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A Trustee of What "Caliber" for the Hospital for Special Surgery

The <a href="http://www.hss.edu/about.asp">Hospital for Special Surgery </a>in New York, a prestigious institution focused on orthopedics and rheumatology, closely affiliated with Weill Cornell Medical College, just announced its newest trustee, whose qualifications for the position turn out to be just a wee bit curious. Here they are as described by <a href="http://au.sys-con.com/node/1121412">the press release</a>: He is a former CEO of Wachovia <blockquote> Hospital for Special Surgery announced today that Robert K. Steel, former President and Chief Executive Officer of Wachovia Corporation, has been named a member of the hospital's Board of Trustees. Steel facilitated Wachovia's merger with Wells Fargo to create the second-largest retail brokerage in the country. </blockquote> Before then, he served in the Treasury Department <blockquote> Prior to running Wachovia, Steel served in the U.S. Treasury Department as Under Secretary for Domestic Finance, a Senate-confirmed position. In that role, he was the principal adviser to Secretary Henry Paulson on matters of domestic finance and led the department's activities regarding the domestic financial system, fiscal policy and operations, and governmental assets and liabilities. Steel brings a wealth of experience to the Hospital for Special Surgery Board. He regularly testified before House and Senate Committees on matters such as reform at Fannie Mae and Freddie Mac, foreclosure prevention, and the rescue of Bear Stearns. </blockquote> Before then, he was a leader at Goldman Sachs <blockquote> Steel spent almost 30 years at Goldman Sachs, rising to vice chair of the firm. </blockquote> He was also chairman of the board of Duke University <blockquote> In 2009, Steel completed his term as chair of the board of Duke University. </blockquote> The other members of the Hospital for Special Surgery board were delighted by Steel's qualifications: <blockquote> 'All on the Board of Trustees are delighted to have someone of the caliber of Robert Steel join us to help guide the future of our institution as a leader in orthopedics, rheumatology and their related disciplines,' said Aldo Papone, Co-Chair of the Board of Trustees at the Hospital for Special Surgery. Hospital Board Co-Chair Dean R. O'Hare added, 'As patients continue to seek the Hospital for Special Surgery's world class services in record numbers, we are very pleased Robert Steel is here to support this institution and the superb team of people who work here.' </blockquote> Setting aside the obvious issues that Mr Steel seems to have no particular knowledge of or training in medicine or health, and nothing in the press release suggests he has particular devotion to the values of health care, what do his cited qualifications really mean? Let's go through them in the order they were mentioned above. Former CEO of Wachovia In fact, Steel became CEO of Wachovia in July, 2008, only to soon preside over the company's failure and its hurried merger with Wells Fargo. As <a href="http://www.nytimes.com/2008/09/27/business/27bank.html">reported by the New York Times</a>, by September, 2008, Steel had to give up any hopes of keeping Wachovia independent, <blockquote> As concern spread Friday that more banks might run into trouble even with a $700 billion rescue for the financial system, Wachovia, one of those hardest hit by the housing crisis, became the latest to reach for a lifeline. Weighed down by a huge portfolio of troubled mortgage loans, the nation’s fourth-largest bank by assets entered into preliminary deal talks with Citigroup, and extended feelers to Wells Fargo and Banco Santander of Spain.... In July, the bank hired Robert K. Steel, 56, a former vice chairman at Goldman Sachs, from the Treasury Department, where he worked with Treasury Secretary Henry M. Paulson Jr., trying to resolve the mortgage market crisis. Mr. Steel vowed to keep Wachovia independent and sought to raise $5 billion in capital over the next year by selling noncore assets. </blockquote> The deal with Citigroup fell through, and Wachovia was <a href="https://www.wellsfargo.com/press/2009/20090101_Wachovia_Merger">taken over by Wells Fargo </a>on January 1, 2009. So although Wachovia's portfolio of doubtful mortgages was not the fault of Robert K Steel, he did not succeed in his vow of independence proved to be hollow. Furthermore, questions were raised about Mr Steel's overly optimistic predictions about Wachovia's financial conditions just before the company had to enter into merger talks. As <a href="http://query.nytimes.com/gst/fullpage.html?res=9F04E7D91730F933A0575AC0A96E9C8B63">reported by the New York Times </a>on September 30, 2008: <blockquote> 'Jim, we have a great future as an independent company,' Robert K. Steel, Wachovia's chief executive, told James Cramer on CNBC's 'Mad Money.' 