healthy4u

Bloggers Can Spread the Word, Just Not About the Sponsors' Competitors

The internet, social media, web 2.0 etc have changed how important health care issues are discussed. So, it is not surprising that big health care organizations are trying to use these new media to promote their messages. New media, however, are no more immune from the effects of conflicts of interest than are old media. An <a href="http://www.ragan.com/ME2/Audiences/dirmod.asp?sid=&nm=&type=MultiPublishing&mod=PublishingTitles&mid=5AA50C55146B4C8C98F903986BC02C56&tier=4&id=49D51282F593432BB0D53C8D849E2193&AudID=3FF14703FD8C4AE98B9B4365B978201A">article</a> from corporate communications company Ragan.com about how the American Heart Association (AHA) is using bloggers to get people interested in a heart-healthy diet and exercise program illustrates how even "civilian" bloggers can get caught up in the web of conflicts of interest that pervades health care. The background is: <blockquote>Keeping track of the conversations on the array of social media networks can gobble up your workday. So why not find someone else to do it for you? The American Heart Association did just that, approaching four established bloggers with a proposal: Write about our new campaign, Go Red For Women: BetterU, and we’ll link to your blog from our site. BetterU is a 12-week online nutrition and fitness program to improve heart health among women. The blogs appear to be working. They’ve helped drive traffic to Go Red/BetterU since the program’s June 1 launch. </blockquote> It did seem that the AHA went to considerable effort to make sure they had recruited just the right bloggers. <blockquote>The AHA researched potential candidates with the help of agencies Edelman PR and Edelman Digital. After a month-and-a-half, they settled on four bloggers: Joshilyn, Nyasha, Stacey, and Nadia. The criteria: The bloggers had to be female, have an enthusiastic following, be diverse in age and ethnicity, and have a high Technorati rating. Most important, their content and advertising had to align with the association’s values, says Director of Marketing Anu Gandhi. 'You’re really ultimately picking a spokesperson for Go Red for Women and the larger American Heart Association,' [senior manager for cause communications Megan] Lozito says. 'That’s a really important process for us — that it be correct and that it be the right people. So we spent a lot of time getting to know those ladies and making sure our mission would be aligned.' </blockquote>More interesting was the values with which the bloggers were supposed to align, particularly those relating to the program's corporate sponsors (see the logos at the bottom right of the <a href="http://www.goredforwomen.org/BetterU/index.aspx">BetterU web-site</a>). <blockquote>From there, the association brought the bloggers to the Dallas headquarters for a full health screening at The Cooper Institute, a photo session, a preview of the BetterU program, and some message training. Although the BetterU bloggers got some message training in Dallas, Gandhi says AHA has been hands off when it comes to what they can and can’t say about the program. The bloggers are asked to post once a week about BetterU and follow basic guidelines—no profanity, no defamation, no writing about nor condoning any medications or treatments. She says they also ask bloggers not to talk about competitors of AHA’s two national sponsors: Macy’s and Merck Pharmaceuticals. </blockquote> I would suspect that the explicit instruction not to favor Merck's competitors would also remind the bloggers not not do say anything that might make the giant pharmaceutical company unhappy. <blockquote>Eight weeks into the program, they haven’t had any problems. 'There are things we don’t want them to write, like profanity, but that’s also part of the vetting in the beginning,' Lozito says. 'We wanted to find people who believe in our mission, who speak to the same type of audience, but at the same time we want them to have their own flavor and own tone, because it’s a blog.' </blockquote>So the bloggers recruited by the AHA may be happy, since they now have a big organization's web-site driving traffic to their blogs. The AHA may be happy, since the bloggers can spread the word about their BetterU program. I imagine the marketers at Merck may be happy too, since the bloggers have been warned about the need to keep the corporate sponsors happy. However, what may be good for all the parties in this transaction may not be so good for the general public, as another opportunity for uninhibited, honest discussion of health care issues has been lost. This is an explicit example of the adverse effects of commercial funding of not-for-profit disease advocacy groups. Corporate sponsors may not expect anything as gross as advertising in return for their money. However, they may expect something more subtle, a generally favorable attitude toward the sponsor, at least the disinclination to say anything that might put the sponsor in a negative light. After all, politeness requires that we be nice to the people who are nice to us. But being nice to sponsors may not be so nice for the people that a health care not-for-profit organization is supposed to serve. PS - for those who like science fiction, see the <a href="http://abc.go.com/fallpreview/index?pn=v">preview</a> of the new version of "V," in which Anna, the leader of the Visitors, an invasion force disguised as human-appearing, benign aliens, warns her television interviewer, <blockquote>Just be sure not to ask anything that would put us in a negative light. </blockquote>

