healthy4u

Sanofi-Aventis Settles

Here is another addition to the parade of multi-million dollar legal settlements by health care corporations. As <a href="http://www.google.com/hostednews/ap/article/ALeqM5iz-Iv0odwT89eHgHRlkwHSgLx5RwD98FB4T80">reported by the AP</a>: <blockquote> Drugmaker Sanofi-Aventis has agreed to pay nearly $100 million to settle allegations it cheated Medicaid on the cost of nasal sprays. The Justice Department said Aventis Pharmaceutical Inc., a wholly owned subsidiary of Sanofi-Aventis U.S. LLC, has agreed to pay the government $95.5 million to settle the charges. The government charged that between 1995 and 2000, Aventis and its corporate predecessors did not offer Medicaid the best prices for the sprays Azmacort, Nasacort and Nasacort AQ. In reaching the settlement, Sanofi-Aventis U.S. did not admit any wrongdoing. The company, based in Bridgewater, N.J., issued a statement saying it believed the old pricing system was legal. Under the law, the company was required to tell Medicaid the lowest price that it charged companies for those products, and offer state Medicaid programs rebates based on those prices. Prosecutors contend that in order to dodge that obligation, Aventis entered into a private deal with the HMO Kaiser Permanente that repackaged Aventis drugs under a new label, allowing them to overcharge Medicaid programs for the same product. </blockquote> It seems that scarcely a week goes by without a settlement of charges of unethical behavior by some major health care organization. The ongoing parade of such cases ought to inspire some worry about the ethics of the leaders of such organization. Given the current very public discussion of how expensive health care has become, one would think that there would be some discussion of how much of this expense is due to various kinds of deceptive and unethical behavior by some of the biggest, richest, and most powerful health care organizations. But perhaps that would be too upsetting for those who make so much money running these organizations. As we have <a href="http://hcrenewal.blogspot.com/2009/05/synthes-settles-agrees-to-stop-giving.html">said before</a>, most recently <a href="http://hcrenewal.blogspot.com/2009/05/novo-nordisk-accepts-deferred.html">here</a>, 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 fine. In this case, the fine was, in corporate terms, of modest size. However, even a large fine, may come out of dividends or the stock price, dispersing the cost to stock-holders, or out of salaries across the board, dispersing the cost to all employees. 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 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. ADDENDUM (2 June, 2009) - See <a href="http://scienceblogs.com/effectmeasure/2009/06/placing_a_vaccine_order_with_c.php#more">these comments </a>on the Effect Measure blog.

Sanofi-Aventis Settles

Here is another addition to the parade of multi-million dollar legal settlements by health care corporations. As reported by the AP : Drugma...

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Canadian Health IT Ripoff ... Is Anyone in the U.S. Paying Attention?

