What the Pfizer (IV)? - One Board to Rule Them All

The recent in-depth <a href="http://features.blogs.fortune.cnn.com/2011/07/28/pfizer-jeff-kindler-shakeup/"><span style="color: #6699cc;">investigation</span></a> by Fortune reporters of 10 years of dysfunctional leadership at <a href="http://www.pfizer.com/"><span style="color: #6699cc;">Pfizer</span></a>, the "world's largest research-based pharmaceutical company," raises many issues about leadership and governance in health care (see our post <a href="http://hcrenewal.blogspot.com/2011/08/10-years-of-pfizer-leadership-saga-of.html"><span style="color: #6699cc;">here</span></a>).  We then discussed lack of transparency in Pfizer's communication about management performance <a href="http://hcrenewal.blogspot.com/2011/08/what-pfizer-ii-lack-of-transparency.html">here</a>, and how bad management was rewarded with outsize compensation <a href="http://hcrenewal.blogspot.com/2011/08/what-pfizer-iii-enormous-pay-for-poor.html">here</a>.  To continue what has become a lengthy series, let us now discuss the board of directors who were responsible for "stewardship" or governance of what turned out to be a very troubled company.<br /><br />Let us focus on the membership of the boards that appointed the two CEOs Fortune described as failed.<br /><br /><strong>Henry A "Hank" McKinnell - 2001</strong><br /><br />In 2001, the board appointed Henry A "Hank" McKinnell CEO.    Mr McKinell was forced to retire in 2006. The Fortune article described Mr McKinnell as a "desperate CEO" by 2002 because he could find no way to replenish the company's fading drug pipeline; who then became an absent CEO who "left a power vacuum" and then triggered internal political warfare by setting up a "bitter contest" over succession planning.<br /><br />In 2001, the board is as listed below.  (I include their current positions, any former positions as chairman, CEO, president or the equivalence, and current leadership positions in health care or finance.)  -<br /><br /><em>- Michael S Brown -</em><br /><br /><span style="color: red;">Distinguished Chair in Biomedical Sciences, Texas Southwestern Medical Center</span>...  <span style="color: lime;">Director of Regeneron Pharmaceuticals</span><br /><br /><em>- M Anthony Burns -</em><br /><br />Chair of the Board, former CEO of Ryder System Inc ...  <span style="color: blue;">Director of JP Morgan Chase and Co</span>...  <span style="color: red;">Trustee of the University of Miami</span><br /><br /><em>- Robert N Burt -</em><br /><br />Chairman of the Board and CEO of FMC Corporation...  <span style="color: red;">Director of the Rehabilitation Institute of Chicago and Evanston Hospital Corp</span><br /><br /><em>- W Don Cornwell -</em><br /><br />Chairman of the Board and CEO of Granite Broadcasting Corporation...  <span style="color: cyan;">Director of CVS Corporation</span><br /><br /><em>- William H Gray III -</em><br /><br />President and CEO of the College Fund/UNCF...   <span style="color: blue;">Director of JP Morgan and Co</span>...  <span style="color: red;">Trustee of the University of Miami</span><br /><br /><em>- Constance J Horner -</em><br /><br />Guest Scholar at the Brooking Institution...  <span style="color: blue;">Director of the Prudential Insurance Company of America</span><br /><br /><em>- William R Howell -</em><br /><br />Chairman Emeritus and former CEO of JC Penney Company Inc...  <br /><br />- Stanley O Ikenberry -<br /><br />President of the American Council on Education...  <span style="color: red;">Former President of the University of Illinois</span>...  <span style="color: blue;">President of the Board of Overseers of Teachers' Insurance and Annuity Association - College Retirement Equities Fund (TIAA-CREF)</span><br /><br /><em>- Harry P Kamen -</em><br /><br />Former Chairman of the Board and CEO of <span style="color: blue;">Metropolitan Life Insurance Company...  Director of Banco Santander Central Hispano SA, BDirect Capital ...  Metropolitan Life Insurance Company</span><br /><br /><em>- George A Lorch -</em><br /><br />Chairman Emeritus and Former CEO of Armstrong Holdings Inc...<br /><br /><em>- Alex J Mandl - </em><br /><br />Chairman of the Board and CEO of Teligent<br /><br /><em>- Henry A McKinnell -</em><br /><br />CEO of Pfizer...  <span style="color: blue;">Director of Moody's Corporation</span><br /><br /><em>- Dana G Mead -</em><br /><br />Retired Chairman and CEO of Tenneco Inc...  <span style="color: blue;">Director of Zurich Financial Services</span><br /><br /><em>- John F Niblack -</em><br /><br />President of Pfizer Global Research and Development<br /><br /><em>- Franklin D Raines -</em><br /><br /><span style="color: blue;">Chairman and CEO of Fannie Mae</span>...  <br /><br /><em>- Ruth Simmons -</em><br /><br /><span style="color: red;">President of Brown University</span>... <span style="color: blue;">Director of Goldman Sachs Group Inc, Metropolitan Life Insurance</span><br /><br /><em>- Michael I Sovern -</em><br /><br />Chairman of the Board of Sotheby's Holdings Inc...  <span style="color: red;">President Emeritus of Columbia University</span>  <br /><br /><em>- Jean-Paul Valles -</em><br /><br />Chairman and Former CEO of Minerals Technology Inc<br /><br /><em>- William C Steer Jr -</em><br /><br />Former CEO of Pfizer...  <span style="color: blue;">Director of Metropolitan Life Insurance Company</span>...  <span style="color: red;">Director of New York University Medical Center....  Member of the Board of Overseers of Sloan-Kettering Cancer Center</span><br /><br />The box score is...  Of 19 directors, 17 were current or former chairpeople or CEO/ Presidents of large organizations.  <br /><br />Eight  had <span style="color: red;">leadership positions at teaching hospitals, academic medical centers, medical schools or their parent universities, or other influential non-profit health care organizations</span>.  1 had a<span style="color: lime;"> leadership position at a potentially competing pharmaceutical company</span>.  1 had a <span style="color: cyan;">leadership position at a pharmacy corporation.</span><br /><br />Furthermore, 10 had <span style="color: blue;">leadership positions in financial services corporations</span>, including some that were implicated in the global financial collapse, and/or required massive federal bail-outs to avoid collapse.