healthy4u

Who Is Warning Us About the Perils of a Government-Run Public Health Insurance Plan?

There has been considerable discussion lately about whether the US government should offer a publicly run health insurance plan similar to the current Medicare program for the elderly and disabled. A recent report has thrown a bit of cold water on the idea, as noted in <a href="http://www.google.com/hostednews/ap/article/ALeqM5jfURxbLWn8rhtoJfttnajw7d3JswD97D7P5O0">this AP article</a>: <blockquote>A public health insurance option for middle class families could help cover the uninsured but it may well put private insurers out of business, a respected consulting firm concluded in a study released Monday. The report by the Lewin Group, a numbers-crunching firm that serves government and private clients, said it all depends on details that lawmakers are far from deciding. Nonetheless, the report could provide ammunition for critics who say a public plan would move in the direction of government-run medicine. President Barack Obama and many Democrats want to create a government insurance plan to compete with private plans that now cover about 170 million Americans. The issue is major sticking point for Republicans and the insurance industry. The Lewin study found that if such a plan were open to all employers and individuals, and if it paid doctors and hospitals the same as Medicare, the government plan would quickly grow to 131 million members, while enrollment in private insurance plans would plummet. 'The private insurance industry might just fizzle out altogether,' said John Sheils, a Lewin vice president and leading author of the study. By paying Medicare rates the government plan would be able to set premiums well below what private plans charge. Monthly premiums for family coverage would be $761 in the government plan, compared with an average of $970 in private plans, the study estimated. Employers and individuals would flock to the public plan to cut costs. </blockquote> This new <a href="http://www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%20DesignOptions.pdf">report by the Lewin group </a>also provided more ammunition to politically conservative commentators opposed to a public health insurance plan, e.g., see <a href="http://blog.heritage.org/2009/04/06/the-public-plan-threat-to-your-health-care-2/">this link</a>. I am not going to comment on the substance of the report, or the argument over the merits of a public health insurance plan, save to note that in my humble opinion, the biggest danger of such a plan would be to further exaggerate differences in payments made to primary care and other "cognitive" physicians and to physicians who mainly do procedures. We have posted before (e.g., <a href="http://hcrenewal.blogspot.com/2009/02/what-ruc-again-one-of-worlds-most.html">here</a>) on how Medicare has come to fix payments to favor procedures and disfavor primary care and other cognitive services. Increasing the number of patients covered by Medicare or a Medicare-like plan, without changing the current Medicare payment system, would only make these discrepancies worse. Note that this potential problem with the public health insurance plan was not mentioned in the Lewin Group report. Perhaps the nature of the Lewin Group influenced what this report did and did not emphasize. The group was described above as an independent consulting firm. Its <a href="http://www.lewin.com/WhyLewin/">web-site </a>says it is "a premier national health care and human services consulting firm." It also claims: <blockquote>The Lewin Group is committed to independence and integrity in our work. We combine professional expertise with extensive knowledge and a rigorous approach to analyzing and solving problems to deliver value to each of our clients and to the larger community as well. </blockquote> That's a somewhat self-contradictory assertion. It seems that delivering "value" to specific clients might be hard to do while maintaining "independence." Perhaps considering the nature of the Lewin Group's clients would clarify things. The group <a href="http://www.lewin.com/">says</a> its clients include "hospitals, health systems and providers;" "payers / insurers;" and "pharma/bio/device." The middle group seems most germane to a debate about The services provided to them include: <blockquote>The Lewin Group helps payers and insurers succeed in complex government, commercial, and long-term care markets. Based on our more than 20 years of experience, The Lewin Group offers our clients detailed understanding of the competitive marketplace and the expectations of purchasers. Based on rigorous, data-driven research, we provide our clients with actionable information grounded in practical, real-world advice. Our understanding of public policy through our work with government entities, including Medicaid and SCHIP, helps us understand how policies are shaped and how they impact our clients. With this insight, we help our clients strategize and succeed in public programs and new product offerings. </blockquote>So, the Lewin Group specifically offers to help insurers succeed in a complex market partially controlled by government. Maybe this orientation had some influence on the report they published now being used to support arguments for private, commercial health insurance. Finally, who owns the Lewin Group? The description provided in the news story above suggests it is independent, and perhaps is even not-for-profit. <a href="http://www.lewin.com/WhyLewin/">Per Lewing Group web-site</a>, it is neither: <blockquote>The Lewin Group is an Ingenix company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. </blockquote> Ingenix has been in the news lately. See our posts <a href="http://hcrenewal.blogspot.com/2009/01/unitedhealth-and-ingenix-settles.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/02/aetna-settles.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/02/wellpoint-settles.html">here</a> about legal settlements of charges that large health care insurance companies used a database created and allegedly manipulated by Ingenix to underpay out of network claims. So, the Lewin Group is a part of Ingenix, an organization that just settled claims that it manipulated data about insurance payments. Furthermore, Ingenix is in turn part of UnitedHealth. It is amazing how often UnitedHealth's antics have provided grist for the Health Care Renewal mill. See <a href="http://hcrenewal.blogspot.com/2009/01/unitedhealth-and-ingenix-settles.html">this post </a>for a summary of the company's more recent escapades. For balance, I must note that the Lewin Group web-page asserts: <blockquote> The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. </blockquote> But again, note that the focus is on making clients happy, not providing the public with unbiased knowledge. So a report being used to support arguments against government-run health insurance was published by a subsidiary of one of the largest commercial health care insurance companies and managed care organizations, a subsidiary that just settled charges that it manipulated data to increase insurance company profits. With a new administration in the White House, there is new interest in health care reform. It is not surprising that this has inspired some vigorous discussion. Nor is it surprising that some of the discussion comes from those with vested interests to protect. They have, of course, every right to make their views known. But it would be a more honest discussion if everyone were willing to put their vested interests on the table.

