healthy4u

YouTube Symphony Orchestra: from idea to reality

(Cross-posted from the <a href="http://www.youtube.com/blog?entry=mjTQtrvsAP8">YouTube</a><a href="http://www.youtube.com/blog?entry=mjTQtrvsAP8"> Blog</a>) Today represents the final culmination of an idea many months in the making: a first-class global orchestra brought together by YouTube. This week, over 90 musicians from around the world -- including a Spanish guitarist, a Dutch harpist and a Lithuanian birbyne player — have gathered in New York City in preparation for tonight's historic YouTube Symphony Orchestra performance at Carnegie Hall. And today on YouTube's homepage, we are proud to present the world premiere of Tan Dun's composition "Internet Symphony, Eroica," as selected and mashed up from nearly 3,000 video submissions from around the globe. Maestro — the mash-up, please! <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/oC4FAyg64OI&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/oC4FAyg64OI&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object> Along with the "Eroica" premiere, we're also posting exclusive behind-the-scenes footage of the preparation leading up to tonight's performance. Learn more about the <a href="http://www.youtube.com/symphony">YouTube Symphony Orchestra</a> by watching candid vlogs, early rehearsals with conductor and creative director <a href="http://www.youtube.com/michaeltilsonthomas">Michael Tilson Thomas</a>, and meet-and-greets between the musicians lucky enough to participate in this once-in-a-lifetime event. Many thanks to our "Vlog Squad" team of classical musicians (<a href="http://www.youtube.com/user/alicelizard">Caeli Smith</a>, <a href="http://www.youtube.com/user/jeremydenk">Jeremy Denk</a>, and <a href="http://www.youtube.com/user/eikosudoh">Eiko Sudoh</a>), and to <a href="http://www.youtube.com/gramafilm">Harmony Films</a>, who are currently putting together a full-length documentary on the YouTube Symphony Orchestra. And for those of you who can't make it to New York in time for the big show, don't fret. We'll be posting the full performance from Carnegie Hall on YouTube tomorrow at <a href="http://www.youtube.com/symphony">www.youtube.com/symphony</a>. Posted by Michele Flannery, YouTube Music

YouTube Symphony Orchestra: from idea to reality

(Cross-posted from the YouTube Blog ) Today represents the final culmination of an idea many months in the making: a first-class global orc...

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An ARIA for Google Moderator

From time to time, our own <a href="http://emacspeak.sourceforge.net/raman/" style="font-style: italic;">T.V. Raman</a> shares his tips on how to use Google from his perspective as a technologist who cannot see -- tips that sighted people, among others, may also find useful. - Ed. Google-AxsJAX was launched in late 2007 as a library for access-enabling Web-2.0 applications. Since then, we have released accessibility enhancements for many Web-2.0 applications via the <a href="http://code.google.com/p/google-axsjax/">AxsJAX site</a> as early experiments that have eventually graduated into full-fledged products. Just recently we <a href="http://googleblog.blogspot.com/2009/04/aria-for-google-calendar-finance-and.html" id="o9.g" title="posted">posted</a> about using the AxsJAX library to provide ARIA enhancements for Google Calendar, Google Finance and Google News. Now we are happy to share an early AxsJAX extension for <a href="http://moderator.appspot.com/" id="v.:0" title="Google Moderator">Google Moderator</a> that enables fluent eyes-free use of the tool. For details about AxsJAX enhancements, see the <a href="http://google-axsjax.googlecode.com/svn/trunk/docs/faq.html">AxsJAX FAQ</a>. Briefly, you need Firefox 3.0 and a screenreader that supports W3C ARIA to take advantage of these enhancements. Users who do not have a screenreader installed can most easily experience the results by installing <a href="http://www.clcworld.net/">Fire Vox</a>, a freely available self-voicing extension for Firefox. You can activate the AxsJAX enhancement for Google Moderator either by clicking on the link that says "Click here for ARIA enhanced Google Moderator" or by <a href="http://moderator.appspot.com/?axs#16/e=1a26" id="xuh-" style="background-color: rgb(255, 255, 255);" title="accessing the ARIA-enhanced version directly">accessing the ARIA-enhanced version directly</a>. After enabling the enhancement, you can use Google Moderator via the keyboard, with all user interaction producing spoken feedback via W3C ARIA. Here is a brief overview of the experience: 1. The user interface is divided into logical panes — one listing topic areas, and the other listing questions on a given topic. At times (e.g., before a meeting), you may find an additional Featured Question pane that shows a randomly selected question that you can vote on. 2. Users can ask new questions under a given topic, or give a thumbs-up/thumbs-down to questions that have already been asked. 3. Use the left and right arrow keys to switch between the two panes. You hear the title of the selected pane as you switch. 4. Use up and down arrows to navigate among the items in the selected pane. As you navigate, you hear the current item. 5. Hit enter to select the current item. 6. The current item can be magnified by repeatedly pressing the + (or =) key. To reduce magnification, press the - key. 7. When navigating the questions in a given topic, hit y or n to vote a question up or down. 8. When navigating items in the topic pane, hit a to ask a question. Once you confirm your request to post the question, it will show up in the list of questions for that topic so that others can vote that question up or down. Please visit the <a href="http://groups.google.com/group/accessible/?pli=1">Google Group for accessibility</a> to provide feedback. This AxsJAX extension is still a work in progress, so we'd love to hear from you as we continue to work out the kinks. Update on 4/14: Clarified in the second and third paragraphs that you do not need to install this enhancement. You can access it directly from Google Moderator. Posted by Posted by T. V. Raman, Research Scientist, and Charles L. Chen, Software Engineer

An ARIA for Google Moderator

From time to time, our own T.V. Raman shares his tips on how to use Google from his perspective as a technologist who cannot see -- tips th...

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Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?

