healthy4u

BLOGSCAN - Why Problems at Local Marquee Hospitals May be Anechoic

We have often discussed how the shortcomings of leadership of big health care organizations may be anechoic.  (See <a href="http://hcrenewal.blogspot.com/2011/01/who-undermined-these-wonderful.html">this post</a> for a recent example.)  Now, on the HealthBeat blog, Maggie Mahar <a href="http://www.healthbeatblog.com/2011/01/when-a-local-newspaper-investigates-local-hospitals-.html">discussed</a> how journalists often fail to look closely at the actions of large, well-known local hospitals.  She noted some possible causes: - "Hospitals, after all, are major advertisers." - "the marquee hospital’s patrons tend to be powerful local figures." - " most readers really don’t want to hear that their local academic medical center is having problems...." She also summarized just how unhealthy relationships among the news media and marquee hospitals can become, but also provided some examples of incisive investigative reporting.  As they say, read the whole thing.

BLOGSCAN - Why Problems at Local Marquee Hospitals May be Anechoic

We have often discussed how the shortcomings of leadership of big health care organizations may be anechoic. (See this post for a recent e...

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"I'm Not Here to Sell Drugs" - Then Why Use Company Provided "Correct" Slides?

In October, 2010, we <a href="http://hcrenewal.blogspot.com/2010/10/not-best-and-brightest-drug-marketers.html">discussed</a> a series of reports by Pro Publica and multiple other respected news organizations about payments by seven pharmaceutical companies to thousands of doctors.  Industry often claims that they only pay the best and the brightest physicians and academics to provide education relevant to their products.  However, the ProPublica et al report suggested that they mainly recruited physicians who already showed their favor to their products by prescribing them often, but soothed their consciences by dubbing them "thought leaders" or "key opinion leaders."  While some of the physicians were well-known academics, others had notably blemished records.  Since then, news media around the US have looked into interactions among local physicians and academic medical institutions and the seven pharmaceutical companies.  In November, 2010, <a href="http://hcrenewal.blogspot.com/2010/11/of-drug-talks-deception-and-denial.html">here</a> we discussed cases that suggested that pharmaceutical companies like physician speakers because they are more "believable" than pharmaceutical representatives, and choose physicians who already are prolific prescribers of the drug to be promoted, and that suggested that some physicians realized that speaking for pharmaceutical companies influenced their own prescribing. Since then, more investigations of local physicians' interactions with pharmaceutical companies have appeared that reinforced contrasts between rationalizations that physicians and drug companies use to support continued payments for "drug talks," and what these talks are really about. "Leaders in Their Field" vs Sanctions and Crimes  Many pharmaceutical (and other health care corporations) have repeated the mantra that the physicians they hire to give talks are the best and the brightest.  The physicians who give the talks sometimes get to believe this.  For example, a ProPublica follow-up report[1] on discrepancies between data the pharmaceutical companies put on the web and gave to state regulators noted: <blockquote>Pfizer, for example, told the state it paid Dr. Randy Schapiro $1,770 last year. But on the firm’s website, it reported spending $43,827 on him in the second half of 2009 alone.</blockquote>It then quoted Dr Schapiro: <blockquote>Schapiro said the doctors paid by pharmaceutical companies are 'leaders in their fields,' and patients should want to see their physician among them. 'If their doctor is not on the list,' he said, 'maybe they should look for a different doctor.'</blockquote> On the other hand, several of the local news articles focused on physicians who were paid drug company speakers despite having chequered backgrounds, shall we say. In the Elmira Star Gazette[2]: <blockquote>Tulio Ortega, a Rochester psychiatrist who made $144,548 from Eli Lilly and AstraZeneca for speaking to groups of peers during the last two years - was put of [sic] probation for two years in 2008 and ordered to pay a $7,500 fine after being sanctioned for negligence and incompetence.</blockquote>Also, <blockquote>Lilly also paid Yonkers physician Ali Sherzoy $4,334 in the first two quarter of this year, even though he had his license suspended in New York and New Jersey earlier this year after pleading guilty to a count of criminal sexual contact in 2008. Sherzoy told ProPublica the incident involted his family's nanny and had nothing to do with his ability to practice medicine. Other New York doctors were sanctioned for incidents ranging from deficiencies in handling controlled substances to being convicted of tax evasion.</blockquote> Another article by the same author[3] noted two more cases: <blockquote>In 1991, Johnson City doctor Louis Mateya was charged with professional misconduct after a 22-year-old woman accused him of unzipping his pants and fondling himself during an examination. Mateya admitted guilt to the charge. The State Board for Professional Medical Conduct suspended his license for two months, followed by a 58-month probationary period, during which he was monitored by a psychiatrist and a health professional selected by the board. During the last nine months of 2009, GlaxoSmithKline paid Mateya, an internist at United Health Services, $1,750 to speak on behalf of Lovaza, Glaxo's prescription omega 3 fish oil, according to an e-mail from a United Health Services spokeswoman.</blockquote> Also, <blockquote>A second Southern Tier physician, Robert Douenias, of Corning, was also paid by Glaxo: $20,000 during the same time frame to deliver speeches, even though he received sanctions in 1992. According to the Office for Professional Medical Conduct (OPMC) records, Douenias lied about a previous criminal conviction on his application for a New York medical license. He received a censure and reprimand from the OPMC, was ordered to perform 200 hours of public service and was placed on probation for two years. Douenias said on his application he had never been convicted of a crime in any state or country, even though he had a previous conviction, according to OPMC records.</blockquote> Note that the original ProPublica reporting from their database emphasized cases of physicians paid to speak by pharmaceutical companies who also had been sanctioned by medical boards or the criminal justice system (see post <a href="http://hcrenewal.blogspot.com/2010/10/not-best-and-brightest-drug-marketers.html">here</a>). Although drug marketers like to tell physicians they are selected as "thought leaders" because of their brilliance, it appears that the selection of such "key opinion leaders" is not necessarily based on sterling character. "I'm Not There to Sell a Drug," But Then Why Use the Company's Slides? A number of the reports featured physicians who asserted their independence, at least from marketing goals.  