Who Is Warning Us About the Perils of a Government-Run Public Health Insurance Plan?

There has been considerable discussion lately about whether the US government should offer a publicly run health insurance plan similar to t...

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Enhanced Gmail and Calendar web app for iPhone and Android

Today we're happy to announce a new and improved experience when you access Gmail and Calendar through the browser of your iPhone and Android-powered devices. What's new? For Gmail, we've improved the user interface to make it easier to message on the go, and we've introduced "Floaty Bar," which makes sure common actions such as archive and delete are only a click away (check out the video tour below). You can also start the application, compose mail, and open recently read messages even when you're offline. With the new Calendar, you can edit or respond to an event and, like Gmail, the app is accessible even without a network connection. To quickly navigate between Gmail, Calendar, and other mobile applications, you can use the classic links that now always appear across the top of the screen. The "more" menu provides easy access to the full list of applications. To read more about what's new, take a look at the <a href="http://googlemobile.blogspot.com/2009/04/gmail-gets-new-engine-for-iphone-and.html">Gmail</a> and <a href="http://googlemobile.blogspot.com/2009/04/mobile-web-calendar-for-iphone-and.html">Calendar</a> posts on the Mobile blog. So you may be asking, "Why web apps?" Well, from a product perspective, web apps allow us to iterate quickly, so users benefit because they will see new features appear in the browser without having to download anything. We can experiment rapidly by learning how people use the features and then choose whether to invest further in that direction or move on. Using the browser as a delivery platform also means that users will see new feature releases happening more frequently because we can maximize our engineering efficiency by sharing code across device families. Looking at this release of Gmail, there is 90%+ code share between the Android and iPhone experience. As new devices come on the market with high-end browsers, most of the work is already done. (Hint to OEMs: you provide a world-class browser, we'll make sure Gmail and Calendar for mobile works on your platform.) To give it a try, visit gmail.com in your mobile browser. To access Calendar, click on the Calendar link at the top of the Gmail page. To make it easy to access Gmail and Calendar, we recommend creating a <a href="http://www.google.com/support/mobile/bin/answer.py?answer=31238">home screen link</a>. Please note, these web-based mobile products are only available on iPhone OS 2.2.1 or higher and on all Android-powered devices. We love feedback, so please<a href="http://www.google.com/support/forum/p/Google+Mobile?hl=en"> let us know what you think</a>. For more technical information on how we implemented these web apps using HTML5, check out the <a href="http://google-code-updates.blogspot.com/2009/04/html5-and-webkit-pave-way-for-mobile.html">Google Code blog</a>, and come visit us at <a href="http://code.google.com/events/io/">Google I/O</a>, our upcoming developer conference (May 27-28 in San Francisco). <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/v5J5sA48eV0&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/v5J5sA48eV0&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object> Posted by Shyam Sheth, Product Manager, Google Mobile

Enhanced Gmail and Calendar web app for iPhone and Android

Today we're happy to announce a new and improved experience when you access Gmail and Calendar through the browser of your iPhone and An...

