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Guest Blog - On the Need to Get Ethical

Guest blog by Dr William Tierney - This is old news. I'm the Co-Editor-in-Chief of the Journal of General Internal Medicine, and in our June 2005 issues we reported in detail a case of medical ghostwriting that had the particular target of showing the hazards of the oral anticoagulant drug warfarin, supporting a drug company's new oral anticoagulant. This article was accompanied by an editorial by me any my Co-Editor and a position statement by the World Association of Medical Editors decrying such practices. I am a practicing general internist who prescribes drugs regularly that help my patients. I want and need new drugs to be developed, and I believe that users of those drugs should pay for the necessary research and development through both drug pricing and funding of NIH. I am also a patient and similarly want there to be effective drugs to prolong my life and healthy living. But they should be described in an evidence-based manner, and the evidence must be unbiased. The drugs should be priced so the drug company recoups its costs and makes a profit. I have no problems with any of that. But when they try to enhance their profits through illegitimate means -- by essentially lying through advertisements masquerading as scientific articles sneaked into peer-reviewed journals -- then these drug companies are behaving unethically and need to be punished. I also am a clinical epidemiologist, and as such I do research investigating the positive and adverse outcomes of drugs. I have worked with and been funded by drug companies to do this work, collaborating with company scientists. To a person, I have found them to be honest, careful, and caring people who truly want to positively impact people's lives. It is the marketing divisions of these drug companies that operate in an atmosphere of "anything goes that helps the bottom line." My father was a purchasing agent for a factory that made automobile parts. We used to get "presents" every Christmas, tickets to Broadway, etc. from suppliers, blatant attempts to influence his decision-making. I can't say whether it ever did, but in the end he had to live with his decisions and so did the company for which he worked. But as a physician, I don't receive the benefits of the drugs I prescribe for my patients, nor do I pay the costs. I act as an agent of my patients, and as such I need to balance benefits, adverse effects, and costs of everything I order. If I have bad information, or if I succumb to company bribes in the form of honoraria, meals, or gifts, my patients pay the price both directly (through my ordering an expensive drug they might not need) and indirectly (through inflated drug prices in general). It is time for the drug companies to get ethical. Cut out the ghostwriting. Cut out the bribes. Cut out the marketing to patients that inflate drug benefits and minimize their costs and risks. Charge prices that recoup their drug development costs and stop paying billions to "push" drugs on physicians and patients, adding those costs to their drug prices. And we physicians likewise need to get ethical, stop taking bribes, stop reading propaganda or listening to drug detailmen, and base our decisions solely on what is best for our patients, without ignoring costs. (Nobody benefits if we bankrupt our system -- but that's another story...) We are seeing changes. Eli Lilly now lists all payments they make to physicians (honoraria for speaking, meals, trips, etc.). Many medical schools and large practice organizations have outlawed meals and gifts by drug companies. Journals are more vigilant for ghostwriting and other conflicts of interest among authors. We are seeing a change, and hopefully the abuses by Wyeth, DesignWrite, and other companies involved in ghostwriting will become a thing of our (sordid) past. We can only hope and maintain our diligence as caring health care providers. Dr Tierney is Co-Editor-in-Chief, the Journal of General Internal Medicine, and Professor of Medicine, Indiana University School of Medicine. This was also posted as a comment <a href="http://community.nytimes.com/comments/www.nytimes.com/2009/08/05/health/research/05ghost.html?permid=163#comment163">here</a> on the <a href="http://www.nytimes.com/2009/08/05/health/research/05ghost.html">NY Times article </a>about Wyeth's sponsoring of ghost-writing of articles on hormone replacement therapy. See our most recent post on this topic <a href="http://hcrenewal.blogspot.com/2009/08/wyeths-industrial-scale-ghost-writing.html">here</a>.

Guest Blog - On the Need to Get Ethical

Guest blog by Dr William Tierney - This is old news. I'm the Co-Editor-in-Chief of the Journal of General Internal Medicine, and in our ...