For example, as reported by the Duluth (MN) News Tribune[4], <blockquote>A Duluth psychiatrist has received more than $525,000 since 2002 in payments from pharmaceutical companies, far more than any other Northland doctor, an analysis by the News Tribune shows. Dr. Tracy Tomac of St. Luke’s hospital was paid by the companies to give presentations on health and drug issues.</blockquote> Furthermore, <blockquote>'I’m there as an educator and resource,' she said. 'I’m not in business to do a sales pitch. I’m not a salesperson.'</blockquote> Also, <blockquote>In 2007, [Dr] Tomac said her presentations included content that was screened and approved by the FDA,....</blockquote> However, other reporting suggested that content "screened and approved by the FDA" was content provided by the pharmaceutical companies. For example, The Tennessean noted[5]: <blockquote>Dr. Jan Brandes heads the Nashville Neuroscience Group, a clinic that's now part of Nashville-based Saint Thomas Health Services. She made $111,150 in outside income over the past two years, largely in speaker fees paid by drug company GlaxoSmithKline, which markets a wide array of brand-name drugs, literally from A to Z.</blockquote> Dr Brandes also asserted, <blockquote>'The real point is I'm not there to sell a drug,' Brandes said. 'I'm there to interpret trial results, talk about disease states and help physicians understand where this research might fit in the context of their practice.'</blockquote> However, <blockquote>Most drug companies now require physicians to use the company's slides and presentations if they pay them to speak at an event. The industry says that is to ensure that all U.S. Food and Drug Administration rules are met and that physicians don't wander off into discussing uses for a particular product that haven't been approved by regulators.</blockquote> Also, an article in the Alexandria (VA) Gazette Packet[6] noted: <blockquote>Whistleblower lawsuits filed in recent years have accused firms of using doctors to push pills for unapproved uses during dinnertime talks, prompting at least 10 firms to settle cases for nearly $7 billion in the last three years. Since that time, pharmaceutical companies have tightened control over what happens during presentations given on their dime. Last year, for example, GlaxoSmithKline instituted a new policy prohibiting doctors from using their own slides during presentations. Starting in 2010, all doctors giving speeches sponsored by GlaxoSmithKline must use slides presented by the pharmaceutical company in the order specified. 'We want to make sure that everything is correct,' said Mary Anne Rhyne, a spokeswoman for GlaxoSmithKline. 'The best way to do that is to have our team prepare the slide.'</blockquote>Note that Dr Brandes above was paid mainly by GlaxoSmithKline, who presumably also provided all her slides and made sure that everything she said was "correct," at least in terms of what GlaxoSmithKline thought was correct. And one more example per MyFoxAtlanta[7]: <blockquote>Some of Georgia's highest paid physicians? .... and Roswell psychiatrist Dr. Michael Banov: over $68,000, also from Lilly.</blockquote>Dr Banov asserted: <blockquote>We don't sell medications. We simply educate physicians about data, and they make their own mind up.</blockquote>However, <blockquote>Banov says, the drug company - not him - creates the materials used in his speeches, and he says there's a reason for that. 'We are only able to present the data. We're not able to present our personal opinions. Our personal preferences, how we use the medication off label. any of that. So we're held to a very tight standard by the FDA,' said Banov.</blockquote>Drug companies may say they make their paid physician speakers use slides provided by the company to prevent them from talking about "off-label" uses.  However, there is no reason for a physician-educator not to talk about "off-label" uses, and physicians can prescribe any legal drug for whatever purpose they see fit, whether or not the drug is on or "off label."  But drug companies are prohibited by law from promoting off-label uses.  Requiring physicians to use drug companies' slides and preventing them from talking about "off-label" uses demonstrates that the physicians are functioning as marketers, not educators.  Summary As local reporters look into more cases, it becomes increasingly clear that up to now, pharmaceutical companies have been none too fussy about which physicians they pay to speak about their products. It is self-serving, but inaccurate for both sets of parties to assert that the companies choose only the "best and the brightest."  Furthermore, it has now become glaringly obvious that the purpose of "drug talks" is, well, to sell drugs.  Some physicians paid by drug companies to speak may bluster about their independence, but if they are using company provided slides, who can deny they are influenced  by the company.  Furthermore, when companies insist not merely on providing slides, but on ensuring that "everything is correct," then it is clear that it is the companies' talks that the physicians are giving.  Physicians giving company talks cannot be speaking independently, and hence must be regarded as company sales personnel, whose disguises as independent doctors or medical academics are now in tatters. Doctors who still choose to go to "drug talks" should have no illusions that they are being exposed to anything other than marketing.  Thus, I urge my colleagues to forgo the nice meals and the company prepared "correct" slides, and spend the time trying to more critically assess the clinical evidence.  References 1.  Ornstein C, Weber T. In Minnesota, drug company reports of payments to doctors arrive riddled with mistakes.  ProPublica, Dec 10, 2010.  Link <a href="http://www.propublica.org/article/in-minnesota-drug-company-reports-of-payments-to-doctors-mistaken">here</a>. 2. Hunter J. Rochester psychiatrist, sanctioned for incompetence, made $144K from drug companies. Elmira Star-Gazette, Dec 4, 2010. 3. Hunter J. Despite sanctions, physicians hired as drug company pitchmen. PressConnects.com, Dec 4, 2010. Link <a href="http://www.pressconnects.com/article/20101204/NEWS01/12040345/Despite-sanctions-physicians-hired-as-drug-company-pitchmen">here</a>. 4. Stahl B. Duluth doctor denies payments from drug companies sway decisions.  Duluth News Tribune, Dec 20, 2010.  Link <a href="http://www.duluthnewstribune.com/event/article/id/186841/">here</a>. 5. Ward G. They say they prescribe based on patients, not Big Pharma. Tennessean, Dec 19, 2010. Link <a href="http://www.tennessean.com/article/20101219/BUSINESS01/12190355/TN-doctors-get-big-bucks-from-drugmakers">here</a>. 6. Pope ML. Conflict of interest? - Alexandria doctors receive thousands of dollars from Big Pharma.  Alexandia Gazette Packet, Jan 13, 2010.  Link <a href="http://www.connectionnewspapers.com/article.asp?article=347442&paper=59&cat=104">here</a>. 7. Galvin B. Health watch: doctors and drug companies. MyFoxAtlanta, Dec 29, 2010. Link <a href="http://www.myfoxatlanta.com/dpp/health/Health-Watch%3A-Doctors-and-Drug-Companies-20101229-gda-sd">here</a>.

"I'm Not Here to Sell Drugs" - Then Why Use Company Provided "Correct" Slides?

In October, 2010, we discussed a series of reports by Pro Publica and multiple other respected news organizations about payments by seven p...