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Google becomes more local

If you're like us, you're constantly looking for things in your neighborhood, whether it's [<a href="http://www.google.com/search?q=restaurants+in+zurich" id="dpr8" title="restaurants in zurich">restaurants in zurich</a>] or a new [<a href="http://www.google.com/search?q=dentist+in+houston" id="hbsb" title="dentist in houston">dentist in houston</a>]. If you specify your location in your query, we often show your results on a map. But we've noticed that much of the time users make simpler searches, like [<a href="http://www.google.com/search?q=restaurants" id="kpr1" title="restaurants">restaurants</a>] or [<a href="http://www.google.com/search?q=%20dentist" id="g2hw" title="dentist">dentist</a>]. We like to make search as easy as we can, so we've just finished the worldwide rollout of local search results on a map, which will now appear even when you don't type in a location. When you search on Google, we will guess where you are and show results near you. (Click on the image to view larger.) <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjriP12p8z2TNHZ6zuer61FNKUEMnoQN0DYERvMFQdc6WiwSyrjOkQbhuv_jGUkrbfKKNDitGUO4W4D6TTRhvGUqJZEimtPdj0WK1-_vQXAge_sucYN2msmor3qvbpv1MCDd76z2U5EtQOm/s1600-h/Picture+5.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5320497689059449426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjriP12p8z2TNHZ6zuer61FNKUEMnoQN0DYERvMFQdc6WiwSyrjOkQbhuv_jGUkrbfKKNDitGUO4W4D6TTRhvGUqJZEimtPdj0WK1-_vQXAge_sucYN2msmor3qvbpv1MCDd76z2U5EtQOm/s400/Picture+5.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 130px;" /></a>How do we guess your location? In most cases, we match your IP address to a broad geographical location. You can also specify your likely location using the "Change location" link on the top right corner, above the map. We try to make our guesses as good as they can be so that whether you're shopping for [<a href="http://www.google.com/search?q=groceries">groceries</a>], [<a href="http://www.google.com/search?q=sporting+goods">sporting goods</a>] or [<a href="http://www.google.com/search?q=flowers">flowers</a>], or looking for your [<a href="http://www.google.com/search?q=bank">bank</a>], your [<a href="http://www.google.com/search?q=gym">gym</a>], or the [<a href="http://www.google.com/search?q=post+office">post office</a>], you can just say what you want, and we'll try to find it right where you are. You can also search for specific stores or street addresses near you, like [cornelia st cafe] in New York, for example. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiR4iwI1TMcMdxhIcTmNnUGyWlP17Ycuu67huCX9nSUfczI1HOJ8hMYqfe7XK9CnVgbrGudyUCx073m5rYYeYxJzmRyk2ScDscYyb5zxv9xxXzCT8r5n4XhRZXoBhcPPFBNHVESZ0v9LRdA/s1600-h/Picture+7.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5320498178571212642" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiR4iwI1TMcMdxhIcTmNnUGyWlP17Ycuu67huCX9nSUfczI1HOJ8hMYqfe7XK9CnVgbrGudyUCx073m5rYYeYxJzmRyk2ScDscYyb5zxv9xxXzCT8r5n4XhRZXoBhcPPFBNHVESZ0v9LRdA/s400/Picture+7.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 87px;" /></a>Or [<a href="http://www.google.com/search?q=111+8th+ave">111 8th ave</a>] in New York. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVs7zswJ62IoWxdW0Ec6wMylygFQD4wXy3cbq4yZ4-WzNU1gZjjbnpxv7KgpnMesUrxJPS5AvLwZw6iyvyhVB0AA62M2C1GDRLbK1r5Hp-xYlCgBRruA1CNkMoNqrBc2BiSYfKbJW7RY9o/s1600-h/Picture+6.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5320497856139811538" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVs7zswJ62IoWxdW0Ec6wMylygFQD4wXy3cbq4yZ4-WzNU1gZjjbnpxv7KgpnMesUrxJPS5AvLwZw6iyvyhVB0AA62M2C1GDRLbK1r5Hp-xYlCgBRruA1CNkMoNqrBc2BiSYfKbJW7RY9o/s400/Picture+6.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 125px;" /></a>We hope this new feature will make it just a little bit easier for you to get where you're going. Posted by Jenn Taylor and Jim Muller, Software Engineers

