more likely UPHS (as well as the children and their parents, and the pediatricians who held the ultimate responsibility per Koppel and Kreda's <a href="http://hcrenewal.blogspot.com/2009/03/health-care-information-technology.html">Hold Harmless</a> paper in JAMA) learned the "hard way" because the organization <span style="font-weight: bold;">ignored</span> the work of the pioneers.<br /><br />There is literature going back fifty years on the challenges of health IT as mentioned in my many posts at HC Renewal, such as <a href="http://hcrenewal.blogspot.com/2009/03/reader-on-why-we-have-busywork.html">here</a>.<br /><br />I began my informatics postdoc in <span style="font-weight: bold;">1992-4 </span>working on CPOE implementation at Yale-New Haven Hospital. I'd learned lessons from the writings of others who'd experienced CPOE difficulties <span style="font-weight: bold;">years before that</span>, such as (emphases mine):<br /><blockquote><br /><div class="ref-cit"><div class="citation"><span style="font-weight: bold;">Massaro TA.</span> Introducing physician order entry at a major academic medical center. I: Impact on organizational culture and behavior. <span class="ref-journal">Acad Med</span> 1993;<span class="ref-vol">68</span>:20–5. <span style="white-space: nowrap;">[<a class="ref-extlink" href="http://www.pubmedcentral.nih.gov/redirect3.cgi?&&auth=0jaErvytwwQQq76TgXy2EDyit4gLe3fP78UcXhAi7&reftype=pubmed&artid=342045&article-id=342045&iid=134759&issue-id=134759&jid=76&journal-id=76&FROM=Article%7CCitationRef&TO=Entrez%7CPubMed%7CRecord&rendering-type=normal&&http://www.ncbi.nlm.nih.gov/pubmed/8447887">PubMed</a>]</span><br /><span style="white-space: nowrap;"><br /></span><span style="font-weight: bold; color: rgb(0, 0, 0);font-size:100%;" >Summary: In 1988 the University of Virginia Medical Center</span><span style="color: rgb(0, 0, 0);font-size:100%;" > began implementation of a medical information system based on mandatory physician order entry. The implementation process was much more difficult than expected. The program experienced considerable delays, and cost much more than was originally estimated. Although there were some legitimate questions concerning the user-friendliness of the new technology, these were less significant than the cultural and behavioral problems encountered. <span style="font-weight: bold;">The new system challenged basic institutional assumptions; it disturbed traditional patterns of conduct and forced people to modify established practice routines</span> ... The author describes the problems that occurred and the organizational behaviors on which they were based, <span style="font-weight: bold;">analyzes the lessons learned, documents the progress that has been achieved, and outlines the challenges that remain.</span> The center's experience provides insight into the issue of technology-driven organizational transformation in academic medical centers. <span style="font-weight: bold;">Recommendations for successful introduction of similar agents of institutional change are presented.</span></span><br /><br />and <span style="font-weight: bold;"><br /><br />Massaro TA.</span> Introducing physician order entry at a major academic medical center: II. Impact on medical education. <span class="ref-journal">Acad Med</span> 1993;<span class="ref-vol">68</span>:25–30. <span style="white-space: nowrap;">[<a class="ref-extlink" href="http://www.pubmedcentral.nih.gov/redirect3.cgi?&&auth=0JyfUmP1NgTDWGmXZYjyGg84htX5bDyZoGiLjMQOj&reftype=pubmed&artid=342045&article-id=342045&iid=134759&issue-id=134759&jid=76&journal-id=76&FROM=Article%7CCitationRef&TO=Entrez%7CPubMed%7CRecord&rendering-type=normal&&http://www.ncbi.nlm.nih.gov/pubmed/8447888">PubMed</a>]:</span><br /><br /><span style="color: rgb(0, 0, 0);font-size:100%;" ><span style="font-weight: bold;">Summary: </span>The introduction <span style="font-weight: bold;">[in 1988]</span> of an information technology (IT) system that mandates order entry by physicians had significant and often unexpected effects on medical education at the University of Virginia Medical Center. <span style="font-weight: bold;">The system was deactivated briefly after the introduction of laboratory ordering, and frustration with the pharmacy ordering pathways provoked a major confrontation between the residents and medical center management. </span><span style="font-weight: bold;">Changes in responsibilities, patterns, and priorities of work introduced by the system also contributed significantly to the general dissatisfaction. These issues had not been thoroughly considered in the planning stage</span>, but it was only after accommodation was made to these changes that integration of the technology into routine practice could proceed. The author emphasizes the importance of extensive involvement and leadership of attending physicians in the planning and implementation of such a system. <span style="font-weight: bold;">He presents a set of recommendations </span>to those considering similar IT initiatives and wishing to reduce the disruptions that may accompany their introduction. With time and experience, however, the housestaff have adjusted to the system and developed facility in using it. Much of the dissatisfaction was derived from the perception that "doctors spend too much time on the computer." In fact, less than 10% of the physicians spent more than an hour each day. However, a small group of residents on call for the busier services were sometimes at the computer for more than four hours each day.</span> </div></div></blockquote><div class="ref-cit-blk" id="r12"><div class="ref-cit"><div class="citation"><span style="white-space: nowrap;font-size:85%;" ></span></div></div></div><br />The entire thirty year old field of <a href="http://www.amazon.com/Understanding-Communicating-Social-Informatics-Communication/dp/1573872288/ref=sr_1_1/102-9749119-8288920?ie=UTF8&s=books&qid=1174318804&sr=8-1">Social Informatics</a> spells out the dangers of unintended consequences, and books such as Lorenzi and Riley's "<a href="http://www.amazon.com/Managing-Technological-Change-Organizational-Informatics/dp/0387985484/ref=sr_1_1/102-9749119-8288920?ie=UTF8&s=books&qid=1174319044&sr=8-1">Managing Technological Change: Organizational Aspects of Health Informatics</a>", which contains enough information to have allowed avoidance of the issues in the 2005 paper, was first published in 1994.<br /><br />My <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">website on HIT difficulties</a> would have helped avoid these issues as well, and it has been online and nearly unique (and the top hit on queries on 'healthcare IT failure' - <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&q=healthcare+IT+failure&btnG=Google+Search">click here</a> - and similar) for a decade. Did anyone in this CPOE project do such a search, read it, and perhaps query its author about the material <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[of course not - ed.]</span> before spending tens of millions of dollars and putting patients at risk?<br /><br />In other words, was true <span style="font-weight: bold;">due diligence</span> performed? Considering this was a Children's Hospital, one would have expected <span style="font-weight: bold;">extraordinary levels</span> of due diligence.<br /><br />Pioneers learning the hard way? No. It seems this medical center was a pioneer in ignoring the lessons of the past. I believe a simpler explanation of the difficulties in this CPOE project might be that, like many HIT projects, the <span style="font-weight: bold;">project was mismanaged.</span><br /><br />Perhaps Dr. Martich meant UPMC were pioneers in <span style="font-style: italic;">this particular</span> new CPOE system. As in <a href="http://www.pittsburghlive.com/x/pittsburghtrib/news/s_449506.html">this article in the Pittsburgh Tribune</a>:<br /><br /><blockquote>The University of Pittsburgh Medical Center is taking another step in a quest to commercialize new medical technology.