healthy4u

Does Pharma Want its Researchers to Believe They Are Next to God?

In "<a href="http://www.nytimes.com/2009/03/20/us/20psych.html?_r=1">Drug Maker Told Studies Would Aid It, Papers Say</a>" (New York Times, Mar. 19, 2009), the Times discusses the case of psychiatrist Dr. Joseph Biederman. Dr. Biederman outlined plans to test Johnson & Johnson’s drugs including risperidone/Risperidal in presentations to company executives and seemed to guarantee positive outcomes for his studies of the drug, raising questions about his research. Biederman has become a key witness in a series of lawsuits filed by state attorneys general claiming that makers of antipsychotic drugs defrauded state Medicaid programs by improperly marketing their medicines. His work helped fuel a rapid rise in the use of these medicines in children. Biederman earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but failed to report all but about $200,000 of this income to university officials. However, if a passage about Dr. Biederman's testimony in court is correct, I believe pharma should consider whether it wants to use someone who believes they are next to God in any capacity whatsoever. There are certain damning statements that, once made by a person, cast a deep shadow over a person's character. I believe this one, if true, may rise to that level: <blockquote>In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard. “Full professor,” he answered. “What’s after that?” asked a lawyer, Fletch Trammell. “God,” Dr. Biederman responded.“Did you say God?” Mr. Trammell asked.“Yeah,” Dr. Biederman said.</blockquote> One does not usually joke in deposition. I've been Yale faculty, and would never, ever have made anything even approaching such a comment, least of all in a deposition about drug issues affecting kids. Let alone the the palm-greasing he was afforded, could Dr. Biederman's apparently hyperinflated ego have clouded his judgment and scientific objectivity? In drug R&D, that is inherently an extremely dangerous proposition. Where children are concerned, catastrophic might be a more apt term. -- SS

Does Pharma Want its Researchers to Believe They Are Next to God?

In " Drug Maker Told Studies Would Aid It, Papers Say " (New York Times, Mar. 19, 2009), the Times discusses the case of psychiatr...

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March is for hoops

As a big college hoops fan, I'm pretty excited that it's finally March. Sadly, my beloved Stanford Cardinal didn't make it to the tourney, but as a proud Arizona native, I still root for my hometown Arizona State Sun Devils. I always go a little crazy -- you might even say mad -- this time of year. I fill out my bracket, wear a lot of red and gold, and get into arguments with friends of mine from the UofA. I'm a little obsessed. If you're like me, then I have some good news for you. We have several products that can help you follow the tournament. <ul><li>Live scores when you search for your favorite team</li><li>An iGoogle gadget for following the action</li><li>Breaking news on all the tournament excitement on Google News</li><li>Local search to find a spot to watch the game </li></ul>To get you started, we put together <a href="http://www.google.com/landing/collegebasketball09/">some helpful tips</a> about using Google to keep up with the Madness. Best of luck to you and your team! Unless, of course, they're playing ASU. ;-) Posted by Nundu Janakiram, Associate Product Manager

March is for hoops

As a big college hoops fan, I'm pretty excited that it's finally March. Sadly, my beloved Stanford Cardinal didn't make it to th...

