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A "Safety-Net" Medical Center CEO Gets a Golden Parachute

<a href="http://www.thebostonchannel.com/investigative/20987735/detail.html">From theBostonChannel.com </a>comes this story on executive compensation in a not-for-profit health care organization, <blockquote> Boston Medical Center – a financially troubled hospital – gave its outgoing CEO a one-time, nearly $3.5 million payment, in addition to her $1.3 million annual salary, Team 5 Investigates reported Friday. Elaine Ullian, 61, has led the city’s major 'safety net' hospital for the last 15 years. She recently announced she will retire when her contract expires in January. The hospital's financial situation is such that hospital leaders say it could face closure in the years ahead. It is currently suing the Executive Office of Health and Human Services over how it gets paid for treating poor and uninsured patients. Team 5 Investigates discovered, in a review of the hospital’s financial filings with the state, that Ullian was paid $3,466,458 'in recognition of exceptional performance over a period of 15 years.' The nearly $3.5 million bonus was on top of Ullian’s 2008 compensation of $1,348,504 including salary and benefits. In a written statement to Team 5 Investigates, Ted English, the chairman of BMC’s board said that Ullian’s 'compensation is set by a committee of the Boston Medical Center Board of Trustees who consult with independent compensation advisors. It is based on her performance evaluation and measurable goals that are reviewed annually.' 'The Board considers Elaine Ullian to be one of the most competent and successful hospital CEOs in the country and believes she is primarily responsible for the success of Boston Medical Center over the past 15 years,' English's statement said. </blockquote> Boston Medical Center was formed by the merger of University Hospital (the Boston University teaching hospital), and Boston City Hospital, the legendary municipal hospital. (Note: I served as an internal medicine intern and resident in the University Hospital program, and rotated through Boston City frequently.) Thus, as noted above, BMC is the city's primary "safety net" hospital for the care of the poor. BMC has for <a href="http://www.bmc.org/about/who/mission.htm">its mission</a>: <blockquote> We will provide consistently excellent and accessible health services to all in need of care regardless of status or ability to pay – exceptional care, without exception. </blockquote> Such generous pay seems inconsistent with this mission and the organization's not-for-profit status. Such a golden parachute seems inconsistent with the current threats to its finances. Any worry about the CEO's retirement finances should further be reduced by her ongoing part-time work on the boards of directors of three public for-profit health care corporations, <a href="http://www.hologic.com/">Hologic</a>, a medical device company specializing in "womens' health," <a href="http://www.thermofisher.com/global/en/home.asp">ThermoFisher Scientific</a>, a manufacturer of laboratory equipment and supplies for health care and research, and <a href="http://www.vrtx.com/">Vertex Pharmaceuticals</a>, a biotechnology company focusing on small-molecule drugs. For her work as a director of Hologic, she received $304,698 in total compensation in 2008, and owned 40,000 shares or equivalent of common stock (per the company's <a href="http://www.sec.gov/Archives/edgar/data/859737/000119312509009496/ddef14a.htm">2009 proxy statement</a>). For her work for ThermoFisher Scientific, she received $275,319 total compensation, and owned 61,068 shares or equivalent (per the <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6256980&format=PDF">2009 proxy statement</a>). For her work for Vertex Pharmaceuticals, she received $337,480 total compensation, and owned 79,500 shares or equivalent (per the <a href="http://investors.vrtx.com/secfiling.cfm?filingID=1047469-09-3942">2009 proxy statement</a>). As Robert AG Monks put it, corporate directors are supposed to "demonstrate unyielding loyalty to the company's shareholders" [Per Monks RAG, Minow N. <a href="http://www.amazon.com/Corporate-Governance-Robert-G-Monks/dp/1405116986">Corporate Governance</a>, 3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.] Therefore, Ms Ullian's directorships seem to pose conflicts with her primary employment as CEO of an academic medical center which must buy products used in womens' health, buy laboratory supplies, and implement basic and clinical research. The BMC board chair's assertion that the CEO is "primarily responsible for the success" of the institution merits special comment. It seems obvious that the main determinant of the success of a medical center is the work done by its health care professionals and support personnel. A medical center cannot provide care, much less good care, without doctors, nurses, therapists and technicians, supported by supply, logistics, cleaning, maintenance, dietary, clerical, medical record, financial and yes, even health care information technology workers and systems (and if I left out an important group of support personnel, I apologize now.) The chair's assertion suggests the hubris central to the ethos of contemporary business managers, but is at odds with the clinical context. (Of course, if the CEO was primarily responsible for the organization's success, she should now shoulder primary blame for its current awkward financial situation, but such consistency may be the hobgoblin of minds too little to understand the gravitas of the C-level manager.) A long time ago, in a galaxy far, far away, health care was a calling. Doctors once pledged to avoid all commercialization (see post <a href="http://hcrenewal.blogspot.com/2009/06/why-did-us-physicians-give-up-their.html">here</a>), and hospital directors or superintendents (not CEOs) did not earn riches, much less become "imperial." (See Ludmerer's <a href="http://www.oup.com/us/catalog/general/subject/HistoryOther/HistoryofMedicine/?view=usa&ci=9780195181364">Time to Heal</a>.) But in the culture of wretched excess that spread from the financial world, hospital CEOs now seem to feel entitled to become wealthy, as they claim responsibility for all successes, while all failures are blamed on someone else. The current system has made hired managers into an ersatz aristocracy, entitled to fill their pockets while denying any responsibility for ever rising costs, declining access, poor quality and demoralized professionals. In my humble opinion, to achieve true health care reform, health care again must become a calling, lead by people who will put the mission ahead of the accumulation of wealth and power.