<br /><br />UPMC on Monday signed a three-year deal with health care information technology provider Cerner Corp. to develop and market medicine-related technological advances. Both parties will contribute $10 million in cash, services and intellectual property to the effort.<br /><br />The deal is a smaller version of an April 2005 deal between UPMC and information technology behemoth IBM.<br /><br />As is the case in the IBM deal, UPMC will serve as a built-in <span style="font-weight: bold;">p</span><span style="font-weight: bold;">roving ground for jointly developed technologies and products</span>, with Cerner marketing the products and UPMC awarded a share of profits.<p><br /></p></blockquote><p></p><span style="font-weight: bold;">"Proving ground?"<br /><br /></span>I cannot believe I am reading such a claim. A hospital and patients, as I have written before, are not a learning lab for HIT vendors. The appropriate "proving ground" for new medical technology is the <span style="font-weight: bold;">controlled clinical trial</span> where participants (in this case, patients and healthcare professionals alike) have freedom of choice whether or not to participate, and a chance to give (or deny) consent after being <span style="font-weight: bold;">fully informed of potential risk.</span><br /><br />Were patients or their parents asked to give consent to the use of HIT (such as <a href="http://hcrenewal.blogspot.com/2009/03/draft-patient-rights-statement-and.html">here</a>)? Were they even aware they were serving as subjects of a "proving ground?" Likewise for clinicians?<br /><br /><span style="font-weight: bold;">It should be kept in mind that in this "proving ground" (i.e., experimental) situation we are dealing with children.</span> Using a hospital as a "proving ground" for unproven HIT on unconsented or coerced subjects (e.g., children, their parents, and the doctors themselves) probably amounts to battery at the very least, is consistent with violations of <a href="http://www.hcrenewal.blogspot.com/2009/03/health-it-hold-harmless-and-defects-gag.html"><span>fiduciary and Joint Commission safety standards</span></a><span>, and I am concerned about it representing human rights violations as well.<br /><br />In view of the recent <a href="http://hcrenewal.blogspot.com/2009/03/health-care-information-technology.html">Koppel and Kreda paper </a>in JAMA on "hold HIT vendors harmless" and "defects gag" clauses, </span><span style="font-weight: bold;">this entire arrangement seems incredibly disturbing at the very least.<br /><br /></span>I also believe the conflict of interest represented by a healthcare organization partnering with a vendor to "<span style="font-weight: bold;">commercialize new medical technology</span>" on unconsented subjects while sharing profits is a horrendous development, for as I stated, the appropriate settings for such practices are properly conducted, impartial clinical trials. The potential for abuses in the current arrangement seems uncomfortably high.<br /><br />My sentiments seem aligned with IOM's recommendation 4.1 and others on Conflict of Interest as pointed out by fellow HC Renewal blogger Bernard Carroll <a href="http://hcrenewal.blogspot.com/2009/04/institute-of-medicine-report-on.html">at this post</a>:<br /><br /><em></em><blockquote style="font-style: italic;"><em>Academic medical centers and other research institutions should establish a policy that individuals generally <span style="font-weight: bold;">m</span><span style="font-weight: bold;">ay not conduct research with human participants if they have a significant financial interest in an existing or potential product or a company that could be affected by the outcome of the research.</span> Exceptions to the policy should be made public and should be permitted only if the conflict of interest committee (a) determines that an individual’s participation is essential for the conduct of the research and (b) establishes an effective mechanism for managing the conflict and protecting the integrity of the research…”</em> (page S-14).</blockquote><br />One wonders if the individuals involved in the CPOE project had unreported conflicts of interest with the HIT industry. Perhaps, as in pharma, this needs to be explored.<br /><br /><span>Han's 2005 article in Pediatrics suggesting children died as a result of the "experiment" should probably be further explored on the basis of the issues I raise above. I also note Han is no longer at UPMC; perhaps his treatment after publication of this article should also be investigated.</span><br /><br />In Dec. 2005 on this blog <a href="http://hcrenewal.blogspot.com/2005/12/upi-picks-up-on-pitfalls-of-bad.html">I wrote</a>:<br /><br /><blockquote>... This study is dealing with children, of course, and is perhaps a flag that much more detailed study of these systems, especially in socially-sensitive environments such as pediatrics, need to be performed.<br /><br />For if this study's findings are not just due to serendipity and do reflect some underlying causation, <span style="font-weight: bold;">the medical, ethical and legal issues could be enormous</span>.</blockquote><br />I stand by that assessment.<br /><br />Finally, putting the camera to my statement that medicine is <span style="font-weight: bold;">suffering a cross occupational invasion by the IT industry</span>, in Business Week the picture below appeared of a handsome and proud physician in his office:<br /><br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_8YphtkAHyDU/Sfe2wnhL92I/AAAAAAAAALw/teBfY9F_DHM/s1600-h/cerner.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5329929630374426466" src="http://3.bp.blogspot.com/_8YphtkAHyDU/Sfe2wnhL92I/AAAAAAAAALw/teBfY9F_DHM/s320/cerner.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 255px; height: 193px;" /></a><span style="font-size:85%;"><span style="font-family:arial;">Cerner CEO Neal Patterson</span></span><br /></div><br />Oh, wait...<br /><br />That person is not a physician nor does he have any medical experience of which I am aware. He is the CEO of the Cerner HIT company.<br /><br />This picture is the future face of medicine, and it will not be the brightest of futures if this cross occupational invasion continues unopposed by those of a scientific and biomedical mindset much longer.<br /><br />I really do believe it is the time for a Congressional investigation of these issues, and strong consideration of FDA regulation of health IT, a precedent set long ago in the pharmaceutical industry.<br /><br />-- SS<br /><br />Addendum: I note in Dr. Martich's <a href="http://www.ccm.upmc.edu/archive/faculty/bios/martich.html">bio</a> an impressive list of medical credentials; however I find formal Biomedical Informatics and/or computer science training lacking. This is not to attack the person, but the culture of HIT, as this scenario is common in HIT and represents what I refer to as "amateurs" running health IT.<br /><br />I use the term "amateur" not derisively, but in the same sense that I am a <a href="http://www.arrl.org/">radio amateur</a> (albeit licensed after examination at the <a href="http://en.wikipedia.org/wiki/Amateur_radio_licensing_in_the_United_States#Current_license_classes">Extra class</a> and in the "old days", when 20 WPM morse code proficiency was also required). I am not a telecommunications professional. While I have excellent skills in telecommunications theory, hardware, antennas, and operations, I would not consider myself even remotely qualified to, say, run a strategic telecommunications project for a large organization.<br /><br />In medicine, I always believed education was critical. I may have been mistaken.<br /><span style="font-weight: bold;"></span>