Google becomes more local

If you're like us, you're constantly looking for things in your neighborhood, whether it's [ restaurants in zurich ] or a new [ ...

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India's 15th general election: tools for citizen empowerment

(Cross-posted from the <a href="http://googleindia.blogspot.com/2009/04/indias-15th-general-election-tools-for.html" style="font-style: italic;">Google India Blog</a>) At Google, we believe information is fundamentally empowering. While all of our technologies demonstrate a commitment to this guiding principle, information is especially important when a society comes together to participate in democratic elections. Beginning ten days from today, more than 700 million eligible voters in India will over the course of four weeks have the opportunity to participate in the <a href="http://eci.nic.in/press/current/pn020309.pdf">largest democratic event</a> in human history — India's 15th general election. Today, along with a <a href="http://www.google.co.in/intl/en/landing/loksabha2009/partners.html">wide range of partners</a>, we are happy to announce the launch of the <a href="http://www.google.co.in/intl/en/landing/loksabha2009/">Google India Elections Centre</a> — available in <a href="http://www.google.co.in/loksabha2009">English</a> and in <a href="http://www.google.co.in/intl/en/landing/loksabha2009/index-hindi.html">Hindi</a>. People from across India can use the centre to do the following: <ul><li> Confirm their voter registration status</li><li> Discover their polling location</li><li> View their constituency on a map</li><li> Consume relevant election-related news, blogs, videos, and quotations</li><li> Evaluate the status of development in their constituency across a range of indicators</li><li> Learn about the background of their Member of Parliament and this year's candidates</li></ul>With still more features to be added during the election, we hope the site will be an ongoing resource for analysis, governance, and democracy in India after the election. This project would not have been possible without the shared vision of a broad coalition of partners: the <a href="http://www.adrindia.org/home/index.asp">Association for Democratic Reforms</a>, <a href="http://www.htmedia.in/">HT Media Limited</a>,<a href="http://www.indicus.net/"> Indicus Analytics</a>, the <a href="http://www.janaagraha.org/">Janaagraha Centre for Citizenship and Democracy</a>, the <a href="http://www.empoweringindia.org/new/home.aspx">Liberty Institute</a>, and <a href="http://www.prsindia.org/">PRS Legislative Services</a>. These groups are the true champions of promoting a more transparent democracy, and we're privileged to be able to shine a light on their work on the occasion of India's 15th Lok Sabha polls. We're hopeful not only that the elections centre will further a culture that seeks access to information, but that it will also yield positive changes in voting patterns during the upcoming polls. Please visit the <a href="http://www.google.co.in/intl/en/landing/loksabha2009/">site</a>, select your constituency, and get started! Spread the word about what you learn and, of course, don't forget to visit the polls. Posted by Rishi Jaitly, Senior Policy Analyst, and Sanjay Jain, Product Manager

India's 15th general election: tools for citizen empowerment

(Cross-posted from the Google India Blog ) At Google, we believe information is fundamentally empowering. While all of our technologies demo...