A "Safety-Net" Medical Center CEO Gets a Golden Parachute

From theBostonChannel.com comes this story on executive compensation in a not-for-profit health care organization, Boston Medical Center – a...

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Physicians, Even Those Educated in IT and Informatics, Are Not "Real" IT People

I've been participating in the comment thread on the HisTALK heath IT industry news/gossip site at <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=6e88815ddf904c1088c4e7892352e56a&URL=http%3a%2f%2fhistalk2.com%2f2009%2f09%2f17%2fnews-91809%2f" target="_blank">http://histalk2.com/2009/09/17/news-91809/</a> . At this time there are 40 comments - mine start at #4. (I've also archived the thread in Word format <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Responses%20to%20HISTALK%20News%2009_18_09.doc">here</a>.) It's been quite interesting, demonstrating that many of the harmful attitudes of IT personnel about healthcare I observed more than a decade ago are still around. An anonymous commenter under the title "Programmer" has been forthcoming with views I think are actually common in the health IT field about medicine, science, IT flaws and shortcomings, and physician involvement in HIT. I will let you read them for yourself at the above link. Others have indicated in that comment thread and other threads that "Programmer" is an executive with a large HIT company, but I cannot confirm this. Among other stunning views, this commenter exhibited: <ul><li>Serious errors in logic such as repeatedly and unshakably mistaking well-documented reports about known rates of IT project failure as a condemnation that all IT projects fail, perhaps reflecting a state of denial; </li><li>Lack of understanding that in scientific fields such as biomedicine, conclusions generally should be supported by reasonable evidence, not "because I think so"; </li><li>Lack of understanding and dismissal of the value of the peer reviewed scientific literature on health IT, and further, a seeming inability or unwillingness to peruse the "references" section of scientific articles, a profoundly unscientific approach to the world; </li><li>Dismissal of the written views of organizations such as the Joint Commission, US National Research Council, European Federation for Medical Informatics and others on HIT deficiencies; </li><li>Perhaps most harmfully, dismissal of faulty conceptual and physical data models, inadequate workflow and cognitive support, and IT of poor user interaction design that presents a mission hostile user experience as a real problem in critical care areas such as Invasive Cardiology (specifically, in <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">this case</a>). Instead, this IT person dismissed physician dismay and rejection of such ill-designed and profoundly unusable IT as a mere "pissing contest" between IT and clinicians, consistent with narrow, territorial, paternalistic, indeed autocratic IT-centric views and a reversal of enabler (clinician) vs. facilitator (IT service provision) roles in patient care.</li></ul> "Programmer" also attacks (from the perspective of arrogant ignorance) the "<a href="http://www.jamia.org/cgi/content/full/16/3/291">Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop</a>" white paper drawing together the thinking at a workshop attended by over fifty informatics experts from all areas of medicine and technology. The role of the medical informatics expert itself, and other issues as well relating to reasons for HIT failure and difficulty are attacked and dismissed. (If the person is a fake or "sock puppet", they're doing a mighty accurate approximation of my own uncomfortably-common observations in managing health IT and biomedical research IT projects while working with non-biomedical IT personnel, see cases <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=home">here</a>.) The crux of the matter came out towards the end where "Programmer" maintains in Comment #28 that I am "just someone who likes to talk about IT” and he is a “real IT person.” A "real IT person?" I've heard that before: this is the "doctors don't do things with computers" (including medical informaticists) type of comment I've heard face-to-face periodically from healthcare IT personnel since I entered the field in the early 1990's, and commented upon a decade ago <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/informaticsmd/tactics.htm#dddtwc">here</a>. I've emailed Tim, the proprietor of the HISTalk site [mr_histalk AT yahoo.com], to inquire if this poster was real or just a provocateur. Tim's response: "He's real and has been around for awhile, although lately he seems to be enjoying an escalated level of confrontation when he can create one." I maintain -- based on personal experience and that told me by others -- that this person's views are not all that rare in the HIT vendor and hospital IS communities. I also opine that thinking such attitudes can be dealt with by logical argument and persuasion is a belief itself lacking in rigor. IT personnel of views as in the HisTALK comments thread represent an older culture of data processing, dating from the days of card punch tabulators that ran businesses prior to computers. It is a culture that has failed to mature with the times. As I wrote <a href="http://hcrenewal.blogspot.com/2008/05/seedie-society-for-exorbitantly.html">here</a>, the unimaginative, process over results, tight fisted control, bureaucratic data-processing culture of the business IT (management information systems) world is the lineal descendant of <a href="http://www.columbia.edu/acis/history/tabulator.html">IBM's patchcord plug-panel programmed, card tabulating machines</a> from which IBM made a large portion of their profit in the days before the electronic computer: <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtzPSYfQOl-r_AY2tMvOiNYhzoGThK0-_X7Xy_KAOQYMox-IK8N8u3Lz-n7cwYwbkDrau7lm2ya8P8S_uYDp9EylhKIFfAq-ltb5zgOjz-LSciW7IPT-SLXr4YvJ2KYVpSqpkY1rMh3qBg/s1600-h/tabulator.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5384014906855078690" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtzPSYfQOl-r_AY2tMvOiNYhzoGThK0-_X7Xy_KAOQYMox-IK8N8u3Lz-n7cwYwbkDrau7lm2ya8P8S_uYDp9EylhKIFfAq-ltb5zgOjz-LSciW7IPT-SLXr4YvJ2KYVpSqpkY1rMh3qBg/s320/tabulator.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 222px; height: 145px;" /></a>Hollerith Type III Tabulator with its control panel exposed. Photo: MNRAS, Vol.92, No.7 (1932). Click to enlarge. </div> Fortunately, such personnel and their designer-centric, as opposed to user- and work-centric philosophies are starting to become obsolete. This can be observed (as an example) via the mission of the <a href="http://www.ischools.org/">iSchool consortium</a>, of which my organization, the Drexel College of Information Science and Technology, is a member: <blockquote>The iSchools are interested in the relationship between information, people and technology. This is characterized by a commitment to learning and understanding the role of information in human endeavors. The iSchools take it as given that expertise in all forms of information is required for progress in science, business, education, and culture. This expertise must include understanding of the uses and users of information, as well as information technologies and their applications. [the order of these priorities is pertinent - ed.]</blockquote> Unfortunately, the data processing culture and its adherents are not becoming obsolete quite fast enough. There are still too many in the upper echelons of management, including health IT vendors, hospitals and pharmaceutical R&D environments. Finally, IT personnel with such attitudes as displayed in the comments, from the lowliest programmer to the CEO and Board, have no place anywhere near where patient care is conducted, or where information systems serving clinical medicine are designed and built. In line with other character types one encounters in healthcare that are often discussed on Healthcare Renewal, clinicians should not accommodate such IT personnel and these types of views. -- SS Addendum: The final (at this time) comment, #40, left by the above commenter states: <blockquote> #40 Programmer: If I decide to become a medical informatproctolicist, I’m going to specialize in sardonicology.</blockquote> IT personnel of such views bring to life Lecia Barker's paper "Defensive climate in the computer science classroom": <blockquote>“Defensive climate in the computer science classroom” by Barker et al., <st1:place st="on"><st1:placetype st="on">Univ.</st1:placetype> of <st1:placename st="on">Denver</st1:placename></st1:place>. Link <a href="http://portal.acm.org/citation.cfm?id=563354&coll=portal&dl=ACM">here</a> (subscription required). May help explain the control-seeking culture of IT personnel. As part of an NSF-funded IT workforce grant, the authors conducted ethnographic research to provide deep understanding of the learning environment of computer science classrooms. Categories emerging from data analysis included 1) impersonal environment and guarded behavior; and 2) the creation and maintenance of informal hierarchy resulting in competitive behaviors. These communication patterns lead to a defensive climate, characterized by competitiveness rather cooperation, judgments about others, superiority, and neutrality rather than empathy.</blockquote> -- SS

