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"Why Do We Always Need to Blame Somebody?" - An Investment Banker Pushes Back Against Health Care Leadership Accountability

One of the many dramatic stories generated by the destructive Hurricane Sandy illustrated, oddly enough, the influence of big finance on American academic medicine. Vivid video showed patients being carried down darkened stairways after flooding and a power failure at Langone Medical Center in New York (for example, see<a href="http://www.cnn.com/2012/10/30/health/sandy-hospital/index.html"> this CNN story</a>.)  Amazingly, all the patients survived, thanks to heroic work by health care professionals and first responders.  CNN noted, "Some 1,000 staff members -- doctors, nurses, residents and medical students -- along with firefighters and police officers evacuated the patients." The medical center suffered significant damage beyond that caused by the blackout.  A New York Times <a href="http://www.nytimes.com/2012/11/10/nyregion/damage-from-hurricane-sandy-could-cost-nyu-langone-millions.html">story</a> about the problems was entitled, "A Flooded Mess that was a Medical Gem."  It noted the hospital's basement flooding destroyed major equipment like MRI machines, a linear accelerator and a gamma knife.  An animal research facility was destroyed and most of the animals died.  A renovated lecture hall and the library were ruined. What Went Wrong? However, soon after the debate began about why the hospital flooded and power failed.  A Bloomberg <a href="http://www.businessweek.com/news/2012-10-30/new-york-hospital-evacuates-patients-as-sandy-hits-power">story</a> stated,   <blockquote class="tr_bq">New York University Langone Medical Center, the 705-bed hospital in lower Manhattan that assured city officials it was ready for Hurricane Sandy, stood dark and empty a day after the storm rolled through. </blockquote> That story raised questions whether hospital leadership gave adequate priority to infrastructure like generators, or put too much emphasis on spending likely to produce more rapid rewards. <blockquote class="tr_bq">Blame is being placed on the building’s outdated backup power system, which has raised concern that aging infrastructure at U.S. hospitals has created a risk for similar outages that jeopardize patient care. 'Hospitals are careful to get the latest and greatest medical equipment, but then they don’t spend on the infrastructure,' Michael Orlowicz, a principal at consulting company Lawrence Associates LLC, said....</blockquote> A story on ProPublica (<a href="http://www.salon.com/2012/11/01/why_do_hospital_generators_keep_failing/">available on Salon</a>) noted, <blockquote class="tr_bq">Experts say such failures are troubling but not entirely surprising. Dr. Arthur Kellermann founded the emergency department at Emory University and headed it from 1999 to 2007. Now, he’s Paul O’Neill-Alcoa Chair in Policy Analysis at RAND Corporation think tank. The other night, as the NYU evacuation was unfolding, he tweeted, 'Hospital preparedness and well-functioning backup systems are a costly distraction from daily business, until they are needed. Like now.' In an email interview with ProPublica, Kellermann elaborated: 'I have no doubt when the hospital assured the Mayor that their backup systems were ready, they believed they were. They were wrong. What I find most remarkable about this story is that [more than seven] years after Hurricane Katrina, major hospitals still have critical backup systems like generators in basements that are prone to flooding.'</blockquote> Similarly, a <a href="http://www.reuters.com/article/2012/11/03/storm-sandy-hospitals-idUSL1E8M1LR620121103">Reuters story</a> included another quote from Dr Kellermann, <blockquote class="tr_bq">'I've been asking hospitals to look at their own survivability' after a natural or manmade disaster, 'and I just can't get it on their radar screens,' said Dr. Art Kellerman,...</blockquote>  It added, <blockquote class="tr_bq">For hospital administrators trying to keep their institutions in the black, disaster-resistant infrastructure is expensive and lacks the sex appeal of robotic surgery suites and proton-beam cancer therapy to attract patients. 'People don't pick hospitals based on which one has the best generator,' Kellerman said. </blockquote> The notion that hospital leaders may put short-term revenue ahead of long-term infrastructure development, even when such development might be critical for patient safety, should not surprise <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a> readers.  Hospitals are often lead or influenced by those who believe maximizing short-term revenue should be the main goal of all management, an over-generalization of the idea promoted in business schools for a generation that business leaders should maximize "shareholder value," which has come to be defined as short-term stock price (see <a href="http://hcrenewal.blogspot.com/2012/04/health-care-dysfunction-explained-by.html">this post</a>).   