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A New CEO for Independence Blue Cross

Independence Blue Cross (IBC) of Pennsylvania just announced the appointment of a new CEO after the untimely death of its former leader, G. Fred DiBona Jr. His <a href="http://www.philly.com/mld/philly/news/10622025.htm">Philadelphia Inquirer obituary </a>summarized his career before he started at Blue Cross: <blockquote>In 1976, at the age of 25, he was appointed to the Philadelphia Zoning Board of Adjustment, quickly rising to become its chairman. Two years later, Mr. DiBona was named head of the Philadelphia Port Corp. He led the agency for four years and was appointed president and chief executive officer of the Greater Philadelphia Chamber of Commerce in 1983. During his three years there, membership rose to 5,000 from 1,800. From the chamber, he moved in 1986 to Pennsylvania Blue Shield....</blockquote>The new CEO is Joseph Frick. His brief bio in the <a href="http://biz.yahoo.com/prnews/050126/phw041_1.html">IBC press release </a>includes: <blockquote>Frick, 52, had been Senior Vice President - Human Resources and Administration since 1997. In this capacity, he was responsible for corporate planning and business development, as well as IBC's Human Resources and Administrative services functions. He joined IBC in 1993 as Vice President, Human Resources, after spending almost six years in several HR positions at Philadelphia Newspapers Inc. (PNI). Before coming to PNI, Frick spent 13 years at Westinghouse Electric Corporation in various training and development, quality control and planning positions. </blockquote>Thus IBC, a huge health insurer and managed care organization with 3.5 million subscribers and $10 billion in revenue, will have had two successive CEOs with no demonstrable experience "on the ground" in health care. I received a comment on this issue from a correspondent with considerable relevant insurance and managed care experience:<blockquote>What you're seeing is typical of most businesses. This seems to me to be the result of some myopic views taught in B-schools; "you don't have to know 'THE' business, just how to run 'A' business." Similarly, some folks think just because they can "do anything," they can run a business. I'm trying to convince them that "it ain't necessarily so." </blockquote>It makes you wonder how much better off we all would be if such large health organizations had leaders who actually had experience in health care. We can only hope that Mr. Frick at least gets some input from people with real "on the ground" experience. <blockquote></blockquote>

A New CEO for Independence Blue Cross

Independence Blue Cross (IBC) of Pennsylvania just announced the appointment of a new CEO after the untimely death of its former leader, G. ...

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Ban on Federal Scientists' Consulting Nears