Physicians, Even Those Educated in IT and Informatics, Are Not "Real" IT People

I've been participating in the comment thread on the HisTALK heath IT industry news/gossip site at http://histalk2.com/2009/09/17/news-9...

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Wyeth, Ghostwriting, Dr. Joseph Camardo and a Big Liquor Store With a Little Grocery Department

Ghostwriting is a topic covered extensively at Healthcare Renewal, including at my post "Wyeth: Ghostwritten Papers Fake, But Accurate" <a href="http://hcrenewal.blogspot.com/2009/07/wyeth-ghostwritten-papers-fake-but.html">here</a>, Roy Poses' "Wyeth's Industrial Scale Ghost-Writing" <a href="http://hcrenewal.blogspot.com/2009/08/wyeths-industrial-scale-ghost-writing.html">here</a>, and many others about Wyeth and other pharmas that can be viewed via this link: <a href="http://hcrenewal.blogspot.com/search/label/ghost%20writing">http://hcrenewal.blogspot.com/search/label/ghost writing</a>. A story in the Philadelphia Inquirer yesterday about Wyeth and ghostwriting brought to mind my medical school days at Boston University, in a metaphorical and rather negative way, regarding an oddity reflecting today's pharma industry. In those years I lived next to Boston City Hospital on the top floor of a 29-story high rise at 35 Northampton Street, at that time one of the toughest and highest crime neighborhoods in the region if not the country (I was careful and lucky, and only got mugged at gunpoint once.) I had an excellent bird's-eye view of the urban decay in the area, reflective of ethical decay in the community. <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7vNBFn1J7Bb7S6KLdAmIjH6aiXSl7CjnfwJg4EsGq-QPlmRvxKG4XTGpzN7bfX-ftFuAruX9UmdPFKv3LJ9n0X1VdjfsPhE9Z_sqtoc_35gbYgASZ6WH43vQr6VFEk-8ikjZX8ZHpQLmu/s1600-h/35_northampton.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5383914860418843218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7vNBFn1J7Bb7S6KLdAmIjH6aiXSl7CjnfwJg4EsGq-QPlmRvxKG4XTGpzN7bfX-ftFuAruX9UmdPFKv3LJ9n0X1VdjfsPhE9Z_sqtoc_35gbYgASZ6WH43vQr6VFEk-8ikjZX8ZHpQLmu/s320/35_northampton.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 182px;" /></a>35 Northampton St., next to Boston Medical Center (formerly Boston City Hospital) </div> Across the street from the high rise was an oddity - a very large liquor store named Blanchard's. Inside Blanchard's was a very small grocery department of all things. Have a snack with your booze! (I went in only twice; once to see what it was all about, and again during the Blizzard of '78 to get some needed food when all transit in the city was shut down and several feet of snow -- and neighborhood guns -- inhibited foot travel.) The area has much improved in the past three decades, but according to Google street view the liquor store is still there: <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8hVLN1xPYNj6Jt7lCFLCqQ9tX7vWk4mSlLg-z7VuExANGbS1DUhqUIBr4mtJe388bRXneRyEQbAsNrXhJVKrwgJMp8JoBDBuDoT3XveF6u8j-6APhZYHLtWP5B-ue4Bzu8DQcuMEWHEGS/s1600-h/blanchards.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5383914675457072370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8hVLN1xPYNj6Jt7lCFLCqQ9tX7vWk4mSlLg-z7VuExANGbS1DUhqUIBr4mtJe388bRXneRyEQbAsNrXhJVKrwgJMp8JoBDBuDoT3XveF6u8j-6APhZYHLtWP5B-ue4Bzu8DQcuMEWHEGS/s320/blanchards.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 186px;" /></a>In the 1970's "Liquor Land" was a large liquor store with a small grocery department named "Blanchard's." Click to enlarge. </div> Why does this odd store remind me of Wyeth, and more generally today's pharmaceutical industry? Because that industry has turned from what used to be a biomedical research & development industry with decent ethics and a small marketing arm, to large marketing industry with poor ethics and a small R&D arm. (Or, perhaps more accurately, a large marketing industry with poor ethics and a busywork section disguised to look like R&D. As a colleague noted in my post "Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place" <a href="http://hcrenewal.blogspot.com/2009/01/pfizerwyeth-merger-and-sacrificing.html">here</a>, a small fraction of prime scientist intellectual horsepower and time is actually spent on true R&D today, the rest wasted on feeding the bureaucratic corpulence that is the modern pharma research lab. He observed that "what we today call pharmaceutical R&D is in reality busywork disguised to look like R&D, in effect a well engineered, well managed, massively expensive failure.") Here is what led to my "pharmas have become large marketing firms with a small R&D effort" metaphor. It was a story in the local newspaper on ghostwriting. The glib quotes from Dr. Joseph Camardo, Wyeth's senior vice president of global medical affairs, on the practice of ghostwriting are simply stunning: <blockquote>Philadelphia Inquirer <a style="font-weight: bold;" href="http://www.philly.com/philly/business/59905997.html">Ghosts in the medical machine</a> Was drug research infected by ghostwriters? With Paxil suit in court, a Chadds Ford firm says it was ethical. <div class="article_timestamp"> Sun, Sep. 20, 2009 </div> By Miriam Hill Inquirer Staff Writer When GlaxoSmithKline P.L.C. marketers looked for doctors to promote the antidepressant Paxil, they called the project CASPPER. The name was more than just an offbeat tribute to the friendly cartoon ghost. It was a wink and a nod to "ghostwriting," a questionable practice in which scientists put their names on research written by someone else, usually a writer paid by a drugmaker. Ghostwriting critics say it disguises marketing material as scientific research. Charges of ghostwriting have been lobbed against many companies in recent years, including Glaxo, Wyeth, AstraZeneca P.L.C., and Merck & Co. Inc., often arising in lawsuits from consumers claiming a drug hurt them.... Documents released in connection with 8,000 lawsuits filed against Wyeth over Premarin and Prempro show that the company, which employs several thousand people in Collegeville, paid a medical-writing firm to produce articles from 1998 to 2005 that allegedly downplayed the risks of hormone treatment and emphasized benefits. In 2002, researchers stopped a landmark federal study after finding that menopausal women who took certain hormones had an increased risk of breast cancer, heart disease, and stroke. "Ghostwriting was used to sway physician opinions to favor hormone use as disease prevention long after that was a scientifically defensible position," Fugh-Berman [writer Adriane Fugh-Berman - ed.] said. Joseph Camardo, Wyeth's senior vice president of global medical affairs, called Fugh-Berman's view "baseless." Medical opinion evolves, he said, and the papers in question reflected scientific understanding then. He also said the authors alone controlled the content and writing of the papers, though some did have outside help paid for by Wyeth. "It's really being misrepresented as something we wrote and paid for that said what we thought it should say," Camardo said. "But the authors were not paid, and the authors had the final say." ... Studies on ghostwriting have suggested that anywhere from 8 percent to 75 percent of articles in medical journals may involve the practice.</blockquote> Aside from the point I raised in my post "Has Ghostwriting Infected The Experts With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?" <a href="http://hcrenewal.blogspot.com/2009/08/has-ghostwriting-infected-experts-with.html">here</a> regarding possible severe contamination of the literature and therefore of "expert knowledge" as it exists today, Camardo's response raises a cornucopia of questions. Regarding "Medical opinion evolves, he said, and the papers in question reflected scientific understanding then": <ul><li>Whose scientific opinion do they reflect, exactly? </li><li>Does Camardo believe these ghostwritten papers, usually written by party "A" but with authorship claimed by party "B" (usually prominent academic physicians often nurtured by the industry into the role of "key opinion leaders", KOL's) are objective?</li><li>Does Camardo actually believe most of the content comes from party "B" rather than party "A" in these papers? </li><li>Does Camardo understand that paying a MECC (Medical education & communications company) or other firm to write scientific papers puts the author(s) of those papers in a conflict of interest position relative to the paying sponsor, injurious to objectivity?</li><li>Is Camardo that naive to believe a paid writer would "diss" the holder of his or her paycheck?</li></ul>Regarding "the authors alone controlled the content and writing of the papers, though some did have outside help paid for by Wyeth": <ul><li>Which authors is he referring to? </li><li>The ghostwriters?</li><li>Wyeth scientists?</li><li>Academics claiming authorship? </li><li>Was the "outside help" from Wyeth "authors" to the ghosts, or from the ghosts to Wyeth "authors", or from Wyeth to the academics claiming authorship, or what? </li><li>Can Camardo produce statistics on what % of article content on ghostwritten articles Wyeth sponsored were written by the ghost vs. written by Wyeth scientists and/or the claimed academic author? If not, why not? And if not, why should any intelligent person not assume the papers are, say, 99% the product of the hired guns?</li></ul>Regarding "the authors were not paid, and the authors had the final say": <ul><li>Again, which author(s) is he referring to?</li><li>In terms of the ghosts, I assume they were not working for the MECC's for free.