Is this Any Way to Discuss Health Care Policy? - Television Advertising about US Health Care Reform Cost $445 Million from 2010 -2014

Every now and then, we get an anonymous comment criticizing our "lack of balance" or words to that effect, maybe because we criticized some action by a big, often but not always for-profit, health care organization.  We usually respond that we have no obligation to be balanced, since<br />- We publish opinion, not hard news<br />-  It is questionable that even hard news reporters must report all opinions on an issue, if some of those opinions are demonstrably less credible<br />-  There are far more voices extolling the wonderful "innovations" provided by our current "best health care system in the world," than providing our sorts of criticism.<br /><br />To expand on that last point - a recent news item suggests how much of the health care policy debate is paid marketing and public relations, rather than individual voices of citizens, health care professionals, or even health care policy experts.<br /><br />From the AP, <a href="http://www.seattlepi.com/news/article/Study-Political-TV-ads-on-health-law-total-445M-5483653.php">via the Seattle Post -Intelligencer</a>,<br /><br /><blockquote class="tr_bq">A new analysis finds the nation's health care overhaul deserves a place in advertising history as the focus of extraordinarily high spending on negative political TV ads that have gone largely unanswered by the law's supporters.<br /><br />The report, released Friday by nonpartisan analysts Kantar Media CMAG<a href="http://www.seattlepi.com/?controllerName=search&action=search&channel=news%2Fpolitics&search=1&inlineLink=1&query=%22Kantar+Media+CMAG%22"></a>, estimates <i><b>$445 million</b> was spent on political TV ads mentioning the law since the enactment of the Affordable Care Act in 2010</i>. Spending on negative ads outpaced positive ones by more than 15 to 1.</blockquote><br />In particular,<br /><br /><blockquote class="tr_bq">In the 2014 congressional races, 85 percent of the anti-Obama ads were also anti-'Obamacare' ads, the analysis found. In some competitive races, 100 percent of the pro-Republican TV ads aimed at Democrats contained anti-health law messages.<br /><br />Over the four years,<i> an estimated $418 million was spent on 880,000 negative TV spots focusing on the law, compared to $27 million on 58,000 positive spots</i>, according to the analysis. Nearly all of the spending was on local TV stations, in races ranging from state offices such as treasurer and governor to Congress and the presidential election.</blockquote><br />That is just amazing. <br /><br />My concern is not so much that much of this advertising is against "Obamacare."  We have not often written about the Affordable Care Act (ACA), aka "Obamacare," and what we wrote at best was mild praise.  As I <a href="http://hcrenewal.blogspot.com/2010/03/health-care-reform-bill-and-health-care.html">posted</a> back in 2009, very little of the law had anything to do with the issues we discuss on Health Care Renewal.  In my humble opinion, since the law went into effect, it has increased access to health insurance, especially for certain groups of people that commercial health care insurers previously spurned, e.g., older people and people with pre-existing diseases.  It also contained provisions that might increase disclosure of conflicts of interest, and foster comparative effectiveness research.  On the other hand, the law has done nothing to reduce <a href="http://hcrenewal.blogspot.com/search/label/concentration%20of%20power">concentration of power</a> in health care.  It has done nothing to make health care leaders more <a href="http://hcrenewal.blogspot.com/search/label/accountability">accountable</a>, especially for their organization's unethical or even <a href="http://hcrenewal.blogspot.com/search/label/crime">criminal</a> behavior, decrease their ability to <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">line their pockets</a> regardless of such behavior, and thus reduce their <a href="http://hcrenewal.blogspot.com/search/label/impunity">impunity.</a>  It will not obviously decrease <a href="http://hcrenewal.blogspot.com/search/label/conflicts%20of%20interest">conflicts of interest </a>affecting those who make decisions about patient care or health policy, lock the <a href="http://hcrenewal.blogspot.com/search/label/revolving%20doors">revolving door</a> between government and the health care industry, end <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">manipulation of clinical research</a> to serve vested interests, or <a href="http://hcrenewal.blogspot.com/search/label/suppression%20of%20medical%20research">suppression of research</a> whose results offend such interests, etc, etc.  So there is plenty to discuss about health care reform and related matters of health care policy.<br /><br />Yet a major venue of US public discussion about health care policy, at least having to do with health care reform legislation, appears to be 15 -60 second paid television advertisements.  Often who pays for these ads are obscure, as certainly are the identities of the advertising or public relations firms that actually craft them.  Certainly, the ads do not explain who might profit were what they urge be implemented. The ads may appeal to emotion, or engage in logical fallacies.  And they appear in millions of peoples homes day in and day out.<br /><br />Such advertising, added to all the other billions of dollars worth of <a href="http://hcrenewal.blogspot.com/search/label/marketing">marketing</a> and <a href="http://hcrenewal.blogspot.com/search/label/public%20relations">public relations</a> that swirl around health care, make any sort of intelligent discussion very difficult.  The advertising frenzy renders the voices of individual citizens, health care professionals, and even health policy experts  whispers in comparison.<br /><br />While there are ostensible free speech advocates who defend these advertisements, and maybe who promote the free speech rights of corporations as the same as those of human citizens (without, of course, many of the responsibilities of citizens), none of these vocal self-proclaimed civil libertarians seem to be doing anything to defend the audibility of the voices of individuals in the health care policy debate.<br /><br />So we will continue to do what we can to bring some healthy skepticism about loud proclamations in health care made by people who stand to gain financially from their effects.  But is it any wonder that our voices create <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">so few echoes</a>? <br /><br />

Is this Any Way to Discuss Health Care Policy? - Television Advertising about US Health Care Reform Cost $445 Million from 2010 -2014

Every now and then, we get an anonymous comment criticizing our "lack of balance" or words to that effect, maybe because we critic...

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What Sorts of People are "Most Influential in Healthcare?"

Modern Healthcare just put out their list of the <a href="http://www.modernhealthcare.com/article/20130824/INFO/130829987/100-most-influential-people-in-healthcare-2013-text-list">"100 Most Influential People in Healthcare"</a> for 2013.  A look at what sorts of people are on this list says a lot about who runs US health care, and raises questions about who should.<br /><br /><b>Some Health Care Professionals, Lots of Hired Managers</b><br /><br />I did some quick descriptive categorizations. (Counts were double checked but I am not guaranteeing accuracy.  Categorizations were sometimes difficult for highly diversified organizations.)<br /><br />First, less than one third of list members are physicians (31% by my count).  I did not see any other health professionals on it (although I confess I did not look up the biographies of all 100).<br /><br />Of these physicians, most are now functioning as hired managers, usually at the CEO level, of big health organizations.  I found only a few who could be characterized as somewhat academic: Dr Atul Gawande, professor at Harvard Medical School, Dr Eric Topol, chief academic officer at Scripps Health, Dr Harvey Fineberg, President, Institute of Medicine, Dr Brent James, chief quality officer and executive director, Institute for Health Care Delivery Research, Intermountain Healthcare,  and probably Dr Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine.  <br /><br />My counts of hired managers on the list included<br /><br />CEOs of For-Profit Health Insurers - 5%<br /><br />CEO of For-Profit Hospital Systems - 8%<br /><br />CEOs of Non-Profit Hospital Systems - 21%<br /><br />CEOs of Other For-Profit Care Delivery Corporations - 7%<br /><br />CEOs of Drug/ Device/ Medical Supply Corporations - 2%<br /><br />CEOs of Health Care Information Technology Corporations - 1%<br /><br />CEOs of Non-Profit Trade Associations - 14%<br /><br />CEOs and other Leaders of Professional or Medical Association - 5%<br /><br />CEOs of Health Care Charities - 4%<br /><br />CEOs of Other Non-Profit Organizations - 15%<br /><br />Elected Government Leaders - 6%<br /><br />Leaders of Government Agencies, Departments - 10%<br /><br />Union Leaders - 2%<br /><br /><b>People Whose Organizations Have Issues</b><br /><br />The list included quite a few people who lead organizations which have had issues of the sort we discuss on Health Care Renewal.  For example, the list included the following among its top 10 most influential, in order of listed influence -<br /><br />4.  Stephen Hemsley, CEO of <a href="http://hcrenewal.blogspot.com/search/label/UnitedHealth">UnitedHealth Group</a> - We have discussed concerns about his executive compensation and how it does not fit his organization's stated mission, or his organization's long list of ethical misadventures (most recently summarized <a href="http://hcrenewal.blogspot.com/2013/05/unitedhealth-ceo-continues-to-prosper_3.html">here</a>) <br /><br />6. Mark Bertolini, CEO, Aetna - We most recently discussed how Aetna's leaders' pontifications on health policy seem mainly based on self-interest (<a href="http://hcrenewal.blogspot.com/2012/07/fool-us-once-shame-on-you-fool-us-twice.html">here</a>)  We also <a href="http://hcrenewal.blogspot.com/search/label/Aetna">discussed</a> various other management, ethical and legal issues. <br /><br />7.  Richard Bracken, CEO, HCA - A long time ago, HCA was one of the first big health care corporations to have to make a billion dollar plus settlement for fraud, among other issues (look <a href="http://hcrenewal.blogspot.com/2010/05/how-did-ceo-who-presided-over-company.html">here</a>).  The company has had legal, ethical, and management issues <a href="http://hcrenewal.blogspot.com/search/label/HCA">since</a>. <br /><br />8.  Joseph Swedish, CEO, WellPoint - He is new as CEO, but under previous leadership, the company amassed a record of misadventures while making its leadership very rich (summarized <a href="http://hcrenewal.blogspot.com/2013/04/wellpoints-former-manager-queen-got-206.html">here</a>, and look <a href="http://hcrenewal.blogspot.com/search/label/WellPoint">here</a> for details.) <br /><br />The list also included many other people whose organizations have been frequent fliers on Health Care Renewal.  For example, the CEOs of <a href="http://hcrenewal.blogspot.com/search/label/EPIC">Epic Systems</a> (ranked 13),  <a href="http://hcrenewal.blogspot.com/search/label/Tenet">Tenet Healthcare</a> (18), <a href="http://hcrenewal.blogspot.com/search/label/CIGNA">Cigna</a> (20), <a href="http://hcrenewal.blogspot.com/search/label/McKesson">McKesson Corp</a> (24), <a href="http://hcrenewal.blogspot.com/search/label/Sutter%20Health">Sutter Health</a> (42), <a href="http://hcrenewal.blogspot.com/search/label/Johnson%20and%20Johnson">Johnson & Johnson</a> (46), <a href="http://hcrenewal.blogspot.com/search/label/PhRMA">Pharmaceutical Research and Manufacturers of America (PhRMA)</a> (48), <a href="http://hcrenewal.blogspot.com/search/label/HealthSouth">HealthSouth</a> (59),  <a href="http://hcrenewal.blogspot.com/search/label/UPMC">UPMC</a> (69), and  <a href="http://hcrenewal.blogspot.com/search/label/Steward%20Health%20Care">Steward Health Care System</a> (86).<br /><br />There are many other people on the list who lead organizations that have gotten unfavorable notice on this blog, and a few whose own extreme <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">executive compensation</a> garnered comment.  As my science professors used to say, I leave their identification as an exercise for those interested.<br /><br /><b>Who Is Not on the List</b><br /><br />It is interesting who is not on the list.  There are no physicians in private practice.   I would argue there are no physicians who are "pure" academics at the moment.  There are no other health care research, health policy research, or public health academics.<br /><br />I saw only one person on the list (Senator Charles Grassley - R, Iowa) who has been identified with the sorts of real health care reforms we discuss here.  (Senator Grassely has investigated many instances of alleged conflicts of interest and fraud, and sponsored the Sunshine Bill to disclose better physicians' conflicts of interest.)  I do not see anyone else who in my humble opinion is identified as a dissident within the current environment. <br /><br />Many of the media accounts we have noted include people identified as experts who decried such issues as excessive <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">executive compensation</a>, <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">mission-hostile management</a>, <a href="http://hcrenewal.blogspot.com/search/label/conflicts%20of%20interest">conflicts of interest</a>, ethical issues leading to <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">legal settlements</a>, or <a href="http://hcrenewal.blogspot.com/search/label/crime">crime</a> and <a href="http://hcrenewal.blogspot.com/search/label/health%20care%20corruption">corruption</a> in health care.  None of them save Senator Grassley  are on this list.  <br /><br /><b>Summary</b><br /><br />The Modern Healthcare list of 100 most influential people in health care demonstrates the enormous influence of hired managers in modern health care.  The vast majority of list members were hired managers.  While the list did include some physicians, most of them were currently working as hired managers. <br /><br />It also demonstrates the influence of the for-profit, industrial part of health care.  It included 5 for-profit insurance CEOs, 8 for-profit hospital corporation CEOs, 7 for-profit health care delivery corporation CEOs, 2 for-profit drug/device company CEOs, and 1 for-profit health care IT CEO, a total of 23.  It also included CEOs of multiple trade associations, some of which represent the for-profit side of health care (e.g., PhRMA, America's Health Insurance Plans).  While it included leadership of many <a href="http://hcrenewal.blogspot.com/search/label/non-profit%20organizations">non-profit organizations</a> as well, some of these organizations have clear financial links to the for-profit industrial side.  These ties may include significant financial support from industry, significant holdings of health care corporate stock, or managers or board members with their own relationships to industry.  (For example,  see <a href="http://hcrenewal.blogspot.com/2011/04/third-rail-that-no-one-wishes-to.html">this discussion </a>of conflicts of interest affecting the Gates Foundation, whose co-chair is 76 on the Modern Healthcare list.)  Many of the large, non-profit hospital systems, 21 of whose CEOs are on the list, have major<a href="http://hcrenewal.blogspot.com/search/label/institutional%20conflicts%20of%20interest"> institutional conflicts of interest</a>, and have many people with individual <a href="http://hcrenewal.blogspot.com/search/label/conflicts%20of%20interest">conflicts of interest</a> among their leadership and on their <a href="http://hcrenewal.blogspot.com/search/label/boards%20of%20trustees">boards of trustees</a>.<br /><br />As opposed to the influence of the for-profit industrial part of health care, the influence of government seems muted.  The list included only 6 politicians and 10 government managers.  Some of the politicians are notable proponents of smaller government, e.g. Senator Grassley, and specifically of a smaller role of government in health care, e.g., Governor Bobby Jindal, R, Louisiana.    Nor do unions have much influence.  Only two union leaders were on the list.  There was little counterweight provided to industrial influence from academia, and an almost complete absence of those who might question the current US status quo of dominance of health care by commercial interests.  <br /><br />So here is the latest evidence that US health care is dominated by commercial interests (in an era of <a href="http://hcrenewal.blogspot.com/search/label/regulatory%20capture">regulatory capture</a>, <a href="http://hcrenewal.blogspot.com/search/label/revolving%20doors">revolving doors</a>, and <a href="http://hcrenewal.blogspot.com/search/label/financialization">financialization</a>) and professional, if often generic managers.  This suggests why our health care system seems more about revenue (and thus is very expensive), and less about improving patients' and the public's health.  True health care reform would require increasing the influence of people who have different priorities than the currently most influential.  <br /><br />