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Clinicians Going for a Swim and Drowning in Information

Clinicians these days at computerized facilities are often drinking information from a firehose, and even worse. Just to make their tasks more difficult, the firehose is <a href="http://www.tinyurl.com/hostileuserexper">difficult to use</a>, it sputters on occasion due to "glitches" in the water pumps, and sometimes even emits fouled water due to problems at the reservoir or connecting pipes, without frequent "workarounds" and mental gymnastics by the clinicians. I've seen it personally in the care of relatives. This is far from the dream of Medical Informatics, whose specialists viewed IT as a tool to reduce cognitive overload and make healthcare provision more efficient. Why is information overload a bad thing? Here's why: <blockquote>New York Times <a style="font-weight: bold;" href="http://www.nytimes.com/2011/01/17/technology/17brain.html">In New Military, Data Overload Can Be Deadly</a> By THOM SHANKER and MATT RICHTEL January 16, 2011 When military investigators looked into an attack by American helicopters last February that left 23 Afghan civilians dead, they found that the operator of a <a class="meta-classifier" title="More articles about unmanned aerial vehicles." href="http://topics.nytimes.com/top/reference/timestopics/subjects/u/unmanned_aerial_vehicles/index.html?inline=nyt-classifier">Predator drone</a> had failed to pass along crucial information about the makeup of a gathering crowd of villagers.But Air Force and Army officials now say there was also an underlying cause for that mistake: information overload. At an Air Force base in Nevada, the drone operator and his team struggled to work out what was happening in the village, where a convoy was forming. They had to monitor the drone’s video feeds while participating in dozens of instant-message and radio exchanges with intelligence analysts and troops on the ground. There were solid reports that the group included children, but the team did not adequately focus on them amid the swirl of data — much like a cubicle worker who loses track of an important e-mail under the mounting pile. The team was under intense pressure to protect American forces nearby, and in the end it determined, incorrectly, that the villagers’ convoy posed an imminent threat, resulting in one of the worst losses of civilian lives in the war in Afghanistan. “Information overload — an accurate description,” said one senior military officer, who was briefed on the inquiry and spoke on the condition of anonymity because the case might yet result in a court martial. The deaths would have been prevented, he said, “if we had just slowed things down and thought deliberately.” Data is among the most potent weapons of the 21st century. Unprecedented amounts of raw information help the military determine what targets to hit and what to avoid. And drone-based sensors have given rise to a new class of wired warriors who must filter the information sea. But sometimes they are drowning. Research shows that the kind of intense multitasking required in such situations can make it hard to tell good information from bad. The military faces a balancing act: how to help soldiers exploit masses of data without succumbing to overload. </blockquote> Read the entire NY Times piece.I have no other comments to offer, other than (as the military seems to recognize for its own needs through engaging experts in domains such as neuroscience), the time to "accelerate interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering" as recommended in 2009 by the <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">National Research Council</a> is before the attempted national rollout of hundreds of billions of dollars of technology. The time to do so is not during - and certainly not after - the HITECH-led medical re-engineering attempt.Finally, unlike the health IT industry, I don't see the military attributing these issues to "Luddite soldiers." <table id="Table1" width="100%" align="left" border="0" cellpadding="1" cellspacing="1"><tbody><tr></tr></tbody></table>-- SS

Clinicians Going for a Swim and Drowning in Information

Clinicians these days at computerized facilities are often drinking information from a firehose, and even worse. Just to make their tasks mo...

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Guidant (Boston Scientific) Gets Probation

The latest in the parade of <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">legal settlements</a> by health care corporations involves a new wrinkle.  We have been writing about the case of <a href="http://hcrenewal.blogspot.com/search/label/Guidant">Guidant Corporation's</a> faulty implantable cardiac defibrillators (ICDs) <a href="http://hcrenewal.blogspot.com/2005/05/guideants-short-circuit.html">in 2005</a>, almost since the start of the Health Care Renewal blog.  A quick summary, <a href="http://www.startribune.com/business/113367264.html">via the Minneapolis Star-Tribune</a>, is: <blockquote>In 2005 Minneapolis Heart Institute doctors Barry Maron and Robert Hauser went public with concerns about a Guidant defibrillator called the Ventak Prizm 2 after a 21-year-old patient died when his defibrillator short-circuited and failed to revive him after he went into sudden cardiac arrest. Guidant had known about the short-circuiting issue since 2002 and had made two attempts to fix the device, according to court documents. The company did not alert the FDA -- even though federal law requires manufacturers to report changes that may pose a health risk to patients. In early 2004, Guidant discovered a similar short-circuiting problem in different defibrillator models called Contak Renewal 1 and 2. The company ordered its factory to stop making and shipping the models, but potentially faulty products on hospital shelves continued to be implanted in thousands of patients. Although engineers at Guidant had recommended recalling the Contak Renewal devices, upper management rejected the proposal, court documents state. Instead, Guidant issued the 'least aggressive' form of communication, called a product update, in which sales representatives were told to tell doctors that 'nothing was broken' with the device. Maron and Hauser met with top Guidant officials in May 2005 and urged the company to communicate the problem to doctors, but Guidant refused. The doctors then went to the New York Times, which published an article indicating that the company had known for three years that the Ventak Prizm model could short-circuit, but did not communicate that to doctors. In June 2005, Guidant issued a public missive detailing safety issues with the defibrillators, which were later recalled by the FDA.</blockquote> A longer version from a series of Health Care Renewal posts can be found <a href="http://hcrenewal.blogspot.com/2010/04/who-guards-guardians-case-of-boston.html">here</a>. In 2010, Guidant, now a subsidiary of <a href="http://hcrenewal.blogspot.com/search/label/Boston%20Scientific">Boston Scientific</a>, agreed to a settlement which would involve guilty pleas to misdemeanors and payment of a large ($296 million) fine, but the settlement was rejected by a federal judge who found it to be too lenient (see post <a href="http://hcrenewal.blogspot.com/2010/04/judge-rejects-prosecutors-lenient.html">here</a>). Now the judge has approved a new version, again per the Star-Tribune, <blockquote>In what is believed to be the largest criminal penalty ever imposed in a medical device case, a federal judge on Wednesday approved an agreement calling for Guidant Corp. to pay $296 million for concealing safety information about several of its heart devices. The denouement in U.S. District Court in St. Paul ended a difficult chapter for one of the biggest players in Minnesota's signature medical technology industry. Thirteen patient deaths have been associated with faulty devices made by Arden Hills-based Guidant, which is now part of Boston Scientific Corp. The controversy lingered for almost six years and raised questions about how safety issues involving medical devices are communicated to the Food and Drug Administration, doctors and patients. Last April, U.S. District Judge Donovan Frank rejected a previous $296 million settlement between the Department of Justice and the company. This time that fine remained intact, but Frank also called for Boston Scientific to serve three years' probation. Boston Scientific will be required to make quarterly reports to the U.S. Probation Office regarding safety and compliance issues, as well as submit to regular, unannounced inspections of its records. Frank also called upon Boston Scientific to continue charitable programs intended to raise awareness about heart disease. 'I believe this serves not only the interests of the community and the interests of justice, but respect for the law and corporate responsibility,' Frank said.</blockquote> The new wrinkle is, of course, probation. I have not previously heard of a US health care corporation put on probation in a criminal settlement. Presumably, the idea is that probation will involve court supervision of the company that might be less lenient than US Department of Justice oversight via a <a href="http://hcrenewal.blogspot.com/search/label/corporate%20integrity%20agreements">corporate integrity agreement.</a> So this is a small step forward, but once again, the extent that this settlement will deter future bad behavior seems small. Once again, although the fine imposed seems large, it is small compared to the money to be made by selling these very expensive devices. Moreover, the cost of the fine can be diffused over the entire company, and ultimately over all its employees, its stockholders, and its customers. Since no individual will pay a penalty, and since it is likely some individuals made themselves rich or richer from the company's actions, it is likely that other individuals in the future will authorize, direct, and implement similar bad behavior to fatten their bonuses and total compensation. Last June, we <a href="http://hcrenewal.blogspot.com/2010/06/attempt-to-hold-health-care-leaders.html">noted</a> that some government officials were starting to talk tough about imposing penalties on individuals for misbehavior by health care corporations. In fact, in 1943, the US Supreme Court found that corporate leaders could be held responsible for corporate bad behavior, the so-called Responsible Corporate Officers doctrine. However, the laissez faire malaise that apparently infected most government officials starting in the 1980s seemed to prevent anyone from invoking this doctrine during the last 30 years of health care dysfunction. That malaise still seems to be rendering US federal law enforcement effete, at least when applied to wrong-doing by big, powerful, rich health care corporations. So like Cassandra, fated to have her predictions always ignored, I repeat: When it comes to health care's leadership, society seems to have acceded to defining deviancy down. Until we start holding health care leaders to high standards, expect their organizations not to uphold high standards.  Further, expect organizations that did not uphold high standards in one instance to fail to uphold them in other instances.  If we really want high quality accessible, reasonably priced health care, we need true health care reform that reduces concentration of power in large organizations, and makes health care organizations' leadership accountable, ethical, and transparent. That will not be easy.