<br /><br /><strong>Jeffrey Kindler 2006</strong> <br /><br /><br />In 2006, the board appointed Jeffrey Kindler CEO.  Mr Kindler was forced to resign in 2010. The Fortune article also described Mr Kindler as "suddenly desperate" after two failures of drugs in development; someone who "just couldn't make up his mind," about acquisitions and spin-offs; "anguished" about research, leading to a "messy" overhaul; and putting "destructive" trust in a subordinate with previously described problems with "character, integrity and divisiveness" leading to loss of the loyalty of the executive team.<br /><br />The board in 2006 appears below, with information formatted as above.  Note that all were members in 2001, although some members from 2001 were no longer there. <br /><br /><em>- Michael S Brown -</em><br /><br /><span style="color: red;">Distinguished Chair in Biomedical Sciences at University of Texas Southwestern Medical Center at Dallas</span>...  <span style="color: lime;">Director of Regeneron Pharmaceuticals</span>.<br /><br /><em>- M Anthony Burns -</em><br /><br />Chairman and CEO Emeritus of Ryder System Inc....  <span style="color: red;">Life trustee of the University of Miami</span><br /><br /><em>- Robert N Burt -</em><br /><br />Retired Chairman and CEO of FMC Corporation...<br /><br /><em>- W Don Cornwell -</em><br /><br />Chairman of the Board and CEO of Granite Broadcasting Corporation....  <span style="color: cyan;">Director of CVS Corporation</span>.<br /><br /><em>- William H Gray III -</em><br /><br />Chairman of the Amani Group...  <span style="color: blue;">Director of JP Morgan Chase and Co, Prudential Financial Inc</span><br /><br /><em>- Constance J Horner -</em><br /><br />Former Guest Scholar at the Brookings Institute...  <span style="color: blue;">Director of Prudential Financial Inc</span><br /><br /><em>- William R Howell -</em><br /><br />Chairman and CEO Emeritus of JC Penney Company Inc...  <span style="color: blue;">Director of Deutsche Bank Trust Corporation and Deutsch Bank Trust Company Americas.</span><br /><br /><em>- Stanley O Ikenberry -</em><br /><br /><span style="color: red;">President Emeritus University of Illinois</span>... <span style="color: blue;"> President, Board of Overseers TIAA-CREF</span><br /><br /><em>- George A Lorch -</em><br /><br />Chairman and CEO Emeritus of Armstrong Holdings Inc....  <span style="color: blue;">Director of HSBC Finance Co and HSBC North America Holding Company.</span><br /><br /><em>- Henry A McKinnell -</em><br /><br />CEO of Pfizer...   <span style="color: blue;">Director of Moody's Corporation</span>.<br /><br /><em>- Dana G Mead -</em><br /><br />Chairman of Massachusetts Institute of Technology Corporation.  Former Chairman and CEO of Tenneco Inc...  <span style="color: blue;">Director of Zurich Financial Services</span>.<br /><br /><em>- Ruth J Simmons -</em><br /><br /><span style="color: red;">President of Brown University</span>...  <span style="color: blue;">Director of Goldman Sachs Group Inc.</span><br /><br /><em>- William C Steere Jr</em> -<br /><br />Chairman and CEO Emeritus of Pfizer...  <span style="color: blue;">Director of Metlife Inc</span> and <span style="color: purple;">Health Management Associates</span>...  <span style="color: red;">Director of New York University Medical Center...  Member of the Board of Overseers of Memorial Sloan-Kettering Cancer Center.</span> <br /><br />The new box score is similar to the old one, as expected, since none of the directors in 2006 was new since 2001.  Of 13 directors, 11 were current or former chairpeople or CEO/ Presidents of large organizations.<br /><br />Five had <span style="color: red;">leadership positions at teaching hospitals, academic medical centers, medical schools or their parent universities, or other influential non-profit health care organizations</span>. 1 had a <span style="color: lime;">leadership position at a potentially competing pharmaceutical company</span>. 1 had a <span style="color: cyan;">leadership position at a pharmacy corporation</span>. 1 had a <span style="color: purple;">leadership position at a for-profit hospital operating company</span>.<br /><br /><br />Furthermore,  9 had <span style="color: blue;">leadership positions in financial services corporations</span>, including some that were implicated in the global financial collapse, and/or required massive federal bail-outs to avoid collapse.<br /><br /><strong>Summary</strong><br /><br />The board that acquiesced to huge compensation for very dysfunctional leadership arguably provided dubious "stewardship" of the company and the interests of its stockholders.  The composition of the board suggests some reason for this.  The board itself was mainly composed of current and former CEOs, and hence may have felt more in common with the executives whom it was supposed to supervise than the stockholders.  Many board members had conflicts of interests, also leading organizations that were supposed to be dealing at least at arms length with Pfizer.  Many of the board members were likely influenced by the corporate culture of the financial services industry, since they were in leadership roles there as well.  That culture, which let unaccountable, hugely remunerated executives gamble with other peoples' money, personally benefit when the gambles went well, and unload their losses on others, including tax-payers when their gambles failed, seems to have infected health care.<br /><br />We have often discussed how conflicted, overpaid, and/or unaccountable leadership can damage non-profit health care organizations, like hospitals and academic medical institutions.  I would suggest it can also damage for-profit health care corporations, sapping their ability to create new and useful products, and undercutting shareholders.<br /><br />I submit that all health care organizations would benefit from leadership and stewardship that cares more about patients' and the public's health, and the values of health care professionals than it does about the welfare of CEOs; that is accountable for and receives incentives proportionate to its effect on health and health care; and that is free from conflicts of interest and corruption.  True health care reform would reform health care leadership and governance. 

