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WellCare Settles, Accepts Deferred Prosecution Agreement

'Tis the season for deferred prosecution agreements for health care organizations. As <a href="http://online.wsj.com/article/SB124153953103687873.html">reported by the Wall Street Journal</a>: <blockquote> WellCare Health Plans Inc. agreed to pay $80 million to settle a Florida Medicaid fraud investigation that has embroiled the company since the fall of 2007, previously prompting a management shake-up and restatement of more than three years of the company's earnings. The settlement resolves federal and state criminal probes into allegations that WellCare defrauded Florida benefits programs for low-income adults and children of about $40 million by improperly inflating what it spent on care. WellCare, based in Tampa, Fla., administers medical benefits for about 2.5 million enrollees in government-sponsored plans in several states. Under a deferred prosecution agreement, the U.S. Attorney's Office for the Middle District of Florida in Tampa filed a fraud conspiracy charge against the company but said it wouldn't prosecute the case if WellCare meets all of the deal's terms. U.S. Attorney A. Brian Albritton said in a news conference Tuesday that his office could have pursued a conviction but that it likely would have put the insurer out of business, hurting customers, innocent employees and shareholders. In penalizing the company, 'we have, at the same time, tried to avoid crushing it,' he said. Under the terms, WellCare must forfeit $40 million and pay another $40 million in restitution to Florida's Medicaid and 'Healthy Kids' plans. WellCare also has agreed 'to accept and acknowledge full responsibility for the conduct that led to the government's investigations,' according to the deferred prosecution agreement. The company declined to elaborate. In addition, the company also must retain an independent monitor to review its business operations, cooperate with the government's ongoing investigations and implement new procedures within 60 days to prevent future abuse or faulty reports to state health care programs. </blockquote> This was not the first bit of trouble WellCare got itself into. We posted <a href="http://hcrenewal.blogspot.com/2007/11/health-plans-programs-cancelled-for.html">here</a> about how the state of Connecticut stopped WellCare from running a plan for poor children after the company refused to reveal what it was paying physicians, and why it was failing to pay for particular services. So, as we have found from blogging on Health Care Renewal for a while, organizations that are found to be committing one sort of mischief often are also found to be committing another sort. We also see some other familiar patterns. While human beings authorized or committed the acts that got the organization in trouble, rarely do these people seem to suffer any negative consequences. At most, the organization may pay a seemingly large fine. This, however, may come out of dividends or the stock price, dispersing the cost to stock-holders, or out of salaries across the board. Thus, those who got the organization into trouble are unlikely to feel pain from it. Perhaps because of reverence for all organizations related to health care, and fear that the bankruptcy of any health care organization, even a health care insurance company, will leave patients in the lurch, prosecutors do not seem inclined to actually prosecute such organizations. The net effect, though, seems to be that dishonest executives of health care organizations can continue to act with impunity. Until bad leadership of health care organizations leads to negative consequences for those practicing it, health care leadership can be expected to continuously degrade. By the way, one member of the <a href="http://ir.wellcare.com/phoenix.zhtml?c=176521&p=irol-govboard">WellCare board of directors </a>is Regina Herzlinger, a well known and prolific health policy expert, and holds the <a href="http://drfd.hbs.edu/fit/public/facultyInfo.do?facInfo=bio&facEmId=rherzlinger">Nancy R. McPherson Professor of Business Administration Chair of the Harvard Business School</a>. As far as I know, Prof Herzlinger is one of the many health policy experts who avoids discussing the sorts of problems with the accountability, integrity, and transparency of health care leadership which is grist for the mill here at Health Care Renewal. Yet under the stewardship of such an august expert, WellCare had to "accept and acknowledge full responsibility for ... conduct" that included fraud. Perhaps, Prof Herzlinger, like many other main stream health policy experts, should learn to acknowledge that health care leadership may be unaccountable, opaque, dishonest, and sometimes flagrantly corrupt. Furthermore, Prof Herzlinger, like many other well-paid board members of health care organization, should pay a bit more attention to the mischief being committed by those who answer to her.

WellCare Settles, Accepts Deferred Prosecution Agreement

'Tis the season for deferred prosecution agreements for health care organizations. As reported by the Wall Street Journal : WellCare Hea...