'We're also focused on very exciting prospects when we get things right going forward. I didn't have time today to talk about the good things going on at Wachovia.' That interview wasn't last month or last year -- it took place, amazingly, two weeks ago. Wachovia's shares closed at $10.71 that day. On Monday, Citigroup bought the company for $1 a share. What was Mr. Steel thinking? Did he think he could 'spin' his way to survival? On Mr. Cramer's show Monday night, he spent an entire segment apologizing to his viewers about having Mr. Steel on the program and for his own bullish call on Wachovia's stock. 'I screwed up,' he said, referring at one point to Mr. Steel as a friend for 25 years. 'I believed in the guy. Did he take advantage of me? Perhaps yes.' </blockquote> Early this year, the <a href="http://online.wsj.com/article/SB123275454114111651.html">Wall Street Journal reported </a>that these remarks lead to an investigation by the US Securities and Exchange Commission (SEC): <blockquote> The Securities and Exchange Commission is investigating remarks that former Wachovia Corp. Chief Executive Robert K. Steel made about the future of the bank the day before it started talks about a potential merger.... Among the issues under scrutiny is whether Mr. Steel, 57 years old, misled investors when he appeared on CNBC's 'Mad Money' program on Monday, Sept. 15. The next day, Sept. 16, Wachovia's board met by telephone to discuss strategic options for the company, including raising money, selling core businesses and merging with another company, according to an SEC filing. On Sept. 17, Mr. Steel called Morgan Stanley CEO John Mack to discuss a potential merger, according to people familiar with the matter. By the week of Sept. 22, under pressure from regulators and with customers starting to withdraw deposits, Mr. Steel was immersed in merger negotiations with Citigroup Inc. and Wells Fargo & Co. executives, according to regulatory filings and people familiar with the matter. After initially agreeing to sell its banking operations to Citigroup, Wachovia on Oct. 3 agreed to sell the full company to Wells Fargo. </blockquote> So although Mr Steel could not be blamed for the unfortunate financial position of Wachovia on the day he took over as CEO, he failed in his goal of keeping the company independent, and questions have been raised as to whether his overly optimistic comments just before merger negotiations began misled investors. Thus, his brief performance as leader of Wachovia does not seem something to boast about as a qualification to be a trustee of the Hospital for Special Surgery. Under Secretary of the Treasury For Finance Mr Steel was appointed to his post at the Treasury Department by Henry Paulson. Mr Steel seemed to have a major role in the Paulson Treasury Department's response to the global financial meltdown of 2008. Criticism of Paulson and his department's response to the crisis is so well-known that we need not repeat it here. In response to the discussion in the news release above about Steel's testimony before congress, it is worth quoting a <a href="http://www.nytimes.com/2008/04/04/business/04scene.html">New York Times article </a>about a hearing that took place after the bail out of Bear Stearns, but before the crisis became full-blown. <blockquote> 'How do we guard against a future Bear Stearns,' asked Senator Charles E. Schumer. 'Was someone asleep at the switch?' </blockquote> Later, <blockquote> Did Henry M. Paulson Jr., the Treasury secretary, mandate a rock-bottom price for Bear? 'What did you know and when did you know it,' [Senator Christopher] ... Dodd asked, his voice loud as he pressed Mr. Bernanke, Mr. Steel and Mr. Geithner for an answer. Mr. Steel and Mr. Geithner were artful and vague in their responses.... </blockquote> And just a few days ago, a story emerged that Paulson's plans to force a merger of Wachovia and Goldman Sachs failed because of the multiple conflicts of interest involved, including those affecting Mr Steel (as <a href="http://www.bloomberg.com/apps/news?pid=20601087&sid=aDuX0FiPrFA4">per Bloomberg News</a>): <blockquote> Paulson, the CEO at Goldman Sachs until mid-2006, contacted current CEO Lloyd Blankfein and an unidentified Wachovia director, urging them to consider a combination, Sorkin reported. Goldman Sachs co-President Gary Cohn and Wachovia CEO Robert Steel -- a former vice chairman at the New York investment bank and an undersecretary to Paulson at Treasury -- thought they were near completion of a transaction after Fed Governor Kevin Warsh said the central bank would consider a merger, according to the excerpt. Billionaire investor Warren Buffett, chairman of Omaha, Nebraska-based Berkshire Hathaway Inc., was contacted about investing in the combined companies, Sorkin reported. Buffett told a Goldman Sachs banker the merger would never happen because