healthy4u

Blogger is turning 10

Google's about to have its <a href="http://www.google.com/tenthbirthday/">second tenth birthday</a>. In late August, <a href="http://blogger.com/">Blogger</a> will officially turn 10 years old. As our birthday draws near, we thought it would be interesting to share some fun facts about Blogger: <ul><li>Every minute of every day, 270,000 words are written on Blogger</li><li>Millions of people worldwide use Blogger to publish to their blog each week</li><li>Almost two thirds of Blogger's traffic comes from outside North America (What's the #2 country after the U.S.? Brazil, followed by Turkey, Spain, Canada, and the U.K.)</li><li>The most popular sport for our bloggers? Soccer (that's football to the rest of the world), more than four times larger than the #2 sport, baseball</li></ul>While we're really excited about this milestone, we want the focus to be on you and the remarkable stories that you and millions of people around the world document on Blogger. After all, blogs are one of the true building blocks of the web, constantly updated not only with news and personal stories, but any kind of information you can imagine. Just this week, there's an Iranian student <a href="http://shooresh1917.blogspot.com/">documenting</a> the minute-by-minute proceedings in Iran, while a British woman is uploading <a href="http://rozsavage.blogspot.com/">nightly blog posts</a> from her satellite phone while rowing solo from Hawaii to Australia, while an <a href="http://ryanrunseurope.blogspot.com/">American college student</a> is running from Amsterdam to Athens with nothing but the pack on his back. There are literally millions more. What's your story? Did your blog help you find a job? Learn a language? Interact with your fans? Master a new skill? Battle an illness? Turn a hobby into a career? We read as many blog posts as we can, and what we do read is often brilliant. But we want to know more — we want to hear from you about what Blogger has meant to you over the past decade. Do what you do best: tell your story. Write a post, and then let us know about it by filling out <a href="http://spreadsheets.google.com/viewform?hl=en&formkey=clFhSG1FUXFtUFFnT3FfUU9Yd3EwYVE6MA..">this form</a>. Keep an eye on <a href="http://buzz.blogger.com/">Blogger Buzz</a>, where we'll be sharing some of our favorites over the coming weeks. To the millions who have depended on Blogger to help you tell your story, thank you. To those of you who have yet to tell your story, creating a blog couldn't be easier: just visit <a href="http://www.blogger.com/">blogger.com</a> to get started. We can't wait to see what the next ten years bring — and stay tuned for details about the tenth birthday itself. Posted by Rick Klau, Product Manager, Blogger

Blogger is turning 10

Google's about to have its second tenth birthday . In late August, Blogger will officially turn 10 years old. As our birthday draws nea...

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The next edition of Google Books

The next edition of Google Books

Today, we're launching a host of new features in Google Books that give you more ways to browse and share the content from the Google B...

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A Clear-Headed Defense of Comparative Effectiveness Research