Bloggers Can Spread the Word, Just Not About the Sponsors' Competitors

The internet, social media, web 2.0 etc have changed how important health care issues are discussed. So, it is not surprising that big healt...

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I now pronounce you monetized: a YouTube video case study

(Cross-posted from the <a href="http://ytbizblog.blogspot.com/2009/07/i-now-pronounce-you-monetized-youtube_30.html">YouTube Biz Blog</a>) Last week the world watched in wonder as <a href="http://www.youtube.com/watch?v=4-94JhLEiN0">Jill Peterson and Kevin Heinz's wedding party</a> transformed a familiar and predictable tradition into something spontaneous and just flat-out fun. The video, set to R&B star Chris Brown's hypnotic dance jam "Forever," became an overnight sensation, accumulating more than 10 million views on YouTube in less than one week. But as with all great YouTube videos, there's more to this story than simple view counts. At YouTube, we have sophisticated <a href="http://www.youtube.com/t/contentid">content management tools</a> in place to help rights holders control their content on our site. The rights holders for "Forever" used these tools to claim and monetize the song, as well as to start running <a href="http://googleblog.blogspot.com/2008/10/i-clicked-to-buy-and-i-liked-it.html">Click-to-Buy</a> links over the video, giving viewers the opportunity to purchase the music track on Amazon and iTunes. As a result, the rights holders were able to capitalize on the massive wave of popularity generated by "JK Wedding Entrance Dance" — in the last week, searches for "Chris Brown Forever" on YouTube have skyrocketed, making it one of the most popular queries on the site: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYnjNQAEcwibWDqUDzVZSF0XyH_ANWS_YUbsQbXrLnaiNvhUmP_9ABcORtDEBPk8i8Ufty_uKCFwE7hnckYihiTdddYzi0fO_zQ9tPN8fMRgPPP8uzkk2jA69-eQIRJHuwR4G6_jsF7aEo/s1600-h/chris+brown+forever.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364282734135124178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYnjNQAEcwibWDqUDzVZSF0XyH_ANWS_YUbsQbXrLnaiNvhUmP_9ABcORtDEBPk8i8Ufty_uKCFwE7hnckYihiTdddYzi0fO_zQ9tPN8fMRgPPP8uzkk2jA69-eQIRJHuwR4G6_jsF7aEo/s400/chris+brown+forever.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 153px;" /></a> This traffic is also very engaged — the click-through rate (CTR) on the "JK Wedding Entrance" video is 2x the average of other Click-to-Buy overlays on the site. And this newfound interest in downloading "Forever" goes beyond the viral video itself: "JK Wedding Entrance" also appears to have influenced the official <a href="http://www.youtube.com/watch?v=X2IExa2A198">"Forever" music video</a>, which saw its Click-to-Buy CTR increase by 2.5x in the last week. So, what does all of this mean? Despite compelling data and <a href="http://news.bbc.co.uk/2/hi/technology/7967908.stm">studies</a> around consumer purchasing habits, many still question the promotional and bottom-line business value sites like YouTube provide artists. But in the last week, over a year after its release, Chris Brown's "Forever" has again rocketed up the charts, reaching as high as #4 on the <a href="http://www.apple.com/itunes/top-100/songs/">iTunes singles chart</a> and #3 on <a href="http://www.amazon.com/gp/bestsellers/dmusic/digital-music-track/ref=pd_ts_dmusic_nav">Amazon's best selling MP3 list</a>. We've seen <a href="http://www.fastcompany.com/blog/kit-eaton/technomix/monty-python-youtube-move-boosts-dvd-sales-23000">similar successes</a> in the past with partners like Monty Python. One of our main goals at YouTube is to help content creators effectively make money from the distribution of their content online. That they can do so in a way that brings artists and our community together to create fun, spontaneous and inspiring works, is one of the best and most exciting things about YouTube. Posted by Chris LaRosa, Technical Account Manager, and Ali Sandler, Music Partner Manager