In my Feb. 18, 2009 <a href="http://hcrenewal.blogspot.com/2009/02/medinformaticsmd-in-wall-street-journal.html">Wall Street Journal letter to the editor</a> I wrote: <blockquote>You observe that the true political goal is socialized medicine facilitated by health care information technology. You note that the public is being deceived, as the rules behind this takeover were stealthily inserted in the stimulus bill. I have a different view on who is deceiving whom. In fact, it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants. For £12.7 billion the U.K., which already has socialized medicine, still does not have a working national HIT system, but instead has a major IT quagmire, some of it caused by U.S. HIT vendors. HIT (with a few exceptions) is largely a disaster. I'm far more concerned about a mega-expensive IT misadventure than an IT-empowered takeover of medicine. The stimulus bill, to its credit, recognizes the need for research on improving HIT. However this is a tool to facilitate clinical care, not a cybernetic miracle to revolutionize medicine. The government has bought the IT magic bullet exuberance hook, line and sinker. I can only hope patients get something worthwhile for the $20 billion. </blockquote>Regarding my fears about waste and about the identity of the true beneficiaries, this in from the Toronto Sun in Canada: <h3></h3><blockquote><h3 style="font-weight: normal;"><a href="http://www.torontosun.com/news/canada/2009/05/29/9607096-sun.html">eHealth making critics sick</a></h3> Opposition wants 'walking papers' issued to minister, CEO over questionable expenditures By Antonella Artuso, QUEEN'S PARK BUREAU CHIEF29th May 2009 eNough, government critics say. Opposition parties at Queen's Park are calling for heads to roll after the newest revelations of eye-popping expenditures at eHealth Ontario -- the taxpayer-funded agency established to produce electronic medical records for every citizen in the province. One consultant with a four-month contract worth $210,600 billed taxpayers for items as small as her $1.57 Tim Hortons tea, her BBQ chicken sub, a $2.98 soup, and her muffins and pops, as well as travel to and from Alberta, and a $2,820-a-month apartment in Toronto. Even Premier Dalton McGuinty is struggling to understand the spending and has said that he welcomes the results of an ongoing investigation of the agency by the auditor general. ... Freedom of Information documents obtained by the Progressive Conservatives have revealed that eHealth Ontario CEO Sarah Kramer approved nearly $5 million in contracts that weren't put out for a competitive bid. Sun Media has learned that one consultant charged taxpayers $300 an hour to consult with her husband -- who also had a consulting contract with eHealth Ontario. Taxpayers paid $7,000 to a consultant to write Kramer's speech to Health Active 2008, and hundreds of dollars more to update her biography. Even the official spokesman for eHealth was a consultant who charged $1,600 a day to provide communications advice and talk to media, billing $33,200 for 20.75 days work in March alone. Questions were also raised in the legislature about consultants who billed the Ontario taxpayer to read The New York Times, talk on the subway and watch TV. On top of that, Kramer received a $114,000 bonus within months of beginning her $380,000-a-year position. eHealth Ontario and its predecessor agency have spent $146 million on consultants since 2003, despite commitments to reign in billings for outside expertise, and overall agency spending has ballooned to $839 million. Other provinces are ahead of Ontario in producing records although so far they have spent less money. ... During Question Period, Runciman called on the premier to give Kramer and Caplan their "walking papers." </blockquote>I stand by my Wall Street Journal letter, to the letter. The Toronto Sun article concluded with this: <blockquote> NDP MPP France Gelinas also called for heads to roll, saying eHealth Ontario and its predecessor agency have produced next to nothing for more than three-quarters of a billion dollars.</blockquote> I reiterate, I hope patients in the U.S. actually get something for the $20+ billion we're about to spend to force health IT down doctors' throats. -- SS

Canadian Health IT Ripoff ... Is Anyone in the U.S. Paying Attention?

In my Feb. 18, 2009 Wall Street Journal letter to the editor I wrote: You observe that the true political goal is socialized medicine facil...

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Went Walkabout. Brought back Google Wave.