Simply amazing. One of the richest and most "leading edge" IT companies in the world with almost unlimited resources and access to expertise commits one of the most fundamental biomedical information science (a.k.a. informatics) blunders, as in the taxonomy in my post <a href="http://hcrenewal.blogspot.com/2009/03/draft-patient-rights-statement-and.html">here</a>, at the level of "likely to cause patient harm in short term if uncorrected." I have repeatedly written over at least the past ten years that applying the leadership and methodologies of business IT to clinical computing is both ill conceived and dangerous, as business computing and clinical computing are two very different computing subspecialties, the latter requiring quite specialized leadership and approaches. I've written it at <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">academic sites</a>, in magazines, in newspapers, and other venues. Yet, as we have observed at HC Renewal regarding other flavors of healthcare mismanagement and malfeasance, these words seem to <a href="http://hcrenewal.blogspot.com/2006/07/anechoic-effect-explained.html">suffer an anechoic fate</a>. Here we go again with another example of what appears to be gross mismanagement of clinical IT by business IT personnel and organizations. The following type of debacle is sooner or later going to kill patients and must end, immediately: <blockquote> Boston Globe <a href="http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt/?page=full" style="font-weight: bold;">Electronic health records raise doubt</a> Google service's inaccuracies may hold wide lesson ["may?" - ed.] By Lisa Wangsness, Globe Staff April 13, 2009 WASHINGTON - When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found. Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention." "I wondered, 'What are they talking about?' " said deBronkart, who is 59 and lives in Nashua. DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment. </blockquote> (Addendum April 19: a first hand account of this problem is at e-patients.net <a href="http://e-patients.net/archives/2009/04/imagine-if-someone-had-been-managing-your-data-and-then-you-looked.html">here</a>.) What manner of amateurs made and approved the decision to map semantically and often medically imprecise, and often deliberately overstated or misused billing codes to diagnoses, and then display the diagnostic terms to a user - ANY user, patient or "learned intermediary" - in an electronic health record? Not to mention how <a href="http://hcrenewal.blogspot.com/2009/04/masochism-medicine-and-clinical-it-how.html">poorly conceived and implemented</a> many of the HIT billing systems themselves are, making billing data even less trustworthy... <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinOXLmoUpcH2XE8DCduOm8-bnlZPwBkhOwAAGuhxIX94n-rV4NauiHoaC-UAYsXbSG3kklzXezv6MtRFqj_f9wqUXwwhtzDUA0BNY9jPABeBYPwRajgZdfEMwKnVVFb8Y9azjzxOGH44OQ/s1600-h/doh.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5324254310017454930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinOXLmoUpcH2XE8DCduOm8-bnlZPwBkhOwAAGuhxIX94n-rV4NauiHoaC-UAYsXbSG3kklzXezv6MtRFqj_f9wqUXwwhtzDUA0BNY9jPABeBYPwRajgZdfEMwKnVVFb8Y9azjzxOGH44OQ/s320/doh.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 115px; height: 146px;" /></a>Injecting humor into a most somber post, Homer succinctly summarizes the situation. </div> It is common knowledge to any competent person in healthcare informatics that doing what was done by Google Health is prone to create exactly the kind of situation that occurred. <blockquote>Insurance data, by contrast, is already computerized and far easier and cheaper to download. But it is also prone to inaccuracies, partly because of the clunky diagnostic coding language used for medical billing, or because doctors sometimes label a test with the disease they hope to rule out, medical technology specialists say.</blockquote> One does not have to be much of a "specialist" to make this realization. Almost anyone who's ever practiced medicine could probably have told Google's designers, developers and programmers this. This raises a number of questions, which also do not require a specialist to raise: <ul><li>What were the designers, implementers and management of this project thinking? </li><li>Who was leading the project? </li><li>What were there backgrounds? </li><li>Who made the decision to implement in this manner?</li></ul> Danny Sands raises the obvious: <blockquote>"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said deBronkart's primary care doctor, Daniel Z. Sands, who is also the director of medical informatics at <org idsrc="NASDAQ" value="CSCO">Cisco Systems</org>.</blockquote> Indeed. <blockquote>Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," ["could be?" - ed.] said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum. For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.</blockquote> And when such an event occurs and a patient is harmed or killed, who then is held accountable - and who is held harmless? (Oh wait ... we know the answer to that question thanks to <a href="http://hcrenewal.blogspot.com/2009/03/health-care-information-technology.html">Koppel and Kreda</a>...) This "billing data" issue and other EHR issues like it are not rocket science, they are Medical Informatics 101. I've seen such issues before, such as at "<a href="http://hcrenewal.blogspot.com/2006/08/aol-kerfuffle-information-technology.html">AOL kerfuffle: information technology vs. information science, a distinction lost at industry's peril</a>" and at "<a href="http://hcrenewal.blogspot.com/2006/10/on-intels-and-walmarts-prescription.html">On Intel's and Walmart's prescription for Healthcare IT</a>." I summed the problem up like this at the post "<a href="http://hcrenewal.blogspot.com/2008/12/biomedical-informatics-manifesto.html">A Biomedical Informatics Manifesto</a>": <blockquote style="font-weight: bold;">Biomedical Informatics as a specialty might as well be invisible. Amateurs** rule HIT.</blockquote> (** Amateur in the sense that I am a <a href="http://www.arrl.org/">radio amateur</a>, not a telecommunications professional and would not deem myself appropriate to design and run a critical telecommunications project). Perhaps, though, I should have added "amateurs rule HIT, and even worse are too often managed by incompetents." I believe Google should conduct a top to bottom investigation of the management chain and the decision making process that led to such a fiasco, which can only further erode public confidence in electronic health records at a time of national distrust in Big Business and Big Medicine. Those who made such design and implementation decisions without appropriate input from those who know better, or worse, those who might have overridden or ignored such counsel, should be dealt with appropriately. (If it were me, I'd ask for their resignation, but that's my opinion.) Clinical medicine, Electronic Health Records and patients' well being are not an information technologists' learning lab. Also of concern to me, this is the type of data our government seems to be <a href="http://hcrenewal.blogspot.com/2009/04/have-we-suffered-complete-breakdown-in.html">touting for use in Comparative Effectiveness Research</a>. (It is also of concern to me in this regard that our new Secretary of HHS was the former Kansas commissioner for insurance from 1994 to 