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Google Trends on your website

One thing we've noticed here at Google over the years is that the more popular something becomes, the more people search for it online. Our annual <a href="http://www.google.com/zeitgeist">zeitgeist</a> catalogs some of the more interesting trends we've seen in a year's worth of web search data. We also like to keep our eye out for more timely events, such as the <a href="http://googleblog.blogspot.com/2009/01/search-findings-from-us-presidential.html">U.S. presidential inauguration</a>. As we head into the last month of this season's "American Idol," we thought this would be a good opportunity to introduce our new <a href="http://www.google.com/landing/trendsgadget/">embeddable Google Trends gadget</a> to track your favorite trends, right on your own website. It's as easy as "cut and paste" to showcase the rising popularity of your own idols, even if they're not on a hit television show. You get to choose which trends you want to track. I've been using <a href="http://www.google.com/trends">Google Trends</a> to follow my favorite "Idol" contestants for the past three years. It all started in 2006 when I was a <a href="http://www.google.com/search?hl=en&q=chris+daughtry&sourceid=navclient-ff&rlz=1B5GGGL_enUS315US315&ie=UTF-8&aq=t&oq=chris+dautry">Chris Daughtry</a> fan. Looking at the search trends I could tell I wasn't the only one, and I felt pretty good about the odds that Chris was going to fare well against the other contestants. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8cQrl_B08x1RqYAPNuRbQkGcHU3iQbSWLSS6TX_cynUUdKKUReOCexkgLKkc4AS4nLpeEJylLVlaUGTBqAQkNCE82QAdl5hJgKR5Xgy8k9cLNHMMmVQMbUWQHMxDYi3dqmTDvGtUYUdb3/s1600-h/American_Idol_Insights_Screenshot_2006_v2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332737182804756226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8cQrl_B08x1RqYAPNuRbQkGcHU3iQbSWLSS6TX_cynUUdKKUReOCexkgLKkc4AS4nLpeEJylLVlaUGTBqAQkNCE82QAdl5hJgKR5Xgy8k9cLNHMMmVQMbUWQHMxDYi3dqmTDvGtUYUdb3/s400/American_Idol_Insights_Screenshot_2006_v2.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 180px;" /></a> Going into the final four, Chris had a lead on <a href="http://www.google.com/search?hl=en&q=Elliott+Yamin+american+idol&btnG=Search">Elliott Yamin</a>, and I was pretty confident he'd advance. But over the week leading up to the performance, Chris' lead began to diminish. Despite his early lead, Chris ended up getting eliminated. I was totally bummed, but wasn't all too surprised given that they were neck and neck on Trends days before elimination night. Fast-forward to 2008. I was rooting for <a href="http://www.google.com/search?hl=en&rlz=1B5GGGL_enUS315US315&q=David+Cook+American+Idol&btnG=Search">David Cook</a>, and after each performance I'd check so see how he was doing on Trends. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm6VtHzK9zlz5VNMmlFVwGO2h4jI9D_dmoM6mKFc5IfVdLp_6mwm2eboEAkw6H-kfE3hXDPQ5QcqB0fUMU4znfDHYTqzQ0xHgh5JlCN58pcUlugqxq2AmewSJLDgXbJy6DFWBAzi2yE6Tl/s1600-h/American_Idol_Insights_Screenshot_2008_v2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332737441344686162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm6VtHzK9zlz5VNMmlFVwGO2h4jI9D_dmoM6mKFc5IfVdLp_6mwm2eboEAkw6H-kfE3hXDPQ5QcqB0fUMU4znfDHYTqzQ0xHgh5JlCN58pcUlugqxq2AmewSJLDgXbJy6DFWBAzi2yE6Tl/s400/American_Idol_Insights_Screenshot_2008_v2.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 152px;" /></a> I was excited to see him getting more and more popular each week, and each week I could rest a little easier when I found out that David was more popular than the other contestants. David ended up walking away with the crown that year, and I had finally picked a winner! This year, I had the good fortune of attending an "American Idol" show in person. Not really knowing what to expect, I was completely blown away by the evening's final performance: <a href="http://www.google.com/search?hl=en&rlz=1B5GGGL_enUS315US315&q=Adam+Lambert&btnG=Search">Adam Lambert</a>'s rendition of the Tears for Fears song "Mad World." I could literally feel the building move under my feet from his powerful vocals and the roar of the crowd. Since then I have been an Adam fan all the way. And just when I thought that <a href="http://www.google.com/search?hl=en&rlz=1B5GGGL_enUS315US315&q=Allison+Iraheta&btnG=Search">Allison Iraheta</a> was closing in, Adam raised the bar yet again with his rockin' performance of Led Zeppelin's "Whole Lotta Love." Let's see what Google Trends has to say about Adam this week. And if after last night's show you're worried that your favorite "Idol" had a bad night and might not make it to the next round, see if you can <a href="http://www.google.com/landing/trendsgadget/">glean some insights</a> from the search trends. Posted by R.J. Pittman, Director, Product Management