of the investment bank’s ties to officials at the Treasury and Wachovia, Sorkin reported. </blockquote> So it is not obvious that Mr Steel's work at the Treasury Department covered him in glory, or constituted a particular qualification to lead the Hospital for Special Surgery. Chairman of the Board of Duke University Mr Steel's time in the leadership of Duke coincided with one of the major scandals to afflict higher education in the 21st century, usually called the Duke Lacrosse Scandal. Very briefly, several Duke University students who were also on the university's lacrosse team were charged with raping an exotic dancer. After they were charged, the university leadership seemed to judge that the players were guilty before the trial, and that the whole lacrosse team had to bear some sort of collective guilt. Eventually, the charges were dismissed for lack of evidence, and the prosecutor who pursued them so avidly was disgraced. It turns out that Mr Steel had a role in this scandal too. According to <a href="http://www.newyorker.com/archive/2006/09/04/060904fa_fact">a New Yorker article</a>, Mr Steel took a leadership role in the hiring of Due President Richard H Brodhead: <blockquote> The man charged with bringing Brodhead to Duke was Robert K. Steel, a trustee and chairman of the search committee.... </blockquote> After the lacrosse players were accused of rape, a bizarre email led Brodhead to abandon a measured approach: <blockquote> Brodhead, who had been trying to maintain a balance between avoiding prejudgment and satisfying the mounting pressure for action, was outraged. He said he found the message 'sickening and repulsive,' and he acted immediately. He suspended McFadyen [the student who wrote the email]. Coach Pressler was informed that he had until the end of the day to leave the campus, where he had coached for sixteen years. Brodhead also announced a series of committees that would investigate the team, the administration’s handling of the matter, and the Duke culture itself. In a letter to the Duke community, he wrote that the lacrosse episode 'has brought to glaring visibility underlying issues that have been of concern on this campus and in this town for some time.' The letter went on: They include concerns of women about sexual coercion and assault. They include concerns about the culture of certain student groups that regularly abuse alcohol and the attitudes these groups promote. They include concerns about the survival of the legacy of racism, the most hateful feature American history has produced. Compounding and intensifying these issues of race and gender, they include concerns about the deep structures of inequality in our society—inequalities of wealth, privilege, and opportunity (including educational opportunity), and the attitudes of superiority those inequalities breed. And they include concerns that, whether they intend to or not, universities like Duke participate in this inequality and supply a home for a culture of privilege. </blockquote> This quote in retropsect is beyond ironic given that there was never good evidence to support the charges against the lacrosse players. Brodhead cancelled the lacrosse team's season, but it turned out his reasoning, and that of Mr Steel who seemed to have a major role in the decision, was based mainly on the perceived need to preserve the "Duke brand": <blockquote> When Brodhead cancelled the season, he had said that the moment was too serious to be playing games. What he meant, in part, was that Duke could not be seen to be playing games. From the start, Brodhead had been forced to navigate among several potentially hazardous interests—lacrosse parents who felt angry and abandoned by the school, dismayed alumni and donors, the agitated citizens of Durham, the clamoring press—while protecting what is known in the Allen Building as 'the Duke brand.' On that fitful weekend in late March when the TV satellite trucks hit campus, the lacrosse team could be seen practicing for the Georgetown game, a scene that became an endless video loop suggesting institutional indifference. 'We had to stop those pictures,' Bob Steel says. 'It doesn’t mean that it’s fair, but we had to stop it. It doesn’t necessarily mean I think it was right—it just had to be done.' </blockquote> Clearly, according to Mr Steel and his protege, President Brodhead, preserving the Duke brand was more important than the fair treatment of its students. In 2007, as per <a href="http://www.foxnews.com/story/0,2933,265481,00.html">this Fox News report</a>, the North Carolina Attorney General dispelled the accusations against the lacrosse players. <blockquote> [Attorney General Roy] Cooper said Wednesday that not only was there insufficient evidence proving the three assaulted an exotic dancer at an off-campus lacrosse player in March 2006, but there was 'no credible evidence that an attack occurred at that house on that night.' He even proclaimed the players 'innocent.' 