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Wyeth's Industrial Scale Ghost-Writing

MedInformaticsMD <a href="http://hcrenewal.blogspot.com/2009/07/wyeth-ghostwritten-papers-fake-but.html">noted</a> the impending release of documents about how Wyeth engineered ghost-writing of articles about hormone replacement therapy (HRT) here. Now the NY Times has had a chance to review the documents, with fascinating results. The scope of the ghost-writing campaign was on an impressively industrial scale: 26 articles published over 7 years in 18 medical journals. The details were ably covered by at least three other blogs. Dr Adriane Fugh-Berman, guest- (not ghost-) blogging <a href="http://pharmagossip.blogspot.com/2009/08/guest-blog-by-adriane-fugh-berman.html">on PharmaGossip </a>discussed how the documents reached the public domain. Dr Daniel Carlat <a href="http://carlatpsychiatry.blogspot.com/2009/08/ghostwriting-for-premarin-steroids-on.html">on the Carlat Psychiatry Blog</a>, Prof Margaret Soltan <a href="http://www.margaretsoltan.com/?p=15907">on the University Diaries </a>offered some choice comments - By Dr Carlat <blockquote>As with baseball players on steroids, when companies pour marketing money into ghostwriting campaigns, they change the rules of the academic game. The playing field is no longer level; the drug company's version of the truth gains the upper hand. Sometimes, their truth really is the truth, but sometimes it's a carefully crafted lie. Sorting it out is difficult even for physicians who specialize in the area being written about. It's essentially impossible for the average generalist physician, to say nothing of patients who did not have the advantage of attending medical school. </blockquote> By Prof Soltan <blockquote> This filthy practice incorporates just about everything people rightly revile about some precincts of academia: Plagiarism. Fakery. Arrogance. Laziness. Cynicism (Wyeth was promoting drugs that turned out to be dangerous.). People make fun of postmodernists by talking about the <a href="http://www.elsewhere.org/pomo/">Postmodern Generator</a>, a program that automatically generates articles full of obscurantist rhetoric. But that’s only generating words. Ghosting whores among our medical faculties are generating real sickness. </blockquote> These are hard acts to follow, so my comment is: ghost writing is also corrupt. <a href="http://www.transparency.org./global_priorities/health/">Transparency International</a> <a href="http://www.transparency.org/about_us">defines corruption </a>as abuse of entrusted power for private gain. Medical academics are entrusted to discover and disseminate the truth. Practicing physicians, patients and the public entrust medical academics to provide honest, informed, unbiased information and opinions. When academics allow marketing hacks to write supposed scholarly articles in their name, they abuse this entrusted power (and privately gain by padding their CV, and often by direct payment as "consultants.") Of course, as noted above, this sort of corruption deceives the public, patients, and physicians into thinking that drugs and devices are better and more valuable than they actually are, denying patients preferable treatments, increasing the risk of needless adverse effects, and driving up the costs of health care. Those who are pushing for meaningful health care reform ought to put fighting health care corruption at the top of their agendas, starting with the blatant corruption of academic medicine and medical research of which ghost-writing is but one species.

Wyeth's Industrial Scale Ghost-Writing

MedInformaticsMD noted the impending release of documents about how Wyeth engineered ghost-writing of articles about hormone replacement th...

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A speedier, spiffier beta for Google Chrome