Back in early 2004, Google took an interest in a tiny mapping startup called Where 2 Tech, founded by my brother Jens and me. We were excited to join Google and help create what would become <a href="http://maps.google.com/">Google Maps</a>. But we also started thinking about what might come next for us after maps. As always, Jens came up with the answer: communication. He pointed out that two of the most spectacular successes in digital communication, email and instant messaging, were originally designed in the '60s to imitate analog formats — email mimicked snail mail, and IM mimicked phone calls. Since then, so many different forms of communication had been invented — blogs, wikis, collaborative documents, etc. — and computers and networks had dramatically improved. So Jens proposed a new communications model that presumed all these advances as a starting point, and I was immediately sold. (Jens insists it took him hours to convince me, but I like my version better.) We had a blast the next couple years turning Where 2's prototype mapping site into Google Maps. But finally we decided it was time to leave the Maps team and turn Jens' new idea into a project, which we codenamed "Walkabout." We started with a set of tough questions: <ul><li>Why do we have to live with divides between different types of communication — email versus chat, or conversations versus documents?</li><li>Could a single communications model span all or most of the systems in use on the web today, in one smooth continuum? How simple could we make it?</li><li>What if we tried designing a communications system that took advantage of computers' current abilities, rather than imitating non-electronic forms? </li></ul>After months holed up in a conference room in the <a href="http://maps.google.com/maps?q=48+Pirrama+Road+Pyrmont,+NSW+2009&oe=utf-8&client=firefox-a&ie=UTF8&split=0&gl=us&ei=Y3EcSsGXO46UswOYme3ZCA&ll=-33.865997,151.195736&spn=0.009229,0.022745&z=16&iwloc=A">Sydney office</a>, our five-person "startup" team emerged with a prototype. And now, after more than two years of expanding our ideas, our team, and technology, we're very eager to return and see what the world might think. Today we're giving developers an early preview of Google Wave. A "wave" is equal parts conversation and document, where people can communicate and work together with richly formatted text, photos, videos, maps, and more. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNCGFN-xwcoNlkDo4kO-aMA1dIYF1rPa_xaX6N2bU-4F-7C6d8_q-ATQtMgtNImxU7L7WBY6PNc40IC6KvNGC5vJ7zERjbAaS4wosKVy8JvVFEfFAbZJ21RZpqJgAaJX_Qx_CW9HO87PdK/s1600-h/Google_Wave_snapshots_inbox.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5340763954261169682" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNCGFN-xwcoNlkDo4kO-aMA1dIYF1rPa_xaX6N2bU-4F-7C6d8_q-ATQtMgtNImxU7L7WBY6PNc40IC6KvNGC5vJ7zERjbAaS4wosKVy8JvVFEfFAbZJ21RZpqJgAaJX_Qx_CW9HO87PdK/s400/Google_Wave_snapshots_inbox.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 261px;" /></a> Here's how it works: In Google Wave you create a wave and add people to it. Everyone on your wave can use richly formatted text, photos, gadgets, and even feeds from other sources on the web. They can insert a reply or edit the wave directly. It's concurrent rich-text editing, where you see on your screen nearly instantly what your fellow collaborators are typing in your wave. That means Google Wave is just as well suited for quick messages as for persistent content — it allows for both collaboration and communication. You can also use "playback" to rewind the wave and see how it evolved. As with <a href="http://code.google.com/android/">Android</a>, <a href="http://code.google.com/chromium/">Google Chrome</a>, and many other Google efforts, we plan to make the code open source as a way to encourage the developer community to get involved. Google Wave is very open and extensible, and we're inviting developers to add all kinds of cool stuff before our public launch. Google Wave has three layers: the product, the platform, and the protocol: <ul><li>The Google Wave product (available as a developer preview) is the web application people will use to access and edit waves. It's an HTML 5 app, built on <a href="http://code.google.com/webtoolkit/">Google Web Toolkit</a>. It includes a rich text editor and other functions like desktop drag-and-drop (which, for example, lets you drag a set of photos right into a wave). </li><li>Google Wave can also be considered a platform with a rich set of open APIs that allow developers to embed waves in other web services, and to build new extensions that work inside waves.</li><li>The Google Wave protocol is the underlying format for storing and the means of sharing waves, and includes the "live" concurrency control, which allows edits to be reflected instantly across users and services. The protocol is designed for open federation, such that anyone's Wave services can interoperate with each other and with the Google Wave service. To encourage adoption of the protocol, we intend to open source the code behind Google Wave. </li></ul>So, this leaves one big question we need your help answering: What else can we do with this? If you're a developer and you'd like to roll up your sleeves and start working on Google Wave with us, you can read more on the <a href="http://googlewavedev.blogspot.com/2009/05/introducing-google-wave-apis-what-can.html">Google Wave Developer blog</a> about the <a href="http://code.google.com/apis/wave/">Google Wave APIs</a>, and check out the <a href="http://google-code-updates.blogspot.com/2009/05/hello-world-meet-google-wave.html">Google Code blog</a> to learn more about the <a href="http://www.waveprotocol.org/">Google Wave Federation Protocol</a>.  If you'd like to be notified when we launch Google Wave as a public product, you can sign up at <a href="http://wave.google.com/">http://wave.google.com</a>/. We don't have a specific timeframe for public release, but we're planning to continue working on Google Wave for a number of months more as a developer preview. We're excited to see what feedback we get from our early tinkerers, and we'll undoubtedly make lots of changes to the Google Wave product, platform, and protocol as we go. We look forward to seeing what you come up with!<div> </div><div>Update @ 7:07PM: The <a href="http://www.youtube.com/watch?v=v_UyVmITiYQ">video</a> of the Google Wave keynote presentation is now available:</div><div> </div><div><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/v_UyVmITiYQ&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/v_UyVmITiYQ&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object> </div><div> Posted by Lars Rasmussen, Software Engineering Manager</div>

Went Walkabout. Brought back Google Wave.

Back in early 2004, Google took an interest in a tiny mapping startup called Where 2 Tech, founded by my brother Jens and me. We were excite...

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Search engineer stories

I came to Google because I wanted to work on hard problems and have a big impact on the world. Four years later, I'm still constantly awed by how challenging search is. We work on improving the entire search process, including formulating queries, evaluating results, reading and understanding information, and digging deeper with this new information. Every day we work on ways, both big and small, for search to be better, faster, and more effortless. My fellow engineers and I wanted to give a peek into some of the challenges we face and how we're trying to make search even better. We created a <a href="http://www.youtube.com/view_play_list?p=396574970FFD6E31">series of short videos</a> so you could hear straight from the engineers. Here's mine, where I talk about a change to spell suggestions. <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/SWTzYAIkBdE&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/SWTzYAIkBdE&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> Some of the videos may talk about things you are already familiar with and some may be new. Either way, we hope that you enjoy hearing these stories, and do stay tuned for more! Posted by Patrick Riley, Software Engineer

Search engineer stories

I came to Google because I wanted to work on hard problems and have a big impact on the world. Four years later, I'm still constantly aw...

