healthy4u

BLOGSCAN - At UMDNJ, Lose Your Job, Keep Your Cell Phone

We have frequently discussed the plight of the University of Medicine and Dentistry of New Jersey (UMDNJ), the largest health care university in the US. Facing indictment for federal crimes, the university operated under a deferred prosecution agreement and the supervision of a federal monitor from 2005 to 2007. We most recently blogged about UMDNJ <a href="http://hcrenewal.blogspot.com/2008/11/politician-medical-school-dean.html">here</a>, and see links backward to previous posts from <a href="http://hcrenewal.blogspot.com/2008/03/money-for-nothing-more-guilty-pleas-at.html">here</a>. On the University Diaries blog, Prof Margaret Soltan <a href="http://www.margaretsoltan.com/?p=12392">discussed</a> the latest aspect of mismanagement at UMDNJ to be uncovered.

BLOGSCAN - At UMDNJ, Lose Your Job, Keep Your Cell Phone

We have frequently discussed the plight of the University of Medicine and Dentistry of New Jersey (UMDNJ), the largest health care universit...

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BLOGSCAN - Merck Hired Elsevier to Create Fake Peer-Reviewed Medical Journal

You just can't make this stuff up. <a href="http://scienceblogs.com/insolence/2009/05/when_big_pharma_pays_a_publisher_to_publ.php">On the Respectful Insolence blog</a>, Orac recounted how pharmaceutical giant Merck hired medical publishing giant Elsevier to create what appeared to be a peer-reviewed journal, but theAustralasian Journal of Bone and Joint Medicine really was just a marketing outlet. The goal was to market Fosamax and Vioxx. This is another bizarre variant on the stealth marketing theme, taken to quite an extreme. And the pharmaceutical companies wonder why people don't trust them? ADDENDUM (4 May, 2009) - Dr Aubrey Blumsohn is <a href="http://scientific-misconduct.blogspot.com/2009/04/fake-editorial-board-of-mercks-fake.html">back online </a>on his Scientific Misconduct Blog, and noted the academic luminaries who were willing to serve on the editorial board of this fake peer-reviewed journal. ADDENDUM (11 May, 2009) - See also <a href="http://laikaspoetnik.wordpress.com/2009/05/08/mercks-ghostwriters-haunted-papers-and-fake-elsevier-journals/">comments</a> on Laika's MedLibBlog.

BLOGSCAN - Merck Hired Elsevier to Create Fake Peer-Reviewed Medical Journal

You just can't make this stuff up. On the Respectful Insolence blog , Orac recounted how pharmaceutical giant Merck hired medical publis...

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Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At "<a href="http://hcrenewal.blogspot.com/2009/04/should-google-seek-resignations-of.html">Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?</a>" I expressed great concern about what I term the cross occupational intrusion of the IT industry into healthcare. My major concern in that post was how the information technologists at Google, even with nearly unlimited access to capital (and therefore to the world's informatics expertise) badly mismanaged a Personal Health Records (PHR) project through commission of a most fundamental biomedical information science blunder (quite distinct from IT; most IT technologists and MIS personnel really stink at biomedical information science). They tried to map relatively ungranular, imprecise, and often misused billing codes back to enduser-viewable diagnoses, resulting in easily predictable patient panic and mayhem. As usual in HIT: it's possibly even worse. I am quite concerned about a letter from the consumer education and advocacy organization <a target="blank" href="http://www.consumerwatchdog.org/about/">Consumer Watchdog.org</a> and their allegations that Google has been lobbying Congress to be excluded from HIPAA provisions on privacy and forbidding sales of medical records. The letter, dated April 22, is <a target="blank" href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf">here</a> (<a target="blank" href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf">http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf</a>). Considering that Google is heavily into the PHR space, and even worse, considering they made an Informatics 101 error in attempting to map billing codes into user-viewable diagnostic data, I would (and I'm sure others would as well) view such attempts if they indeed occurred as ominous, a true heavy handed intrusion of the IT industry not only into the affairs of medicine but into what really is another human rights issue. (I'd pointed out another potential HIT-related human rights issue at the post "<a style="font-family: arial;" href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html">UPMC as Proving Ground for IT Tests On Children</a>".) I would be interested in additional information on the Google lobbying issue, especially from those at Harvard and other academic centers who have been involved in the Google PHR initiative. I have shared these concerns with the American Medical Informatics Association (<a href="http://www.amia.org/">AMIA</a>) clinical information systems workgroup (cis-wg) and the people & organizational issues workgroup (poi-wg) as well. I hope the Consumer Watchdog allegations are not accurate, because if they are valid, the implications of national EHR grow increasingly unsettling.

Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At " Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle? " I expressed great concern about wh...

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Mowing with goats

At our <a href="http://maps.google.com/?q=Google%20Inc.@37.423156,-122.084917&hl=en">Mountain View headquarters</a>, we have some fields that we need to mow occasionally to clear weeds and brush to reduce fire hazard. This spring we decided to take a low-carbon approach: Instead of using noisy mowers that run on gasoline and pollute the air, we've rented some goats from <a href="http://californiagrazing.com/">California Grazing</a> to do the job for us (we're not "kidding"). A herder brings about 200 goats and they spend roughly a week with us at Google, eating the grass and fertilizing at the same time. The goats are herded with the help of Jen, a border collie. It costs us about the same as mowing, and goats are a lot cuter to watch than lawn mowers. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSD-jalYioSSGyYgIJvTNhyh0can8_pK-wSVCRnvhJzwQJHa6J7eW1xJrrmxytFmvZfxp0N8qcTAeKfv8ccJf1psXdcBCSQe48guSVYSjC9OV6FVcE72QaHo80CtMWReuwRoiL6M4BRUmC/s1600-h/Goats.JPG"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5330894068972928818" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSD-jalYioSSGyYgIJvTNhyh0can8_pK-wSVCRnvhJzwQJHa6J7eW1xJrrmxytFmvZfxp0N8qcTAeKfv8ccJf1psXdcBCSQe48guSVYSjC9OV6FVcE72QaHo80CtMWReuwRoiL6M4BRUmC/s400/Goats.JPG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 240px;" /></a> Posted by Dan Hoffman, Director Real Estate and Workplace Services

Mowing with goats

At our Mountain View headquarters , we have some fields that we need to mow occasionally to clear weeds and brush to reduce fire hazard. Thi...

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What's a rich media ad, anyway?

Since last year's DoubleClick acquisition, we've increased our focus on helping marketers and agencies use Google tools for all of their display advertising needs. DoubleClick Rich Media is the part of DoubleClick that provides the technology for the most technically advanced and engaging of these display ads, which are typically created by creative agencies for their brand-focused clients. To help make this process even easier and efficient, today we're launching <a href="http://studio.doubleclick.com/">DoubleClick Studio</a>, our new rich media production and development tool. To describe rich media, it helps to think about other ad formats that we're all familiar with, starting with the simplest: text ads. With just a few keystrokes, anyone can create simple messages in a standardized format, and place them on a site like Google.com in minutes. Then we have standard display ads, ads that usually include text with a visual such as a logo or a graphic. These can be in formats we're all familiar with like .jpg, .gif, .swf and more. Standard display ads can either be static or animated with tools like Flash. They typically have only one interaction, meaning that when you click on them, you'll be taken to a destination site. And then at the most complex level, from a design and interaction perspective, we have rich media ads. With rich media, you can have ads that expand when users click or roll over, for example, and there are extensive possibilities for interactive content, such as HD video or even the ability to click to make a phone call. But making a rich media ad possible requires much more complex technology to ensure that all of the ad behaviors function properly, that all of the interactions can be measured, and to serve the ads onto web pages. Every piece of the canvas, from the video play button to the button that allows for expansion, requires coding in Flash that's made possible by a rich media technology provider like DoubleClick Rich Media. With all of this complexity, there's also a lot of room for error. So in addition to enabling the development of the ads, tools like DoubleClick Studio provide quality analysis and preview functionalities to make sure that the ads work the way they should. Here is a graphic that represents some of the differences between types of online ads: <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxzTXOHtPfvpxmL4UFx1SSn1aX2Jl34cDqzAZfOMK1n3zTkTGE-IFyq57csbUK9rMkq-42V4bbLUpcXWFgNxfCCbMn6P-qRaAISCP0XxKjrWojx9iXI8uAxdjH83CCWzXADL9XExZSzpOn/s1600-h/0904_r3_GoogleBlogGC.GIF"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5330542555361733618" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxzTXOHtPfvpxmL4UFx1SSn1aX2Jl34cDqzAZfOMK1n3zTkTGE-IFyq57csbUK9rMkq-42V4bbLUpcXWFgNxfCCbMn6P-qRaAISCP0XxKjrWojx9iXI8uAxdjH83CCWzXADL9XExZSzpOn/s400/0904_r3_GoogleBlogGC.GIF" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 160px;" /></a>With DoubleClick Studio, we hope to make it easier for our existing users to produce rich media ads, and to expand the number of advertisers that can make these useful formats part of their marketing strategy. This is also a good thing for Internet users; rich media capabilities make advertising even more useful, letting a viewer interact with an ad and learn about a brand without having to leave the page they're on. And, advertisers have an expanded creative canvas within the ad itself, allowing for deeper, higher-quality content in the ad itself. At Google, we believe that ads at their best are useful information. To read more about DoubleClick Studio, visit the <a href="http://www.doubleclick.com/insight/blog/archives/doubleclick-rich-media-and-video/create-and-manage-rich-media-ads-more-efficiently-with-doubleclick-studio.html">DoubleClick blog</a>. Posted by Shamim Samadi and Ari Paparo, DoubleClick Rich Media Team

