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A Handbook for Ghost-Writing

We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa (olanzapine). A post from 2007, with links backward, is <a href="http://hcrenewal.blogspot.com/2007/02/more-on-zyprexa-memos.html">here</a>, and our most recent post is <a href="http://hcrenewal.blogspot.com/2009/01/what-me-worry-lilly-fined-over-zyprexa.html">here</a>. The company remains entangled in litigation over its marketing of this drug. That litigation has lead to the release of numerous internal documents that provide quite a view of Lilly's marketing practices. In particular, a Bloomberg <a href="http://www.bloomberg.com/apps/news?pid=20601109&sid=aVvfe.v1k_VY">news article </a>discussed how the company used ghost-writers: <blockquote> Ensuring that medical journal articles presented Zyprexa study results in a positive light was one way for Lilly to reach its sales goal, company officials said in its plan, according to the documents. To do that, Lilly officials hired ghostwriters to prepare submissions to journals such as Progress in Neurology and Psychiatry, according to the unsealed documents. </blockquote> The article then described how Lilly marketers set up a ghost-written article. <blockquote> 'The paper for the Progress in Neurology and Psychiatry supplement has been completed and sent to the journal for peer review,' Kerrie Mitchell, an employee of the public relations agency Cohn & Wolfe, wrote in a Feb. 23, 2001, e-mail to Michael Sale, a Lilly marketing official. The message was among the unsealed files. 'We ‘ghost’ wrote this article and then worked with author Dr. Haddad to work up the final copy,' Mitchell said in the e- mail. Eric Litchfield, a spokesman for Cohn & Wolfe, didn’t immediately return a call seeking comment. Peter Haddad, a researcher at Greater Manchester West Mental Health NHS Foundation Trust in the U.K., was listed as the article’s lead author. Haddad didn’t respond to requests for comment. The global Lilly team approved a draft of Haddad’s ghost- written paper in 2000, according to the unsealed documents. </blockquote> Lilly marketers, rather than articles' putative authors, sometimes exerted pressure to get ghost-written articles published. For example, <blockquote> Lilly officials e-mailed journal editors to complain about delays in publishing favorable Zyprexa articles, according to the unsealed documents. In one instance, Lilly employees contacted the Journal of Clinical Epidemiology about delays of an article criticizing a previously published piece linking Zyprexa, as well as the class of atypical antipsychotics, to diabetes. After Suraja Roychowdhury, Lilly’s senior scientific communications coordinator, wrote to the journal in November 2002, its editor, Andre Knottnerus, replied in an e-mail that it was 'a bit strange to be contacted via the Lilly product team. Dr. Buse and coauthors can contact us directly next time.' Knottnerus was referring to the manuscript’s lead author, John Buse, a former president of the American Diabetes Association. A copy of the Nov. 22, 2002, e-mail was included in the unsealed documents. Patrizia Cavazzoni, a Lilly staffer who co-wrote the article, e-mailed Buse on Jan. 9, 2003, seeking permission to send a separate e-mail asking to expedite publication. She also asked Buse if he would prefer 'to send it in your name?' It isn’t clear from the e-mail chain whether the e-mail was sent by Buse or Cavazzoni. </blockquote> Finally, Lilly developed a handbook for ghost-writers: <blockquote> To ensure that ghostwritten Zyprexa articles met Lilly’s standards, company officials issued a guide to preparing them, according to the unsealed files. The guide, 'Medical Press: Pre-Launch Feature Outline,' was undated. It’s unclear from the documents which teams in Lilly’s top 10 markets for the drug received it. The primer provided a how-to for writing articles, such as instructing the author to use Zyprexa’s generic name, olanzapine, instead of its brand moniker, according to the documents. Scientists in medical research traditionally refer to a drug’s chemical name. The guide also offered tips on how to find authors by identifying a 'key opinion leader' and providing them either an outline of the article or a finished copy. Authors could include a study investigator, an advisory board member or “Lilly-friendly” doctor, according to the documents. A sample article laid out how a Lilly employee may find a doctor to ghostwrite a submission that would 'prepare the market' for the launch of an intramuscular injectable version of the drug. It also offered an outline for the contents of the article, beginning with background on another drug, droperidol, which had been withdrawn from several countries. The article, with the suggested title 'Filling the Droperidol Gap,' noted that an anti-anxiety drug could be used, before going on to say, 'more advanced IM treatments may soon be available to provide a superior alternative.' The article explained that injectable Zyprexa had just received approval from the FDA, and recounted its clinical trial history. 'The anticipated forthcoming availability of atypical antipsychotics in an IM formulation could be a major step forward in the treatment of acute agitation associated with schizophrenia,' the sample article concluded. </blockquote> We addressed ghost-writing frequently when we started Health Care Renewal, and have returned to the topic periodically (see these more recent links, from 2008, <a href="http://hcrenewal.blogspot.com/2008/04/ghosts-come-home-to-roost.html">here</a> and <a href="http://hcrenewal.blogspot.com/2008/12/haunting-of-hormone-replacement-therapy.html">here</a>). The most striking feature of this newest case is the use of a "ghost-writers' handbook" denoting how systematized the practice has become. With each new case, it becomes clearer how common the practice may be. Since the parties involved seem ashamed enough of the practice to try to keep it well hidden, it may be that ghost-writing is even more common than we now realize. Nonetheless, while the practice may be common, and mutually advantageous for ghost-writers, the academics who front for them, and the marketers who hire them all, as we and others have <a href="http://hcrenewal.blogspot.com/2007/04/haunted-medical-literature-moffatt-and.html">said before</a>, ghost-writing is dangerous to health. It deludes physicians and patients into thinking health care products are more beneficial and less risky than they really are. Ghost-writing also undermines science by shifting the agenda away from interesting and important questions to questions whose answers may mainly benefit vested interests. Finally, on a personal note, ghost-writing demoralizes honest academics who must run their own studies, write their own papers, and manage the logistics of paper submission in competition with fake authors backed by corporate money and corporate staff. Scientists and academics who allow and front for ghost-writers ought to be ashamed of themselves. See also <a href="http://clinpsyc.blogspot.com/2009/06/greedy-and-ghostly-scientists.html">comments</a> in the Clinical Psychology and Psychiatry blog, and <a href="http://brodyhooked.blogspot.com/2009/06/lillys-off-label-marketing-of-zyprexa.html">discussion</a> of some of the other recent revelations about Zyprexa marketing in the Hooked: Ethics, Medicine and Pharma blog. ADDENDUM (14 June, 2009) - Also see <a href="http://www.margaretsoltan.com/?p=13876">comments</a> by Prof Margaret Soltan on the University Diary blog on the "Stockholm Syndrome" as manifested by "key opinion leaders" in the pay of health care corporations. ADDENDUM (15 June, 2009) - Furthermore, see <a href="http://brodyhooked.blogspot.com/2009/06/more-zyprexa-documents-released.html">comments</a> by Dr Howard Brody in the Hooked: Ethics, Medicine and Pharma Blog.

