healthy4u

Bio-Tech U

The San Francisco Chronicle just <a href="http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/01/BA7517D185.DTL">reported</a> that a new Chancellor has been nominated for the <a href="http://www.ucsf.edu/">University of California - San Francisco </a>(UCSF). UCSF is functionally a health sciences university, and its Chancellor functions as its president. The UCSF medical school is generally considered one of the elite US academic medical institutions. <blockquote> Genentech executive Susan Desmond-Hellmann has been nominated to be the next chancellor of UCSF, making her the first woman or biotech leader ever asked to run the research campus and hospital system that is San Francisco's second-largest employer. Desmond-Hellmann has served most recently as president of drug development at Genentech, the South San Francisco biotech firm that was recently acquired by Swiss drugmaker Roche. She was trained as a physician, did her internship at UCSF and has taught there recently as an adjunct associate professor while working at Genentech. Although prior UCSF chancellors have come from more academic or scientific backgrounds, [Dr Holly] Smith said Desmond-Hellmann's biotech connections would be an advantage as the university tries to translate scientific discoveries into medical treatments. </blockquote> Dr Desmond-Hellmann is, in my humble opinion, a very unusual candidate to be Chancellor of one of the country's premier academic medical institutions. According to her official Genentech bio (taken off the Genentech server, but transiently available in the Google cache <a href="http://74.125.95.132/search?q=cache:9WvMoqIzF38J:www.gene.com/gene/about/management/exec/desmond-hellman.html+Desmond-Hellmann&cd=3&hl=en&ct=clnk&gl=us">here</a>), and a <a href="http://www.nature.com/drugdisc/nj/articles/nrd1794.html">biography in Nature Drug Discovery</a>, Dr Desmond-Hellmann, after getting both an MD and an MPH, spent two years doing AIDS research in Uganda as a UCSF junior faculty member, and then spent a few years in private practice hematology-oncology. She published few articles (5, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=Desmond-Hellmann[author]">according to Medline</a>, last in 1995), and by 1993 went to work in industry, first for Bristol-Myers-Squibb. She started at Genentech in 1995, and worked her way up to her current position, "president, Product Development. In this role, Hellmann is responsible for Genentech's Development, Process Research & Development, Business Development, Product Portfolio Management, Alliance Management and Pipeline Planning Support functions. Hellmann is a member of Genentech's executive committee." Before her nomination to be Chancellor, Dr Desmond-Hellmann was <a href="http://www.epibiostat.ucsf.edu/general/people/affilfac.html">"affiliated" faculty </a>of the Department of Epidemiology and Biostatistics at UCSF, apparently with the rank of adjunct associate professor. In that capacity, she apparently <a href="http://www.epibiostat.ucsf.edu/general/events/seminar_archives.html">gave a single seminar in 2007,</a> and lectured in the <a href="http://www.epibiostat.ucsf.edu/courses/clin_research/2003/">Designing Clinical Research course in 2003</a>. So, on one hand, Dr Desmond-Hellmann, to be charitable, does not have much of an academic track record, at best approximating that of a very junior medical faculty member. She also certainly has no experience in academic administration. In general, people who lead academic medicine often have substantial track records in academics and in academic administration. So, in some sense, Dr Desmond-Hellmann's appointment seems to based on the theory of the generic manager. That is, the popular notion in the business world managers can manage anything, any organization, with any mission, in any context. Managing in the complex health care context, especially managing large, complex academic medical institutions, may not be easy for those used to managing elsewhere, even in the health care corporate world. Furthermore, the complex mission of academic medicine, which includes providing excellent care of individual patients, while discovering and disseminating the truth in a spirit of free enquiry, is very different from the mission of a for-profit biotechnology company. How well someone used to the bottom-line mentality of the corporate world would uphold the academic mission is not clear. Dr Desmond-Hellmann came from a company known for charging very high prices for the drugs it marketed, and Dr Desmond-Hellmann was on record personally defending this practice. Quoting from a <a href="http://jnci.oxfordjournals.org/cgi/content/extract/djm031v1">news article </a>in the Journal of the National Cancer Institute [McNeil C. Sticker shock sharpens focus on biologics. JNCI 2007; 99: 910-914.] <blockquote> Never mind their novel targets and mechanisms. It's the cost of new biologic agents that's creating a buzz these days. At thousands of dollars a month, which can mean many tens of thousands for some regimens, sticker shock has generated recent, prominent articles in both the national and trade press. On one level, the argument is about macroeconomics. Neal Meropol, M.D., of Fox Chase Cancer Center in Philadelphia, pointed out that cancer drugs account for 40% of