UPMC as "Proving Ground" for IT Tests On Children: Pioneers in Health IT, or Pioneers in Ignoring the Past?

Hospitals as a "Proving Ground" for tests of unproven health IT - upon children? At my post " BusinessWeek on Health IT: The ...

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INSTITUTE of MEDICINE REPORT on CONFLICT of INTEREST

<div align="left"><br />INSTITUTE of MEDICINE REPORT on CONFLICT of INTEREST<br /><br />Today we saw a new marker laid down in the arena called Conflict of Interest (COI). The Institute of Medicine of the National Academy of Sciences issued a <a href="http://policymed.typepad.com/files/medical-coi-full-report-4-28-09.pdf">report</a> of its Committee on Conflict of Interest in Medical Research, Education and Practice. The report is comprehensive, even exhaustive, running to 353 pages. Gardner Harris in the New York Times <a href="http://www.nytimes.com/2009/04/29/health/policy/29drug.html?_r=1">today</a> calls it “scolding,” “stinging,” and “damning.” The recommendations go well beyond any proposed in the recent past by medical schools or by other professional organizations. The NYT quoted David Rothman, president of the Institute on Medicine as a Profession at Columbia University: “With the I.O.M.’s endorsement, issues that were once controversial now are indisputable. Conflicts of interest in medicine are no longer acceptable.”<br /><br />It will take some time for the field to digest the scope of the IOM recommendations. It will take even longer for the new standards to be implemented. For now, I offer just a few observations.<br /><br />First, if the IOM hopes for maximum credibility then it might ought want to do some housecleaning. A few years ago I fired a shot across the bow of the IOM concerning COI. [Can the Institute of Medicine Review the FDA? Nature Medicine 11, 369 (1 April 2005) doi:10.1038/nm0405-369] Nothing much changed, and in the following years, national scandals erupted involving several of the issues I had highlighted. Prominent IOM members, who were well known to be poster boys for COI, were exposed by Senator Charles Grassley (R-Iowa). Their embarrassing behaviors included incomplete financial disclosures and noncompliance with NIH policy on financial conflict of interest. The exposés included Emory’s Charles Nemeroff and Stanford’s Alan Schatzberg. In both cases, administrative rearrangements have now been implemented. The case of Dr. Nemeroff has been referred by Senator Grassley to the Inspector General of the Department of Health and Human Services. It is perhaps no accident that Dean Claudia Adkison of Emory and Dean Philip Pizzo of Stanford were included as external reviewers of the draft IOM report. Their insights would have been invaluable.</div><br /><div align="left"><br />Another ongoing embarrassment for the IOM is Lester Crawford. He was the FDA Commissioner who resigned abruptly in 2005 and later pleaded guilty to criminal conflict of interest. He had been charged with falsely reporting information about his stock holdings in companies he was in charge of regulating. He received a sentence of three years of supervised probation and a fine of about $90,000. He is now senior counsel with a health care lobbying firm in Washington, DC. The Institute of Medicine does not help its image by continuing the membership of such a compromised individual.</div><br /><div align="left"><br />As the Emory-Nemeroff and Stanford-Schatzberg cases unfolded it appeared that the respective institutions had themselves contributed to the problems, either through inaction or through studiously nontransparent procedures on disclosure. Stanford, for instance, apparently did not require faculty members to report the proceeds of stock sales, and when challenged the university invoked on-line financial reporting services and SEC filings as a sufficient substitute. Not surprisingly, because Stanford didn’t know about Dr. Schatzberg’s realized gain of some $109,000 from sale of founder’s stock in his biotech start-up company, Corcept Therapeutics, this information was not reported to NIH.<br /><br /><strong>Recommendation 4.1</strong> One of the IOM’s recommendations applies particularly to the Stanford-Schatzberg case. Recommendation 4.1 addresses the boundary between academia and commerce in the case of research involving human subjects. Here is the specific language:<br /><br /><em>“Academic medical centers and other research institutions should establish a policy that individuals generally may not conduct research with human participants if they have a significant financial interest in an existing or potential product or a company that could be affected by the outcome of the research. Exceptions to the policy should be made public and should be permitted only if the conflict of interest committee (a) determines that an individual’s participation is essential for the conduct of the research and (b) establishes an effective mechanism for managing the conflict and protecting the integrity of the research…”</em> (page S-14).<br /><br />Last year I posted <a href="http://hcrenewal.blogspot.com/search?q=Schatzberg">several times</a> about this issue in the Stanford-Schatzberg case. It is gratifying now to see the IOM affirm the importance of the boundary. The activities declared off-limits by the IOM include not only <em>“recruiting subjects; obtaining informed consent; assessing the clinical end points;”</em> but also <em>“analyzing data; or writing the results, conclusions, and abstracts for publications reporting the findings of the study.”</em> (page 4-17). In Stanford’s earlier plan for managing the conflict and protecting the integrity of the research, Dr. Schatzberg was free to engage in the latter group of activities. Indeed, his hands were all over the project when it came to responding to scientific critiques, managing the climate of professional opinion, attacking and threatening critics, promoting his company’s interest through review articles and press releases, slipping unpublished and non-peer-reviewed commercial data into academic reviews, and generally conducting commercially slanted public relations through academic outlets.<br /><br />When Stanford adopts the IOM recommendations, such activities will be blocked. As I <a href="http://hcrenewal.blogspot.com/2008/07/managing-conflicts-of-interest-at.html#links">stated</a> last year, “Review articles that assess a field and synthesize data form a crucial part of science that has to be off-limits to Dr. Schatzberg just as much as assessing patients in one of his clinical trials would be.”</div><br /><div align="left"><br />We should congratulate the IOM committee members for their work, and we hope to see the field embrace their recommendations.<br /><br />Bernard Carroll. </div><div align="left"></div><div align="left"><strong>UPDATE 04-30-2009:</strong> The link provided earlier for the IOM report document is no longer operative. Here is where to go now for a copy of the report. This time it will cost you.</div><div align="left"><a href="http://www.nap.edu/catalog.php?record_id=12598">http://www.nap.edu/catalog.php?record_id=12598</a> </div>

INSTITUTE of MEDICINE REPORT on CONFLICT of INTEREST

INSTITUTE of MEDICINE REPORT on CONFLICT of INTEREST Today we saw a new marker laid down in the arena called Conflict of Interest (COI). The...

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Adding search power to public data

Earthquakes are not the only thing that can shake Silicon Valley. After the dot-com bubble burst back in 2000 the unemployment rate of <a href="http://maps.google.com/maps?q=santa+clara+county&oe=UTF-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&tab=wl&ei=OF3vScWjMZfglQeqpOw0&oi=property_suggestions&resnum=0&ct=property-revision&cd=3">Santa Clara county</a> went up to 9.1%. During the last couple of months, it has gone up again:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_7ZYqYi4xigk/SfdH_e-rFdI/AAAAAAAADq0/grvoSkFGdNY/s1600-h/PD1+pic.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5329807839989536210" src="http://2.bp.blogspot.com/_7ZYqYi4xigk/SfdH_e-rFdI/AAAAAAAADq0/grvoSkFGdNY/s400/PD1+pic.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 264px;" /></a><br />We just launched a new search feature that makes it easy to find and compare public data. So for example, when comparing Santa Clara county data to the national unemployment rate, it becomes clear not only that Santa Clara's peak during 2002-2003 was really dramatic, but also that the recent increase is a bit more drastic than the national rate:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_7ZYqYi4xigk/SfdIWCOdlrI/AAAAAAAADq8/_UeYY8F3W-4/s1600-h/pD2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5329808227408123570" src="http://3.bp.blogspot.com/_7ZYqYi4xigk/SfdIWCOdlrI/AAAAAAAADq8/_UeYY8F3W-4/s400/pD2.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 256px;" /></a><br />If you go to Google.com and type in [unemployment rate] or [population] followed by a U.S. state or county, you will see the most recent estimates:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://4.bp.blogspot.com/_7ZYqYi4xigk/SfdIuDYSEDI/AAAAAAAADrE/bEDojlTdXRo/s1600-h/PD3.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5329808640034607154" src="http://4.bp.blogspot.com/_7ZYqYi4xigk/SfdIuDYSEDI/AAAAAAAADrE/bEDojlTdXRo/s400/PD3.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 186px;" /></a><br />Once you click the link, you'll go to <a href="http://www.google.com/publicdata?ds=usunemployment&met=unemployment_rate&idim=county:CN060850">an interactive chart</a> that lets you add and remove data for different geographical areas.<br /><br />Here's a video showing how it works:<br /><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/9Qt2n34VEr4&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/9Qt2n34VEr4&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="344" width="425"></embed></object><br /><br />The data we're including in this first launch represents just a small fraction of all the interesting public data available on the web. There are statistics for prices of cookies, CO2 emissions, asthma frequency, high school graduation rates, bakers' salaries, number of wildfires, and the list goes on. Reliable information about these kinds of things exists thanks to the hard work of data collectors gathering countless survey forms, and of careful statisticians estimating meaningful indicators that make hidden patterns of the world visible to the eye. All the data we've used in this first launch are produced and published by the <a href="http://www.bls.gov/">U.S. Bureau of Labor Statistics </a>and the <a href="http://www.census.gov/popest/estimates.html">U.S. Census Bureau's Population Division</a>. They did the hard work! We just made the data a bit easier to find and use.<br /><br />Since Google's <a href="http://googleblog.blogspot.com/2007/03/world-in-motion.html">acquisition of Trendalyzer</a> two years ago, we have been working on creating a new service that make lots of data instantly available for intuitive, visual exploration. Today's launch is a first step in that direction. We hope people will find this search feature helpful, whether it's used in the classroom, the boardroom or around the kitchen table. We also hope that this will pave the way for public data to take a more central role in informed public conversations.<br /><br />This is just the beginning. Stay tuned for more.<br /><br /><span class="byline-author">Posted by Ola Rosling, Product Manager</span>

Adding search power to public data

Earthquakes are not the only thing that can shake Silicon Valley. After the dot-com bubble burst back in 2000 the unemployment rate of Santa...

