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Synthes Indicted

Last month, we <a href="http://hcrenewal.blogspot.com/2009/05/synthes-settles-agrees-to-stop-giving.html">posted</a> about a legal settlement in which device manufacturer Synthes agreed to stop creating conflicts of interests by paying physicians who performed its trials with company stock. Synthes is back in the news, and not in favorable terms. As <a href="http://www.philly.com/inquirer/health_science/daily/20090617_Indictment_says_W__Chester_firm_tested_cement_on_patients.html">reported by the Philadelphia Inquirer</a>, <blockquote> A Swiss company with major operations in West Chester illegally tested its bone cement on about 200 people, three of whom died, according to a 52-count indictment issued yesterday by the U.S. attorney in Philadelphia. Synthes Inc., a producer of orthopedic products that employs about 1,400 in Chester County, did not tell any of the patients that they were participating in experimental surgeries, the indictment said. Federal prosecutors also accused Synthes executives of lying to the U.S. Food and Drug Administration about whether they had tested the product for uses that the agency had not approved. </blockquote> Particularly striking were allegations that the company's CEO was directly involved in the decisions. <blockquote> The FDA had approved Norian XR to fill bony voids or defects in some parts of the body, but not in the spine. The agency insisted that Synthes conduct clinical trials, which are lengthy and expensive and require FDA oversight, if it wanted to expand the uses of Norian XR to treat spinal fractures. But, a company executive identified in the indictment as 'Person No. 7' decided not to conduct clinical trials. Instead, the person said the company should 'get a few sites to perform 60-80 procedures and help them publish their clinical results,' according to the indictment. The report never explicitly identifies 'Person No. 7,' but says he was the chief executive officer and a large shareholder. A company spokesman identified Hansjörg Wyss as the CEO while the tests occurred. Forbes Magazine lists Wyss, a Swiss citizen, as a West Chester resident and the Philadelphia area's wealthiest person, with a net worth of $5.7 billion. Last year, Wyss gave the largest amount from a single source in Harvard University's history when he donated $125 million to create a bio-engineering institute. Wyss owns about 40 percent of outstanding Synthes stock. The company, which had about $805 million in first-quarter sales this year, specializes in orthopedic devices, including plates and screws. </blockquote> The Inquirer article included more detail about how the company allegedly disregarded risks to patients as it pushed the surgeons to try Norian XR on them, without disclosing that its use was experimental, <blockquote> Instead of conducting trials with FDA oversight, Synthes executives convinced about 50 surgeons to test Norian XR in people with spinal fractures. Synthes sales representatives often were in the operating room during the surgeries, including those where patients died, prosecutors said. When company executives began these surgical tests in 2002, they knew that Norian XR caused blood clots in test tubes and that clots became lodged in the lungs in tests with pigs, the indictment said. Synthes continued the experimental surgeries even after two patients died on the operating table, prosecutors said. The company stopped the tests after a third patient died in January 2004. </blockquote> Again, it seems that the current leaders of health care all too often put more priority on personal profits than on protecting patients' health and safety. So instead of all the talk about reforming how health care is financed, maybe the conversation should be about reforming how health care is lead, and finding ethical, honest leaders who put patients' welfare ahead of their own wealth.

Synthes Indicted

Last month, we posted about a legal settlement in which device manufacturer Synthes agreed to stop creating conflicts of interests by payin...

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Managed Care Executives Will Not Limit Rescissions

We have posted before about how certain health care insurance companies/ managed care organizations in California were found to have cancelled individual health insurance policies after the people holding them made substantial claims, supposedly rationalized by minor errors or omissions in the information the people supplied to the companies on their individual applications found after the claims were made. Several companies were subsequently disciplined by the state government for these "rescissions." See posts on rescissions by WellPoint <a href="http://hcrenewal.blogspot.com/2007/03/wellpoint-fined-1-million-for-canceling.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/07/more-than-half-of-wellpoints-policy.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2008/07/wellpoint-settles-but-has-it-become-too.html">here</a>, and by Health Net <a href="http://hcrenewal.blogspot.com/2007/11/health-net-statements-inoperative-in.html">here</a>. Executives of several such companies testified before a US congressional committee recently, with remarkable results, as reported by Lisa Girion <a href="http://www.latimes.com/business/la-fi-rescind17-2009jun17,0,5870586.story">writing in the Los Angeles Times</a>. First, by way of background, the article suggested that rescissions are widespread: <blockquote>An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period. </blockquote> Furthermore, <blockquote> The committee's investigation found that WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies. One employee, for instance, received a perfect 5 for 'exceptional performance' on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care. </blockquote> Nonetheless, the executives were not prepared to abandon rescissions: <blockquote> Executives of three of the nation's largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive. The executives -- Richard A. Collins, chief executive of UnitedHealth's Golden Rule Insurance Co.; Don Hamm, chief executive of Assurant Health and Brian Sassi, president of consumer business for WellPoint Inc., parent of Blue Cross of California -- were courteous and matter-of-fact in their testimony. But they would not commit to limiting rescissions to only policyholders who intentionally lie or commit fraud to obtain coverage, a refusal that met with dismay from legislators on both sides of the political aisle. Sassi said rescissions are necessary to prevent people who lie about preexisting conditions from obtaining coverage and driving up costs for others. 'I want to emphasize that rescission is about stopping fraud and material misrepresentations that contribute to spiraling healthcare costs,' Sassi told the committee. But rescission victims testified that their policies were canceled for inadvertent omissions or honest mistakes about medical history on their applications. Rescission, they said, was about improving corporate profits rather than rooting out fraud. </blockquote> Also, <blockquote> Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show 'intentional fraud.' The answer from all three executives: 'No.' </blockquote> This is just amazing. Here are executives of three of the country's largest for-profit health care insurance companies/ managed care organizations asserting they will continue cancelling peoples' policies after they make claims, simply because of minor errors or omissions in the application documents that have no bearing on the particular claims, or on discrepancies between information provided by patients and doctors, given that patients may not have full access to or understanding of what is in their charts. What good is an insurance policy that is liable to be cancelled as soon as one makes a claim on it? Whatever these companies are selling, it is not insurance. Basing our health care system on their products is foolish, but that is what we are doing, and what many political leaders would continue to do. In my humble opinion, if we are going to have a system based on privately provided insurance, that insurance has to be honest, unlike what some of our largest insurance companies seem to be peddling.