We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in <a href="http://hcrenewal.blogspot.com/2007/09/comparative-effectiveness-kerfuffle.html">a previous post</a>, <blockquote> Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only studies done compared individual treatments to placebos, and when even those were restricted to narrow patient populations unlike those patient usually seen in daily practice, physicians are left juggling oranges, tomatoes, and carburetors. Comparative effectiveness studies are simply studies that compare plausible treatments that could be used for patients with particular problems, and which are designed to be generalizable to the sorts of patients usually seen in practice. As a physician, I welcome such studies, because they may provide very useful information that could help me select the optimal treatments for individual patients. Because I believe that comparative effectiveness studies could be very useful to improve patient care, it upsets me to see this particular kind of clinical study get caught in political, ideological, and economic battles. </blockquote> In particular, we have discussed a number of high profile attacks on comparative effectiveness research, which often have featured arguments based on logical fallacies. While some of the people making the attacks have assumed a conservative or libertarian ideological mantle, one wonders whether the attacks were more driven by personal financial interests. For example, see our blog posts <a href="http://hcrenewal.blogspot.com/2007/09/over-top-denunciation-of-comparative.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/09/comparative-effectiveness-kerfuffle.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/10/whose-opinions-did-new-york-times.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/02/attack-on-government-funded-comparative.html">here</a>. Therefore, it was refreshing to see <a href="http://www.nytimes.com/2009/06/14/business/economy/14view.html">this defense </a>of comparative effectiveness research in the opinion pages of the New York Times, which demonstrated that the issues here are really not ideological. <blockquote> Drawing upon the ideas of the Harvard economist David Cutler, the Obama administration talks of empowering an independent board of experts to judge the comparative effectiveness of health care expenditures; the goal is to limit or withdraw Medicare support for ineffective ones. This idea is long overdue, and the critics who contend that it amounts to 'rationing' or 'the government telling you which medical treatments you can have' are missing the point. The motivating idea is the old conservative chestnut that not every private-sector expenditure deserves a government subsidy. </blockquote> This was written by <a href="http://www.gmu.edu/jbc/Tyler/">Tyler Cowen</a>, a well known academic economist, a Professor in that department at George Mason University with impeccable libertarian credentials. (Prof Cowen also blogs on <a href="http://www.marginalrevolution.com/">Marginal Revolution</a>.) Prof Cowen reminded us how the current health care reform debate could benefit from some clear thinking that eschews ideological posturing.

A Clear-Headed Defense of Comparative Effectiveness Research

We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in a previous post , Physicians ...

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Free webinar: Google Apps Education Edition

Around the world, schools and universities continuously face the difficult challenge of reducing costs while improving the quality of education they provide. This challenge becomes even more critical in turbulent economic times. Not to mention the fact that this next generation of students – the "<a href="http://www.google.com/search?hl=en&client=firefox-a&rls=org.mozilla:en-US:official&hs=rM0&ei=oHUpSt6pDJXktAPE9tW5Cw&sa=X&oi=spell&resnum=0&ct=result&cd=1&q=millennials&spell=1">millennials</a>" – brings a different set of expectations to campus. For example, they expect the ability to work together without sitting in the same room, they want to take their data with them wherever they go, they want to chat (over voice and video) with friends and family, and they expect instantaneous and unwavering access to the Internet. By harnessing the power of technology, we think we can offer the education community the means to meet these expectations. <a href="http://www.google.com/a/edu">Google Apps Education Edition</a> is a free suite of hosted tools including mail, calendar, document, and site creation that helps campuses save money while providing a rich set of technology tools that will enable schools to better meet the demands of savvy students. Millions of students, staff, and faculty are using Google Apps today, with more signing up every day. A big welcome to some of the schools we've recently welcomed to the Google Apps family, including: <ul><li>Allegheny College</li><li>Beloit College</li><li>Boise State University (for faculty and staff)</li><li>Clemson University</li><li>Cornell University</li><li>Georgetown University</li><li>Pittsburgh State University</li><li>Southern Illinois University Carbondale</li><li>Temple University</li><li>Truman State University</li><li>University of Alaska</li><li>University of California at Davis</li><li>University of Minnesota</li><li>University of Sunderland</li><li>Wagner College</li></ul>To share info about these latest innovations, we'd like to invite you to a free live <a href="https://googleonline.webex.com/googleonline/onstage/g.php?t=a&d=572458080">customer webinar</a> on Thursday, June 25 at 10:00 a.m. PDT. In this session you'll hear directly from Arizona State University, the <a href="http://googleblog.blogspot.com/2006/10/score-one-for-sun-devils.html">first school</a> to deploy Google Apps Education Edition, back in 2006. Key administrators will talk about their decision to go with Google Apps, the results they've seen so far, and their future plans for Apps. Whether you're a student, work at a school, or went to school, we hope you'll join us to hear about how Google Apps can help institutions like ASU save money and IT resources, plus make students' lives easier with a set of tools for working together. Posted by Miriam Schneider, Apps EDU Marketing Team

Free webinar: Google Apps Education Edition

Around the world, schools and universities continuously face the difficult challenge of reducing costs while improving the quality of educat...

