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Pfizer Settles Trovan Case with Kano State

As <a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/07/30/AR2009073001847.html">reported</a> by the Washington Post, and many news sources outside of the US, Pfizer Inc has settled another lawsuit, <blockquote> Pfizer signed a $75 million agreement Thursday with Nigerian authorities to settle criminal and civil charges that the pharmaceutical company illegally tested an experimental drug on children during a 1996 meningitis epidemic. Nigerian authorities say Pfizer's test of the antibiotic Trovan killed 11 children and disabled scores more. Pfizer says the deaths and injuries were the result of meningitis. An attorney for the state of Kano, where the charges were lodged, said the settlement was a long time in coming but welcome because it set the record straight about Pfizer's culpability. 'People and entities can and must be held accountable for the consequences of their conduct,' the attorney, Babatunde Irukera, said. 'People around the world are no different and must be accorded the same levels of protections, always.' </blockquote> Pfizer is not quite done with this case. <blockquote> Charges filed against Pfizer by Nigeria's federal government, which is seeking about $6 billion in damages, are unaffected by the settlement, Irukera said. Two lawsuits related to the Trovan experiment also remain pending in New York. </blockquote> The Post's article summarized the issues in the case, thus: <blockquote> Details of the drug trial were first made public in December 2000 in a Washington Post investigative series. The articles reported that the trial did not conform to U.S. patient-protection standards and that the oral form of the drug used in the trial had not been previously tested in children. Pfizer had no signed consent forms for the children, the articles said, and the company relied on a falsified ethics approval letter. Five years later, in May 2006, The Post obtained and published a confidential report that concluded that Pfizer violated Nigerian and international law in the experiment. That set in motion the criminal charges. </blockquote> We first posted about this case in 2006, <a href="http://hcrenewal.blogspot.com/2006/05/nigerian-committee-criticizes-pfizers.html">here</a>. We posted about Pfizer's heretofore most recent legal settlement, <a href="http://hcrenewal.blogspot.com/2009/02/pfizer-settles-for-mere-2300000000.html">here</a>. I wonder again whether multi-million, or even billion dollar settlements have that much effect on the leadership of a company as big as Pfizer? Such settlements do not affect the leaders directly, and their financial effects one a company so big are negligible. Be that as it may, do we need more examples to remind us that strong skepticism should be the rule when evaluating clinical research done or sponsored by pharmaceutical companies, or other health care corporations with vested interests in the research turning out a certain way? Such skepticism is warranted whatever the clinical context, whatever the product being evaluated, and whatever country in which the research is done. Here in the US, debate has been swirling about health care reform. Many of the arguments have been about how costs can be controlled while health care quality is increased. Better research about the benefits and harms of specific drugs, procedures, devices and tests might enable physicians to choose the most appropriate care for each patient, potentially improving quality while also reducing costs. This example, plus many others discussed on Health Care Renewal, suggests that putting at least an arm's length between companies which sell drugs and devices and the clinical research meant to evaluate these drugs and devices has the potential for making better quality, less biased, more accurate clinical research available (see the topics: <a href="http://hcrenewal.blogspot.com/search/label/suppression%20of%20medical%20research">suppression of medical research</a> and <a href="http://hcrenewal.blogspot.com/search/label/manipulating%20clinical%20research">manipulating clinical research</a>.) Maybe putting this topic on our local US health care policy radar would increase the chances of achieving meaningful health care reform. Maybe if the US took the lead in separating clinical research meant to evaluate drugs, devices, procedures, or tests from the corporations selling them, the result would be a movement that would benefit health care around the world?

Pfizer Settles Trovan Case with Kano State

As reported by the Washington Post, and many news sources outside of the US, Pfizer Inc has settled another lawsuit, Pfizer signed a $75 mi...