What's a rich media ad, anyway?

Since last year's DoubleClick acquisition, we've increased our focus on helping marketers and agencies use Google tools for all of t...

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BLOGSCAN - Accountable Academic Governance Under Threat

On The Torch blog, hosted by FIRE (Foundation for Individual Rights in Education), <a href="http://www.thefire.org/index.php/article/10538.html">this post </a>by Kyle Smeallie summarized the travails of "petition candidates" for the boards of trustees of two elite American universities (<a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">Dartmouth</a> and <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">Harvard</a>). As we have noted, at most universities, the boards of trustees, the bodies ultimately responsible for upholding the universities' missions, are closed shops. At most universities, the boards appoint new members to replace departing ones, without input from alumni, parents, students, faculty or anyone else who might be considered constituents. Thus, at most universities, even though the boards are ultimately responsible for the stewardship of the institutions, and upholding the institutions' missions, practically, they are accountable to no one. At very few universities, there may be contested elections for a few board seats, and an opportunity for those outside the board, usually alumni, to place candidates on the ballot. However, even at those somewhat more enlightened universities, those candidates face an uphill battle. Thus, while Dartmouth and Harvard have somewhat more transparent, accountable, and representative governance than do most academic institutions, even that is under threat.

BLOGSCAN - Accountable Academic Governance Under Threat

On The Torch blog, hosted by FIRE (Foundation for Individual Rights in Education), this post by Kyle Smeallie summarized the travails of ...

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Another Key Opinion Leader Confesses