Guidant (Boston Scientific) Gets Probation

The latest in the parade of legal settlements by health care corporations involves a new wrinkle. We have been writing about the case of G...

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Interesting HIT Testimony to HHS Standards Committee, Jan. 11, 2011, by Dr. Monteith

Psychiatrist-medical informaticist Dr. Scott Monteith was a guest blogger on the complications of "Meaningful Use of EHR's" in the Dec. 21, 2010 post "<a href="http://hcrenewal.blogspot.com/2010/12/meaningful-use-and-devil-in-details.html">Meaningful Use and the Devil in the Details: A Reader's View</a>." He also testified at the Office of the National Coordinator's Health IT Standards Committee Implementation Workgroup which recently had a meeting, Jan. 10-11, 2010, as I wrote about <a href="http://hcrenewal.blogspot.com/2011/01/onc-workgroup-document.html">here</a>. With his permission I am reproducing his testimony to the Committee (which is supposed to also be posted to the <a href="http://healthit.hhs.gov/portal/server.pt?open=512&objID=1482&&PageID=17128&mode=2">meeting website</a>) without further comment. None is needed. Emphases in the original:  <a name="_GoBack"></a><blockquote>HIT Testimony in DC January 11, 2011 My name is Scott Monteith, a board-certified psychiatrist and Fellow of the APA from Michigan. I work in private practice and with Community Mental Health (CMH). I also teach in MSU’s medical school. My 21 year interest in HIT includes: <ul><li>being a CCHIT Juror; </li></ul> <ul><li>appointed by our Governor to three terms on the Controlled Substances Advisory Commission, which has a role overseeing Michigan’s Automated Prescription System; </li></ul> <ul><li>a member of the Business Operations Workgroup for Michigan’s Health Information Network;</li></ul> <ul><li>working with malpractice insurance companies to manage growing risks from EHRs;</li></ul> <ul><li> and more.</li></ul> I’m “pro-HIT.” For all intents and purposes, I haven’t handwritten a prescription since 1999. That said and with all due respect to the capable people who have worked hard to try to improve health care through HIT, here’s my frank message: ONC’s strategy has put the cart before the horse. HIT is not ready for widespread implementation. The problem isn’t Luddite doctors not adopting; the problem is that HIT isn’t ready, especially if we want safe and efficacious bells and whistles like CDS, interoperability, etc. To describe ONC’s handling of HIT promotion, let me use an analogy: It’s as if policy makers said, “Let’s promote a cure for cancer. By curing cancer, we can save money and improve the quality of people’s lives.” Like our collective fantasy for the benefits of widespread HIT use, which I share, who can argue with the dream of curing cancer, or the good intentions behind it? The problem is that finding a cure for cancer isn’t as simple as declaring a cure, and then merely getting resistant doctors to start using it. Continuing the analogy, ARRA dollars are incenting doctors to use Laetrile, the supposed cancer cure that was not evidence-based and didn’t work. ONC has promoted HIT as if there are clear evidence-based products and processes supporting widespread HIT implementation. But what’s clear is that we are experimenting…with lives, privacy and careers. As a clinician, I’m here to report that certified EHRs are not necessarily producing better documentation or improved care. Yes, EHR-generated documentation is usually more legible, but it’s often “legible gibberish.” And there’s a lot of it, including meaningless data, burying relevant information. Example: A colleague requested records for his mother’s nearly two-week hospital stay; this particular hospital is an early adopter of EHRs. He received almost 2,900 pages. Finding relevant data in the midst of 2,900 pages can be like finding a needle in a haystack. Here’s another example of EHRs degrading documentation: In our CMH, administration inserted language into the doctors' treatment plans. The problem is that the language is patently false and untrue. Unfortunately, administration controls the EHR, and physicians cannot change the untrue language. “Ghost writing” clinical notes – often incorrectly – is increasingly common, whether through fixed fields, no or limited free text, inserted language that cannot be changed, multi-authored documents, or other means. I have documented scores of error types with our certified EHR, and literally hundreds of EHR-generated errors, including consistently incorrect diagnoses, ambiguous eRxs, etc. As a CCHIT Juror, I’ve seen an inadequate process. Don’t get me wrong, the problem is not CCHIT. The problem stems from MU. EHRs are being certified even though they take 20 minutes to do a simple task that should take about 20 seconds to do in the field. Certification is an “open book” test. How can so many do so poorly? For example, our EHR is certified, even though it cannot generate eRxs from within the EHR, as required by MU. To CCHIT’s credit, our EHR vendor did not pass certification. Sadly, our vendor went to another certification body, and now they’re certified. MU does not address many important issues. Usability has received little more than lip-service. What about safety problems and reporting safety problems? What about computer generated alerts, almost all of which are known to be ignored or overridden (usually for good reason)? The concept of “unintended consequences” comes to mind. All that said, the problem really isn’t MU and its gross shortcomings, it is ONC trying to do the impossible: ONC is trying to artificially force a cure for cancer, basically trying to promote one into being, when in fact we need to let one evolve through an evidence-based, disciplined process of scientific discovery and the marketplace. Thank you for the opportunity to be a part of this process.</blockquote> Actually, I will make one comment: In the current climate of "cybernetics over all" in healthcare, this is not the type of testimony that will get the good Dr. any dinner invitations. -- SS