What Sorts of People are "Most Influential in Healthcare?"

Modern Healthcare just put out their list of the "100 Most Influential People in Healthcare" for 2013.  A look at what sorts of p...

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Fool Us Once, Shame on You, Fool Us Twice, Shame on Us - The Untrustworthy Pronouncements of Aetna's Former CEOs

A small tempest in the larger US health care reform teapot was produced a few weeks ago when Ron Williams, former CEO of Aetna, declared in a <a href="http://online.wsj.com/article/SB10001424052702303734204577464713182634028.html">Wall Street Journal op-ed</a> that he no longer supported the health insurance mandate.  The "mandate" for all US citizens to buy health insurance, actually a relatively small tax that would be imposed on people without health insurance, was the central point of contention in the lawsuit before the US Supreme Court challenging the Affordable Care Act (ACA).  <br /><br /><strong>Immediate Past-CEO of Aetna Ron Williams' Abrupt Change of Mind on the Individual Mandate</strong><br /><br />Williams wrote,<br /><blockquote>Soon the U.S. Supreme Court will rule on the constitutionality of the Affordable Care Act. I am not a lawyer, or an expert on the Constitution. But as the chairman and CEO of a major health plan, <em>I had a ringside seat to the entire health-care reform process</em>. After much reflection, <em>I have concluded that the federal individual mandate, which requires all Americans to purchase health insurance starting in 2014, will not be upheld. </em></blockquote><br />On this, Williams was soon proven wrong. The Supreme Court upheld the law. However, the tempest was not due just to Williams' reversal of his former opinion, but the role he actually played in pushing his former opinion into the passage of the law, which was really far more than being a "ringside" spectator.<br /><br />In an August 24, 2009 <a href="http://www.forbes.com/forbes/2009/0824/outfront-insurance-premiums-aetna-ron-williams-health-reform.html">article</a>, "Aetna's Ron Williams on Health Reform," Forbes' Dan Whelan noted, <br /><blockquote>Williams, 59, is<em> taking a surprisingly visible role in arguing for change in the health care system. He has met with Obama a half-dozen times </em>(he shrugs off the surname gaffe), has testified four times in front of Senate committees this year and participates in shindigs set up by the many trade groups for which he's a director.<br /><br />Williams' position echoes that of the HMO industry generally: <em>He's against a government-run plan but favors universal coverage</em> and forcing insurers to take all comers.</blockquote><br />As Wendell Potter, the former head of public relations for large health for-profit health insurance company Cigna, who is now a strong industry critic, put it on <a href="http://wendellpotter.com/2012/06/flip-flop-on-healh-care-refrom-casts-president-as-modern-day-julius-caesar">his blog</a>,<br /><blockquote><em>Ron Williams who possibly more than anyone else had persuaded the President to reconsider his campaign pledge to enact reform without making people buy coverage from a private insurer. </em>Candidate Obama’s reform platform differed from those of Hillary Clinton’s and John Edwards’ in only one significant way: both Clinton and Edwards embraced the mandate, which Williams was championing, first behind the scenes and then publicly, on behalf of the insurance industry. Candidate Obama said he didn’t believe it was right for people to be forced to buy something they couldn’t afford.<br /><br /><em>Williams was the industry’s most visible CEO on Capitol Hill during the debate on reform.</em> He testified at numerous congressional hearings about how essential it was to move the millions of uninsured Americans into private health insurance plans and <em>how an individual mandate was necessary to make that happen.</em> He also never missed an opportunity to trash the idea of a 'public option' to compete with private insurance companies, which candidate Obama had said was essential 'to keep private insurers honest.'<br /><br />Capitol Hill was not the only place Williams was frequenting during the reform debate. In an August 2009 article in Forbes, Williams was quoted as saying that he already had met with the President six times. When I called the White House to confirm that, <em>a top aide told me it was true Williams had been there many times,</em> adding, 'We’ve found him to be one of the more reasonable ones.' </blockquote><br />Williams' recent seeming disavowal of the individual mandate raises the question of why anyone, much less President Obama, trusted him in the first place. After all, he was CEO of Aetna.<br /><br /><strong>2001 Aetna CEO John Rowe Blamed Everyone Else for Health Care Problems</strong><br /><br />In fact, perusal of my memory, and a few file folders suggested several previous cases in which Aetna CEOs issued pronouncements that should not have been trusted.<br /><br />First I recalled a meeting in 2001 at Brown during which the then Aetna CEO was honored by giving the Paul Levinger Lecture on "Good Health: Can We Afford It?" (See original Brown news release <a href="http://brown.edu/Administration/News_Bureau/2001-02/01-056.html">here</a>.) My memory is that of Dr Rowe blaming just about everybody other than the for-profit health care insurance companies for health care's ills. A Brown Daily Herald article (not currently on line, Baskin B. Health care getting harder to afford, Aetna chief tells Brown U. Brown Daily Herald, November 30, 2001) recounted him blaming "cost inflation," (presumably due to doctors and hospitals), and employers, for whom "quality doesn't matter." He only allowed that insurers were to blame for not giving "better service," but not either rising costs or poor quality. I also recall Dr Rowe being treated with great respect by the audience. After all, this was a prestigious lecture. <br /><br />However, his talk seemed just the least bit self-serving. If the audience had been aware of his record at the time, maybe we would have been more skeptical. <br /><br /><strong>Mount Sinai CEO Dr John Rowe Extolled Merger with New York University, Jumped to Become Aetna CEO as Merger Began to Fail</strong><br /><br />By 1993, Dr Rowe was CEO of Mount Sinai Medical Center, and was seemingly at the vanguard of the movement for health care CEOs to be paid a lot. The New York Times <a href="http://www.nytimes.com/1993/04/05/us/top-charity-executives-earn-6-figures.html">reported</a> that the 1993 Chronicle of Philanthropy survey showed him to be the country's best paid non-profit CEO, bringing in total compensation of over $800,000 in 1993 dollars. By 1998, Dr Rowe's big project was pushing concentration of power in health care in the form of a proposed merger between New York University Medical Center and Mount Sinai. <a href="http://www.nytimes.com/1998/01/25/nyregion/after-earlier-failure-nyu-and-mount-sinai-medical-centers-to-merge.html">According to the New York Times</a>, the plan would be for Dr Rowe to become CEO of the combined entity. At the time, he said,<br /><blockquote><em>The advantages of merging hospitals are so great, they far outweigh any hypothetical potential negative impact</em>.</blockquote><br />The bond issue needed to finance the merger, however, ran into trouble by early 2000.  Soon after that, Dr Rowe seemingly demonstrated his lack of faith in it by jumping to the leadership of Aetna. It turned out, <a href="http://articles.courant.com/2000-10-19/business/0010191503_1_aetna-mount-sinai-nyu-health-quarterly-dividend">according to the Hartford Courant</a>, Aetna's offer was just to rich to turn down.<br /><blockquote>Rowe got a $2 million sign-on bonus to leave Mount Sinai NYU Health and become chief executive of Aetna's health business, the document says. He will also get a $1.4 million retention bonus on July 3, 2001.<br /><br />Both bonuses are designed to replace money that Rowe forfeited by leaving the giant New York hospital system, Aetna spokeswoman Joyce Oberdorf said.<br /><br />In addition, Rowe will get an annual salary of at least $1 million and an annual bonus of $1 million to $3 million, depending on how well goals are met, under a three-year employment agreement with two possible one-year extensions.<br /><br />Rowe, who already received 25,000 shares of restricted Aetna stock and options on 500,000 shares, will get another 100,000 options. The new options will be granted when Aetna spins off its health business to shareholders, or on Jan. 1, 2001 -- whichever comes first. The exercise price will be about $72.73, or whatever price Aetna stock is trading at the time if it's higher than that.</blockquote><br />By 2001, the New York Times <a href="http://www.nytimes.com/2001/12/02/nyregion/celebrated-hospital-merger-a-union-in-name-only.html">referred</a> to the merger as existing "in name only." That year, the campuses resumed separate administration. The merger was officially terminated in 2008. Its failure was documented in an Academic Medicine article. (Kastor JA. Failure of the merger of the Mount Sinai and New York University hospitals and medical schools: part 2. Acad Med 2010; 85: 1828-32. Link <a href="http://www.ncbi.nlm.nih.gov/pubmed/20856095">here</a>.)<br /><br />If the Brown audience had known that the merger Dr Rowe extolled with such confidence was already failing, but that he was able to leverage his role in its development to go from the country's best paid non-profit CEO to a multi-million dollar a year insurance CEO, maybe we would have felt less guilt about our responsibility for health care's high cost, low access and poor quality.<br /><br /><strong>Aetna CEO Richard Huber's Failure to "Walk the Walk"</strong><br /><br />In fact, searching through the files showed an even earlier example of an Aetna CEO talking out of two sides of his mouth.<br /><br />By 1998, an <a href="http://www.ama-assn.org/amednews/1998/amn_98/summ1109.htm">American Medical News article </a>documented the "rocky relations" between Aetna and physicians. By early 2000, Aetna CEO Richard Huber was known as "the managed care executive physicians love to hate," <a href="http://www.ama-assn.org/amednews/2000/03/13/mksb0313.htm">per the American Medical News</a>. His departure was <a href="http://www.ama-assn.org/amednews/2000/03/13/mkca0313.htm">characterized by then American Medical News Street Smarts columnist Dr Scott Gottlieb</a>, as partly due to how<br /><blockquote><em>Huber talked out of one side of his mouth about his company's obsessive quest for 'quality' health care -- while out of the other he was screaming at doctors, hospitals and drug firms about controlling costs</em>. Yet Aetna's medical costs were still creeping up. As Richard Huber learned, <em>you can't talk the talk if you don't walk the walk</em>. </blockquote><br /><strong>Summary</strong><br /><br />So the unreliability of recent Aetna CEO Ron Williams' advocacy of the "patient mandate," was presaged by similarly untrustworthy pronouncement by two former Aetna CEOs. In each case, the remarks of the particular CEO seemed more designed to promote his immediate self-interest than to provide trustworthy opinion or policy advice.<br /><br />By the way, this summary should not be viewed as particularly an indictment of Aetna. I am sure I could find equally untrustworthy but self-serving pronouncements from the leaders of many other health care organizations. (Recall the visionary pronouncements of the failed and ultimately jailed CEO of the now vanished Allegheny Health Education and Research Foundation, see post <a href="http://hcrenewal.blogspot.com/2008/07/10-years-later-eerie-echo-of-fall-of.html">here</a>.)<br /><br />The recent Ron Williams reversal should serve, however, as a stark reminder that we, meaning physicians, other health care professionals, those who study health care and health policy, policy makers, and the public at large, should be very, very skeptical about any pronouncements about health policy by top executives of health care organizations. They as a group have shown themselves to be remarkably good at doing whatever it takes to buttress their immediate self-interest, including making apparently oracular but ultimately foolish policy pronouncements.<br /><br />The real question is why these pronouncements continue to be treated with reverence, if not as "visionaries,"  by health care professionals, health care and policy researchers, the news media, health care and medical journals, policy makers, politicians, and the public at large? Why has hardly anyone, besides yours truly, gone back to check the accuracy of their previous pontifications before swooning over their latest ones? Why has hardly anyone examined the accuracy of their predecessors' opinions, given that most executives these days seem to be subject to the same incentives to make things look good in the short term, and never mind the consequences?