</li><li>In terms of the academics and KOL's claiming authorship, they (maybe!) were not paid in money, but instead in the valuable academic currency of a publication in a major biomedical journal. </li></ul>To claim the KOL's were "not paid" is disingenuous. In fact, I find his entire argument disingenuous, a play on words, PR "spin" completely callous to the needs for scientific objectivity, the advancement of science, and ultimately to patient's lives. This is marketing, with poor ethics, in the extreme. Being somewhat familiar with authorship issues as former Director of Published Scientific Information Resources and The Merck Index (of Chemicals, Drugs & Biologicals), 13th ed. at Merck Research Labs, I further pointed out in my post "Wyeth: Ghostwritten Papers Fake, But Accurate" <a href="http://hcrenewal.blogspot.com/2009/07/wyeth-ghostwritten-papers-fake-but.html">here</a>, that: <blockquote>... in addition to the violation of accepted practices of authorship, such as specified by <a href="http://www.docstoc.com/docs/922992/Guidelines-for-the-Conduct-of-Research-at-NIH">NIH</a> and the <a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1416675">International Committee of Medical Journal Editors</a>, among others, such lucky authors [i.e., those who claim authorship of ghostwritten papers] get to "count" such papers in their academic portfolios, presumably also in violation of their own institutional policies and guidelines for fair attribution and intellectual honesty, e.g., <a href="http://www.hms.harvard.edu/fa/attribution.html">here</a> [Harvard - ed.] </blockquote> These industry practices and Camardo's position may be based on: <ul><li>Ignorance of accepted practices of authorship of the NIH, the International Committee of Medical Journal Editors, and most academic institutions, or perhaps: </li><li>Cavalier dismissal of these practices for pecuniary reasons. </li></ul> Is Camardo informed and upfront? Inept? Disingenuous and dishonest? That is up to the reader to decide. In my aforementioned post "<a href="http://hcrenewal.blogspot.com/2009/07/wyeth-ghostwritten-papers-fake-but.html">Wyeth: Fake but Accurate</a>" I'd also noted Wyeth attorney Stephen Urbanczyk acknowledging that the ghostwritten articles were part of a marketing effort. But he said that they were also "fair, balanced, and scientific." More spin. This raises the following observation. It is said that you can judge people by the company they keep. I also believe that: <blockquote style="font-weight: bold;">You can judge companies by the people they keep. </blockquote> This raises the following very serious questions: <ul><li>Is the presence of a senior vice president of global medical affairs and a lawyer with such views on ghostwriting representative of the senior executive leadership's views on dissemination of biomedical scientific information? </li><li>Is their presence reflective of the views of Wyeth's Board of Directors?</li></ul> If so, then the objectivity of any article about Wyeth drugs is called into question, and physicians and patients should utilize Wyeth drugs (and literature on them) with great caution. -- SS<div> </div><div>Addendum: this from the <a href="http://thestar.blogs.com/ethics/2009/09/wyeth-ghostwriting-documents-now-searchable.html">Medical Ethics blog</a>:</div><div><a href="http://www.nytimes.com/2009/08/05/health/research/05ghost.html?pagewanted=1&_r=1" style="text-decoration: none; color: rgb(51, 102, 153);"></a><blockquote><a href="http://www.nytimes.com/2009/08/05/health/research/05ghost.html?pagewanted=1&_r=1" style="text-decoration: none; color: rgb(51, 102, 153);">Recently released</a> court documents in a lawsuit against drug giant Wyeth, thanks to a court action by the New York Times and <a href="http://www.plosmedicine.org/home.action" style="text-decoration: none; color: rgb(0, 51, 102);">PLoS Medicine</a>, are now searchable at a University of California, San Francisco web site.The Wyeth documents are the latest made searchable at the <a href="http://dida.library.ucsf.edu/" style="text-decoration: none; color: rgb(51, 102, 153);">Drug Industry Document Archive</a>, or DIDA, which archives the documents from <a href="http://dida.library.ucsf.edu/documents.jsp" style="text-decoration: none; color: rgb(0, 51, 102);">several high-profile cases</a>.... The documents were first made available last month on the <a href="http://www.plosmedicine.org/static/ghostwriting.action" style="text-decoration: none; color: rgb(0, 51, 102);">PLoS web site</a>, but were not searchable and difficult to sort through. The DIDA site now make it possible to search for documents by name, type or content. </blockquote></div><div>Also see "<a href="http://thestar.blogs.com/ethics/2009/08/ghostwriting-why-they-do-it.html">Ghostwriting: Why they do it</a>" at that blog.</div><div> </div><div>-- SS</div>