Who Defended the Disaster Planning  In response to this or anticipated criticism, leaders of Langone Medical Center deployed.  Not unexpectedly, one was Richard Cohen, the vice president for facilities, as reported by ProPublica, <a href="http://www.huffingtonpost.com/sheri-fink/nyu-hospital-evacuation_b_2072362.html">via the Huffington Post,</a>   <blockquote class="tr_bq">After Hurricane Irene, officials at NYU Langone Medical Center spent several million dollars protecting its backup power system from flooding, according to Richard Cohen, vice president of facilities operations. The hospital removed a fuel tank and a set of emergency generators at street level and chose to depend on what Cohen termed an 'extremely modern, extremely reliable' system of rooftop generators. The hospital also built a new, flood-resistant house for pumps that draw fuel from the hospital's sealed underground tank and feed it to the generators that make electricity when New York City's power fails. One vulnerability remained, and it proved to be the system's Achilles Heel. A portion of the hospital's power distribution circuits, which direct the generated electricity out into various areas of the hospital, were located in the hospital's basement. 'It's like what happens when you have a flood in your basement and the electrical panel is in your basement,' Cohen said.</blockquote> Oops.  Why a crucial component of the system meant to protect the back up power system from threats including flooding was placed in an area at risk from flooding was not clear.   Only one story I could find (<a href="http://www.nytimes.com/2012/11/10/nyregion/damage-from-hurricane-sandy-could-cost-nyu-langone-millions.html?smid=tw-nytimeshealth&seid=auto">in the NY Times</a>) included a response by the Dean of the Medical School and CEO of the Medical Center Dr Robert I Grossman. <blockquote class="tr_bq">At this point, Dr. Grossman said, he could only theorize as to why the generators had shut down. All but one generator is on a high floor, but the fuel tanks are in the basement. The flood, he said, was registered by the liquid sensors on the tanks, which then did what they were supposed to do in the event, for instance, of an oil leak. They shut down the fuel to the generators.</blockquote> Oops again.  Why an effort to flood proof the hospital included an undeground fuel tank which could not be operated if water got near it was also not clear.  The most voluble defender of the hospital's management proved to be one Mr Kenneth Langone.  As noted in a <a href="http://blogs.wsj.com/metropolis/2012/10/30/among-the-patients-at-evacuated-hospital-a-benefactor/">blog post</a> in the Wall Street Journal, Mr Langone is the medical center's "board chair and benefactor."  In fact, as the NY Times <a href="http://www.nytimes.com/2008/04/16/nyregion/16donate.html">reported</a> in 2008, <blockquote class="tr_bq">Kenneth G Langone, a billionaire financier and founder of Home Depot, is giving another $100 million donation to New York University Medical Center, matching the one he made anonymously in 1999.  In return, the university plans to name the medical center the N.Y.U. Langone Medical Center,....</blockquote> The WSJ blog post asserted, <blockquote class="tr_bq">Langone said the hospital 'frequently' tested its generators and they had passed the tests, and the hospital was prepared for a 12-foot storm surge. 'We anticipated 12-foot surges, which we knew we could handle. We got 14-foot surges,' he said. Some of the hospital generators were in the basement, which flooded. Langone acknowledged that the generators were 'not in the right location,' but that was an artifact of aging facilities undergoing an extensive upgrade. 'They’ve been there for years,' he said of the generators in the basement. As part of a $3.2 billion modernization, NYU Langone was planning on buying new generators and locating them in better locations than the basement, Langone said.</blockquote> Oops one more time.  Mr Langone seemed to only offer inertia as an excuse for why some generators remained in the basement after an effort to flood proof the back up electrical system. Langone was quoted in the CNN story mentioned above, <blockquote class="tr_bq">Kenneth Langone, the chairman of the hospital's board of trustees who also happened to be a patient there until he was discharged Tuesday morning, said that regulations require the generators to be tested regularly and that they've worked every time. Langone said the hospital is in the midst of an 'enormous' building campaign. The generators are going to be replaced in a renovation, he said.</blockquote> In a Bloomberg <a href="http://www.bloomberg.com/news/2012-10-30/chairman-langone-was-nyu-hospital-patient-in-storm-evacuation.html">story</a>, Langone was quoted again, <blockquote class="tr_bq">'We believed the machines would work, and we believed everything we were told about the scope and size of the storm,' Langone said.