AFL/CIO Interested in Healthcare IT Failure?

In today's Wall Street Journal, in a piece entitled "<a href="http://online.wsj.com/article/SB20001424052970204908604574334623330098540.html">You Are Terrifying Us</a>" about the growing opposition to the administration's healthcare reform plan, columnist Peggy Noonan writes:<br /><br /><blockquote>... But every day the meetings seem just a little angrier, and people who are afraid—who have been made afraid, and left to be afraid—can get swept up. As this column is written, there comes word that <span style="font-weight: bold;">John Sweeney of the AFL-CIO</span> has announced he’ll be sending in union members to the meetings to counter health care’s <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[i.e., the reform plan's - ed.]</span> critics.</blockquote><br />Massive expansion of healthcare IT is one of the cornerstones of the healthcare reform initiative. I have expressed <a href="http://hcrenewal.blogspot.com/2008/12/open-letter-to-president-barack-obama.html">my concerns</a> in an open letter to the President on this blog about the dangers of too rapidly pushing health IT in its present underdeveloped and experimental condition.<br /><br />With that in mind, I've just noted several "hits" on my Drexel website on healthcare IT failure from the following IP number (internet digital address):<br /><br /><blockquote>06 Aug, Thu, 16:22:42 <span style="font-weight: bold;">12.4.17.250</span> Netscape 7 Windows XP<br />06 Aug, Thu, 16:45:53 <span style="font-weight: bold;">12.4.17.250</span> Netscape 7 Windows XP<br />06 Aug, Thu, 17:03:07 <span style="font-weight: bold;">12.4.17.250</span> Netscape 7 Windows XP </blockquote><br />These occurred as a result of someone at IP 12.4.17.250 searching Google on the phrase "<span style="font-weight: bold;">drexel university health information tech</span>."<br /><br />I cannot tell what they looked at besides the site's main page at 16:22, but at 16:45 and 17:03 the referring URL's were:<br /><br /><span style="font-size:100%;"><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=about" style="font-style: italic; font-family: arial;">http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=about</a></span><br /><br />In other words, my biographical information was being reviewed.<br /><br />IP 12.4.17.250 <a href="http://ip-lookup.net/index.php">translates as follows</a>:<br /><br /><span style="font-weight: bold;"></span><blockquote><span style="font-weight: bold;font-size:100%;" >AFL-CIO</span><span style="font-size:100%;"> AFLCIO-17-0 (NET-12-4-17-0-1)<br />12.4.17.0 - 12.4.17.255</span></blockquote><br />Perhaps someone at AFL-CIO is interested in pursuing a graduate certificate in healthcare informatics at Drexel, or perhaps someone there is conducting background research on potential or perceived IT-related "impediments" to healthcare reform. (Such as my writings?)<br /><br />I don't know which, but I thought the hits interesting.<br /><br />-- SS<br /><br /><span style="font-weight: bold;">Aug. 11 update:</span><br /><br />This "hit" just in on unknown referrer:<br /><br /><blockquote>Aug, Tue, 08:13:39 <span style="font-weight: bold;">12.32.3.194</span> Netscape 7 Windows XP<br /><br /></blockquote>IP 12.32.3.194<span style="font-weight: bold;"> </span>translates to:<br /><blockquote><br /><span style="font-weight: bold;">UNITED STEELWORKERS OF AMERICA</span> UNITED-S 21-3-192<br />(NET-12-32-3-192-1) 12.32.3.192 - 12.32.3.199<br /> </blockquote><br />A lot of hits on my HIT failure site with union labels lately.<br /><br />-- SS

AFL/CIO Interested in Healthcare IT Failure?

In today's Wall Street Journal, in a piece entitled " You Are Terrifying Us " about the growing opposition to the administrati...