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Business in the cloud

There's a lot of interest in understanding cloud computing these days, so we thought we'd share some thoughts. If you're interested in hearing what we talk about when we talk about the role of cloud computing in business, check out our <a href="http://googleenterprise.blogspot.com/2009/04/what-we-talk-about-when-we-talk-about.html">post</a> on the Google Enterprise Blog.<br /><br /><span class="byline-author">Posted by Rajen Sheth, Senior Product Manager, Google Apps</span>

Business in the cloud

There's a lot of interest in understanding cloud computing these days, so we thought we'd share some thoughts. If you're intere...

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Hospital Board Members with "the Juice" in New Jersey

We recently <a href="http://hcrenewal.blogspot.com/2009/04/new-jersey-legislator-found-guilty-of.html">commented</a> on the conviction of a state legislator charged with selling his influence to a powerful local medical center. NorthJersey.com has a <a href="http://www.northjersey.com/news/njpolitics/humc042609.html">follow-up </a>on this story which shows how health care leaders are often members of the power elite, if not quite of the superclass, and how their machinations put this group's interests ahead of the mission of their health care organizations.<br /><br /><br /><strong>The General Overview</strong><br /><br /><blockquote><br />The trial of former state Sen. Joseph Coniglio, convicted in a bribery scandal involving Hackensack University Medical Center [<a href="http://humed.com/index.php?page=about">affiliated with UDMNJ</a>, which has had its own issues, e.g., <a href="http://hcrenewal.blogspot.com/2008/11/yet-more-investigations-of-umdnj.html">here</a>], <em>exposed the hospital’s reach into the State House — and put a spotlight on the wealthy, influential men who serve as the hospital’s power brokers.<br /></em><br /><em>Hackensack’s board members have connections and political muscle that extend far beyond the hospital</em>. At black-tie fund-raisers and dinners at board member Joseph Sanzari’s Stony Hill Inn, business — hospital and otherwise — is on the agenda.<br /><br /><em>Various board members help to underwrite Bergen County’s Democratic machine and powerful lawmakers in Trenton. They’re awarded many of the region’s public construction contracts. They have the network — and the money — to smooth over zoning issues for the hospital</em>. Testimony at the trial this month showed they supported the hiring of Coniglio, who was convicted of steering millions in grants to Hackensack while on the hospital’s payroll.<br /><br />'A political machine' is how Assistant U.S. Attorney Thomas R. Calcagni described the hospital as he told jurors about Hackensack’s relationships with former acting governor and Senate President Richard Codey, state Sen. Paul Sarlo, Coniglio and others during the trial. </blockquote><br /><strong>Board Members' Self-Dealing</strong><br /><br />There are several results. One is that "some [board members] are also <em>making money off the hospital</em>." The article gave several examples of such conflicts of interest.<br /><br /><blockquote><br />A few examples from the hospital’s federal tax filings for 2007, the latest available:<br /><br />* Companies owned by Sanzari and Creamer are building a 975-car garage as part of the $135 million cancer center now under construction. Creamer was paid more than $475,000 by the hospital for construction services.<br /><br />* The hospital paid more than $2 million to Progenitor Cell Therapy, a private stem cell research company owned in part by Ferguson; Dr. Andrew Pecora, director of the cancer center; board members Peter C. Gerhard, George T. Croonquist and Samuel Toscano Jr.; and the hospital’s chief operating officer, Robert C. Garrett.<br /><br />* The hospital paid $2.5 million to lease space from Sanzari 2001, where board member David Sanzari — Joseph’s cousin — is a managing member with an ownership stake. It also spent $68,000 at the Marriott at Glenpointe hotel, which is owned by David Sanzari’s family.<br /><br />* The DeCotiis law firm, one of the most influential in the state, made more than $1 million from the hospital. It is representing the hospital in the Coniglio case and guiding its campaign to reopen Pascack Valley Hospital in Westwood. During that time, Frank Huttle III, a partner, served on the board. He said Friday that he resigned recently.<br /><br />* Universal Health, which operates a retail pharmacy at the hospital, received $200,000. At the time, Toscano was the company’s chief executive officer.<br /></blockquote><br /><br /><strong>Political Influence Disadvantages the Competition</strong><br /><br />The membership of the hospital's leaders in the power elite could be used to advance the hospital against less-connected competitors.<br /><br /><blockquote><br />The Coniglio trial served as a primer on the backroom politics of New Jersey, where certain grants, known as 'Christmas tree items,' were doled out based on who has 'the juice.' By all accounts, Hackensack mastered the game and loomed large in Trenton. From 2004 to 2006, the hospital received $17.4 million for its cancer center, an extra $9 million in charity care above the millions it was already getting and $250,000 for the Joseph M. Sanzari Children’s Hospital. A $900,000 research grant was awarded to the private stem cell firm at the hospital and $70,000 went for a seat belt study.<br /><br />Those awards dwarf the grants given to Hackensack’s competitors.<br /><br /></blockquote><br /><strong>Connectedness of the Hospital's Board Members</strong><br /><br />The article gave further examples of how connected were the board members, and how they used their connections.<br /><br /><blockquote><br />At Hackensack, a few names — Simunovich, Ferguson, Sanzari, Creamer — keep showing up in influential roles on key boards. They serve as trustees of the Hackensack University Medical Center Foundation, the hospital’s fund-raising arm, as well as the hospital’s board of governors and Hillcrest Health Service System, the hospital’s parent corporation. Leading contractors and developers — Sanzari, Creamer and John C. Fowler — are on the building committee.<br /><br />Simunovich is the former chairman of the board of governors and current chairman of the board of trustees for the Hackensack University Medical Center Foundation, the hospital’s fund-raising arm.<br /><br />Governor Corzine did not reappoint Simunovich to the Turnpike Authority in 2007 after he was investigated by the State Ethics Commission; as chairman, he had voted on millions in public contracts that were awarded to Sanzari while he accepted free rides on the contractor’s private jet. Simunovich paid a $50,000 fine, which was not an admission of guilt.<br /><br />'Mr. Simunovich’s actions do not reflect the standards demanded by the governor for those who serve in his administration,' Corzine’s then-spokesman Anthony Coley said.<br /><br />Joseph Sanzari serves as first vice chairman, the No. 2 position on the hospital’s board of governors.<br /><br />Sanzari is part owner of both the Stony Hill Inn in Hackensack and the New Bridge Inn in New Milford, popular hangouts for Bergen County’s political elite. Sanzari, his companies and employees have contributed more than $100,000 to political campaigns and political action committees in the past three years, according to data the company provided to state elections regulators.<br /><br />Among his top employees is state Sen. Paul Sarlo, also the mayor of Wood-Ridge. Sarlo oversees billions in public spending as a lead member of the Senate Budget and Appropriations Committee. As chairman of the Senate Judiciary Committee, he also controls key appointments to state agencies that have awarded millions in contracts to Sanzari’s firms.<br /><br />Sarlo, chief operating officer for Sanzari’s construction company, testified at the trial that he was largely responsible for getting the $900,000 grant for the hospital’s cancer center. He said he also lobbied Codey for the $9 million cancer center grant and played a role in the $900,000 grant for stem cell research at the hospital. </blockquote><strong>Conclusions<br /></strong><br />Hospitals often have sterling reputations within their communities as selfless organizations devoted to improving the health of the people. As we have noted, hospitals and other health care organizations have come to be run more often by people with managerial background than those with health care experience. Not-for-profit hospitals have boards of trustees who are supposed to exercise stewardship, making sure the organization upholds its mission. But as we have noted before, e.g., <a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">here</a>, boards of health care and related organizations may put their own agendas ahead of the mission. Furthermore, boards of big hospitals and other health care organizations seem to be increasingly composed of the well-connected, often to the point that they can be regarded as members of the power elite, if not the superclass. There may be some short term benefits to having such people on the boards. In the long run, however, is it any surprise that their missions may give way to other interests?<br /><br />Hat tip to <a href="http://www.margaretsoltan.com/?p=12174">University Diaries</a>.<br /><br />ADDENDUM (4 May, 2009) - Hackensack University Medical Center's <a href="http://www.politickernj.com/wallye/29412/humc-bans-record">response</a> to the news story discussed above was apparently first to stop advertising in the offending newspaper, and ban its sales in the hospital. Another example, almost laughable, of a health care organization's leadership trying to shoot the messenger, and of how the anechoic effect may be generated. Hat tip to the <a href="http://blog.lib.umn.edu/schwitz/healthnews/178972.html">Schwitzer Health News Blog</a>.