Wyeth, Ghostwriting, Dr. Joseph Camardo and a Big Liquor Store With a Little Grocery Department

Ghostwriting is a topic covered extensively at Healthcare Renewal, including at my post " Wyeth: Ghostwritten Papers Fake, But Accurate...

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A mysterious series for H.G. Wells

You might have noticed an unexplained set of doodles on the Google homepage and a couple tweets from our official Twitter stream, <a href="http://twitter.com/google">@google</a>, over the last two weeks. On September 5th, we posted a doodle with the abduction of our second 'o' and a coded tweet from its alien captors: 1.12.12 25.15.21.18 15 1.18.5 2.5.12.15.14.7 20.15 21.19, which translates into "All your O are belong to us" (a nod to the Japanese video game, <a href="http://en.wikipedia.org/wiki/Zero_Wing">Zero Wing</a>). <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjInnmNhYlSX93geyP9B0N07i7tGN01Ow0tLtSdr-mzNjrYuhAh7OtkIYCKrQ2Jv0Jp-aMeeI-3BeI-CllUG72D0LFgbZM0oq9xrz7qXwzxs46MziZBkJvSmkZ8zBTeM76z3e60xfj3Xy2r/s1600-h/go_gle_1.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5383766814533279858" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjInnmNhYlSX93geyP9B0N07i7tGN01Ow0tLtSdr-mzNjrYuhAh7OtkIYCKrQ2Jv0Jp-aMeeI-3BeI-CllUG72D0LFgbZM0oq9xrz7qXwzxs46MziZBkJvSmkZ8zBTeM76z3e60xfj3Xy2r/s400/go_gle_1.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 144px;" /></a><div style="text-align: left;"> </div><div>We were delighted that people around the world played along with us and shared their <a href="http://news.google.com/news/more?pz=1&cf=all&ncl=dFakfc8c2RaGIzMGOqyHjkY0-FAjM">theories for why we would have posted this "unexplained phenomenon</a>." Ten days later, the UFO returned. This time, it was to leave its mysterious mark on the fields. <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMnSjINuF3Dp4KDxuuiiiUkdCWUTjV9Z4bXM-PtPV6fumO1Ou5NoHJyLOdDZOkJoa5ylWOmFtHNl2-fZmLFHmKeceIGAQfTMQjnWd2i50hgk-jksIIBJ-d2Rm_Fh8lY2b82uVPFRcmp82L/s1600-h/goog_e_2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5383766823458096754" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMnSjINuF3Dp4KDxuuiiiUkdCWUTjV9Z4bXM-PtPV6fumO1Ou5NoHJyLOdDZOkJoa5ylWOmFtHNl2-fZmLFHmKeceIGAQfTMQjnWd2i50hgk-jksIIBJ-d2Rm_Fh8lY2b82uVPFRcmp82L/s400/goog_e_2.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 144px;" /></a> <div style="text-align: left;">While the link from the doodle to a search for "crop circles" didn't provide any more clues, we also tweeted the lat/long coordinates of <a href="http://maps.google.com/maps?f=q&source=s_q&hl=en&geocode=&q=horsell+common+england&sll=37.0625,-95.677068&sspn=38.365962,56.513672&ie=UTF8&ll=51.343481,-0.553436&spn=0.029595,0.055189&t=h&z=14&iwloc=A">Horsell Commons</a>, the location of the first alien landing in H.G. Wells 1898 classic, <a href="http://books.google.com/books?q=the+war+of+the+worlds&btnG=Search+Books">The War of the Worlds</a>. Some of you <a href="http://www.guardian.co.uk/books/2009/sep/15/google-crop-circle-hg-wells">figured out what we were doing</a>, but we weren't ready to reveal it all just yet. </div> Now, we're finally acknowledging the reason for the doodles with an official nod to Herbert George, who would be 143 years old today.  <a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkpujaaVQWspdLcIyg1IizoDRmHIl7SLaA7l-T1HxWr53_idWEIC26x_Tx2yiUXikIBrPrteoPxPpBk6Ti7TfUujXq5GauHXMGy_lkoAQ2bm0IJrlzy_GP2lYHA8p5RyQMnNlkdHnY4bs_/s1600-h/hg_wells_birthday2009_part3_highres.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5383767868197563858" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkpujaaVQWspdLcIyg1IizoDRmHIl7SLaA7l-T1HxWr53_idWEIC26x_Tx2yiUXikIBrPrteoPxPpBk6Ti7TfUujXq5GauHXMGy_lkoAQ2bm0IJrlzy_GP2lYHA8p5RyQMnNlkdHnY4bs_/s400/hg_wells_birthday2009_part3_highres.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 181px;" /></a> <div style="text-align: left;">Inspiration for innovation in technology and design can come from lots of places; we wanted to celebrate H.G. Wells as an author who encouraged fantastical thinking about what is possible, on this planet and beyond. And maybe have some fun while we were doing it. </div></div><div> The invasion of the logo by alien crafts and pods makes our series complete, but you'll have to read the book to find out how Wells' story really ends. Posted by Micheal Lopez, Web Design Lead</div>

A mysterious series for H.G. Wells

You might have noticed an unexplained set of doodles on the Google homepage and a couple tweets from our official Twitter stream, @google , ...

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The DoubleClick Ad Exchange: growing the display advertising pie for everyone