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SGIM Urges "Chuck the RUC"

This week, <a href="http://www.sgim.org/">Society of General Internal Medicine </a>(SGIM) members received the 5 August, 2009, Update in Health Policy that urged we "chuck the RUC," (quoted in its entirety below, italics added for emphasis):<br /><blockquote><br /><strong>Who will assign the value of primary care services? Chuck the RUC!</strong><br /><br />How does Medicare determine physician payment rates? The answer to this question is a core element of the ongoing debate about health care reform. <em>Changing how Medicare sets payment rates for physicians is especially critical since Medicare rates also guide the rates set by private insurers. </em>Since 1992, Medicare has paid physicians according to the Resource Based Relative Value Scale (RBRVS), a fee schedule that multiplies relative values for physician services by a conversion factor to determine the amount of payment. <em>The Centers for Medicare and Medicaid Services (CMS) has historically used the Relative Value Scale Update Committee, or RUC, as the sole source of recommendations</em>. This committee within the AMA performs broad reviews of the RBRVS every five years. <em>Twenty three of the RUC's twenty nine members are appointed by major national medical specialty societies, including those that account for high percentages of Medicare expenditures for procedures. All meetings are closed and discussions are confidential. The over-representation of procedure-driven subspecialties and under-representation of generalist physicians in the RUC has contributed to the current undervalued cognitive services (especially for primary care) and over-valued reimbursement for procedures. In March 2007, the Medicare Payment Advisory Commission (MedPAC) identified the RUC process as a major reason for undervalued primary care services and a significant contributor to the crisis in primary care.</em> MedPAC has recommended that an independent expert panel of economists, technology experts, physicians and private citizens be created to supplement the RUC's recommendations to CMS regarding fee schedules. Health reform discussions have included moving MedPAC into the executive branch and giving it authority to review and recommend Medicare payment policy, thus reducing the RUC's influence. Not surprisingly, both the AMA and the American College of Surgeons have opposed this proposal. <em>Groups representing primary care physicians, including SGIM, are in favor of this proposal which could ensure fair and unbiased assignment of work RVUs to all the service codes used by physicians. We believe that this will correct the payment inequalities of the current fee scale and ultimately renew trainees' interest in primary care</em>. In the coming weeks, SGIM may ask you to act on this issue and contact your legislators to urge them to support these transformative proposals for primary care. Please monitor your e-mail for action alerts and be prepared to act.<br /></blockquote><br />We have previously posted (most recently <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">here</a> in considerable detail) about the perverse incentives given US physicians by the payment schedule dictated by the US Medicare system. These incentives have been largely responsible for the increasingly dire status of primary care/ generalist care in the US. Revisions to the Resource-Based Relative Value System (RBRVS) disproportionately reward physicians for performing procedures and diagnostic tests instead of talking with, examining, thinking about, diagnosing, recommending decisions for, and counseling patients. The US Center for Medicare and Medicaid Services (CMS) uses the RBRVS Update Committee (RUC) de facto as its sole source for advice on revising the system. The RUC is dominated by representatives of medical societies whose members predominantly perform procedures and do diagnostic tests. The RUC is secretive. The identities of its individual members are difficult to ascertain. Its proceedings are secret. <br /><br />Thus, the RBRVS updating process run by the RUC is opaque, unaccountable, and not representative of patients and "cognitive" physicians. The result of this process has been perverse incentives that have driven up health care costs without obvious improvements in quality or outcomes.<br /><br />I applaud SGIM for being the first medical society to challenge how the RUC controls payments to physicians, and the perverse incentives the RUC process has generated.<br /><br />As the Update above says, meaningful health care reform in the US will not occur unless we address the perverse incentives that drive up costs without improving care.

SGIM Urges "Chuck the RUC"

This week, Society of General Internal Medicine (SGIM) members received the 5 August, 2009, Update in Health Policy that urged we "chuc...

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Recreating the Google Chrome icon: videos from around the world