A Handbook for Ghost-Writing

We posted a number of times about questionable practices Eli Lilly used to market its atypical anti-psychotic drug Zyprexa (olanzapine). A p...

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Voting for iGoogle photo themes now open

A few weeks ago we launched the <a href="http://www.google.com/intl/en/landing/photographyprize/">Google Photography Prize</a>, a global student competition for students to create themes for iGoogle. Our goal was to find talented student photographers and give them unprecedented online and offline exposure. It may seem a little brave to unleash student art on our homepage, but we've been hugely impressed the number and quality of entries we received. From among the thousands of entries from around the world, we've just announced the shortlist of 36 finalists. Now they're up for your vote - the most popular six you choose will make it to the finals. The 6 finalists will be exhibited at the <a href="http://www.saatchi-gallery.co.uk/gallery/intro.htm">Saatchi Gallery</a> in London and have the chance to win the first prize of £5,000 ($7,500), plus an invitation to spend the day with the internationally renowned photographer <a href="http://images.google.com/images?hl=en&q=martin+parr&btnG=Search+Images&gbv=2&aq=f&oq=">Martin Parr</a>. On the voting page you can also add your favourite as a theme to your iGoogle homepage. Millions of people have already chosen to adorn their iGoogle page with images, with everything from seascapes to original art. Now you can have some fantastic photography from some of the best up-and-coming photographic talent out there right on your homepage. So take a look, enjoy the photographs, and <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html">please vote</a> — the deadline is June 17th. And if you are in London this month, come see the exhibit of the winners at the Saatchi Gallery, starting the 24th and running for a week. Posted by Posted by Louise Rigby, Consumer Marketing Team

Voting for iGoogle photo themes now open

A few weeks ago we launched the Google Photography Prize , a global student competition for students to create themes for iGoogle. Our goal ...

