healthy4u

Send a video message with Google Latitude

If you're like us, you never tire of finding fun ways to send a simple message (what's the challenge, after all, in just flipping open your phone?). Here's our latest idea: spell out the words with Google Latitude. <object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/h0GA73O_9O4&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/h0GA73O_9O4&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="344" width="425"></embed></object> After you watch the video, feel free to send your own Latitude message by creating <a href="http://services.google.com/latitudevideo/">a custom video</a> for a friend. You can also check out the <a href="http://googlemobile.blogspot.com/2009/04/google-latitude-ftw.html">Google Mobile Blog</a> to learn about some of the other creative ways people are using Latitude. Posted by Heaven Kim, Product Marketing Manager

Send a video message with Google Latitude

If you're like us, you never tire of finding fun ways to send a simple message (what's the challenge, after all, in just flipping op...

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BLOGSCAN - A Not So Tough Policy on Industry Interactions

BLOGSCAN - A Not So Tough Policy on Industry Interactions

On the Carlat Psychiatry Blog, Dr Daniel Carlat dissected Johns Hopkins' heralded new "tough" policy on interactions with ind...

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Designing lean, green, energy-saving machines

Last week Google hosted a <a href="http://www.google.com/corporate/green/datacenters/summit.html">Data Center Efficiency Summit</a>, bringing together approximately 160 industry leaders to share insights and best practices. Since it was April Fool's Day, we threw in a few jokes to keep the atmosphere fun (<a href="http://www.greenm3.com/2009/04/april-fools-joke-googles-oil-tanker-data-center.html">oil-cooled data center</a>, anyone?), but the topic is serious: How can the IT industry keep growing while also exercising good environmental stewardship? We disclosed for the first time details about the design of our <a href="http://www.google.com/corporate/datacenters">ultra-efficient data centers</a>. We also provided a first-ever video tour of a Google <a href="http://www.youtube.com/watch?v=zRwPSFpLX8I">container data center</a> as well as a <a href="http://www.youtube.com/watch?v=nPjZvFuUKN8">water treatment facility</a>. We detailed how we measure data center efficiency and discussed how we reduced our facility energy use by up to 85%. The engineers who developed our efficient battery backup solution even brought an actual <a href="http://news.cnet.com/8301-1001_3-10209580-92.html">Google server</a> to the event. By the end of the day, we narrowed in on a recurring theme: Reducing resource use through efficiency efforts is not just good for the environment, it saves money too. And it is this economic advantage which makes efficient data centers not just green, but truly sustainable. For a tour of a Google container data center check out the video below or watch the entire summit: <a href="http://www.youtube.com/watch?v=Ho1GEyftpmQ">part 1</a>, <a href="http://www.youtube.com/watch?v=m03vdyCuWS0">part 2</a>, and <a href="http://www.youtube.com/watch?v=91I_Ftsd-7s">part 3</a>. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/zRwPSFpLX8I&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/zRwPSFpLX8I&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object> Posted by Jimmy Clidaras, Principal Engineer

Designing lean, green, energy-saving machines

Last week Google hosted a Data Center Efficiency Summit , bringing together approximately 160 industry leaders to share insights and best pr...