What the Pfizer (IV)? - One Board to Rule Them All

The recent in-depth investigation by Fortune reporters of 10 years of dysfunctional leadership at Pfizer , the "world's largest re...

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Blake Medical Center (Bradenton, Fla.) Ignores Health IT Warning Letter From 100 Staff Physicians

In an article in the Bradenton Herald, Bradenton, FL, I found the following passage I bolded below truly striking:<br /><br /><a href="http://www.bradenton.com/2011/09/04/3467295/digital-doctors-will-technology.html"></a><blockquote><a href="http://www.bradenton.com/2011/09/04/3467295/digital-doctors-will-technology.html">Digital doctors: Will technology help or harm?</a><br />Sept. 4, 2011<br /><span class="byline">By DAVID GULLIVER</span><br /><br />BRADENTON -- At <a href="http://blakemedicalcenter.com/home/index.dot">Blake Medical Center</a>, the prognosis for pen and paper is poor: Doctors’ traditional tools for tracking cases and ordering medications and procedures are being phased out in favor of computers.<br /><br />... Blake [Medical Center], which has been building its EHR system for years, launched a feature in April for doctors to enter their daily progress notes electronically. In June, it added a feature for ordering medications and procedures via computer. It’s part of a national push, called hCare, by Blake’s parent company HCA.<br /><br />But many doctors were reluctant to give up their pens. <span style="font-weight: bold;">More than 100 staff physicians signed a letter asking for the computerization project to be put on hold, saying the system is cumbersome and likely to induce errors.</span></blockquote><div style="border: medium none; text-align: left; background-color: transparent; color: rgb(0, 0, 0); overflow: hidden; text-decoration: none;"><p>Wow. Physicians with guts.<br /></p><p>If I were an executive at this hospital, I'd make sure I were fully insured and my assets were in my spouse's name, especially in lawsuit-happy Florida.<br /></p><p>If a patient injury or death occurs related to the EMR issues addressed in the letter from 100 staff physicians, which would/should seriously concern if not <span style="font-weight: bold; font-style: italic;">absolutely alarm</span> any reasonable person, there could be charges of negligence, including criminal negligence, against the administration.<br /></p><p><br /></p><p><i><i><a href="http://legal-dictionary.thefreedictionary.com/Criminal+Negligence"></a></i></i></p><blockquote><i><i><a href="http://legal-dictionary.thefreedictionary.com/Criminal+Negligence">Criminal negligence</a>: The failure to use reasonable care to avoid consequences that threaten or harm the safety of the public and that are the foreseeable outcome of acting in a particular manner ... Criminal negligence is negligence that is <a href="http://definitions.uslegal.com/c/criminal-negligence/">aggravated, culpable or gross</a>.<br /><br /></i></i></blockquote><p></p><p>A jury will not be happy with the letter being ignored, either.</p><p><br /></p><p></p><blockquote><p>... The project’s supporters acknowledge <span style="font-weight: bold;">doctors and nurses have made mistakes as they learn the system</span>, though they are unaware of any resulting in harm to patients. <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[Is that how you want your healthcare to proceed? - ed.]</span><br /></p><br /></blockquote><span style="color: rgb(51, 0, 51);">In other words, no patient exposed to this experiment and its <span style="font-weight: bold; font-style: italic;">risks</span> (a key issue here) was known to "hit the jackpot" - yet:</span><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"><br /><br /></span><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJxrkTkwmZ4rUVbNMcwUGcPnqsuk5muXrpiwzPFpGyAIZPQrsk4eKnupZETpkoJ4ErpTkqK7djgYv1Kclh7hhWHfWJZRAr2OlaFa6T52CNYS7icmgYYH2NK5VyMDlhIYReUqrKRjgnAz6j/s1600/winner.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5653834695663706834" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJxrkTkwmZ4rUVbNMcwUGcPnqsuk5muXrpiwzPFpGyAIZPQrsk4eKnupZETpkoJ4ErpTkqK7djgYv1Kclh7hhWHfWJZRAr2OlaFa6T52CNYS7icmgYYH2NK5VyMDlhIYReUqrKRjgnAz6j/s320/winner.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 320px; height: 240px;" /></a><span style="font-size:85%;">The EHR Slot Machine of Risk.</span><span style="font-size:85%;"> Click to enlarge. </span><span style="font-size:85%;">(From my March 2011 post "<a href="http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html">On an EMR Forensic Evaluation by Professor Jon Patrick from Down Under: More Thoughts</a>."</span><span style="font-size:85%;">) <span>Congratulations! You've hit the EHR mis-processing jackpot! Perhaps today is a good day to die...</span></span><br /></div><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"><br /><br /></span><p></p><blockquote><p>But they contend that, <span style="font-weight: bold;">in the long run, an electronic system will be safer than using paper records -- something critics grudgingly admit</span>. </p><p>Still, even as a $27 billion federal program is encouraging hospitals and doctors to launch EHR systems, no regulatory agency tests or regulates them. So a crucial question remains unanswered: Does it truly improve care? <span style="font-weight: bold; font-style: italic;"><span style="color: rgb(255, 0, 0);">[Nobody really knows - e.g., see recent post </span></span><a href="http://hcrenewal.blogspot.com/2011/09/does-highly-wired-correspond-to-best.html"><span style="font-weight: bold; font-style: italic;">here</span></a><span style="font-weight: bold; font-style: italic;"><span style="color: rgb(255, 0, 0);">, and literature list</span> <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=readinglist">here</a> <span style="color: rgb(255, 0, 0);">- ed.]</span></span><br /></p></blockquote><br />Critics readily admit health IT has the <span style="font-style: italic;">potential</span> to improve healthcare, but that the technology is not yet nearly ready to do so, especially on a national basis, and is <span style="font-style: italic;">experimental</span>. Far more work is needed. For example, according to the <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">National Research Council of the United States</a>:<br /><br /><blockquote>Current efforts aimed at the nationwide deployment of health care information technology (IT)<span style="font-weight: bold;"> will not be sufficient to achieve medical leaders' vision of health care in the 21st century and may even set back the cause</span>, says a new report from the National Research Council. The report, based partially on site visits to eight U.S. medical centers considered leaders in the field of health care IT, concludes that greater emphasis should be placed on information technology that provides health care workers and patients with cognitive support, such as assistance in decision-making and problem-solving.<br /><br />... In the long term, success will depend upon accelerating <span style="font-weight: bold;">interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering</span>.</blockquote><br />Critics also readily admit that organizations experimenting with this technology without patient informed consent, on the basis of some future good, need lessons on the ethics of human experimentation.<br /><br />Risk to patients seems to be of little concern to this industry.<br /><br />It also now seems that hospital executives have become so arrogant that they fail to recognize the risks to themselves in ignoring their own medical staffs on HIT issues.<br /><br />Perhaps they think they will be able to simply blame the physicians, using clinicians as scapegoats, but with official sites like <a href="http://www.ucguide.org/">this</a> now coming online ... I think that excuse will rapidly lose traction.<br /><br /></div>-- SS<br /><br /><span style="font-weight: bold;">Sept. 19 addendum:</span><br /><br />A major motivator for ignoring the physicians' warnings at this <a href="http://hcahealthcare.com/home/index.dot">HCA</a> (Hospital Corp. of America) hospital may be financial. See my Aug. 2011 post "<a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2011/08/why-ehrs-are-mission-hostile.html">Why EHR's Are Mission Hostile</a>."<br /><br />-- SS

Blake Medical Center (Bradenton, Fla.) Ignores Health IT Warning Letter From 100 Staff Physicians

In an article in the Bradenton Herald, Bradenton, FL, I found the following passage I bolded below truly striking: Digital doctors: Will tec...