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Snack time with the new iGoogle for Android and iPhone

<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEholG9oSlNgGhVUAXdDbuy_JBEUjQvSpreqOLX0AKm0qUyB3dNqNy0XDCU0pW3xxDP9H-lubOMwsfblg3Zm-c3G0cQem9xisp1ThlFWWCCsiAc0hbVKJ-VMvuQovC6KKAFvnbKBmJbpmxen/s1600-h/igoogle.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5346285525123312402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEholG9oSlNgGhVUAXdDbuy_JBEUjQvSpreqOLX0AKm0qUyB3dNqNy0XDCU0pW3xxDP9H-lubOMwsfblg3Zm-c3G0cQem9xisp1ThlFWWCCsiAc0hbVKJ-VMvuQovC6KKAFvnbKBmJbpmxen/s400/igoogle.jpg" style="float:right; margin:0 0 10px 10px;cursor:pointer; cursor:hand;width: 272px; height: 331px;" /></a>(cross-posted with the <a href="http://googlemobile.blogspot.com/2009/06/snack-time-with-new-igoogle-for-android.html">Google Mobile Blog</a>) We like iGoogle because it lets us "snack" on interesting information all day long. We can read a little bit of news here and there, glance at finance portfolios, take a look at the weather forecast, and then do a Google search. It doesn't require a big commitment of time and energy — it's simply there for us whenever we need it. This kind of availability is even more important on a phone, where it can take a long time to surf. That's why iGoogle is so convenient on mobile devices. When you're waiting in line, you can check iGoogle on your phone for a quick "info snack" — even in areas with mediocre network coverage. But speed isn't everything. Many of you have told us that you wanted to use more of your iGoogle gadgets on your phone. You wanted to see your tabs, too. We read your blog comments and forum posts and put your requests at the top of our to-do list. Today, we're excited to roll out an improved beta version of iGoogle for the iPhone and Android-powered devices. This new version is faster and easier to use. It supports tabs as well as more of your favorite gadgets, including those built by third-party developers. Note that not all gadgets — like those with Flash — will work in mobile browsers. One of our favorite new features is the in-line display of articles for feed-based gadgets. That means you can read article summaries without leaving the page. You can also rearrange gadget order or keep your favorite gadgets open for your next visit. None of these changes will mess up the layout of gadgets on your desktop computer, so feel free to play around and tune your mobile experience.  <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/B_ICorRs6J8&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/B_ICorRs6J8&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> The new version of iGoogle for mobile is available in 38 languages. To try it out, go to igoogle.com in your mobile browser and tap "Try the new Mobile iGoogle". Bookmark the page or make it your home page so you can return to it quickly. Finally, please fill out our survey by clicking on the "Tell us what you think" link at the top of the new home page. We'll continue to use your feedback to make iGoogle even better.<div> </div><div>Update on 6/12 @ 8:50 AM: Video added. Check it out!</div><div> <div>Posted by Dan Zivkovic and Zhen Wang, Software Engineers, Google mobile team</div></div>

Snack time with the new iGoogle for Android and iPhone

(cross-posted with the Google Mobile Blog ) We like iGoogle because it lets us "snack" on interesting information all day long. We...

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Wharton on Healthcare IT: Can I Go Home Now?