</blockquote>  In that story, he tried to deflect attention from tha apparent infrastructure failure, and presumably the responsibility of the organization's leadership for it, to the efforts of health professionals, <blockquote class="tr_bq">'The backup generators failed, it’s that simple, but the story here is the magnificence of the effort of all of our people and what they did,' Langone, 77, said yesterday.... </blockquote> He also defended the relatively silent Dean and medical center CEO, <blockquote class="tr_bq">'What this dean has done is nothing short of spectacular, in every respect,' Langone said of Grossman. 'So last night God decides to give us a test and our machines failed.' </blockquote> The story ended with yet another of his attempts to deflect attention to management's responsibility, <blockquote class="tr_bq">'Machines fail, airplanes take off in great shape and they have malfunctions,' Langone said. 'Why do we always need to blame somebody for something that could just have happened? Why not write a story about what people did because things happened? Let’s be a little positive once in a while.' </blockquote> And in the <a href="http://www.wnyc.org/blogs/wnyc-news-blog/2012/nov/10/nyu-chairman-says-hospital-shut-down-sandy-was-configured-code/">WNYC News Blog</a>, Langone appeared yet again with this apologia,  <blockquote class="tr_bq">He said hospital pumps failed, because they were overwhelmed by an event that was 'unprecedented' and 'an act of god.' 'The generators are on the seventh floor, and the fuel supply is in cement vaults in the basement, where they're supposed to be according to code,' Langone said. 'Moisture sensors shut down the pumps, but they did what they're supposed to do.'</blockquote> Summary Certainly the survival of all the former patients at Langone Medical Center due to brave efforts by health care professionals and first responders ought to be celebrated.  From the discussion so far, it is not clear whether the infrastructure failures were unavoidable due to the scope of a huge natural disaster, or whether the failures were the results of poor planning and insufficient attention to and investment in infrastructure.  Celebration of personal and professional dedication, however, ought not to distract from determining what lessons could be learned about making health care infrastructure safer in cases of natural disaster.  It also ought not to distract from concerns about management accountability.  In this day and age, it is not surprising that no executive at Langone Medical Center would accept any responsibility for an effort to protect its electrical back-up power from flooding that included an underground fuel tank which would be shut down if any water affected it.  However, these executives are rewarded handsomely supposedly for their "spectacular" leadership.  (Dean Grossman received $1,744,780 in the 2010-2011 period according to the NYU Hospitals Center 2010 form 990.  That document listed four other executives who made over $1 million.)  One would think they would at least try to substantively address how their patients got put into such a precarious situation. It is surprising that the silence from management was supplanted by the opinions of a very wealthy board chairman who paid hundreds of millions for some of the improvements to the hospital that were destroyed by the storm, but improvements that may not have included fully flood proofing the hospital's back up electrical system.  Why he may well be disappointed about the loss of what he spent so much to build, it is not clear why his opinions about technical aspects of disaster preparation should replace responses from those who were responsible for disaster preparedness.  After all, Mr Langone, while very wealthy, has no evident expertise in engineering, science, or anything pertaining to protecting infrastructure from natural disasters.  (Mr Langone's <a href="http://csis.org/expert/kenneth-g-langone">biography</a> showed his background seems to be only in investment banking and finance.)  One wonders whether Mr Langone's prominence in the discussion suggests how influential the views of investment bankers, versus those of health care professionals, engineers and scientists, have become in the operation of health care systems. Again, it appears that the culture of <a href="http://hcrenewal.blogspot.com/search/label/finance">finance</a> has intruded progressively into the cultures of health care and academics during an era in which finance has been increasingly irresponsible, as shown by the global financial collapse and our current economic woes.  Instead, true health care reform would develop leadership and governance that upholds health care professionals' values rather than worshiping short term revenue.