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Another Episode of "But Don't Worry, Your Records are Safe..."

Oops!<br /><p> <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-trust-sends-data-cd-to-landfill-2355834.html"></a></p><blockquote><p><a href="http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-trust-sends-data-cd-to-landfill-2355834.html">NHS trust sends data CD to landfill</a><br /><br />By Wesley Johnson<br /><br />Friday, 16 September 2011</p><p><span style="font-weight: bold;">The personal information of 1.6 million people</span> has been put at risk after a CD was sent to a landfill site by an NHS trust by mistake, a watchdog said. </p> <p> The Eastern and Coastal Kent Primary Care Trust put the CD, which contained the <span style="font-weight: bold;">name, address, date of birth, NHS number and GP </span>of about 1.6 million people, in a filing cabinet during an office move.<br /></p> <p> But no one told staff who sent the cabinet to the landfill site and it has not been recovered, the Information Commissioner's Office said. </p> <p> ... An undertaking signed by the trust's chief executive Ann Sutton read: "The Information Commissioner was provided with a report by the data controller informing that a filing cabinet containing personal data had been sent to landfill during a move of office premises. </p> <p> "The filing cabinet contained a CD holding the address, date of birth, NHS number and GP practice code of approximately 1.6 million individuals. </p></blockquote><p></p><br />Read the whole article. They promise to be more careful - next time.<br /><blockquote><br />The trust said it would now take action to bring in clear policies and procedures for when moving office, improve staff training and boost security against unauthorised and unlawful processing, accidental loss, destruction and damage of personal records.</blockquote><br />That is reassuring - I guess.<br /><br />-- SS

Another Episode of "But Don't Worry, Your Records are Safe..."

Oops! NHS trust sends data CD to landfill By Wesley Johnson Friday, 16 September 2011 The personal information of 1.6 million people has b...

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Does "Highly wired" Correspond to "Diligence in Following Guidelines" for Care?

<span style=";font-family:arial;font-size:100%;" >One might think the hospitals that have spent tens or hundreds of millions of dollars on healthcare IT would fare the best in performance measures, i.e., adherence to guidelines (irrespective of whether those measures reflect better outcomes, a topic for another time).<br /><br />Yet, once again that does not appear to be the case. This might seem paradoxical at first glance.<br /><br />However, as I tell my students, there are no paradoxes - only false assumptions:<br /></span><blockquote style="font-family:arial;"><span style="font-size:100%;"><br /><a href="http://www.nytimes.com/2011/09/15/us/hospital-performance-improved-report-finds.html?_r=1">Report Finds Improved Performance by Hospitals</a><br />New York Times<br />By KEVIN SACK<br />Published: September 14, 2011<br /><br />In the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a <a title="Link to Joint Commission list of top performers." href="http://www.jointcommission.org/assets/1/18/Top_Performers_2010_list_9_13_11.pdf">list</a> on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like <a href="http://health.nytimes.com/health/guides/disease/heart-attack/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Heart attack." class="meta-classifier">heart attack</a> and <a href="http://health.nytimes.com/health/guides/disease/pneumonia/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Pneumonia." class="meta-classifier">pneumonia</a>. <span style="font-weight: bold;">Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list. </span></span></blockquote><span style=";font-family:arial;font-size:100%;" ><br />The "most highly regarded" hospitals tend to also be "the most wired." One would think that all that hardware would improve "</span><span style="font-size:100%;"><span style="font-style: italic;">diligence in following protocols</span>" compared to paper-based hospitals.</span> But this is apparently not the case.<br /><span style=";font-family:arial;font-size:100%;" ><br /></span><blockquote style="font-family:arial;"><span style="font-size:100%;">... “Reputation and performance on important measures of quality do not always correlate,” said Dr. Mark R. Chassin, the Joint Commission’s president. </span><p><span style="font-size:100%;"> As an example, <span style="font-weight: bold;">none </span>of the 17 medical centers listed by U.S. News & World Report on its “<a title="Link to US News & World Report hospital honor roll." href="http://health.usnews.com/health-news/best-hospitals/articles/2011/07/18/best-hospitals-2011-12-the-honor-roll">Best Hospitals Honor Roll</a>” this year are on the Joint Commission’s list of 405 hospitals that received<span style="font-weight: bold;"> at least a 95 percent composite score for compliance with treatment standards</span>. About one-third of a hospital’s score in the U.S. News methodology is based on its reputation as gauged by a survey of physicians. </span></p></blockquote><p style="font-family:arial;"><span style="font-size:100%;">These results are not inconsistent with reports such as:</span></p><p style="font-family:arial;"> </p><ul type="disc" style="font-family:arial;"><li class="MsoNormal" style="">The 2009 <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">National Research Council report on Health IT</a>, that found that IT even at some of the "best" computerized centers "did not support physicians' cognitive needs";</li></ul><ul><li><a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387">The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview</a>. Black AD, Car J, Pagliari C, Anandan C, Cresswell K, et al. PLoS Medicine 8(1): e1000387 (Jan. 18, 2011). doi:10.1371/journal.pmed.1000387, that found that "There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and “techno-enthusiasts” as if this was a given";</li></ul><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <ul><li><span style="font-family:Arial;"><a href="http://www.amjmed.com/article/S0002-9343%2809%2900816-X/abstract">Hospital Computing and the Costs and Quality of Care: A National Study</a>. Himmelstein. Wright, Woolhandler. The American Journal of Medicine, Volume 123, Issue 1 , Pages 40-46, January 2010, that found "</span>Hospitals on the “Most Wired” list performed no better than others on quality, costs, or administrative costs";</li></ul> <!