healthy4u

What Influenced a Paean to Karen Ignagne?

As the discussion here in the US about health care reform gathers steam, the Washington Post published a rather uncritical <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/24/AR2009052400551.html">profile</a> of one of the prominent participants, Ms Karen Ignagni, CEO of America's Health Insurance Plans (AHIP), the trade group for the health insurance/ managed care industry. It included some compliments from Princeton Professor and prominent health care economist Uwe Reinhardt: <blockquote> 'Whatever AHIP pays her, it's not enough. She's unbelievably effective,' said Princeton economist Uwe Reinhardt. 'It's just amazing what she's achieved for them against all odds.' Ignagni's total compensation, according to AHIP's most recent filing from 2007, was $1.58 million, which includes $700,000 in base salary, $370,000 in deferred compensation and a bonus. Ignagni won't say how many hours a week she works. The number's so high it's embarrassing, she said. Among successes cited by Reinhardt and others is helping persuade the Bush administration to develop private insurance plans within Medicare that are producing unexpectedly high payments for private insurers. </blockquote> What the Washington Post article did not bother to mention was that in addition to being on the Princeton faculty, Professor Reinhardt is a member of the <a href="http://phx.corporate-ir.net/phoenix.zhtml?c=122199&p=irol-govboard">board of directors </a>of <a href="http://www.amerigroupcorp.com/Pages/Home.aspx">Amerigroup</a>, a health insurance company specializing in providing Medicaid and Medicare managed care (see this <a href="http://hcrenewal.blogspot.com/2009/01/what-ruc-prominent-health-care-policy.html">previous post</a>), and a member of AHIP. Former Amerigroup CEO Jeffrey McWalters was <a href="http://orlando.bizjournals.com/gen/executive.html?excode=406F5DF537D14F3AACA5084EC5142068">on the board of AHIP</a>. According to Amerigroup's<a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6228231&format=PDF"> 2009 proxy statement</a>, Professor Reinhardt controls (via ownership or options) 144,558 shares of Amerigroup stock, and received $226,531 in compensation from Amerigroup in 2008. Perhaps Professor Reinhardt's enthusiasm for Karen Ignagne's performance as CEO of AHIP derived more from his leadership of Amerigroup than a scholarly analysis. Note also that Professor Reinhardt is a member of the <a href="http://phx.corporate-ir.net/phoenix.zhtml?c=62272&p=irol-govBoard">board of directors </a>of <a href="http://www.bostonscientific.com/">Boston Scientific</a>, a medical device company. Furthermore, per proxy statements from the above companies, Professor Reinhardt is on the board of two funds from H&Q Healthcare Investors, and is a Trustee of Duke University and the Duke University Health System. Professor Reinhardt's leadership roles in US publicly traded corporations are public, but not easily found unless one knows where to look. We had first <a href="http://hcrenewal.blogspot.com/2006/03/economist-puts-down-physicians-cri-du.html">discussed</a> these relationships on Health Care Renewal in 2006. However, many of the more academically tinged biographies of him publicly available omit his leadership roles in the for-profit world. At the moment, biographies of Professor Reinhardt on the <a href="http://wws.princeton.edu/people/display_person.xml?netid=reinhard&all=yes">Princeton web-site</a>, and furnished by the <a href="http://www.princeton.edu/~bioethic/about_us/advisors/reinhardt.html">Princeton Bioethics Forum</a>, the <a href="http://www.commonwealthfund.org/bios/bios_show.htm?doc_id=239402">Commonwealth Fund</a>, and the <a href="http://www.kff.org/about/reinhardt.cfm">Henry J Kaiser Foundation </a>did not note these relationships. This illustrates once more participation in the current health policy debate may be driven by vested interests, rather than ideology, much less dispassionate analysis. Were the participants yo disclose, at least, their financial interests, the debate would become that much clearer. Meanwhile, when listening to the debate, always ask, "cui bono?" (Who benefits?) Hat tip to <a href="http://www.thehealthcareblog.com/the_health_care_blog/2009/05/im-not-sure-thats-how-uwe-meant-it.html">the Health Care Blog</a>.

What Influenced a Paean to Karen Ignagne?

As the discussion here in the US about health care reform gathers steam, the Washington Post published a rather uncritical profile of one o...

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BLOGSCAN - Comparative Effectiveness Research, the Partnership to Improve Patient Care, and PhRMA

BLOGSCAN - Comparative Effectiveness Research, the Partnership to Improve Patient Care, and PhRMA

On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody dissected a campaign to redirect comparative effectiveness research by mak...