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Kicking off 2nd annual Google I/O developer gathering

Today is the first day of <a href="http://code.google.com/events/io/">Google I/O</a> — two days of developer talks, fireside chats and demos, all focused on the latest innovations in the web as a development platform. We're excited to have this chance to welcome more than 3,000 developers to the Moscone Center in (unusually) sunny San Francisco for a variety of interactive roundtables and talks on subjects like Android, Google Maps and Google Apps for the Enterprise. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX-nh8xY-Q55cJ5BV6GeJgtqah1afl0XS_ac-kSc3vD77AmBEEiB-4r1ckj1qKc2ac95Vp_Jk7MkZXzggrE_Gpsf2n6rrUKkKSisrtptrfXawLMuXf0Y6jEvFQN1X2lCtzSW8pu19IL8J6/s1600-h/10135098.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5340565901979996258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiX-nh8xY-Q55cJ5BV6GeJgtqah1afl0XS_ac-kSc3vD77AmBEEiB-4r1ckj1qKc2ac95Vp_Jk7MkZXzggrE_Gpsf2n6rrUKkKSisrtptrfXawLMuXf0Y6jEvFQN1X2lCtzSW8pu19IL8J6/s400/10135098.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 300px; height: 400px;" /></a> We'll be back with more news as the conference progresses. In the meantime, you can follow updates on the <a href="http://twitter.com/googleio">@googleio</a> Twitter stream; videos of all sessions will be available on <a href="http://code.google.com/">code.google.com</a> shortly after they conclude. Update @ 3:20PM: Videos from Day 1 of Google I/O are now available on our <a href="http://www.youtube.com/view_play_list?p=41F4CEB92D80C4B7">YouTube playlist</a>. Posted by Emily Wood, Google Blog team

Kicking off 2nd annual Google I/O developer gathering

Today is the first day of Google I/O — two days of developer talks, fireside chats and demos, all focused on the latest innovations in the ...

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Harvard's EMR Justification: We Just Have To Do Something?

I think what I termed "irrational exuberance" over health IT is now devolving into just simple irrationality. I am unfamiliar with the reasoning employed below (in boldface) by the Harvard researcher, Ashish Jha, MD, MPH (who authored the April 2009 EHR usage survey "<a href="http://content.nejm.org/cgi/content/full/360/16/1628" style="font-family: arial;">Use of Electronic Health Records in U.S. Hospitals</a>" in the NEJM). From "<a href="http://www.healthleadersmedia.com/content/232813/topic/WS_HLM2_MAG/Cash-for-Computers.html" style="font-family: arial;">Cash for Computers</a>", HealthLeaders Media, May 11, 2009. First, my opinions: <blockquote style="font-family:arial;"> ... "This forced timeline [by 2014] is a <a href="http://www.jamia.org/cgi/content/abstract/13/1/106">very bad thing</a>. I'm concerned it is going to take an experimental technology and turn it into a train wreck," Silverstein [me - ed.] says. "We need a more gradual process where we can learn from mistakes on a small scale to avoid reproducing them on a large scale ... So now, Silverstein says, healthcare providers are caught between their mission to provide quality care and the financial pressure to install an unproven technology that may threaten the mission. "Health IT, when it's done correctly, can improve healthcare and reduce costs. But health IT when it is not done well has the exact reverse potential," Silverstein says. "It can impair healthcare, decrease quality, and create other adverse effects for patients. That is the missing element in this discussion."</blockquote> Then, Jha's: <blockquote style="font-family:arial;">A need to act Others aren't so pessimistic. Jha [Ashish Jha, MD, MPH, the lead author of the survey, and an associate professor of health policy and management at Harvard] says hospitals will have five years to establish EHR before federal penalties kick in. And because it involves the federal government, Jha says it's more than likely that those deadlines will get pushed back even further [not according to ONC chair and fellow Harvard professor David Blumenthal, who as I noted in <a href="http://www.healthleadersmedia.com/content/232813/topic/WS_HLM2_MAG/Cash-for-Computers.html">this post</a> said HIT timelines were "cemented in law" - ed.] Jha says critics are "missing the point." "I'm not suggesting EHR is going to be a panacea, but the one thing that is absolutely true is there is nothing else out there now that has any more political appeal," Jha says. "Everybody agrees, whether you are a conservative, moderate, or liberal, that we have to do something about healthcare. So the one place where we can all come to agreement is we have to do something about electronic records." </blockquote> $20+ billion and penalties upon already squeezed practitioners and hospitals for non-adoption of expensive, experimental technology is a lot of "doing something.", especially at a time when many are medically uninsured or underserved. I am also not sure about what point critics are "missing." (Note: I am not a critic, but am a gadfly of healthcare IT mis-design, mismanagement and fraud.) It appears that reasoning at Harvard has dropped to the level of "we should do it, because we have to do something." Good intentions trump outcomes. Not to make a comparison between HIT and other types of medical experimentation, but it's likely the PI's of the <a href="http://en.wikipedia.org/wiki/Tuskegee_Study_of_Untreated_Syphilis_in_the_Negro_Male" style="font-family: arial;">Tuskegee Experiment</a> felt the same way. Ironically, Harvard is home to Medical Informatics pioneers such as Dr. Octo Barnett, coauthor of the National Research Council report warning that <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572" style="font-family: arial;">approaches to today's HIT are inadequate</a>. -- SS