An article in the NY Times today on a forthcoming ban on consulting arrangements for NIH employees. Whether hard action occurs and is strictly enforced over the long haul remains to be seen. These type of scandals tend to burn brightly for awhile, then turn to more lukewarm efforts once out of the public spotlight. February 1, 2005 Ban on Federal Scientists' Consulting Nears By GARDINER HARRIS The National Institutes of Health and the Office of Government Ethicsare expected to announce a ban today on private consulting arrangements between scientists at the institutes and pharmaceutical and biotech companies. The ban comes in the wake of damaging revelations that some government scientists leveraged their positions at the institutes to gain lucrative consulting contracts with such companies, arrangements that sometimes overlapped with their government work. Dr. Elias Zerhouni, director of the institutes, emphasized in an interview last year that only 369 of the institutes' 6,000 scientists had consulting arrangements with such companies from 1999 to 2004. More than 80 percent of these scientists received $5,000 or less from outside consulting, Dr. Zerhouni said. "I want to dispel the notion here that every scientist at N.I.H. has consulting arrangements with 10 companies," he said in the interview. Dr. Zerhouni had hoped for months to preserve scientists' right to engage in some of these activities, saying a ban would turn the institutes into "a convent," which, he said, was not in keeping with Congress's insistence that its research lead to cures. But a series of articles in The Los Angeles Times detailing the conflicts between some N.I.H. scientists' public and private work and several hearings by the House Energy and Commerce Committee forced Dr.Zerhouni to retreat and finally propose late last year a ban on outside consulting activities. Since the ban was a change to government policies, it required approval from the Office of Government Ethics. That office is expected to announce today that it has approved such a ban. Representative Diana DeGette, a Democrat from Colorado and a member of the House Energy and Commerce Committee, released a statement yesterday saying that the institutes' new consulting guidelines would be "a major step toward restoring public confidence in our nation's premier research institution." Studies show that researchers who accept money from private companies are less likely than others to share the results of their work with their colleagues. Such researchers are also more likely to focus on commercially applicable studies, said Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospitalin Boston. Mildred Cho, associate director of the Center for Biomedical Ethics at Stanford University, said that academic researchers increasingly collaborated with drug and biotech companies, and that the growing number of consulting relationships between N.I.H. researchers and companies had simply reflected that trend. "What's different about this," Dr. Cho said, "is that it involves the government, government research and government funding of research. That represents a crossing of a line that hadn't been crossed before." The number of cases that have come to light so far are wide-ranging and include top-level administrators and working researchers alike. Dr. Bryan Brewer Jr., for instance, is chief of the National Heart,Lung and Blood Institute's molecular disease branch. In 2003, he wrote an article promoting the benefits of Crestor, a cholesterol-lowering medicine from AstraZeneca. The article was published in a medical journal "supplement" that was paid for by AstraZeneca, and Dr. Brewer's N.I.H. title was prominently displayed. The article failed to mention potentially serious safety problems with Crestor. In the interview last year, Dr. Zerhouni distanced himself from Dr.Brewer's Crestor article, saying that it was a "marketing effort" and "a product-driven endorsement" that should be banned. Dr. P. Trey Sunderland, a senior researcher at the National Institute of Mental Health, received more than $500,000 in consulting fees from Pfizer at the same time that he was collaborating with it in his government capacity of studying patients with Alzheimer's disease. Despite rules requiring that government scientists disclose their consulting arrangements to the health institutes, Dr. Sunderland failed to make such a disclosure. Dr. Zerhouni has described Dr. Sunderland's case as "a way outlier" that is being closely investigated. Private consulting arrangements between N.I.H. researchers and drug and biotech companies were relatively rare until the 1980's, when they slowly started to grow. They grew quickly after Dr. Harold Varmus, who was the institutes' director in the 1990's, decided to lift the limits on outside income, and administrators loosened disclosure rules about these activities. When the House began investigating, it asked Dr. Zerhouni to produce a list of agency researchers who were consulting for companies and the amounts they made. At first, Dr. Zerhouni said such a list would be impossible to produce. The committee asked pharmaceutical companies to disclose a list of their consultants at the agency. Finally, Dr. Zerhouni produced a list of consultants. But the lists produced by the drug companies included dozens of researchers who had not been listed by the institutes. Dr. Zerhouni said some of those names were errors. But, he said, the agency is investigating "30 or 40" people whose outside consulting arrangements were unknown to the institutes, and among them is Dr. Sunderland. Neither Dr. Sunderland nor Dr. Brewer could be reached. An institutes spokesman also declined to comment.

Ban on Federal Scientists' Consulting Nears

An article in the NY Times today on a forthcoming ban on consulting arrangements for NIH employees. Whether hard action occurs and is strict...

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The Doppler Effect on the Fate of NIH Whistle-Blowers

The Doppler Effect on the Fate of NIH Whistle-Blowers

See The Doppler Effect for an expanded discussion of the firing by the NIH of Dr. Fishbein after he raised questions about the Ugandan site ...