Professors at the <a href="http://www.wharton.upenn.edu/">Wharton School</a> of the University of Pennsylvania (one of the most prestigious business colleges in the world) had some very interesting observations about healthcare IT yesterday in an article entitled: <blockquote>"<a href="http://knowledge.wharton.upenn.edu/article.cfm?articleID=2260">Information Technology: Not a Cure for the High Cost of Health Care</a>."</blockquote> I have been writing on these same themes - <a href="http://hcrenewal.blogspot.com/search/label/irrational%20exuberance">irrational exuberance</a>, HIT not being a panacea or cybernetic miracle, HIT as a facilitating tool in medicine, not a revolutionary one (but only if "done right"), inadequate research to back up the often grandiose claims, and so forth for over a decade ("Contemporary Issues in Medical Informatics: Common Examples of Healthcare IT Failure", <a href="http://www.tinyurl.com/hit-misadventure">link</a>). I penned such sacrilege, often at risk to my career due the unpopularity of these ideas, itself due to the irrational exuberance of the HIT community (these attitudes were perhaps in part <a href="http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html">manufactured by a healthcare IT lobby</a>). Here are excerpts of what Wharton professors observed. Do read the entire article at the link above: <blockquote> President Obama made information technology a linchpin in his plan to reform health care when he included $19 billion in computerized medical record funding in the $787 billion American Recovery and Reinvestment Act of 2009. The goal: Use technology to reduce costs and improve the quality of care. The reality: Technology could increase health care costs without markedly improving quality, according to experts at Wharton [except perhaps in very highly specialized projects, not easily portable, such as <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">here</a> - and not without its own set of problems - ed.] ... "No one has done the careful research to indicate that if one health care system has information technology and the other doesn't, then the care is different. There are no controlled trials," says <a href="http://www.wharton.upenn.edu/faculty/pauly.html">Mark Pauly</a>, a health care management professor at Wharton. All that technology is no panacea, he warns. In fact, he believes IT could actually raise costs because of culture clashes, training, the implementation of the systems [I would say "the mayhem that often goes on during the implementation" - ed.] and the labor required to maintain the new technology. "The best-case scenario is that information technology will improve quality but not lower costs. The worst case is that there's no difference at all." [I believe if HIT is "done well", we can achieve best case, and lower costs as well to an extent, but there is enormous complexity behind the two simple words "done well" that I'm not sure we've fully mastered as a society yet - ed.] ... That opinion is echoed by other experts at Wharton and the University of Pennsylvania. "The focus on IT in health care is a good thing, but there's way too much hype about it [an understatement - ed.] and misunderstanding about what the benefits will be and how quickly they will come," says <a href="http://www.med.upenn.edu/apps/faculty/index.php/g346/p6433357">Peter Gabriel</a>, medical director of clinical information systems at the University of Pennsylvania Health System. [<a href="http://www.wharton.upenn.edu/faculty/volpp.html">Kevin Volpp</a>, professor of medicine and health care management] agrees that tracking real cost savings from health care IT is a difficult task, but he expects there to be some benefits from spotting and eliminating redundant care. [Agree - ed.] But those benefits aren't likely to add up to big savings, says <a href="http://www.wharton.upenn.edu/faculty/burnsl.html">Lawton R. Burns</a>, director of the <a href="http://hcmg.wharton.upenn.edu/chme/">Wharton Center for Health Management and Economics</a>. "I agree that information technology is important, but it's not the slam dunk it's portrayed to be," he says. The chase to reduce costs, improve quality and expand coverage is deemed the "iron triangle of health care. A lot of us wince [at that goal]," Burns notes. "It's arguable that we can't do any of those things well." <a href="http://www.wharton.upenn.edu/faculty/asch.html">David A. Asch</a>, a Wharton health care management and economics professor, agrees that technology is a big part of reform. "No one is arguing against it, but that doesn't mean that it's not oversold," he says. Gabriel likens the fascination over IT in health care to a shiny new object that's easier to focus on relative to more daunting issues. ... In addition, it's unclear what cultural issues [a big theme in my writings - ed.] will emerge as information technology is adopted. These cultural issues are in the forefront of primary care physician relationships. Experts at Wharton and Penn say physicians are generally skeptical of the technology movement. How much will a technology overhaul add to operating costs? How much will it cost to retrain workers? What's the electronic record learning curve? And what happens when a doctor has a laptop between him and the patient? "Individual physicians just don't know where the money is going to come from," says Pauly. "If IT is tied to reimbursements it could work, but [many] are skeptical." Burns adds that the physician-patient relationship can also be altered. "Technology adoption changes the way you practice. What happens when your primary care physician is looking at his screen instead of you?" </blockquote> All themes obvious to me after an informatics fellowship and term as CMIO at a major hospital, and to a number of my like minded colleagues as well. However, these themes were as hard to get published and recognized (i.e., turned into "memes") as a book against Global Warming ... The Wharton article concludes with this pithy wisdom: <blockquote>Experts say these projects are worth the effort, but the industry should keep its expectations in check [i.e., ditch the irrational exuberance - ed.] and closely scrutinize investments. "To the extent [that] these technologies improve the quality of care and get the patient more involved, I'm all for them," says [<a href="http://pennhealth.com/WagForm/MainPage.aspx?config=provider&P=PP&ID=268">Richard Neill</a>, residency director and vice chair at the University of Pennsylvania's <a href="http://www.uphs.upenn.edu/fampract/">Department of Family Medicine and Community Health</a>]. "But the technology is not a sea change -- just a chance to change."</blockquote> Anyone in Washington listening? Finally, after a decade of writing on these same observations to a public apparently inclined to believe the myths and promised cybernetic miracles nourished by the IT industry, and getting nowhere until some very serious organizations caught on this year and joined in (the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=JointCommissionAlert">Joint Commission</a>, the <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">National Research Council</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=UK">UK House of Commons</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda">JAMA</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=workshop">AMIA</a>, Wharton, etc.) I ask: can I go home now? -- SS