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iGoogle goes au naturel

We are excited to release a new set of iGoogle themes today. Drawing on the arrival of summer and the spectacular beauty of the world around us, our <a href="http://www.google.com/help/ig/naturethemes/index.html">new iGoogle themes</a> focus on nature. To create these themes, we worked with organizations and photographers who capture the world's best nature photography, including National Geographic Society, BBC and Ansel Adams Gallery. At its core, iGoogle is about personal expression. Themes are one of many ways we invite you to personalize your homepage with things that inspire you — artists, fashion designers, musicians, video games or simply the stunning beauty of the world around us. Here's a quick preview of some of the highlights in our new nature collection: <ul><li>National Geographic's "<a href="http://www.google.com/help/ig/naturethemes/index.html#ngocean">Ocean Blue</a>" takes you from shark territory in the Caribbean to ice floes on the polar caps</li><li>The National Audubon Society's "<a href="http://www.google.com/help/ig/naturethemes/index.html#audubonprey">Birds of Prey</a>" features winged predators depicted in the classic Audobon hand-drawn illustration style</li><li>Art Wolfe's "<a href="http://www.google.com/help/ig/naturethemes/index.html#wolfetravels">Travels to the Edge</a>" includes views deep into the forests of North America and aerial shots of river deltas and rice paddies</li><li>Rodney Lough's "<a href="http://www.google.com/help/ig/naturethemes/index.html#loughdeserts">Deserts</a>" presents striking images of the most desolate — and stunning — corners of our planet</li></ul><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB6_6L09aeLvGNnkFfTJnEZRgvKYxs_xY96qSi7beFuCxOoHGeh59xxDZHS6r1_gvsXNsFOj1fzEfJ4Y4Ye8RHK3F-auV2WjcTPi5UbWaEpyTIypPRr8_zxhtR6nM8s1KsbDwM9w2sWqSU/s1600-h/Picture+5.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5348357429515793650" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB6_6L09aeLvGNnkFfTJnEZRgvKYxs_xY96qSi7beFuCxOoHGeh59xxDZHS6r1_gvsXNsFOj1fzEfJ4Y4Ye8RHK3F-auV2WjcTPi5UbWaEpyTIypPRr8_zxhtR6nM8s1KsbDwM9w2sWqSU/s400/Picture+5.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 230px;" /></a> So, check out the new <a href="http://www.google.com/help/ig/naturethemes/index.html">nature themes</a>. We hope you enjoy exploring the world's wonders from the comfort of your iGoogle page. Then get outside this summer and celebrate the real thing. Posted by Marissa Mayer, Vice President of Search Products and User Experience, and Nate Johnson, Product Marketing Manager

iGoogle goes au naturel

We are excited to release a new set of iGoogle themes today. Drawing on the arrival of summer and the spectacular beauty of the world around...

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Pharmacy Benefit Managers as Pharmaceutical Marketers