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"A Breach of Trust"

This new variation on a now old theme first <a href="http://www.nytimes.com/2009/05/13/business/13surgeon.html">appeared in the New York Times</a>: <blockquote> A former surgeon at Walter Reed Army Medical Center, who is a paid consultant for a medical company, published a study that made false claims and overstated the benefits of the company’s product in treating soldiers severely injured in Iraq, the hospital’s commander said Tuesday. An investigation by Walter Reed found that the study cited higher numbers of patients and injuries than the hospital could account for, said the commander, Col. Norvell V. Coots. 'It’s like a ghost population that were reported in the article as having been treated that we have no record of ever having existed,' Colonel Coots said in a telephone interview on Tuesday. 'So this really was all falsified information.' The former Army surgeon, Dr. Timothy R. Kuklo, reported that a bone-growth product sold by Medtronic Inc. had much higher success in healing the shattered legs of wounded soldiers at Walter Reed than other doctors there had experienced, according to Colonel Coots and a summary of an Army investigation of the matter. Dr. Kuklo, 48, now an associate professor at the Washington University medical school in St. Louis, did not respond to numerous e-mail messages and telephone calls to his office and home seeking comment over the last two weeks. Walter Reed officials say he did not respond to their inquiries during their investigation. Army investigators found that Dr. Kuklo forged the signatures of four Walter Reed doctors on the article before submitting it last year to a British medical journal, falsely claiming them as co-authors. He also did not obtain the Army’s required permission to conduct the study. In its March edition, at the Army’s request, the journal retracted the article — something that has gone largely unnoticed outside orthopedic circles. While at Walter Reed and since, Dr. Kuklo has given talks to other doctors around the country about the bone-growth product, a protein called Infuse, according to meeting agendas and published documents. A Medtronic spokeswoman, Marybeth Thorsgaard, confirmed that Dr. Kuklo was a paid consultant to the company and that the company financially supported some of his research at Walter Reed, through a foundation affiliated with the hospital. During his time at Walter Reed Dr. Kuklo was extensively involved in research and writing about various Medtronic products, including editing two books published by the company and conducting three studies that were approved by his Army superiors, according to his list of publications and an Army report. Colonel Coots said Tuesday that the total number of patients Dr. Kuklo reported as having been treated for extensive lower leg wounds at Walter Reed during the study period — 138 soldiers — was greater than the number for which the hospital could find records. 'It is a significant breach of academic protocol,' Colonel Coots said. 'It’s a breach of trust.' </blockquote> This story has several familiar elements, but combines them in some interesting ways. We have <a href="http://hcrenewal.blogspot.com/search/label/key%20opinion%20leaders">discussed</a> how health care corporations, particularly pharmaceutical manufacturers, cultivate "key opinion leaders," and use them to market their products. This may amount to stealth marketing, since KOLs rarely disclose in detail their relationships with corporate sponsors, and instead further their marketing objectives cloaked as academics. We have also <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">discussed</a> how health care corporations, particularly pharmaceutical manufacturers, may sponsor clinical research on their own products. However, such sponsors often manipulate the research projects' design, implementation, analysis, and dissemination so as to favor their products. While the sponsorship may be disclosed, the extent of the sponsors' control over the project may not be. Furthermore, scientific investigators running such projects may have their own personal financial relationships with the sponsors. This case apparently shows how a medical academic can both be a paid "key opinion leader," and manipulative clinical researcher. While many examples of key opinion leaders as stealth marketers, and manipulated research involved pharmaceutical companies, this one involves a medical device company. In addition, this research project was not just manipulated, but allegedly falsified. This variation has at least one other interesting element. Again, from the New York Times, <blockquote>A former Walter Reed colleague, Dr. David W. Polly Jr., who is also a Medtronic consultant, said he believed that Dr. Kuklo’s data was “strong” and the episode had been overblown. </blockquote>According to the <a href="http://www.publicintegrity.org/blog/entry/1366/">Center for Public Integrity Paper Trail blog</a>, <blockquote>A former colleague of Kuklo’s at Walter Reed Army Medical Center, Dr. David W. Polly Jr., took even more expensive trips than Kuklo. Polly went on at least 12 Medtronic-sponsored trips costing about $30,000, including a $10,000 trip to Switzerland. </blockquote> Furthermore, the New York Times <a href="http://www.nytimes.com/2009/05/21/business/21surgeon.html">reported</a>, <blockquote>[Senator Charles] Grassley, the ranking Republican [from Iowa] on the Senate Finance Committee, has been investigating since last year whether Medtronic illegally promoted unapproved uses for Infuse. Medtronic, which has denied that accusation, provided him last year with a list of Infuse consultants. After Dr. Kuklo’s links to Medtronic and Infuse came to light last week in a New York Times article, Mr. Grassley’s staff checked the consultants list and noted that Dr. Kuklo’s name was not on it. In reaction, he wrote a letter to Medtronic’s president and chief executive, William A. Hawkins III, asking why Dr. Kuklo had been omitted. Mr. Grassley entered that letter and the list he had received into The Congressional Record. 'In the future, I hope that instead of not providing me with the name of the physician involved in Infuse, or any other matter that I am looking into, that Medtronic contact me to avoid the situation in which we find ourselves,' Mr. Grassley wrote to Mr. Hawkins. </blockquote>So, as soon as this case came to light, the spinning of public discussion to favor Medtronic and its key opinion leaders began. Thus, this case also involved stealth policy advocacy. Stealth marketing, clinical research manipulation, and stealth advocacy all in one case, we seem to have hit the jackpot. The most recent development, again <a href="http://www.nytimes.com/2009/05/23/business/23surgeon.html">according to the NY Times</a>, is <blockquote> Dr. Timothy R. Kuklo, a former Army physician accused of falsifying research involving injured soldiers, has taken a leave of absence from the Washington University School of Medicine in St. Louis and its affiliated hospitals, the medical school said Friday. Dr. Kuklo, an associate professor of orthopedic surgery, will not be performing operations, conducting research or teaching students, said a medical school spokeswoman, Joni Westerhouse. The university granted the leave, she said, so that Dr. Kuklo 'can focus on responding to queries about his research and consulting.' </blockquote>At least his absence was not ascribed to the need to spend more time with his family or pursue other opportunities. Finally, note that we <a href="http://hcrenewal.blogspot.com/2008/05/corporate-integrity-agreement-for.html">posted</a> last year that Medtronic had submitted to a corporate integrity agreement after the US Department of Justice accused it of defrauding Medicare in connection with activities by its Kyphon subsidiary. So this case additionally suggests that such agreements have little effect on the actual integrity of corporate leaders. Hat tip to and see further commentary by Prof Margaret Soltan <a href="http://www.margaretsoltan.com/?p=12853">on the University Diaries blog</a>. ADDENDUM (24 May, 2009) - see further comments by Prof Soltan <a href="http://www.margaretsoltan.com/?p=13249">on the University Diaries blog</a>.