<span class="Apple-style-span" style="font-style: italic;"><span class="Apple-style-span" style="font-size:x-small;"><span class="Apple-style-span" style="font-size:x-small;">(Cross-posted from the <a href="http://chrome.blogspot.com/2009/08/recreating-google-chrome-icon-videos.html">Google Chrome blog</a>)</span><br /></span></span><br />When I was originally designing the <a href="http://www.google.com/landing/chrome/ugc/chrome-icon.jpg">Google Chrome icon</a>, I went through many iterations to figure out how to best represent our brand new web browser. The design needed to stand out on the desktop, look stable yet dynamic, and use color to show some Google branding. Through the design process, another quality that became important to the team was to make the icon feel like a real, tangible object so that clicking on it would be like pressing a real button.<br /><br />This June, <a href="http://googleblog.blogspot.com/2009/06/get-creative-with-google-chrome-icon.html">we invited users</a> to take the icon and actually build it in a new, creative way. Many people around the world accepted the challenge and submitted fun and surprising videos of their process. We got to see the icon made out of some interesting materials — like <a href="http://www.youtube.com/watch?v=TOGaO7L6QGw">cups</a>, <a href="http://www.youtube.com/watch?v=S_Vn1C7eUzA">dominos</a>, <a href="http://www.youtube.com/watch?v=F0TqJzz1nvE">food</a> and even <a href="http://www.youtube.com/watch?v=XKy0lKQ5kUE">clothing</a> — as well as <a href="http://www.youtube.com/watch?v=pl3nnJVFj_I">many</a> <a href="http://www.youtube.com/watch?v=_vsFW6wKsNc">unique</a> <a href="http://www.youtube.com/watch?v=OF8TioEopKI">digital</a> <a href="http://www.youtube.com/watch?v=HNmXhtExbU4">creations</a>.<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2MRuFoZ9F4hd5XhS6hUHLMQo_WOTl3bIajlcY2VU0IbOetu8mwDRw8V1qhlz9Fr5lYjvvr_5gfRo_OuWrFzoFPCjYBb6EefRfsI3afr8vvMWIj3EjQKeaWs4F_wDOfYg85WQPfYdcAOg6/s1600-h/collage.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366642544195012178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2MRuFoZ9F4hd5XhS6hUHLMQo_WOTl3bIajlcY2VU0IbOetu8mwDRw8V1qhlz9Fr5lYjvvr_5gfRo_OuWrFzoFPCjYBb6EefRfsI3afr8vvMWIj3EjQKeaWs4F_wDOfYg85WQPfYdcAOg6/s400/collage.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 225px;" /></a><br />I was really impressed by the great care people took in recreating the icon, and I particularly enjoyed this video by Renaud, a fan of Google Chrome in Annecy, France:<br /><br /><center><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/m22f-77nK3c&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/m22f-77nK3c&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object></center><br /><br />A big thank you to everyone who sent us videos. Check out all the submissions <a href="http://www.youtube.com/video_response_view_all?v=bGJOmGL6mYM">here</a>.<br /><br /><span class="byline-author">Posted by Micheal Lopez, Web Design Lead </span>

Recreating the Google Chrome icon: videos from around the world

(Cross-posted from the Google Chrome blog ) When I was originally designing the Google Chrome icon , I went through many iterations to figur...

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Has Ghostwriting Infected The "Experts" With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?