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The Managed Care View on the Vioxx Mess

On <a href="http://www.medrants.com/index.php">MedRants</a>, a commentator expressed this "managed care" view of the Vioxx mess: <blockquote>Payers are frustrated that MDs are prescribing drugs patients don’t need, driving up short term costs with no attendant benefit to patients. Meanwhile, these decisions may very well lead to additional costs, as patients suffering cardiovascular events who also took COX-2s for WC injuries seek compensation from their WC payer. The net - payers see MD prescribing behavior as abdicating responsibility, and increasing payer costs. Frustration is rampant.</blockquote>I think there is plenty of blame to spread around for the Vioxx debacle. Physicians' enthuisiasm for Vioxx and other Cox-2 inhibitors clearly went beyond the evidence. And I think some physicians believed that Cox-2 inhibitors are actually more effective than regular non-steroidal anti-inflammatory drugs (NSAIDS), without evidence to support this belief. However, before 2004, it would have taken some digging to find evidence that suggested Cox-2 inhibitors were actually dangerous. The published VIGOR trial data did show heart attack risk was higher in the Vioxx group, but this could have been due to chance alone.[1] Although the most evidence-based discussions of Cox-2 inhibitors did raise questions about cardiac risk, they offered no definitive conlusions (see the Cochrane Review[2] and ACP Journal Club[3] from 2002.) Furthermore, even the most evidence-based physician would have had a hard time discouraging a patient absolutely determined to get a Cox-2 inhibitor before 2004, especially in the context of the typical 15 minute visit during which Cox-2 may have been only one of many issues raised. Such patients were not rare, due to vigorous direct to consumer (DTC) advertisements. Managed care, of course, has to accept some blame for deluging physicians with paper-work and bureaucracy, while cutting reimbursements for office visits, thus making it financially disadvantageous for physicians to spend enough time with patients to discuss benefits and harms of treatments. Managed care, of course, likes to talk about "evidence-based medicine," but has provided little real support for clinical trials, systematic reviews, or educating physicians about evidence-based medicine. And managed care did nothing to counter all those fancy pharamaceutical DTC advertising campaigns that down-played the adverse effects of drugs, including Cox-2 inhibitors. If managed care organizations really want patients to get the best possible care based on the best possible evidence, they should provide support and incentives for physicians to take enough time with patients, and for physicians to understand, have access to, and be able to use the tools of evidence-based medicine. References [1] Bombardier C et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 2000; 343: 1520-8. [2] Garner S et al. Rofecoxib for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2002; CD003685. [3] Meyerhoff J. Rofecoxib, 25 md/d, was more effective than rofecoxib, 12.5 md/d, or acetaminophen in osteoarthritis of the knee. ACP Journal Club 2002; 137: 26.

The Managed Care View on the Vioxx Mess

On MedRants , a commentator expressed this "managed care" view of the Vioxx mess: Payers are frustrated that MDs are prescribing d...

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AdWords: Code it your way

Despite all the development we've done for our AdWords program, much more remains to be built. Fortunately there's no shortage of good ideas outside the Googleplex -- our community of users is amazingly expert and innovative and knows exactly what features they want. Many successful companies fall prey to the NIH ("Not Invented Here") syndrome, but as hard as we try, not every talented developer is <a href="http://www.google.com/jobs/eng.html">working at Google</a>. Which is why we've just announced the arrival of the <a href="http://www.google.com/apis/adwords/">AdWords API beta</a><a href="http://www.google.com/apis/adwords/">.</a> The AdWords API beta program is an open invitation to developers to explore new concepts (and then write great software) for managing Google AdWords advertising campaigns. Large advertisers can use it for their complex ad management needs, like tying product margins to optimized keyword bids. Third parties can use the API to build new interfaces to manage their client accounts. Best of all, an API enables the creation of all sorts of unanticipated ideas. In our experience, it's better to wear "Not Invented Here" as a badge of honor than as a chip on your shoulder. Come sign up for a developer token and show us what we've been missing. - Josh McFarland, Product Manager - Nelson Minar, Software Engineer

AdWords: Code it your way

Despite all the development we've done for our AdWords program, much more remains to be built. Fortunately there's no shortage of go...

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