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Chrome Experiments are here

When Google Chrome launched last September, it included a powerful JavaScript engine, V8, which was built to make the next generation of web applications perform faster in the browser. In the past few months, we've reached out to more than a dozen developers and designers to experiment with V8 and to find new and fun uses for JavaScript. We worked with <a href="http://www.reas.com/">REAS</a>, <a href="http://www.mrdoob.com/">Mr. Doob</a>, <a href="http://onecm.com/">Ryan Alexander</a>, <a href="http://www.jtnimoy.net/">Josh Nimoy</a>, <a href="http://www.weareinstrument.com/#/team/mark-mahoney">Mark Mahoney</a>, and <a href="http://postspectacular.com/">Toxi</a>, among others. The results of their experimentation have been great, with each project turning the browser window into an interactive application, a game, or even a piece of art. Whether you're a casual web surfer or an advanced JavaScript developer, we think you'll appreciate what they've achieved. Here's a preview of what they have built: <object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/aZo-Uv7TZs8&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/aZo-Uv7TZs8&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object> Take a look for yourself at <a href="http://www.chromeexperiments.com/">Chrome Experiments</a>. Although you don't need Google Chrome to view the site, some of the experiments may run slower, or incorrectly, in older browsers. To download Google Chrome, click <a href="http://www.google.com/chrome?brand=CHMP">here</a>. Naturally, we're looking for more experiments. We will update the site regularly and promote the best projects as Featured Experiments. So, if you have an idea for a web browser experiment, please build it, make it sparkle, and submit it. We'll be highlighting more experiments and holding sessions on Google Chrome at <a href="http://code.google.com/io">Google I/O</a> on May 27 - 28 in San Francisco. Posted by Aaron Koblin, Google Creative Lab

Chrome Experiments are here

When Google Chrome launched last September, it included a powerful JavaScript engine, V8, which was built to make the next generation of web...

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A few not so random thoughts on Healthcare IT

A few thoughts for a Wednesday morning: <ul><li>I had recently written on some (probably) minor issues about <a href="http://hcrenewal.blogspot.com/2009/02/cchit-dissolved-involuntarily-in-april.html">CCHIT</a>, the Certification Commission for Healthcare Information Technology. However, I have more substantive concerns. I would like to know how CCHIT functions differently from a fictional "Drug Certification Commission." Imagine such a Commission founded by <a href="http://www.phrma.org/">PhRMA</a> and other pharmaceutical industry advocates, partly staffed at high levels by pharmaceutical executives, and "certifying" drugs for consumer purchase simply on the basis of their being manufactured under cGMP guidelines (current good manufacturing processes). Imagine this Commission declaring drugs "certified" without clinical trials, impartial regulatory oversight, postmarketing surveillance and in the face of equivocal studies and outright unfavorable studies showing increased risk of adverse events. How is CCHIT conceptually and substantively different from this fictional drug certification commission? </li></ul><ul><li>I would also like to know how the irrational exuberance over Health IT, vastly accelerated for reasons unclear to me by the "Economic Stimulus Bill", differs from the Madoff scandal. The "Bernard Madoff" version of HIT reality promotes the point of view that even in the face of flimsy and/or <a href="http://hcrenewal.blogspot.com/2009/03/reader-on-why-we-have-busywork.html">contradictory evidence</a>, billions of dollars in investment in today's HIT is guaranteed to reap massive rewards, no matter what. Worse than Madoff's scam, those clinicians who don't invest will be penalized. In effect, the government has now taken over Madoff's Acme Anvil EMR Securities, Inc. and is forcing everyone to invest - or else. </li></ul> -- SS

A few not so random thoughts on Healthcare IT

A few thoughts for a Wednesday morning: I had recently written on some (probably) minor issues about CCHIT , the Certification Commission fo...

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Spargel

Whenever I get the chance to practice my German with a native speaker, there is invariably a point in the conversation where we come across a word that neither of us can translate into English. At that point, the conversation typically devolves into something like the following: Native speaker: "It's a vegetable." Me: "A tomato?" Native speaker: "No, it's green and sometimes white." Me: "Lettuce?" Native speaker: "No, more like a spear." Me: "Asparagus?" Native speaker: "I think that's right. I'm not sure." These guessing games really interrupt the conversation, and sometimes you're not even quite sure you've figured out the right answer. Recently, I discovered that I can use <a href="http://images.google.com/">Google Image Search</a> as a visual dictionary and cut down on the guesswork. To get to the bottom of what spargel is once and for all, <a href="http://images.google.com/images?hl=en&q=spargel&btnG=Search+Images&gbv=2">I just searched for it</a>. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK6-xqZ2uc9n8OLzrX30t3ilMwX9MQjlny218KGAJNdoaC6glQ3XheC4H0qjDV4ujBZkCSmBkPKnOFoD-lQQBe4Eq-4_lsGe4uxygjXzcFUQCHgDf4vSpftSN2JiOc6JcE8-hea5LskToE/s1600-h/Spargel.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5314564994273362642" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK6-xqZ2uc9n8OLzrX30t3ilMwX9MQjlny218KGAJNdoaC6glQ3XheC4H0qjDV4ujBZkCSmBkPKnOFoD-lQQBe4Eq-4_lsGe4uxygjXzcFUQCHgDf4vSpftSN2JiOc6JcE8-hea5LskToE/s400/Spargel.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 111px;" /></a>Instantly I realized it's asparagus. No 20 questions, and no guesswork. So the next time you're brushing up on your foreign language skills, remember Google Image Search. It may just save you from eating <a href="http://images.google.com/images?gbv=2&hl=en&q=rosenkohl&btnG=Search+Images">rosenkohl</a>. Posted by Pete Lidwell, Product Manager, Google Zürich