I now pronounce you monetized: a YouTube video case study

(Cross-posted from the YouTube Biz Blog ) Last week the world watched in wonder as Jill Peterson and Kevin Heinz's wedding party transf...

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BLOGSCAN - Live-Blogging Senate Hearing on Conflicts of Interest and Continuing Medical Education

BLOGSCAN - Live-Blogging Senate Hearing on Conflicts of Interest and Continuing Medical Education

Dr Daniel Carlat is live-blogging the US Senate Special Committee on Aging hearing on conflicts of interest and continuing medical education...

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Polly Want a Million (Plus)

We have frequently posted about attempts to justify financial relationships among physicians and medical academics on one hand, and pharmaceutical, biotechnology, device and other health care corporations, on the other. Some defenders of such relationships now have gone so far as to start their own society, whose meeting was covered and commented on by fellow "pharmascolds," including <a href="http://carlatpsychiatry.blogspot.com/2009/07/acre-meeting-welcome-to-anger-village.html">Dr Daniel Carlat </a>and <a href="http://brodyhooked.blogspot.com/2009/07/carlats-take-on-acre-some-ruminations.html">Dr Howard Brody</a>. The usual justification of these relationships is that they are necessary for "innovation" and the onward progress of medical science, education, and care. I have yet to see any logic or evidence to back up these assertions, nor have I seen anyone defend these relationships who does not also have personal financial relationships of their own with health care corporations. (See examples <a href="http://hcrenewal.blogspot.com/2008/01/logical-fallacies-and-discussion-of.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/04/can-people-with-conflicts-of-interest.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/07/again-logical-fallacies-in-defense-of.html">here</a>.) Meanwhile, cases of individual physicians and academics whose lucrative relationships with industry seem to generate huge conflicts of interest continue to surface. The latest example ferreted out by investigators working for US Senator Charles Grassley (R - Iowa) is that of Dr David Polly. (Recall that Dr Polly was one of the strongest defenders of Dr Thomas Kuklo, who was accused of falsifying clinical research results in a way that seemed to favor the product of his own corporate benefactor [see post <a href="http://hcrenewal.blogspot.com/2009/05/breach-of-trust.html">here</a>].) The main points were <a href="http://online.wsj.com/article/SB124882216054688233.html">reported</a> by David Armstrong and Thomas M Burton in the Wall Street Journal, <blockquote>In May 2006, University of Minnesota spine surgeon David Polly urged a Senate committee to fund research into the severe arm, leg and spine injuries suffered by soldiers in Iraq and elsewhere. Dr. Polly told the committee he was testifying on behalf of the American Academy of Orthopaedic Surgeons and referenced his prior work caring for soldiers as a surgeon at the Walter Reed Army Medical Center. What Dr. Polly didn't disclose during his testimony was that his trip to Washington was paid for by Medtronic Inc., the big medical-device maker whose bone growth product, called Infuse, has been used to treat soldiers, according to company records. Dr. Polly and colleagues in Minnesota subsequently received a $466,644 Department of Defense grant for a two-year study beginning in February 2007 to evaluate Infuse in cases where an injury is also infected, according to the university. Dr. Polly was paid $1.14 million by Medtronic for consulting services from 2004 to 2007. Details of Dr. Polly's consultant billing were provided by Medtronic to Sen. Charles Grassley, an Iowa Republican who has been scrutinizing the relationship between academics and industry. </blockquote> Although there have now been many reported cases of medical academics who collected large payments from health care corporations, the services they provided in exchange for the money have not always been very clear. Defenders of financial relationships among physicians and medical academics and industry have argued that most payments were for valuable research, education, or health care activities. However, Senator Grassley's office provided the details of Dr Polly's invoices, and several of the news articles so far described what he did for the money. Per the Wall Street Journal article, <blockquote>In total, Dr. Polly billed Medtronic for more than $50,000 in lobbying-related costs. He made trips to Washington in 2005 and 2006 and called on several members of Congress, according to the records. According to billing records, Dr. Polly's billing rate was $4,750 for an eight-hour day in 2007, and he billed as many as 13,000 minutes a quarter -- or 216 hours over three months. In some months, he conducted at least some Medtronic business on nearly every day. His consulting