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CVS joins Google Health Rx network: millions can access medication records online

When I first started working on Google Health, I was shocked by how hard it is for people to access their own medical records. I wondered why that's the case when it's so easy to access other types of personal information like bank transactions, cell phone records, and utility bills. In many states you can even renew your car registration online with a few clicks. Yet when it comes to something arguably much more important, such as your own medical records or a current list of medications, we have little to no access. It just doesn't seem right. We're working to solve this problem. With the recent addition of CVS/pharmacy to our network of pharmacy partners, more than 100 million people can now access their prescription history online and import it into a central, secure place — a Google Health Account. In addition to CVS, we're proud to be working with <a href="http://www.google.com/intl/en/health/downloadprescriptions/" onclick="javascript: pageTracker._trackPageview('google.com/intl/en/health/downloadprescriptions');">several other well-known national and regional pharmacy chains</a> to improve patient safety, reduce medical errors, and increase efficiencies in health care. Having a list of all your medications all in one place from the pharmacies you shop at helps your doctor, pharmacist and other care providers do a better job of taking care of you. In fact, it's estimated that <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11623" onclick="javascript: pageTracker._trackPageview('nationalacademies.org');">1.5 million Americans</a> are sickened or injured each year by errors in prescribing, dispensing and/or taking medications. Some experts suggest that medication errors claim more than 7,000 lives each year. Making your medications known to those who care for you is a simple step to ensure you get the best possible care. Not to mention, imagine how important having immediate access to this information could be during an emergency. To get started, first <a href="https://www.google.com/health/directory?cat=importrecords" onclick="javascript: pageTracker._trackPageview('google.com/health/directory?cat=importrecords');">see if your pharmacy is connected with Google Health</a>. If so, just sign up for an online account at your pharmacy's website, and then you can securely import your data into your Google Health account. Once your medication information is in Google Health, you can use our new <a href="http://googleblog.blogspot.com/2009/03/google-health-helping-you-better.html">sharing feature</a> to share it with anyone in your care network, including family members, doctors, and other caregivers. If you have pharmacy benefits through your employer or your health plan, you may also be able to import your prescription history into Google Health. We are working with two of the largest pharmacy benefit managers in the nation, <a href="http://www.medcohealth.com/medco/consumer/partner/home.jsp?partner=GGL">Medco</a> and <a href="https://www.caremark.com/wps/portal/GOOGLELANDING" onclick="javascript: pageTracker._trackPageview('caremark.com/wps/portal/GOOGLELANDING');">CVS Caremark</a>, so check your wallet to see if you have a prescription drug card from either one of them today (see examples below). If you are a Medco or Caremark member, simply log in to your online Medco or Caremark account (or register for one if you don't already have an account set up) and then link your Google Health profile to it. If you are unsure if Caremark or Medco manages your pharmacy benefits, check your prescription drug card for one of their logos, or call the number on the back of your card. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZ574tvQ4y8Ydcdxevh02Fo5gh387wgNbXZApK6LwiixpvjEgUauwEwq-oPrmFV2g7BpV61WHaO2uRKLBS7jthNGQfXHXHTpxznHz4Lw1ONlBGm8Ejd1ki2hJbNn5clihEHDeWs-2ba8pK/s1600-h/cvs-medco-idcards.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5321396990158771794" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZ574tvQ4y8Ydcdxevh02Fo5gh387wgNbXZApK6LwiixpvjEgUauwEwq-oPrmFV2g7BpV61WHaO2uRKLBS7jthNGQfXHXHTpxznHz4Lw1ONlBGm8Ejd1ki2hJbNn5clihEHDeWs-2ba8pK/s400/cvs-medco-idcards.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 144px;" /></a>Posted by Maneesh Arora, Product Manager, Google Health

CVS joins Google Health Rx network: millions can access medication records online

When I first started working on Google Health, I was shocked by how hard it is for people to access their own medical records. I wondered wh...