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/2009/06/handbook-for-ghost-writing.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. Bloomberg continued its reporting on these documents, with its latest effort <a href="http://www.boston.com/business/healthcare/articles/2009/06/14/zyprexa_suit_highlights_cvs_links_to_lilly/">here</a> via the Boston Globe, describing yet another surprising way this drug was sold: <blockquote> A unit of CVS Caremark Corp. used its access to doctors to market Eli Lilly & Co.'s Zyprexa antipsychotic while it was under contract to bargain with the drug maker on behalf of health insurers, internal Lilly files disclosed in a multibillion-dollar lawsuit by insurers show. The subsidiary of CVS, the largest US drugstore chain, touted Zyprexa starting in 2003, according to e-mails made public by lawyers suing Lilly for overpayment. CVS's AdvancePCS, a pharmacy benefit manager, or PBM, offered to send 120,000 letters to doctors promoting the drug, Lilly's top-seller with $4.7 billion in sales last year, according to a confidential 2004 proposal. The CVS unit said it would charge $5 per letter. AdvancePCS, acquired by Woonsocket, R.I.-based CVS in 2007, said in the documents that the direct-mail campaign was 'designed to influence key prescribers' as part of a 'tactical plan for Zyprexa.' </blockquote> Furthermore, <blockquote> In AdvancePCS's 2004 pitch to Lilly offering to send out letters promoting Zyprexa, Kevin Aholt, the company's assistant vice president in charge of strategic alliances, said he could target physicians based 'on the most recent AdvancePCS claims data,' according to the unsealed documents. Aholt also said that one of the 'key issues' in the market for antipsychotic drugs was finding ways to 'accelerate the growth of new patient starts,' according to the proposal. </blockquote> Also, <blockquote> Steven Fuchs, an official at the PBM, asked Lilly officials in an April 2004 e-mail whether he should include information about Zyprexa's ability to calm agitated patients in the next round of letters to doctors. 'Would a discussion of that be something you would want to include?' Fuchs asked, according to the document. Lilly marketing executive Scott Dell responded in an e-mail that officials at the drug maker had discussed asking AdvancePCS to include material highlighting 'the new bipolar maintenance indication for Zyprexa.' </blockquote> AdvancePCS was not the only pharmacy benefits manager (PBM) that offered to help sell Zyprexa. <blockquote> CVS rival Express Scripts Inc. also sent out Zyprexa marketing letters, according to the unsealed documents and also isn't named as a defendant in the suits. </blockquote> So here we have at least two pharmacy benefit managers (PBMs) offering to help market a particular drug, for money, of course. What is the problem here? <blockquote> CVS's contracts with insurers and pensions meanwhile place it in an adversarial posture with Lilly, requiring it to use its buying power as leverage in drug-price negotiations. 'The problem is that PBMs are negotiating these hidden deals while at the same time telling employers that they represent them at the negotiating table,' said Gerry Purcell, a former PBM executive who advises companies on their drug plans. 'These documents will add fuel to the perception that the companies and the PBMs are in cahoots with each other.' </blockquote> Also, <blockquote> While PBMs negotiate on behalf of insurers, most states don't designate them as agents of the benefit plans, said Robert Garis, a pharmacy professor at Creighton University in Omaha who studies the industry. As a result, they aren't legally required to act only in the best interest of their clients, he said. Maine is one of a few states that have specified PBMs as fiduciaries, or agents, he noted. 'The companies have gotten around that by adding language to their contracts that exclude them from having to meet those fiduciary duties,' Garis said. </blockquote> Apparently, in this case, one PBM said it disclosed its relationship to the drug company to physicians, but it is not clear whether it was disclosed to the health care insurers and managed care organizations which paid the PBM to reduce the costs of drugs: <blockquote> CVS, which isn't a defendant in the Lilly suit, said that it tells doctors when it has 'financial relationships' with drug makers and that they are free to opt out of mailings. 'To engage in a point/counterpoint in a media outlet rather than in court would not be productive,' said Lilly spokeswoman Marni Lemons. Lemons declined to answer specific queries about the CVS or Express Scripts letters, whether Lilly paid for the practice, or other questions raised by the unsealed documents.... CVS said in its e-mailed statement that it has 'no active educational programs' related to Zyprexa. 'CVS Caremark discloses to its PBM clients that it may have financial relationships with pharmaceutical manufacturers in connection with these educational programs,' said Christine Cramer, a spokeswoman for the chain. 'CVS Caremark's PBM clients are aware of these programs and have the opportunity to opt out.' Maria Palumbo, a spokeswoman for Express Scripts, didn't respond to eight telephone and e-mail requests seeking comment. CVS covers 82 million people, with a market share of 12 percent, and is the largest pharmacy benefit manager, according to Atlantic Information Services. Express Scripts, which covers 55 million people, is the fifth largest. PBMs process about 75 percent of the retail prescriptions written annually in the United States, according to the insurance plans. The insurance plans sued the drug maker in 2005, contending it used researchers, pharmacy benefit managers, advocacy groups, and public agencies to promote Zyprexa. </blockquote> Whether or not the PBMs disclosed their relationships to the pharmaceutical company to everyone who might be interested, it does seem that having PBMs who are supposed to help insurers and managed care organizations control drug costs be paid by pharmaceutical companies to market drugs is yet another new species of institutional conflict of interest. Like the many other conflicts of interest, individual and institutional, we have discussed, this one appears to be mutually advantageous to the parties involved. However, it could have adverse consequences for physicians, patients, and the health care system. If the organizations that are supposed to be controlling drug costs are also promoting expensive drugs, the likely result would be excess prescription of expensive drugs to patients who may not derive benefits from the drugs outweighing their harms. This is another reminder how much we need more sunshine shone on the multitudinous conflicts of interest affecting just about every type of actor within the current US health care system.