Interesting HIT Testimony to HHS Standards Committee, Jan. 11, 2011, by Dr. Monteith

Psychiatrist-medical informaticist Dr. Scott Monteith was a guest blogger on the complications of " Meaningful Use of EHR's " ...

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IBM's Watson, Jeopardy, and "Revolutionizing Medicine"

In the news recently was a story about a new supercomputer doing amazing things. In a technological tour de force, IBM's Watson supercomputer research project has reached a milestone, beating a group of contestants in the TV gameshow <a href="http://www.jeopardy.com/">Jeopardy</a>. <div style="text-align: left;"> </div> <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4R5y1uoDll8zLUmx22rZxiqAHl5hq0tvpaRRKSekUIfyB2becLGwwv1vErfjt3RvXL99H1grtWsHE65PN6auQh3CSEw1sBlb-CbQwFZ2FlB7c2hXGq_x_RGso6s4oS2W95riDNqkRtBqg/s1600/jeopardy.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5563164871585166706" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4R5y1uoDll8zLUmx22rZxiqAHl5hq0tvpaRRKSekUIfyB2becLGwwv1vErfjt3RvXL99H1grtWsHE65PN6auQh3CSEw1sBlb-CbQwFZ2FlB7c2hXGq_x_RGso6s4oS2W95riDNqkRtBqg/s320/jeopardy.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 274px; height: 205px;" /></a>The TV game show "Jeopardy" </div> Will predictions of advancements in medicine follow? Predictably so: <blockquote><a href="http://www.eweek.com/c/a/IT-Infrastructure/IBMs-Watson-Supercomputer-Beats-Humans-in-Jeopardy-Practice-Match-296135/">IBM's Watson Supercomputer Beats Humans in Jeopardy Practice Match</a> eWeek.com By: Fahmida Y. Rashid 2011-01-13 Watson, IBM's latest DeepQA supercomputer, defeated its two human challengers during a demonstration round of Jeopardy on Jan. 13. The supercomputer will face former Jeopardy champions Ken Jennings and Brad Rutter in a two-game, men-versus-machine tournament to be aired in February. However, the Jeopardy match-up was not the "culmination" of four years of work by IBM Research scientists that worked on the Watson project, but rather, "just the beginning of a journey," Katharine Frase, vice president of industry solutions and emerging business at IBM Research, told eWEEK. Supercomputers that can understand natural human language—complete with puns, plays on words and slang—to answer complex questions will have applications in areas such as health care, tech support and business analytics, David Ferrucci, the lead researcher and principal investigator on the Watson project, said at the media event showcasing Watson at IBM's Yorktown Heights Research Lab. Watson analyzes "real language," or spoken language, as opposed to simple or keyword-based questions, to understand the question, and then looks at the millions of pieces of information it has stored to find a specific answer, said Ferrucci. </blockquote> This is undoubtedly a remarkable accomplishment. Indeed, accompanying the announcements we are also seeing predictions that such supercomputers "will have applications in health care." Indexing of the medical literature, and data mining (for better or worse) from free text come to mind. However, the current irrational exuberance about healthcare IT in 2011 is based on several misconceptions. This leads to predictions such as this ... <blockquote>The technology has to process natural language to understand "what did they mean" versus "what did they say," which has a lot of implications in the health care sector, said Frase. Patients are not using the terms doctors learned in medical school to describe their ailments, but more likely the terms they picked up from their parents growing up, she said. </blockquote> "Patients are not using the terms doctors learned in medical school to describe their ailments"? What medical school(s), exactly, are being spoken of here? It seems as if IT folks think medicine was invented just yesterday. In fact, in medical school, internship, residency and practice we learn all about that, and learn how to 'translate' that information or use it to elicit more information as needed in order to provide care. I'm not sure a multimillion dollar supercomputer is needed for that ... ... and related "platform database" predictions such as this: <blockquote> ... A Watson-like system can take that information and co-relate it against all the medical journals and relevant [who decides that? - ed.] information, and say, "Here's what I think [think? -ed] and why," while showing its evidence for how it came up with the conclusion, according to Frase.</blockquote> (Actually, computers don't think. A more correct statement would be "here are the results of the algorithms that your faithful machine has crunched, using the medical literature as input.") That's quite naïve and idealistic with regard to actual medical decision making. It is a computer technician's oversimplified, reductionist, amateur view regarding biomedicine, a domain of often <a href="http://en.wikipedia.org/wiki/Wicked_problem">wicked complexity</a>. As I intimated above, one key issue is what is "relevant" with regard to information. Consider the issue of the medical literature suffering from numerous conflict of interest and dishonesty-related phenomema making it increasingly untrustworthy, as pointed out by Roy Poses in a Dec. 2010 post "<a href="http://hcrenewal.blogspot.com/2010/12/lancet-emphasizes-threats-to-academic.html">The Lancet Emphasizes the Threats to the Academic Medical Mission</a>", at my Aug. 2009 post "<a href="http://hcrenewal.blogspot.com/2009/08/has-ghostwriting-infected-experts-with.html">Has Ghostwriting Infected The "Experts" With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?</a>" and <a href="http://hcrenewal.blogspot.com/search/label/pseudo-evidence%20based%20medicine">elsewhere</a> on this blog. Then too, there are plausibility issues in medical research, as expressed in the paper "<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124">Why Most Published Research Findings Are False</a>", John P. A. Ioannidis, PLoS Medicine 2(8): e124, 2005. Dr. Ioannidis observes: <blockquote>There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. </blockquote> Dealing with these very real-world issues in patient care requires nothing less than human judgment borne of experience, critical thinking skills (emphases on "thinking", which computers cannot do, sorry all you <a href="http://en.wikipedia.org/wiki/HAL_9000">HAL-9000</a> and <a href="http://en.wikipedia.org/wiki/The_Ultimate_Computer">M5</a> fans) and intuition to manage. "Garbage in, garbage out" applies in the extreme. <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj54NUfsCx-Pmm61Zbeam-zOBWRhBAgx6qothqp5ellRv_f_oMnXIsWcS8K2Xtr1_2X5vNWPJWPJqcnP0QV6m66Pta0ixSnrGFxZ_kYWLH0Dj1QA55vFYqoRTBvPvonsz5AnDyUuJi2oR1q/s1600/m5.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5575927899141022466" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj54NUfsCx-Pmm61Zbeam-zOBWRhBAgx6qothqp5ellRv_f_oMnXIsWcS8K2Xtr1_2X5vNWPJWPJqcnP0QV6m66Pta0ixSnrGFxZ_kYWLH0Dj1QA55vFYqoRTBvPvonsz5AnDyUuJi2oR1q/s320/m5.