log indicates that on one occasion he spent one minute to wake up a Medtronic executive, although he listed 'no charge' for that service. He did bill Medtronic for the 30 minutes he spent in the car with that executive after waking him up. </blockquote> An accompanying post on the Wall Street Journal Health Blog provided <a href="http://blogs.wsj.com/health/2009/07/29/what-a-doctor-did-that-was-worth-1-million-to-medtronic/">more information</a>: <blockquote>Did you ever wonder what doctors do to earn big consulting contracts from medical device companies and pharmaceutical concerns? Records released by Medtronic to Sen. Charles Grassley, a longtime critic of the ties between academics and and health-care companies, provide a rare and detailed glimpse into the daily billings of a consultant — in this case, spine surgeon David Polly of the University of Minnesota. Polly collected more than $1 million in four years of work for Medtronic, according to the records, which you can take a look at <a href="http://s.wsj.net/public/resources/documents/UMinnLetter.pdf" target="blank">here</a>. The services he provided were many, but among them, Polly was paid to write articles for medical journals; write a chapter in a book and a book outline; recruit patients for publicity efforts; attend Medtronic national sales meetings; travel to conferences in Japan, Paris and elsewhere; lead training and educational sessions for physicians; and lobby Congress. Polly also billed for at least two phone calls with Medtronic CEO William Hawkins as well as charging the company $2,000 when Mr. Hawkins visited an operating room. In October, 2003, he billed the company $12,000 for attending a medical meeting of the North American Spine Society, at $4,000 a day. There are also scores of entries for work billed in five-minute increments, usually to send email or return phone calls. The bill for each five-minute charge? $49.48 a pop. </blockquote> So did the $1.2 million Medtronic spent on Dr Polly's services inspire any "innovation?" Did it lead to any scientific progress or improved health care? I am not sure. It is clear, however, that a good chunk of this money went to support marketing, advocacy, and lobbying. The items in bold italics above were clearly in support of marketing, advocacy and lobbying, not science, medical education, or patient care. (To give Dr Polly the benefit of a doubt, some other items listed above could have been related to research, education, or patient care, although this is not indisputable.) So the case of Dr Polly corroborates my deep skepticism of the financial relationships among physicians and medical academics on one hand, and corporations that sell health care goods and services on the other. We "pharmascolds," - a preferable term might be health care skeptics - suspect that many of these relationships are really about stealth marketing and advocacy. The companies often pay to market their products and services, or advocate positions to the companies' advantage, but prefer that their salespeople and advocates are cloaked in academic guises, and wreathed in the rarefied aura of respected academic institutions. (Note that some of us are just as skeptical about relationships among academic institutions and other health care not-for-profit organizations on one hand, and such corporations on the other, for analogous reasons.) While the leadership of our formerly distinguished medical academic institutions remains infiltrated, if not dominated by people earning many thousands of dollars from health care corporations, I must remain skeptical about how much of these institutions supposedly academic output is actually stealth marketing and stealth health policy advocacy. At the very least, medical academics, medical academic institutions, and other health care not-for-profits or NGOs should reveal in detail what payments they get from companies selling health care products or services, and how these payments could relate to the companies' marketing or lobbying efforts. In the US, some such disclosure would be mandated by the proposed "Sunshine" legislation now being considered by the US Congress. (By the way, note that this problem is hardly confined to the US, and needs global, not just American attention.) However, physicians (at least physicians in full-time private practice, academic positions, and employed by mission-oriented not for profit organizations) should go further, and consider whether receiving industry money is worth the ongoing damage it does to our professionalism and our professional reputations. Medical schools, universities, health care foundations, disease advocacy groups, and other health care not-for-profits and NGOs should also go further, and consider whether receiving industry money is worth the ongoing damage it does to their missions, and their institutional reputations. See also comments by Prof Margaret Soltan <a href="http://www.margaretsoltan.com/?p=15588">on the University Diaries blog</a>.

