healthy4u

The Kelo Case Redux: Pfizer's "Nice Place" Ends Up Covered with Weeds

Four years ago we posted (<a href="http://hcrenewal.blogspot.com/2005/07/kelo-case-pfizer-and-conflicts-of.html">here</a>, <a href="http://hcrenewal.blogspot.com/2005/10/pfizers-fingerprints-on-kelo-case.html">here</a> and <a href="http://hcrenewal.blogspot.com/2005/09/kelo-revisited-conflicts-of-interest.html">here</a>) about the controversial US Supreme Court decision in the Kelo case. Most discussion of the case at the time focused on individual property rights vs the power of the government to promote economic development, but the case had an important health care angle. Briefly, the case centered on the taking of private property, including a house owned by Susette Kelo, by a not-for-profit organization, the New London (Connecticut) Development Corporation (NLDC) given the power of eminent domain by the New London city government. While the ostensible rationale for the taking was economic development, the action appeared to have been at the behest of Pfizer Inc, the world's largest pharmaceutical company, which had built a research and development facility in the city, and wanted a suitably upscale and sanitized environment for its workers. As we <a href="http://hcrenewal.blogspot.com/2005/07/kelo-case-pfizer-and-conflicts-of.html">previously posted</a>, the NLDC's leadership had multiple conflicts of interest that involved ties to Pfizer. One board member was a Pfizer vice-president. The board president was married to another Pfizer vice-president. Pfizer wanted the part of New London that included Kelo's house made more attractive to complement its new research facility. The husband of the NLDC president had said, "Pfizer wants a nice place to operate. We don't want to be surrounded by tenements." Kelo's and other property owners' protest of the taking went all the way to the US Supreme Court. As we posted <a href="http://hcrenewal.blogspot.com/2005/07/kelo-case-pfizer-and-conflicts-of.html">here</a>, the Court decided against the property owners by a 5-4 vote. Justice John Paul Stevens wrote for the majority that the city's "determination that the area was sufficiently distressed to justify a program of economic rejuvenation is entitled to our deference. The city has carefully formulated an economic development plan that it believes will provide appreciable benefits to the community, including - but by no means limited to - jobs and increased revenues." This majority opinion is important, because the Fifth Amendment to the US Constitution provides "nor shall private property be taken for public use without just compensation." Many had interpreted this provision to mean that eminent domain could only be used to take property for public use, e.g., to build a road or a public school, but not for private purposes, like building upscale waterfront developments. The Associated Press just <a href="http://www.google.com/hostednews/ap/article/ALeqM5jV-KB6t5TnnZ4pF71h4oAiviGOSgD9AUJS5O0">published</a> an ironic follow-up. <blockquote>Weeds, glass, bricks, pieces of pipe and shingle splinters have replaced the knot of aging homes at the site of the nation's most notorious eminent domain project. There are a few signs of life: Feral cats glare at visitors from a miniature jungle of Queen Anne's lace, thistle and goldenrod. Gulls swoop between the lot's towering trees and the adjacent sewage treatment plant. But what of the promised building boom that was supposed to come wrapped and ribboned with up to 3,169 new jobs and $1.2 million a year in tax revenues? They are noticeably missing. </blockquote> What happened? <blockquote>New London the city's prized economic development plan has fallen apart as the economy crumbled. The Corcoran Jennison Cos., a Boston-based developer, had originally locked in exclusive rights to develop nearly the entire northern half of the Fort Trumbull peninsula. But those rights expired in June 2008, despite multiple extensions, because the firm was unable to secure financing, according to President Marty Jones. </blockquote> So that was the result of the economic development plan the Supreme Court majority termed "carefully formulated." The lesson seems to be that when government makes policy to favor individual corporations, the results are bad policy and little public benefit. Government leaders often seem willing to favor specific health care organizations, rationalizing their actions in terms of economic development or promoting health and health care. Doing so may benefit the corporations involved, but rarely individual or public health. Although US local and national government officials have have increasingly practiced such corporate socialism, they have neglected their regulatory roles. Instead of picking winners and losers, government would do better to act like a combination of an honest policeman on the beat, deterring and punishing dishonest behavior, and in impartial referee, trying to make sure everyone is playing the game honestly. But no doubt government officials used to mingling with the corporate superclass would not be comfortable in the roles of honest cop or impartial referee.