Harvard's EMR Justification: We Just Have To Do Something?

I think what I termed "irrational exuberance" over health IT is now devolving into just simple irrationality. I am unfamiliar with...

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Health IT Failure Never Puts Patients at Risk

At "<a href="http://hcrenewal.blogspot.com/2009/05/dangerous-health-it-mismanagement-spin.html">Dangerous Health IT Mismanagement, Spin Control and the World's Longest Teething Pains</a>" I commented that executives always find that "patient safety is not compromised" when health IT malfunctions. Here's another hair-raising story from Down Under. Just a wee glitch: <blockquote><h3 class="post-title entry-title" style="font-family: arial;"><a href="http://healthcareitaustralia.blogspot.com/2009/05/power-failure-lasting-36-hours-cripples.html">Power failure lasting 36 hours cripples hospital care</a></h3>By Kate Benson healthcareitaustralia.blogspot.com DOCTORS at more than 100 hospitals in the state could not access patient records or vital test results for up to 36 hours last weekend after a power failure crippled NSW Health's computerised database. Some records were lost, X-ray and pathology results could not be accessed and staff were forced to use whiteboards to keep track of emergency patients after the main server shut down at 9am on Saturday because of a faulty circuit-breaker. Back-up power from the Cumberland Data Centre, which provides computer access to the Greater Western, Greater Southern and Sydney West area health services also failed, plunging some of the busiest hospitals in the state into chaos. Thousands of patients were affected, with doctors and nurses forced to take notes on paper and go to other parts of the hospital to collect hard copies of results, extending treatment times and adding to the confusion. Some staff, who did not want to be named, said the weekend was chaotic and a shambles. One surgeon said it was fortunate no lives were lost. The chief executive of Sydney West Area Health Service, Steven Boyages, said hospital blackouts that lasted more than 30 to 60 minutes were unacceptable, but the Health Minister, John Della Bosca, insisted patients were not put at risk. "At no time was there any threat to patient care or safety," he said yesterday. The Opposition spokeswoman on health, Jillian Skinner, said the blackout was "a serious failure" with great potential for disaster. "Hospitals affected not only lost access to patient records, some lost some patient records altogether … and couldn't access X-rays unless they physically went to the X-ray department for a film copy," she said. "John Della Bosca should explain why the patient records system lost power, why back-up systems also failed, and whether patient safety was compromised." A spokesman for Mr Della Bosca said workers doing routine maintenance at the data centre had triggered the outage. No patients had reported problems connected to the blackout but a full investigation would be launched. "If necessary changes will be implemented to prevent a recurrence," he said. with Louise Hall BLACKED OUT Hospitals at Westmead, Auburn, Blacktown, Nepean, Lithgow, Mount Druitt, Cumberland, Blue Mountains, Dubbo, Bathurst, Orange, Mudgee, Parkes, Bourke, Albury, Queanbeyan and Goulburn were affected.</blockquote> Move along, nothing to see here. Patients were not put at risk. Who needs regulation? It would only stifle innovation. -- SS

Health IT Failure Never Puts Patients at Risk

At " Dangerous Health IT Mismanagement, Spin Control and the World's Longest Teething Pains " I commented that executives alw...

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