I could have titled this piece "have the deceivers been themselves deceived?"<br /><br />Recent revelations have shown that biomedical ghostwriting is a scourge that some physicians and scientists -- who are clearly lacking ethics, insight and perhaps an understanding of psychiatric defense mechanisms such as rationalization -- engage in all too often, as it taints the corpus of worldwide scientific literature.<br /><br />(I covered the issues related to ethical and justified claims of provenance for scientific writing in my post "<span style="font-weight: bold;">Wyeth: Ghostwritten Papers Fake, But Accurate</span>" <a href="http://hcrenewal.blogspot.com/2009/07/wyeth-ghostwritten-papers-fake-but.html">here</a> along with a discussion of why lay leadership of biomedical R&D organizations was not a good idea. Such leaders cannot vouch for the scientific fairness and accuracy emanating from their own organizations.)<br /><br />One should examine the evidence in a first-person manner. The New York Times has made available <a href="http://documents.nytimes.com/design-write-medical-writing">secret documents and emails</a> secured by Senator Grassley on Wyeth's ghostwriting practices. These documents were unsealed by a judge in a personal injury lawsuit and chronicle Wyeth's use of a medical writing company to prepare articles for publication in medical journals.<br /><br />Wyeth said all the articles are "scientifically accurate" and that "it is a common practice in the pharmaceutical industry to work with such firms" (and, by implication, to falsify claimed authorship). As justification for clearly unethical practices, this is a rather poor argument, being a classic logical fallacy known as the <a href="http://www.nizkor.org/features/fallacies/appeal-to-common-practice.html">Appeal to Common Practice</a>:<br /><br /><blockquote><span style="font-weight: bold;">Description of Appeal to Common Practice</span><br />The Appeal to Common Practice is a fallacy with the following structure:<br /><br />1. X is a common action.<br />2. Therefore X is correct/moral/justified/reasonable, etc. </blockquote><br />That said, these documents raise an important question of a systemic nature:<span style="font-weight: bold;"><br /><br />Have the scientific ghostwriting deceivers themselves been deceived</span> regarding biomedical reality by these practices?<br /><br />Might they genuinely believe they are contributing to the scientific literature based on their own erroneous notions, the latter based upon a scientific literature <span style="font-style: italic;">contaminated by other ghostwriters?</span><br /><br />To illustrate this point, in the New York Times online document pool, we discover that Dr. Gloria Bachmann, Associate Dean for Women's Health and Professor of OB/GYN and Medicine at UNDNJ-Robert Wood Johnson Medical School was presented with a tidy ghostwritten article entitled "The Importance of Treating Vasomotor Symptoms" (in peri- and post-menopausal women) by authors "TBD" (to be decided):<br /><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpfNVCXAffsmRekuHW9VznAj01upkonEa1MGa1YXaE0kCPu-e15jPxm9VsodoXfxp9S1NiSu6TM4owNzlhKT0NYCSUZ8lPts5OVOeQYqs7qWDpAMgOTFhebLVgYBwKDqhApnSnMUARZmCH/s1600-h/Picture+1.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366869892151207106" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpfNVCXAffsmRekuHW9VznAj01upkonEa1MGa1YXaE0kCPu-e15jPxm9VsodoXfxp9S1NiSu6TM4owNzlhKT0NYCSUZ8lPts5OVOeQYqs7qWDpAMgOTFhebLVgYBwKDqhApnSnMUARZmCH/s320/Picture+1.jpg" style="cursor: pointer; display: block; height: 427px; margin: 0px auto 10px; text-align: center; width: 323px;" /></a><span style="font-size: 85%;">(Original ghostwritten draft. Authors "TBD." Click to enlarge)</span></div><br /><br />about which Bachmann wrote the following in an email to the true authors' organization:<br /><br /><blockquote>"Outline is excellent as written. I would like to try for publication as a review article in Obstetrics and Gynecology. We would have to change the title to "Vasomotor Symptoms: Evidence Based Treatment Options" or a title that emphasizes the data driven writing style."