Since our <a href="http://chrome.blogspot.com/2009/05/speedier-google-chrome-for-all-users.html">last major update</a> of Google Chrome in May, we've been hard at work improving some of its most used and loved features. Today, we're releasing a <a href="http://www.google.com/intl/en/landing/chrome/beta/">new beta</a> for you to try. Not only is it speedier than ever, but we've also given the browser a little bit of design whimsy that we hope will bring some color and delight to your day. This new beta is fitted with a customizable <a href="http://chrome.blogspot.com/2009/06/get-to-where-youre-going-faster.html">New Tab page</a>, an improved <a href="http://chrome.blogspot.com/2009/06/get-to-know-omnibox.html">Omnibox</a> and a few basic <a href="https://tools.google.com/chrome/intl/en/themes/index.html">themes</a> that allow you to deck out your browser with colors, patterns and images. We've also built <a href="http://en.wikipedia.org/wiki/HTML_5">HTML5</a> capabilities into this release, as well as a few other nifty technical improvements that will help Google Chrome make the most of your network connection. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhl1mTOSNDud3-Lp2W-hj_ySzCfDmr1XCw0So_R8EL9G3mb7khZp9-Hmvr9ExBxmupMFBYedgegissExXAxNZrCSx1gsKpfkKK5x5CJBIuwwudJoUy8ak7fDISANf9lgy87_lYBRobGvePI/s1600-h/Pinning-Beta--Recent-Activities.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366499135749648594" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhl1mTOSNDud3-Lp2W-hj_ySzCfDmr1XCw0So_R8EL9G3mb7khZp9-Hmvr9ExBxmupMFBYedgegissExXAxNZrCSx1gsKpfkKK5x5CJBIuwwudJoUy8ak7fDISANf9lgy87_lYBRobGvePI/s400/Pinning-Beta--Recent-Activities.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 298px;" /></a> You can learn more on the <a href="http://chrome.blogspot.com/2009/08/new-beta-why-slow-down-when-you-can.html">Google Chrome Blog</a>, or download the <a href="http://www.google.com/intl/en/landing/chrome/beta/">beta version of Google Chrome </a>to give these new features a whirl. Being on the <a href="http://blog.chromium.org/2009/01/google-chrome-release-channels.html">beta channel</a> gives you a sneak preview of things to come with occasional rough edges, but it's a great way for us to quickly churn out new features and get your feedback. Posted by Brian Rakowski, Product Manager, and Min Li Chan, Associate Product Marketing Manager, Google Chrome team

A speedier, spiffier beta for Google Chrome

Since our last major update of Google Chrome in May, we've been hard at work improving some of its most used and loved features. Today,...

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Harvard Cut Money for Primary Care "Step-Child"