Fool Us Once, Shame on You, Fool Us Twice, Shame on Us - The Untrustworthy Pronouncements of Aetna's Former CEOs

A small tempest in the larger US health care reform teapot was produced a few weeks ago when Ron Williams, former CEO of Aetna, declared in ...

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US Presidential Candidates' Financial Relationships with Health Care Organizations

As the leadership of the large field of Republican candidates for the US Presidency shifts, different candidates come in for increased media scrutiny.  Recently, reporting about former Pennsylvania Senator Rick Santorum focused on his financial relationships with a health care organization. Senator Santorum, however, is only the candidate with ties to health care organizations to come into the spotlight most recently.  We will review the report on Santorum, and then summarize the publicly known relationships of the other candidates.<br /><br /><b>Republican Former Pennsylvania Senator Rick Santorum and Universal Health Services<br /></b><br />The relationship was first revealed by <a href="http://www.businessweek.com/news/2012-01-09/santorum-becomes-millionaire-in-six-years-after-u-s-senate-loss.html">Bloomberg</a>,<br /><blockquote>Santorum’s greatest financial gain came from $395,414 in director fees and stock options he listed in a recent financial disclosure.<br /><br />The fees and options came from King of Prussia-based Universal Health Services Inc., a publicly traded health-care management company....<br /></blockquote><br />Senator Santorum started on his board service in 2006. He resigned in June, 2011, when he started his campaign for the presidency. <br /><br />Note that while Santorum served on the board, the company was accused of ethical missteps:<br /><blockquote>The Justice Department accused the company in a 2010 lawsuit of submitting fraudulent reimbursement claims under the Medicaid health-care program for the poor. The government said the company falsely claimed to have provided inpatient psychiatric services to children at a detention facility in Marion, Virginia. Pantaleoni said the case has been settled.<br /><br />The company has also risked losing certification to receive Medicare reimbursement for medical centers that it owns.<br /><br />According to a release on the UHS website, the Rancho Springs Medical Center and Inland Valley Regional Medical Center in Riverside County regained their certification in November after the Centers for Medicare and Medicaid Services threatened to terminate their provider agreement in June 2010. The state of California had also threatened to revoke the group’s hospital license.<br /><br />It wasn’t the first time UHS risked losing certification for one of its facilities. In late September 2008, CMS terminated participation in Medicare for the Two Rivers Psychiatric Hospital in Kansas City. It’s a decision that led to a court appeal and settlement requiring Two Rivers to retain an outside monitor for six months.<br /></blockquote><br />Thus, Senator Santorum was on the board of a for-profit hospital corporation until just before he became a presidential candidate. While he was on the board, the company allegedly committed unethical actions.<br /><br /><b>Republican Former Georgia Congressman Newton Leroy "Newt" Gingrich and the Center for Health Transformation and its Numerous Corporate Sponsors<br /></b><br />A few weeks ago, we <a href="http://hcrenewal.blogspot.com/2011/12/health-care-policy-of-insiders-by.html">posted</a> about Congressman Gingrich's operation of a health care consulting firm, the Center for Health Transformation. It had relationships with a long list of major health care organizations, including Allscripts, the American Hospital Association, AstraZeneca, Blue Cross Blue Shield, GE Healthcare, Gundersen Lutheran Health System, <a href="http://hcrenewal.blogspot.com/search/label/Johnson%20and%20Johnson">Johnson and Johnson</a>, <a href="http://hcrenewal.blogspot.com/search/label/Pfizer">Pfizer</a>, Pharmaceutical Research and Manufacturers' of America, Siemens, and <a href="http://hcrenewal.blogspot.com/search/label/WellPoint">WellPoint</a>. At a minimum, the Center helped some of these organizations try to influence health care policy to favor their vested interests in the guise of promoting health policy solutions. <br /><br />The juxtaposition of the stories about Senator Santorum's and Congressman Gingrich's financial ties to health care organizations suggested we review whether other current candidates also had such ties. Some quick searching revealed that some others did. We will review the other current major candidates below, starting with the other Republicans, in alphabetical order.<br /><br /><b>Republican Former Utah Governor Jonathan Huntsman Jr<br /></b><br />I could not find any publicly reported relevant relationships.<br /><br /><b>Republican Texas Congressman Dr Ronald E Paul<br /></b><br />Dr Paul is a physician, an obstetrics-gynecology specialist. According to Wikipedia, he apparently practiced until his current stint in the Congress began in 1996. I could not find any publicly reported relevant relationships. <br /><br /><b>Republican Texas Governor James Richard "Rick" Perry and Merck<br /></b><br />In September, 2011, Governor Perry's prominence in the campaign caused a reconsideration of his relationship to Merck. As MSNBC <a href="http://www.msnbc.msn.com/id/44442051/ns/politics/t/perrys-merck-link-spotlight-following-vaccine-order/#.TwtMfoHfWSo">reported</a>, <br /><blockquote>On the campaign trail, Perry had recently apologized for the executive order-which would have made Texas the first state in the country to mandate that all teenage girls, starting with 12-year-old sixth graders, be vaccinated with Gardasil. <br /></blockquote><br />Gardisil is made by Merck. Then candidate Representative Michele Bachmann noted that Governor Perry had received campaign contributions from Merck. As the Los Angeles Times <a href="http://articles.latimes.com/2011/sep/13/news/la-pn-perry-merck-campaign-cash-20110913">reported</a>, <br /><blockquote>In fact, Merck PAC — the company’s Washington, D.C.-based political action committee — has given Perry $28,500 since 2001, according to Texas Ethics Commission filings.<br /><br />The bulk of that money came before 2007, when the governor signed an executive order mandating all sixth-grade girls in the state to receive the Gardasil vaccine against HPV. <br /></blockquote><br />However, Governor Perry had another tie to Merck, as noted by MSNBC,<br /><blockquote>Perry's order came after the drug company that manufactured the vaccine hired Mike Toomey, his former chief of staff, as one of the firm's top lobbyists in Austin.<br /><br />Toomey, who is now running the main 'super pac' backing Perry's candidacy, was retained by pharmaceutical giant Merck & Co., maker of the Gardasil vaccine, which is designed to prevent the human papillomavirus, or HPV, an infection linked to cervical cancer in women. <br /><br />His hiring was part of an aggressive lobbying push in Texas by the drug company, which also donated $16,000 to Perry's gubernatorial campaigns in the two and a half years prior to the executive order. Merck paid Toomey between $260,000 and $535,000 in lobbying fees between 2005 and 2010, according to state lobbying records.<br /><br />Although Perry's GOP foes never brought up the connection during the debate, Democratic political operatives and a public watchdog group said Thursday his association with Merck is likely to be emerge as a prime example of Perry's 'crony capitalism,' should he win the GOP nomination.<br /></blockquote><br />Although there were no reports that Governor Perry personally financially benefited from a relationship with Merck, the company paid substantial amounts to his campaign and to an organization he ran, and to his former chief of staff. There seems to be at least a reason to think that these relationships had something to do with a decision he made that lead to increased sales of a Merck product, and which he now regrets.<br /><br /><b>Republican Former Massachusetts Governor Willard Mitt Romney and Bain Capital and Numerous Health Care Corporations<br /></b><br />Today's Wall Street Journal <a href="http://online.wsj.com/article/SB10001424052970204331304577140850713493694.html">summarized</a> the investments made by Bain Capital, a venture capital and private equity firm lead by Governor Romney,<br /><blockquote>The Wall Street Journal, aiming for a comprehensive assessment, examined 77 businesses Bain invested in while Mr. Romney led the firm from its 1984 start until early 1999, to see how they fared during Bain's involvement and shortly afterward.<br /><br />Among the findings: 22% either filed for bankruptcy reorganization or closed their doors by the end of the eighth year after Bain first invested, sometimes with substantial job losses. An additional 8% ran into so much trouble that all of the money Bain invested was lost. <br /></blockquote><br />Of the 10 firms that produced the biggest returns for Bain, four were involved in health care, PhysioControl, Waters, Dade, and Wesley Jessen VisionCare. Dade, a medical diagnostics company, went bankrupt in 2002.