Polly Want a Million (Plus)

We have frequently posted about attempts to justify financial relationships among physicians and medical academics on one hand, and pharmace...

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Wyeth: Ghostwritten Papers Fake, But Accurate

It looks like Wyeth has lost its battle to keep secret its practices regarding <a href="http://hcrenewal.blogspot.com/2005/04/ghosts-busted.html">ghostwriting</a> of scientific papers. The issue in question is whether ghostwriting contributed to excessive prescription of post-menopausal hormones and increased the incidence of breast cancer: <blockquote>Posted on Sun, Jul. 26, 2009 Philadelphia Inquirer <a href="http://www.philly.com/inquirer/world_us/51709602.html">Wyeth told to release documents on ghostwriting</a> Associated Press LITTLE ROCK, Ark. - A federal judge has ordered the unsealing of thousands of pages of documents pertaining to the ghostwriting practices of Wyeth Pharmaceuticals, which is being sued over hormone-replacement drugs. U.S. District Judge Bill Wilson ordered the papers unsealed Friday at the request of a medical journal and the New York Times. Plaintiffs' attorneys presented the papers earlier at trial to show that Wyeth routinely hired medical-writing firms to ghostwrite articles that appeared in seemingly objective medical journals but included only the name of a scientific researcher as the author. </blockquote>Of course, in addition to the violation of accepted practices of authorship, such as specified by <a href="http://www.docstoc.com/docs/922992/Guidelines-for-the-Conduct-of-Research-at-NIH">NIH</a> and the <a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1416675">International Committee of Medical Journal Editors</a>, among others, such lucky authors get to "count" such papers in their academic portfolios, presumably also in violation of their own institutional policies and guidelines for fair attribution and intellectual honesty, e.g., <a href="http://www.hms.harvard.edu/fa/attribution.html">here</a>. Ghostwriting may also skew the tenure process, providing advantages to the unscrupulous academic over the ethical scientist or scholar. (One wonders about the true percentage of the massive number of papers claimed by some medical academics actually written by the putative first author.) <blockquote>The ruling came in a case that involves about 8,000 lawsuits that have been combined before Wilson. The lawsuits focus on whether Wyeth hormone-therapy drugs Prempro and Premarin, used to treat symptoms of menopause, have caused breast cancer in some women. The New Jersey drugmaker, which has major operations in the Philadelphia area, had already turned over the documents, which it says concern about 40 articles in medical journals and other publications, to Sen. Charles Grassley (R., Iowa).</blockquote> How is evidence based medicine possible if just one drug company has sponsored ghostwritten articles in 40 medical journals and other publications? What is the "total mass" of questionable articles now infecting the literature? <blockquote>Grassley sought them last year without a subpoena as part of a congressional investigation into drug-industry influence on doctors. The documents were shown to jurors at trial but have otherwise been unavailable publicly. Plaintiffs say ghostwriting is when a drug company conjures up the concept for an article that will counteract criticism of a drug or embellish its benefits, hires a professional writing company to draft a manuscript conveying the company's message, retains a physician to sign off as the author, and finds a publisher to unwittingly publish the work. </blockquote> There are several layers of dishonesty in this activity, including foreknowledge of scientific deception through fraudulent misrepresentation of authorship by the pharma, dishonesty of the physician who "signs off" as first author, and misrepresentation by the pharma, the writing company and the physician about provenance of the article to scientific publishers. <blockquote>Drug firms disseminate their ghostwritten articles to their sales representatives, who present the articles to physicians as independent proof that the companies' drugs are safe and effective. Wyeth attorney Stephen Urbanczyk acknowledged that the articles were part of a marketing effort. But he said that they were also fair, balanced, and scientific.