Hundreds of thousands of advertisers use search advertising — short, highly relevant text ads alongside search results on Google and other search engines — to grow their businesses. Thanks to a decade of innovation, search advertising is an open platform that allows businesses to easily connect with customers. As you browse the web today, you'll also see "display advertising," such as videos, images and interactive ads. Like search ads, these connect users with products, services and ideas that interest them. For advertisers, display ads are vital in boosting awareness and sales. For websites and online publishers, they help fund investments in online content and the web services that we all use. But with a multitude of display ad formats, and thousands of websites, it often takes thousands of hours for advertisers to plan and manage their display ad campaigns. With this complexity, lots of advertisers today just don't bother, or don't invest as much as they would like. On the other side of the equation, some publishers are left with up to 80% of their ad space unsold. It’s like airlines flying with their planes mostly empty. And for the ad space that they do sell, publishers also have to deal with the complexity of managing thousands of advertisers and campaigns. We believe that a better system built on better technology can help grow the display advertising pie and benefit everyone. Three principles underpin our approach to the display advertising field: 1. Simplify the system for buying and selling display ads: For example, our DoubleClick ad serving products help advertisers and publishers manage campaigns and ad formats across thousands of websites and from thousands of advertisers. 2. Deliver better performance that advertisers and agencies can measure: We're building a host of new features to help advertisers to run display ad campaigns across the Google Content Network (comprising hundreds of thousands of AdSense partner sites) and on YouTube. We're also developing better measurement and reporting technology so they can figure out what's working and what's not. 3. Open up the ecosystem: We want to democratize access to display advertising and make it accessible and open, like search advertising. We recently launched the <a href="http://www.google.com/adwords/displayadbuilder/">Display Ad Builder</a> to help businesses easily set up and run display ad campaigns. 80% of advertisers who use that product have never run a display ad campaign before. We've been working hard to put these principles into practice, and today we're excited to announce the new DoubleClick Ad Exchange, a step towards creating a more open display advertising ecosystem for everyone. The Ad Exchange is a real-time marketplace that helps large online publishers on one side; and ad networks and agency networks on the other, buy and sell display advertising space. These publishers and ad networks manage and represent large volumes of ads and ad space from lots of advertisers and websites. By bringing them together in an open marketplace in which prices are set in a real-time auction, the Ad Exchange enables display ads and ad space to be allocated much more efficiently. This improves returns for advertisers and enables publishers to get the most value out of their online content. An explanation of the Ad Exchange is <a href="http://google.com/adexchange/AdExchangeOverview.pdf">here</a> (PDF). You can read in more detail about the features of the new DoubleClick Ad Exchange on the <a href="http://www.doubleclick.com/insight/blog/archives/doubleclick-advertising-exchange/announcing-the-new-doubleclick-ad-exchange.html">DoubleClick blog</a>. AdWords advertisers will be able to run ads on sites in the Ad Exchange, using their existing AdWords interface. This means more high quality sites for AdWords advertisers to run display ads on. Similarly, our AdSense publishers will benefit from more high-quality display advertisers coming through the Ad Exchange. You can read more about these benefits on the <a href="http://adwords.blogspot.com/2009/09/announcing-new-doubleclick-ad-exchange.html">AdWords Blog</a> and the <a href="http://adsense.blogspot.com/2009/09/bringing-more-buyers-to-adsense-through.html">AdSense Blog</a>. To find out more about our overall display advertising vision and the many services and features we've been investing in across the Google Content Network, YouTube and DoubleClick, check out the video below: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/pQZZId4TamI&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/pQZZId4TamI&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object> We believe that growing the display advertising pie for everyone will greatly enhance the web experience for advertisers, publishers, and ultimately users. The DoubleClick Ad Exchange will help create a more open marketplace and is a major step towards that vision. Posted by Neal Mohan, Vice President, Product Management

The DoubleClick Ad Exchange: growing the display advertising pie for everyone

Hundreds of thousands of advertisers use search advertising — short, highly relevant text ads alongside search results on Google and other s...

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UPMC Fouls Another One Off

It's almost World Series time in the US, so here's a baseball story, <a href="http://pittsburgh.bizjournals.com/pittsburgh/stories/2009/09/07/daily21.html">courtesy the Pittsburgh Business Times</a>, <blockquote> University of Pittsburgh Medical Center lobbyist Leslie McCombs used Pittsburgh Pirates baseball tickets purchased by UPMC’s insurance arm to entertain film executives and others to promote the creation of a state film tax credit, according to the State Ethics Commission. The commission fined McCombs $5,025 for failing to promptly register as a lobbyist for Lions Gate Entertainment Corp. and omitting a daytime phone number in registering as a lobbyist for UPMC, according to a commission ruling reached on July 22. The confidential decision was disclosed Sept. 9 by The Associated Press. McCombs, who works for UPMC as a consultant, received permission from UPMC President and CEO Jeffrey Romoff to lobby on behalf of Lions Gate, which she described in a February 2007 e-mail to him as the, 'largest independent producer and distributor of motion pictures and television in the country.' Romoff cleared her work with Lions Gate after consulting with UPMC legal counsel and assured by McCombs in the e-mail that, 'UPMC signs will be prominently featured throughout the (‘Kill Pit’ television) series.' Filming for the eight-part miniseries, which was renamed 'The Kill Point,' began in March 2007 in Pittsburgh. Gov. Ed Rendell signed the Film Production Tax Credit bill into law in July 2007, which provided for a 25 percent film tax credit to offset production expenses. </blockquote> Also, <blockquote> From 2005 to 2006, McCombs was director of public relations for UPMC Health Plan, a for-profit subsidiary of the nonprofit hospital network. She was then named senior consultant with UPMC’s government relations department. The State Ethics Commission lists 18 baseball games where McCombs treated Lions Gate and government officials using UPMC tickets. In addition, she attended a June 15, 2007, matchup against the Chicago White Sox with Rendell and his wife, Marjorie, and Romoff and his wife, Stefania, according to the commission. It’s not clear from the commission report whose interests McCombs was representing at that game, but Rendell later reimbursed $960 for the tickets to the five games that he attended, which was returned to the health plan. In 2007, UPMC Health Plan bought $61,440 worth of Pittsburgh Pirates tickets, which were available to employees of the insurer 'in the performance of their duties,' the report states. The sum included a $20,000 seat license. </blockquote> So did you get all that? The director of public relations for the UPMC Health Plan, the managed care subsidiary of UPMC, a large academic medical center, lobbied the state governor for the enactment of a tax credit for television and movie production, partially so that the UPMC logo would appear in a television series, and entertained the governor using a few of the more than $60,000 worth of baseball tickets the medical center purchased for employee use. Amidst the complication, the public relations director violated state lobbying rules. None of these shenanigans had anything directly to do with health care, or medical education and research. The only conceivable advantage accruing to the institution would be the appearance of the UPMC logo in a television series. But most likely everyone had good times at the ball game. This story again suggests that managers of health care organization are more focused on playing marketing and political games than on health care, and generally are more focused on benefiting themselves than upholding their organizations' mission. The amounts of money involved in this case may be small, but do not underestimate the collective effects on health care access, cost and quality of managers who have their eyes on the wrong balls. UPMC has provided grist for the Health Care Renewal mill before, see earlier posts <a href="http://hcrenewal.blogspot.com/2008/11/questions-of-benefits-vs-risks-for-upmc.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/01/can-hospital-have-trade-secrets.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/02/healthcare-it-blamed-in-patient-death.html">here</a> and <a href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html">here</a>.