2002, and such billing data is likely where the majority of her experience with medical datasets resides.) Finally, like the financial schemes of the past decade, I can only wonder when the computational House of Cards that is being built in healthcare as a result of the quasi-religious Syndrome of Inappropriate Overconfidence in Computing, and worship of its priests, the IT Whiz Kids and consultants to whom domain expertise is optional, will come crashing down. -- SS Addendum: A physician correspondent who wishes to remain anonymous writes (emphases mine): <blockquote style="font-family:arial;">[The Boston Globe article] could not have come at a better time. Just today, a spouse had his "home grown" PHR for his wife who was hospitalized with multiple medical problems, including advanced metastic breast cancer and complex vascular disease. He has an elaborate PHR with history, treatments, allergies, medication lists, etc. It was so impressive that when this 80ish year old patient was admitted, he gave the medication list from the computer to the physicians and nurses. It appeared so reliable that not one health care professional bothered to question it or reconcile it with the labels on the bottles (everyone is so busy nowadays clicking and scrolling the computer silos for information). As it turns out, he left out a decimal point on a dose of a potent medication that should have been 2.5 mg. The computer printed a legible list (with other errors too) stating the dose of this med was 25 mg per day (10 times too much). It was ordered that way by the doctors. It got to the pharmacy, but somewhere in this complex chain, a non physician non nurse individual got the dose to the patient correctly as 2.5 mg [fortunately, the error was caught, this time. What about next time? - ed.] Being a detective with an eye for detail and a stickler for accuracy, I happened to notice the error when the spouse was showing off his PHR to me. Again, this is one case with potentially dangerous consequences of a pervasive error generated in the PHR by flawed data entry. It was not a Google or Health Vault device, but I cannot believe that these companies have garbage filters on their devices to prevent the "garbage in, garbage out" syndrome. Good medical care is being subverted by these experimental devices. Upon scratching the surface of PHR, EMR, and CPOE devices' functional impact on the administration of medical care, the dangers are widespread. This toxicity is covered up from scrutiny by the "non-disclosures" and "hold harmless" contractual obligations described in the Koppel and Kreda report.</blockquote> One wonders how many incidents like this happen every day and are being concealed by the HIT industry and the pundits profiting handsomely from selling defective HIT devices. I am quite concerned that nobody really knows. This is not science. On a final sobering note, as the "hold harmless" and "defects gag" clauses are purged from HIT contracting, which they will most certainly be, I would suggest the many amateurs in HIT obtain some very solid liability insurance covering patient harm related to their systems and their advice. For they may just find themselves as defendants answering questions on the witness stand in front of a hungry plaintiff's attorney, a jury of average citizens, bereaved relatives of patients who were harmed via IT misadventure, and questions composed by people of my background. These questions will place the true nature of their expertise and qualifications to be tooling around with medical care under severe scrutiny. That will likely not be very pretty. -- SS April 22 addendum: In comment #15 to this post <a href="http://www.thehealthcareblog.com/" onclick="window.open(this.href);return false;" rel="nofollow">Matthew Holt</a> issued this filled with absolutes <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">ad hominem</a> comment ... <blockquote>Seriously, MedInformaticsMD, you are so pissed off with everyone in IT [everyone? - ed.] that you're now part of the problem [problem of vendors creating bad IT? - ed.] Do you seriously think that the people at BIDMC, Google and everyone else in health IT (even Cerner) just dont give a shit? [I cannot read minds. I can only see results - ed.] Or do you think that they might be trying to figure out how to solve these problems [of course they're trying to solve problems, but good intentions without requisite ability and expertise are inadequate in healthcare - ed.], and perhaps could you some constructive help. Rather than a barrage of attacks on anything they try to do. [Anything? You mean, such as <a href="http://hcrenewal.blogspot.com/2009/01/who-can-solve-hits-challenges-part-1.html">in this post praising Google</a> in areas where they do leverage their expertise properly? -ed.] </blockquote>Perhaps my direct Chairman of Medicine-after-patient-mishap tone in offering the most constructive of criticism - i.e., don't embark on medical projects in which you are over your head, find people who do know the domain and let them lead, don't release anything in medicine without appropriate, rigorous premarket trials - upset him. In addition to the inserts above, in the comments section I replied: <blockquote>I'm sorry you feel that way. I'm not sure what "problem" you're referring to, but if it's harming patients due to badly implemented HIT, I'm certainly not part of that problem. As just one example, my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" rel="nofollow">website on HIT difficulties</a> serves as a resource read <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/content/documents/FINAL_Healthcare%20IT%20Failure_Oct_19_2006.ppt">internationally</a> on how to best avoid HIT errors, has been online for a decade, and is quoted in one of the newest and best books on HIT, specifically "Medical Informatics 20/20." Did anyone at BIDMC, Google or Cerner ever read it? Did you ever read it? If not, why not? It is in fact the first link that comes up on a google search on "healthcare IT failure", for example. Do they take it seriously? If not, why not? I believe they were negligent on this project. This suggests they need to give a bit more of a s--- about their work, expecially since real, live patients are involved and the mistake made was so fundamental. Finally, see my post "<a href="http://hcrenewal.blogspot.com/2009/04/health-it-eloquence-and-software.html" rel="nofollow">A Software Engineer's Eloquence on Health IT</a>" for what I consider an attitude of someone who really does give a s--- about such matters.</blockquote> Finally, I see no links to my decade-old academic <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">website on HIT difficulties</a> over at <a href="http://www.thehealthcareblog.com/">Matthew's blog</a>. One wonders why. It may have to do with a tension between the statement that "the Health Care Blog (THCB) has acquired a reputation as one of the most respected <a href="http://matthewholt.typepad.com/the_health_care_blog/2005/01/about_the_healt.html">independent voices in the healthcare industry</a>" and the post "<a href="http://www.thehealthcareblog.com/the_health_care_blog/2009/04/thcb-would-not-be-possible-without-the-generous-support-of-our-sponsors-thanks-to-our-latest-sponsor-sage-software.html">A Shout out to our sponsors</a>." Healthcare Renewal has no sponsors and does not take advertising. We report, you decide. -- SS

Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?

Simply amazing. One of the richest and most "leading edge" IT companies in the world with almost unlimited resources and access t...

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Hedge Fund U, Version 2

We have posted frequently on the governance and leadership of academic medical organizations. While one would think that health care organizations, and especially academic health care organizations ought to be held to a particularly high standard of governance, we have noted how their governance is often unrepresentative of key constituencies, opaque, unaccountable, unsupportive of the academic and health care mission, and not subject to codes of ethics. How the governance of organizations with such exemplary missions and sterling repuations got this way has been unclear. In 2007, we <a href="http://hcrenewal.blogspot.com/2007/09/oceania-in-new-hampshire.html">reported</a> on one famous institution which had a more representative, transparent, and accountable form of governance. Let me provide a <a href="http://www.thefire.org/index.php/article/10355.html">summary</a> of the background from <a href="http://www.thefire.org/">FIRE</a>, the Foundation for Individual Rights in Education, <blockquote>For over a century, <a href="http://www.thefire.org/index.php/schools/979" title="http://www.thefire.org/index.php/schools/979 blocked::http://www.thefire.org/index.php/schools/979 http://www.thefire.org/index.php/schools/979">Dartmouth College</a> provided alumni with an avenue for direct participation in selecting leadership, with eight of the 18 members of Dartmouth's Board of Trustees coming from popular vote (the other ten were appointed by the Board). Starting in 2004, petition candidates—those who had to gather alumni signatures to be nominated—<a href="http://www.thefire.org/index.php/article/5400.html" title="http://www.thefire.org/index.php/article/5400.html blocked::http://www.thefire.org/index.php/article/5400.html http://www.thefire.org/index.php/article/5400.html">challenged</a> those selected by the Association of Alumni in the annual trustee elections. Alumni <a href="http://www.thefire.org/index.php/article/5645.html" title="http://www.thefire.org/index.php/article/5645.html blocked::http://www.thefire.org/index.php/article/5645.html http://www.thefire.org/index.php/article/5645.html">responded</a> in kind: over the next four years, four petition candidates were elected to the Board of Trustees. These trustees spoke out when they perceived their alma mater as not living up to its mission, and Dartmouth students benefited. In May 2005, the college <a href="http://www.thefire.org/index.php/article/5624.html" title="http://www.thefire.org/index.php/article/5624.html blocked::http://www.thefire.org/index.php/article/5624.html http://www.thefire.org/index.php/article/5624.html">repealed</a> its speech code, and it immediately moved from FIRE's "<a href="http://www.thefire.org/pdfs/5622_3832.pdf" title="http://www.thefire.org/pdfs/5622_3832.pdf blocked::http://www.thefire.org/pdfs/5622_3832.pdf http://www.thefire.org/pdfs/5622_3832.pdf">red-light</a>" rating and became a <a href="http://www.thefire.org/index.php/codes/979" title="http://www.thefire.org/index.php/codes/979 blocked::http://www.thefire.org/index.php/codes/979 http://www.thefire.org/index.php/codes/979">'green-light</a>' institution.These developments did not please everyone, however. Some campus officials viewed the propensity of petition candidates to voice their opinions on illiberal policies as detrimental to the school's image. The Wall Street Journal <a href="http://www.opinionjournal.com/editorial/?id=110010549" title="http://www.opinionjournal.com/editorial/?id=110010549 blocked::http://www.opinionjournal.com/editorial/?id=110010549 http://www.opinionjournal.com/editorial/?id=110010549">profiled</a> T.J. Rodgers, a petition-nominated trustee, who explained the criticisms leveled at the 'divisive dissidents.'>> If 'divisive' means there are issues and we debate the issues and move forward according to a consensus, then divisive equals democracy, and democracy is good. The alternative, which I fear is what the administration and [Board of Trustees Chairman] Ed Haldeman are after right now, is a politburo-one-party rule. <<As the petition candidates <a href="http://www.thefire.org/index.php/article/5645.html/" title="http://www.thefire.org/index.php/article/5645.html/ blocked::http://www.thefire.org/index.php/article/5645.html/ http://www.thefire.org/index.php/article/5645.html/">grew in numbers</a> (including George Mason Law Professor Todd Zywicki), so too did the <a href="http://www.thefire.org/index.php/article/9462.html" title="http://www.thefire.org/index.php/article/9462.html blocked::http://www.thefire.org/index.php/article/9462.html http://www.thefire.org/index.php/article/9462.html">official criticism</a>. After Zywicki expressed disagreement with Dartmouth's leadership, the Board's chairman responded.Haldeman and his cohorts wrote in a statement on the board's Web site that Zywicki 'violated his responsibilities as a trustee of Dartmouth College, which includes acting in the best overall interests of Dartmouth and representing Dartmouth positively in words and deeds.' It was clear that a frank discussion of the issues at Dartmouth was not welcome on the governing board. The Trustees thus moved to alter the playing field. In September 2008, the Board declared that it would <a href="http://thedartmouth.com/2008/09/06/news/boardupdated/" title="http://thedartmouth.com/2008/09/06/news/boardupdated/ blocked::http://thedartmouth.com/2008/09/06/news/boardupdated/ http://thedartmouth.com/2008/09/06/news/boardupdated/">add five new positions</a>—all hand-picked by current Trustees. The century-long tradition of parity between alumni-elected Trustees and the self-perpetuating Board members was erased. It came as no surprise when the Association of Alumni <a href="http://thedartmouth.com/2009/01/27/news/aoa/" title="http://thedartmouth.com/2009/01/27/news/aoa/ blocked::http://thedartmouth.com/2009/01/27/news/aoa/ http://thedartmouth.com/2009/01/27/news/aoa/">announced</a> in January that the 2009 election would feature no petition candidates. </blockquote> In 2007, what really got our attention was the stated rationale for this push towards less representative and accountable governance. Mr Haldeman, the chairman of the board of trustees, announced a smaller proportion of elected trustees would ensure that the board "has the broad range of backgrounds, skills, expertise, and fundraising capabilities needed," and that the board members would possess "even more diverse backgrounds." Yet when we examined the backgrounds of the current charter trustees, we found that they exhibited little diversity. Remarkably, three-quarters (6/8) were in leaders of the finance sector. In 2007, they seemed not very diverse, but why the majority should be in the financial sector, and what implications that had, was then obscure. Things have changed. In the fall of 2008, the world economy descended into an unprecedented financial collapse. Many concluded that the global economic collapse was caused by arrogance, greed, and corruption within the financial sector. This suggested that leadership of academia, and academic medicine in particular, by leaders of the finance sector might not, in retrospect, have been a such a good idea. Furthermore, when we had other occasions to look, we found that Dartmouth College was not an isolated case. We <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">noted</a> that half of the Fellows of Harvard, the university's equivalent of a board of trustees, were from finance, and two were affiliated with corporations at the center of the global financial collapse. We recently <a href="http://hcrenewal.blogspot.com/2009/04/hedge-fund-u.html">found</a> that