Wharton on Healthcare IT: Can I Go Home Now?

Professors at the Wharton School of the University of Pennsylvania (one of the most prestigious business colleges in the world) had some ve...

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Public CCHIT response to NJ "CCHIT or else" Health IT Bill

In my June 7 post <a href="http://hcrenewal.blogspot.com/2009/06/open-letter-to-mark-leavitt-chairman.html">Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-"Certified" HIT</a> I asked CCHIT's chair pointed questions about a remarkable NJ Bill to make non-CCHIT-certified health IT forbidden for sale or use, with civil penalties, in the state of NJ. His response is posted in the link. I've just become aware of a June 8 public response to the Bill at CCHIT's site "EHR Decisions" entitled <a href="http://ehrdecisions.com/2009/06/08/legislating-health-it-beware-of-land-mines/">Legislating Health IT: Beware of Land Mines:</a><blockquote style="font-family:arial;"> <a href="http://ehrdecisions.com/2009/06/08/legislating-health-it-beware-of-land-mines/"></a>... A number of people contacted me this weekend about a <a title="More on the New Jersey bill" href="http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM">bill on the floor of the New Jersey legislature</a> which proposes to make the purchase of non-CCHIT Certified products illegal. I want to make a few facts clear, then share some news about our plans going forward in the new environment created by ARRA. First, I do not believe this is an appropriate use of health IT certification. Our goal, stated in almost every presentation I’ve given, and to which I’ve adhered in my leadership of the Commission, has always been to unlock positive incentives for health IT adoption. <a title="Bridges to Excellence" href="http://www.bridgestoexcellence.org/">Bridges to Excellence</a> provides a role model for integrating health IT into outcome-based, pay for performance incentives. Successfully executed, <a title="Recovery.gov" href="http://www.recovery.gov/">ARRA</a> might too. But the New Jersey bill is nowhere near that. Making software purchases illegal, like dangerous substances? Let’s “just say no” to that idea. Second, neither I personally, nor <a title="CCHIT" href="http://cchit.org/">CCHIT</a> as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill. We were unaware of it until it started showing up on listserves Friday. The bill has never been mentioned in any of our Trustee, Commission, or staff meetings ... </blockquote> A fine answer. Read the whole thing. I was probably one of the first to call this NJ Bill to his attention, under the assumption the leader of CCHIT would know about a bill calling for CCHIT exclusivity and "or else" civil penalties in a major state. (CCHIT's founder HIMSS <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/20/AR2009052003600.html?nav=emailpage">certainly has been cheerleading</a> for all health IT that receives ARRA support to be CCHIT certified. Is it reasonable to assume CCHIT's leader had knowledge of that?)Instead of thanks for my calling the NJ Bill to Mark Leavitt's attention, potentially saving him from far worse troubles over it than my questions (I am, after all, a political nobody!), I got ... well, embellishments ... decide for yourself at the "Open Letter" link above. You're welcome, Mark. Hope you're equally as charitable to the NJ Assembly members who actually made this trouble for you. p.s. the exact wording of a question I asked him on Jun. 7: <blockquote style="font-family:arial;">"Did you, or anyone in a governance or leadership position at CCHIT, play a role in sponsorhip of this bill, through financial contributions, lobbying, advocacy for its proposals, and/or other means to prohibit sale of non-CCHIT certified HIT?"</blockquote> His June 8 post says:<blockquote>Second, neither I personally, nor <a title="CCHIT" href="http://cchit.org/">CCHIT</a> as an organization, have lobbied, advocated, sponsored, or had anything to do with that bill</blockquote>It even looks like I gave him the language for the public response. Again, Mark, you're welcome.And your apology for the embellished section of your response to my simple questions is accepted.Oh wait...Haven't gotten that yet.<div>-- SS</div><div> </div>