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Hedge Fund U

We previously <a href="http://hcrenewal.blogspot.com/2008/12/screamer-who-got-his-way-madoff-case.html">posted</a> about how the Bernie Madoff scandal shed light on problems in the governance and leadership of one major university (which includes a well-known medical school). Yeshiva University, which includes the Albert Einstein College of Medicine, reportedly lost more than $11o million of its investments with Madoff. Not only was Madoff on the university's board of trustees, but also the chairman of the board's investment committee was hedge fund leader Ezra Merkin. Merkin invested the university's money in his own hedge funds, which, in turn, turned over the money to Madoff. This week, Merkin, who like Madoff has left the Yeshiva board, was charged with civil fraud. As <a href="http://online.wsj.com/article/SB123903070566093099.html">reported by the Wall Street Journal</a>, <blockquote> J. Ezra Merkin, a money manager who funneled $2.4 billion from universities and nonprofit organizations into Bernard Madoff's firm, was charged Monday on allegations he "betrayed hundreds of investors" by repeatedly lying to them about how he invested their money. Mr. Merkin, a New York philanthropic leader and the former chairman of finance company GMAC, raised billions of dollars for his three hedge funds, telling clients he was managing the money himself. But instead, according to a civil fraud complaint filed by New York state's attorney general, Andrew Cuomo, Mr. Merkin collected hundreds of millions of dollars in fees over more than a decade while weaving a 'panoply of lies' to conceal that he was channeling much of his clients' funds to Mr. Madoff. 'Merkin held himself out to investors as an investing guru...In reality, Merkin was but a master marketer,' Mr. Cuomo said in the complaint. Mr. Merkin, who met Mr. Madoff in 'the very late 1980s, maybe 1990,' according to his testimony, has emerged as a prominent figure in the Madoff scandal because of his stature among charities, universities, funds and even sophisticated value investors. Many of his clients were entities he courted through his social ties among monied New Yorkers. Mr. Merkin sat on the boards of some charities whose money he managed. The sales pitches for Mr. Merkin's three funds -- Ascot Partners LP, Gabriel Capital Corp. and Ariel Fund Ltd. -- included promises that he actively managed their funds, according to the complaint. Mr. Cuomo said the Ascot fund was formed by Mr. Merkin in 1992 as a 'feeder' fund for Mr. Madoff. It grew to hold $1.8 billion from 300 investors by the end of December 2008. Mr. Madoff pleaded guilty last month to using the money in a Ponzi scheme, where funds from new investors were used to pay existing ones. About 85% of investors in the Ascot fund didn't know their money was flowing largely to Mr. Madoff, Mr. Cuomo's complaint said. In two meetings with Ascot investors in his offices at 450 Park Ave. in Manhattan, it says, Mr. Merkin pointed through a glass partition to a trading area and said his staff 'right here' was doing the work of managing their money. Mr. Merkin collected an annual fee from Ascot's investors amounting to 1% to 1.5% of the fund's total assets, which included the fictitious Madoff returns, Mr. Cuomo's complaint said. By 2008, Mr. Merkin was collecting about $25.5 million a year from managing Ascot -- generating management fees of about $169 million from Ascot from 1995 to 2007, the complaint says. Mr. Merkin told investors that 60% of his Ascot fund was comprised of money that came from his personal family trusts, the complaint alleges. But all told, Mr. Merkin invested personally and through family trusts and foundations $7 million in Ascot through 1998, and less than $2 million over the following 10 years. </blockquote> Seeing how readily Madoff's institutional investors, in particular, the leadership of Yeshiva University were bamboozled, I thought maybe it was time to see who that leadership actually was. Yeshiva's current Board of Trustees is listed <a href="http://www.yu.edu/board/">here on the University web-site</a>, but without any detail about the people whose names appear there. A bit of Google searching revealed that the group included, besides Merkin and Madoff, - Morry J Weiss (chairman), who is <a href="http://spider.mc.yu.edu/news/articles/article.cfm?id=100763">on the advisory