"Why Do We Always Need to Blame Somebody?" - An Investment Banker Pushes Back Against Health Care Leadership Accountability

One of the many dramatic stories generated by the destructive Hurricane Sandy illustrated, oddly enough, the influence of big finance on Ame...

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Will the Circle be Unbroken? - Hospital Executive Compensation Continues to Defy Gravity and Logic

A <a href="http://www.healthleadersmedia.com/content/MAG-286243/Senior-Leadership-Pay-Continues-to-Rise">report</a> from Health Leaders Media, a prominent media site about health care management, shows how non-profit hospital executive compensation continues to levitate.  In general, <blockquote class="tr_bq">For not-for-profit CEOs nationwide the median total cash compensation (base plus incentives) increased 3% to 6.7% over last year, and these organizations' senior leadership teams gained similar pay increases,...</blockquote> The specifics included <blockquote class="tr_bq">Health system CEOs' median base salaries increased to $717,500 (2012) from $650,000 (2011), while independent hospital CEOs' median base salaries rose to $506,100 from $472,000 during that period, according to IHS. Comparatively, Sullivan, Cotter and Associates shows the base pay for system CEOs nationwide increased while the TCC declined slightly—base pay increased to $334,700 from $325,000, while TCC decreased to $411,100 from $412,100 from 2012 to 2011, respectively. Unlike their health system counterparts, independent hospital CEOs' base pay and TCC climbed between 2011 and 2012—base pay went up to $530,000 from $504,000 (a 4.9% gain) and TCC jumped 4.3% to $600,000 from $574,000.</blockquote> The report also showed that pay increased for some species of top executives.  CIOs (chief information officers) did the best, <blockquote class="tr_bq">Nationally, system CIOs received one of the largest TCC increases year over year, according to Sullivan, Cotter and Associates (5.8%). IHS reported a median base salary increase of (3.5%). </blockquote> These increases ought to be compared to the base rate for the population.  In September, the Census Bureau reported that median family income dropped in 2011 (<a href="http://www.nytimes.com/2012/09/13/us/us-incomes-dropped-last-year-census-bureau-says.html">per the New York Times</a>): <blockquote class="tr_bq"> Median household income after inflation fell to $50,054, a level that was 8 percent lower than in 2007, the year before the recession took hold. </blockquote> The actual decline from 2010 to 2011 was 1.5% (look <a href="http://www.census.gov/newsroom/releases/archives/income_wealth/cb12-172.html">here</a>). So executive compensation in health care continues to defy gravity, even as the income of the typical family does the opposite.  Will the Circle be Unbroken? Conveniently, the day before, another well regarded site for hospital management information, Becker's Hospital Review, provided a rationale for current health care executive compensation, based on a <a href="http://www.integratedhealthcarestrategies.com/blog/post/2012/11/01/Are-Executives-Paid-Too-Much.aspx">blog post</a> from Integrated Healthcare Strategies, which claims to be one of the largest US healthcare consulting firms. The Review article first noted that "executive compensation is a delicate subject," without explaining why it was more delicate than the compensation given to other people.  It then answered the question its title posed, "are hospital executives paid too much?"  In summary, <blockquote class="tr_bq">compensation levels are currently appropriate, on the whole, because employers are generally keeping them on the job with such consistent pay levels. </blockquote> The syntax is a little difficult, but I believe the translation is the circular cliche, "it is what it is."  More formally, this appears to be a version of <a href="http://www.nizkor.org/features/fallacies/begging-the-question.html">begging the question</a>, or <a href="http://www.logicalfallacies.info/presumption/begging-the-question/">circular reasoning</a>. The Integrated Healthcare Stragies blog post by <a href="http://www.integratedhealthcarestrategies.com/knowledgecenter_bio.aspx?l=y&author_id=7">David Bjork</a>, "thought leader," Senior Vice President and Senior Advisor, who authored two books on executive compensation in health care, rotated this again. <blockquote class="tr_bq">ARE EXECUTIVES PAID TOO MUCH?  The short answer is no. Executives are not overpaid. If they were, employers would not willingly pay them as much as they do.</blockquote>And again <blockquote class="tr_bq">the intrinsic value of a job can be quantified. Economists and most workers judge the value of a job by how much it pays. A job is worth what an employer is willing to pay an employee to do it, or what an employee is willing to accept as payment for the job. Virtually no one doubts that principle—except when it comes to executive jobs.