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <span style=";font-family:Arial;font-size:10pt;" ></span><ul face="arial" type="disc"><li class="MsoNormal" style=""><a href="http://archinte.ama-assn.org/cgi/content/full/archinternmed.2010.527">Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality</a>. Max J. Romano, BA; Randall S. Stafford, MD, PhD, Arch Intern Med. Published online Jan. 24, 2011. doi:10.1001/archinternmed.2010.527, that found that there was "no consistent associationbetween EHRs and CDS and better quality. These results raiseconcerns about the ability of health information technologyto fundamentally alter outpatient care quality";</li></ul><ul face="arial" type="disc"><li class="MsoNormal" style=""><a href="http://archinte.ama-assn.org/cgi/content/short/167/13/1400" target="_parent">Electronic Health Record Use and the Quality of Ambulatory Care in the United States</a>. Linder, Ma, Bates et al. Arch Intern Med. 2007;167:1400-1405, that found that "as implemented, EHRs were not associated withbetter quality ambulatory care";</li></ul><ul face="arial" type="disc"><li class="MsoNormal" style="">Other articles compiled at my post "<span style="font-weight: bold;">An updated reading list on heath IT</span>" <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=readinglist">at this link</a>.<span style="font-size:100%;"><br /></span></li></ul> <p style="font-family:arial;"><span style="font-size:100%;"><br /></span></p><p style="font-family:arial;"><span style="font-size:100%;">In fact, it is my belief further investigation is needed to measure the distracting effects of information technology on the delivery of healthcare.</span></p><p style="font-family:arial;"><span style="font-size:100%;"><br /></span></p><blockquote style="font-family:arial;"><p style="font-family:arial;"><span style="font-size:100%;">... The Joint Commission list, at <a target="_" href="http://www.jointcommission.org/">www.jointcommission.org</a>, omitted the Cleveland Clinic; Massachusetts General Hospital in Boston; Duke University Medical Center in Durham, N.C.; Ronald Reagan U.C.L.A. Medical Center; and the University of California San Francisco Medical Center, among others. It did not include a single hospital in New York City, or the most prominent centers in Chicago and Houston.<br /></span></p><p style="font-family:arial;"><span style="font-size:100%;"> “It’s pretty glaring that they’re not there,” said Dr. Peter J. Pronovost, the senior vice president for patient safety and quality for Johns Hopkins Medicine.</span></p><p><span style="font-size:100%;">Rather, the Joint Commission list of top performers included a <span style="font-weight: bold;">disproportionate share of small and rural hospitals</span>, as well as 20 Veterans Affairs medical centers. About 14 percent of roughly 3,000 eligible hospitals made the cut.<br /></span></p><p><br /></p></blockquote><p face="arial"><span style="font-size:100%;">Small and rural hospitals may have clinicians who are able to remain focused on the business of healthcare - patient care - rather than the business of bureaucracy - notably, performing the task of data entry clerks for payers, and being subject to the whims of the <span style="font-weight: bold;">mission hostile user experience</span> (<a href="http://www.tinyurl.com/hostileuserexper">link</a>) of commercial health IT that can <span style="font-weight: bold;">cause injury</span> (<a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html">link</a>) and even <span style="font-weight: bold;">kill</span> (<a href="http://hcrenewal.blogspot.com/2011/06/babys-death-spotlights-safety-risks.html">link</a>).</span></p><p style="font-family: arial;">In my own personal experience, the care provided to my mother in her final months of life by a small local hospital in my area - using paper - was superior in terms of ensuring basics of good care were followed, to that of the highly computerized behemoth that maimed my mother. The smaller hospital provided more individualized care and attention, because the clinicians were not distracted by balky technology and the "legible gibberish" output by these systems.<br /></p><p style="font-family: arial;">Unfortunately, the small hospital was then acquired by the behemoth. I was there during the rollout of the EHR from the parent. It was not pretty, and I soon found the small hospital's nurses and physicians as distracted as those at the large center, for example in dealing with risky informational abominations such as grossly defective allergy lists (<a href="http://hcrenewal.blogspot.com/2011/03/ehr-legible-gibberish-another-example.html">link</a>).</p><p style="font-family: arial;">Perhaps the toxic effects of today's commercial health IT need to be taken into account in the Joint Commission's future studies.<br /></p><p style="font-family: arial;"><span style="font-family:arial;">-- SS</span><br /></p>