UPMC Fouls Another One Off

It's almost World Series time in the US, so here's a baseball story, courtesy the Pittsburgh Business Times , University of Pittsbur...

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"Seeking Justice for My Son"

At Healthcare Renewal we often write of the dangers of financial conflict of interest towards medical research and practice. Here is a plea from a father of an 18 year old patient whose death became a cause célèbre against conflict of interest, only to then be swallowed up in the sea of silence known as the "<a href="http://hcrenewal.blogspot.com/2007/08/bling-bling-poltical-correctness-and.html">anechoic effect</a>." The plea is in our local newspaper, but deserves much wider attention: <blockquote>Philadelphia Inquirer <div class="sig"><div class="article_timestamp"> Posted on Thu, Sep. 17, 2009 </div> </div> <a href="http://www.philly.com/inquirer/opinion/59589542.html">Seeking justice for my son</a> He died in a gene-therapy trial. Penn and the FDA should release the records. By Paul Gelsinger Ten years ago today, my 18-year-old son, Jesse Gelsinger, died at the University of Pennsylvania in a gene-therapy trial. Who is responsible? Could his life have been saved? Are other patients at risk? These questions have yet to be fully answered. Jesse lived with a rare metabolic disease. The point of the research trial was to see if an adenovirus (a cousin of the cold virus) could safely deliver corrective genes to Jesse's liver. Instead, the adenovirus killed Jesse. Jesse became the poster child for what not to do in human-subjects research. Neither he nor I was warned that, as the Washington Post later reported, monkeys had died in a prior trial. And the Wall Street Journal reported that the researcher who developed the adenovirus, James Wilson, had a seven-figure financial interest in the trial's outcome, as did Penn. I stood by Penn, Wilson, and the two principal investigators, Mark Batshaw and Steven Raper, until I understood the extent of Wilson's financial ties and the extent to which Jesse was misled about the risks and efficacy of the therapy. I eventually sued and ultimately settled. The amount of the settlement was sealed; the documents were not. The federal government also sued, claiming that the researchers blew through clinical stop signs in conducting the trial, ignoring evidence that Jesse was not well enough to receive the adenovirus and failing to sufficiently alert the Food and Drug Administration about severe incidents involving prior patients. The researchers disagreed, saying they had the discretion to proceed despite Jesse's test results, and that they had alerted the FDA. The government also reached a settlement, which restricted the researchers' activities for a period of years. Before the government settled, I urged federal officials to make the documents they collected public. They refused, saying this is simply not done. I believe a better understanding of what happened to Jesse could improve practices. So I gave the documents collected for my lawsuit to a law professor, Robin Wilson, who teaches at Washington and Lee University in Lexington, Va. They appear in her new book, Health Law and Bioethics: Cases in Context. While they are incomplete, the documents show a chilling pattern. They show that a lot of good people inside Penn raised alarms about Wilson's financial ties from the get-go, but that Penn approved the deal anyway. The documents also show misleading disclosures to Jesse about the risks posed to him. For example, although animals died in prior trials, we were told that "animals have not shown toxic effects ... at the dosage of virus that is needed to transport the gene in this study." I thought the lawsuits brought by me and the government would change research practices and the rules governing research. When I settled, real reform seemed likely. The Senate had held hearings, the FDA was investigating whether mistakes were made in the trial, and influential medical bodies such as the Association of American Medical Colleges had begun to examine disclosure practices and financial ties. But, sadly, we have not yet learned enough from Jesse's death. The shroud of secrecy that envelops legal settlements has helped hinder reform. No one has publicly accounted for the mistakes that led to Jesse's death. We don't know whether the FDA was misled or dropped the ball. We don't know whether the researchers' claims of efficacy had any basis in fact or were just wishful thinking. We don't know why Penn approved the deal despite warnings. And we don't know whether the researchers' decision to administer the virus to Jesse was reasonable or reckless. Ten years ago today, my son died in a science experiment. A complete record of what the researchers and FDA regulators knew is the best precaution against future tragedies like Jesse's death. I am asking that the University of Pennsylvania and the FDA finally do the right thing and release their records. If they did nothing wrong, let us see the proof. If they made a mistake, let us all learn from it and do better in the future. We owe it to Jesse to make his life and death mean something. [Emphases mine - ed] </blockquote> Other than stating that I strongly agree that these records should be released for others to learn from, I do not think additional commentary is necessary. -- SS

"Seeking Justice for My Son"

At Healthcare Renewal we often write of the dangers of financial conflict of interest towards medical research and practice. Here is a plea ...

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