Pharmacy Benefit Managers as Pharmaceutical Marketers

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

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Citizentube: Watching video change our world

As you might have noticed, there's a lot of fascinating stuff that happens on YouTube every day. For example, did you know that a nine-year-old recently used YouTube to successfully <a href="http://www.citizentube.com/2009/05/9-year-old-uses-youtube-to-save.html">campaign</a> to save his local kickball lot? Have you seen the video of a Guatemalan lawyer who predicted his own <a href="http://www.citizentube.com/2009/05/dead-lawyers-video-accusation-causes.html">assassination</a> on YouTube moments before it happened? Or did you know that YouTube and Google have launched a <a href="http://www.citizentube.com/2009/06/new-model-for-political-interviews-and.html">new technology platform</a> for political debates, which allows you to submit and vote on the most important issues you want to discuss with political candidates? These are the sorts of things you can stay on top of with <a href="http://www.citizentube.com/">Citizentube</a>, a special YouTube blog devoted to chronicling the way that people are using video to change the world. If you've followed news and politics on YouTube, you might have <a href="http://www.youtube.com/blog?entry=zADtM47GcO0">noticed</a> that we started Citizentube as a <a href="http://www.youtube.com/citizentube">video channel</a> on the site a few years back, but we soon realized that keeping track of all the phenomenal uses of YouTube by posting our own videos just wasn't fast enough — so now we're blogging, too. We generally focus on two types of posts: the compelling political and social uses of YouTube that we see the community bubble up every day, and our own programming initiatives and partnerships in the political, news, and nonprofit arenas. Our team creates opportunities for you to engage with content that goes beyond the humorous or even the educational — content that changes the way you interact with your communities, institutions, and leaders. The first initiative we launched in this space was the You Choose '08 platform and the <a href="http://www.youtube.com/republicandebate">CNN/YouTube Debates</a> in 2007. Since then we've expanded our programming to the fields of <a href="http://www.youtube.com/senatehub">government</a>, <a href="http://www.youtube.com/inmyname">activism</a>, and <a href="http://www.youtube.com/projectreport">news & information</a>. On the blog, we'll post an occasional series that gives a bigger picture perspective of what's happening in the worlds of news reporting, government, and social change on YouTube. So be sure to check out www.citizentube.com and subscribe to our <a href="http://feeds.feedburner.com/blogspot/PrYR">RSS feed</a> (we're on Twitter, too: @citizentube). With more than 20 hours of video uploaded to YouTube every minute, our blog helps provide you with a filter that you can use to see the way that video is changing our world. Posted by Steve Grove, YouTube News and Politics

Citizentube: Watching video change our world

As you might have noticed, there's a lot of fascinating stuff that happens on YouTube every day. For example, did you know that a nine-y...

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