</blockquote> Have we got that?  Bjork argued that executive pay is self-justifying.  All executives are worth what they are paid because that is what they are paid. Another way to understand the fallaciousness of this argument is to try to apply it to jobs other than executive positions.  Presumably, it would mean that everybody's pay is appropriate, and hence nobody's pay could ever be changed.  But one's head begins to hurt just trying to think about this. Yet those were the main arguments that Mr Bjork made to justify his contention that <blockquote class="tr_bq">There is no rational basis for the view that executives should not be paid as much as they are paid, just a personal attitude, generally held by someone who is paid less.</blockquote> A Side Trip to the Fallacy of Composition Mr Bjork did make an attempt to supplement that argument.  For example, he wrote "labor market forces drive pay for executives," without explaining how much they do so, or the nature of the market for executive pay.  Later, he wrote, <blockquote class="tr_bq">Hospitals and health systems continually look for ways to reduce their costs. When they come across jobs that cost more than they are worth, they eliminate the jobs and either eliminate the work, redistribute it to other employees, or outsource it to cheaper labor. They view executive jobs the same way. When hospitals and health systems find an executive job that seems to cost more than it is worth, they eliminate it if they can and redistribute the work to other managers. </blockquote> Let us unpack this a bit.  First, hospital and health systems are organizations composed of humans.  They do not look for anything, but the executives who run them may certainly look for ways to reduce costs and eliminate apparently unnecessary jobs.  Confusing hospital executives with the organizations they run appears to be a version of the <a href="http://www.nizkor.org/features/fallacies/composition.html">fallacy of composition</a>, which "arises when a person reasons from the characteristics of individual members of a class or group to a conclusion regarding the characteristics of the entire class or group (taken as a whole)." Taken literally, this paragraph suggested that executives could decide their own jobs "cost more than they are worth," and then fire themselves and give their work to someone else.    Nonetheless, were this targument to be true, it in fact contradicts the conclusion based on this argument that appeared two sentences later <blockquote class="tr_bq">Therefore, executives must be worth what they are paid, because employers keep them on the job and willingly continue to pay what¬ever they are paid. </blockquote> Note that this conclusion is yet another restatement of the circular argument above.  .  Summary We have noted that <a href="http://hcrenewal.blogspot.com/search/label/logical%20fallacies">logical fallacies</a> are increasingly deployed to defend the status quo in health care, and particularly to defend the interests of those who are profiting the most from the current dysfunctional system.  In our latest example we find some particularly ripe repitition of a fundamentally fallacious argument to support ever rising compensation for health care executives.  It is distressing that the arguments were made by a prominent health care management consultant and published author on the subject of health care executive pay, and was picked up without question by a prominent health care management media site.  It suggests, like other posts we have written about the generous use of logical fallacies to protect the powers that be, that these eminences really may have not the slightest idea what they are doing, and have truly risen to their level of incompetence, if not ridiculousness; or else, they do know what they are doing, but have nothing but contempt for the reasoning powers of anyone outside their circle, and feel no need to justify their actions to such hoi polloi. The sheer foolishness of arguments made to protect the status quo ought to lead the rest of us, particularly health care professionals, to question that status quo further.  The ability of top executives of many, probably most health care organizations to collect bloated paychecks out of proportion to, if not despite their performance attracts the wrong people to lead these organizations, and provides incentives for even the right people to lead badly. Until we make health care leaders accountable, and until their incentives reflect their ability to uphold the health care mission, expect more unaccountable leadership that subverts the health care mission, and hence continually rising costs, declining access, and deteriorating quality.