Spargel

Whenever I get the chance to practice my German with a native speaker, there is invariably a point in the conversation where we come across ...

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A shiny new beta for Google Chrome

In December, <a href="http://googleblog.blogspot.com/2008/12/google-chrome-beta.html">we took the 'BETA' label off</a> our first version of the Google Chrome browser. Since then, we have continued to release fixes and updates to this version, while building and testing new browser improvements in our <a href="http://blog.chromium.org/2009/01/google-chrome-release-channels.html">developer releases</a>. Now, we're ready to roll out the <a href="http://www.google.com/intl/en/landing/chrome/beta/index.html">next </a><a href="http://www.google.com/intl/en/landing/chrome/beta/index.html">beta of Google Chrome</a> to get some early feedback on features that are still being polished. The first thing you might notice about this new beta is the speed improvement, but you'll also find additional browsing tools, such as basic <a href="http://www.google.com/support/chrome/bin/answer.py?answer=142464">form autofill</a>, <a href="http://www.google.com/support/chrome/bin/answer.py?answer=96810">full page zoom</a>, support for <a href="http://www.google.com/support/chrome/bin/answer.py?answer=95743#webpage">autoscroll</a>, and a new way to <a href="http://www.google.com/support/chrome/bin/answer.py?answer=95622#resizing">drag tabs</a> into side-by-side view. If you're already using Google Chrome and choose to install the new beta, you will update and replace the current version on your desktop. Otherwise, you can just keep on using the <a href="http://www.google.com/chrome?brand=CHMP">stable version</a>. You can find out more about this release on the brand-new <a href="http://chrome.blogspot.com/">Google Chrome Blog</a>. Posted by Brian Rakowski, Product Manager, Google Chrome

A shiny new beta for Google Chrome

In December, we took the 'BETA' label off our first version of the Google Chrome browser. Since then, we have continued to release ...

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A Primer On Why We Have Busywork Generators Masquerading as EMR's: Health IT Reality vs. the Bernard Madoff Version