This story, about cuts in the funding for Harvard Medical School's minimal program in primary care, has received little attention in the US. I was alerted to an article about it <a href="http://www.thecrimson.com/article.aspx?ref=528576">in the Harvard Crimson </a>by a news article in the British Medical Journal that was picked up <a href="http://www.medscape.com/viewarticle/706379">by Medscape</a>. Here are the main points, from the Crimson article, <blockquote>Harvard Medical School has suspended funding for its Primary Care Division as part of a broader departmental restructuring effort, prompting students and faculty to circulate a <a href="http://www.petitiononline.com/PCHMS/petition.html">petition</a> calling on HMS Dean Jeffrey S. Flier to reaffirm the School's commitment to primary care education. According to Nancy J. Tarbell, dean for academic and clinical affairs at HMS, the School had provided roughly $200,000 in funding each year to the Division. She said that the Division, which has not been disbanded but whose structure and administration is being reviewed, will remain affiliated with HMS. The Division has always been funded exclusively by the Medical School, according to HMS spokesman David J. Cameron. 'The reorganization of this division is really a narrow administrative issue,' said HMS Dean of Medical Education Jules L. Dienstag. 'It has nothing to do with the commitment of HMS to primary care, which is unchanged, undiluted, and undiminished.' Nevertheless, as of Thursday afternoon, over 450 individuals had signed the online petition, including students, residents, faculty, and physicians from HMS and its affiliated hospitals. The petition calls for the School's administration to present a detailed plan of action for expanding institutional support despite the budget cut, expand loan forgiveness initiatives that financially enable students to pursue primary care specialties, support efforts to strengthen primary care in a reformed national health care system, and solicit and implement proposals from the HMS community to improve primary care education. The Division was previously part of the HMS-HPHC jointly administered Department of Ambulatory Care and Prevention (DACP), which Tarbell said was recently restructured and renamed as the Department of Population Medicine and placed solely under HPHC's administrative purview in order to better reflect its core research and teaching activities. Tarbell, who seemed unclear about what actual services were provided by the Division, said that the HMS administration is conducting a 'comprehensive review' of the its programs and that the Division has historically been 'relatively small.' 'When you look at [HMS's primary care initiatives] as a whole, at the big picture, you can't make the argument that funding has decreased for primary care training at HMS,' Tarbell said, adding that the school is expanding its funding this year for a required third-year medical clerkship from $600,000 to $800,000. But despite administrators' reassurances that primary care education remains a top priority at the Medical School, some students and faculty maintain that the cut sends a negative message about the School's priorities, which they say have traditionally centered on specialty medicine and research. And the petition expressed concern about the future of outreach activities previously coordinated by the Division, including a Primary Care Mentorship Program, if funding or a Divisional home were to be eliminated. 'Primary care, from the perspective of the Medical School, was sort of a stepchild [in the past], and not much was done to provide students with information about primary care careers or to connect them with role models in primary care,' said Susan Edgman-Levitan, executive director at The John D. Stoeckle Center for Primary Care Innovation. 'Harvard's goal has always been to create leaders in medicine, with regards to basic science and new developing fields. Primary care has never really been a major emphasis, although I think on a global basis, Harvard has put a major emphasis on reaching out to the rest of the world,' said Martin P. Solomon, an assistant clinical professor of medicine at the Brigham. 'People like Jim Kim and Paul Farmer are all very important and have had an enormous impact on primary care worldwide, but in our own backyard, Harvard has had very little impact. [Primary care] is not ... glamorous....' </blockquote> Indicating where the medical school's priorities lie, during the month in which the cuts were announced, Dean Flier took the time to open, and thereby endorse the meeting of ACRE (the Association of Clinical Researchers and Educators). The grandiosely named group promotes unrestricted financial relationships among medical academics and health care corporations, and dismisses those concerned with the effects of these relationships (see our posts <a href="http://hcrenewal.blogspot.com/2009/07/stossel-and-acre-wheres-beef.html">here</a> and <a href="http://hcrenewal.blogspot.com/2009/07/blogscan-reports-from-acre-meeting.html">here</a>). It is true that the cuts in primary care occurred at a time of general belt-tightening, due to the sudden decline in the value of Harvard University's endowment. However, as reported in a muck-raking<a href="http://www.vanityfair.com/politics/features/2009/08/harvard200908"> article in Vanity Fair </a>by Nina Munk, even the reduced endowment is still the largest of any university in the US. Furthermore, primary care generated relatively small costs to the university. However, as reported by Vanity Fair, the current financial crisis was generated on the University's tremendous building binge during the years the endowment seemed like it would grow forever: <blockquote>... the university is facing the onerous financial consequences of over-building. Consider this: Over the 20-year period from 1980 to 2000, Harvard University added nearly 3.2 million square feet of new space to its campus. But that’s nothing compared with the extravagance that followed. So far this decade, from 2000 through 2008, Harvard has added another 6.2 million square feet of new space, roughly equal to the total number of square feet occupied by the Pentagon. All across campus, one after another, new academic buildings have shot up. The price of these optimistic new projects: a breathtaking $4.3 billion. </blockquote> The University also rewarded the managers of the endowment with pay sufficient to make them very rich. <blockquote>By the early 2000s, Harvard’s top moneymen were making as much as $30 million to $40 million a year. Finally, in 2003, seven members of Harvard’s class of 1969 wrote a strong letter of protest to the university’s president, Larry Summers. They spoke out loudly, publicly, informing any member of the media who would listen that compensation at Harvard Management Company was 'obscene.' At other American universities, where investing money for the institution is regarded as a kind of public service, Harvard’s swagger raised deep suspicion. 'Harvard became a bunch of mercenaries,' the chief investment officer of another big private university told me. </blockquote> Most of these managers decamped, taking the money with them, before the endowment value crashed. <blockquote>By 2005, Jack Meyer had had enough. After 15 years at Harvard Management Company, frustrated by the circular fights about compensation, and sick of justifying himself to Summers and Rubin, he walked out and started his own giant hedge fund. Shamelessly, he took many of Harvard Management Company’s best people with him, about 30 portfolio managers and traders, along with the chief risk officer, chief operating officer, and chief technology officer. Harvard’s trading floor was decimated. </blockquote> No one in the current or past Harvard leadership has yet been held accountable for the overspending that seemed predicated on the absurd (at least in retrospect) assumption that the endowment would continue to grow indefinitely. <blockquote>At some point in the last five years, the men and women who run Harvard convinced themselves that the endowment would grow at double-digit rates forever. If Harvard were a publicly traded company, those people would have been fired by now. </blockquote> Because of the case of the Harvard endowment, the US Internal Revenue service is reportedly investigating how university endowments were run (e.g., see <a href="http://www.reuters.com/article/gc04/idUSTRE5711V420090802">Reuters</a>). But meanwhile, primary care, already a step-child, was cut. The case of primary care at Harvard shows how the leadership of academia, and academic medicine in particular, has become entranced by the glamorous, the glitzy, the high-tech, and the prospects of wealth to be made by their pursuit, while neglecting the core academic and health care missions that are the reasons for the existence of universities and medical schools. No wonder US health care is in a crisis. Those who want meaningful health care reform should find a way to push academic medicine to uphold its mission rather than enrich and glamorize its leaders, and to allow health care professionals to reaffirm their professionalism (regardless of <a href="http://hcrenewal.blogspot.com/2009/06/why-did-us-physicians-give-up-their.html">past interpretations </a>of US anti-trust law to the contrary). ADDENDUM (5 August, 2009) - see more comments on Harvard's failed governance <a href="http://www.goactablog.org/blog/archives/2009/08/#a000685">here</a> on the ACTA Blog.