</blockquote><br />Here is an image of the email:<br /><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglfJCs7MUOzFBfvlngFeXxR74ABCDQpvIgv0XBujGInP40VytV7Zb83dmtpdB4ASnVE4s8wKK0HGkjLGaKrhQCTtKw36K9KB5bCk0XpWuxD0KjtNOYDJqbPJx2j8DdpHGVWOKPMwh-GXcW/s1600-h/Picture+3.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366872232373912850" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglfJCs7MUOzFBfvlngFeXxR74ABCDQpvIgv0XBujGInP40VytV7Zb83dmtpdB4ASnVE4s8wKK0HGkjLGaKrhQCTtKw36K9KB5bCk0XpWuxD0KjtNOYDJqbPJx2j8DdpHGVWOKPMwh-GXcW/s320/Picture+3.jpg" style="cursor: pointer; display: block; height: 359px; margin: 0px auto 10px; text-align: center; width: 300px;" /></a><span style="font-size: 85%;">(Approval email. Click to enlarge)</span></div><br /><br />She found the content OK and agreed to review it.<br /><br />Apparently, only minor changes were made. (Bachmann should have received accreditation in the <span style="font-style: italic;">acknowledgments</span> section for reviewing the article, and/or a position <span style="font-weight: bold;">far down the authorship hierarchy</span> if she actually added some material).<br /><br />Instead, the reverse occured.<br /><br />The published document appeared with Bachmann as first (and only) author after Bachmann submitted it to a medical journal under her name, itself unethical. See what "Authors TBD" morphed into in the image below:<br /><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFwtod-h29l228wXBF4RE3uSG0PYu6LVv4SFOcQixGn7VEiT3hjC8M7BiUjk_Mhc-O5J9M3YQ-Eq2NVKyv0xMDShshemCGrvFRFN-mIgVzzvBAqqnd13qHvn4aTtfEVPGBseZrOH1o4DRU/s1600-h/Picture+4.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366873203094683218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFwtod-h29l228wXBF4RE3uSG0PYu6LVv4SFOcQixGn7VEiT3hjC8M7BiUjk_Mhc-O5J9M3YQ-Eq2NVKyv0xMDShshemCGrvFRFN-mIgVzzvBAqqnd13qHvn4aTtfEVPGBseZrOH1o4DRU/s320/Picture+4.jpg" style="cursor: pointer; display: block; height: 341px; margin: 0px auto 10px; text-align: center; width: 283px;" /></a><span style="font-size: 85%;">(Article submission cover page. Click to enlarge)</span></div><br /><br />Here is how the true authors, medical writers for DesignWrite, the medical writing and communications company retained by Wyeth to write the article, received credit:<br /><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUALG8sej3YfhGCix3j59Kc4gm8mh5HQONCBaHcw9SFHKfBrbMpmQgVbZft7UNEl6C0qfLtdrcS_hG824AYKI4rn-_RN5CP9l95qL2pKcZE8A1XDIh0NeSNfbcxy94nydJfP9IhCgVbhAF/s1600-h/Picture+5.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366880395546903266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUALG8sej3YfhGCix3j59Kc4gm8mh5HQONCBaHcw9SFHKfBrbMpmQgVbZft7UNEl6C0qfLtdrcS_hG824AYKI4rn-_RN5CP9l95qL2pKcZE8A1XDIh0NeSNfbcxy94nydJfP9IhCgVbhAF/s320/Picture+5.jpg" style="cursor: pointer; display: block; height: 353px; margin: 0px auto 10px; text-align: center; width: 292px;" /></a><span style="font-size: 85%;">(How the "ghosts" received credit for writing the paper. Click to enlarge)</span></div><br />Unbelievable.<br /><br />Bachmann has since stated that she believed she was adding to science by engaging in this deceit. From the New York Times:<br /><br /><blockquote>The article, <span style="font-weight: bold;">a nearly verbatim copy of the DesignWrite draft</span>, appeared in 2005 in The Journal of Reproductive Medicine, with Dr. Bachmann listed as the primary author. It described hormone drugs as the “gold standard” for treating hot flashes and was less enthusiastic about other therapies.<br /><br />The acknowledgments thanked several medical writers for their “editorial assistance,” not disclosing that those writers worked for DesignWrite, which charged Wyeth $25,000 to generate the article.<br /><br />Dr. Bachmann, who has 30 years of research and clinical experience in menopause, said she played a major role in the publication by <span style="font-weight: bold;">lending her expertise. </span>Her e-mail messages do not reflect contributions she may have made during phone calls and in-person meetings, she said. <span style="color: red; font-style: italic; font-weight: bold;">["May have made?" This gossamer excuse is embarrassing to me, as an academic myself - ed.]