</blockquote> What business does a lawyer have lecturing the public that the articles were a dishonest marketing effort masquerading as legitimate science, but were "fair and scientific?" How does he know? In addition, the "fake but accurate" excuse is getting quite shopworn. Hopefully, Sen. Grassley will approach ending this ghostwriting practice with vigor. In fact, this raises another issue. I have written that management of pharma by those lacking biomedical bona fides is, by definition, mismanagement. This is a case in point. Wyeth's President, Board Chair and CEO <a href="http://www.nj.com/business/index.ssf/2008/06/wyeth_ceo_poussot_takes_chairm.html">Bernard Poussot</a> lacks <a href="http://phx.corporate-ir.net/phoenix.zhtml?c=78193&p=irol-govBio&ID=161712">biomedical credentials</a>. Harry Truman said "the buck stops here", but a in the case of scientific ghostwriting, CEO's such as Poussot cannot vouch firsthand for the accuracy and fairness of their company's science. He lacks the expertise. The buck does not stop at his desk; he is dependent on scientific underlings in such matters. This affair is another instantiation of my belief that pharma is best led by those with relevant scientific expertise such as Merck under clinician-scientist <a href="http://en.wikipedia.org/wiki/P._Roy_Vagelos">Dr. Roy Vagelos</a>. (It is perhaps not coincidental that Merck became a shadow of its former self under non-scientist Raymond Gilmartin.) <blockquote>Wyeth, the world's No. 12 pharmaceutical company by sales, is being bought this fall by No. 1 drugmaker Pfizer. </blockquote> How appropriate, as Pfizer is led by the former top lawyer for McDonald's and Boston Chicken, <a href="http://www.nytimes.com/2006/07/29/business/29pfizer.html?_r=1&adxnnl=1&ref=business&adxnnlx=1154188929-t+A9XFX2vNTip4coSmtyLA&oref=slogin" title="external link">bringing to life my "If you've run McDonald's, you can run anything" metaphor.</a> If a wise investor were to take a bearish position on a stock, this merged company would be an excellent candidate. Finally, another ghostwriter of sorts recently died, Sandford Dody (1918-2009). Dody anonymously penned best selling autobiographies of actresses Bette Davis and Helen Hayes, among many other notables. Such ghostwriting is essentially victimless, as opposed to its counterpart in the scientific domain. However, Mr. Dody had an astute observation about the practice, even when there was no trail of diseased or dead bodies. Per the WSJ article "<a href="http://online.wsj.com/article/SB124881878743688051.html">A Ghostwriter Who Struggled to Accept Life in the Shadows</a>": <blockquote> ... Mr. Dody, who died July 4 at the age of 90, found the work spiritually destructive. "After all," he wrote, "how does one become a ghost without dying a little?"</blockquote> In the case of biomedical ghostwriting, the conspirators all "die a little" in purveying their intellectual dishonesty on a trusting public. It's too bad some of that same public also dies, and not just a little, as wages of professorial ghostwriting sins. <div>The acknowledgements are where minor contributions and reviews get placed in an ethically-attributed scientific paper. Anyone who does not understand this, or rationalizes "honorary authorship" or similar workarounds to meaningful attribution does not belong in science.</div><div> Finally, scientific ghostwriting must stop. I also believe its conspirators should be excluded from receiving public money for research and excluded from the biomedical literature for a good, long period of time.<div> -- SS<div> </div><div> <a href="http://www.nytimes.com/2006/07/29/business/29pfizer.html?_r=1&adxnnl=1&ref=business&adxnnlx=1154188929-t+A9XFX2vNTip4coSmtyLA&oref=slogin" title="external link"> </a></div></div></div>