board </a>of <a href="http://www.primuscapital.com/">Primus Venture Partners</a>, a private equity firm - Sy Syms (vice chairman), who is <a href="http://www.sec.gov/Archives/edgar/data/724742/000093041308003580/0000930413-08-003580-index.htm">on the board of the Israel Discount Bank of New York</a> - Alan E Goldberg (treasurer), who is <a href="http://www.lindsaygoldbergllc.com/#/team/">co-managing partner and co-founder of Lindsay Goldberg</a>, a private equity firm - Israel A Englander, who is co-founder if <a href="http://iaenglander.com/">I A Englander & Co</a>, a financial derivatives trading firm, and founder of Millennium Partners, a hedge fund (also note that Millennium Partners and Mr Englander personally settled lawsuits in 2005 that charged they used an elaborate scheme using market timing, as per <a href="http://www.nytimes.com/2005/12/02/business/02fund.html">this NY Times story</a>) - Ruth L Gottesman, <a href="http://www.aecom.yu.edu/home/fullstory.asp?id=198">the spouse of David Gottesman</a>, the founder and senior managing director of <a href="http://investing.businessweek.com/businessweek/research/stocks/private/snapshot.asp?privcapId=4613435">First Manhattan Company</a>, an investment adviser, (and also a former chairman of the Yeshiva University board) - Lance L Hirt, another <a href="http://www.lindsaygoldbergllc.com/#/team/">partner at Lindsay Goldberg</a>, a private equity firm (see above) - Michael Jesselson, the president of <a href="http://investing.businessweek.com/businessweek/research/stocks/private/snapshot.asp?privcapId=2567724">Jesselson Capital</a>, an investment company - Henry Kressel, a <a href="http://www.warburgpincus.com/people/ViewEmployee,employeeid,69.aspx">partner and senior managing director of Warburg Pincus</a>, a venture capital company So, before the resignation of Madoff and Merkin, nine of the 40 officers and trustees of Yeshiva University were in finance, all in leadership positions (and the board also included the spouse of another financial leader). Most were not in retail banking or retail stock brokerages, but in the more exotic areas of finance that are most associated with the global economic collapse, including derivative trading, hedge funds, private equity, etc. On one hand, it would appear that a board so heavily stocked with finance leaders ought to have been sophisticated enough to do the due diligence their role required in evaluating the university's investments. On the other hand, perhaps the enrichment with finance people created a clubby atmosphere that discouraged questioning their fellow financiers too closely. That almost 25% of Yeshiva University's board was composed of finance leaders is striking, given that the <a href="http://www.bls.gov/emp/empmajorindustry.htm">US Bureau of Labor Statistics estimates </a>that less than 6% of employed people work in finance. But note that we previously <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">found</a> that 50% of the Harvard Fellows (the equivalent of their board of trustees' executive committee), and <a href="http://hcrenewal.blogspot.com/2008/11/leadership-of-elite-american-university.html">69%</a> of Dartmouth College's charter (self-appointed, as opposed to elected by alumni) trustees were leaders in the financial sector. This is somewhat anecdotal evidence, but it suggests that leaders of finance are much more prevalent among the top leadership of elite US institutions of higher education than would be explained by their prevalence in the population. This raises the question of why financial leaders seem to have become so prevalent in academic leadership. This question is important, since this prevalence seems to have increased in a time when the culture of the leadership of the financial sector seemed to become more and more alien to the values that academic leaders ought to support, culminating in a global financial collapse that many blame on the sector leaders' arrogance, greed, and sometimes outright corruption. At least it seems a reasonable hypothesis that some of the problems of academia, and particularly the problems of medical academia, may have been at least enabled by leadership more used to working in an increasingly amoral marketplace than to upholding the academic mission. We hope that there will be more interest in who now leads academia, especially medical academia, how they got there, and what they have wrought.