"A Breach of Trust"

This new variation on a now old theme first appeared in the New York Times : A former surgeon at Walter Reed Army Medical Center, who is a p...

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BLOGSCAN - "Money-Driven Medicine," the Film

BLOGSCAN - "Money-Driven Medicine," the Film

On the Health Care Blog, Maggie Mahar announced the screening of the new documentary film based on her book "Money-Driven Medicine....

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New logo look

You may have noticed new logos at the top of some of Google's web pages, including <a href="http://www.googlelabs.com/">Google Labs</a>, <a href="http://moderator.appspot.com/">Google Moderator</a>, and <a href="http://code.google.com/">Google Code</a>. These are the result of a new logo design we are rolling out. We hope this design freshens up our look as well as improves consistency and ease of use across our sites. Now, our product names will appear in clean, simple blue lowercase type alongside the Google logo as shown here: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9U7wY742vUfVnjxYtu9x9XFvtAULZnipztA4GEaOIWKN4HYJr5A4yCXIyYiWfXCUvRnTphTwd8Buu0F1Dff90gDm-xbhseNT0GCuCYYAF0ZIJbKmbVb8b9lRPSMXL4pCq7JrJR4qvFMP6/s1600-h/google_logos.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5338408223180742370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9U7wY742vUfVnjxYtu9x9XFvtAULZnipztA4GEaOIWKN4HYJr5A4yCXIyYiWfXCUvRnTphTwd8Buu0F1Dff90gDm-xbhseNT0GCuCYYAF0ZIJbKmbVb8b9lRPSMXL4pCq7JrJR4qvFMP6/s400/google_logos.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 303px;" /></a>Since the logos appear in many different locations and sizes on our websites, our new designs are standardized to be the same size and color wherever they appear. This should make it easier for you to recognize which site you are on and navigate to wherever you want to go. They are also consistent across all our international domains, which is especially helpful for people using right-to-left languages such as Arabic and Hebrew. We are happy with this change since it will help us streamline our user experience. Count on seeing the new logos rolling out to Google Maps, Google News, Google Docs and more over the next few weeks. Posted by Marissa Mayer, Vice President of Search Products and User Experience, and Jamie Divine, Senior Visual Designer

New logo look

You may have noticed new logos at the top of some of Google's web pages, including Google Labs , Google Moderator , and Google Code . Th...