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5 years of Gmail

<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuq596mXTr0XFk_zzanTEMSMNoQDmHMzlgqpDhF0BCkoqZw-3QJaIj8dsAE2Bxq3MwDq-r3sOMEM0uUjVVQo9SXLe8ivXnH1m5a5fF9BZGa-DgHmIZuI8NRgqHq-iVssZxcReinytQC5lX/s1600-h/mvelope_fifth_bday_cake.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" id="BLOGGER_PHOTO_ID_5320252237763311890" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuq596mXTr0XFk_zzanTEMSMNoQDmHMzlgqpDhF0BCkoqZw-3QJaIj8dsAE2Bxq3MwDq-r3sOMEM0uUjVVQo9SXLe8ivXnH1m5a5fF9BZGa-DgHmIZuI8NRgqHq-iVssZxcReinytQC5lX/s200/mvelope_fifth_bday_cake.jpg" style="border:0pt none; margin: 0pt 10px 10px 0pt; float: left; cursor: pointer; width: 146px; height: 200px;"/></a> It was five years ago yesterday that <a href="http://www.google.com/press/pressrel/gmail.html" id="a1wp" title="Gmail started">Gmail launched</a> by giving out a gig. Back then, a typical webmail account could only store about five megabytes of mail. It's hard to remember what those days were like, considering that today, you can send a single 20 megabyte attachment, four times the size of an entire webmail account from 2004. A gigabyte of online storage may have been what got a lot of people to give Gmail a try, but changes to the email experience — like search, labels, conversation view, and strong spam protection — seem to be what kept people around. The engineers who created Gmail were frustrated with the existing email solutions, and wanted to build a better tool for people who got a lot of mail, which meant rethinking everything from the ground up. They built an architecture that was a combination of HTML and JavaScript (this later became known as <a href="http://en.wikipedia.org/wiki/Ajax_%28programming%29" id="phui" title="AJAX">AJAX</a>), which offered a smoother, faster interface. And they designed Gmail with the most demanding users in mind — Googlers who got hundreds of messages each day and power users with broadband connections, back when 56k modems were still the norm. The last 5 years have brought about a lot of change, and Gmail is now more than just mail. We added <a href="http://googleblog.blogspot.com/2006/02/chat-email-crazy-delicious.html">chat</a>, and then <a href="http://gmailblog.blogspot.com/2008/11/say-hello-to-gmail-voice-and-video-chat.html">video chat</a>. We've invested in <a href="http://gmailblog.blogspot.com/2007/10/code-changes-to-prepare-gmail-for.html">under-the-hood changes</a> that allow for the rapid development that's been happening lately in Gmail Labs — 43 experimental features in 43 weeks including <a href="http://gmailblog.blogspot.com/2008/12/new-in-labs-tasks.html">tasks</a>, <a href="http://gmailblog.blogspot.com/2009/01/new-in-labs-offline-gmail.html">offline</a>, <a href="http://gmailblog.blogspot.com/2009/03/new-in-labs-undo-send.html">undo send</a>, and even some <a href="http://gmailblog.blogspot.com/2008/10/new-in-labs-stop-sending-mail-you-later.html">silly stuff</a>. What started as internal email for Google employees is now used by more than a million companies and tens of millions of people in 52 languages. And one gigabyte doesn't feel like very much space anymore. Today's email problems are different than the problems people had five years ago, and Gmail's most demanding users continue to push it to its limits. We're getting more mail and communicating in more ways than ever before. Web browsers are getting faster and offering functionality that people could only dream of in 2004. We expect the changes over the next five years to be even more radical than those of the past five. We're already getting excited about some new stuff we're testing internally, and we'll keep you updated on our progress on the <a href="http://gmailblog.blogspot.com/">Gmail Blog</a>. Posted by Todd Jackson, Gmail Product Manager

5 years of Gmail

It was five years ago yesterday that Gmail launched by giving out a gig. Back then, a typical webmail account could only store about five ...

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In Defense of Psychiatric Diagnoses and Treatments