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 260px; height: 195px;" /></a>(The Ultimate Computer, Dr. Richard Daystrom's mid-23rd century Multitronic unit, M5. Fun to watch it beat up on <a href="http://images.wikia.com/startrek/images/2/29/Constitutions_formation.jpg">starships Excalibur, Hood, Lexington and Potemkin</a> due to malfunction. Even more fun to watch William Shatner talk it into cybernetic suicide via guilt, and yes, as a teen I knew all the ST trivia cold, but I think sci-fi has gone too far into people's heads.) </div> There are also other computer-vs-human mind issues at play. First, let's look at Watson. Just to play the TV quiz show game show Jeopardy, a game largely about the knowledge and recall of trivia, it took the following: <ul><li>Watson is a breakthrough human achievement in the scientific field of Question and Answering, also known as "QA." The <a href="http://www-03.ibm.com/press/us/en/pressrelease/33233.wss">Watson software is powered by an IBM POWER7 server</a> optimized to handle the massive number of tasks that Watson must perform at rapid speeds to analyze complex language and deliver correct responses to Jeopardy! clues. The system incorporates a number of proprietary technologies for the specialized demands of processing an enormous number of concurrent tasks and data while analyzing information in real time.</li></ul><ul><li><a href="http://www-03.ibm.com/innovation/us/watson/research-team/algorithms.html">An entire team of "algorithm specialists"</a> writing algorithms specialized to the purpose of "the special question processing" needed to answer Jeopardy questions, such as: "On Sept. 1, 1715 Louis XIV died in this city, site of a fabulous palace he built", and "To marry Elizabeth, Prince Philip had to renounce claims to this southern European country's crown."</li><li> <a href="http://latimesblogs.latimes.com/technology/2011/01/ibm-computer-named-watson-will-battle-jeopardy-champs-for-1-million.html">Watson took about four years to build and is made up of 10 racks of [multiprocessor - ed.] IBM servers running Linux with 15 terabytes of memory </a><a href="http://latimesblogs.latimes.com/technology/2011/01/ibm-computer-named-watson-will-battle-jeopardy-champs-for-1-million.html">[presumably fast-access RAM, not hard disk -ed.]</a>, the report said. [as per the LA Times - ed.] Over those four years, IBM has filled Watson with about 200 million pages' worth of information from encyclopedias, dictionaries, books, news and movie scripts, the AP said.</li></ul> <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjllrDkbM4zyrUvmBggvXWfT8H_n5BVjW166X1Q1fRpNWpAR-gdlemHQz0UPPZ-ZtybUndKwKgb7whbaqCKmfhy9DjOYnPnbAEWarzT6EDxISvP5Ybz5vdd46lF-qn1j68bbpkIM5ugay8G/s1600/server_blade.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5563166290700826178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjllrDkbM4zyrUvmBggvXWfT8H_n5BVjW166X1Q1fRpNWpAR-gdlemHQz0UPPZ-ZtybUndKwKgb7whbaqCKmfhy9DjOYnPnbAEWarzT6EDxISvP5Ybz5vdd46lF-qn1j68bbpkIM5ugay8G/s320/server_blade.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 213px;" /></a>A rack-mountable server ("blade"). </div> <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLkv9ctR4kO4KZFzY43DlIAVfOwcmPnEyPY9vG-zALrf2xeuYcT0mChTXvDQ-w_THGGNFNWWyDzgXZJfcW_XCYFXNuWZjgi-Z0xJHuMYZ7s_B62nKt1UjkFmEPaJVawb8slDrH1CWUh6uC/s1600/rack_of_servers.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5563161488373887826" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLkv9ctR4kO4KZFzY43DlIAVfOwcmPnEyPY9vG-zALrf2xeuYcT0mChTXvDQ-w_THGGNFNWWyDzgXZJfcW_XCYFXNuWZjgi-Z0xJHuMYZ7s_B62nKt1UjkFmEPaJVawb8slDrH1CWUh6uC/s320/rack_of_servers.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 302px;" /></a>Racks of servers, each with multiple advanced CPU's </div> <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjrYT6l_MtNTP0fDPKPAwWphw0r-52n19DGUNTXbOtSI7YtUsD7eMvA3tbXkfpZVL5LCsBrpUMl9W0Mfa5N8t7jSupxZDnsjaE8KlB3v0onZT0owL8e6Fj9ulBloSOuCdLq-WGElDpppC9/s1600/watsonibm.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5563162581131539810" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjrYT6l_MtNTP0fDPKPAwWphw0r-52n19DGUNTXbOtSI7YtUsD7eMvA3tbXkfpZVL5LCsBrpUMl9W0Mfa5N8t7jSupxZDnsjaE8KlB3v0onZT0owL8e6Fj9ulBloSOuCdLq-WGElDpppC9/s320/watsonibm.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 233px;" /></a>Racks of servers in IBM's Watson supercomputer, all prettied up, HAL 9000-style </div> Second, it will be many years indeed before even the current Watson QA capabilities can be tailored to a domain as complex as biomedicine and made widespread for the hundreds of thousands of practicing physicians and the much larger number of allied healthcare professionals in the U.S. or worldwide. Third, there's this from the same LA Times article linked above: <ul><li>Like its human competitors, Watson won't have Internet access [or access to anything outside its immense local storage - ed.] during the games, so Googling an answer won't be an option, the report said.</li></ul> I see a significant degree of machine-human unfairness right there. A computer has 100% reliable access to information in its storage media. The human mind does not. That's appropriate for a TV game show that tries to test a persons' knowledge of trivia, but that's not how medicine works. What if the match were made more fair, giving the humans error-free access to the same information Watson has stored in its own 15 terabytes and 200 million pages? Fourth, medicine is not about recalling trivial factoids of information based on parsing natural language queries in the "puzzle format" of Jeopardy. As I wrote <a href="http://hcrenewal.blogspot.com/2011/01/google-ceo-eric-schmidt-on-healthcare.html">here</a> and <a href="http://hcrenewal.blogspot.com/2010/01/does-ceo-of-google-use-google.html">here</a>, medicine is not a platform database information retrieval problem. (I would argue medicine, except in simple cases, is in large part a matter of filtering the irrelevant, unlikely, and unreliable, of which there is an exponentially increasing amount, from information relevant to the subtleties of a complex medical situation.) Certainly, today's clinical IT will make little dent in healthcare quality and error reduction, as those issues are not in majority due to record keeping problems of paper vs. electronic, as I pointed out in my Dec, 2010 post "<a href="http://hcrenewal.blogspot.com/2010/12/is-healthcare-it-solution-to-wrong.html">Is Healthcare IT a Solution to the Wrong Problem?</a>". The expectations for today's health IT are grossly exaggerated. How about expert systems technology such as Watson? Regarding NLP and fact retrieval 'tours de force' like IBM Watson, medicine is about cognition, about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners. The end result is not just recall of a piece of information. I consider a statement such as: <blockquote>... a Watson-like system can take that information and co-relate it against all the medical journals and relevant information, and say, "Here's what I think [actually, as mentioned previously, here's the results of the algorithms - ed.] and why"</blockquote> ... to imply just as grandiose a valuation to the technology as the statements I heard a decade ago about the health IT of the day - or even today - "revolutionizing medicine." I'm not even sure such a capability would be very useful; we already have <a href="http://dxplain.org/dxp/dxp.pl">DXplain</a> developed by domain experts over decades, and that's not had a major impact on healthcare to date. The real breakthrough will be when a cybernetic expert system can take, say, cases from the Case Records of the Massachusetts General Hospital in the NEJM verbatim, and compete as a peer (e.g., as a peer not recognized to be a machine) with a round-table panel of expert physicians with facile access to the medical literature (e.g., PubMed) on the differential diagnosis, how to establish the diagnosis and to rule out others, the treatment strategies, and the likely outcomes, and then participate in the care. When this happens (call this the "NEJM <a href="http://en.wikipedia.org/wiki/Turing_test">Turing Test</a>"), and when such capabilities are affordable and widely available, then medicine will have been revolutionized. Of course, the enormity