Wyeth: Ghostwritten Papers Fake, But Accurate

It looks like Wyeth has lost its battle to keep secret its practices regarding ghostwriting of scientific papers. The issue in question i...

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Are the Health Plans of the Very Rich Different from Yours and Mine?

Yesterday, the New York Times published an intriguing <a href="http://www.nytimes.com/2009/07/27/health/policy/27insure.html">story</a> about "Cadillac" (that is, expensive) health insurance plans, <blockquote> Goldman Sachs is one of the nation’s richest banks, and hundreds of top Goldman employees have a health care package to match — one of the 'gold-plated Cadillac' plans cited by those involved in the health care debate in Washington. Goldman’s 400 or so managing directors and its top executive officers participate in the bank’s executive medical and dental program as part of their benefits, according to documents filed with the Securities and Exchange Commission. The program generally costs the bank $40,543 in premiums annually for each participant’s family. Those taking part in the plan include the company’s chief executive, Lloyd C. Blankfein, and four other top officers, as well as managing directors, whose base salary is $600,000. Goldman’s medical coverage entered the health care discussion on Sunday when David Axelrod, senior adviser to President Obama, cited the Goldman program as an example of the expensive benefits the administration might consider taxing to help pay for its health care program. 'The president actually was asked this the other day by Jim Lehrer, and what he said was that this was an intriguing idea to put an excise tax on high-end health care policies like the ones that the executives at Goldman Sachs have, the $40,000 policies,' Mr. Axelrod said. A proposal by Senator John F. Kerry, Democrat of Massachusetts, would impose an excise tax on the insurers that issue policies like Goldman’s, with the expectation that the insurers would pass along most, if not all, of the cost to employers who buy the plans. Leaders of the Senate Finance Committee, which is working on bipartisan version of the health care legislation in Congress, had long expressed interest in taxing some employer-provided benefits — a move many budget experts say would help slow the steep rise in health costs. Negotiators have not yet determined the value of the plans that would set off a tax on the insurance companies; the numbers under discussion range from $20,000 to $40,000 annually, a senior administration official said. The lower end of that range would increase the amount of money the tax would raise but would also hit some middle-class workers, whose unions in some cases negotiated robust health benefits in lieu of pay increases. Typical employer-provided plans cost $13,000 to $20,000 per family, depending on the location and the age of the plan participants. A health care package costing $40,000 or more a year would generally have no co-payments or deductibles, according to Paul Fronstin, an analyst at the Employee Benefit Research Institute, a Washington nonprofit that studies benefits. It would also have no limits on doctors or procedures, no restrictions on pre-existing conditions and no requirements for referrals. Few people have such policies, Mr. Fronstin said. 'It would only be top executives who run big businesses, mainly people in the C suite,' said Mr. Fronstin, referring to companies’ chief officers. </blockquote> It was not clear from this article how many top corporate executives have such plans, and whether leaders of other kinds of organizations, like large not-for-profits, also have them. My main concern about such plans is not how much they contribute to top corporate leaders' compensation packages. Such packages are generally already so outrageously huge that providing $40,000 rather than $13,000 worth of health insurance is a trivial increase. My concern is not that plan recipients' demands for health care will collectively increase health care costs, because they include only a tiny portion of the population. My main concern, instead, is how much these plans further insulate already cocooned top executives from the vicissitudes of daily life, particularly related to coping with our current dysfunctional health care system. What benefits executive health care plans provide is not clear, but presumably they insulate executives from having to deal with the managed care/ health insurance bureaucracy which frustrates patients seeking particular services, but not necessarily the most expensive, or least beneficial services. Such executives might thus not have gut level appreciation of how dysfunctional the health care system has become for even insured patients. Since top executives often are disproportionately influential members of the "<a href="http://hcrenewal.blogspot.com/search/label/superclass">superclass</a>," their disconnection from the realities of dysfunctional health care is likely to translate into little real support by the powers that be for meaningful health care reform. There support may be further retarded by the influence of their fellow superclass members whose personal fortunes depend on the status quo in health care. Real improvement of health care may depend on finding leaders who have better understanding of the plight of real people.