Hedge Fund U

We previously posted about how the Bernie Madoff scandal shed light on problems in the governance and leadership of one major university (w...

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Have we suffered a complete breakdown in the scientific method with regard to EHR and clinical IT?

Have we suffered a complete breakdown in the scientific method with regard to EHR and other clinical IT? I read announcements like this with trepidation: <div style="margin-left: 40px;"><a href="http://govhealthit.com/articles/2009/03/31/sebelius-confirmation.aspx" style="font-family: arial;" target="blank">http://govhealthit.com/articles/2009/03/31/sebelius-confirmation.aspx </a> “The goal,” Sebelius said, “is to provide every American with a safe, secure electronic health record by 2014." The nominee also endorsed efforts to use data gleaned from electronic medical records to conduct “comparative effectiveness research" (CER) to provide information on the relative strengths and weaknesses of alternative medical interventions to health providers and consumers.” </div> Recovery Act funds have been allocated to NIH specifically for comparative effectiveness research. NIH has further specified the definition of CER as: <blockquote>"[A] rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy."</blockquote> NIH states that such research may include "the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data as they apply to CER." The problems I foresee concern the word "rigorous" as in the above definition. The use of EHR data to reliably detect uncommon (but strong, discrete) early warning signals from a single drug or treatment -- to then be subject to more rigorous study with reasonable controls -- is itself a Medical Informatics "Grand Challenge." An example would be finding VIOXX's association with myocardial infarction earlier than we did, via an EHR-based automated postmarket surveillance process. Doing this is a "grand challenge" due to the nature of EHR data, which is as far from "clinical trials clean" as possible. It is what might be called highly uncontrolled. The statistical methods needed to reliably pull signals out of the muck for even a single drug are still exploratory, the problems formidable if one wants to stay scientifically sound. I wrote about the experimental nature of such efforts a few years ago <a href="http://www.scribd.com/doc/12392184/A-Medical-Informatics-Grand-Challenge-the-EMR-and-PostMarketing-Drug-Surveillance-" target="blank">here</a>, and believe an effort got underway at U. Indiana/Regenstrief to test such methodologies for postmarket surveillance about the same time. Now we have had what appears to be a leap of faith and logic of irrationally exuberant proportions, and probably a deviation from sound science as well. The government has announced enthusiasm for EHR data-based comparative effectiveness research (CER) not to aid science, but to cut costs (implying skipping the rigorous confirmatory phases) through elimination of more costly drugs and treatments deemed less effective or at effectiveness parity compared to less expensive choices. Following this thinking, perhaps in the future a metric will be developed for an "acceptable" improved benefit/cost ratio for expensive drugs that are better than cheaper alternatives? This overconfidence in EHR data is of concern. To detect relatively less concrete (i.e., than major ADE) "outcomes differences" between two or more drugs or treatments via EHR data - did treatment A lower blood pressure more than drug B, did drug C lessen depression more than drug D - rises to the level of "grand overconfidence in computing." To accomplish this task with reasonable scientific certainty from reams of EHR data, originating from different vendor systems, input by myriad people of different backgrounds with differing interpretations of terminologies (students/MD's/RN's etc) under different pressures (time, reimbursement maximization), and so forth, seems a stretch. What will the p values and predictive values be for such studies? Yet our incoming HHS secretary touts such methods? Ironically, the gold standard in medical science is the controlled clinical trial, yet EHR-based comparative effectiveness research itself as a research methodology, now touted by our government, seems to have gotten a pass. Even what I would consider minimum requirements for scientific treatment comparisons, such as well designed and reasonably controlled registries as developed <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">here for interventional cardiology</a>, with hundreds of granular, finely defined and "tuned" data elements, appear to be bypassed in EHR "miracle claims." Such precise registries take months or years to develop, implement, and train users to interact with properly. Further, such registries are not portable and must be created for individual medical domains and subdomains. Uncontrolled EHR data is no substitute for such efforts. The following question arises: Where are the comparative effectiveness studies that compare 1) EHR-based comparative effectiveness studies of drugs and treatments to 2) controlled clinical trials-based comparative effectiveness studies? In other words, where are the meta-clinical trials that compare EHR data mining-based comparative effectiveness research as a methodology, vs. the "traditional" gold standard methodology of controlled clinical trials to compare drugs or treatments? How do we know EHR-based CER studies will not produce GIGO that will cause harm through ham-fisted elimination or defunding of useful treatment options? While there are initial efforts underway to increase understanding of CER, e.g., <a href="http://grants.nih.gov/grants/funding/challenge%5Faward/High_Priority_Topics.pdf#topic_05">"Broad Challenge Area 5</a>" (PDF) of the NIH RC1 Challenge Grants in Health and Science Research, ominously, there is a lot of potential advantage to be had with terabytes of uncontrolled data and a political agenda. I fear that what will come from "comparative effectiveness research" that draws upon uncontrolled EHR data will be politics masquerading as comparative effectiveness research. Good luck to private practitioners and medical innovators. Good luck, pharma. Good luck, patients. This movement towards EHR uncontrolled data alchemy represents a further deviation from medical science towards the Syndrome of Inappropriate Over-Confidence in Computing (a.k.a. SICC Syndrome) writ large. It seems the IT industry has now rendered a scientific approach to HIT and its use obsolete. We see this "post scientific era" phenomenon in the takeover of clinical IT by vendors who contractually demand suppression of sharing of problems, we see it in a remarkably uncritical push for EMR's by 2014 now involving force of government (only financial at present, but will punitive licensure issues and other measures be off the table?) despite a growing body of literature advising caution, we see a consortium of big business/payers/vendors/myriad secondary feeder organizations gunning full blast for this technology without consideration of the possible downsides. Biomedical informatics, a scientific discipline (at least those parts of it not yet compromised by conflicts of interest), as a relevant field is very much a minority player in today's health IT. Even the contributions from experts and pioneers in the field of Biomedical Informatics, in the form of the Jan. 2009 National Research Council's report that "Current Approaches to U.S. Health Care Information Technology are Insufficient" (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">here</a>) has not had much impact. I see Biomedical Informatics' death as a relevant discipline that anyone of importance pays attention to, not too far down the road as well. -- SS Addendum April 20: We've seen this phenomenon in our economy. WSJ "Information Age" writer L. Gordon Crovitz <a href="http://online.wsj.com/article/SB124018430498933171.html">notes</a>: <blockquote>... In a paper for the scientific journal of the Royal Society back in 1994, Harvard economist Robert Merton wrote that "any virtue can become a vice if taken to extreme, and just so with the applications of mathematical models in finance practice." We know even better now that some risks can be calculated and thus reduced, while some unknowns cannot be turned into probabilities. "The mathematics of the models are precise, but the models are not, being only approximations to the complex, real world."</blockquote> I believe EMR data at best is a very loose approximation to the real world. It contains many "unknowns" regarding quality and reliability that cannot be turned into probabilities no matter how fancy the math. Asking too much of EHR data becomes a vice, not a virtue. -- SS