Will the Circle be Unbroken? - Hospital Executive Compensation Continues to Defy Gravity and Logic

A report from Health Leaders Media, a prominent media site about health care management, shows how non-profit hospital executive compensati...

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Why It's Crazy to Want Your Most Confidential Information Put into An Electronic Medical Records System

Besides the reasons I outlined in posts retrievable by these query links (<a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20confidentiality" target="_blank">link</a>, <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy" target="_blank">link</a>), there's this from ZDNet.com: <blockquote class="tr_bq"><a href="http://www.zdnet.com/microsoft-warns-of-first-critical-windows-8-rt-security-flaws-7000007175/?s_cid=e539" target="_blank">Microsoft warns of first critical Windows 8, RT security flaws </a> It's been less than a month since Windows 8 and Windows RT-powered Surface tablets were launched and went on sale, but Microsoft is already warning that the two next-generation operating systems contain <a href="http://technet.microsoft.com/en-us/security/bulletin/ms12-nov">critical security vulnerabilities that are due to be patched</a> this coming Tuesday. Among the various flaws, versions from Windows XP (Service Pack 3) all the way through to Windows 8 are affected, including versions of the Office suite, and versions of Windows Server. Released only in September, Windows Server 2012 requires patching to maintain maximum security. The latest vulnerabilities include three critical security vulnerabilities for Windows 8, and one critical security vulnerability for the Surface-based Windows RT operating system. These flaws are considered "critical" and could allow remote code execution on vulnerable systems. </blockquote> I note that Windows XP was released worldwide for retail sale on <a href="http://en.wikipedia.org/wiki/Windows_XP" target="_blank">October 25, 2001</a>, which was more than eleven years ago.  That security vulnerabilities are still being patched in 2012 is stunning.  Also, many enterprise information systems and most hospital clients (workstations) run on Windows-based servers and Windows installed local machines (UNIX, MacOS and other OS's are very rare on general-purpose hospital workstations). From a Microsoft website <a href="http://www.microsoft.com/industry/government/health/physician.aspx" target="_blank">here</a>: <div style="padding-left: 20px;"><div class="contentText1 padding_btm1">... The partners listed below are CCHIT 07/08 certified and fully utilize the Microsoft database and server platform.</div><div><table border="0" cellpadding="2" cellspacing="0" style="width: 100%px;"> <tbody><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#Abraxas_Medical_Solutions">Abraxas Medical Solutions</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#gehealthcare">GE Healthcare</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#Allscripts">Allscripts</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#gMed">gMed</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#Aprima_Medical_Software_Inc.">Aprima Medical Software Inc.</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#Greenway_Medical_Technologies">Greenway Medical Technologies</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#ASG_Software_Solutions">ASG Software Solutions</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#Henry_Schein">Henry Schein, Inc.</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#Eclipsys">Eclipsys</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#McKesson">McKesson</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#e-MDs">e-MDs</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#NextGen">NextGen</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#GEMMS">GEMMS, Inc.</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#urochartehr">UroChartEHR</a> </td> </tr><tr align="left" class="padding_btm1" valign="top"> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx#gloStream">gloStream</a> </td> <td><a class="normalLink" href="http://www.microsoft.com/industry/government/health/physician_partners.mspx">Learn more about our partners</a> </td> </tr></tbody></table></div></div><div> This partial list includes many very large HIT sellers.  There are many others as well.</div> By simple reckoning, it's likely we'll be seeing critical security vulnerabilities in Windows 8 - in 2023. It goes without saying that these security problems will continue to be exploited by identity thieves, medical information merchants, and others with no rights to "protected" information. In my opinion, the (still not yet realized) convenience of being able to have one doctor transmit your record to another, thus avoiding a FAX machine, the Postal Service or the telephone, and the <a href="http://hcrenewal.blogspot.com/2012/09/wsj-koppel-and-soumerai-major-glitch.html" target="_blank">trillion-dollar</a> "solution" to the nearly non-existent problem of being found unconscious in some foreign land with no ID, no companions, and some hidden, critical medical condition not findable on physical exam and bloodwork, EKG, x-rays etc. that will cause death if not treated in minutes, is not worth the risk of having one's most private information spilled all over the Internet. EHR's should not be accessible on networks beyond a physician's office or the robustly encrypted network of a hospital, and the information security personnel kept on very short leashes, for the foreseeable future. I am unwilling to cede my own privacy to cybernetic utopians who ignore alarming evidence - plain to see at the aforementioned query links at the top of this post - nor can I in good faith recommend doing so to the public in 2012. Considering the information in the many posts at the aforementioned query links (as here: <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20confidentiality" target="_blank">link</a>, <a href="http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy" target="_blank">link</a> -- be aware you need to hit "older posts" at the bottom of each page to see all of them), that position is straightforward. -- SS 11/9/2012 Addendum: Also see my Oct. 2012 post "<a href="http://hcrenewal.blogspot.com/2012/10/computer-viruses-are-rampant-on-medical.html" target="_blank">Computer Viruses Are 'Rampant' on Medical Devices in Hospitals</a>." -- SS