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"Going Google" with Google Apps

Every morning, millions of people wake up to a very refreshing experience at work. They don't see "mailbox is full" errors in their email. They don't worry about backing up their data. They can get to any file they need from any computer, anywhere with Internet access and a browser. They can all access and edit the same documents and spreadsheets at the same time as their colleagues. They use Gmail and Google Calendar at work as fluidly and easily as they use their personal Gmail accounts. They video, voice and text chat with their peers globally as naturally as they send email. The IT people at these companies and organizations don't waste time or money buying, installing or managing email servers. They focus on the smart, innovative stuff they want to work on, because they never have to bother with expensive and painful software upgrades, hardware compatibility issues or managing data centers. They have left many IT frustrations and costs behind and moved on to something better. Here at Google, we have a term for the moment a company realizes there's a better way and goes for it: "going Google." Over 1.75 million businesses, schools and organizations have gone Google — including Motorola, University of Notre Dame, the Mercy Corps and many more — and each day, 3,000 more organizations join them. We want every organization to understand the benefits of going Google, so today we're telling the story in a new way. We're kicking off a series of outdoor billboards in four cities — Boston, Chicago, New York and San Francisco — that will change every weekday for the next four weeks. The billboards tell the story of an anonymous IT manager who gets so fed up with the typical IT status quo that his company eventually — you guessed it — goes Google. Here's a preview: <object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/QJ06e0SpNII&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/QJ06e0SpNII&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object> Visit <a href="http://www.google.com/apps/intl/en/business/gogoogle.html#utm_campaign=gogoogle&utm_source=en-na-us-ogblog-gogoogle&utm_medium=blog">www.google.com/appsatwork</a> to get more information about the benefits of going Google. Already gone Google? <a href="http://twitter.com/home?status=I%27ve+%23gonegoogle+-+here%27s+why%3A">Tweet your story</a> and check out our tools to help <a href="http://www.google.com/apps/intl/en/business/spreadtheword.html">spread the word</a>. Posted by Andy Berndt, Managing Director, Google Creative Lab

"Going Google" with Google Apps

Every morning, millions of people wake up to a very refreshing experience at work. They don't see "mailbox is full" errors in ...

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Making Hospitals Safer by Making Healthcare IT Safer

At my July 24, 2009 HC Renewal post "<a href="http://hcrenewal.blogspot.com/2009/07/inquiry-to-joint-commission-on-points-i.html">Inquiry to Joint Commission on points raised in my July 22, 2009 JAMA letter on HIT</a>", I reproduced a letter I sent to the Joint Commission seeking their opinions on the issue of Health IT "hold harmless" and "defects nondisclosure" contractual terms. (See "<a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' Hold Harmless Clause - Implications for Patients and Clinicians</a>", JAMA 2009;301(12):1276-1278 and my HIT difficulties website essay <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=koppel_kreda">here</a>.) Those contractual terms cause hospital executives to violate Joint Commission safety standards and their own fiduciary responsibilities to people both providing and seeking care in hospitals. My inquiry was acknowledged, and I await a reply. In <a href="http://www.nytimes.com/2009/08/03/opinion/l03medical.html?_r=2&ref=todayspaper">Making Hospitals Safer for Patients</a>, New York Times, Aug. 2, 2009 , Mark R. Chassin, president of The Joint Commission, wrote: <div style="margin-left: 40px; font-family: arial;">To the Editor:Jim Hall makes an important point about the costs and preventability of harm caused by medical errors, but his suggestion for a National Medical Safety Board is not the answer. It is not sufficient to investigate health care “crashes” one at a time and hope to transform the health care system into one that performs more reliably.Too often, the lessons learned are not easily transferable to other hospitals or even to other problems within the same organization. The key to transforming our health care system into a safer one is to use proven quality improvement methods — already in use in high-risk fields like aviation and nuclear power — as part of everyday work ... </div> In a followup email to the Joint Commission, I pointed out to Dr. Chassin that this is the same key to improving the quality and safety of EHR, CPOE and other information technology-based medical devices. I also pointed out that "Hold harmless" and "Defects nondisclosure" -- a.k.a. "gag clause" -- contractual methods (unless I'm mistaken, in which case we're all in jeopardy) are not used in building and deploying safety-critical devices found in the aviation and nuclear energy industries. -- SS

Making Hospitals Safer by Making Healthcare IT Safer

At my July 24, 2009 HC Renewal post " Inquiry to Joint Commission on points raised in my July 22, 2009 JAMA letter on HIT ", I re...