Hospital Board Members with "the Juice" in New Jersey

We recently commented on the conviction of a state legislator charged with selling his influence to a powerful local medical center. NorthJ...

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Listening to Google Health users

At Google, we believe that consumers should have convenient and secure access to all their health data so that they can be better informed and be more involved in their care. Recently, a data-savvy patient known as e-Patient Dave <a title="blogged" href="http://patientdave.blogspot.com/2009/04/imagine-someone-had-been-managing-your.html" id="lc:c">blogged</a> about data that was imported into his Google Health Account from his hospital in Boston, <u><a id="o5rs" href="https://www.google.com/health/directory?url=www.patientsite.org" title="Beth Israel Deaconess Medical Center">Beth Israel Deaconess Medical Center</a></u>. Once he saw his data in Google Health, he saw diagnoses that were both alarming and wrong. Where did they come from?<br /><br />It turns out that they came from the billing codes and associated descriptions used by the hospital to bill the patient's insurance company. These descriptions, from the <a id="w_s." href="http://www.cdc.gov/nchs/icd9.htm" title="International Classification of Diseases (ICD9)">International Classification of Diseases (ICD-9)</a>, often do not accurately describe a patient because the right ICD-9 code may not exist. So the doctor or hospital administrator chooses something that is "close enough" for billing purposes. In other cases, the assigned code is precisely what the doctor is trying to rule out, and if the patient turns out not to have that often scary diagnosis, it is still associated with their record. Google Health faithfully displayed the data we received on Dave's behalf. We and Beth Israel knew that this type of administrative data has its limitations but felt that patients would find it a good starting point. Too often, this is wrong.<br /><br />At Google, we are constantly learning important lessons from our users. Two days after we learned about this issue, I met with Beth Israel <u><a id="fds_" href="http://geekdoctor.blogspot.com/" title="CIO John Halamka">CIO John Halamka</a></u>, the patient's physician <a href="http://services.bidmc.org/Find_a_doc/doc_detail.asp?sid=41414547464148">Dr. Danny Sands</a>, and e-Patient Dave himself. We agreed on a reasonable plan: Beth Israel will stop sending ICD-9 billing codes and will instead only send to Google Health the free text descriptions entered by doctors. Beth Israel is also working with the <a id="rg-q" href="http://www.nlm.nih.gov/" title="National Library of Medicine (NLM)">National Library of Medicine (NLM)</a> to associate those free text descriptions with a more clinically useful coding system called <a id="iwwf" href="http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html" title="SNOMED-CT">SNOMED-CT</a>, so that we can offer patients useful services like automatic drug interaction checking. The result will be more accurate and useful information in patients' Google Health profiles.<br /><br />This week, all four of us were also at a conference called <a title="Health 2.0" href="http://health2con.com/" id="vbuo">Health 2.0</a> in Boston. Dave's story, and the lessons we all learned, were the focus of much discussion. We are grateful to Dave for his openness and passion for making things right. We're also glad this happened because we and many others now better understand the limitations of certain types of health data and we are working with partners to improve the quality of the data before it gets to Google Health and our users. We look forward to sharing what we learn with the broader community. We also learned that the patient community is surprisingly interested in understanding these data issues. Dave and his doctor Danny Sands collaborated on an <a title="informative post" href="http://e-patients.net/archives/2009/04/part-of-it-is-encoding-information.html" id="jj7s">informative post</a> about different data vocabularies used in different aspects of healthcare. The patient-controlled "data liquidity" that Google Health supports is clearly an important part of the future of health care. We are more committed than ever to putting consumers in charge of their own health information.<br /><br /><span class="byline-author">Posted by Roni Zeiger, M.D., Product Manager, Google Health</span>

Listening to Google Health users

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Coming soon to YouTube: Besson's and Bertrand's environmental film project

Today we're pleased to share an exciting new project that taps into the power of YouTube and Google Maps to spread the word about the state of our planet. <a href="http://en.wikipedia.org/wiki/Luc_Besson">Luc Besson</a>'s and <a href="http://www.yannarthusbertrand.org/index_new.htm">Yann-Arthus Betrand</a>'s 90 minute full-length film "Home" will exclusively be available online on YouTube for English, French, Spanish and German–speaking countries beginning June 5 — just in time for the 37th <a href="http://www.unep.org/wed/2009/english/">World Environment Day</a>.<br /><br />Through stunning displays of aerial camerawork, the film will give people from all corners of the world a glimpse of our planet like never before and visually demonstrate the urgency for preservation efforts. In addition to its Internet premiere, "Home" will be shown in movie theaters and outdoors on big screens at key locations around the globe. It will also air on TV stations around the world. Using this unique distribution model, one with a massive online and offline effort, the film creators are able to reach the widest audience possible. So whether you'd prefer to head to the theaters, watch it under the stars, or just stay put on the couch — the way you view "Home" is up to you.<br /><br />And starting today, YouTube channels in English, French, Spanish and German will feature behind-the-scenes looks from the making of the film, as well as interviews, and extras. To add even more dimension, Google Maps is featuring specially created layers that shed more light on some of the material covered in the movie. You can also use Maps to find a theater location near you.<br /><br />To get a preview of what you can expect on June 5, check out some of the spectacular footage in the <a href="http://www.youtube.com/homeproject">Home YouTube channel</a>, like the video below of the Arctic world and its wild terrain that's essential to preserve. Or <a href="http://www.youtube.com/watch?v=0rET3CvmyD4&feature=channel">this one</a> of Los Angeles exclusively seen from the sky, giving us a new perspective of the cityscape at night. And please respond and react to the film via video responses, comments, and ratings and share links via email with your friends.<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/sLbHicGdXvw&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/sLbHicGdXvw&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object><br /><br /><span class="byline-author">Posted by Mats Carduner, Head of Google France and Southern Europe</span>

Coming soon to YouTube: Besson's and Bertrand's environmental film project

Today we're pleased to share an exciting new project that taps into the power of YouTube and Google Maps to spread the word about the st...

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BusinessWeek on Health IT: "The Dubious Promise of Digital Medicine"

While I would have used the title "The Dubious Promise of Digital Medicine When Led By Amateurs in the Health IT Industry", the following Business Week article is one of the better and more realistic appraisals of the current state of Health IT.<br /><br />Business Week, April 23, 2009<a href="http://www.businessweek.com/magazine/content/09_18/b4129030606214.htm?campaign_id=rss_daily"><br /><span style="font-weight: bold;">The Dubious Promise of Digital Medicine</span></a><span style="text-decoration: underline;"><br /></span>Chad Terhune, Keith Epstein and Catherine Arnst<br /><br />Recommended reading for anyone interested in improving healthcare via information technology. (Full disclosure: MedInformaticsMD was a contributor to the article.)<br /><br />I will be commenting in upcoming posts on the article's points and HIT industry's customary, self serving and unscientific counterpoints. The article's thrust is that a HIT remains an experimental technology with a mixed history, which like any societal-level experiment (HIT representing a form of social engineering) carries individual and public risk. The risk is that when misled, any social experiment can and will lead to serious unintended consequences, which in this case ultimately means patient harm.<br /><br />The first counterpoint that struck me in the article was this one:<br /><br /><blockquote>Allscripts CEO Glen Tullman [a non-clinician businessman and an advisor to the Obama campaign on HIT] ... compares the <span style="font-weight: bold;">skeptics of health info tech </span>to doctors who questioned the introduction of the stethoscope in the 19th century: "There have been <span style="font-weight: bold;">Luddites in every industry</span>." </blockquote><br />This profoundly unscientific, ad hominem dismissal represents the poster example of what I call a <span style="font-weight: bold;">cross-occupational invasion of medicine by the IT industry</span>. The attitude represents the antithesis of medical and scientific culture.<br /><br />It simpy dismisses with a wave of the hand a growing body of authoritative literature going back decades. A small sample of that literature can be <a href="http://hcrenewal.blogspot.com/2009/04/health-it-vendor-blames-hit-problems-on.html">seen here</a>, and anyone in HIT is grossly negligent to dismiss, or worse, not to be aware of such findings. There's really not much more to say on this issue.<br /><br />This is an example of the attitudes of HIT industry leaders who believe they will "revolutionize" medicine via IT. Health IT with appropriate leadership can do quite well for healthcare. In the wrong hands, I'm sorry to say, the opposite is true.<br /><br />It is, in fact, Mr. Tullman and like minded others in the IT industry, who make similar statements about those with the ultimate responsibility and liability for patient care, physicians (as Koppel and Kreda point out, the vendors have none), who are the Luddites. They are Luddites through their dismissal of the best thinking in modern IT and in biomedical information science.<br /><br />On second thought, it might be more accurate to say they leverage their Luddism and willful ignorance in an opportunistic manner. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">Caveat emptor</a>.<br /><br />-- SS

BusinessWeek on Health IT: "The Dubious Promise of Digital Medicine"

While I would have used the title "The Dubious Promise of Digital Medicine When Led By Amateurs in the Health IT Industry", the fo...