Harvard Cut Money for Primary Care "Step-Child"

This story, about cuts in the funding for Harvard Medical School's minimal program in primary care, has received little attention in the...

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Innovation in video on the web

Today, video is an important part of many people's everyday activities on the Internet and a big part of many Google products. Because we spend a lot of time working to make the overall web experience better for users, we think that video compression technology should be a part of the web platform. To that end, we're happy to <a href="http://www.google.com/intl/en/press/pressrel/ir_20090805.html">announce today</a> that we've signed a deal to acquire On2 Technologies, a leading creator of high-quality video compression technology. The deal is still subject to approval by On2 Technologies' stockholders and review by relevant regulatory authorities, including the SEC, but we expect it to close in Q4. Although we're not in a position to discuss specific product plans until after the deal closes, we are committed to innovation in video quality on the web, and we believe that On2 Technologies' team and technology will help us further that goal. We'll update everybody when we're able to share more information. In the meantime, nothing will change for On2 Technologies' current and prospective customers.<div> </div><div>Update on Feb 19, 2010: On2 <a href="http://investor.google.com/releases/20100219.html">has been acquired</a> by Google. <div> Posted by Jeremy Doig, Engineering Director - Video, and Mike Jazayeri, Group Product Manager Caution Concerning Forward-Looking Statements This document includes certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements regarding the expected timing of the acquisition, Google’s and On2’s ability to close the acquisition, Google’s ability to integrate On2’s technology and employees, and the expected benefits of the acquisition, including that the acquisition will further Google’s goal to enhance the web experience with video. These statements are based on the current expectations or beliefs of managements of Google Inc. and On2 Technologies, Inc., and are subject to uncertainty and changes in circumstances. Actual results may vary materially from those expressed or implied by the statements herein due to (1) changes in economic, business, competitive, technological and/or regulatory factors, (2) failure to receive the required stockholder and regulatory approval for the acquisition, (3) failure to compete successfully in this highly competitive and rapidly changing marketplace, (4) failure to retain key employees, and (5) other factors affecting the operation of the respective businesses of Google and On2. More detailed information about these and other factors that may affect current expectations may be found in filings by Google or On2, as applicable, with the Securities and Exchange Commission, including their respective most recent Annual Report on Form 10-K and Quarterly Report on Form 10-Q. Google and On2 are under no obligation to, and expressly disclaim any such obligation to, update or alter their respective forward-looking statements, whether as a result of new information, future events, or otherwise. Additional Information and Where to Find It Google plans to file with the Securities and Exchange Commission a Registration Statement on Form S-4 in connection with the transaction, which will include a Proxy Statement of On2 that also constitutes a Prospectus of Google. On2 will mail the Proxy Statement/Prospectus to its stockholders in connection with the transaction. The Registration Statement and the Proxy Statement/Prospectus will contain important information about Google, On2, the transaction and related matters. Investors and security holders are urged to read the Registration Statement and the Proxy Statement/Prospectus carefully when they are available. Investors and security holders will be able to obtain free copies of the Registration Statement and the Proxy Statement/Prospectus and other documents filed with the SEC by Google and On2 through the web site maintained by the SEC at <a href="http://www.sec.gov/">www.sec.gov</a> and by contacting Google Investor Relations at 650-253-7663 or On2 Investor Relations at 518-881-4299. In addition, investors and security holders will be able to obtain free copies of the documents filed with the SEC on Google’s website at <a href="http://investor.google.com/">investor.google.com</a> and on On2’s website at <a href="http://www.on2.com/">www.on2.com</a>. Participants in the Solicitation Google, On2 and their respective directors and executive officers may be deemed to be participants in the solicitation of proxies in respect of the proposed transaction. Information regarding Google’s executive officers and directors is included in Google’s definitive proxy statement, which was filed with the SEC on March 24, 2009, and information regarding On2’s executive officers and directors is included in On2’s definitive proxy statement, which was filed with the SEC on April 7, 2009. The Proxy Statement / Prospectus for the proposed transaction will provide more information about participants in the solicitation of proxies from On2 stockholders, which participants may have interests different from On2 stockholders generally. You can obtain free copies of these documents from Google or On2 using the contact information above. </div></div>