Public CCHIT response to NJ "CCHIT or else" Health IT Bill

In my June 7 post Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use...

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Get creative with the Google Chrome icon

Two years ago, we invited people around the world to participate in a <a href="http://gmailblog.blogspot.com/2007/07/help-make-gmail-video.html">video project</a> imagining how Gmail messages travel around the world. The response was overwhelming, with <a href="http://www.youtube.com/video_response_view_all?v=VfDW7qAdFGk">971 video submissions</a> in total — many of which were <a href="http://www.youtube.com/watch?v=gR_61WdpcmU">really</a>, <a href="http://www.youtube.com/watch?v=coraBHKcX5M">absurdly</a> <a href="http://www.youtube.com/watch?v=eojiOhMvTAg">cool</a>. Today, we are announcing a new global project. Your task? Film yourself building the Google Chrome icon in a creative way, with whatever materials, as big, small, or crazy as you want. We will feature the best submissions. A handful of Googlers and a couple of <a href="http://www.youtube.com/flippycat">our</a> <a href="http://annathered.wordpress.com/2009/06/11/bento53-google-chrome-bento/">friends</a> created some sample videos for inspiration. Check them out: <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/bGJOmGL6mYM&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/bGJOmGL6mYM&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object> <a href="http://www.google.com/landing/chrome/ugc/">Learn more and submit your video</a> by July 22. For more information on this project, visit the <a href="http://chrome.blogspot.com/2009/06/join-google-chrome-icon-project.html">Google Chrome blog</a>. We can't wait to see the clever ways that you build the Google Chrome icon. Posted by Jason Toff, Google Chrome team

Get creative with the Google Chrome icon

Two years ago, we invited people around the world to participate in a video project imagining how Gmail messages travel around the world. ...

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Lessons From Aviation Heroes Towards Healthcare IT