The Kelo Case Redux: Pfizer's "Nice Place" Ends Up Covered with Weeds

Four years ago we posted ( here , here and here ) about the controversial US Supreme Court decision in the Kelo case. Most discussion of t...

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Keep up with the latest trends using Google Search

Today, we're launching a new web search feature that will help you stay in touch with the latest trends on the web. You might already be familiar with <a href="http://www.google.com/trends/hottrends">Hot Trends</a>, which lists the fastest rising searches on the web at any given hour. Now, when you search Google.com and your query matches one of the top 100 fastest-rising search terms, we'll show you a graph at the bottom of page, with more information — like how popular the query is, how fast it's rising over time, and other useful data. Below is a picture of what you'd find today if you searched for [<a href="http://www.google.com/search?q=reina+capodici">reina capodici</a>], who just wed American Idol star Justin Guarini. Or try another example: [<a href="http://www.google.com/search?q=gotthard+base+tunnel">gotthard base tunnel</a>], which is set to become the longest tunnel in the world. (But make sure you search for these examples today — nothing stays hot for long.) <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuS2faZA9w_xr08G9LYjkRRn5wXdrjflM5TkQIcjNYMKGe3RGC5mHfnhiW141HC6K9HyGlvVibklPCCe1Klk9wOMDkR7JrU7fL5yzD5pRZ_Riggy7nOa1NAh9G8BGusr3o_aKngynSFDQ2/s1600-h/dczchqb_44gm4wtkgz_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5386654552957847554" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuS2faZA9w_xr08G9LYjkRRn5wXdrjflM5TkQIcjNYMKGe3RGC5mHfnhiW141HC6K9HyGlvVibklPCCe1Klk9wOMDkR7JrU7fL5yzD5pRZ_Riggy7nOa1NAh9G8BGusr3o_aKngynSFDQ2/s400/dczchqb_44gm4wtkgz_b.png" style="cursor: hand; cursor: pointer; display: block; height: 95px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a> <div>To coincide with this change, we've also reduced the number of trends listed on the Google Hot Trends homepage to 40 from 100. This feature, however, will show up for any query that matches the top 100. We hope this change will make for a simpler user experience, and help you focus better on the top, most interesting content. This new feature is available in the U.S. and Japan. We hope it will help you keep up with everything there's to know about the latest trends online. No more being out of the loop at your office watercooler! Posted by Aaron Wise, Associate Product Manager and Hiroshi Kuraoka, Product Manager </div>

Keep up with the latest trends using Google Search

Today, we're launching a new web search feature that will help you stay in touch with the latest trends on the web. You might already be...

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Back to school with Google Docs