almost 40% of the board of Yeshiva University were from finance as of the end of 2008. One former board member was Bernie Madoff, now in jail for running a giant Ponzi scheme disguised as an unregistered hedge fund. Yeshiva lost $110 million of its investments with Madoff. Another former member was indicted, accused of fraudulently abetting Madoff's operations. One current member runs a hedge fund that had to pay $180 million to settle other fraud allegations. So we raised the 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. Simultaneously, a <a href="http://chronicle.com/weekly/v55/i31/31a06001.htm">commentary </a>in the Chronicle of Higher Education put it this way, <blockquote> Most college and university boards are composed largely of wealthy people, usually from the worlds of finance, law, and private enterprise. They are sometimes alumni but are often selected for their personal capacity to give, their links to other people who might give, or their historical record of having given. Many trustees today have in fact been part of the elite sectors of finance, law, and enterprise that have proven improvident, shortsighted, and badly governed. Can they be seen as the wisest of our wise who will bring both generosity and wisdom to the academy? </blockquote> News items from last week, some generated by release of financial disclosure forms from new members of the current US administration, add insight into what now appears to be a pervasive web of entanglements among academia and the finance sector. One set of stories was about Lawrence Summers, now chief economic advisor to the US President, but president of Harvard University from 2001-2006. Just after resigning as president, and while still a <a href="http://www.hks.harvard.edu/about/faculty-staff-directory/lawrence-summers">professor at the university's Kennedy School of Government</a>, Mr Summers suddenly began lucrative relationships with multiple players in the financial sector. <a href="http://www.nytimes.com/2009/04/06/business/06summers.html">Per the New York Times,</a> Mr Summers assumed an amazingly well-paid part-time position at a hedge fund, <blockquote>Mr. Summers, the former Treasury secretary and Harvard president who is now the chief economic adviser to President Obama, earned nearly $5.2 million in just the last of his two years at one of the world’s largest funds, according to financial records released Friday by the White House. Impressive as that might sound, it is all the more considering that Mr. Summers worked there just one day a week. Much is known about Mr. Summers’s days in Washington and Cambridge, but little attention has been paid to his two years in New York, from late 2006 to late 2008, advising an elite corps of math wizards and scientists devising investment strategies for D. E. Shaw & Company. </blockquote>Mr Summers also collected prodigious speaking fees from many financial corporations, some of which subsequently failed or had to be bailed, out, as <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/04/03/AR2009040303732.html">per the Washington Post</a>, he <blockquote>was paid more than $2.7 million in speaking fees by several troubled Wall Street firms and other organizations. Financial institutions including JP Morgan Chase, Citigroup, Goldman Sachs, Lehman Brothers and Merrill Lynch paid Summers for speaking appearances in 2008. Fees ranged from $45,000 for a Nov. 12 Merrill Lynch appearance to $135,000 for an April 16 visit to Goldman Sachs, according to his disclosure form. Summers reported donating two fees totaling $70,000, including the payment from Merrill Lynch, to charity. </blockquote>Summers received all this money why he was still a faculty member at Harvard. As noted by the Washington Post, he did not leave his faculty position there until 2009. Although there is no evidence that Summers had financial relationships with corporations in the finance sector while president of Harvard, his sudden and very lucrative jump into that sector after leaving the presidency, and while nominally a full-time faculty member, suggests at least a major alignment of interests. Some commentators have made this point more forcefully, for example, <a href="http://www.thenation.com/doc/20090420/scheer?rel=hp_picks">Robert Scheer in the Nation</a>, <blockquote> Not surprisingly, Lawrence Summers is convinced that he deserved every penny of the $8 million that Wall Street firms paid him last year. And why shouldn't he be cut in on the loot from the loopholes in the toxic derivatives market that he pushed into law when he was Bill Clinton's treasury secretary? No one has been more persistently effective in paving the way for the financial swindles that enriched the titans of finance while impoverishing the rest of the world than the man who is now the top economic adviser to President Obama. </blockquote> Perhaps this alignment was related to charges that while president of Harvard, Summers helped stifle someone who tried to blow the whistle on excessively risky investment practices involving financial derivatives at the Harvard Management Company. <a href="http://www.thecrimson.com/article.aspx?ref=527380">Per the Harvard Crimson</a>, <blockquote> After a year-long stint at a European investment bank and another at Enron, Iris M. Mack signed on to be a quantitative analyst for Harvard Management Company in early 2002, hoping, she says, to find job security and distance from the risky trading and accounting practices that forced her last employer into bankruptcy in the company charged with managing Harvard’s endowment. But only a few months later, Mack says she was fired after she raised concerns to University officials about managers’ qualifications and possibly irresponsible usage of financial instruments that could have contributed to the recent and sudden decline in Harvard’s endowment. In an e-mail sent May 30, 2002 to Marne Levine, chief of staff for then-Harvard President Lawrence H. Summers, Mack detailed her concerns regarding what she deemed HMC’s 'frightening' usage of derivatives and statistical modeling techniques, as well as the Company’s lack of a timely and portfolio-wide risk management system, high employee turnover rate, and low level of productivity in the workplace, specifically among managers. According to documents and e-mail records, all provided by Mack, Levine had initially assured Mack that their correspondence would remain confidential. But on July 1, HMC chief Jack R. Meyer called Mack into a meeting, in which she was presented with copies of her e-mails, according to a letter sent to Levine and Summers by Mack’s attorney. The next day, Meyer dismissed Mack, pointing to 'these baseless allegations against HMC [that you sent] to individuals outside of HMC,' the letter says. Ultimately, Mack says she reached an out-of-court settlement with Harvard over her firing because her lawyers felt that the University did not want to attract media attention from the dismissal.... Now, with the economy in an unprecedented slump in part due to the widespread and unregulated use of derivative contracts, Mack says she feels 'vindicated' but also sad. 'I’m not trying to pretend I’m omniscient or anything, but a lot of people who were quantitative traders, in the back of our minds, we knew a lot of these models were just that: guestimates,' Mack says. 'I have mixed feelings, on the one hand, I wasn’t crazy, I knew what I was talking about. But maybe if more and more people had spoken up, the economy wouldn’t be the way it is now.' </blockquote> So now we wonder whether the poor governance practices, and resultant poor leadership of many academic health care institutions may have resulted from the increasing dominance of the governance of these organizations by people from the "improvident, shortsighted, and badly governed" finance sector?