Innovation in video on the web

Today, video is an important part of many people's everyday activities on the Internet and a big part of many Google products. Because w...

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HIMSS: Hospital CIO's Should Not Only Manage Healthcare IT, But Also Biomedical Engineering

I have written in the past about the territoriality of the IT department in hospitals, observing that the departments I was exposed to seemed more political than the clinical departments themselves. This territoriality came at the expense of clinicians' and patients' best interests. This phenomenon seems to go beyond the confines of the hospital IT shop, perhaps as a manifestation of the IT culture. For example: Other have observed - unapprovingly so - how the health IT trade group HIMSS, via a <a href="http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html">massive lobbying effort</a> and via its offspring, the CCHIT, has sought to gain hegemony over health IT through a "certification" process, a service for which CCHIT desires to be the sole provider. It's become worse. Now control over biomedical instrumentation (which includes such safety critical devices as ventilators, cardiac and other physiologic monitors, heart-lung machines, radiological devices, etc.) is sought. <div dir="ltr" align="left">In the June 2009 HIMSS analytics report "Devices in Hospitals" (<a href="http://www.himssanalytics.org/docs/HA_MedDevices.pdf">link to PDF</a>): <a href="http://www.himssanalytics.org/docs/HA_MedDevices.pdf"> </a></div> Page 7: <div style="margin-left: 40px;"> ... It appears that the IS department [a.k.a. IT department, or Management Information Systems department - ed.] is becoming the key support department for interfaced intelligent medical devices. This is a natural extension as IS departments build and support a cadre of interfaces to improve the collection and use of data within the hospital. </div> Then at the end of the report, in the Conclusion, a leap of logic of gargantuan proportions: <div style="margin-left: 40px;"> What is less clear at this time is whether the biomedical operations will be placed under the IS department for management. We believe that it should be , ala the movement of responsibility for telecommunications to the CIO when telecommunications and information technologies merged in the last 15 years . </div> Au contraire ... it is very clear to those who know what they're doing that this is a very bad analogy and suggests HIMSS does not understand the vast differences between the discipline and functions of biomedical engineering, versus the IT department role of management of computer and other ICT's (information and communications technologies). I find this astonishing. Having done a clerkship in biomedical engineering in medical school, and being somewhat knowledgeable about electronics as an <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinformatic1/ham.htm">FCC-licensed radio amateur</a> at the Extra class (highest certification attainable by a series of FCC examinations), I find the HIMSS Analytics position risible and dangerous. It suggests a desire to expand territory even further into an area for which CIO's and hospital IT personnel are even less qualified - indeed, far less qualified - than clinical IT. Apparently, CCHIT wants to have hegemony over "certification" of clinical IT, and the parent organization HIMSS through its research arm opines IT should also take over "medical devices" (while still excluding clinical IT from that categorization to avoid regulation, of course).As I first asked <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">over ten years ago</a> after observing IT personnel in hospitals : <blockquote> Who, exactly, are the IT personnel in hospitals, and what, exactly, in their backgrounds qualifies them for major involvement in clinical affairs, let alone leadership roles regarding safety-critical clinical devices?</blockquote> Perhaps the Joint Commission, FDA, and other regulators need to start asking the same question.-- SS