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An Outsider’s Take on American Medicine

Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine, but one part concerns his coming from Britain to America in the late 1980s. Born in South Africa, he attended medical school there, then went to Britain rather than be drafted into the military. With research budgets cut under Thatcher, he came to America to be able to pursue his medical career. After his dreary British experience during a period of budget cutbacks, he greatly enjoyed the cheerful commercialism and general prosperity of American medicine. He promptly found a research project to work on that would enable him to write a Master’s thesis, and the work was fun and went swimmingly. Nonetheless, Dr. Kaplan was quite disconcerted by some of the differences between British and American medicine. Working on another study, he reviewed hemorrhoid surgery results. He was startled to realize how much more surgery was done for minor piles in the U.S. than in Britain, though results were unimpressive – then “I found the payment invoices in each patient’s folder. These were met by the health insurers, who paid out a lot more for an operation than injections. . . . The logic of a for-profit system appeared to lead to expensive solutions and spiraling costs.”He was also startled by anecdotal reports of how the stock market crash of 1987 led one surgeon to actually shed tears mid-surgery when he heard the news. As well, the serious, money-oriented medical students surprised him, as he was used to quite a number of more arty, intellectual types among medical students in other countries.Still, he was thrilled about his promising research results on a heated balloon angioplasty device. Later, he was disillusioned to hear that after the device received FDA approval, the main competitor, a laser manufacturer, bought out the idea and shelved it to keep it off the market. I thought his observations fit well with Dr. Poses’ concern about insidious corruption in medicine and too many physicians who don’t feel the expected fiduciary responsibility to patient welfare. As well, it makes Maggie Mahar’s term of “money-driven medicine” seem – well – on the money.

An Outsider’s Take on American Medicine

Jonathan Kaplan’s The Dressing Station was published in 2001, but I am only reading it now. Much of the book is about battlefield medicine...

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Should you spring clean your solar panels?

Ever since we <a href="http://www.google.com/intl/en/press/pressrel/rechargeit_20070618.html">assembled a 1.6 MW solar panel installation</a> at our <a href="http://maps.google.com/?q=Google%20Inc.@37.423156,-122.084917&hl=en">headquarters</a> in Mountain View in 2007, we've been wondering, "Does cleaning the solar panels make them more effective?" We thought it might, but we needed to be sure. So we analyzed the mountains of data that we collect about the energy that these panels produce — after rain, after cleaning and at different times of the year. We have two different sets of solar panels on our campus — completely flat ones installed on carports, and <a href="http://www.google.com/corporate/green/footprint.html">rooftop ones</a> that are tilted. Since the carport solar panels have no tilt, rain doesn't do a good job of rinsing off the dirt they collect. (Also, our carports are situated across from a sand field, which doesn't help the situation.) We cleaned these panels for the first time after they had been in operation for 15 months, and their energy output doubled overnight. When we cleaned them again eight months later, their output instantly increased by 36 percent. In fact, we found that cleaning these panels is the #1 way to maximize the energy they produce. As a result, we've added the carport solar panels to our spring cleaning checklist. The rooftop solar panels are a different story. Our data indicates that rain does a sufficient job of cleaning the tilted solar panels. Some dirt does accumulate in the corners, but the resulting reduction in energy output is fairly small — and cleaning tilted panels does not significantly increase their energy production. So for now, we'll let Mother Nature take care of cleaning our rooftop panels. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0lx40pCSuxxwsXj3WgaWURsWSnzV0jBr7I07IK1dVjYHgMM3cnbSyVD6by6DO5PVJI5ysZVCwYSNOr7xKD2ziHC6FNMzbh58k36nl0QmjEINA-XLmBVeH3_zyjCmp8x-4febMvC0RdX1t/s1600-h/solar+panels+photo.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364735671269906418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0lx40pCSuxxwsXj3WgaWURsWSnzV0jBr7I07IK1dVjYHgMM3cnbSyVD6by6DO5PVJI5ysZVCwYSNOr7xKD2ziHC6FNMzbh58k36nl0QmjEINA-XLmBVeH3_zyjCmp8x-4febMvC0RdX1t/s400/solar+panels+photo.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 248px;" /></a><div style="text-align: center;">Accumulated dirt in the corners of a rooftop solar panel</div> We've also been crunching numbers on dollars-and-cents; the more energy our panels produce, the sooner we'll be paid back by our solar investment. Our analysis now predicts that Google's system will pay for itself in about six and a half years, which is even better than we initially expected. If you want to learn more about our solar study, check out these <a href="http://docs.google.com/present/view?id=dfhw7d9z_0gtk9bsgc">slides</a> showing the effects that seasonality, tilt, dirt, particulate matter, rain and cleaning have on Google's solar energy output. We hope you solar panel owners out there can tailor our analysis to the specifics of your own installation to produce some extra energy of your own! Posted by Winnie Lam, Senior Product Manager

Should you spring clean your solar panels?