As many have now observed, electronic medical records products on the market are clunky, fail to support the cognitive and workflow needs of clinicians, contribute to clinician cognitive overload and increased clerical work burden, and may be harming patients at a rate far higher than, say, VIOXX, which was summarily withdrawn from the market to be followed by billions of dollars of lawsuits. Health IT can indeed improve healthcare quality, reduce costs and achieve other benefits claimed of it, but only if it's done well. There is tremendous underlying social and technical complexity underlying those two words "done well", and unfortunately in 2009 most health IT is simply not done well. Yet the technology is actually worshipped in what I see as a Bernard Madoff syndrome, an irrational exuberance in IT for reasons not entirely clear to me considering the existing objective evidence. The motivation to learn how to truly "do HIT well" before embarking on a multi-billion dollar HIT adventure is sorely lacking -- our current approaches being inadequate per such authoritative sources as <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">the National Research Council</a>. In my transit authority safety officer-trained mind, I sense a train wreck approaching. Further, a federally pushed national HIT initiative using billions of dollars, dollars that might be better spent to prevent events like <a href="http://www.philly.com/philly/news/homepage/42841077.html">this hospital closure in an underserved area</a>, is premature. In regard to doing HIT well, usability and usefulness of EMR's have been largely stifled by traditional approaches to Health IT. Those approaches fail to adhere to "innovation" - innovation, that is, compared to traditional IT practices - that was called for by the pioneers beginning in the 1950's and 1960's. (Should I really use the term "innovation" if it's been called for now for over forty years?) Dr. Don Lindberg in 1969: <blockquote face="arial">"... computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems…in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information" (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21). </blockquote> Others such as Morris Collen, Octo Barnett, et al. published guidelines on how to best implement clinical IT that if followed would have alleviated many of the problems we have today. Sadly, they published their ideas starting in -- and perhaps even before -- the 1960's. The recommendations of the pioneers are documented in "<a href="http://www.amazon.com/exec/obidos/tg/detail/-/0964774305/qid=1111634652/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-5628970-2983252?v=glance&s=books&n=507846">A History of Medical Informatics in the United States 1950-1990</a>", by Morris Collen MD, section 3.4. For example, Octo Barnett's clinical IT "10 Commandments" (written in 1970) as reproduced in Collen's book on page 169, as well as 1960's and 70's material by Lindberg, Lamson, Collen, Davis, Baker, and numerous others address many of the substantial problems that plague health IT today. What we largely have today are "busywork generators masquerading as EMR's." I've only begun to illustrate some of the mission hostile user experiences presented by major vendor "CCHIT Certified" EHR's at <a href="http://tinyurl.com/hostileuserexper">this eight part series</a>. Below is a suggested reading list on the problems we have today. Anyone contemplating policy work in health IT should be intimately familiar with these works, as they illustrate the true HIT environment in 2009, not the Bernard Madoff "unlimited returns no matter what" version. What these articles do not illustrate is the common atmosphere of irrational exuberance and complacency now prevalent about HIT, with healthcare organizations and physicians now being pushed forcefully to adopt these technologies or suffer payment penalties they can ill afford: <blockquote style="font-family: arial;">Joint Commission: <a href="http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm">Sentinel Events Alert on HIT</a>, Dec. 2008. National Research Council report. <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">Current Approaches to U.S. Healthcare Information Technology are Insufficient</a>. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, Jan. 2009 <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15302.htm"> The National Programme for IT in the NHS: Progress since 2006,</a> Public Accounts Committee, January 2009. Summary points <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">here</a>. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">Common Examples of Healthcare IT Difficulties</a> (website). S. Silverstein, MD, Drexel University College of Information Science and Technology. <a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' "Hold Harmless" Clause - Implications for Patients and Clinicians</a>, Ross Koppel and David Kreda, Journal of the American Medical Association, 2009; 301(12):1276-1278 <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/regulation_and_oversight_hoffman.pdf">Finding a Cure: The Case for Regulation And Oversight of Electronic Health Records Systems</a>, Hoffman and Podgurski, Harvard Journal of Law & Technology 2008 vol. 22, No. 1 <a href="http://www.ncbi.nlm.nih.gov/pubmed/18213422">Failure to Provide Clinicians Useful IT Systems: Opportunities to Leapfrog Current Technologies</a>, Ball et al., Methods Inf Med 2008; 47: 4–7, <a href="http://jama.ama-assn.org/cgi/content/extract/301/9/919">IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans’ Medical Centers</a>, JAMA Mar. 4, 2009, p. 919-920. <a href="http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1506">Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System</a>, Han et al., Pediatrics Vol. 116 No. 6 December 2005, pp. 1506-1512 <a href="http://jama.ama-assn.org/cgi/content/abstract/293/10/1197">Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors</a>. Ross Koppel, PhD, et al, Journal of the American Medical Association, 2005;293:1197-1203 <a href="http://www.ctlab.org/documents/Hiding%20in%20plain%20sight.pdf">Hiding in Plain SIght: What Koppel et al. tell us about healthcare IT</a>. Christopher Nemeth, Richard Cook. Journal of Biomedical Informatics. 38 (4): 262-3. <a href="http://www.jamia.org/cgi/content/short/15/4/408">Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes and Threats to Patient Safety</a>, Koppel, Wetterneck, Telles & Karsh, JAMIA 2008;15:408-423 <a href="http://www.nytimes.com/2009/03/06/opinion/06coben.html">The Computer Will See You Now</a>, New York Times, Armstrong-Coben, March 5, 2009, <a href="http://hcrenewal.blogspot.com/2009/03/health-it-project-success-and-failure.html">Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop</a>. Journal of the American Medical Informatics Association. Bonnie Kaplan and Kimberly D. Harris-Salamone (preprint, doi:10.1197/jamia.M2997) <a href="http://iig.umit.at/efmi/badinformatics.htm">Bad Health Informatics Can Kill</a>. Working Group for Assessment of Health Information Systems of the European Federation for Medical Informatics (EFMI). <a href="http://archinte.ama-assn.org/cgi/content/short/167/13/1400">Electronic Health Record Use and the Quality of Ambulatory Care in the United States</a>. Arch Intern Med. 2007;167:1400-1405 <a href="http://archinte.ama-assn.org/cgi/reprint/165/10/1111.pdf">High Rates of Adverse Drug Events in a Highly Computerized Hospital</a>, Nebeker at al., Arch Intern Med. 2005;165:1111-1116. "<a href="http://articles.icmcc.org/2009/01/23/dutch-ehr-postponed-are-they-in-good-company/">Dutch nationwide EHR postponed: Are they in good company?</a>", ICMCC.org, Jan. 24, 2009 “<a href="http://www.ama-assn.org/amednews/2006/12/11/bisa1211.htm">Avoiding EMR meltdown</a>.” About a third of practices that buy electronic medical records systems stop using them within a year, AMA News, Dec. 2006. "The failure rates of EMR implementations are also consistently high at close to 50%", from <a href="http://www.infoclin.ca/assets/emr%20success%20methodologies%20framework%20development%20ishimr%202006%20v2.pdf">Proceedings of the 11th International Symposium on Health Information Management Research</a> – iSHIMR 2006 "Industry experts estimate that failure rates of Electronic Medical Record (EMR) implementations range from 50–80%.", from <a href="https://www.advancedmd.com/pressroom/white_papers/commonsense_to_emrs.pdf">A Commonsense Approach to EMRs</a>, July 2006 <a href="http://www.taxonomer.com/PublishTxgd001/index.htm">Adverse Effects of Information Technology in Healthcare</a>. This knowledge center presents a collection of information on the adverse effects of information technology in its application to healthcare. It also references sources of information on information security, and related media reports. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Goldfinch_pessimism_PAR.pdf">Pessimism, Computer Failure, and Information Systems Development in the Public Sector</a>. Shaun Goldfinch, University of Otago, New Zealand, Public Administration Review 67;5:917-929, Sept/Oct. 2007 </blockquote> This is a short list, but if there were such articles about VIOXX or Phen-Fen and pharma or the government not just approved but demanded they be used, (figuratively) there would have been heads rolling. There were outspoken people challenging the <a href="http://en.wikipedia.org/wiki/Bernard_Madoff">Bernard Madoff scheme</a> ... <blockquote style="font-family: arial;">... Concerns about Madoff's business had surfaced as early as 1999, when financial analyst-whistleblower <a href="http://en.wikipedia.org/wiki/Harry_Markopolos" title="Harry Markopolos">Harry Markopolos</a> informed the SEC that he felt it was legally and mathematically impossible to achieve the gains Madoff claimed to deliver. Others felt it was inconceivable that his growing volume of accounts could be competently serviced by his documented accounting/auditing firm, a three-person firm with only one active accountant.</blockquote> ... but they were just disruptive, negative, bad people. -- SS

A Primer On Why We Have Busywork Generators Masquerading as EMR's: Health IT Reality vs. the Bernard Madoff Version

As many have now observed, electronic medical records products on the market are clunky, fail to support the cognitive and workflow needs of...

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