Are the Health Plans of the Very Rich Different from Yours and Mine?

Yesterday, the New York Times published an intriguing story about "Cadillac" (that is, expensive) health insurance plans, Goldman...

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Announcing the 10 Days in Google Books game

Which infamous book thief got caught stealing from the Chicago Public Library and was later acquitted on grounds of insanity? How many European cities are mentioned in Karen Fowler's "The Jane Austen Book Club?" And can you figure out what curious objects Dorothy is picking from a tree in this illustration from Frank Baum's "Ozma of Oz?" <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlYJENkQ3uyj2sjkEScqiSK0eDXcxnf4QD_6NMFB-41ALPnJEK9g958EAZ9nXtWP7JLKK3ULvu-UV8s_lFUqgh7Ksx1Q-YJkgPSgpDf-rxUnl1X4_QV3-Xj3TcuMwaYYd5U7HilIHBw4kK/s1600-h/books1.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5363180930433724594" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlYJENkQ3uyj2sjkEScqiSK0eDXcxnf4QD_6NMFB-41ALPnJEK9g958EAZ9nXtWP7JLKK3ULvu-UV8s_lFUqgh7Ksx1Q-YJkgPSgpDf-rxUnl1X4_QV3-Xj3TcuMwaYYd5U7HilIHBw4kK/s400/books1.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 289px; height: 400px;" /></a> Stumped? Find the answers to these and other fun questions in the <a href="http://books.google.com/game">10 Days in Google Books game</a>. Each day, we'll ask you five trivia questions on a different theme. Search <a href="http://books.google.com/">Google Books</a> to find the answers with hints to help you along the way. After you answer each day's questions, you can enter a contest to win a Sony Reader. If you enjoy the game, come back the next day for another set of questions — and another chance to win. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhobbpw4g8MWdZHFuEvdqL_YpiUA0hiE4Lm75MQAxk4a7RPQX5zsLW4r4vVT6s8df2cNbdYf_w8fjibKC0hfqUlBRxboapvCrTzfVrQbZ905bovvRGB8Gliie8yuch57DxVcnc5CMnsEw5b/s1600-h/Books2.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5363181083101871602" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhobbpw4g8MWdZHFuEvdqL_YpiUA0hiE4Lm75MQAxk4a7RPQX5zsLW4r4vVT6s8df2cNbdYf_w8fjibKC0hfqUlBRxboapvCrTzfVrQbZ905bovvRGB8Gliie8yuch57DxVcnc5CMnsEw5b/s400/Books2.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 259px;" /></a> For official rules, including prize descriptions, visit <a href="http://books.google.com/game">http://books.google.com/game</a>. (Please note: Some books may not be available in full view to those outside the United States.) The first 20,000 people to play the game will also receive commemorative Google Books laptop stickers. So all you bookworms out there, <a href="http://books.google.com/googlebooks/game">start playing</a> now! Posted by Hicham Alaoui, Associate Product Marketing Manager, Google Books

Announcing the 10 Days in Google Books game

Which infamous book thief got caught stealing from the Chicago Public Library and was later acquitted on grounds of insanity? How many Europ...

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