Google Trends on your website

One thing we've noticed here at Google over the years is that the more popular something becomes, the more people search for it online. ...

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More tools and tricks for teachers

Hello teachers, We hope that your desk was deluged with a bunch of shined-up apples this morning as a thank you from your students for all that you do for them every day. At Google, we'd like to thank you as well, and acknowledge that we wouldn't be where we are today if it hadn't been for the great teachers who mentored us through school. In support of <a href="https://www.nea.org/grants/1359.htm">National Teacher Day</a>, we'd like to announce that applications are open for our next <a href="http://www.google.com/educators/gta.html">Google Teacher Academy</a>, which will take place in our <a href="http://maps.google.com/maps?f=q&hl=en&geocode=&q=google+boulder&sll=40.022291,-105.26134&sspn=0.008183,0.017896&ie=UTF8&t=h&ll=40.022586,-105.26119&spn=0.00866,0.01869&z=16&iwloc=A">Boulder, Colorado office</a> on Wednesday, August 5th. The Google Teacher Academy is a free professional development experience designed to help K-12 educators get the most from innovative technologies. Each academy is an intensive, one-day event where participants get hands-on experience with Google's free products, which will help you bring communication, collaboration and fun into your classrooms. Teachers will also learn about innovative instructional strategies, receive resources to share with colleagues, and immerse themselves in an innovative corporate environment. Upon completion, participants become Google Certified Teachers who share what they learn with other K-12 educators in their local region. <a href="http://www.google.com/educators/gta.html">Applications</a> are due Friday, July 3rd. We'd also like to thank our cadre of Google Certified Teachers, who spread all kinds of professional development love every day. Specifically, we'd like to highlight GCT Jerome Burg, whose <a href="http://www.googlelittrips.org/">Google Lit Trips</a> was recently awarded the <a href="http://asiasociety.org/education/prizes/home.htm">2008 Goldman Sachs Foundation Prize</a> for Excellence in International Education in Media and Technology. Google Lit Trips uses the technologies of <a href="http://earth.google.com/">Google Earth</a> and social networking to bring literature to life through virtual mapping. By placing markers on Google Earth tracking the journeys of characters from literature and populating those placemarks with a wide variety of supplemental resources, students can “ride along as virtual passengers” on the same journey the characters are taking. The site gives teachers access to previously constructed Google Lit Trips as well as the ability to interact and post new trips online. Congratulations, Jerome — you couldn't have made us prouder! <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE6YltVd78r0yTVnqC31cSNttBAkHtMKFOlzlEFCoQ6WlsFolFEw3T_MzlJNnNAcxrGc35C460x9ZOZRwavWqokx3xG18NigK6zyPny607gq75Hck-O3jjwoUyeIlWIqtLD7n5tKoBwujk/s1600-h/candide_3.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332568671784206354" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiE6YltVd78r0yTVnqC31cSNttBAkHtMKFOlzlEFCoQ6WlsFolFEw3T_MzlJNnNAcxrGc35C460x9ZOZRwavWqokx3xG18NigK6zyPny607gq75Hck-O3jjwoUyeIlWIqtLD7n5tKoBwujk/s400/candide_3.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 394px; height: 309px;" /></a>Update: Corrected the application due date. Posted by Cristin Frodella, Product Marketing Manager

More tools and tricks for teachers

Hello teachers, We hope that your desk was deluged with a bunch of shined-up apples this morning as a thank you from your students for all t...