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Netlog integrates with Google Friend Connect

When we started building <a href="http://www.google.com/friendconnect/">Friend Connect</a>, we wanted to provide a fully open system — one that lets you join any website and interact with the people there in a meaningful way, regardless of where they come from. To enable this kind of engagement, we used open standards like <a href="http://openid.net/">OpenID</a>, <a href="http://oauth.net/">OAuth</a>, and <a href="http://www.opensocial.org/">OpenSocial</a> as underlying technologies, enabling any other service to plug into Friend Connect. Today, we're excited to share that <a href="http://www.netlog.com/">Netlog</a> has used these open standards to integrate their social networking service with Google Friend Connect. Now, Netlog's more than 45 million users across Europe can: <ul><li>Sign into any of the millions of sites and blogs using Friend Connect with their Netlog credentials</li><li>Use their Netlog profiles on these sites</li><li>See if any of their friends are already members of the same sites and invite other Netlog friends to join</li><li>Share their Friend Connect activities with their friends on Netlog, and</li><li>Send messages back to their Netlog friends</li></ul>Additionally, for sites that are already using Friend Connect, one of the benefits of this standards based model is that they can take advantage of any new service that chooses to join this open ecosystem, like Netlog, without any additional work. The new network option simply appears. <div> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqwxKAM7cRs1HJuyX2KmJjNIugJrJn8xr4whJ_e5dOLBu_4qhufqgjirEifz4DivG_0t4EqGLpoqsmkFjPnyys86HegUjDs0-hum9EFQhUTGgdvH8TTP3fGYQ4qGTfbuHyy9DNoBg2HAcV/s1600-h/blog_post_netlog.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5338341913176005730" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqwxKAM7cRs1HJuyX2KmJjNIugJrJn8xr4whJ_e5dOLBu_4qhufqgjirEifz4DivG_0t4EqGLpoqsmkFjPnyys86HegUjDs0-hum9EFQhUTGgdvH8TTP3fGYQ4qGTfbuHyy9DNoBg2HAcV/s400/blog_post_netlog.gif" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 361px; height: 333px;" /></a> Any social network or service, whether they are large or small, regional or global, niche or general audience, is welcome to take advantage of these open standards to integrate with Friend Connect, and participate in an open social web. Posted by Mussie Shore, Product Manager</div>

Netlog integrates with Google Friend Connect

When we started building Friend Connect , we wanted to provide a fully open system — one that lets you join any website and interact with th...

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Put the pedal to the metal with a faster Google Chrome

We <a href="http://googleblog.blogspot.com/2008/09/fresh-take-on-browser.html">introduced Google Chrome</a> back in September, and it's received a great response so far. Since launching, we've been working hard on adding the <a href="http://www.google.com/support/forum/p/Chrome/label?lid=4b62763ab25c3274&hl=en&sort=popularity">top requested features</a> and making Google Chrome even faster. Today, we are updating to a new version of Google Chrome that is faster than ever. JavaScript-heavy web pages will now run about 30% faster. See the chart below or <a href="http://v8.googlecode.com/svn/data/benchmarks/v4/run.html">compare scores yourself</a>. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSZAzK3OoCBpp1eV0CBGT0gI215oECId-mjRQW1Fd-hgbeMZJ_4sGsZxJgTE1AUwvgRPbSX9UVP0bbWX65RqG-3FVZU28dkVS_lQOrN35sDMgtl4L9uz0qYE34wHH5y5Ej5ZWL2ijErkDS/s1600-h/V8.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5338308324481850370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSZAzK3OoCBpp1eV0CBGT0gI215oECId-mjRQW1Fd-hgbeMZJ_4sGsZxJgTE1AUwvgRPbSX9UVP0bbWX65RqG-3FVZU28dkVS_lQOrN35sDMgtl4L9uz0qYE34wHH5y5Ej5ZWL2ijErkDS/s400/V8.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 230px;" /></a>Additionally, we've added some useful features like <a href="http://www.google.com/support/chrome/bin/answer.py?hl=en&answer=142464">form autofill</a>, full screen mode, and the ability to remove thumbnails from the <a href="http://www.google.com/support/chrome/bin/answer.py?hl=en&answer=95451">New Tab page</a>. Here's a short video demonstrating some of this new functionality: <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/rubd9bqjS64&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/rubd9bqjS64&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object> If you're already using Google Chrome, you'll be automatically updated with these new features soon. If you haven't downloaded Google Chrome, get the latest version at <a href="http://google.com/chrome">google.com/chrome</a>. To read more about this update, visit the <a href="http://chrome.blogspot.com/2009/05/speedier-google-chrome-for-all-users.html">Google Chrome blog</a>. Posted by Darin Fisher, Google Chrome Team

Put the pedal to the metal with a faster Google Chrome

We introduced Google Chrome back in September, and it's received a great response so far. Since launching, we've been working hard ...

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