'The result of our review and investigation shows clearly that there is insufficient evidence to proceed on any of the charges,' Cooper said. 'Today we are filing notices of dismissal for all charges.' He added: 'We believe these cases were a result of a tragic rush to accuse and failure to verify serious allegations. Based on these significant inconsistencies of evidence and the various accounts given by the accusing witness, we believe these three individuals are innocent of these charges.' </blockquote> After their exoneration, Mr Steel sent out a message affirming his support of President Brodhead's decisions (presumably including suspending the lacrosse season to preserve the Duke brand, firing the lacrosse coach for no obvious reason, and launching an unwarranted witch-hunt against erroneous attitudes toward sexual assault, and race and gender.) Per <a href="http://durhamwonderland.blogspot.com/2007/04/steel-e-mail.html">the Durham-in-Wonderland blog </a>(written by Prof KC Johnson, who also wrote <a href="http://www.amazon.com/Until-Proven-Innocent-Correctness-Injustices/dp/0312369123">the book </a>about the Duke lacrosse scandal), here is what Steel wrote: <blockquote> Throughout the past year President Richard Brodhead consulted regularly with the trustees and has had our continuing support. He made considered and thoughtful decisions in a volatile and uncertain situation. Each step of the way, the board agreed with the principles that he established and the actions he took. </blockquote> Finally, Steel is now a defendent in a law-suit in the aftermath of of this case, <a href="http://abclocal.go.com/wtvd/story?section=news/local&id=6099859">per the AP</a>: <blockquote> Three unindicted Duke University lacrosse players have amended their civil lawsuit against the school and the city of Durham stemming from false rape accusations two years ago. The Herald-Sun of Durham reported Wednesday the players allege that Duke trustees chairman Robert Steel controlled the school's response and that the school was most interested in protecting its image. </blockquote> So Mr Steel's handling of the Duke lacrosse scandal during his time as chairman of the board of that university also did not exactly cover him in glory, or provide an obvious qualification for him to be a trustee of the Hospital for Special Surgery. Summary So Mr Steel -as CEO of Wachovia failed to keep the company independent, and is under investigation of charges that he misled stock-holders; - as Under Secretary of the Treasury was involved in what many believe was a bungled strategy to combat the global financial meltdown mainly by handing billions of dollars to the misguided Masters of the Universe who brought the meltdown upon us; and - as Chairman of the Board of Duke University seemed to put an ultimately unsuccesful attempt to defend the Duke brand ahead of the rights of its students, and is now the defendent of at least one related lawsuit. It is too soon to tell whether the SEC investigation of the lawsuit will be decided for or against Mr Steel. However, it seems utterly bizarre that the board of the Hospital for Special Surgery would regard Mr Steel's track record as indicative of the "caliber" needed to lead one of the country's premier hospitals. How Mr Steel inspires such praise brings to mind some findings of pollster Frank Luntz that <a href="http://www.latimes.com/news/opinion/la-oe-luntz27-2009sep27,0,4242608.story">appeared in the Los Angeles Times</a>: <blockquote>Today, Americans are boiling mad, and the elites from Washington to Wall Street to West Hollywood don't get it. It can best be summarized by 12 short words bellowed by Howard Beale, the deranged TV anchor in the movie 'Network': 'I'm as mad as hell, and I'm not going to take this anymore.' Americans in the unhappy majority are struggling to keep their jobs as million-dollar bonuses are being awarded at companies their tax dollars bailed out. The core American complaint about politics is that wrongdoing isn't punished, other than at the next election. From scandalous personal behavior to bailouts of everyone and everything except the hardworking middle class, Washington is seen as the source for America's mistakes. Enforcing rules and letting failures fail would stop the excesses today and prevent the mistakes of tomorrow. Such accountability in business would likewise prevent executives at imploding companies from walking away with millions while their employees get skunked. For business and political elites, the message should be clear: Restore trust. </blockquote>Mr Steel's unlikely career trajectory shows how once someone becomes a member of the superclass, the new power elite that spans business, government, and academics, that person is likely to continue to wield power no matter how poor his or her track-record, to the detriment of nearly everyone else.