Hedge Fund U, Version 2

We have posted frequently on the governance and leadership of academic medical organizations. While one would think that health care organiz...

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Will it lens?

Not long ago, a bunch of us in our <a href="http://maps.google.com/?q=604+Arizona+Ave%2C+Santa+Monica%2C+CA+%28Google+Santa+Monica%29">Santa Monica office</a> pooled together the money to buy a four-foot by three-foot <a href="http://en.wikipedia.org/wiki/Fresnel_lens">Fresnel lens</a>. We've since been spending our lunch hours out in the sun playing with it. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGrc6e7MqD0cXDQJ-EsLM25_PV2_LbpRiEuSnWUghW-WSRQgA8SnpxwiXxhlavc45UeCl8TR8KtO2xrHHvqeVw6TB2VtNf7qqorr6OtePPK7t9_i5t_DoMWz8Mw6my0RO6oOrAnRIZLeCv/s1600-h/first+day.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812932029818850" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGrc6e7MqD0cXDQJ-EsLM25_PV2_LbpRiEuSnWUghW-WSRQgA8SnpxwiXxhlavc45UeCl8TR8KtO2xrHHvqeVw6TB2VtNf7qqorr6OtePPK7t9_i5t_DoMWz8Mw6my0RO6oOrAnRIZLeCv/s400/first+day.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" /></a> A normal lens this big would be several feet thick and weigh a proverbial ton (the right-hand image below). However, it's possible to remove much of the inside of a lens and collapse down the shape without introducing too much distortion (the left-hand image): <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFv0stjbEmVcfYEFhL6E5ZarKQ7bSSMGpprrlOFacsV8NzoasBXwETzb45MLqFWrkvTcFu8sWOWLzipgiyxkdOnECHxM90zqnPmmvMVNC0_b7na5gkOpBajx9nKXhVfMfgI3PlwBaj7hf5/s1600-h/401px-Fresnel_lens.svg.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812928721086178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFv0stjbEmVcfYEFhL6E5ZarKQ7bSSMGpprrlOFacsV8NzoasBXwETzb45MLqFWrkvTcFu8sWOWLzipgiyxkdOnECHxM90zqnPmmvMVNC0_b7na5gkOpBajx9nKXhVfMfgI3PlwBaj7hf5/s400/401px-Fresnel_lens.svg.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 267px; height: 400px;" /></a>Fresnel (pronounced "freh-NELL") lenses are used in overhead projectors and lighthouses. We've been using ours, however, to see what happens when you focus 1,000 watts of sunlight onto a single point. It's like when you were a kid and tried to burn ants with a pocket magnifying glass — but 400 times stronger. We built a wooden frame to keep the lens flat and focused, and a stand to hold it steady: <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFupQP3PaAHKGNfO6YG_npMtMs005AnziI-C5tvQ0gX_7K2rdv54VAxIulay3tnT5YgizvNCiZ8kcFLaSrfbjBFqyzmThaCtApbk75v05Cj7dFwF5wXTX5A7sJjXrcmAJ6DciwAp2yVJLh/s1600-h/alternative+lens+stand+2.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812929088300530" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFupQP3PaAHKGNfO6YG_npMtMs005AnziI-C5tvQ0gX_7K2rdv54VAxIulay3tnT5YgizvNCiZ8kcFLaSrfbjBFqyzmThaCtApbk75v05Cj7dFwF5wXTX5A7sJjXrcmAJ6DciwAp2yVJLh/s400/alternative+lens+stand+2.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 400px;" /></a>The light in the focal point is so bright that you can't look directly at it without welding goggles. </div> The lens maker claimed you could melt a penny with it, so that was the first thing we tried: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgSqeRs_zvYfXEwnEyurvP1R2lHuhP_C5CPvzQEH9OGC02e-kKC_KP80hPNJrrdUGJk_eiRc268GluQH-d4r9dfD-z9WTqCYjx_bz4F-ZZ79fLBdYi8tbbSE-WGdQgFe61Ko0UZwPHKsYJ/s1600-h/pennies.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812461074296450" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgSqeRs_zvYfXEwnEyurvP1R2lHuhP_C5CPvzQEH9OGC02e-kKC_KP80hPNJrrdUGJk_eiRc268GluQH-d4r9dfD-z9WTqCYjx_bz4F-ZZ79fLBdYi8tbbSE-WGdQgFe61Ko0UZwPHKsYJ/s400/pennies.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" /></a> Modern pennies are made of zinc with a copper coating. The bottom row shows what happens when you put a penny in the focal point of the lens: the inside melts away and the coating stays intact (zinc melts at 693 <a href="http://en.wikipedia.org/wiki/Kelvin">kelvins</a>, copper melts at 1,356 K). But if you heat it just enough, the metals mix and you make brass (the gold-colored penny in the middle). Older pennies (those minted before 1982) are almost entirely copper, so they didn't melt (top row). We also had an aluminum can: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgefKqEltPXRYnVpNtcgUA8lhZdfoIdsESlwyo_6S9-FXctXyd9mP3JcALnqVkSfAZfKzKHSa-6R76_QuthGzvRv1CwD9jTX3B1epjrvBHnBuDsWQYX78d2cO7qRijlNCa2fHO2otSewUeD/s1600-h/can.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812469214949410" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgefKqEltPXRYnVpNtcgUA8lhZdfoIdsESlwyo_6S9-FXctXyd9mP3JcALnqVkSfAZfKzKHSa-6R76_QuthGzvRv1CwD9jTX3B1epjrvBHnBuDsWQYX78d2cO7qRijlNCa2fHO2otSewUeD/s400/can.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 400px;" /></a> The water we poured in boiled quickly, while the can itself became so brittle that we poked holes through it with nothing more than sunlight. Then we tried cooking. Popcorn did both what you'd expect and not quite what you'd expect: when you really focus the light on it, it kinda pops but mostly burns. However, if you don't put it directly in the focal point, so the light is spread over a larger area and doesn't heat it up as quickly, you can get a whole bunch of kernels to pop without burning too much. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA8qTDDwYea-J4Z8hQoFZ9TQWUXCf2D-3wn3Ltxzvj3Mso4l8AhPWPmdfO4uGuFFAPDmm6DVaLqt4919ob5IGfuMXu3bl6XSTaD3b9DrWj5X3aHocpSbloCVGvpGEsXSRuHqiv5xZCrp2f/s1600-h/popcorn+cooking.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812467866512130" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA8qTDDwYea-J4Z8hQoFZ9TQWUXCf2D-3wn3Ltxzvj3Mso4l8AhPWPmdfO4uGuFFAPDmm6DVaLqt4919ob5IGfuMXu3bl6XSTaD3b9DrWj5X3aHocpSbloCVGvpGEsXSRuHqiv5xZCrp2f/s400/popcorn+cooking.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" /></a> The steam/smoke coming up from the kernels really highlighted the spectra from the lens beautifully. Our yield was very low (lots of unpopped kernels for each popped one), but at least we had real popcorn! <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxNIz3WAZTDxGYyEu8xSp9sGhUnCDNrp2PK09ikOwVJMm5YGKAi71NKYnBSfDYAjdSWTXamO16S_1Cv1Ao_p6NmFslU329hj-u1U5V1kTlP5fsAkvrK7-NZz3cHsPhfUMx1D8CmwaXMU7S/s1600-h/finished+popcorn.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812466365970994" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxNIz3WAZTDxGYyEu8xSp9sGhUnCDNrp2PK09ikOwVJMm5YGKAi71NKYnBSfDYAjdSWTXamO16S_1Cv1Ao_p6NmFslU329hj-u1U5V1kTlP5fsAkvrK7-NZz3cHsPhfUMx1D8CmwaXMU7S/s400/finished+popcorn.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" /></a> When we tried to cook bacon, about a third ended up well done, a third was burnt, and a third was uncooked. Cooking with the lens is difficult because it heats stuff up too hot too fast. But the well-cooked parts tasted great, so we added an egg: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjivcszX48n9O4wH0WjoD589W6NILkz5jnyq48jJaLJzGjFVVaacnqILIRrti3utsiYmSbIhooCkWIg181BFIXgym7aP6ZLS4s9IODNsf8k8Ou-inBCgNIngMu1c0F3DyX_lrbGFtUJufoK/s1600-h/bacon.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322812473237975682" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjivcszX48n9O4wH0WjoD589W6NILkz5jnyq48jJaLJzGjFVVaacnqILIRrti3utsiYmSbIhooCkWIg181BFIXgym7aP6ZLS4s9IODNsf8k8Ou-inBCgNIngMu1c0F3DyX_lrbGFtUJufoK/s400/bacon.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 400px;" /></a> (We didn't lens the spoon; we used it to eat the egg afterwards.) It's been fun experimenting with different lensing techniques and items and we've learned a lot (including where the nearest fire extinguisher is!). These are just the highlights — we've lensed gourds, soap, gummy bears, CDs — you name it. Next on our list: marshmallows! We've got more details and more pictures of our results on <a href="http://big-bad-al.livejournal.com/103588.html">Alan's personal blog</a>. If you have ideas of other things we should try lensing, we'd love to hear suggestions. Posted by Alan Davidson and Dustin Boswell, Software Engineers

Will it lens?