Ever since we assembled a 1.6 MW solar panel installation at our headquarters in Mountain View in 2007, we've been wondering, "Do...

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Search Options now on Google Images

A few months ago when we announced the <a href="http://googleblog.blogspot.com/2009/05/more-search-options-and-other-updates.html">Search Options</a> panel, we promised that you would soon see similar functionality across our other search properties. Today we are rolling out Search Options for <a href="http://images.google.com/">Google Images</a>. This new feature offers quick access to existing tools, including search by <a href="http://googleblog.blogspot.com/2009/04/search-rainbow.html">color</a> and <a href="http://googleblog.blogspot.com/2008/12/new-search-by-style-options-for-google.html">image type</a>. Color search will find images that are only in color or only in black and white, or even images that contain a specific color, such as red, pink, or green. Type search is a great way to narrow down your results if you are looking for a specific kind of image, such as a <a href="http://images.google.com/images?q=tiger&imgtype=photo">photo</a>, <a href="http://images.google.com/images?q=tiger&imgtype=clipart">clip art</a>, <a href="http://images.google.com/images?q=tiger&imgtype=lineart">line drawing</a> or <a href="http://images.google.com/images?q=tiger&imgtype=face">face</a>. We've also revamped our size search. In addition to choosing from commonly searched-for sizes, now you can search for an exact image size or any image larger than a certain size. You can find images of practically any size, including <a href="http://images.google.com/images?q=nebula&imgsz=70mp">70 megapixels or more</a>. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheZ67y2bc7uOqLE-nfsFKf7G7i7hah2VJkvms9hGF9kv0tB1rY8YisR8NX_NYWC_MW_-IMZJg1tpPvcJxKJ_VcdxqF_seGLZyzXiTXSLrv8Z-i5Ga4IfIC14M_X9PMXs8LAOMg3Q-Fo9E7/s1600-h/images_toolbelt.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364743947710302882" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheZ67y2bc7uOqLE-nfsFKf7G7i7hah2VJkvms9hGF9kv0tB1rY8YisR8NX_NYWC_MW_-IMZJg1tpPvcJxKJ_VcdxqF_seGLZyzXiTXSLrv8Z-i5Ga4IfIC14M_X9PMXs8LAOMg3Q-Fo9E7/s320/images_toolbelt.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 309px;" /></a> The new layout makes it faster and easier to combine and toggle between options. It also makes it easier for us to add additional image search options in the future, so keep your eyes peeled. Just click "Show options..." in the blue bar on the search results page to try out any of these tools. Posted by Ken Dauber, Software Engineer, and Nate Smith, Associate Product Manager

Search Options now on Google Images

A few months ago when we announced the Search Options panel, we promised that you would soon see similar functionality across our other sea...

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BLOGSCAN - More on Senate Hearings on Industry Funded CME

There has been considerable coverage of the remarkable hearings by the US Senate Special Committee on Aging on industry funded continuing medical education (CME). See <a href="http://carlatpsychiatry.blogspot.com/2009/07/senate-cme-hearing-impressions-more.html">reporting</a> by Dr Daniel Carlat on the Carlat Psychiatry Blog, and <a href="http://blog.prescriptionproject.org/?p=745">by the Prescription Project </a>on their Postscript Blog. See also the <a href="http://brodyhooked.blogspot.com/2009/07/ban-industry-funded-cme-and-accme-while.html">comments </a>by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog. Some key points were that the Senators failed to see why physicians cannot afford to pay for their own CME, and therefore must depend on corporate funding to support; and the Senators failed to buy the argument that medical progress vitally depends on health care corporations paying for and influencing the education physicians get.

BLOGSCAN - More on Senate Hearings on Industry Funded CME

There has been considerable coverage of the remarkable hearings by the US Senate Special Committee on Aging on industry funded continuing me...

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