A Trustee of What "Caliber" for the Hospital for Special Surgery

The Hospital for Special Surgery in New York, a prestigious institution focused on orthopedics and rheumatology, closely affiliated with Wei...

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Fast, simple and now stylish: Google Chrome with Artist Themes

We're always keen to share updates about our browser Google Chrome. This past month, we launched a <a href="http://googleblog.blogspot.com/2009/09/google-chrome-after-year-sporting-new.html">new stable release</a> with speed improvements and updates to key features, as well as a little something extra to make your browser pop: themes. Today, we're excited to build on this initial splash of color. We invited leading artists, architects, musicians, illustrators, filmmakers and fashion and interior designers from around the globe to create artwork for an unusual canvas: the modern web browser. The result? <a href="https://tools.google.com/chrome/intl/en/themes/p/at_chrome.html?hl=en&utm_campaign=en&utm_source=en-googleblog-theme&utm_medium=googleblog">Artist Themes for Google Chrome</a>, a fusion of art and technology, with a hundred Artist Themes that we hope will enrich and personalize your web browsing experience. We're honored to have had the opportunity to work with artists including Jeff Koons, Jenny Holzer, Karim Rashid, Jonathan Adler, Oscar de la Renta, Anita Kunz, Tom Sachs, Kate Spade, Donna Karan, Kid Robot, Casey Reas, Dolce & Gabbana, Michael Graves, Todd Oldham, Yann Arthus-Bertrand and Mariah Carey (and that's just to name a few!). We would like to extend our thanks to all the artists for lending their vision, imagination and hard work to this collaboration. For a behind-the-scenes look at one illustrator's unique creative process, check out the <a href="http://chrome.blogspot.com/2009/10/splash-of-color-to-your-browser-artist.html">Google Chrome Blog</a>. And for a preview of these themes, here's a video flipbook we've compiled to showcase some of the artistry behind this project: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/Q_BSrFCvfww&hl=en&fs=1&hd=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/Q_BSrFCvfww&hl=en&fs=1&hd=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> If you haven't tried Google Chrome recently, <a href="https://tools.google.com/chrome/intl/en/themes/p/at_chrome.html?hl=en&utm_campaign=en&utm_source=en-googleblog-theme&utm_medium=googleblog">download the latest version</a> and give the Artist Themes a whirl. If you're already using Google Chrome, check out the <a href="https://tools.google.com/chrome/intl/en/themes/index.html?hl=en&utm_campaign=en&utm_source=googleblog-theme&utm_medium=googleblog">themes gallery</a> and try on your favorite Artist Themes. Posted by Glen Murphy, Software Engineer, and Mark Sabec, Associate Product Marketing Manager