<br /><br />Furthermore, in 2007, the Boston Globe (<a href="http://www.deseretnews.com/article/680195957/Plenty-of-pitting-preceded-Romneys-profits.html">via the Deseret News</a>) reported on Governor Romney's private equity career, including his involvement with a company that had its ethical challenge,<br /><blockquote>Bain Capital's 1989 purchase of Damon Corp., a Needham medical testing firm that later pleaded guilty to defrauding the federal government of $25 million and paid a record $119 million fine.<br /><br />Romney sat on Damon's board. During Romney's tenure, Damon executives submitted bills to the government for millions of unnecessary blood tests. Romney and other board members were never implicated.<br /><br />More than a decade later, when Romney was in pursuit of the Massachusetts governorship, his Democratic opponent Shannon O'Brien accused him of lax oversight at Damon and failing to report the fraud.<br /><br />Romney replied that he had helped uncover the illegal activity at Damon, asking the board's lawyers to investigate. As a result, he said, the board took 'corrective action' before selling the company in 1993 to Corning Inc.<br /><br />But court records suggest that the Damon executives' scheme continued throughout Bain's ownership, and prosecutors credited Corning, not Romney, with cleaning up the situation. Bain, meanwhile, tripled its investment.<br /><br />Romney personally reaped $473,000.<br /></blockquote><br />Thus, Governor Romney was on the board of a device company, albeit many years prior to when he became a presidential candidate. While he was on the board, the company allegedly committed unethical actions.<br /><br /><b>Democratic President Barack Obama, Michelle Obama, and the University of Chicago Medical Center<br /></b><br />The issue of then Democratic Senator Barack Obama's wife's role at the Medical Center was first discussed in 2008, with some follow up in 2009. As the Washington Post <a href="http://www.washingtonpost.com/wp-dyn/content/article/2008/08/21/AR2008082103646.html">reported</a> in 2008,<br /><blockquote>Shortly after Barack Obama joined the U.S. Senate in 2005, the medical center promoted Michelle Obama to vice president of community and external relations, and more than doubled her salary. She is now on leave from the $317,000-a-year post, in which she sought to bridge the gap between the wealthy institution and its poorer neighbors. The hospital declined to discuss the budget for her program or her input into budgetary decisions.<br /></blockquote><br />She was particularly involved in one program that became controversial,<br /><blockquote>A few years ago, executives at the prestigious University of Chicago Medical Center were concerned that an increasing number of patients were arriving at their emergency room with what the executives considered to be non-urgent complaints. The visits were costly to the hospital, and many of the patients, coming from the surrounding South Side neighborhood, were poor and uninsured. <br /><br />Michelle Obama, an executive at the medical center, launched an innovative program to steer the patients to existing neighborhood clinics to deal with their health needs.<br /><br />That effort, in time, inspired a broader program the hospital now calls its Urban Health Initiative.<br /></blockquote><br />The Post noted,<br /><blockquote>The medical center markets its initiative as an effort to improve patient health for the poor and at the same time free its resources for emergencies and complicated procedures. The Urban Health Initiative also could save the hospital substantial amounts of money, by removing the nonpaying poor patients from its emergency room. <br /></blockquote><br />However, after Senator Obama became President, his wife became the First Lady and quit her job at the medical center, the program became even more controversial. In March, 2009, the Chicago Weekly <a href="http://chicagoweekly.net/2009/03/12/medical-emergency-the-university-of-chicago-hospitals-face-a-crisis-of-conscience/">reported</a> on the extensions of the Urban Health Initiative<br /><blockquote>or UHI, which has garnered a lot of criticism recently, such as accusations that it comes 'dangerously close' to the illegal practice of 'patient dumping.' Additionally, the emergency room structure that it will leave in its wake will likely result in a decline in the quality of care provided to Medicaid, Medicare, and uninsured patients.<br /></blockquote><br />Ultimately, the Wall Street Journal <a href="http://online.wsj.com/article/SB123681502175301913.html">reported</a> that:<br /><blockquote>More than 190 doctors at the University of Chicago Medical Center signed a letter to trustees protesting plans to reduce the number of beds available to emergency patients as 'unnecessarily risky' and a threat to patient safety.<br /></blockquote><br />At that time, this admission appeared,<br /><blockquote>Dr. Madara, the hospital's chief executive, said in an interview last week that the hospital is seeking to admit more patients to its 'programs of distinction' such as oncology and advanced surgery, and treat fewer in the ER, and that these moves will mean more privately insured patients at the hospital.<br /></blockquote><br />Note that "programs of distinction" may also mean programs that provide the most revenue. Ultimately, the Chicago Tribune <a href="http://articles.chicagotribune.com/2009-03-14/news/0903130356_1_emergency-room-medical-school-hospital">reported</a> that the plan was halted by the university president, and a few months later, Dr Madara, the CEO resigned (again <a href="http://articles.chicagotribune.com/2009-08-15/news/0908140312_1_hospital-medical-center-board-medical-education-programs">per the Tribune</a>).<br /><br />Thus, while he was a Senator, current President Obama's wife earned a substantial salary from a non-profit academic medical center and hospital system. A program she ran was then and later alleged to have compromised patient safety and perhaps acted unethically. <br /><br /><b>Summary<br /></b><br />We have frequently discussed how large health care organizations seek to influence discussions of health policy to further their vested interests. At times, they have organized <a href="http://hcrenewal.blogspot.com/search/label/stealth%20health%20policy%20advocacy">stealth health policy advocacy </a>initiatives to comprehensively push their aims. For example, we <a href="http://hcrenewal.blogspot.com/2011/02/wendell-potters-deadly-spin.html">discussed</a> how commercial health insurance companies have tried, often succesfully, to influence health policy as recounted by former CIGNA public relations leader Wendell Potter in his book <i>Deadly Spin</i>.<br /><br />It appears that the more one looks, the more one finds evidence of the web of influence of large health care organizations. Pulling together a variety of journalistic efforts over more than three years, it now appears that the majority of the current credible contenders for the presidency of the US have or had financial relationships with health care organizations. <br /><br />Often these relationships appear significant enough to be called conflicts of interest were the people who had them communicating about health policy in a venue that requires conflict of interest disclosure, like a major medical journal. One candidate until very recently was on the board of directors of a for-profit hospital corporation, and hence had a fiduciary duty to that company and its stock-holders. One candidate until very recently ran a health care consulting company whose clients included major drug, device, and insurance companies. One candidate previously was on the board of a medical device company. One candidate's spouse previously was a top executive of a academic medical center and hospital system. <br /><br />While the current candidates may now now be writing articles for medical or health care policy journals, by virtue of their candidacies they now receive enormous attention. Anything they say about health care policy is likely to be influential. Yet there is reason to be concerned that many of their views on health policy were influenced by their financial relationships. In particular, would a candidate who at one time got a major part of his or his family's livelihood from a big health care organization be likely to strongly challenge the status quo that allowed that organization to prosper?<br /><br />In my humble opinion, there needs to be complete reconsideration of how health care policy is made. In particular, we must define how much of the discussion is driven by vested economic interests, and make sure such interests and their relationship to those in the discussion becomes clear. It is just as important for health policy analysts, pundits, and decision-makers to disclose in detail their conflicts of interest as it is for clinical researchers and educators. Maybe the Institute of Medicine would be willing to take up this issue as they <a href="http://www.iom.edu/Reports/2009/Conflict-of-Interest-in-Medical-Research-Education-and-Practice.aspx">took up </a>conflicts of interest affecting research and education.

US Presidential Candidates' Financial Relationships with Health Care Organizations

As the leadership of the large field of Republican candidates for the US Presidency shifts, different candidates come in for increased media...