One of my largest concerns about the state of health IT is its safety, and the effects the irrational exuberance about health IT, including coming use/misuse of EHR data, may have on physicians' ability to exercise judgment borne of experience. For more on this, see my essay "The Syndrome of Inappropriate Overconfidence in Computing: An Invasion of Medicine by the Information Technology Industry?" in the Journal of the Association of American Physicians and Surgeons (<a href="http://www.aapsonline.org/">AAPS</a>), Summer 2009, <a href="http://www.jpands.org/vol14no2/silverstein.pdf">at this link</a> (PDF). I believe there is a strong lesson to be learned that is applicable to healthcare and HIT from the aviation industry. Namely, the wisdom of Captain Chesley Sullenberger, who guided a damaged and unpowered jet safely into the Hudson River on Jan. 15, 2009, saving all aboard. The lessons are so obvious, I will not comment on the parallels between Capt. Sullenberger's observations and the issues in healthcare and healthcare IT: <blockquote>Excerpts from: Wall Street Journal June 10, 2009 <a href="http://online.wsj.com/article/SB124454975782297751.html">Hero Pilot 'Sully' Stars at Safety Hearing</a> Transcript Reveals Details From Hudson Splashdown By Andy Pasztor WASHINGTON -- US Airways Capt. Chesley "Sully" Sullenberger, the much-heralded hero of the January airliner ditching on New York's Hudson River, told federal investigators Tuesday that in a matter of seconds he determined only the river was "long enough, wide enough and smooth enough" to put down his crippled jetliner. ... At a time when many commercial airline pilots say they are frustrated by dwindling pay, longer work weeks and eroded pensions, the testimony of the captain recalled the golden age of aviators exuding confidence and sangfroid. [self-possession or imperturbability especially under strain - ed.] Many of the flight attendants and passengers thought the Airbus was headed for land. But Capt. Sullenberger, who started flying at the age of 16 and has been at the controls of everything from gliders to three different jetliners, told the safety board he picked his landing spot with care. The airline's training instructed pilots that if they ever had to ditch, they should "land near vessels to try to facilitate rescue." Responding to questions about the lessons to be learned from the extraordinary landing, Capt. Sullenberger mentioned training to help pilots work together as a team and additional efforts to improve emergency evacuations. But his comments repeatedly swung back to the notion of an airline culture that stresses safety and respects the judgment of experienced pilots. US Airways pilots received classroom instruction in ditching procedures, but Capt. Sullenberger testified that they never practiced any ditching scenarios in simulators. In a pointed remark on the cost-cutting and heightened corporate regimentation that currently drive many airlines, Capt. Sullenberger considered the intangibles of safe airmanship. "The captain's authority is a precious commodity that cannot be denigrated," [see all too typical IT attitudes about physicians in <a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2009/06/histalk-has-pair.html">this post</a> - ed.] he said. The captain's testimony also highlighted the importance of relying on experience and memory, rather than rigidly using written checklists to deal with unexpected emergencies. With both pilots in the cockpit boasting about 20,000 hours of total flight time, Capt. Sullenberger said that teamwork and experience "allowed us to focus on the high priorities without referring to written" checklists.</blockquote> Cybernetic miracles would not help here and might in fact have caused a different outcome than this, especially if they malfunctioned, caused cognitive overload, or otherwise impeded the pilots' abilities to utilize their expertise: <blockquote>Billy Campbell, one of the passengers on the plane, testified about seeing the left engine engulfed in flames as though it were "a bonfire," and then scampering out of the aircraft as water was seeping in near the tail. "We were so fortunate to have an unbelievable pilot, an unbelievable copilot" and a highly experienced cabin crew, he told the board. [Note not a mention of "great computers", which in fact might be implicated due to faulty speed data in a recent and unfortunate Air France crash with no survivors - ed.] </blockquote> The parallels between Capt. Sullenberger's observations and the observations of those concerned with ever growing exuberance about HIT should be obvious. (If not, spend some time <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">here</a>.) The lesson can be summarized through a line from another aviation hero: <blockquote>"It's the man, not the machine." </blockquote> That hero was <a href="http://en.wikipedia.org/wiki/Chuck_Yeager">Chuck Yaeger</a>: <blockquote>The most famous Mustang pilot and ace is Chuck Yeager. Yeager was the ultimate fighter pilot. As a young Mustang pilot he once downed five German fighters in one mission. He downed two much faster Me-262 jet fighters, escaped captivity after being shot down over occupied France, and when the war ended, it was still just the beginning of his amazing career. After the war Yeager became a test pilot, and in 1947 he earned his place in the history books as the first man who "broke the sound barrier" in the daring first supersonic flight.</blockquote> The WSJ article concludes: <blockquote>Robert Sumwalt, the safety board member chairing the hearing, said that after listening to the cockpit voice recorder after the ditching of US Airways Flight 1549, he was impressed by the actions of the pilots. "I've never walked out of a flight recorder lab with a smile."</blockquote> I wish I could walk with a smile about the state of health IT, but lately that just has not seemed possible. -- SS

Lessons From Aviation Heroes Towards Healthcare IT

One of my largest concerns about the state of health IT is its safety, and the effects the irrational exuberance about health IT, including ...

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