Have we suffered a complete breakdown in the scientific method with regard to EHR and clinical IT?

Have we suffered a complete breakdown in the scientific method with regard to EHR and other clinical IT? I read announcements like this with...

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Click-to-Buy expands to 8 new countries

Whether you come to YouTube to watch a specific video, discover related content, or engage and interact with people and videos from all around the world, our goal is to put you in control of your online video experience. This means making it easier for you to find what you're looking for (like dedicated channels for <a href="http://www.youtube.com/music">music</a> or <a href="http://www.youtube.com/browse?s=mphd">HD</a> videos) and offering you new and innovative ways to engage with that content. One way we already offer you this kind of deeper experience on YouTube involves music videos on the site: <a href="http://googleblog.blogspot.com/2008/10/i-clicked-to-buy-and-i-liked-it.html">Click-to-Buy</a>, our eCommerce platform, helps you find products (like songs and DVDs) related to the videos that you're watching. <a href="http://news.bbc.co.uk/2/hi/technology/7967908.stm">A recent study</a> found that after watching a music video on YouTube, 50% of adult users in the U.K. then go on to purchase music from that artist. And we've seen these results for ourselves — three of the four major music labels are Click-to-Buy partners and are already selling millions of songs a year from these links on YouTube. We're excited to announce that today we're rolling out Click-to-Buy links on music videos in 8 additional countries: Australia, Canada, France, Ireland, Italy, Japan, New Zealand, and Sweden. Now Click-to-Buy partners can offer music downloads to hundreds of millions of people around the world. We enjoy working with our music partners to provide them with these kinds of opportunities, and we look forward to further expanding the program in the coming months. Posted by Thai Tran, YouTube Product Manager

Click-to-Buy expands to 8 new countries

Whether you come to YouTube to watch a specific video, discover related content, or engage and interact with people and videos from all arou...