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Health Care Policy of the Insiders, by the Insiders, for the Insiders - the Newt Gingrich Case Files

Newt Gingrich's rise to the top of the pack of Republican contenders for the US presidency has earned him increased scrutiny.  The resulting investigative reporting has provided a revealing set of case studies showing how insiders have come to dominate US health care policy.<br /><br />Below I have reorganized the information presented in a series of news articles from mid-November to mid-December, 2011.<br /><br /><b>Mr Gingrich's Consulting Empire</b><br /><br />A general description of Mr Gingrich's health care "think tank" appeared in the Washington Post.(1)<br /><blockquote><em>A think tank founded by GOP presidential candidate Newt Gingrich collected at least $37 million over the past eight years from major health-care companies and industry groups</em>, offering special access to the former House speaker and other perks, according to records and interviews.<br /><br />The Center for Health Transformation, which opened in 2003, <em>brought in dues of as much as $200,000 per year from insurers and other health-care firms</em>, offering some of them 'access to Newt Gingrich' and 'direct Newt interaction,' according to promotional materials.</blockquote><br />Despite its name, the CHT was for-profit. Much of its actual workings are confidential, per the Post,(1)<br /><blockquote>Susan Meyers, a center spokeswoman, declined to comment on the think tank’s income or staffing levels because it is a private-sector organization.</blockquote><br />Despite its pretentious name, the CHT was apparently a vehicle for its wealthy corporate clients to influence health policy to favor their business interests.  A NY Times article(2) reported that:<br /><blockquote>His consultancy practice was centered around <em>his ability to help big corporate interests speak the language of Republicans and navigate the corridors of Capitol Hill on issues vital to their businesses.</em></blockquote><br />According to a Bloomberg article(3), the work was quite lucrative:<br /><blockquote>Two companies founded by Newt Gingrich announced yesterday that they had <em>grossed $55 million between 2001 and 2010,</em> part of an effort to quiet questions about how the former U.S. House speaker earned millions since he resigned from Congress in 1999.<br /><br />That revenue supports the Center for Health Transformation and The Gingrich Group LLC, which have a staff of as many as 30 people, stage health-care policy events, and provide advice to clients, Nancy Desmond, the chairman and chief executive officer of the firms, said in a written statement. </blockquote><br />The CHT was linked to a small corporate empire, as described by the Washington Post,(4)<br /><blockquote>Former House speaker Newt Gingrich transfigured himself from a political flameout into a thriving business conglomerate. The power of the Gingrich brand fueled <em>a for-profit collection of enterprises that generated close to $100 million in revenue over the past decade</em>, said his longtime attorney Randy Evans.<br /><br />Among Gingrich’s moneymaking ventures: a health-care think tank financed by six-figure dues from corporations; a consulting business; a communications firm that handled his speeches of up to $60,000 a pop, media appearances and books; a historical documentary production company; a separate operation to administer the royalties for the historical fiction that Gingrich writes with two co-authors; even an in-house literary agency that has counted among its clients a presidential campaign rival, former senator Rick Santorum (R-Pa.).<br /><br />Separate from all of that was his nonprofit political operation, American Solutions for Winning the Future.</blockquote><br /><strong>Relationships with Big Health Care Corporations</strong><br /><br />The Center for Health Transformation was largely funded by big health care corporations. The Post first noted,(1)<br /><blockquote>The biggest funders, ... [included] firms such as <strong>AstraZeneca, Blue Cross Blue Shield and Novo Nordisk,</strong>...</blockquote><br />Also,(1)<br /><blockquote>The center has listed scores of firms and industry groups as members over the years, amounting to a Who’s Who of the medical field, from <strong>GE Healthcare</strong> to the <strong>American Hospital Association</strong> to <strong>Wellpoint</strong>, the nation’s largest health insurer. </blockquote><br />Other clients were listed in a Bloomberg article,(5)<br /><blockquote>Among the member companies were drugmaker <strong>Johnson & Johnson</strong> (JNJ) and health insurer <strong>Blue Cross and Blue Shield Association</strong>....</blockquote><br />Also,(5)<br /><blockquote><strong>Pfizer Inc</strong>. (PFE), the world’s largest drugmaker, had consulting contracts with Gingrich, according to two people familiar with the arrangements. Pfizer spokesman Ray Kerins didn’t respond to requests for comment.<br /><br />The <strong>Pharmaceutical Research and Manufacturers of America</strong>, the industry’s trade group, was also a client. His firm 'was retained by the PhRMA general counsel’s office at one time to provide advice on a positioning project,' the group said. </blockquote>In addition, as noted below, clients included important firms in the health care information technology (IT) sector, including <strong>GE</strong>, <strong>IBM</strong>, <strong>Microsoft</strong>, <strong>Allscripts</strong>, and <strong>Siemens</strong>.<br /><br />Below, we present several cases in which Mr Gingrich apparently intervened on behalf of his clients to promote their business interests in the guise of promoting his views on health policy solutions.  In some cases, the views he promoted did not fit with what is generally regarded as his political philosophy, suggesting that the interests of his paying clients overrode his political views.<br /><br /><strong>Case: End of Life Care</strong><br /><br />The New York Times reported,(2)<br /><blockquote>Writing on the Web site of the Washington Post, <em>Mr Gingrich praised Gundersen Lutheran Health System of LaCrosse, Wis., for its successful efforts to persuade most patients to have 'advance directives,'</em> saying if Medicare had followed Gundersen's lead on end-of-life care and other practices, it would 'save more than $33 billion a year.'</blockquote><br />Note that<br /><blockquote><em>Gundersen was one of the paying clients of Mr. Gingrich's Center for Health Transformation</em>....</blockquote><br />However, <br /><blockquote>within weeks, Mr. Gingrich would find himself <em>on the wrong end of what some Republicans labeled the 'death panel' issue.</em></blockquote><br />At that point, Mr Gingrich abruptly changed his tune, <br /><blockquote>As it happens, <em>shortly after Mr. Gingrich wrote his article praising Gundersen, he joined the conservative critics of the provision</em>. 'You are asking us to trust turning power over to the government,' Mr Gingrich told George Stephanopoulos of ABC News that August 'when there are clearly people in America who believe in establishing euthanasia, including selective standards.'</blockquote><br />This suggested that Mr Gingrich took up the cause of end-of-life decision making not be cause he deeply believed in it, but because it was expeditious given the wishes of his clients, despite the assertion made by his spokesperson,(2)<br /><blockquote>Mr. Hammond said that Mr. Gingrich did not take policy positions for pay; rather, he said, clients sought him out because of the views he already held and his expertise in communicating ideas.</blockquote><br /><strong>Case: Medicare Prescription Coverage Sans Negotiations about Drug Prices</strong><br /><br />As reported by Bloomberg,(5)<br /><blockquote>When U.S. House Republican leaders in 2003 were short of votes to pass a $395 billion Medicare prescription drug benefit, they recruited former House Speaker Newt Gingrich for help.<br /><br />In a hushed room on Capitol Hill, <em>Gingrich told his former Republican colleagues that if he could endorse the measure, they should be comfortable with it, too</em>, said two former senior House aides who attended the closed-door session.<br /><br />Two days later, after a vote was held open for three hours as leaders corralled the final ayes, the measure passed and was eventually signed into law by President George W. Bush.<br /><br /><em>What Gingrich didn’t mention during the Republican caucus meeting was that he was also building a for-profit, health-care research company and seeking financing from drugmakers, which were investing $128.6 million in lobbying for passage of the new benefit for seniors. </em><em><br /></em></blockquote><br />Note that the legislation that provided Medicare drug coverage forbade the government from negotiating prices with drugmakers.  This was unprecedented, because drug coverage from the US Veterans Administration and Medicaid did not come with the obligation to pay whatever the drug-makers charged.  The inability of Medicare to negotiate the prices it paid for drugs certainly helped the companies' revenues while driving up the costs of Medicare, the federal deficit and the costs of health care in general.<br /><br /><strong>Case: Promoting Expensive Diabetes Care</strong><br /><br />The Washington Post reported,(4)<br /><blockquote><em>Novo Nordisk, a Denmark-based drug firm that specializes in diabetes treatments.... paid a total of $1.2 million</em> to Gingrich’s foundation over six years as a 'founding charter member.'<br /><br />'It was strictly a business, nonpolitical relationship,' Novo Nordisk spokesman Ken Inchausti said. 'We admired his leadership on issues related to health-care delivery systems. We thought the CHT brought something to the table to us in terms of finding ways to help people prevent diabetes.'<br /><br /><em>Gingrich loaned his celebrity to causes that, whatever their other merits, could also be good for Novo Nordisk’s bottom line. For instance, he was the keynote speaker at Novo Nordisk’s 'diabetes summit' in 2005 and joined the company in issuing a 'call to action' to fight diabetes in Texas and Georgia</em>.</blockquote>One wonders how many of the widely promoted "summits" and other star-studded conferences on health care featuring corporate  and political leaders as speakers are just stealth health policy advocacy or stealth marketing.<br /><br /><strong>Case: Irrational Exuberance for Electronic Health Records</strong><br /><br />My fellow Health Care Renewal blogger has often discussed the <a href="http://hcrenewal.blogspot.com/search/label/irrational%20exuberance">"irrational exuberance"</a> for electronic health records (EHRs) despite scant information about their benefits, and increasing data suggesting their harms.  It now appears that Mr Gingrich, sponsored by copious funds from the health care IT sector, has been a major source of such exuberance.  <br /><br />Mr Gingrich had a complex relationship with the health care information technology (IT) industry. It began to come out first in a NY Times story,(6)<br /><blockquote>When the center [for Health Transformation] sponsored a 'health transformation summit' at the Florida State Capitol in March 2006, lawmakers who attended Mr. Gingrich's keynote speech inside the House chamber received a booklet promoting not just ideas but also the specific services of two dozen of his clients. Executives from some of those companies sat on panels for discussions that lawmakers were encouraged to attend after Mr. Gingrich's address.<br /><br />Gerard White, president of Clearwave, which paid about $50,000 to become a center member, <em>used the occasion to pitch his company's system for managing patient data</em>.</blockquote><br />This had all began earlier,<br /><blockquote>Two years before the Florida 'summit,' Mr. Gingrich made a presentation to Republican lawmakers in Georgia, promoting the work of his member companies by citing specific benefits if they were hired. For example, 'VitalSpring could save the State Employee Program over $20 million a year.'<br /><br />Minutes of the members-only conference call from March 2004 said <em>the center had 'arranged joint meetings' for members to present their work on electronic health records to top federal officials,</em> noting that Mr. Gingrich 'reported very positive feedback overall from these meetings.'<br /><br />He also<em> pressed for passage of a federal bill to increase the use of electronic health records</em>, collaborating with one of its co-sponsors, Representative Patrick J. Kennedy of Rhode Island, and Senator Hillary Rodham Clinton of New York, both Democrats.</blockquote><br />Furthermore,<br /><blockquote><em>Many of the ideas he has pushed involve the increased use of information technology, and companies specializing in that are well represented in the center's roster</em>. They also figured prominently in an early center initiative, teaming up in 2003 with the conservative Georgia Public Policy Foundation to promote changes in health care in Mr. Gingrich's home state.<br /><br />At his discussion with Georgia House Republicans in 2004, Mr. Gingrich gave examples of companies whose services could 'both improve health and start saving money,' according to the center's summary of his presentation.</blockquote><br />And there is more,<br /><blockquote>In Washington, Mr. Gingrich's push for electronic health records illustrated how his own policy advocacy and ties to former Congressional colleagues made him a sought-out consultant for companies like Astra Zeneca and Siemens. Mr. Gingrich hailed HealthTrio, one of the center's 'founding charter members,' during a hearing held in 2003 by Senator Larry Craig, Republican of Ohio. <em>Telling the senator that HealthTrio's chief executive had helped design the electronic records program in the United Kingdon, Mr. Gingrich said the company 'estimates we could have an electronic health record for American for about 10 cents per month, per person</em>.' <br /><br /><em>The center later arranged for HealthTrio and I.B.M to meet with senior federal health officials and congressional leaders 'to review the U.K. approach</em> and how it might be applied in the U.S.,' according to center records.<br /><br /><em>Some of the ideas promoted by the center found their way into the electronic health records legislation proposed by Mr. Kennedy, which was prepared with input from Mr. Gingrich</em>.</blockquote>This is especially ironic, given that the UK NHS electronic health record initiative has become a crashing failure (for example, see<a href="http://hcrenewal.blogspot.com/2011/08/you-saw-it-here-first-uk-nhs-pulls-plug.html"> this post</a>).<br /><br />Even more involvement with the push for electronic health records (EHRs) appeared in a Boston Globe article,(7)<br /><blockquote>Newt Gingrich seized the TV airwaves in 2009 to bash President Obama’s stimulus package, calling it 'entirely a pork-barrel bill' that would do little to solve the recession.<br /><br />Later, in a separate web video, the former House speaker stepped back from his blanket criticism. He explained that <em>he strongly supported spending $27 billion of stimulus funds to encourage doctors and hospitals to create electronic medical records for their patients. Left unsaid was that the Gingrich Group, his consulting business in Washington, received large payments from medical technology companies that stand to profit from the federal money</em>.</blockquote><br />In particular,<br /><blockquote><em>The stimulus infusion Gingrich supported is expected to benefit health care technology companies, including those who have been clients such as <strong>GE Healthcare</strong> and <strong>Allscripts</strong></em>.<br /><br />GE Healthcare said it pays Gingrich’s center to act as a 'collaborator and facilitator' among a diverse group of health care interests.<br /><br /><em>'We work with the Center for Health Transformation in an effort to improve the effectiveness of the health system through the use of information technology,' said GE Healthcare spokesman</em> Corey Miller.<br /><br />Allscripts spokeswoman Ariana Nikitas said the company ended its relationship with Gingrich’s center two years ago but considered the venture 'a think-tank to advance health care efforts.'</blockquote><br />It does not stop there. Per the NY Times,(8)<br /><blockquote>Mr. Gingrich was <em>cheering a $19 billion part of the [Obama stimulus] package that promoted the use of electronic health records, something that benefited clients of his consulting business</em>. 'I am delighted that President Obama has picked this as a key part of the stimulus package,' he told health care executives in a January 2009 conference call.<br /><br />After the bill was passed a month later, <em>Mr. Gingrich's consultancy, the Center for Health Transformation, joined two of his clients, Allscripts and Microsoft, in an 'Electronic Health Records Stimulus Tour'</em> that traveled the country, encouraging doctors and hospitals to buy their products with billions in federal subsidies. </blockquote>We, particularly InformaticsMD, have frequently commented on how health care information technology has been promoted not just by enthusiasts in the field, and by companies that manufacture such devices, but by the government.  The bandwagon has gone down the road despite little clinical evidence that such technology is beneficial, and increasing evidence of its harms.  Now it appears that an important reason for this ruch to promote expensive, but unproven devices comes from the sort of stealth health care policy advocacy on behalf of corporate vested interests described above. <br /><strong>Summary</strong><br /><br />So Newt Gingrich parlayed his political track record into a lucrative "consultancy" which enthusiastically promoted the health policy objectives of its clients, who included some of the biggest US health care corporations.  Some of the policy positions the consultancy promoted seemed to run counter to Mr Gingrich's political record.  Worse, some of the initiative he successfully promoted seem to have contributed to US health care dysfunction.<br /><br />These stories, some of which are many years old, only came out after Mr Gingrich became the front runner for the Republican nomination for US President.  Had he not chosen to re-enter politics, it is not clear when reporters would have had time to due the required investigations.  One wonders how many similar stories have not been made public because they do not involve prominent presidential candidates.<br /><br />The bottom line seems to be that there are myriad ways corporate and political insiders push health policy agendas because of self-interest, regardless of their effects on patients' and the public's health.  Health policy in the US has become an insiders' game.  Unless it is redirected to reflect patients' and the public's health, facilitated by the knowledge of unbiased clinical and policy experts rather than corporate public relations, expect our efforts at health care reform to just increase health care dysfunction.  <br /><br />Physicians, public health advocates, whatever unbiased health policy experts remain must educate the public about how health policy has been turned into a corporate sandbox.  We must try to somehow activate the public to call for health care policy of the people, by the people, and for the people.<br /><br /><strong><span style="font-size: x-small;">References</span></strong><br /><span style="font-size: x-small;"><br /></span><br /><span style="font-size: x-small;">1.  Eggen D. Gingrich think tank collected millions from health-care industry.  Washington Post.  November 17, 2011.  Link </span><a href="http://www.washingtonpost.com/politics/gingrich-think-tank-collected-millions-from-health-care-industry/2011/11/16/gIQAcd72VN_story.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">2. Rutenberg J. Gingrich faces more scrutiny over corporate clients. NY Times, November, 17, 2011. Link </span><a href="http://www.nytimes.com/2011/11/18/us/politics/newt-gingrich-faces-more-scrutiny-on-corporate-clients.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">3. Benson C, Lerer L. Gingrich health center and group paid $55M. Bloomberg, November 22, 2011. Link </span><a href="http://www.bloomberg.com/news/2011-11-22/corporations-pay-gingrich-health-center-and-consulting-group-55-million.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">4. Tumulty K, Eggen D. Newt Gingrich Inc.: how the GOP hopeful went from political flameout to fortune. Washington Post, November 26, 2011. Link </span><a href="http://www.washingtonpost.com/politics/newt-gingrich-and-how-he-got-rich/2011/11/21/gIQAftOglN_story.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">5. Davis JH, Jensen K. Gingrich campaigning as change agent profited as an insider. Bloomberg, November 18, 2011. Link </span><a href="http://www.bloomberg.com/news/2011-11-18/gingrich-running-as-change-agent-profits-from-washington-insider-status.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">6. McIntire M, Rutenberg J. Gingrich gave push to clients, not just ideas. NY Times, November 29, 2011. Link </span><a href="http://www.nytimes.com/2011/11/30/us/politics/gingrich-gave-push-to-clients-not-just-ideas.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">7. Rowland C. Newt Gingrich supported $27 billion of President Obama's stimulus for electronic medical records, helping his consulting clients. Boston Globe, December 16, 2011. Link </span><a href="http://www.boston.com/Boston/politicalintelligence/2011/12/gingrich-stimulus-support-benefited-his-consulting-clients/IoXiAqmY1h1A74SYCwckdJ/index.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span><br /><span style="font-size: x-small;">8. Rutenberg J, McIntire M. Gingrich push on health care appears at odds with G.O.P. NY Times, December 16, 2011. Link </span><a href="http://www.nytimes.com/2011/12/16/us/politics/gingrichs-health-care-policy-history-at-odds-with-gop.html"><span style="font-size: x-small;">here</span></a><span style="font-size: x-small;">.</span>