Fast, simple and now stylish: Google Chrome with Artist Themes

We're always keen to share updates about our browser Google Chrome. This past month, we launched a new stable release with speed improv...

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AdSense for Mobile optimized for high-end phones

High-end mobile phones, like iPhone, Android-powered devices and the Palm Pre , continue to grow — Gartner estimates that global sales of smartphones will soar by 27% in 2009, to 177 million units. Naturally, as a result more and more people are browsing the web on the go. Because these devices offer a browsing experience that is similar to desktop computers, advertising on smartphones is a natural extension for any AdWords campaign. However, it's not always been easy for advertisers to reach people on smartphones. That's why we're investing in new high-end mobile advertising products such as <a href="http://googlemobile.blogspot.com/2008/12/new-adwords-options-for-iphone-and-g1.html">our search ad options for high-end phones</a> and <a href="http://googleblog.blogspot.com/2009/06/announcing-adsense-for-mobile.html">AdSense for mobile applications</a>. We hope to make advertising on high-end mobile devices as intuitive, effective and user-friendly as our existing AdWords tools. Today, we're excited to announce a new feature for our AdSense mobile publishers that enables them to serve text and image ads on their sites — specifically on these high-end smartphones. This helps mobile publishers earn revenue and fund more mobile-specific sites and web content. New features like this help to nurture the smartphone ecosystem by encouraging the creation of more mobile content and by helping advertisers to grow their businesses by reaching new audiences. Our users' experience is also improved, with increasingly relevant and device-optimized mobile ads that load faster and fit better on small screens. For more info about this feature, check out the <a href="http://adsense.blogspot.com/2009/10/adsense-for-mobile-goes-high-end.html">Inside AdSense Blog</a>. Posted by Danielle VanDyke, Software Engineer

AdSense for Mobile optimized for high-end phones

High-end mobile phones, like iPhone, Android-powered devices and the Palm Pre , continue to grow — Gartner estimates that global sales of sm...

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Teaming up with Adobe and the Open Screen Project

At Google, we've been working closely with the folks at Adobe for years. Some of our most exciting projects such as YouTube, Android, <a href="http://googleblog.blogspot.com/2008/09/adobe-users-get-help-with-google-site.html">Google Site Search</a>, Google Chrome and even <a href="http://googleblog.blogspot.com/2008/06/google-learns-to-crawl-flash.html">Google web search</a> require close integration with Adobe's technologies. Our engineering teams regularly exchange ideas, tips and bugs as we build upon each others' efforts. Along these lines, we're excited to be <a href="http://www.adobe.com/aboutadobe/pressroom/pressreleases/200910/100509AFPforMobileDevicesandPCs.html">joining</a> Adobe's <a href="http://www.openscreenproject.org/">Open Screen Project</a>, an initiative established a year and a half ago to help developers more easily design content for the web across multiple screens using the Flash Platform. We've always believed that open platforms lead to greater innovation on the web and we see participating in the Open Screen Project as another step in that direction. We're excited to continue working with the teams at Adobe on pushing the web forward and to see where the next generation of web development will take us. Posted by Bill Coughran, Senior Vice President of Engineering

Teaming up with Adobe and the Open Screen Project

At Google, we've been working closely with the folks at Adobe for years. Some of our most exciting projects such as YouTube, Android, Go...