The Milwaukee Journal-Sentinel published <a href="http://www.jsonline.com/features/health/43933562.html">another story </a>in their series on physicians' entanglements with health care corporations. This one tells the story of a single university faculty member who was seduced by pharmaceutical companies, then eventually became disillusioned. <blockquote> [Dr James] Stein, now a professor at the University of Wisconsin School of Medicine and Public Health, was a 29-year-old cardiology fellow in Chicago in 1994 when his faculty mentor asked him to fill in for him at a drug company-funded lecture to a large group of doctors. It would be his first taste of life as a drug company speaker and consultant. Stein got first-class airfare to Dallas. A limousine took him to a luxury hotel for the talk. He walked off the stage, and a doctor from the conference handed him an envelope containing a $500 check. 'I got a pat on the back and he said, 'There's more where that came from, son.' I had no idea what that meant, but I went home and paid off part of my student loans,' Stein said in a presentation at UW this month. Stein's first drug company talk led to more than a decade of work for drug companies before he gave it up for ethical reasons. Now he is speaking out. Over the years, many of the big names in the drug industry would hire Stein to give speeches or serve as a consultant, eventually leading to fees of $2,000 to $3,000 per talk. About a month after his first talk in 1994, Stein was asked by another drug company to give a lecture on cholesterol at a small hospital in Chicago, just as blockbuster statin drugs were coming on the market. 'I was really flattered because over and over again I was told that I was a future thought leader,' he said. 'I did my talk. I got a $750 honorarium and I was hooked.' Stein said he now realizes that the speech at the hospital was just an audition. 'They wanted to know what I would say and how I would deliver,' he said. 'And I think they also wanted to know what I would say about their product.' He joined speakers bureaus for several drug companies. It was a kind of badge of honor, he said. The more companies a doctor spoke for, the more highly he or she was regarded. Stein, now 44, came to UW in 1996. Over the years, he would give talks and do other work for many of the top names in the pharmaceutical industry. For instance, in 2005 Stein did work for six drug makers, according to a disclosure form filed with UW. That year, Pfizer paid him between $10,000 and $20,000 for four days of work as a speaker and advisory board member. LipoScience, a firm that markets a cholesterol test, paid him $10,000 to $20,000 for four days of similar work. Another firm, Schering-Plough, paid him about $12,000 for two days as a lecturer. Although he said he had concerns about the propriety of his work, Stein said he was assured by his superiors there was nothing wrong with it as long as he did it on his own time. Indeed, they said it enhanced the reputation of the university. And, he said, he considered himself an educator, not a salesman. He said he tried to manage any conflicts of interest by disclosing who paid him, controlling the content of what he said and doing the work on personal time. Things started to change rapidly beginning several years ago. Drug companies began referring to the talks as promotional. They wanted him to use their slides; he refused. Then, medical journals and the lay press began printing articles questioning the ethics of the relationships. A 2006 article in a Madison newspaper listed Stein as being among the UW doctors who reported the most money from the drug industry. Stein said he was embarrassed. But, he said, he continued to try to manage his relationships with drug companies. He sent letters to patients disclosing his ties to industry. As of December 2006, he donated all the money from his talks to charity. Why didn't he just stop doing the work? He said he believed he could save more lives lecturing than by working in the emergency room. Stein said he saw no harm in being paid. But he admitted that giving the talks also made him feel important. At the same time, new scientific articles suggested that it is impossible for doctors to be unbiased when they receive gifts or payments from drug companies. 'I have learned that human beings, physicians included, are incapable of recognizing bias in themselves, and even when you try not to be biased it is impossible to avoid it, especially when money is involved,' he said. He said he came to realize that drug and medical device firms were no longer trustworthy partners in medical education. He also said it has become obvious that patients have the least power and drug companies have the most power. 'I was wrong,' he said. Stein said he stands by what he taught. But, he added, 'I was naïve to think I was not influenced by the money and power of the drug and device companies.' As of last December, he said, he stopped all drug company speaking and consulting other than bona fide research. </blockquote> It is nice that a few commercially paid "key opinion leaders" have realized what they were really doing. Maybe, Dr Stein will follow in the footsteps of Dr Daniel Carlat, and try to atone for his previous role in drug marketing disguised as education. (See Dr Carlat's excellent blog <a href="http://carlatpsychiatry.blogspot.com/">here</a>, and his now classic article, "<a href="http://www.nytimes.com/2007/11/25/magazine/25memoir-t.html">Dr Drug Rep</a>.") This compelling narrative reinforces some points about relationships among physicians and health care corporations. Health care corporations do not pay for nothing, and are not charitable organizations. If a company pays a physician to give talks, it is almost certainly because those talks will help market company products or services. Pharmaceutical and device companies have argued that they only pay the best and the brightest physicians as speakers and consultants. But this story (and others, e.g. <a href="http://hcrenewal.blogspot.com/2008/06/key-opinion-leaders-were-sales-people.html">here</a>) suggest that they recruit young physicians who seem to be malleable and likely to go along with the company line, and groom them to do marketing in the guise of education. The company's money thus helps mold "key opinion leaders." Worse, at many medical schools, being a commercially supported speaker or consult was a badge of honor. Thus, faculty chosen by commercial firms as most tractable and sympathetic to the companies' viewpoints, came to be regarded as the best and the brightest. Why getting money from commercial firms was regarded as indicative of honor and intelligence, rather than gullibility, naivete, or worse, is not clear. I wonder whether it correlated with increasing alignment of the leadership of medical schools with commercial interests, and domination of the very top leadership, that is, the universities' board of directors, by those formerly regarded as Masters of the Universe (but now often seen as stupid, arrogant, greedy, or even corrupt. See posts about how the boards of <a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">Dartmouth</a>, <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">Harvard</a>, and <a href="http://hcrenewal.blogspot.com/2009/04/hedge-fund-u.html">Yeshiva</a> were disproportionately populated by leaders of [faux] finance). At any rate, this is truly a cautionary tale of seduction of academia into hucksterism. Hat tip to Margaret Soltan <a href="http://www.margaretsoltan.com/?p=12236">at University Diaries</a>. ADDENDUM (30 April, 2009) - See also the <a href="http://carlatpsychiatry.blogspot.com/2009/04/another-hired-gun-repents-this-time.html">comments</a> by Dr Daniel Carlat on the Carlat Psychiatry Blog.

Another Key Opinion Leader Confesses

The Milwaukee Journal-Sentinel published another story in their series on physicians' entanglements with health care corporations. This ...

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