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EHR's and Scarcity of Public Reviews of the User Experience

I recently downloaded the public beta (incomplete trial version) of Apple's new web browser <a href="http://www.apple.com/safari/">Safari 4</a>. I like its <a href="http://www.interaction-design.org/encyclopedia/user_experience_or_ux.html">user experience</a> and features, presenting a main page "posterboard" of most visited or user-selected sites, a searchable, flip-panel history of visited pages (using the Macintosh OS X Spotlight and Cover Flow paradigms), top located tabs, and other useful features. (Note: I use both Macs and PC's, and hold no financial stakes in Apple whatsoever.) What struck me was the vociferous online discussions and debates about every facet of the new browser version, down to the level of minutiae. The following review particularly struck me for its level of detail - <a href="http://daringfireball.net/2009/03/safari_4_public_beta">Observations, Complaints, Quibbles, and Suggestions Regarding the Safari 4 Public Beta Released One Week Ago, Roughly in Order of Importance</a> by John Gruber. It includes minutiae such as this: <blockquote>... THE TABS Safari’s new tab layout, placing the tabs directly in the window title bar, is a radical change. There’s no use addressing the specific details — good and bad — of this new arrangement, without first trying to figure out why Apple did this. Again, the designers are behind Apple’s wall of silence, so we’re left to speculate. Rule out the notion that Safari’s designers undertook this change lightly. This is a major change to an important feature that many users feel strongly about. My guess is that this is an attempt to bring tabbed browsing to the masses. The biggest and most important change is that the interface for the tabs is now far more prominent. In fact, previously, the entire interface for tabbed browsing was not visible in Safari by default — in a window with just one tab, Safari’s default settings were such that the tab bar was not shown. In Safari 4, there’s a prominent and unique “+” button that is always visible in the top right corner of every window, where the standard tic-tac button for toggling the display of the toolbar usually resides.1 Because the interface to create new tabs is now obvious, I can only assume that the point of this redesign is to encourage more people to use, or at least try, tabbed browsing. But the problems with this new tab layout are significant. Conceptually, the basic idea is sound. Browser tabs are, effectively, a collection of separate browser windows grouped together in a single parent window. Safari’s new tab layout makes this a tab is like a sub-window metaphor more explicit. The anchor, the conceptual root, of a standard Mac OS window is the title bar, and in Safari 4, the tabs aren’t just in the title bar, they are the title bar ... </blockquote> Etcetera and so forth, on and on, as in other reviews easily found online. In Electronic Health Records and other clinical IT, by way of contrast, reviews at this level of detail are ... nearly nonexistent (I use the term "nearly" because I authored such a review, in general terms, <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>). One reason EHR and other clinical IT user experience and performance debates are so rare is because customers are contractually forbidden to engage in them publicly. Koppel's and Kreda's JAMA paper makes that clear: <a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276"></a><blockquote><a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' "Hold Harmless" Clause - Implications for Patients and Clinicians</a>, Ross Koppel and David Kreda, Journal of the American Medical Association, 2009; 301(12):1276-1278 </blockquote> Vendors claim they are protecting their "intellectual property." I'm not exactly sure what IP they are holding as closely as the crown jewels. Is it their: <ul><li>Earth shaking, 22nd century user interfaces?</li><li>Secretive and ingenious widgets that revolutionize user selection from choice lists?</li><li>Hyper-efficient, never before seen data structures and algorithms?</li><li>Artificial intelligence routines that would make Captain Picard and his android sidekick Mr. Data envious?</li></ul> In other words, what, exactly, is being protected by shielding commercial EHR's from external scrutiny and debate? <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgczlrzMT49uJ_QJkT2wm8vN33hCwIzyXC1ucci8-l4iQcivM6j1rjbPhjqOrMsMQHoUrMBsPrNqjcb0lbKKzzbGpeexZbilOno9aLu2hrW3NtnnVPeuNkDP9c42CenvQwZYIknDxwMa8Kz/s1600-h/m5.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332415104338254930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgczlrzMT49uJ_QJkT2wm8vN33hCwIzyXC1ucci8-l4iQcivM6j1rjbPhjqOrMsMQHoUrMBsPrNqjcb0lbKKzzbGpeexZbilOno9aLu2hrW3NtnnVPeuNkDP9c42CenvQwZYIknDxwMa8Kz/s320/m5.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 260px; height: 195px;" /></a>Is this the Secret Sauce the commercial EHR vendors seek to conceal? </div> The loss engendered by such policies is the reduced feedback from, and reduced interaction among endusers. This interaction occurs commonly on the Internet in 2009 on a great number of topics, but EHR user experiences are not one of them. Companies like Apple and Microsoft, strongly user centric, encourage such debates through release of their beta's, both of enduser tools and of operating systems e.g., Windows 7 Beta. I should note that with these pieces of software, lives are not at stake, unlike with electronic health records systems. The Veterans Health Administration makes a full working copy of VistA Computerized Patient Record System (CPRS) available as a free public download to anyone in the world <a href="http://www1.va.gov/cprsdemo/">here</a>. I use it in my teaching (and am forced to do so, as commercial EHR demos are as available as, say, demos of the National Security Agency's spy and decryption software). What, exactly, is the commercial EHR vendors' real excuse for the levels of product secrecy they maintain? Could it be embarrassment and fear of exposure of defects, ill conceived design features and a mission hostile user experience? -- SS