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Helping the victims of Tropical Storm Ketsana

Last weekend, Tropical Storm Ketsana (local name "Ondoy") pounded Manila and nearby areas of the Philippines with a month's worth of rain in just a few hours, resulting in floods that covered 80% of the city with as much as 20 feet of water. The typhoon left in its wake nearly 300 people dead and hundreds of thousands displaced. We're very saddened by the losses the Filipino people have sustained during this calamity. To help you stay up to date on the disaster and contribute to the relief efforts, we've put up a <a href="http://www.google.com/landing/typhoon-ondoy.html">Help for Typhoon Ondoy Victims in the Philippines page</a> that contains the latest news from local media outlets, lists of verified donation sites and emergency hotlines, and a volunteer-maintained map of persons needing rescue. Filipinos have been <a href="http://www.youtube.com/results?search_query=ondoy&search_type=&aq=f">posting videos of the flooding and its aftermath</a> on YouTube. You can also visualize the overflows along main rivers and bays in Google Earth with <a href="http://www.google.com/landing/kmz/Kestana_Cyclone_TayTay.kmz">this kmz file</a>. If you're familiar with Google Maps and would like to get involved in the effort to map <a href="http://maps.google.com/maps/ms?ie=UTF8&hl=en&msa=0&msid=114275963314561391621.000474bb18f93804bc564&ll=14.597372,121.131821&spn=0.038955,0.063944&z=14">missing persons</a>, <a href="http://maps.google.com/maps/ms?ie=UTF8&hl=en&msa=0&msid=114275963314561391621.000474b14dc5c675ed8b5&z=10">relief centers</a> and <a href="http://maps.google.com/maps/ms?ie=UTF8&hl=en&msa=0&msid=114275963314561391621.000474b16c00c055bb4d7&z=8">road conditions</a>, you can email the volunteer team at typhoonondoy@googlegroups.com. We will continue to update the page with the latest information and imagery, and keep your eye on the <a href="http://www.google-latlong.blogspot.com/">Lat Long blog</a> for updates about disaster relief efforts. Posted by Therese Lim, Google Southeast Asia Team

Helping the victims of Tropical Storm Ketsana

Last weekend, Tropical Storm Ketsana (local name "Ondoy") pounded Manila and nearby areas of the Philippines with a month's wo...

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This week in search 10/2/09

This is part of a regular series of posts on search experience updates that runs on Fridays. Look for the label "This week in search" and subscribe to the series. - Ed. At Google, we're completely committed to the needs of our users. This is one reason we make constant changes to the <a href="http://www.google.com/search?hl=en&rlz=1C1GGLS_enUS319US319&defl=en&q=define:User+Experience+&ei=Ek_GSruBAo6gswP9nJiiBQ&sa=X&oi=glossary_definition&ct=title">user experience</a> — so you have a better search experience. Some of the changes are larger features like our <a href="http://googleblog.blogspot.com/2009/05/more-search-options-and-other-updates.html">Search Options</a>; some are small visual refinements, like our <a href="http://googleblog.blogspot.com/2009/09/now-s-u-p-e-r-sized.html">larger search box</a>. Starting today, we'll post a story each Friday that showcases some of the user experience updates we've made to our search in the past week, complete with example searches, and how and where to see the improvements. This way, loyal search aficionados can see and experiment with all of updates in one easy-to-access place. Hot Trends highlighted on results page Have you ever wondered how many people query [tsunami] or [samoa] right after they read about it in the news, or are you the only one looking? For years, <a href="http://www.google.com/trends">Google Trends</a> has let you search an aggregation of what other people are searching for. Now we're taking that concept to the results page and showcasing fast-rising terms with a graph at the bottom of the page. To see it, try one of these searches and scroll to the bottom: Example search: [<a href="http://www.google.com/search?hl=en&rlz=1C1GGLS_enUS291US304&q=olympic+bid&aq=f&oq=&aqi=g10">olympic bid</a>] The queries here are rather fleeting by nature — one minute they're hot; the next, cold. (Apologies if [olympic bid] no longer shows this off.) The easiest way to be sure to see this feature is try one of the searches from our <a href="http://www.google.com/trends/hottrends?sa=X">Hot Trends</a> page. You'll see the hot trend featured at the bottom of the search results page, highlighted with a graph. New tools in Search Options We've just added a host of new tools in our Search Options panel. To view the Search Options, do a search, find "Web" in the top blue bar, and click on the "+ Search Options" link to the right of it. A navigation bar on the left side of the screen will appear. We launched Search Options back in May, but this week we're adding a <a href="http://googleblog.blogspot.com/2009/10/refine-your-search-results-with-new.html">set of new and exciting features</a>. Among them: Better way to shop and research products Have you ever found that your search sometimes feels too commercial when you're just starting to think of buying? Or maybe you've experienced the opposite, where you can't find an online store to buy something despite your best attempts. We've just introduced a way for you to control the number of stores you see in your results. Example search: [<a href="http://www.google.com/search?q=flip%20camera">flip camera</a>] <div>Click on the link in Search Options that says "Fewer shopping sites" and you'll see mostly reviews and technical specifications. When you're ready to buy, click on the link in Search Options that says "More shopping sites." You'll see mostly stores listed, and the results even note the prices and specific products right on that page. Learning from history If you use personalized search and web history, it's now easier for you to see which of the search results you have visited already and which you haven't. Example search: [<a href="http://www.google.com/search?q=youtube">youtube</a>] </div><div>With the Search Options panel open and while you're signed in to Google (look for your user name in the upper righthand corner), click on the "Visited Pages" tool. Your results will then show only pages you've visited that contain the term 'YouTube.' Now, click on the tool "Not yet visited" where you will see only pages you haven't yet seen that contain 'YouTube.' Keeping up with time The Search Options panel has always helped users search over time, but now there are two new features that help you do this even more flexibly: "Past hour" and "Specific date range." Example search: [<a href="http://www.google.com/search?q=obama">obama</a>] </div><div>Click on the "Past hour" link and you'll see all the recent news and web pages published in the past hour on [obama]. Example search: [<a href="http://www.google.com/search?q=michael+jordan">michael jordan</a>] </div><div>Now click on "Specific date range" and try the period surrounding Jordan's last championship (5/1/98 through 7/31/98), and you'll see all the press from the Chicago Bulls' win and various articles covering him that summer. Personalized Suggest now on Mobile Finally, here's a fun tidbit that bridges web search on the desktop to web search on mobile. New this week, Google Suggest (the suggested queries that appear below the search box as you type) on your mobile phone is personalized, based on searches from your desktop. This feature only applies when you are signed in to your Google account, and only for searches done while you are signed in. We think this small feature is significant because it enables you to easily migrate your search tasks from the desktop to your phone. It's also one of the first instances in which your desktop search usage can improve your mobile search experience, and vice versa. Hope you enjoyed this week's features. Stay tuned for what's next! Posted by Marissa Mayer, VP, Search Products & User Experience</div>