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Engineering a healthier diet

Back in 2007, the cafes at our Mountain View campus started color-coding menu items according to healthfulness. The healthiest items are colored green ("go ahead, pile it on!"), foods you should portion-control are yellow, and foods you should eat sparingly -- in the words of my favorite <a href="http://en.wikipedia.org/wiki/Cookie_Monster#Evolution">recently reformed</a> <a href="http://www.google.com/search?q=cookie+monster">blue monster</a>, "sometimes foods" -- are red.<br /><br />While the whole point of the color-coding was to encourage healthy eating, and Google certainly makes it very easy for one to do that, I quickly realized that all of my favorite food items were colored red on the menus. Since all of the cafe menus are posted to separate pages of our intranet, it took too long to look through them to find the one or two items that would hook me into eating at a particular cafe for the day. So I decided to write a script that scans all the pages and creates a single unified menu of just the "heart-stoppingly good" food in all of the Mountain View cafes. (The nutritionist at Google at the time called them "least healthy" rather than "heart-stoppingly good.")<br /><br />It took only a few minutes to write the script for the menus as they existed on the first day I ran it, but there were complications as each following day's menus started rolling in. Not all the chefs were using the same programs to create HTML menus, so the colors were all marked up differently in each. Every morning, I found I needed to add special cases to handle the various HTML variations to the original <a href="http://en.wikipedia.org/wiki/AWK">awk</a> script that I'd started with. Every chef had a different idea of which color should be used for red items, green items and yellow items (the favored color for "yellow" text on white background is actually orange), so I ended up having to write a formula to perceptually classify the colors (by hue angle). Plus, I started to learn how hard things must be for someone who is blind or colorblind when reading web pages. To solve that problem, I had the program generate well-structured HTML with CSS classes applied to each menu item to handle things in a consistent way that was easy to filter by <a href="http://en.wikipedia.org/wiki/XPath">XPath</a>.<br /><br />After I finished the script, I sent a link to the new web page to an internal food discussion mailing list, and soon enough I was receiving fan mail. What I'd intended to be a tool for my own personal use proved so popular that, early this year, the chefs at Google asked if I could expand the tool to include support for historical statistics. They wanted to keep track of which cafes had the greenest menus over time. The result is a tool that tracks the healthiness of all menu items at Google cafes around the world. You can see every color menu item in a single menu and toggle colors on and off as desired, depending on how you want to browse the menus. So I can look only at red items if I'm in the mood for pepperoni pizza or roasted garlic mashed potatoes. And if I want leafy greens, I can limit the menu to show only the healthiest dishes. It has other uses, too: a cafe in Switzerland, for example, could use the stats page (filled with graphs generated using the <a href="http://code.google.com/apis/chart/">Google Chart API</a>) to compete with a cafe in Mountain View for the title of "healthiest cafe." In fact, all the Google cafes worldwide are now in a heated competition now for this very title.<br /><br />If you suspect I've gone "green," and if my mom is reading this: I have. I'm eating healthier, I've had my cholesterol checked, and I walk at least three miles every day. For everyone else, don't worry -- after I produced the healthiest cafe statistics page, I also made another set of graphs that ranks by red items. If you see me eating red items at Google, please don't tell my mom.<br /><br /><span class="byline-author">Posted by Nathan Laredo, Software Engineer</span>

Engineering a healthier diet

Back in 2007, the cafes at our Mountain View campus started color-coding menu items according to healthfulness. The healthiest items are col...

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Project Spectrum: recognizing the talents of children with autism

A couple of years ago, the <a href="http://sketchup.google.com/">Google SketchUp</a> team began hearing from a new group of users -- people on the autism spectrum. After consulting with some experts, we learned the connection between autism and SketchUp isn't particularly surprising. Many people on the autism spectrum have visual and spatial strengths, and 3D design software plays to them. With this in mind, we started a program called <a href="http://sketchup.google.com/spectrum.html">Project Spectrum</a>.<br /><br />As part of <a href="http://www.autism-society.org/site/PageServer?pagename=research_awareness">Autism Awareness Month</a> in April, we've launched a new <a href="http://sketchup.google.com/spectrum.html">webpage</a> showcasing some great SketchUp artists (Rachel, Jeremy, JP and others). We've also created a <a href="http://www.youtube.com/watch?v=gsfH_cyXa1o">Getting Started with Google SketchUp video</a> for anyone who wants to learn the basic tools to start modeling. More of the Project Spectrum models can be seen in the Google 3D Warehouse <a href="http://sketchup.google.com/3dwarehouse/cldetails?mid=be3de3be31be4d088aee1e8fa383e7d3&prevstart=0">collection</a>. Watch the video below to hear the story behind Project Spectrum and meet some of the kids involved:<br /><br /><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/Jw_ZW1NCQgY&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/Jw_ZW1NCQgY&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><br /><br />Googlers around the world are working with the autism community to introduce kids, teachers, parents and adults to SketchUp, and we've been inspired by the results. We hope you take the time to look at Project Spectrum and share it with others in your community. For more detail, check out the <a href="http://sketchupdate.blogspot.com/2009/04/strengths-of-autism-continue-to-shine.html">Google SketchUp blog</a>. <br /><br /><span class="byline-author">Posted by Tom Wyman and Chris Cronin, Project Spectrum Team</span>

Project Spectrum: recognizing the talents of children with autism

A couple of years ago, the Google SketchUp team began hearing from a new group of users -- people on the autism spectrum. After consulting ...

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Pension Fund Scandals, Payment Agents, "Chooch" and the Anechoic Effect