of the hardware and the algorithmic advances required to make a truly "revolutionary" tool such as this are obviously staggering. Considering that it takes 10 racks of multiprocessor IBM servers with 15 terabytes of memory and a team of varied domain experts writing algorithms for several years to accomplish the NLP advances and lookups to answer Jeopardy-style trivia questions, one can only imagine what a truly useful cybernetic medical assistance system would look like. It should also be remembered that Watson does not think. Humans do. Cybernetic Jeopardy and chess playing accomplishments notwithstanding, I believe a machine even close to passing a "NEJM Turing test" will be a long time in coming. Until then, we should be encouraging better support for human physicians struggling to use their medical expertise in a sea of bureaucracy, stress and overwork (part of which will increasingly be a struggle with <a href="http://www.tinyurl.com/hostileuserexper">mission hostile health IT</a>). Finally, far off as I believe it to be, I do think the hundreds of billions of dollars being devoted to today's health IT would be better devoted to developing a "Dr. Watson" that can pass a medical Turing test as described above, than deploying mission hostile, primitive HIT and developing an unsustainable mega-bureaucracy to support it as in my post <a href="http://hcrenewal.blogspot.com/2011/01/health-it-and-dr-truth-hurts.html">here</a>. This is not to minimize the wonderful accomplishments of the Watson team. I just wish predictions of cybernetic miracles in medicine would be held in abeyance after the lessons of the past fifty years of computers in medicine. In the meantime, perhaps the current Watson might be useful in remediating our very sclerotic and moribund "mainsteam media," especially in the domain of politics. Its reporters and writers can certainly use cybernetic help in their fact-checking and logic, Jeopardy-style, far more so than physicians. -- SS Feb. 23, 2011 addendum: <a href="http://www.urbandictionary.com/define.php?term=oy%20gevalt">Gevalt!</a> From the article "<a href="http://www.computerworld.com/s/article/9209899/IBM_s_Watson_could_usher_in_new_era_of_medicine?taxonomyId=67&pageNumber=2">IBM's Watson could usher in new era of medicine</a>", Sharon Gaudin, Computerworld, February 17, 2011: <blockquote> Jennifer Chu-Carroll, an IBM researcher on the Watson project, said the computer system is a perfect fit for the healthcare field ... Think of some version of Watson being a physician's assistant," Chu-Carroll said. "In its spare time, Watson can read all the latest medical journals and get updated. Then it can go with the doctor into exam rooms and listen in as patients tell doctors about their symptoms. It can start coming up with hypotheses about what ails the patient.</blockquote> Gevalt indeed ... incredible irrational exuberance. We can easily go from Jeopardy to Medicine ... and then to the Moon, in a hot air balloon! (The moon is up, hot air balloons go up, what's the problem?) How many patients has Chu-Carroll seen lately? (Her bio at <a href="http://www.blogger.com/%22Jennifer%20Chu-Carroll,%20an%20IBM%20researcher%20on%20the%20Watson%20project,%20said%20the%20computer%20system%20is%20a%20perfect%20fit%20for%20the%20healthcare%20field%20...%20Think%20of%20some%20version%20of%20Watson%20being%20a%20physician%27s%20assistant,%22%20Chu-Carroll%20said.%20%22In%20its%20spare%20time,%20Watson%20can%20read%20all%20the%20latest%20medical%20journals%20and%20get%20updated.%20Then%20it%20can%20go%20with%20the%20doctor%20into%20exam%20rooms%20and%20listen%20in%20as%20patients%20tell%20doctors%20about%20their%20symptoms.%20It%20can%20start%20coming%20up%20with%20hypotheses%20about%20what%20ails%20the%20patient.%22%22%20%20Gevalt%21%20%20Irrational%20exuberance%20%20--%20we%20can%20easily%20go%20from%20Jeopardy%20to%20Medicine...and%20then%20to%20the%20Moon,%20in%20a%20hot%20air%20balloon%21%20%20%28The%20moon%20is%20up,%20hot%20air%20balloons%20go%20up,%20what%27s%20the%20problem?%29%20%20How%20many%20patients%20has%20Chu-Carroll%20seen%20lately?%20%20%28Her%20bio%20at%20http://researcher.ibm.com/researcher/view.php?person=us-jencc%20is%20down;%20%22The%20server%20at%20researcher.ibm.com%20is%20taking%20too%20long%20to%20respond%22;%20Watson%20must%20be%20taking%20a%20nap%29...">http://researcher.ibm.com/researcher/view.php?person=us-jencc</a> was initially down at this moment; "The server at researcher.ibm.com is taking too long to respond." Watson must be taking a nap. Archive.org says "The connection has timed out. The server at web.archive.org is taking too long to respond." Just like a doctor!) Anyway, it now appears: <blockquote> I am a Research Staff Member at <a href="http://www.research.ibm.com/">IBM T. J. Watson Research Center</a>. I also manage the Knowledge Structures group which focuses on improving advanced search technology through the use of natural language processing and machine learning techniques. Prior to joining IBM in 2001, I spent 5 years as a Member of Technical Staff at <a href="http://www.bell-labs.com/">Lucent Technologies Bell Laboratories</a>. My research interests include question answering, semantic search, natural language discourse processing, and spoken dialogue management. </blockquote> Please, please, please, computer scientists: STOP MAKING THESE PREDICTIONS OF CYBERNETIC MIRACLES JUST AROUND THE CORNER. YOU'VE BEEN DOING IT SINCE THE VACUUM TUBE-BASED MACHINES. STOP! PLEASE! (Maybe first they could give us a computer that does a perfect, lucid, coherent, fluent translation of, say, Russian-to-English, another promise made since the 1950's "<a href="http://en.wikipedia.org/wiki/Robby_the_Robot">Robby the Robot</a>" years?) <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjldnVE-YxPUg-hkvX4Hd5X5fYKQAXRofzxvC7_HoF3GWZW6hCxJZc9yKQVZXpYEEjMwu0yQFiY5W6i-FoKaviXmgNELU2r9Lz5wJVjzqMANDpVtr3subr_jGV3-lRnKhzl-0i0hYsvmhPq/s1600/Robbie_Forbidden_Planet.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5577003659342042578" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjldnVE-YxPUg-hkvX4Hd5X5fYKQAXRofzxvC7_HoF3GWZW6hCxJZc9yKQVZXpYEEjMwu0yQFiY5W6i-FoKaviXmgNELU2r9Lz5wJVjzqMANDpVtr3subr_jGV3-lRnKhzl-0i0hYsvmhPq/s320/Robbie_Forbidden_Planet.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 162px;" /></a>Robby the Robot in "Forbidden Planet." Lost in Space fans will remember Robby as doing battle with the <a href="http://www.lostinspacerobot.com/">Class M-3 Model B9, General Utility Non-Theorizing Environmental Control </a><a href="http://www.lostinspacerobot.com/">Robot</a> ("Danger, Danger, Will Robinson") as well! </div> I think the essay in today's WSJ by UC Berkeley philosopher <a href="http://en.wikipedia.org/wiki/John_Searle">John Searle</a> is also apropos: <a href="http://online.wsj.com/article/SB10001424052748703407304576154313126987674.html">Watson Doesn't Know It Won on 'Jeopardy!' </a> -- SS Addendum: See my Wall Street Journal Letter to the Editor on these matters <a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2011/02/medinformaticsmd-in-wsj-again-no.html">at this link</a>. I wrote on a somewhat sarcastic note at this March 2011 post: "<a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2011/03/quick-thought-on-cybernetic-medicine.html">Here Comes the Judge! A Quick Thought on Cybernetic Medicine: Why Can't Computers Also Do Law?</a>" Also see my Sept. 2011 followup post "<a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2011/09/once-again-on-watson-and-reductionistic.html">Once Again, on IBM Watson, Cybernetic Miracles and Reductionist Views of Medicine</a>." -- SS