As interns on the <a href="http://docs.google.com/">Google Docs</a> team this past summer, we were excited to be able to work on making Google Docs that much more useful for students like us. We've now added a bunch of back to school features which should help our fellow students make the transition from summer to school that much easier — and we hope they'll be useful to you non-students as well! We created an equation editor so you can easily complete problem sets online or write papers that include equations. If you're taking math, you can now take notes in class or answer questions using Google Docs. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji_4tIJnVHQAIM-GzzuBz09kVBrj3o7UH80t0fWUMiUqYiAC4mH0grSIFVaWxtNIriccNnxL9-T3vqFFXVkLgTNAgephrbMHnZPZRjOI8YJZYmULP6yGdxXpEqQUXLQPynNz97Nfh460u0/s1600-h/dcfknv9p_86ftfp26fj_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5386583460730458354" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEji_4tIJnVHQAIM-GzzuBz09kVBrj3o7UH80t0fWUMiUqYiAC4mH0grSIFVaWxtNIriccNnxL9-T3vqFFXVkLgTNAgephrbMHnZPZRjOI8YJZYmULP6yGdxXpEqQUXLQPynNz97Nfh460u0/s400/dcfknv9p_86ftfp26fj_b.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 269px;" /></a> <div>In the same vein, we also added superscripts and subscripts — perfect for expressing chemical compounds or algebraic expressions: <iframe src="http://docs.google.com/present/embed?id=d7qpvbb_48cd8cr6d4" frameborder="0" width="410" height="342"></iframe> For language enthusiasts, we integrated <a href="http://googledocs.blogspot.com/2009/08/translate-documents-sharing-across.html">translation features</a> into Google Docs. You can translate either a single word or an entire document — handy for making sure you're on the right track when writing those foreign language essays. For those of you conducting surveys, we added a "Go to page based on answer" option in Google forms, making it easy to show participants only those questions that are relevant to them. <div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi97u6kMz8a9dQzmhUKJFeXjJc2E9eWHmWKfGmuamOKTFTpDlxaiMMw-FX83zdi6AJ_NW6eHCAdAHxDHOtCW0a3Kq8ocH-mwINWk8kZJUF_ZIo1AfK-_OjrmaPIqQjLgdA5k0r8FTKmQ9wp/s1600-h/dcfknv9p_85srpm76gx_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5386583473535480386" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi97u6kMz8a9dQzmhUKJFeXjJc2E9eWHmWKfGmuamOKTFTpDlxaiMMw-FX83zdi6AJ_NW6eHCAdAHxDHOtCW0a3Kq8ocH-mwINWk8kZJUF_ZIo1AfK-_OjrmaPIqQjLgdA5k0r8FTKmQ9wp/s400/dcfknv9p_85srpm76gx_b.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 289px;" /></a> </div><div>We also came up with a few features for humanities buffs. To make outlining term papers more customizable, we made it easy to select different bulleting styles for lists by adding an option to the format menu. And when that paper is written and ready to turn in, you now have the option to print footnotes as endnotes for a cleaner-looking paper. We hope these new features make collaboration in Google Docs even more convenient, whether you're editing group presentations from across campus or collecting survey data from friends. In fact, we've created this video to show how collaboration can even help you out with your "extracurricular" activities: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/A7y7NafWXeM&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/A7y7NafWXeM&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> Posted by Rita Chen and Stephanie Vezich, Google Docs Summer Interns</div></div>

Back to school with Google Docs

As interns on the Google Docs team this past summer, we were excited to be able to work on making Google Docs that much more useful for stu...

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Malpractices of the multitude revisited: "An outstanding job of educating themselves about clinical issues"