In Defense of Psychiatric Diagnoses and Treatments The Boston Globe is out today with a <a href="http://www.boston.com/news/local/massachusetts/articles/2009/04/02/some_who_set_policy_tied_to_industry/?page=1">story</a> about conflicts of interest involving American Psychiatric Association guidelines for treating depression, mania, and schizophrenia – disorders for which the market in medications is said to be $25 billion annually. Conflicts abound, it seems, and the consequent implication is that industry influence has led to guidelines that “focus heavily on medications and give relatively little attention to nondrug treatments.” The lead author of a forthcoming analysis, Lisa Cosgrove from the University of Massachusetts is quoted in the Globe as saying “…the lack of biological tests for mental disorders renders psychiatry especially vulnerable to industry influence." Maybe so, but it’s not just psychiatry. And this new study should not be taken to invalidate psychiatric diagnoses or to undermine the efficacy of psychiatric treatments. The existence of disease is not predicated on having a biological test. It’s nice when we do have one, but there are many disorders throughout medicine, not just in psychiatry, for which there is no conclusively defining biological test. Think migraine. Think multiple sclerosis. Think chronic pain. There is a distinguished tradition of clinical research, going back to the late 1950s, wherein disorders like depression, mania, and schizophrenia were studied for their genetic profiles, their clinically meaningful subtypes, their biological correlates, and their responses to treatments. This bottom-up approach yielded useful theories, which in turn led to better theories and to new treatments for depression, mania, and schizophrenia. Like any other branch of science, clinical science has a self-correcting function that distinguishes it from pseudo-science and propaganda. So, we welcome new theories even though most will not survive, and we welcome new diagnostic proposals and we welcome potential new treatments. All are subject to the test of independent confirmation, and nobody is surprised when many fall away. Since around 1990 that tradition has been corrupted by Pharma and Pharma’s money. There is no shortage of examples regularly in the news. Academic key opinion leaders lost their ethical compass and, with or without a figleaf, devolved into spokespersons for industry. One is reminded of Julien Benda’s term la trahison des clercs. Instead of moving on from undistinguished and problematic new drugs, key opinion leaders work with the marketing departments of Pharma to promote and defend the brand. Remember the <a href="http://www.beforeyoutakethatpill.com/2009/3/psychnet.pdf">PsychNetters</a>? Of course, psychiatry is not the only medical specialty corrupted in this way. Stents, anybody? Orthopedic devices, anybody? Lost in the marketeering and propaganda since around 1990 is the discipline of clinical therapeutics. As one <a href="http://www.margaretsoltan.com/?p=11166">commentator</a> put it, if there is no way to confirm biologically the existence of disease, then “…we cannot confirm with much confidence that this or that treatment treats mental disease.” It actually is possible to identify effective treatments for mental disease. We did it with lithium. We did it with the early antidepressant drugs. And we did it with the early antipsychotic drugs. There was room for improvement in all of these, but make no mistake – they were dramatic positive developments. Most of the work in the past 20 years, however, put marketing first and clinical therapeutics second. Humbug aside, the goal was not to improve the management of depression or mania or schizophrenia but to jump whatever bar the FDA was setting in order to get a product on the market. Indeed, the really hard clinical research issues were studiously avoided. Along the way, the clinical research enterprise became dominated by academic and for-profit contract research organizations in which, to put it gently, standards of recruitment of patients apparently suffered, so that response rates in placebo-treated patients skyrocketed. As a result, proving that a drug does work became harder, and the overall drug advantage over placebo in treating depression <a href="http://www.bmj.com/cgi/content/extract/331/7509/155">came into serious question</a>. In effect, the corruption of clinical research standards has brought us to an epistemologic quagmire about the efficacy of today’s most popular antidepressant drugs. As for the charge that psychiatrists and primary care physicians just throw drugs at mental health problems, that is nothing new. It is a reflection of the professional pragmatism that permeates medical practice. Think back to the 1950s when the new wonder drugs called antibiotics were handed out like Pez, mostly for people who did not really need them and who would not benefit from them. The working principle was misguided simplicity and pragmatism, which minimized and discounted the risks. Even today the over-use of antibiotics remains a public health concern. Just as in the 1950s patients with nonspecific upper respiratory symptoms were “given the benefit of the doubt” and were prescribed an antibiotic on the reasoning that it might help them while probably not hurting them, so today patients with nondescript depressive or anxiety symptoms are prescribed an SSRI drug on the same reasoning. The cost of this approach in wasted money, in unnecessary side effects, and in unproductive clinical management is non-trivial. So, the issues are more nuanced than today’s Boston Globe story would suggest. For good and for ill, psychiatry is not so very different from the rest of medicine. Corruption and compromise respect no subspecialty boundaries. We can have reliable and valid knowledge of disease without a biological test. We can show efficacy of treatments for disorders that lack a biological test. But when simplistic pragmatism and cutting corners dominate in therapeutics and in clinical trials, then we are in trouble.

In Defense of Psychiatric Diagnoses and Treatments

In Defense of Psychiatric Diagnoses and Treatments The Boston Globe is out today with a story about conflicts of interest involving America...

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