all Medicare drug expenditures. That makes them a major contributor to the country's high health care costs, now about 17% of our gross domestic product (GDP) and growing. That percentage is much higher than in other developed countries with higher life expectancies, he said at a forum on cancer care costs at the American Association of Cancer Research annual meeting. On the other side of the macroeconomic debate, experts point out that the U.S. has a high GDP to begin with and so can afford to spend more on health. And cancer biologics, though among the most costly drugs, are still only a tiny fraction of total GDP, said Genentech's Susan Desmond-Hellmann, president for product development, at AACR. Hellmann and others argue that with these drugs’ potential to alleviate the huge societal burden of cancer, biologics are worth the cost. The industry has responded to concerns about costs by putting more resources into patient assistance programs. When Genentech received U.S. Food and Drug Administration approval for bevacizumab in lung cancer last October, it also announced a cap on expenditures for the drug for patients with family incomes less than $100,000 a year. In 2005, the median household income was $46,326. Originally announced as $55,000, the cap actually doesn't kick in until after a patient has received 10,000 mg. At the wholesale acquisition cost, 10,000 mg is about $55,000, said Genentech spokesperson Edward Lang. What the companies have not done so far is reduce prices. The reason, industry representatives say, is the need to recoup massive research and development costs, including high manufacturing costs for biologics. These costs have long kept biotech companies from making much of a profit overall, Hellmann said. She noted that profit levels of publicly held biotech firms have "hovered close to zero" throughout the life of the industry. </blockquote> But, while Dr Desmond-Hellmann was defending pricing drugs that at more than $55,000 a year, and complaining about low industry profits, she was pocketing lavish rewards. According to <a href="http://www.sec.gov/Archives/edgar/data/318771/000095013408004633/0000950134-08-004633-index.htm">Genentech's 2008 proxy statement</a>, (the last available, since the company has been bought out by Roche), her total compensation was $8,361,348 in 2007 and $7,820,142 in 2006. In 2007, her total compensation was equal to 0.3% of the firm's total net income, and the top five company executives' total compensation was equal to about 1.5% of the firm's total revenues. In 2007, the firm's stock price declined from 91.30 on 6 January 2007 to 66.38 on 4 January, 2008, or 27%, <a href="http://www.google.com/finance?q=NYSE%3ADNA">according to Google Finance</a>. In 2007, she held 1,616,383 shares of stock, or stock options exercisable within 60 days of January 31, 2008. In 2007 she exercised 170,000 stock options, realizing $11,556,663. So perhaps those high drug prices were needed not only to pay for research, but to make top executives, including Dr Desmond-Hellmann, very rich. This raises further questions about her inclination to uphold the <a href="http://www.ucsf.edu/about-ucsf/">university's mission </a>in the future. <blockquote> University of California, San Francisco is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. </blockquote> In any case, hiring a lavishly compensated top executive from a biotech firm known for its high drug prices to run a public health sciences university does considerably blur the line between academic medicine and the health care industry. In the Chronicle article, Dr Desmond-Hellmann declared, "I began my career at UCSF and my heart has never left it." If she does become Chancellor, let us hope that her heart will speak louder than all those millions she used to make by, among other means, charging more than $55,000 a year for bevacizumab.

Bio-Tech U

The San Francisco Chronicle just reported that a new Chancellor has been nominated for the University of California - San Francisco (UCSF)....

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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 href="http://www.consumerwatchdog.org/about/" target="blank">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 href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf" target="blank">here</a> (<a href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf" target="blank">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 href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html" style="font-family: arial;">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 href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSD-jalYioSSGyYgIJvTNhyh0can8_pK-wSVCRnvhJzwQJHa6J7eW1xJrrmxytFmvZfxp0N8qcTAeKfv8ccJf1psXdcBCSQe48guSVYSjC9OV6FVcE72QaHo80CtMWReuwRoiL6M4BRUmC/s1600-h/Goats.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><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 href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxzTXOHtPfvpxmL4UFx1SSn1aX2Jl34cDqzAZfOMK1n3zTkTGE-IFyq57csbUK9rMkq-42V4bbLUpcXWFgNxfCCbMn6P-qRaAISCP0XxKjrWojx9iXI8uAxdjH83CCWzXADL9XExZSzpOn/s1600-h/0904_r3_GoogleBlogGC.GIF" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><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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