IBM's Watson, Jeopardy, and "Revolutionizing Medicine"

In the news recently was a story about a new supercomputer doing amazing things. In a technological tour de force, IBM's Watson superco...

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Cyber-Puppeteering on Health IT by Dr. TruthHurts

While the specifics in this <a href="http://www.youtube.com/watch?v=OW92MP-yyOo">Xtranormal video</a> "Dr. TruthHurts" on the Patient Protection and Affordable Care Act (PPACA) might be incorrect, and the political views expressed offensive to some, the scenes of "Dr. A.C.O." using a computer (starting at about time 4:09) might not be far from the future cybernetic "truth" we are headed towards. While the computer-use scenes are mostly sound-based and somewhat hyperbolic, if physicians are not vigilant and outspoken, I fear the machines -- and their users -- will further become servants of bureaucratic control and of money. Click to play the YouTube video. <div style="text-align: center;"><a href="http://www.youtube.com/watch?v=OW92MP-yyOo"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5562258723599160386" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdwVnvHvCvYu-WfkpkNXwlyFHKzb0ahxNknk3xrqG4U4Gu0afjhc5MKXFdOrMymr9Sp9WRSsypLCODWXHDVZmZeJ12KsaAzgwu94xd20SxtFWYF5SuCZVbbJuw3jwJs1d0d2PDeBywsyfM/s320/ppaca.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 194px;" /></a>Click image to play video </div> I also note that the diagram of the healthcare bureaucracy in this cyber-puppeteer video is real: <div style="text-align: center;"><a href="http://www.house.gov/jec/news/2010/obamacare_chart.pdf"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5562255991429227346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPn9U9FMHL8NPPp3DGolylsAvh07gW_Xg1QV2K7R4J9y9SnGRl5ecxev0ld2m1yl7Z_uTpVN2WNda4u2WATdYF1Qrfb-96u5tyNfJ7eGw7WX4ivZjChPZm7EumXdE4XZB5s2SOoPOD9c7d/s320/hcsystem.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 250px;" /></a>The coming Health Care Mega-Bureaucracy (click to download PDF from House.gov). </div> Somewhere, buried in that morass of healthcare facilitators, are quaint relics of the work of the healthcare enablers such as the doctor-patient relationship, informed consent, and private medical decision-making between physician and patient. Oh wait...I forgot, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">there are computers</a> to make the bureaucratic morass all work seamlessly. -- SS

Cyber-Puppeteering on Health IT by Dr. TruthHurts

While the specifics in this Xtranormal video "Dr. TruthHurts" on the Patient Protection and Affordable Care Act (PPACA) might be...

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