Does "Highly wired" Correspond to "Diligence in Following Guidelines" for Care?

One might think the hospitals that have spent tens or hundreds of millions of dollars on healthcare IT would fare the best in performance ...

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Highly Paid "Skilled Executives and Visionary Leaders" Sue a Whistleblower

In May, we <a href="http://hcrenewal.blogspot.com/2011/05/million-dollar-plus-hospital-ceo.html">wondered</a> what some hospital executives did to justify their munificent compensation.  Now we have found out a little more.<br /><br />Specifically, we noted that at Wake Forest Baptist Medical Center, the CEO got $1.68 million in fiscal 2009-2010.  The President got $859,521. The CFO got $734,282.  A hospital statement at the time called them "<em>skilled executives and visionary leaders</em>," but provided no evidence to support this claim.<br /><br /><strong>Audit Showed the Hospital was Overpaid</strong><br /><br />Now recent news stories show just how skilled and visionary these leaders are.  The Winston-Salem Journal <a href="http://www2.journalnow.com/news/2011/sep/07/1/baptist-hospital-received-134-million-in-overpayme-ar-1365985/">reported</a> how a state health insurance plan had overpaid the hospital, and the hospital had refused to give the money back.  <br /><blockquote><em>N.C. Baptist Hospital is keeping about $1.34 million in reimbursement rate overpayments from the State Health Plan</em>.<br /><br />The figure was revealed Wednesday in a State Auditor's Office report on the contract between the two groups. Baptist disputes the description of the amount as an overpayment.<br /><br />Plan officials said they will not attempt to recoup the money, which Baptist has declined to repay because it said it complied with the terms of the contract.<br /><br />'The plan views this as a legal matter, and Baptist Hospital is under no legal/contractual obligation to pay back the overpayments,' said Beth Horner, spokeswoman for the plan.</blockquote><br />The state auditor was none too pleased:<br /><blockquote>However, Beth Wood, the state's auditor, said <em>she believes Baptist has <strong>an ethical obligation</strong> to pay some, if not all, of the overpayment it received from 2003 to 2008</em>.</blockquote><br />A local health care expert also had a dim view of the medical center's actions:<br /><blockquote>Adam Linker, a health-care analyst for the N.C. Justice Center, said the plan 'had the right to ask for more discounts with the Baptist rate increase and failed to do so because it had written a sloppy contract and poorly monitored it.'<br /><br />'But Baptist failed to notify the plan in a direct manner of the rate increase. <em>It clearly had the <strong>obligation as a good partner with the state</strong> to give the discount in the spirit of the contract</em>, and not take advantage of a sloppily written, poorly monitored contract.'</blockquote>The leadership at Wake Forest Baptist apparently were not interested in these ethical distinctions.  <br /><br /><strong>The Hospital Sued the Whistle Blower</strong><br /><br />Instead, they decided to attack the messenger, or sue the whistle blower in this case.  The Winston-Salem Journal's next relevant <a href="http://www2.journalnow.com/news/2011/sep/11/wsmain01-nc-baptist-suing-former-employee-turned-w-ar-1377598/">story</a> stated:<br /><blockquote>A former N.C. Baptist Hospital employee has spent thousands of dollars <em>defending himself in a lawsuit by the hospital accusing him of 'unjustified, vindictive, malicious and gratuitous actions' for alerting state officials that the State Health Plan was overpaying Baptist.</em><br /><br />The case of Joseph Vincoli, a former administrative director at the hospital who was terminated, is an example of <em>how little, if any, legal protection a private employee may have when filing a whistle-blower complaint that could affect a state agency and taxpayer money</em>.<br /><br /><em>A state auditor's report released Wednesday appears to confirm that Vincoli's complaints had validity</em>. He alerted state officials in January 2009 that Baptist was collecting more than it would have been entitled to if the State Health Plan had known about hospital rate increases and had insisted on getting rate discounts it was eligible for.</blockquote><br />In addition,<br /><blockquote>Vincoli, who lives in Clemmons, declined to be interviewed by the Winston-Salem Journal, because he is under legal threat, but Phil Michael, an attorney representing Vincoli, said the state audit report was 'a bittersweet resolution' to the overpayments dispute.<br /><br />'Joe encountered a situation where the hospital received money he believed it wasn't entitled to, and <em>he did what he believed was his duty by reporting it to the state</em>,' Michael said.<br /><br />The Baptist lawsuit, filed Jan. 26, accuses Vincoli of breaching their confidential settlement by contacting the plan and other state agencies about his concerns and <em>'providing disparaging and/or confidential information</em>.'<br /><br />Vincoli worked at Baptist as its managed-care director from July 2006 to October 2007, when his employment was terminated by the hospital.<br /><br /><em>The Baptist lawsuit said Vincoli's actions have caused the hospital 'to suffer embarrassment, negative false publicity, loss of goodwill with the state of N.C. and the communities the hospital serves</em>, and financial loss including, but not limited to, attorneys fees.'<br /><br />'Vincoli had no legitimate reason to involve himself in the SHP contract issue' as a private citizen and later as an employee of two state agencies, the hospital said. Vincoli now works for the N.C. Department of Corrections.</blockquote><br />Didn't they used to teach in citizenship classes that us ordinary civilians are supposed to notify legal authorities when we see something suspicious? That does not appear to be how the august leaders of Wake Forest Baptist see it.<br /><br />In my humble opinion, but based on the auditor's findings, it was the hospital leadership that caused the institution "to suffer embarrassment, negative false publicity, loss of goodwill with the state of N.C. and the communities the hospital serves...."<br /><br />As a Winston-Salem Journal <a href="http://www2.journalnow.com/news/opinion/2011/sep/15/wsopin01-hospital-made-corporate-case-on-whistlebl-ar-1391660/">editorial</a> put it:<br /><blockquote>The nonprofit hospital has built a good corporate legal defense. Meanwhile <em>a good citizen, a whistle-blower, lost his job and will pay thousands to defend himself for doing what most people should view as the right thing. We commend him.</em><br /><br />The hospital will likely prevail on the legal issues. As a corporation, it has a duty to do so. But <em><strong>on the moral scorecard, it loses.</strong></em></blockquote><strong>Summary</strong><br /><br />So now we see just how "visionary" the executives of Wake Forest Baptist are. They seem to have visions about bullying whistle blowers who dare poke their noses into the hospital's dubious financial schemes operated at the expense of local tax-payers. Suing Mr Vincoli would be a low tactic for garbage hauling company to use, but it is incomprehensible how a hospital system could employ it. The "skilled executives" made a mockery of the institution's lofty <a href="http://www.wakehealth.edu/Mission-Statement.htm">vision statement</a>, which included:<br /><blockquote>Compassion - responsive to the physical, emotional, spiritual and intellectual needs of all </blockquote>and<br /><blockquote>Integrity - demonstrate fairness, honesty, sincerity and accountability </blockquote>It looks like protecting revenue and denying that the visionary leaders could make an error trump compassion and integrity.<br />So perhaps the recent high pay of top hospital executives was a terrible error. Maybe the board had no idea what sort of ruthless people it had hired. Or maybe they had a perfect idea, it was no error, and the board wanted to encourage the most ruthless leadership it could, as long as it made money.<br /><br />Perhaps the executives and board members will yet explain why they went after Mr Vincoli.<br /><br />Meanwhile, this case is the latest example of why we need much better legal protections for whistle blowers in health care.<br /><br />So, I turn blue in the face repeating.... health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research. On the other hand, those who authorize, direct and implement bad behavior ought to suffer negative consequences sufficient to deter future bad behavior.<br /><br /><br />If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.

Highly Paid "Skilled Executives and Visionary Leaders" Sue a Whistleblower

In May, we wondered what some hospital executives did to justify their munificent compensation.  Now we have found out a little more. Speci...

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Defending Academic Whistleblowers: Call Out the Marines?