As we get closer to graduation season for most institutions of higher education, another story about the leadership and governance of higher education, involving an institution housing a prominent medical school, has come into view, albeit indirectly. Let me try to explain this complex story, which on its surface has something to do with the ongoing financial crisis, but nothing to to with academia, by quoting, as usual, from media coverage.<br /><br />We start with <a href="http://www.nytimes.com/2009/04/17/nyregion/17pension.html">an article </a>from the New York Times last week:<br /><br /><blockquote><br />The man leading the Obama administration’s efforts to restructure the auto industry has been described in Securities and Exchange Commission documents as having <em>arranged for his investment firm to pay more than $1 million to obtain New York State pension business</em>.<br /><br />Although he is not named in the documents, a person with knowledge of the inquiry said <em>the investment executive is Steven Rattner, co-founder of the Quadrangle Group</em>, the prominent private equity firm.<br /><br />The S.E.C. complaint, filed as part of an expansive state and federal investigation into corruption at the state pension fund, details the efforts of Quadrangle to gain business from the pension fund beginning in 2004.<br /><br /><em>The person who received most of the $1 million-plus payment has been indicted, accused of selling access to the fund</em>.<br /></blockquote><br /><br />Here are the details of allegations of how Mr Rattner interacted with intermediaries to get NY state pension fund investments into his company.<br /><br /><blockquote><br />Investigators are scrutinizing the fees paid by investment firms to intermediaries who arranged deals with the $122 billion pension fund. While such payments are legal, <em>they often raise questions about conflicts of interest and would be illegal if used to bribe public officials</em>.<br /><br />In a 123-count indictment issued last month, two aides to Mr. Hevesi were accused of selling access to the fund. The aides, Hank Morris, who was Mr. Hevesi’s top political consultant, and David Loglisci, the fund’s chief investment officer, have denied any wrongdoing.<br /><br />The S.E.C. complaint, which was released Wednesday, <em>describes steps undertaken by the Quadrangle executive to win $100 million worth of business from the pension fund in 2005</em>. That amount accounted for nearly 5 percent of a Quadrangle private equity fund and helped the company raise money from other investment funds.<br /><br />In October 2004, the executive met with Mr. Loglisci to seek the pension fund investment and Mr. Loglisci 'reacted favorably' and 'began taking the necessary steps to secure approval' for the investment, the complaint said.<br /><br /><em>Two months later, in December, the same executive met with Mr. Morris, who, according to prosecutors, was working in tandem with Mr. Loglisci to generate millions of dollars in fees from the investment firms, and within weeks had agreed to a deal to pay an obscure securities firm that employed Mr. Morris 1.1 percent of any money that the retirement fund invested with Quadrangle, as a placement agent fee. That worked out to $1.1 million, of which Mr. Morris received 95 percent</em>.<br /><br />The timing of the meeting with Mr. Morris was significant, the complaint indicated, because <em>the Quadrangle executive had already met with Mr. Loglisci and would presumably not need a placement agent</em>. In addition, <em>Quadrangle had previously retained a separate placement agent.<br /></em><br />The executive also <em>met with Mr. Loglisci about a low-budget movie Mr. Loglisci was producing, 'Chooch.' Soon afterward, GT Brands Holdings, a company owned by one of Quadrangle’s private equity funds, made a deal to acquire the DVD distribution rights to 'Chooch,'</em> an agreement that <em>made the film’s producers nearly $90,000.<br /></em><br />The Quadrangle executive called Mr. Morris after the distribution deal was closed, and told him of the <em>deal’s 'connection to Loglisci</em>.' Three weeks later, Mr. Loglisci 'personally informed the Quadrangle executive that the <em>retirement fund would be making a $100 million investment' in Quadrangle</em>, the complaint said.<br /></blockquote><br /><br />Later, the Washington Post published <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/04/17/AR2009041701908.html">an article </a>which alleges possible conflicts of interest affecting Mr Rattner in his current position as "automobile czar,"<br /><br /><blockquote><br />The questions around Quadrangle and Rattner follow others that came to light soon after he emerged as a candidate to lead the Obama administration's efforts to prop up Chrysler and General Motors.<br /><br /><em>Quadrangle was, at least indirectly, previously involved in a deal involving Chrysler's majority owner, Cerberus Capital Management</em>, a private equity firm.<br /><br />That connection has led some Chrysler investors to <em>doubt whether Rattner can decide without bias how the government should aid Chrysler</em>.<br /><br />In the summer of 2007, Quadrangle purchased Dennis Publishing, the owner of magazines including Maxim and Blender. The estimated price was $250 million.<br /><br />Quadrangle's new magazine company was renamed Alpha Media and it took a loan of $125 million, much of it coming from Cerberus.<br /><br />A year after Quadrangle's purchase, the publishing company's profits began to plummet.<br /><br />The company announced last month that it would cease publication of its Blender magazine. Quadrangle has written the Alpha Media investment down to zero on its books, and Cerberus, the company's major creditor, is now effectively in control of Alpha, a person familiar with the matter said.<br /></blockquote><br /><br />This week, a NY Times <a href="http://www.nytimes.com/2009/04/22/business/22quadrangle.html">article</a> revealed that Mr Rattner and Quadrangle are facing a wider investigation, and may be a target of investor lawsuits:<br /><br /><blockquote><br />Two months after Steven Rattner left Wall Street for Washington, his private investment company is facing a widening investigation into corruption in public pension funds — and fighting for its future.<br /><br />As state and federal authorities examine Mr. Rattner’s dealings with the New York State retirement fund, questions are emerging about his efforts to gain business from several other public funds, including ones in New Mexico and New York City. His private investment firm, the Quadrangle Group, is moving to calm anxious pension managers, who have entrusted the firm with hundreds of millions of dollars.<br /><br />Mr. Rattner, who is leading the Obama administration’s efforts to revamp the auto industry, has left his small but prominent firm in a bind. Because he was integral to Quadrangle, investors can try to withhold additional money that they have pledged to the firm now that he has left.<br /><br />No charges have been filed against Mr. Rattner, who did not respond to e-mail messages on Tuesday, or against Quadrangle, whose executives declined to comment.<br /><br />While Quadrangle’s funds have not suffered as much as some other private equity funds, its investors have suffered losses in other parts of their portfolios. Some of them might try to capitalize on the inquiry to avoid making good on their pledges.<br /><br />Another crucial question, however, is whether money from one Quadrangle fund was used to lure investors to a second fund. <em>That possibility that might expose Quadrangle to investor lawsuits.<br /></em></blockquote><br /><br />Furthermore, a Washington Post <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/04/22/AR2009042203942.html">article</a> raised the question of a failure of honest disclosure:<br /><br /><blockquote><br />Government officials are expanding their investigation of Quadrangle, the private-equity firm founded by the Obama administration's lead auto negotiator, as new details emerge about an alleged kickback scheme involving the New York state pension fund.<br /><br />On Wednesday, the New York City Comptroller William C. Thompson Jr. said he is working with the state's attorney general, Andrew M. Cuomo, to <em>determine whether the city's pension funds were 'intentionally misled or deceived' by Quadrangle's failure to disclose the use of a middleman who has since been indicted, Hank Morris</em>.<br /><br />New York City's comptroller on Wednesday said <em>Quadrangle never disclosed that it had paid Morris fees in connection with the city pension funds' investment in Quadrangle.</em> The city invested $85 million in 2005 and $40 million in 2006.<br /><br />The city has a rule that use of placement agents must be disclosed, but that rule was implemented in 2008 and does not apply to the Quadrangle investments.<br /><br />But <em>as part of the due diligence for receiving the investment, Quadrangle said in writing at the time that it used only two placement agents, Monument Group and London-based Helix Associates,</em> the comptroller's office said.<br /><br />'We take any ethical lapses by our managers seriously and will consider any remedies available to investors,' Thompson, the city's comptroller, said in a statement. </blockquote><br />In response to all this, New York state government officials decided to ban middle-men from influence over pension fund investment decisions, <a href="http://online.wsj.com/article/SB124040821903043595.html">according to the Wall Street Journal</a>:<br /><br /><blockquote><br />New York state said its public pension fund, one of the nation's largest, would <em>ban the use of middlemen to help private-equity funds and other investors secure its business.<br /></em><br />The move marked a pivotal development in a burgeoning controversy that has grown from a local corruption probe to a broader examination of the tactics that investment firms used to win lucrative business from vast public pension pools.<br /><br />In most states, charging placement fees is legal if they are disclosed as required. But <em>potential conflicts of interest are rife</em>, especially for officials with a legal obligation to make informed, well-intended decisions about how pension-fund money is spent. Lawyers say <em>a gray area emerges when finder's fees are paid to individuals or firms that do little more than trade on their access to public-pension-fund executives</em>.