Health Care Policy of the Insiders, by the Insiders, for the Insiders - the Newt Gingrich Case Files

Newt Gingrich's rise to the top of the pack of Republican contenders for the US presidency has earned him increased scrutiny.  The resul...

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"The 'Third Rail' that No One Wishes to Analyze" - Conflicts of Interest Affecting Health Care Foundations

On Health Care Renewal we discuss what we think are important issues affecting health care that seem to be rarely mentioned in the medical and health care literature and the "main-stream media."  In particular, we focus on problems in health care leadership and governance, how they threatened the core values of health care professionals, and how these threats contribute to rising costs, and declining access and quality.  <br /><br />One of our preoccupations has been why these problems remain so <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic</a>.  A new article in PLoS Medicine [Stuckler D, Basu S, McKee M. Global health philanthropy and institutional relationships: how should conflicts of interest be addressed? PLoS Med 8(4): e1001020. doi:10.1371/journal.pmed.1001020.  Link <a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001020#pmed.1001020-Robert1">here</a>. ] seems to have uncovered another missing link to the anechoic effect.  <br /><br /><strong>Private Foundations and Their Influence on Global Health</strong><br /><br />The article noted the importance of the influence of private foundations on global health:<br /><blockquote>While corporate involvement in and government aid for health has been extensively analyzed and critiqued in the public health literature,<em> less attention has been paid to the impact of private donors on public health.</em> Over the past decade, the bulk of new health aid designed to reach the Millennium Development Goals has come from individuals and corporations. <em>The influence of this private philanthropy on global health is profound and transformative.</em></blockquote><br />So,<br /><blockquote><em>Private foundations operate outside the typical boundaries of democracy; unlike government ministries, private foundations cannot be influenced in the same way by the communities affected by the foundations' actions</em>. In the interests of public health, and particularly because poor communities affected by foundations do not automatically have a feedback mechanism to influence the decisions of private funders, we argue that <em>it is appropriate to subject private foundations to the same scrutiny received by public institutions</em>.<br /><br />In this paper, we examine the scope of potential conflicts of interests that exist among the private foundations that are major funders of global health.</blockquote><br />I would add that private foundations may have an outsize influence not only on global public health policy, but also on health care policy within particular countries, including the US.   This may arise because of the perception that they are more independent and nearer the cutting edge than are government and industry sources of funding. For example, here in the US, the Kellogg and Robert Wood Johnson Foundations have been widely perceived by health care, services and policy researchers as especially influential and respectable sources of funding, possibly partially because of the perception that they have less self-serving agendas than do government agencies and for-profit health care corporations. <br /><br /><strong>The Possibility of Conflicts of Interest</strong><br /><br />The authors noted increasing concern about conflicts of interest affecting the activities of for-profit corporations involved in public health and health care:<br /><blockquote>because tensions can arise between the profit motives of corporations and the promotion of public health. Whereas corporations make products that can improve health (such as pharmaceuticals and vaccines) and relationships between public health institutions and for-profit corporations can be seen as positive opportunities for corporations to improve public health, corporations also make products that damage health (such as tobacco or unhealthy foods). And because some corporations have a vested interest in the activities of public health bodies, there have been documented attempts to influence the public health agenda by establishing associations with health care institutions</blockquote><br />Thus the authors thought it also made sense to address conflicts of interest affecting private foundations operating in the global health space. They performed a case-study of the largest global health foundation, the Bill & Melinda Gates Foundation, while also briefly discussing four other large global health foundations, the Ford Foundation, W. K. Kellogg Foundation, Robert Wood Johnson Foundation, and Rockefeller Foundation.<br /><br /><strong>Stock Holdings </strong><br /><br />The article noted that the Gates Foundation had substantial investments in food and pharmaceutical companies:<br /><blockquote>The Bill & Melinda Gates Foundation's corporate stock endowment is <em>heavily invested in food and pharmaceutical companies</em>, directly and indirectly .... The Foundation holds significant shares in McDonald's (9.4 million shares representing about 5% of the Gates' portfolio), and Coca-Cola (>15 million shares, over 7% of the Foundation's portfolio, not counting Berkshire Hathaway holdings). In 2009 the Bill & Melinda Gates Foundation sold extensive pharmaceutical holdings in Johnson & Johnson (2.5 million shares), Schering-Plough Corporation (14.9 million shares), Eli Lilly and Company (about 1 million shares), Merck & Co. (8.1 million shares), and Wyeth (3.7 million shares).</blockquote><br />Also, the Foundation indirectly invests in food and pharmaceutical companies through its holdings of Berkshire Hathaway:<br /><blockquote>Berkshire Hathaway's largest investment is in Coca-Cola. It owns an additional 8.7% of Coca-Cola (Warren Buffett's firm is the largest shareholder in Coca-Cola, having stock worth >$10 billion dollars) and 6.3% of Kraft (Buffett is also the largest shareholder of Kraft). Berkshire Hathaway also has significant ownership in <em><a href="http://hcrenewal.blogspot.com/search/label/GlaxoSmithKline">GlaxoSmithKline</a>, <a href="http://hcrenewal.blogspot.com/search/label/Sanofi-Aventis">Sanofi-Aventis</a>, <a href="http://hcrenewal.blogspot.com/search/label/Johnson%20and%20Johnson">Johnson & Johnson</a>, and <a href="http://hcrenewal.blogspot.com/search/label/Procter%20and%20Gamble">Procter & Gamble</a>, and is one of the main global investors in the latter two pharmaceutical companies. </em></blockquote><br />The article also noted that the Ford, Rockefeller, Kellogg and Robert Wood Johnson Foundation had significant holdings in Coca-Cola, Kellogg, PepsiCo, <a href="http://hcrenewal.blogspot.com/search/label/Pfizer">Pfizer</a>, GlaxoSmithKline, McDonalds, Nestle, NovoNordisk, YumBrands, Pizza Hut, KFC, Johnson & Johnson, and Sanofi-Aventis, and that the Ford Foundation held shares in a tobacco company, Lorillard, and the Kellogg and Rockefeller Foundations "were indirectly invested in tobacco corporations through conglomerate equity funds...."<br /><br />This admittedly case-based data suggested that the major private foundations active in global health may have financial holdings that could possibly influence their actions in favor of the vested interests of food, pharmaceutical, and even tobacco companies. <br /><br /><strong>Conflicts Affecting Foundation Leadership</strong><br /><br />The article noted that:<br /><blockquote><em>Several of the [Gates] Foundation's members of the management committee, leadership teams, affiliates, and major funders are currently or were previously members of the boards or executive branches of several major food and pharmaceutical companies ... including Coca-Cola, Merck, Novartis, General Mills, Kraft, and Unilever</em>.... </blockquote><br />In addition, <br /><blockquote><em>Further overlaps between Bill & Melinda Gates Foundation leadership, other private foundations, and circular flows of personnel with food and pharmaceutical companies were observed .... Such patterns of interlinked board directorships, common among corporations and nonprofit organizations, were similarly found in the other private foundations studied</em>.</blockquote><br />Examples provided in an appendix were:<br /><blockquote>Anne Fudge, the chairman of the Gates Foundation’s US Program Advisory Panel is also on the board of directors of Rockefeller Foundation (in addition to General Electric, <em><a href="http://hcrenewal.blogspot.com/search/label/Novartis">Novartis</a></em>, Unilever, and Harvard University, among others).</blockquote><br />Furthermore,<br /><blockquote>Members of personnel also move between the Foundation and pharmaceutical companies. For example, in April 2010, <em>a former <a href="http://hcrenewal.blogspot.com/search/label/Merck">Merck</a> senior vice president, Richard Henriques, became the chief financial officer of the Gates Foundation</em>. <em>At least two other members of the Gates Foundation leadership have transferred from the leadership of GlaxoSmithKline to sit on the Foundation’s board of directors, including Kate James, the chief communications officer, and Tachi Yamada, until February 2011, the head of the Foundation’s global health program</em>. Similar patterns were observed with the other foundations studied. </blockquote><br />Again, this admittedly case-based data suggested that the major private foundations active in global health may have leaders who have financial relationships that could possibly influence their actions in favor of the vested interests of food and pharmaceutical companies.<br /><br /><strong>Program Initiatives Possibly Related to Conflicts</strong><br /><br />The article asserted:<br /><blockquote>The bulk of the Bill & Melinda Gates Foundation's financial transfers in global health have been to programs <em>developing medical technologies</em>....</blockquote><br />In particular,<br /><blockquote>Overall, about 42% of all funding was spent on health care delivery or<em> increasing access to drugs, vaccines, and medical commodities</em>, while an additional one-third was allocated to <em>technology development (mainly for vaccines and microbicides)</em> or basic science research.</blockquote><br />Specific programs were related to companies in which the the Gates Foundation or its leaders had financial interests:<br /><blockquote>The Foundation has established partnerships with the Coca-Cola Company, which, in the words of the Foundation, are intended to 'create new market opportunities for local farmers whose fruit will be used for Coca-Cola's locally-produced and sold fruit juices'.</blockquote><br />Also,<br /><blockquote><em>many of the Foundation's pharmaceutical development grants may benefit leading pharmaceutical companies such as Merck and GlaxoSmithKline</em>....</blockquote><br />and<br /><blockquote><em>Johnson & Johnson has entered a clinical partnership to develop new HIV-prevention technology</em>, noting 'the work between Johnson & Johnson and the Gates Foundation is a strong, strategic, comprehensive relationship'.</blockquote><br />While there are many needs in global health, and many approaches to addressing these needs, this limited case-based data suggested that a strong focus of the Gates Foundation was on approaches that revolve around drugs, devices and biotechnology, again which would tend to favor the vested interests of the pharmaceutical companies which the Foundation holds in its investment portfolio and with which some of its leaders have or had financial relationships. <br /><br /><strong>Discussion</strong><br /><br />While the data from this case-study were limited, they do suggest that major private foundations that support global health, and by extension, health care, services, and policy research may have institutional conflicts of interest, and their leaders may have personal conflicts of interest. It is possible that these conflicts have steered global health policy to favor vested interests, particularly towards approaches that depend on drugs and devices, perhaps instead of more effective ones using less technology.<br /><br />Furthermore, it is possible that that these conflicts of interest have helped create the anechoic effect.  Conflicts of interest could have pushed the foundations in directions that favored specific vested interests, and away from others that may threaten such interests.  Many of the issues we discuss on Health Care Renewal may threaten such interests.  Private health foundations have been notably uninterested in addressing how problems in leadership and governance of health care organizations can threaten core values, They have been particularly uninterested in addressing specific tactics used when leadership is ill-informed, incompetent, self-interested, conflicted, or even corrupt, e.g., deceptive practices used to promote products and services, and promote policies favorable to vested interests, including, of course, deliberate creation of conflicts of interest (such as the cultivation of key opinion leaders). <br /><br />In fact, a particular version of the anechoic effect surrounds the private foundations themselves, as described by Stuckler et al:<br /><blockquote>Although the philanthropic activities of wealthy individuals and corporations have attracted controversy in the past (Text S1), their charitable mission often means that <em>they face less scrutiny than governments; critical analysis of foundations can be seen as <strong>'biting the hand that feeds us.'</strong> As a result, within the global health community, private donors are sometimes viewed as the <strong>'third rail' that no one wishes to analyze</strong>. </em></blockquote><br />We have often commented on the pervasiveness of conflicts of interest in health care. Now we see them affecting even the most respected private health care foundations which were previously regarded as independent. The web of conflicts of interest may benefit those personally involved, but to the detriment of patients' and the public's health. Unfortunately, as the web has gotten more complex, it stifles awareness of the problem by the unconflicted, much less their ability to respond. <br /><br />At a minimum, I urge that private health care foundations fully disclose their institutional conflicts of interest, and the conflicts of interest of their leaders. If they wish to maintain their previously sterling reputations, they ought to consider divesting themselves of financial holdings that generate institutional conflicts, and of leaders who have financial relationships that generate personal conflicts. <br /><br />Hat tip: to Ed Silverman <a href="http://www.pharmalot.com/2011/04/foundations-conflicts-of-interest-and-drugmakers/">on the PharmaLot blog</a>.

"The 'Third Rail' that No One Wishes to Analyze" - Conflicts of Interest Affecting Health Care Foundations

On Health Care Renewal we discuss what we think are important issues affecting health care that seem to be rarely mentioned in the medical a...