Not long ago, a bunch of us in our Santa Monica office pooled together the money to buy a four-foot by three-foot Fresnel lens . We've ...

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Mosaic: bringing diverse perspectives together

This is the next post in our <a href="http://googleblog.blogspot.com/search/label/diversity">Interface series</a>, which takes a look at valuing people's similarities and differences in the workplace. For more information on how Google fosters an inclusive work environment, visit <a href="http://www.google.com/support/jobs/bin/static.py?page=about.html">Life at Google</a> on our Jobs site. – Ed. Since joining Mosaic, our diversity initiatives group in the <a href="http://maps.google.com/?q=5+Cambridge+Center%2C+Cambridge%2C+MA+%28Google+Cambridge%29">Boston office</a>, we've seen firsthand how even a small group of Googlers dedicated to a cause can make a real difference. Mosaic was created in 2007 when a few Boston Googlers were talking informally over lunch about how to increase the diversity in our rapidly growing office. Since then, we've made great strides in growing our membership and highlighting the creativity and varied experiences of our colleagues. The idea even spread to other Google offices, with several Mosaic chapters opening across the U.S. Over the past year, Mosaic Boston has participated in Google's university recruitment efforts by holding three open houses to encourage traditionally underrepresented students from the Boston area to apply for careers at Google. This past summer, we hosted two enthusiastic interns as part of <a href="http://www.google.com/support/jobs/bin/static.py?page=bold.html">Google's BOLD</a> (Building Opportunities for Leadership & Development) diversity internship program to explore opportunities in the technology industry. We watched their leadership skills grow as they organized events such as a career panel and product demos for high school students through Mosaic. Most recently, we co-hosted a lunch-and-learn with esteemed Harvard Business School professor <a href="http://drfd.hbs.edu/fit/public/facultyInfo.do?facInfo=bio&facEmId=dthomas">David Thomas</a>, co-author of "Breaking Through: The Making of Minority Executives in Corporate America." Down-to-earth and engaging, Professor Thomas presented his findings about minorities and women who had "made it" in corporate America, stressing the need to build wide networks of support, find strong mentors and develop a niche within a company that meshes with one's personal values. His message reminded us of how important it is for Mosaic to provide these opportunities for our own community here at Google. You can <a href="http://www.youtube.com/watch?v=hGPyU1cJAaM">watch the video</a> from his visit on the Authors@Google YouTube channel. As both Googlers and members of Mosaic, we feel empowered and excited to live out our values in our workplace. To us, this means anything from inviting authors to speak and training non-profits on how to use Google Apps, to throwing a Brazilian Carnaval-themed edition of our weekly company meeting complete with <a href="http://www.youtube.com/watch?v=H3B9V0axCpU&feature=channel_page">capoeira performers</a>, caipirinhas, and authentic Brazilian food. We're excited about what Mosaic has accomplished so far and can't wait to see what's next. In the meantime, we continue to be committed to providing personal and professional growth for the members of our diversity group, as well as doing our part to keep Google an inclusive place to work. <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcI2dvP_3npKQntAHj0ZTNvmPcIZP_cKRqtCXn-127SojQ8K_0oDJtT6ZHOCykAstWAlZ9FFE1UzSQhND9qUE_oIedKE99ggCr9HteXb-HzMxXYMkyDtyxnX2Bnhf5_j98svyBLeaEzibu/s1600-h/DSCN2341.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322805217330592034" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhcI2dvP_3npKQntAHj0ZTNvmPcIZP_cKRqtCXn-127SojQ8K_0oDJtT6ZHOCykAstWAlZ9FFE1UzSQhND9qUE_oIedKE99ggCr9HteXb-HzMxXYMkyDtyxnX2Bnhf5_j98svyBLeaEzibu/s400/DSCN2341.JPG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 300px;" /></a>Boston Mosaic team with capoeira performers </div> Posted by Priti Sanghani and Mariam Shaikh, AdWords Account Associates

Mosaic: bringing diverse perspectives together

This is the next post in our Interface series , which takes a look at valuing people's similarities and differences in the workplace. Fo...

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Who Is Now Scolding the "Pharmascolds?"