<br /><br /><em>Such alleged behavior is at the heart of the scandal unfolding in New York</em>. The state attorney general and the SEC have accused a former top fund official and a political adviser of giving investment funds access to billions of dollars of state pension money, in exchange for kickbacks and other payments for personal and political gain. One such middleman already has pleaded guilty to securities-fraud charges.<br /><br />Some officials across the country have expressed concern about so-called pay-to-play practices -- that is, paying to influence people who direct the investments of public-employee retirement funds. Pay-to-play can range from illegal kickbacks, which in some instances have led to jail time, to legal activities such as campaign contributions to elected officials on the boards of pension funds. Pension funds are especially vulnerable to such accusations because their boards are often populated by elected officials or people with limited financial experience who need to rely heavily on outside advisers.<br /><br />New York state's comptroller, Thomas DiNapoli, said that in light of the allegations contained in the case brought by the state's attorney general and the SEC, <em>'the best way to restore the pension fund's reputation is to say we won't be involved with any transactions that involved placement agents</em>.' </blockquote><br /><br />Meanwhile, several commentators raised questions about Mr Rattner's suitability to be "automobile czar."<br /><br />David Rothkopf, the author of Superclass, <a href="http://rothkopf.foreignpolicy.com/posts/2009/04/17/and_now_introducing_the_kickback_czar">dubbed Mr Rattner </a>the "kickback czar" on the Foreign Policy blog,<br /><br /><blockquote><br />Are you joking? The Obama Administration somehow thought that it was okay to give a pass to Steve Rattner? <em>They thought it was okay to appoint a guy to a key job after he apparently acknowledged to them that he was under investigation for providing a million dollar payment to pension consultant in exchange for receiving an assignment to manage a big chunk of pension fund money for New York State?<br /><br />They thought it was okay in the middle of a justified surge of global disgust with Wall Street to embrace a big time Wall Street player who is smart enough to be arguing the legal technicalities of the transaction but not smart enough to recognize that it might just seem to be sleazy, dubious and a gross disservice to the people who were depending on the State to use appropriate methods and metrics to find stewards for their retirement money?<br /></em><br />They even thought it was okay when part of the deal involved payments to support a movie called 'Chooch.' (What’s worse than bad ethics and bad taste all wrapped up into one sordid exchange? The New York Post called 'Chooch' which scored an amazing 00 rating from Rotten Tomatoes “the kind of vanity project that gives amateurs a bad name.”) What's more they did all this while giving Rattner the job of auto czar for which he had no material auto industry experience? I thought the way high ethical standards worked was that <em>you didn't just bar people convicted of crimes, you tried to weed out people who had done things that were wrong or contrary to the public interest. </em></blockquote><br />On BlackStarNews, Edward Manfredonia <a href="http://blackstarnews.com/?c=121&a=5582">wrote</a>:<br /><br /><blockquote>I believed Rattner’s efforts to take the Times private should have disqualified him from an appointment with the Obama Administration; especially the key post of trying to stabilize the collapsing auto industry.<br /><br />The White House still insists that the Administration fully supports Rattner; that reminds me of Bush proclaiming backing for Don Rumsfeld when it was clear he should have been shown the door as defense secretary.<br /><br />Here's why Rattner deserves the boot.<br /><br />An even more egregious form of activity that what I previously covered has become public. Rattner, who has extensive ties to Bill and Hillary Clinton, has been identified in several published news reports as the Quadrangle Fund executive who paid $1.1 million to receive more than $100 million from New York State’s multi-billion dollar pension fund to manage. <em>The manner in which the payments were made leaves no doubt that they were meant for 'pay to play', which is illegal in my opinion. </em></blockquote><br />Not surprisingly, a NY Times <a href="http://www.nytimes.com/2009/04/22/opinion/22wed1.html">editorial</a> was milder, but did allow,<br /><br /><blockquote><em>Mr. Rattner showed some bad judgment</em> in the 'Chooch' deal, and the public has a right to expect more of him in his new, highly sensitive position. </blockquote><br />It's an interesting story, with implications in many areas, and it has hardly played out. Anyone reading this far is probably wondering, however, what this has to do with leadership, governance, and ethics in health care. None of the articles quoted above mentioned anything related to health care, or academics for that matter.<br /><br />Here is where I pull the rabbit out of the hat.<br /><br />Steven Rattner, in fact, has an important leadership position relevant to academics, and to academic health care. He is a <a href="http://www.brown.edu/Administration/News_Bureau/Info/Corporation.html">member of Brown University's Board of Fellows</a>, the "upper house" in the university's bicameral board of trustees, called the Brown Corporation. Brown University includes the <a href="http://med.brown.edu/">Alpert Medical School</a>, and the Division of Biology and Medicine. (Full disclosure: I am an alumnus of the College at Brown, and of the Medical School. I am a former full-time Brown faculty member, and currently a voluntary Clinical Associate Professor.)<br /><br />And thus the issue here is really about the <a href="http://hcrenewal.blogspot.com/2007/08/bling-bling-poltical-correctness-and.html">anechoic effect</a>. Even though this convoluted case raises issues about Mr Rattner's role at Brown analogous to the issues it raises about his role as "automobile czar," there has been to date not even any media mention of his role at Brown, much less discussion of its implications for the university, academic leadership and governance, etc.<br /><br />To survey the local coverage, the Providence Journal has not published any relevant news stories so far. It did print an <a href="http://www.projo.com/opinion/contributors/content/CT_rick15_04-15-09_DJDVGHK_v17.3e650b1.html">op-ed </a>questioning Mr Rattner's suitability for the "automobile czar" position, which had to do with the lack of sympathy an "investment banker" might have for the United Auto Workers. The Boston Globe ran <a href="http://www.boston.com/news/nation/washington/articles/2009/04/18/auto_task_force_chair_tied_to_investment_investigation/">a story </a>from the Washington Post about the case, but one that had nothing on the local, or the academic angle. The Brown Daily Herald published a two news stories (<a href="http://www.browndailyherald.com/2.12235/alum-may-become-obama-s-car-czar-1.1668270">here</a> and <a href="http://www.browndailyherald.com/2.12235/alum-to-advise-treasury-on-bailout-of-u-s-automakers-1.1667893">here</a>) about Mr Rattner's appointment as "automobile czar," which did note he is a "corporation member," but has not covered the current controversy. I am aware of no recent open discussion, or any discussion at all of Mr Rattner as a member of the Board of Fellows, in light of the recent unpleasantness.<br /><br />Thus, our local angle on the New York pension/ placement agents/ Quadrangle/ "Chooch" affair mainly demonstrates how at many academic institutions, it is simply not done to bring up issues that question leadership and governance, especially at the highest levels. <br /><br />Parenthetically, we have posted many times, most recently <a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">here</a>, about the leadership and governance of Dartmouth College. Some might have interpreted these posts as hostile to that institution. They were anything but. In fact, it has only been possible to discuss leadership and governance at Dartmouth so thoroughly because that institution is much more open about its leadership and governance than is the typical US academic institution. Half of the he Dartmouth Board of Trustees, as we noted, used to be elected by vote of the alumni. The alumni could nominate their own candidates for the Board, through a petition process. The successful attempt to decrease the overall proportion of elected Trustees sparked a tremendous amount of open discussion and debate. Issues of leadership and governance at Dartmouth seem to be frequently discussed in local publications, on blogs, and sometimes even in the national media. I suspect that a governance system at Dartmouth marked by more than average representativeness and accountability has lead to much more vigorous debate and discussion of academic governance and leadership than occurs at more typical universities. (Note that even after the "board packing," Dartmouth still has a larger proportion of alumni-elected trustees than does the typical university, and it is still possible for alumni to put people on the ballot via petition.)<br /><br />Brown University, on the other hand, is lead by a Corporation most of whose members are appointed by the Corporation itself. While a minority (14 of 42) of the Board of Trustees (the lower house) of the Corporation are <a href="http://alumni.brown.edu/about/elections/trustee_bg.html">elected by alumni</a>, to my knowledge, all the election candidates are hand-picked by the Brown Alumni Association, and there is no provision for petition candidates. Although a few fiesty students occasionally call for more light to shine on the Brown Corporation, (e.g., see <a href="http://www.browndailyherald.com/2.12227/ben-bernstein-09-why-the-corporation-matters-and-how-they-get-paid-1.1667634">here</a>), for the most part, questioning the leadership and governance of the university is simply not done. Thus, Brown seems to be typical of most major US academic organizations. <br /><br />However, more transparent, accountable, governance, clearly guided by ethical principles and the organization's mission might allow US academia, and academic medicine to address some of the problems that we too often have opportunities to discuss on Health Care Renewal.

Pension Fund Scandals, Payment Agents, "Chooch" and the Anechoic Effect

As we get closer to graduation season for most institutions of higher education, another story about the leadership and governance of higher...

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