EHR's and Scarcity of Public Reviews of the User Experience

I recently downloaded the public beta (incomplete trial version) of Apple's new web browser Safari 4 . I like its user experience and f...

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More ways to share your Google Latitude location

A few months ago, we introduced <a href="http://www.google.com/latitude/intro.html">Google Latitude</a>, a new feature for mobile and iGoogle that lets you share your location with your friends. Since the launch, a lot of you have asked "What if I want to share my location with people who are not my Latitude friends?" Today, we're happy to release two applications that make that possible. <a href="http://www.google.com/latitude/apps/status">Google Talk location status (beta)</a> automatically updates your Google Talk or Gmail chat status message with your Latitude location. With this application enabled, all of your chat buddies can see your most recent city-level location. The <a href="http://www.google.com/latitude/apps/badge">Google Public Location Badge</a> lets you publish your Latitude location on your blog or website. You can choose to show just the city that you are in or you can have your device's location detected automatically, using GPS, Wi-Fi, or cell tower ID, which provides a more specific location. To read more about these new features, visit the <a href="http://googlemobile.blogspot.com/2009/05/do-more-with-google-latitude.html">Google Mobile Blog</a>. If you're already a Latitude user, give the <a href="http://www.google.com/latitude/apps">new apps</a> a try. If you don't have a Google Latitude account, sign up and start sharing your location now. We take your privacy very seriously and you can read the privacy notice on the application pages for more information. In the near future, we hope to offer a way to share your location in even more applications. If you have any suggestions or comments, please visit our <a href="http://productideas.appspot.com/#16/e=cf">Product Ideas page</a>. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoN_ctzAp6ALJxq2phBgn7O9b3F9s5kp0LCEKOHRWD4Tz0fBgBztnl2cnjgRRyvRQVKIcT9fDZI2iXobGqyGr56w4qOJ5Sl8vwwjrSqgJ0ifsL3XsnvJqx6itT3pTcjFV1BO9bUwf2DWNq/s1600-h/badge-large.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332008432911207586" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoN_ctzAp6ALJxq2phBgn7O9b3F9s5kp0LCEKOHRWD4Tz0fBgBztnl2cnjgRRyvRQVKIcT9fDZI2iXobGqyGr56w4qOJ5Sl8vwwjrSqgJ0ifsL3XsnvJqx6itT3pTcjFV1BO9bUwf2DWNq/s400/badge-large.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 240px;" /></a>Posted by Rohan Seth & Chris Lambert, Software Engineers, Google Mobile

More ways to share your Google Latitude location

A few months ago, we introduced Google Latitude , a new feature for mobile and iGoogle that lets you share your location with your friends. ...

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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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