HIMSS: Hospital CIO's Should Not Only Manage Healthcare IT, But Also Biomedical Engineering

I have written in the past about the territoriality of the IT department in hospitals, observing that the departments I was exposed to seeme...

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Leave the math to us: Advertisers increase their profits using Conversion Optimizer

This post is the latest in an ongoing series on The Power of Measurement. Previous topics have covered ways to make your website as successful as possible through tools such as Analytics and Website Optimizer. – Ed. If you're an old-school <a href="https://www.google.com/accounts/ServiceLogin?service=adwords&cd=null&hl=en-US&ltmpl=adwords&passive=false&ifr=false&alwf=true&continue=https%3A%2F%2Fadwords.google.com%2Fselect%2Fgaiaauth%3Fapt%3DNone%26ugl%3Dtrue">AdWords</a> advertiser, you may remember that you originally set bids based on ad impressions (cost-per-impression, or CPM). Later, AdWords transitioned to a new model where bids were set based on ad clicks (cost-per-click, or CPC). Now, as technology has become even more advanced, we’re seeing the next phase of search engine advertising. What if we told you that you could bid for ads simply based on conversions? (A conversion is a goal set by an advertiser, such as a website visitor purchasing a product or filling out a form.) With <a href="http://www.google.com/adwords/conversionoptimizer/">Conversion Optimizer</a>, Google does all the heavy lifting and complicated analysis, letting you bid simply based on how much a conversion is worth to your business (cost-per-acquisition, or CPA). By using Conversion Optimizer, advertisers are not only seeing an increase in profits but have more time to devote to the rest of their business. We’re excited to announce that this AdWords transformation is well underway: advertisers are already using the Conversion Optimizer to manage approximately $1 billion in spend annually.* This new shift benefits two areas Google cares deeply about: showing our users the most relevant ads and helping our advertisers increase their profits. So how does it work? Each and every time someone types in a search query, AdWords runs a new <a href="http://googleblog.blogspot.com/2009/03/introduction-to-ad-auction.html">keyword auction</a>. Advertisers who are still bidding on a cost-per-click basis will be using the same bid in many different auctions, so sometimes their bid may be too high or too low. However, for advertisers using Conversion Optimizer, we'll automatically adjust the bid for each of these auctions so that it can hit the sweet spot more often, helping the advertiser to make more money. For example, suppose you're advertising an online shoe store and you purchase ads using the keyword "shoes." Because your clicks come from many different types of people who have different intentions, Conversion Optimizer takes many factors into account to optimize your ad performance. If you don't ship internationally, Conversion Optimizer will learn that clicks from international users don't convert and will eliminate traffic from outside the United States. It might also learn that when customers include the word "cheap" in their query, they are particularly likely to convert because your prices are very competitive. Essentially, Google does the detective work — you tell us how much a conversion is worth and our algorithms make it happen. As more advertisers transition to Conversion Optimizer, we look forward to showing more relevant ads and, in doing so, helping our advertisers achieve better results. <a href="http://www.google.com/adwords/conversionoptimizer/">Learn more about Conversion Optimizer</a> and get started using it with your AdWords campaigns. * Annualized figures based on Q2 sales Posted by Andrew Silverman, Product Manager, Conversion Optimizer

Leave the math to us: Advertisers increase their profits using Conversion Optimizer

This post is the latest in an ongoing series on The Power of Measurement. Previous topics have covered ways to make your website as successf...

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