Managed Care Executives Will Not Limit Rescissions

We have posted before about how certain health care insurance companies/ managed care organizations in California were found to have cancell...

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Google translates Persian

Today, we added Persian (Farsi) to <a href="http://translate.google.com/?sl=fa&tl=en#">Google Translate</a>. This means you can now translate any text from Persian into English and from English into Persian — whether it's a news story, a website, a blog, an email, a tweet or a Facebook message. The service is available free at http://translate.google.com. We feel that launching Persian is particularly important now, given ongoing events in Iran. Like <a href="http://www.youtube.com/blog?entry=2soHkPYkGJw">YouTube</a> and other services, Google Translate is one more tool that Persian speakers can use to communicate directly to the world, and vice versa — increasing everyone's access to information. As with all machine translation, it's not perfect yet. And we're launching this service quickly, so it may perform slowly at times. We'll keep a close watch and if it breaks, we'll restore service as quickly as we can. We've optimized this service for translation between Persian and English. But we're working hard to improve Persian translation for the additional 40 languages available via Google Translate. If you see something you think is incorrectly translated, we invite you to click on the "contribute a better translation" link and we'll learn from your correction. The web provides many new channels of communication that enable us to see events unfold in real-time around the world. We hope that Google Translate helps make all that information accessible to you — no matter what language you speak. So please visit <a href="http://translate.google.com/?sl=en&tl=fa#">Google Translate</a> and try it out. Posted by Franz Och, Principal Scientist

Google translates Persian

Today, we added Persian (Farsi) to Google Translate . This means you can now translate any text from Persian into English and from English i...

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GoogleServe: Thinking globally and serving locally

What do painting murals, teaching tech classes, and gardening have to do with Google? These are a few of the activities Googlers have participated in over the past few weeks as part of our second annual GoogleServe — a chance for Googlers to give back to their local communities through service projects. Over the past couple of weeks about 5,000 Googlers from 60 of our offices took a break from their regular jobs to participate in volunteer opportunities. We've found that community service helps to revitalize and deepen our connections with the communities where we live and work, as well as bring us closer together as a team. This year we partnered with nonprofits, schools and local governments across the world on a wide range of activities. Here's a glimpse at some of the projects that we recently participated in: <ul><li>We cleaned beaches with the <a href="http://www.surfrider.org/">Surfrider Foundation</a> in Santa Monica, California and with the <a href="http://www.irishsealsanctuary.ie/">Irish Seal Sanctuary</a> at Balbriggan Beach, Ireland.</li><li>We removed graffiti in Zurich, Switzerland with <a href="http://www.stadt-zuerich.ch/schoenszueri">Beautiful Zurich</a>. </li><li>We removed non-native plant species with <a href="http://www.hoba.org/">Hands on Bay Area</a> and the <a href="http://www.parks.ca.gov/">California State Parks Department</a> in Half Moon Bay, California.</li><li>We painted murals with <a href="http://www.teamupforyouth.org/">Team Up For Youth</a> at the Edna Brewer Middle School in Oakland, California and with <a href="http://www.ruachtova.org/">Ruach Tova</a> at community centers in Tel Aviv and Haifa, Israel.</li><li>We prepped, packed, and sorted food for soup kitchens and homeless shelters with <a href="http://resala.org/">Resala</a> in Cairo, Egypt and with the <a href="http://www.chicagosfoodbank.org/">Greater Chicago Food Depository</a> in Chicago, Illinois.</li><li>We led computer skills classes for NGOs in Beijing, China for senior citizens in Dublin, Ireland and for teens from orphanages in Krakow, Poland. </li><li>We refurbished computer labs at the Westview Middle School in Goose Creek, South Carolina and Schule Steinfeldstrasse in Billstedt, Hamburg, Germany.</li></ul> Take a look at the photo album below to see Googlers in action. And if you're looking to give back to your community, websites like <a href="http://www.allforgood.org/">All For Good</a> can help you find volunteer opportunities. <embed type="application/x-shockwave-flash" src="http://picasaweb.google.com/s/c/bin/slideshow.swf" flashvars="host=picasaweb.google.com&captions=1&hl=en_US&feat=flashalbum&RGB=0x000000&feed=http%3A%2F%2Fpicasaweb.google.com%2Fdata%2Ffeed%2Fapi%2Fuser%2F116887554964117158278%2Falbumid%2F5348771737106393969%3Falt%3Drss%26kind%3Dphoto%26hl%3Den_US" pluginspage="http://www.macromedia.com/go/getflashplayer" height="192" width="288"></embed> Posted by Seth Marbin, GoogleServe Global Leadership Team

GoogleServe: Thinking globally and serving locally

What do painting murals, teaching tech classes, and gardening have to do with Google? These are a few of the activities Googlers have partic...

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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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