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Search the rainbow

No one likes to take work home, but lately I've been looking forward to it. That's because I've been working on our new color filter in <a href="http://images.google.com/">Google Image Search</a>, and my daughter and I have been having a great time together looking at all the colorful animals that we've seen in the tide pools. "Papa, do the <a href="http://images.google.com/images?q=sea+anemone&imgcolor=green">green noodle fish</a>." <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjiHd4AN7JA2jCcVzsSi84z-7-hZciL4mstu1HWYX0c5GJg-QvJd8es3u8OhyphenhyphenOnD8Ziu5tLLaIcEj4Z2FjLhXSvxjxxpUE4WSzRWd1lfPn1VMYu2dASmwEgMN1gnS5SxqWCYbqiChqk6dS/s1600-h/sea_anemone_green.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322371710364923394" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjiHd4AN7JA2jCcVzsSi84z-7-hZciL4mstu1HWYX0c5GJg-QvJd8es3u8OhyphenhyphenOnD8Ziu5tLLaIcEj4Z2FjLhXSvxjxxpUE4WSzRWd1lfPn1VMYu2dASmwEgMN1gnS5SxqWCYbqiChqk6dS/s400/sea_anemone_green.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 88px;" /></a> "Papa, now do the <a href="http://images.google.com/images?q=sea+anemone&imgcolor=red">red one</a>." <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjI8XH1ZzVhW0-lM_PoBHya_BlRzM3fhg5sHNb0N9bf3AyX9kkL0rvXXAk5We8crjV6Z2ShQkTHFrt7GrxqHvm-aRQ9SNe7bB9tS3KQh6Lp-EtgNZ09mbuummoQKKwvfXhKksePUVXknrq/s1600-h/sea_anemone_red.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322371711237139490" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjI8XH1ZzVhW0-lM_PoBHya_BlRzM3fhg5sHNb0N9bf3AyX9kkL0rvXXAk5We8crjV6Z2ShQkTHFrt7GrxqHvm-aRQ9SNe7bB9tS3KQh6Lp-EtgNZ09mbuummoQKKwvfXhKksePUVXknrq/s400/sea_anemone_red.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 95px;" /></a> She loves it. Today, I'm happy to announce that you too can use our color filter in your own image searches. Just search for something the way you normally would, such as [<a href="http://images.google.com/images?q=tulips">tulips</a>]. On the results page, click on the "All colors" drop down in the blue bar and choose a color. For example, try restricting your results to [<a href="http://images.google.com/images?q=tulips&imgcolor=yellow">yellow tulips</a>]. Want to see purple tulips instead? Simply click on the color filter again, select purple, and <a href="http://images.google.com/images?q=tulips&imgcolor=purple">voila</a> — you have pages of beautiful images! You can also combine the color filter with any other image filter to further refine your search. For example, if you're looking for an image of an orange butterfly, try restricting to <a href="http://images.google.com/images?q=butterfly&imgcolor=orange&imgtype=photo">photos</a> or <a href="http://images.google.com/images?q=butterfly&imgcolor=orange&imgtype=clipart">clip art</a>. Color is one of the basic visual elements of an image. Whether you're browsing through photos of sea creatures and flowers or searching for the perfect orange butterfly, we hope you like our new color filter. We've been rolling this out gradually, but it will be available to everyone soon. Posted by Donald Tanguay, Software Engineer

Search the rainbow

No one likes to take work home, but lately I've been looking forward to it. That's because I've been working on our new color fi...

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