At numerous posts at Healthcare Renewal, we have pointed out what we feel to be a serious gap in the credentials of many in biomedical leadership roles. The gaps are in the form of a near complete lack of any scientific or biomedical education and experience, except perhaps a high school chemistry and biology class or two. We often receive comments back, usually from "anonymous" posters such as <a href="https://www.blogger.com/comment.g?blogID=9551150&postID=5185319720165437636&isPopup=true">here</a> to our opinions that this expertise gap impairs the judgment of such leaders on medical matters: <blockquote>... No. I've met individuals with management training who do an outstanding job of educating themselves about clinical issues. And I've met individuals with clinical training who do an outstanding job of educating themselves about management and business issues.</blockquote> I feel this "anyone can be an expert" sentiment is an important issue to bring outside of the comments section of our posts. I raised probing questions in response to such messages <a href="http://hcrenewal.blogspot.com/2009/09/more-on-healthcare-management-by-domain.html#comments">here</a> in my post "<a href="http://hcrenewal.blogspot.com/2009/09/more-on-healthcare-management-by-domain.html">More On Healthcare Management By Domain Neutral Generalists: CIO's Running Hospital Pharmacies and Home Healthcare Divisions?</a>" Here are my most recent questions to the above anonymous medical self-education proponent: Re: "I've met individuals with management training who do an outstanding job of educating themselves about clinical issues." <blockquote>What, exactly, is it that individuals with management training who do an outstanding job of "educating themselves about clinical issues" are professionally or even reasonably qualified to do? Could they pass medical boards? Could they reasonably interpret a complex medical article in, say, The Annals, and make truly informed, wise decisions based on that reading? Could they reasonably evaluate therapeutic alternatives in complex cases, say, someone with a new heart valve who's just developed fever and a lower GI bleed? In an emergency could they provide medical care? (mot in the legal sense, just in the skills sense.) If not, why not, and what do you mean by "outstanding job?" In comparison, I have no MBA or formal business training (other than working for years in my father's pharmacy as a stocker and cashier) but did a good job managing a department of 50+ and a budget of $13 million for an international pharma, solving severe business problems that had been impairing R&D and managing my budget consistently to within 0.5% of EA. Is there perhaps an asymmetry between medicine and business? </blockquote> Finally, I ask: <blockquote>What percentage of a typical medical training curriculum (such as for a Pharm.D. <a href="http://www.hsc.wvu.edu/sop/students/Curriculum/Curriculum2011_2012_2013_fall2009.htm">here</a> or a physician <a href="http://www.bumc.bu.edu/admissions/curriculum/">here</a>) can a person with a management background absorb through self-education, and is the medical training curriculum therefore irrelevant? Should we just go back to the days of self-trained practitioners? If not, why not? </blockquote> The critically thought-out answers to these questions expose the territorial invasion of medicine by ill-suited outsiders and dilettantes quite well. Echoing an observation I wrote about once before in my <a href="http://hcrenewal.blogspot.com/2009/03/malpractices-of-multitudes-mission.html">eight part series on mission hostile EMR's</a>, but addressing it to medical administration where it also applies: Medical administration reminds me of dentistry in its early days, especially when medical administrators lacking biomedical expertise refer to themselves as "medical professionals." B.T. Longbothom, author of the second dentistry book published in the U.S. ("A Treatise on Dentistry", 1802), gave an excellent description in his preface of problems at the time. His observations apply to medical administration in our present age: <blockquote style="font-family:arial;">The word "dentist" has been so infamously abused by ignorant pretenders, and is in general so indifferently understood, that I cannot forbear giving what I conceive to be its original meaning: viz, the profession of one who undertakes and is capable not only of cleaning, extracting, replacing by transplantation and making artificial teeth, but can also from his knowledge of dentistry, preserve those that remain in good condition, prevent in a very great degree, those that are loose, or those that are in a decayed state, from being further injured, and can guard against the several diseases, to which the teeth, gums and mouth are liable, a knowledge none but those regularly instructed, and who have had a long, and extensive practice, can possibly attain, but which is absolutely necessary, to complete the character of a Surgeon Dentist.</blockquote> Hardly anyone spoke out. More than thirty years later, untrained practitioners were as prevalent as ever. One of the leading dentists of the time, Shearjashub Spooner, in his "Guide to Sound Teeth, or, A Popular Treatise on the Teeth" (1836) warned the public of a phenomenon I believe now applies to medical administration: <blockquote style="font-family:arial;"> One thing is certain, this profession must either rise or sink. If means are not taken to suppress and discountenance the malpractices of the multitude of incompetent persons, who are pressing into it, merely for the sake of its emoluments, it must sink, - for the few competent and well educated men, who are now upholding it, will abandon a disreputable profession, in a country of enterprise like ours, and turn their attention to some other calling more congenial to the feelings of honorable and enlightened men.</blockquote> I understand that point of view. -- SS

Malpractices of the multitude revisited: "An outstanding job of educating themselves about clinical issues"

At numerous posts at Healthcare Renewal, we have pointed out what we feel to be a serious gap in the credentials of many in biomedical leade...

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Congress expects physicians to implement EHR's when they can't post a PDF on the web?