At "<a href="http://hcrenewal.blogspot.com/2011/09/academic-medicine-deploys-logical.html">Academic Medicine Deploys a Logical Fallacy to Avoid Disclosing Inconvenient Truths</a>" Roy Poses wrote about the illogic employed by academia to weaken draft rules for researchers to disclose conflicts of interest.<br /><br />Another major component of research in academia might be termed "gangster tactics against whistleblowers on wrongdoing."<br /><br />In the following <a href="http://www.pogo.org/resources/public-health/amsterdam-complaint-to-gutmann-re-evans-et-al-misconduct-20110708.html">July 8, 2011 letter</a> to Dr. Amy Guttmann, President of the University of Pennsylvania (courtesy the <span style="font-weight: bold;">Project on Government Oversight</span> or POGO), a Penn psychiatry researcher, Dr. Jay Amsterdam, has retained a law firm to represent him in alleged research misconduct by others at Penn, specifically Dwight Evans, the Chair of the Department, and an Associate Professor Dr. Laszlo Gyulai (note: I have never met and do not know any of the people involved):<br /><br /><blockquote>"Dear Dr. Guttmann,<br /><br />On behalf of my client, Dr. Jay Amsterdam, Professor of Psychiatry at the University of Pennsylvania, I would like to inform you that we have filed a charge of research misconduct with the Office of Research Integrity (OR!) against Dr. Dwight L. Evans, Professor of Psychiatry and Chairman of the Department of Psychiatry at the University of Pennsylvania, and Dr. Laszlo Gyulai, Associate Professor of Psychiatry at the University of Pennsylvania. I have enclosed a copy of the complaint and referenced documents for your reference. As chairwoman of President Barack Obama's Presidential Commission for the Study of Bioethical Issues, I feel certain you will deal with this matter in a just and sincere fashion.<br /><br /><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFgtT962Efu8-gpfcRYG7kk8975vsX86dRBFgGFGOIuhWHAVS_vmgK4BDh-U3-t6QFUUjmEEoGlZbwQY-S8LpeJ0B5P6HKSQ9t8X2sFehndKgXueq84E53D7guaE8dn_beFFhbVaOspYgb/s1600/guttman.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5652590687739063698" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFgtT962Efu8-gpfcRYG7kk8975vsX86dRBFgGFGOIuhWHAVS_vmgK4BDh-U3-t6QFUUjmEEoGlZbwQY-S8LpeJ0B5P6HKSQ9t8X2sFehndKgXueq84E53D7guaE8dn_beFFhbVaOspYgb/s320/guttman.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 255px; height: 320px;" /></a><span style="font-size:85%;">Letter, page 1 (click to enlarge)</span><br /></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1aOv-Vr6o3qy1-iOMV9mh4lSLef5PjGr0sBsNzs7JTKsg92sZAiEiawooTx2fvXV79VTQQTog74xOMnwIG9syuihF_J6gkSNi_4QE6TBtaHJ5TFUDGaB7jDmayO4lJI2eK6m6ztwafotq/s1600/guttman.jpg"><br /></a><br /><br /><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie1LrZfOQ_TDSIWFhlGVmINoBbW-bcNkaRe4yWU2JcCrayjDrQN_4czphOnxjnEX81Tpse6FZCRDyn-ryGY7bMd4RDjTHCKOiNM6FM8sUAKMY9J3HXF742VQqbsbsjOgfXYhacTtLMLbuW/s1600/guttmannp2.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5652591223811191458" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie1LrZfOQ_TDSIWFhlGVmINoBbW-bcNkaRe4yWU2JcCrayjDrQN_4czphOnxjnEX81Tpse6FZCRDyn-ryGY7bMd4RDjTHCKOiNM6FM8sUAKMY9J3HXF742VQqbsbsjOgfXYhacTtLMLbuW/s320/guttmannp2.jpg" style="display: block; margin: 0px auto 10px; text-align: center; cursor: pointer; width: 249px; height: 320px;" /></a><span style="font-size:85%;">Letter, page 2 (click to enlarge)</span><br /></div></blockquote><br />The allegations are not in themselves surprising (at least to me). The complaint is that the defendants misappropriated data from a study conducted by the plaintiff, manipulated the data, and used it in a ghostwritten article by a major journal, the American Journal of Psychiatry, in a concealed marketing effort to increase sales of Paxil by GSK. We have documented many examples of this type of behavior in medical research at this blog.<br /><br />(By way of my not being surprised by such allegations, I personally have been involved as junior Yale faulty in that research university's professors' attempts to misappropriate my IP, a computer program I wrote for a Yale collaboration on birth defects in the Arab world, for their own use. My internal complaints were followed by severe retaliation, up to the level of blacklisting and extortion. Those attempts were aided by, of all things, an Associate General Counsel who was not authorized to practice law in the state, apparently not having taken the Law Boards. I put an end to that effort through legal means. This was followed a number of years later by attempted misappropriation of the same property by a Johns Hopkins-affiliated professor with his own software company in a DoD proposal. I also put an end to the latter effort, which involved informing the DoD.)<br /><br />However, my purpose here is not to comment on the allegations of research misconduct. It is to comment on a subject that occupies three of the four paragraphs in the above letter - <span style="font-style: italic;">protection from retaliation:</span><br /><br /><blockquote>... By filing this complaint, <span style="font-weight: bold;">I expect my client to receive full and complete protection from retaliation and/ or defamation by either the University of Pennsylvania and/ or</span><span style="font-weight: bold;"> any other parties involved in publishing the referenced study</span>. <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[E.g., GSK - ed.]</span> It is my client's belief that the data from his study was effectively stolen from him, manipulated and used in a ghostwritten article published in the American Journal of Psychiatry in order to advance a marketing scheme by GlaxoSmithKline to increase sales of Paxil.<br /><br />If any <span style="font-weight: bold;">acts of retaliation and/or defamation</span> are taken against my client, I will immediately inform <span style="font-weight: bold;">ORI and the Health and Human Services Office of the Inspector General. </span>Furthermore, it is my understanding that <span style="font-weight: bold;">s</span><span style="font-weight: bold;">everal congressional committees</span> have expressed an interest in investigating the problem of research misconduct and ghostwriting in academia and, thus, I intend to allow my client to fully cooperate with any investigation and <span style="font-weight: bold;">will inform Congress of any retaliation against him for such cooperation.</span><br /><br />To ensure this complaint is taken seriously, and to alert interested parties, I am providing copies of this correspondence to <span style="font-weight: bold;">Senator Charles Grassley, Senator Herb</span><span style="font-weight: bold;"> Kohl, and the Chairman and Ranking members of the House Energy and Commerce, and the House Committee on Oversight and Government Reform</span>.<br /><br /></blockquote>About the only resources left out of the list of protectors of the plaintiff from abuse are the Marines ... and perhaps a threat of "Frontier Justice."<br /><br />That a law firm must include explicit threats to expose retaliation against whistleblowers to high-ranking members of Congress suggests Research universities and their corporate allies have become more like the Mafia than centers of novel scientific discovery.<br /><br />This all reminds me of my Jan. 13, 1999 letter to the editor in the Journal of the American Medical Association (JAMA) entitled "<a href="http://jama.ama-assn.org/content/281/2/135.2.extract">Academic and Legal Aspects of Authorship Disputes</a>."<br /><br />As a result of my Yale experience (which, incidentally, also probably damaged nascent cross-cultural progress due to the unusual aspect of my work in facilitating improved care of children with birth defects in a Middle Eastern oil-producing Kingdom), I wrote a response to a July 1998 JAMA article on growing authorship disputes and abuses at Harvard Medical School ("<a href="http://jama.ama-assn.org/content/280/3/216.abstract">Authorship: The Coin of the Realm, The Source of Complaints</a>" by then-Ombud Linda J. Wilcox).<br /><br />I wrote:<br /><span class="xref-bibr"></span><blockquote><span class="xref-bibr"><br />Jan. 13, 1999<br /><br />To the editor:<br /><br />I was alarmed by the statement in the article on authorship by Ms Wilcox [1] </span>saying, "<span style="font-weight: bold;">It is unreasonable for institutions to promise that they can protect individuals from retaliation for coming forward to complain through formal grievance procedures.</span>" Most organizations have policies on retaliation, especially with regard to grievances. If enforced, these policies can discourage such behavior and ensure the victim of redress. In addition, retaliation such as that mentioned in the public and federal sectors is downright illegal, and university employees fall under Department of Labor workplace standards and laws for their respective states. <br /><br />Universities have serious ethical and credibility problems<span style="font-weight: bold;"> if they have such poor control over their employees that they cannot promise to protect individuals from actions contrary to their own grievance policies and that are probably illegal</span>.</blockquote><br />I continued on with the argument that lawlessness in universities was counterproductive and needed to be halted, but Ms. Wilcox' reply was more platitudinous than substantive about the 'helplessness' of universities in protecting their own from retaliation.<br /><br />It seems little has changed.<br /><br />To expect the best research from such an environment is like expecting silk purses to be manufactured by pork producers.<br /><br />-- SS<br /><br /><span style=";font-family:Arial;font-size:11pt;color:black;" ></span>

Defending Academic Whistleblowers: Call Out the Marines?