</span><br /><br />“There was a need for a review article and I said ‘Yes, I will review the draft and make sure it is accurate,’ ” Dr. Bachmann said in an interview Tuesday. “This is my work, this is what I believe, this is reflective of my view.”…</blockquote><br />She is quite off base regarding scientific authorship and "this being <span style="font-style: italic;">her</span> work", but what also needs examination is her "lending her expertise" and her agreeing with the paper as "<span style="font-weight: bold;">reflective of her view.</span>"<br /><br />The paper itself lists many references, for example these:<br /><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb5ny2qG6A2_7kvtL75s-NPLznznSWCsp03R60pgtjzZnLAZnT0LA6smWFhVSm_79qRKWNRlErRDYz1vjpEdLaazL7TAwr3DQ5mREFpuYkp7yhX5mO_v4oLYdKZot4aFGWM-ZQuVUCOG42/s1600-h/Picture+2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5366874937593524210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhb5ny2qG6A2_7kvtL75s-NPLznznSWCsp03R60pgtjzZnLAZnT0LA6smWFhVSm_79qRKWNRlErRDYz1vjpEdLaazL7TAwr3DQ5mREFpuYkp7yhX5mO_v4oLYdKZot4aFGWM-ZQuVUCOG42/s320/Picture+2.jpg" style="cursor: pointer; display: block; height: 351px; margin: 0px auto 10px; text-align: center; width: 290px;" /></a><span style="font-size: 85%;">(References: click to enlarge)</span></div><br /><br />Here is, then, the dilemma, another major problem posed by ghostwriting:<br /><br />How many of the cited references, which contributed to Bachmann's beliefs regarding these drugs, <span style="font-weight: bold;">were themselves ghostwritten and potentially biased, </span>or otherwise influenced by drug companies?<br /><br />For that matter, how many studies with different ("negative") conclusions on these subjects were suppressed from publication by industry pressure?  <br /><br />Bachmann's own "expert opinions" about these matters may be based upon false or misleading information she's read in other journals, the percentage of which are genuine vs. ghostwritten or industry-influenced being an unknown at this point in time.<br /><br />While I believe Bachmann is most likely <span style="font-weight: bold;">rationalizing away</span> the unethical nature of attribution without fair and justifying contribution, perhaps fueled by additional motives of academic portfolio building and perhaps present and future potential pecuniary gain, it is possible she is being genuine about agreeing with the "science" in the paper.<br /><br />However, her agreement may be predicated upon her own tainted expertise -- tainted by reading ghostwritten or industry-influenced articles in her area of specialty.<br /><br />Will we ever be able to peel back all the layers of the ghostwriting onion to get to the core of impartial and objective scientific articles related to drugs and medical devices? Perhaps not, but the practice must stop going forward.<br /><br />Tainted literature creates tainted scientific knowledge, the carriers of which may then further taint the knowledge base (with the best of intentions and with firm belief in the fairness and accuracy of their activities, of course).<br /><br />Practitioners of evidence-based medicine may be unwittingly practicing "evidence-tainted medicine", or "<span style="font-weight: bold;">pseudo-evidence based medicine</span>" as described by others on this blog.<br /><br />Such are the systemic risks of the scourge of ghostwriting.<br /><br />-- SS<br /><br /><b>Aug. 31, 2012 Addendum:</b><br /><br />I was made aware of the following 2011 paper thanks to a post by Dr Howard Brody <a href="http://brodyhooked.blogspot.com/2012/08/ghostwriting-still-no-consequences-for.html">on the Hooked: Ethics, Medicine and Pharma blog</a>:  "<a href="http://psychrights.org/research/Digest/Science4Sale/WhyDoesAcademiaAllowGhostwritingLeoLacasse2011.pdf" target="_blank"><b>Why Does Academic Medicine Allow Ghostwriting?  A Prescription for Reform</b></a>" by Jonathan Leo, Jeffrey R. Lacasse, and Andrea N. Cimino<br /><br />The paper also observes:<br /><br /><blockquote class="tr_bq">Due to its secretive nature, it is difficult to quantify how many invisible corporate authors haunt the medical literature.</blockquote><br />The paper is worth reading in its entirety and as of this writing is available free at the link above. <br /><br />-- SS