This week in search 10/2/09

This is part of a regular series of posts on search experience updates that runs on Fridays. Look for the label "This week in search...

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The Role of the RUC in Medicare's Price-Fixing and Rationing Remains Anechoic

An important part of the noisy and contentious debate about health care reform in the US centers on the role of the government as a provider of health insurance. Some on the left want a government "single-payer" plan to be the only health insurance available. Some left of center want a government "public option" health insurance plan to be available, particularly to those who have trouble obtaining commercial insurance. Some on the right want none of it, and sometimes note that the existing government single-payer plan for the elderly and disabled, Medicare, has important faults that would only become more significant if the plan is extended or duplicated. Yet even critics of Medicare on the right do not seem to want to talk about what may be its worst fault. The latest example, an <a href="http://online.wsj.com/article/SB20001424052970204488304574435464052451436.html">op-ed piece by Dr Scott Gottlieb</a>, appeared in the Wall Street Journal yesterday. Dr Gottlieb's main point was that health care rationing by either government or private insurers is inevitable, but that "government does it in far more byzantine and arbitrary ways." In particular, <blockquote>Consider the $450 billion Medicare program. It provides a model for—indeed its bureaucracy could well end up running—the 'public option' health plan that Mr. Obama wants to offer all Americans under the age of 65. In recent years, Medicare's staff has been aggressively restricting coverage for costly treatments. This often means limiting access to the costliest technologies. To do this Medicare relies on its rationing and pricing systems. </blockquote> Gottlieb then cited several examples, "tortured decisions concerning the use of implantable defibrillators," and "the travails of the pharmaceutical company Spracor and its drug Xopenex, an innovative respiratory medicine that competes with the chemically distinct and much cheaper generic albuterol." Finally Gottlieb decried Medicare's decision making processes applied to costly technologies as "impenetrable." His summation was <blockquote> There's nothing inherently wrong with a program like Medicare seeking value for taxpayers. But it shouldn't make up the rules as it goes. </blockquote> Let me first say that I actually agree with Dr Gottlieb's main points. Any government or private health insurance plan ought to seek value for its money. However, how it does so ought to be rational, based on understanding of medicine and the clinical context, and transparent and accountable to the patients on whose behalf such plans pay. "Covert rationing" (as has been well discussed in the <a href="http://covertrationingblog.com/">Covert Rationing Blog</a>) raises worries that decisions are being made just to save money, not to improve value, and even that decisions are being made without informed consideration of the clinical context, or based on the self-interest of the decision makers, or even that decisions may result from bribery and corruption. But if Dr Gottlieb is so concerned about Medicare rationing care as a result of opaque and unaccountable decision making, why is he not more concerned about how Medicare controls the prices of physicians' services than about its decisions about a few expensive, high-tech and infrequently used treatments? We have written again and again about how Medicare has allowed decisions about what physicians are paid for providing various services to be made de facto by an opaque private committee run by the American Medical Association. This decision-making process has lead to relatively generous payments for procedures, versus miserly payments for "cognitive services," (that is, "evaluation and management services," or for physicians interviewing, examining, and counseling patients, making diagnoses, predicting prognoses, and making decisions about treatment.) The resulting perverse incentives are a major reason that primary care has become increasingly unavailable, and for our expensive patterns of care dominated by high-technology and invasive procedures. More detail quoted from <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">a previous post </a>appears below. <blockquote>As we have discussed, the US Medicare system determines what it pays physicians using the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/overview-of-rbrvs.shtml">Resource Based Relative Value System (RBRVS)</a>. This system determines the pay for every kind of medical encounter according to a complex formula that is supposed to account for physicians' time and effort, physicians' practice expense, and the cost of malpractice insurance. The components of physicians' effort assessed are, in turn, technical skill and physical effort; the required mental effort and judgment; and stress due to the potential risk to the patient.To keep the system, which was started in 1990, current, requires addition of new kinds of encounters, which means encounters involving new kinds of procedures, and updating of the estimates of various components, including physicians' time and effort. To do so, the Center for Medicare and Medicaid Services (CMS) relies almost exclusively on the advice of the RBRVS Update Committee (RUC). The <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/the-rvs-update-committee.shtml">RUC</a> is a private committee of the AMA, touted as an "expert panel" that takes advantage of the organization's First Amendment rights to petition the government. Membership on the RUC is allotted to represent specialty societies, so that the vast majority of the members represent specialties that do procedures and focus on expensive, high-technology tests and treatments. However, the identities of RUC members are secret, as are the proceedings of the group.This opaque and unaccountable process has resulted in increases outstripping inflation in fees paid for procedures, while fees paid for 'cognitive" medicine,' i.e., for primary care, and for services that involve diagnosis, management of acute and chronic disease, counseling, coordination of care, etc, but not procedures, have lagged inflation. The effects of the RUC have been amplified by the unexplained tendency of commercial managed care and health insurance to track the RBRVS system when making their own payments to physicians.For further details about the RUC, see these posts on Health Care Renewal (<a href="http://hcrenewal.blogspot.com/2007/03/on-disparities-between-reimbursement-of.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/12/is-sustainable-growth-rate-main-problem.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/05/payments-for-patient-centered-medical.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/07/can-we-fix-medicare-while-pretending.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2008/12/no-such-ruc-new-england-journal-takes.html">here</a>) and important articles by Bodenheimer et al,(1) and Goodson.(2) By the way, why the US Center for Medicare and Medicaid Services (CMS) relies de facto exclusively on the RUC to control the RBRVS system, and why the AMA made the RUC into a secret organization apparently beholden only to the organization's proceduralist members are unanswered questions. </blockquote>Our most recent posts about the RUC are <a href="http://hcrenewal.blogspot.com/2009/02/what-ruc-again-one-of-worlds-most.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/08/sgim-urges-chuck-ruc.html">here</a>. Other bloggers, notably including Dr Robert Centor on <a href="http://www.medrants.com/">DB's Medical Rants</a>, have criticized the RUC. The Society of General Internal Medicine seems to be the only medical society that has criticized the RUC (see <a href="http://hcrenewal.blogspot.com/2009/08/sgim-urges-chuck-ruc.html">this post</a>). Yet even ostensibly conservative and libertarian pundits who decry price-fixing and rationing by Medicare have ignored this vivid and important example of opaque and unaccountable price-fixing and rationing. And ostensibly liberal proponents of public options and single-payer systems have not explained how they would make their rationing more rational, transparent, and accountable, or how simply insuring more patients under Medicare-like programs would not result in even higher costs, poorer access, and worse quality. The lack of discussion of the RUC remains one of the more striking examples of the <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic effect</a>. Failing to address why our costs are so high, are access is so poor, and our quality is so challenged will make it likely that any supposed reform effort will only make these problems worse. References 1. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306. Link <a href="http://www.annals.org/cgi/content/full/146/4/301">here</a>. 2. Goodson JD. Unintended consequences of Resource-Based Relative Value Scale reimbursement. JAMA 2007; 298(19):2308-2310. Link <a href="http://jama.ama-assn.org/cgi/content/short/298/19/2308">here</a>.

The Role of the RUC in Medicare's Price-Fixing and Rationing Remains Anechoic

An important part of the noisy and contentious debate about health care reform in the US centers on the role of the government as a provider...

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