At " Academic Medicine Deploys a Logical Fallacy to Avoid Disclosing Inconvenient Truths " Roy Poses wrote about the illogic emplo...

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Academic Medicine Deploys a Logical Fallacy to Avoid Disclosing Inconvenient Truths

We recently <a href="http://hcrenewal.blogspot.com/2011/08/retreat-back-to-regulatory-capture-us.html">discussed</a> a simultaneous retreat from aggressive regulation and enforcement applied to big health care corporations by US government agencies.  Now a story published by Bloomberg (currently available without a subscription <a href="http://pharmagossip.blogspot.com/2011/09/universities-lobby-pushed-obama-to-keep.html">here</a> on PharmaGossip) showed that the push for less disclosure of relationships with industry that generated conflicts of interest for academic medicine came not from industry, but from ... academic medicine:<br /><blockquote><em>The lobby for Harvard University and other research institutions drove the Obama administration to weaken draft rules for scientists to disclose potential conflicts of interest</em>, according to U.S. records and watchdog groups.</blockquote><br />In particular,<br /><blockquote>Universities objected to draft rules in a letter to NIH and in meetings with officials at the White House Office of Management and Budget, approver of the final version, said Carrie Wolinetz, <em>associate vice president for federal relations at the Association of American Universities that represents 61 research universities</em>.</blockquote><br />Also,<br /><blockquote>The letter was co-signed with the <em>Association of American Medical Colleges</em>, American Council on Education and Association of Public and Land-Grant Universities. </blockquote><br />The one example of the universities' reasoning to justify their objections to greater disclosure of conflicts of interest was striking.<br /><blockquote>Wolinetz’s organization wrote in the letter that <em>'there is a paucity of evidence that the disclosure and management of financial conflicts of interest affect objectivity and integrity.'</em></blockquote><br />Recall that the disclosure to which they objected would be by federally funded researchers, and of financial relationships with organizations that had vested interests related to the particular research projects. The Institute of Medicine's landmark <a href="http://www.iom.edu/~/media/Files/Report%20Files/2009/Conflict-of-Interest-in-Medical-Research-Education-and-Practice/COI%20report%20brief%20for%20web.pdf">report</a>, "Conflict of Interest in Medical Research, Education and Practice,"  stated:<br /><blockquote>Disclosure of financial relationships with industry is <em>an essential, though limited, first step</em> in identifying and responding to conflicts of interest.</blockquote><br />One could also argue, as did Senator Grassley, (see <a href="http://hcrenewal.blogspot.com/2011/08/retreat-back-to-regulatory-capture-us.html">here</a>) that disclosure is owed to the tax-payers who support the research. <br /><br />On the other hand, I do not think anyone would argue that disclosure and the ill-defined "management" proposed by the NIH would be sufficient to guarantee "objectivity and integrity" of the research.<br /><br />In fact, the IOM report called for going far beyond disclosure.  Specifically, it called for banning most conflicts affecting most clinical research:<br /><blockquote><em><strong>researchers should not conduct research involving human participants if they have a financial interest in the outcome of the research</strong></em></blockquote><br />This goes far beyond what the original NIH revision of its conflict of interest rules mandated. However, I am sure that banning such relationships was the last thing that the AAU and AAMC wanted. <br /><br />So the academic institutions' argument seems to be a variant on the<a href="http://www.nizkor.org/features/fallacies/false-dilemma.html"> false dilemma logical fallacy</a>. If the only alternative to doing nothing about conflicts of interest is disclosure, and if disclosure is really a poor solution to the problem, than perhaps doing nothing makes sense. However, if disclosure is just a necessary first step, as the IOM asserted, then it is a first step that should be taken in preparation for other steps to come.<br /><br />Note that the academic institutions' argument also seems to be a version of what has been called the <a href="http://www.ozarkia.net/bill/anarchism/Fallacies.html#Nirvana">Nirvana fallacy</a>, or the perfect is the enemy of the good fallacy. That is, if what one can do does not result in Nirvana, then one should do nothing.<br /><br />Finally, in this case the academic medical institutions' argument seemed too extreme even for their pharmaceutical industry supporters. As the Bloomberg article reported, <br /><blockquote>Researchers have been lax making financial disclosures and there’s been an absence of oversight, said Peter Pitts, president of the Center for Medicine in the Public Interest, a nonprofit research institute in New York. 'When you don’t properly disclose, you give the impression that you’re trying to hide something.'<br /><br /><em>Institutes should instead disclose all financial interests without trying to judge whether they are conflicts</em>, Pitts said.</blockquote><br />As we have <a href="http://hcrenewal.blogspot.com/2008/01/logical-fallacies-and-discussion-of.html">discussed previously</a>, Peter Pitts' main occupation has been as a leader in public relations for the pharmaceutical industry. He is currently a senior partner, director, global regulatory & health policy <a href="http://www.porternovelli.com/news-room/forcing-the-hand-facebooks-policy-change-and-the-future-of-pharmaceuticals/">for Porter Novelli</a>. Even though we have previously criticized Pitts for deploying logical fallacies in support of industry positions, in this case the academic medical institutions' argument was too much for him to support.<br /><br />So we have come this far. Universities are ostensibly about finding and disseminating the truth. Yet universities' academic medical subsidiaries now deploy illogic to avoid revealing particular truths that they find uncomfortable, and which might raise questions about relationships with industry that are increasingly lucrative. Universities seem now willing to jettison their mission to make more money. <br /><br />True health care reform would require academic medicine to put its mission ahead of its revenues.

Academic Medicine Deploys a Logical Fallacy to Avoid Disclosing Inconvenient Truths

We recently discussed a simultaneous retreat from aggressive regulation and enforcement applied to big health care corporations by US gover...

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