Ah, there they go again. This week, the Wall Street Journal published an <a href="http://online.wsj.com/article/SB123914780537299005.html">op-ed </a>by David A Shaywitz and Dr Thomas P Stossel whose title says it all, "It's Time to Fight the 'Pharmascolds.'" On the Hooked: Ethics, Medicine and Pharma Blog, Dr Howard Brody <a href="http://brodyhooked.blogspot.com/2009/04/pharmascolds-strike-back-latest-from.html">provided</a> a pithy point by point response to Shaywitz and Stossel, which is very much worth reading. But given the sweeping nature of Shaywitz and Stossel's arguments, and the prominent forum in which they appeared, I thought I could add to the discussion. Shaywitz and Stossel's main point was that "relationships between university researchers and medical product companies are under relentless attack by critics who portray these associations as a morality play in which noble academics struggle to resist the dark, corrupting influence of industry." They castigated <blockquote> the disproportionate influence of a coterie of prominent critics we have previously dubbed 'pharmascolds,' who routinely vilify the medical products industry and portray academics working with it as traitors and sellouts. These critics are pious academics, self-righteous medical journal editors, and opportunistic politicians and journalists. Their condemnation of anyone's legitimate profit -- it's all 'corruption' in their book -- has in fact materially enhanced their own careers. They extrapolate from occasional behavioral lapses in industry -- which is equally, if not more prevalent, in universities -- to demonize the market and portray scientific medicine as an ascetic religion, which it is not. </blockquote> I can't claim to be "prominent," and my career has certainly not been "materially enhanced" so far by my writing on Health Care Renewal, but I am sure some of what my colleagues and I have written puts us at least in the company of more prominent "pharmascolds," in Shaywitz and Stossel's book. However, their arguments seem to be based on a slippery slope, or, on over-generalization of criticism of certain kinds of relationships among certain people and organizations under certain circumstances. In particular, I see nothing wrong, in general, with "relationships" among academics and industry. However, there are specific kinds of conflicts of interest in academic medicine that ought to cause concern. So let me take this opportunity to first postulate a simple definition of conflict of interest in this context, and provide specific examples of the sorts of conflicts that ought to be troubling. Definition: An individual conflict of interest occurs when a person with entrusted responsibility has another interest that may conflict with the proper exercise of that responsibility. Examples of conflicts of interest relevant to academic medicine include: - A physician entrusted to take the best possible care of individual patients receives payments from a drug manufacturer which might bias his or her decisions to use that company's drugs even for patients for whom these drugs would not be the best possible treatment. - A clinical teacher entrusted to honestly impart information, skills, and judgment receives payments from a drug manufacturer which might bias his or her teaching in favor of that company's products - A clinical researcher entrusted to discover and disseminate the truth based on research on human beings receives payments from a drug manufacturer which might bias the design, implementation, analysis or dissemination of studies on humans in favor of that manufacturer's products, or against its competitor's products - An administrator entrusted to uphold the mission of the academic institution receives payments from a drug manufacturer that might bias his or her management decisions in favor of that company's interests, but against the institution's mission - An academic entrusted to provide honest, clear health policy advice receives payments from a drug manufacturer that might bias his or her advice in favor of that company's interests On the other hand, I do not have a problem with true collaboration among academics and industry that does not involve industry paying the academics money, or paying the academics' institutions money for which the individuals receive credit. One can envision all sorts of collaborations that do not involve one party paying the other. Furthermore, I do not necessarily have a problem with industry paying an academic in the course of the conduct of basic science, that is in this case, science that does not involve research done on humans. Shaywitz and Stossel seem most concerned with the damage "pharmascolds" might do to basic and translational research. They warned of dire results from barriers that might mainly be designed to discourage the sorts of conflicts of interest listed above, but would damage the progress of basic science and translational research. For example, they warn <blockquote>each new barrier -- such as the National Institutes of Health's ban on paid consulting for industry -- erected between publicly funded researchers and companies, especially cash-strapped start-ups where many of the breakthroughs occur, slows the progress of potential treatments. </blockquote> There is the germ of an important idea in there. In fact, many medical academics simultaneously wear many hats. So someone who sees patients in practice, and teaches students about clinical medicine may also do bench research in the laboratory. Banning such an individual from receiving consulting payments from drug, biotechnology, device and other companies to prevent bias in his or her patient care or teaching might conceivably adversely affect his or her biomedical research. How to handle such trade-offs has not been widely discussed, but needs to be. But the notion that all relationships among medical academics and industry are meant to promote science and find new cures for disease, but not to market products or influence policy in favor or industry, is at best naive. So Shaywitz and Stossel's dire warnings that seemed based on this notion seem as naive as the notion they attribute to their opponents, that all relationships among academics and industry are evil. Finally, Shaywitz and Stossel did some scolding of their own, addressed to medical academics who do not stand up for their relationships with industry <blockquote>When challenged by reporters, most academic consultants to industry refuse to comment or offer a meek explanation, instead of retorting that industry pays them because they add critically important value. This evasion has only emboldened industry critics, disheartened company employees, and caused even allies to wonder if there really is something to hide. </blockquote>They concluded with plea that academics with industry relationships stand up for these relationships, to wit, <blockquote> For the sake of the many patients whose diseases require innovative treatments -- and for the medical philanthropists determined to make it happen -- it's time for the leaders of the medical products industry to take pride in their purpose and start fighting back. </blockquote> They are entitled to their opinion, of course. However, there is just a whiff of hypocrisy emanating from this. Just below it, Dr Stossel identifies himself as "a professor of medicine at Harvard and a fellow at the Manhattan Institute," which is surely true. But it is also surely incomplete. As we have posted before, Dr Stossel himself has multiple relationships with industry, some of which he has revealed in other venues. As we <a href="http://hcrenewal.blogspot.com/2007/04/can-people-with-conflicts-of-interest.html">wrote in 2007</a>, in a <a href="http://content.nejm.org/cgi/reprint/353/10/1060.pdf">commentary</a> in the New England Journal(1) in which Stossel attacked the rigorous conflicts of interest rules that were once again imposed on the US National Institutes of Health (NIH), Stossel disclosed <blockquote>having received consulting fees from <a href="http://zymequest.com/">ZymeQuest</a>, owning stock options in ZymeQuest and Biogen, and having pending and issued patents, owned by Brigham and Women's Hospital, some of which are licensed to ZymeQuest. </blockquote> In another paean to a laissez-faire approach to conflicts of interest in Perspectives in Biology and Medicine(2), Stossel also disclosed that he <blockquote> is a member of the Board of Directors of Zymequest Inc, and the Scientific Leadership Advisory Board of Merck & Co. The author is a founding scientist of Critical Biologics Corporation and a consultant to Boston Scientific, Inc., and Gerson-Lehrman, Inc. </blockquote> In a commentary in the British Medical Journal(3) arguing once again that concerns with conflicts of interest have gone too far, he disclosed, he <blockquote> is on the boards of directors and owns stock options in ZymeQuest and Critical Biologics Corporations, and his employer has licensed intellectual property to these companies, which may result in his receiving milestone payments, royalties and in the stock options having financial value. He receives fees for speaking to corporations and other organisations on the topic of conflict of interest. He has served on scientific advisory boards for Biogen, Dyax, and Merck. </blockquote> So maybe Dr Stossel should take his own advice, and proudly declare his complex relationships with industry in the course of yet another of his arguments that any criticism of any relationships among medical academics and industry under any circumstances will deprive humanity of future cures of dread diseases. As long as medical academics with relationships to industry, of all kinds and in all contexts, fail to disclose such relationships when they might be germane to the topic at hand, others will continue to wonder if they indeed do have something to hide. References 1. Stossel TP. Regulating academic-industrial research relationships - solving problems or stifling progress? N Engl J Med 2005; 353: 1060-1065. Link <a href="http://content.nejm.org/cgi/content/full/353/10/1060">here</a>. 2. Stossel TP. Regulation of financial conflicts of interest in medical practice and medical research. Perspect Biol Med 2007; 50: 54-71. Link <a href="http://muse.jhu.edu/journals/perspectives_in_biology_and_medicine/v050/50.1stossel.html">here</a>. 3. Stossel TP. Has the hunt for conflicts of interst gone too far? - Yes. Brit Med J 2008; 336: 476. Link <a href="http://www.bmj.com/cgi/content/full/336/7642/476">here</a>.

Who Is Now Scolding the "Pharmascolds?"

Ah, there they go again. This week, the Wall Street Journal published an op-ed by David A Shaywitz and Dr Thomas P Stossel whose title says ...

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