Congress expects physicians to implement EHR's and review patient histories in detail, when they can't even review their own bills before acting, and post a PDF on the web? This has to be the lamest, most inept, and/or most patronizing Congress in history (with approval ratings to match, 16% as of Sept. 25 according to <a href="http://www.rasmussenreports.com/public_content/politics/mood_of_america/congressional_performance">Rasmussen</a>): <blockquote>Washington Examiner <a href="http://www.washingtonexaminer.com/opinion/blogs/beltway-confidential/Baucus-claims-its-too-difficult-to-put-health-care-bill-online-61246377.html">Baucus claims it's too difficult to put health care bill online</a> By: BARBARA HOLLINGSWORTH 09/24/09 A proposal by Sen. Jim Bunning, R-Ky., that would have required the Senate Finance Committee to post the final language of the $900 billion health care reform bill, as well as a Congressional Budget Office cost analysis, on the committee’s website for 72 hours prior to a vote was rejected 12-11. ... Chairman Max Baucus, D-Mont., himself admitted that “This probably sounds a little crazy to some people that we are voting on something before we have seen legislative language.” Indeed. Baucus’ excuse - that it would take his committee staff two weeks to post the bill online – sounds a little crazy too. </blockquote>This very same Congress is pushing physicians to implement EHR's under penalty of Medicare payment reductions, while they claim an inability to post a PDF or Word document online. Implementing EHR's is only <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">several orders of magnitude more complex</a>... Or, perhaps the "inability" to post the text has to do with text that appears at pages 80-81 of the bill: <blockquote> "Beginning in 2015, payment [under Medicare] would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization." Thus, in any year in which a particular doctor's average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor's payments by 5 percent."</blockquote> As in the <a href="http://www.washingtontimes.com/news/2009/sep/25/death-panels-by-proxy/">Washington Times</a>: <blockquote> This provision makes no account for the results of care, its quality or even its efficiency. It just says that if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year's end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties. </blockquote> No metrics on quality of care, outcomes, patient satisfaction, or other aspects of the complex process of medical care are apparently involved. Just an "aggregation of the physician's resource use." May I use the words "capricious and arbitrary" to describe this metric? Now, we should ask: <ul><li>Is this what our government means by "data driven healthcare?"</li><li>Do they realize the likely adverse consequences of such half-baked measures?</li><li>Are those who would propose such a bill friends of patients, and friends of physicians?</li></ul> Where have I seen this before? (How about: biomedical dilettantes helping <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=pharma">impair R&D</a> at a pharmaceutical company, now in sale mode due to a poor pipeline of new drugs, through cutting drug discovery resources on the simplistic metric of "cost per user per database?") Ultimately, this Medicare strategy is the end result of allowing medical dilettantes (no matter how well they've "self educated" themselves about medicine) to control the playing field. It is a poster example of a perverse incentive in direct conflict with the obligation of physicians to provide the best care. In the end, patients and physicians get screwed. -- SS

Congress expects physicians to implement EHR's when they can't post a PDF on the web?

Congress expects physicians to implement EHR's and review patient histories in detail, when they can't even review their own bills b...

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GHOSTING MATILDA

The fall season is upon us and the markets are filled with advertising for Halloween, so our thoughts naturally turn to the recent stories of ghostwriting in medical journals. Here is a lighthearted take on that topic. This parody began on <a href="http://www.margaretsoltan.com/?p=17582">Margaret Soltan’s blog</a> a few days ago, and it has just kept growing. GHOSTING MATILDA Once a jolly bagman signed on to some articles. Corporate ghosts even promised him a fee. And he sang as he watched and waited till they were in print, These will be grand right up there on my CV. Ghosting Matilda, ghosting Matilda, Who’ll come a-ghosting Matilda with me? And he sang as he watched and waited till they were in print, These will be grand right up there on my CV. This month it’s Janssen, next it’s Bristol-Myers Squibb. Wyeth and Lilly soon might want to talk to me. Novartis might sign me up, also AstraZeneca ─ Soon I’ll be famous like that guy at Emory. Ghosting Matilda, ghosting Matilda, Who’ll come a-ghosting Matilda with me? Novartis might sign me up, also AstraZeneca ─ Soon I’ll be famous like that guy at Emory. Up came an editor, looking for the telltale signs. Ghost writing’s hard to cover up, you see. And he found them in the documents: metadata do not lie ─ Bagman just sold his name and passed these off on me. Ghosting Matilda, ghosting Matilda, Who’ll come a-ghosting Matilda with me? And he found them in the documents: metadata do not lie ─ Bagman just sold his name and passed these off on me. Up jumped the bagman, pointing fingers right and left, You’ll never prove that I lied, said he. I will say that underlings failed to send disclosure forms; Let them be blamed instead, while I get off scot-free. Ghosting Matilda, ghosting Matilda, Who’ll come a-ghosting Matilda with me? I will say that underlings failed to send disclosure forms; Let them be blamed instead, while I get off scot-free. Out! said the editor, you’re now persona non grata. So, too, the Dean and the Provost agreed. Bagman’s ghost may be heard now, sighing in the library ─ Could have been grand right up there on my CV. Ghosting Matilda, ghosting Matilda, Who’ll come a-ghosting Matilda with me? Bagman’s ghost may be heard now, sighing in the library ─ Could have been grand right up there on my CV.

GHOSTING MATILDA

The fall season is upon us and the markets are filled with advertising for Halloween, so our thoughts naturally turn to the recent stories o...

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