Has Ghostwriting Infected The "Experts" With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?

I could have titled this piece "have the deceivers been themselves deceived?" Recent revelations have shown that biomedical ghostw...

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The Fighting Irish: a Google Apps Education success story

We love hearing from schools using <a href="http://www.google.com/a/help/intl/en/edu/index.html#utm_campaign=en&utm_medium=ogblog&utm_source=en-ogblog-na-us_q309">Google Apps Education Edition</a>, especially when it's helped them save money, gain back time or make students happy. <a href="http://www.nd.edu/">University of Notre Dame</a> is a <a href="http://www.google.com/apps/intl/en/edu/pdf/notre_dame_case_study.pdf">perfect example</a> (PDF) of one school that's seen great results by "<a href="http://googleblog.blogspot.com/2009/08/going-google-with-google-apps.html#utm_campaign=en&utm_medium=ogblog&utm_source=en-ogblog-na-us_q309">going Google</a>" to help make on-campus communication and collaboration easier.<br /><br />When this Indiana university migrated its 15,000 students and 150,000 alumni to Google Apps Education Edition about a year ago, they were hoping to improve their outdated email system. What they actually got was better than they expected: Not only were they able to improve student satisfaction by 36% according to a poll conducted on campus, but making the switch to Apps also enabled them to save over $1.5 million that they have since been able to reallocate to new IT services for students and faculty.<br /><br />Sure, it's all good to hear this from us, but you'd probably like to hear it from them, right? Well now you can. We're hosting a <a href="https://googleonline.webex.com/mw0305l/mywebex/default.do?nomenu=true&siteurl=googleonline&service=6&main_url=https%3A%2F%2Fgoogleonline.webex.com%2Fec0600l%2Feventcenter%2Fevent%2FeventAction.do%3FtheAction%3Ddetail%26confViewID%3D531776332%26siteurl%3Dgoogleonline%26%26%26#utm_campaign=en&utm_medium=ogblog&utm_source=en-ogblog-na-us_q309">free webinar</a> with Notre Dame on Thursday, August 13th at 10 a.m. PDT where you can learn about their experience deploying Google Apps and find out if this solution might be right for you. Whether you go to school, went to school or run a school, we encourage you to consider <a href="http://googleenterprise.blogspot.com/2009/04/what-we-talk-about-when-we-talk-about.html#utm_campaign=en&utm_medium=ogblog&utm_source=en-ogblog-na-us_q309">life in the cloud</a>. Who knows what results you might see?<br /><br /><span class="byline-author">Posted by Miriam Schneider, Google Apps for Education Team</span>

The Fighting Irish: a Google Apps Education success story

We love hearing from schools using Google Apps Education Edition , especially when it's helped them save money, gain back time or make s...

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Guest Blog - On the Need to Get Ethical

<em><span style="color:#000066;">Guest blog by Dr William Tierney -</span></em><br /><span style="color:#000066;"></span><br /><span style="color:#000066;">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.</span><br /><span style="color:#000066;"></span><br /><span style="color:#000066;">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.</span><br /><span style="color:#000066;"></span><br /><span style="color:#000066;">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."</span><br /><span style="color:#000066;"></span><br /><span style="color:#000066;">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).</span><br /><span style="color:#000066;"></span><br /><span style="color:#000066;">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...)</span><br /><span style="color:#000066;"></span><br /><span style="color:#000066;">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. </span><br /><span style="color:#000066;"></span><br /><em><span style="color:#000066;">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 </span></em><a href="http://community.nytimes.com/comments/www.nytimes.com/2009/08/05/health/research/05ghost.html?permid=163#comment163"><em><span style="color:#000066;">here</span></em></a><em><span style="color:#000066;"> on the </span></em><a href="http://www.nytimes.com/2009/08/05/health/research/05ghost.html"><em><span style="color:#000066;">NY Times article </span></em></a><em><span style="color:#000066;">about Wyeth's sponsoring of ghost-writing of articles on hormone replacement therapy. See our most recent post on this topic </span></em><a href="http://hcrenewal.blogspot.com/2009/08/wyeths-industrial-scale-ghost-writing.html"><em><span style="color:#000066;">here</span></em></a><em><span style="color:#000066;">. </span></em>

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.<br /><br />The scope of the ghost-writing campaign was on an impressively industrial scale: 26 articles published over 7 years in 18 medical journals.<br /><br />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 -<br /><br />By Dr Carlat<br /><br /><blockquote>As with baseball players on steroids, when companies pour marketing money into ghostwriting campaigns, <em>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</em>. 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.<br /></blockquote><br />By Prof Soltan<br /><br /><blockquote><p><br /><em>This filthy practice incorporates just about everything people rightly revile about some precincts of academia: Plagiarism. Fakery. Arrogance. Laziness. Cynicism</em> (Wyeth was promoting drugs that turned out to be dangerous.). </p><p>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. <em>Ghosting whores among our medical faculties are generating real sickness.<br /></em></p></blockquote><br />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. <br /><br />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.<br /><br />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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