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What a Conflicted Web We Weave: More About Leaders of Financial Firms Influencing Policy in the Guise of Independent Academics

The issue of <a href="http://hcrenewal.blogspot.com/2010/10/what-conflicted-web-we-weave-academic.html">conflicted academic economists providing public policy recommendations</a> just got bigger.  As discussed <a href="http://blogs.reuters.com/felix-salmon/2010/11/08/disclosing-economists-conflicts/">by Felix Salmon</a> in his blog for Reuters, and <a href="http://economix.blogs.nytimes.com/2010/11/08/ethics-for-economists">by Nancy Folbre</a> in the Economix blog for the New York Times,  a <a href="http://www.peri.umass.edu/fileadmin/pdf/working_papers/working_papers_201-250/WP239.pdf">new study</a> by Epstein and Carrick-Hagenbarth showed that some very prominent economists who frequently make pronouncements about financial policy often failed to disclose some major conflicts of interest.  <br /><br />In summary, they identified "two groups of economists that were prominent in the field of financial economics and which had taken a public stance on financial regulation."  Some of these economists also had prominent advisory roles for government economic agencies, including the US Federal Reserve, the US Council of Economic Advisers, the Indian Finance Ministry, the Bank of Finland, the World Bank, and the International Monetary Fund. The authors did an extensive search for the economists' financial ties to financial corporations, which probably detected most relationships such as membership on the boards of directors of public companies, but may have missed consulting arrangements.  They found that 12 of 19 had such relationships, mostly positions on boards of directors or ownership interests.  They found that all but one of the economists with such relationships failed to identify these relationships in the majority of their academic papers and writings in the media.  The one economist who always disclosed his relationships in the media only wrote articles for the private financial firm for which he worked.<br /><br />So major financial conflicts of interest were prevalent among "prominent economists who write op-eds for newspapers, they testify on public panels, they take positions as advisers for politicians and they are interviewed by the media. Academic economists often convey the impression that they occupy these positions as independent objective experts."  The authors concluded:<br /><blockquote>Academic economists serve as <em>experts in the media, molding public opinion</em>. They are also <em>important players in government policy</em>. If those that are <em>creating the culture around financial regulation as well as influencing policy at the government level</em> for financial reform also have a significant, if hidden, conflict of interest, <em>our public is not likely to be well-served.</em></blockquote><br />They also noted that economics as a profession does not even have a formal code of ethics, and in particular has never embraced any necessity for disclosing, managing, or restricting conflicts of interest.<br /><br />We had previously <a href="http://hcrenewal.blogspot.com/2010/10/what-conflicted-web-we-weave-academic.html">discussed</a> anecdotal but striking evidence that some of the most prominent economists who influenced public policy up to and after the great recession/ global financial crisis also had major but undisclosed financial ties to financial institutions. It now looks like conflicts of interest could be as prevalent among those who are influential in economics as they may be among those who are influential in medicine, health care, and health care policy. <br /><br />This further corroborates the hypothesis that academic medical institutions are so comfortable with their faculty and leaders' conflicts of interest because they exist in a larger academic culture in which such conflicts are standard operating procedure.  Academic institutions may be particularly happy with economists' conflicts of interest because they involve such large amounts of money. <a href="http://blogs.reuters.com/felix-salmon/2010/11/08/disclosing-economists-conflicts/">Felix Salmon</a> gave the example of  Paul Krugman who when he worked as an economist could command a $40-50,000 fee per speech, easily more than an order of magnitude more than the going rate for medical talks.  Furthermore, as we have noted before, (e.g., <a href="http://hcrenewal.blogspot.com/2010/05/stewards-of-elite-university-or.html">here</a>, <a href="http://hcrenewal.blogspot.com/2010/04/very-well-paid-boob-on-harvard.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2010/02/university-president-but-no-longer.html">here</a>) many prominent academic institutions that incorporate medical schools and academic medical centers have boards of directors dominated by leaders of finance.  Now it appears that these leaders' economic interests may lead them to encourage conflicts of interest among their faculty and administration.<br /><br />So not only do conflicts of interest appear to be a fundamental problem for medicine and health care, they may pose a fundamental problem for society as a whole.<br /><br />Clearly, as Epstein and Carrick-Hagenbarth wrote, economists, like all professionals who can influence public policy, ought to have a code of ethics, and that code, at a minimum, ought to require full disclosure of all conflicts of interest.  Economists who write about policy in the media, write policy-relevant academic articles, and/or who advise non-profit organizations and government agencies should at a minimum reveal all such conflicts.  Similarly, of course, physicians and health policy/ care/ services researchers who write about or otherwise may influence health care policy should at a minimum reveal all such conflicts.<br /><br />Meanwhile, extreme skepticism about policy advice by apparently independent academics and experts is warranted.  We risk sliding into the cynical position that all major policy is now being made by imperial CEOs and their cronies and paid agents. 

What a Conflicted Web We Weave: More About Leaders of Financial Firms Influencing Policy in the Guise of Independent Academics

The issue of conflicted academic economists providing public policy recommendations just got bigger.  As discussed by Felix Salmon in his ...

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Mainstream Media "Discovers" Conflicts of Interest of Prominent Health Policy Pundit

The main-stream media, in this case <a href="http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2010/04/06/businessinsider-new-york-times-health-care-blogger-secretly-holds-5-million-in-health-care-stocks-2010-4.DTL">the San Francisco Chronicle</a>, just "discovered" an important case of a conflicted health policy pundit, <br /><blockquote>Uwe Reinhardt, a Princeton economic professor who often writes about health care for the New York Times' Economix blog, <em>earns more than $500,000 a year working for a number of health care companies. He also holds more than $5 million worth of related stock</em>.<br /><br />Reinhardt's <a href="http://www.nytimes.com/ref/business/economy/reinhardt.ready.html">NYT bio</a> <em>does not mention these financial relationships</em>.<br /><br />As the <a href="http://www.nytpick.com/2010/04/ethics-breach-princeton-prof-who-writes.html">NYTPicker points out</a>, Reinhardt's various incomes <em>break the New York Times rules</em>, which ban anyone who writes for the paper from having any financial interest 'in a company, enterprise or industry that figures or is likely to figure in coverage that he or she provides, edits, packages or supervises regularly.'<br /><br />We asked the New York Times for comment. They sent us this email:<br /><br />'Professor Reinhardt is a leading expert on the economics of health care, and has provided valuable and independent insights in his blog posts. He has mentioned his service on corporate boards in the blog, but we are reviewing how to more fully describe his activities for readers of Economix.'<br /><br />We also asked Reinhardt for comment. He is working on one for us and we will post it here as soon as possible.<br /><br />Here's the breakdown of what he owns, according to NYTPicker:<br /><br />* Reinhardt either earns an income or stock options from the five different private health care companies for which he sits on the board of directors/serves as a trustee.<br />* He has sat on the board of health care company, Amerigroup, since 2003. This tenure has resulted in Reinhardt's accumulation of 144,558 shares in the company and $226,531 in cash-and-stock compensation. These shares are currently valued around $4.8 million.<br />* Reinhardt also holds 75,625 shares of Boston Scientific (worth more than $500,000 in value) and earned $213,132 from the company in 2009. He has sat on the board of this medical device manufacturing company since 2005.<br />* Reinhardt serves as a trustee for H&Q Healthcare Investors and H&Q Life Science Investors. His 2008 income from the companies included $43,000 in income and between $1 and $10,000 worth of securities.<br />* He also made $2.3 million from the 2007, $5.1 billion sale of Triad Hospitals to Community Health Systems.</blockquote>It only took four years for this to get into the main-stream media. The reason "discovered" is in quotes is that we have been writing about Reinhardt's conflicts of interests vis a vis his prominent opinions on health policy since 2006 on <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a>. <br /><br />As I wrote in a comment on the original NYTPicker post, in 2006, we first <a href="http://hcrenewal.blogspot.com/2006/03/economist-puts-down-physicians-cri-du.html">wrote</a> about a letter to the editor of the NY Times by Reinhardt dismissing a physician op-ed writer's concerns about what has gone wrong with health care.  Reinhardt's letter failed to disclose the board memberships he held at that time. In 2009, we <a href="http://hcrenewal.blogspot.com/2009/01/what-ruc-prominent-health-care-policy.html">wrote</a> about how Reinhardt left out some crucial facts in his discussion in the Economix blog of how physicians are paid. That year we also <a href="http://hcrenewal.blogspot.com/2009/05/what-influenced-paean-to-karen-ignagne.html">wrote</a> about how Reinhardt defended Ms Karen Ignagni, CEO of America's Health Insurance Plans (AHIP) in an interview quoted in a Washington Post article.<br /><br />In neither case above did Reinhardt or the newspaper reveal his conflicts.<br /><br />Note that Reinhardt is not the only case of a prominent health policy expert with undisclosed conflicts of interest. See <a href="http://hcrenewal.blogspot.com/2006/03/new-species-of-conflict-of-interest-in.html">this post </a>for some examples we had found in 2006.<br /><br />In fact, in my humble opinion, the public discourse about health care policy in general, and health care reform in particular has been seriously distorted by various commentators, pundits, and experts who have major conflicts of interest, usually in the form of important financial relationships with large health care organizations.  In many cases, these conflicts are not disclosed.  A related problem is the influence of various non-profit organizations that are heavily funded by those with vested interests, usually in selling particular health care products or services.  Such funding is also rarely disclosed.  <br /><br />I further submit that this distortion has overwhelmingly been in favor of various aspects of the status quo that have been so profitable for the discussants, and their commercial sponsors.  This distortion has meant that certain important problems, especially those that we discuss on Health Care Renewal, are rarely even mentioned in the mainstream media, in journals on health care and services research and health policy, and in political discussion.  Try, for example, to find any discussion of the impact of ill-informed, self-interested, conflicted or corrupt leadership of prominent health care organizations on costs, access and quality, or on patient outcomes.  It is simply not done to discuss the shortcomings of leadership, maybe because it is this leadership who subsidizes many of the pundits, commentators and experts.  <br /><br />At a minimum, participants in the health policy discussion, starting with the most prominent, should fully disclose all financial relationships that could constitute conflicts of interest.  <br /><br />Meanwhile, those listening to the discussion should be extremely skeptical about the opinions expressed. 

Mainstream Media "Discovers" Conflicts of Interest of Prominent Health Policy Pundit

The main-stream media, in this case the San Francisco Chronicle , just "discovered" an important case of a conflicted health polic...

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BLOGSCAN - Whose Interests Does Health Care Advocacy Serve?

<span style="color:#006600;">Merrill Goozner, </span><a href="http://www.gooznews.com/archives/001390.html"><span style="color:#006600;">on the GoozNews Blog</span></a><span style="color:#006600;">, dissected recent pronouncements on health care reform by economist Uwe Reinhardt. Reinhardt compared our US "system" of financing health care with those of some other countries. He noted some advantages of the latter systems, but wondered whether US citizens would accept the trade-offs they implied. In particular, he wondered whether the US would accept the tight regulation of private insurance companies found in Germany. But he conveniently failed to note that the German plan's success may depend on its exclusive use of only not-for-profit health insurers. Mr Goozner wondered whether if this omission had to do with Mr Reinhardt's position on the board of a for-profit US health insurance company, a relationship not disclosed in Mr Reinhardt's New York Times blog post. (We have </span><a href="http://hcrenewal.blogspot.com/2009/01/what-ruc-prominent-health-care-policy.html"><span style="color:#006600;">posted</span></a><span style="color:#006600;"> before about how Mr Reinhardt's authoritative writings on health policy have not been accompanied by disclosure of his positions on the boards of several major health care corporations.) Once again, it is hard to tell whose interests prominent health care advocacy serves.</span>

BLOGSCAN - Whose Interests Does Health Care Advocacy Serve?

Merrill Goozner, on the GoozNews Blog , dissected recent pronouncements on health care reform by economist Uwe Reinhardt. Reinhardt compare...

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