Why It's Crazy to Want Your Most Confidential Information Put into An Electronic Medical Records System

Besides the reasons I outlined in posts retrievable by these query links ( link , link ), there's this from ZDNet.com: Microsoft warns o...

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For Whom Does the Center for the Protection of Patient Rights Advocate?

We have occasionally discussed the cases of  some patient advocacy organizations which seem to be influenced by substantial financial support from the health care industry.  For example, look <a href="http://hcrenewal.blogspot.com/search/label/patient%20advocacy%20groups">here</a> and <a href="http://hcrenewal.blogspot.com/search/label/NAMI">here</a>.  Related are "astroturf" organizations, which promote policies that may be favored by their industrial sponsors (e.g., <a href="http://hcrenewal.blogspot.com/2007/11/cultivating-astroturf.html">here</a>.) Background on the Center for Protection of Patient Rights The topic of this post is the Center for Protection of Patient Rights, which may have started out as something like an astroturf organization, but seems to have become something even more interesting.  The Center, which, by the way, seems not to have a web-site, was the subject of an <a href="http://www.latimes.com/news/nationworld/nation/la-na-secret-money-20120528,0,7342535,full.story">investigative report</a> in the Los Angeles Times in May, 2012.  Here is the article's description of how the Center began, <blockquote class="tr_bq">The Center to Protect Patient Rights was created in April 2009, just as the debate over the healthcare bill was heating up. The group's mission was to 'protect the rights of patients to choose and use medical care providers,' according to its corporate paperwork, filed in Maryland. While never surfacing publicly, the center sent more than $10 million in its first year to groups such as Americans for Prosperity, which took a lead in protesting the measure. 'I think they saw what we were doing and liked it,' said Tim Phillips, president of Americans for Prosperity, which got $4.1 million. He said he did not know the source of the center's funding and declined to comment on whether it still supports his group.</blockquote> So this group supported an advocacy position about health care reform, so perhaps it could be considered an astroturf organization, were we to know it was funded by the health care industry.  Many astroturf organizations do reveal support from particular corporations.  However, at the time the Los Angeles Times published the report, the source of the Center's funding was unknown.  Secretive Leadership Furthermore, while astroturf organizations may be eager to get more public notice, presumably so they can further their advocacy, the Center seemed oddly secretive.  Its executive director and president is one Sean Nobel.  However, as the LA Times article noted, <blockquote class="tr_bq">Noble did not respond to repeated phone calls and emails. Courtney Koshar, a Phoenix anesthesiologist and the organization's only other director, did not respond to requests for comment. And a Phoenix doctor who once sat on its board said he couldn't remember who asked him to join. 'I honestly played very little role,' said Dr. Eric Novack, who headed an organization called the US Health Freedom Coalition that received nearly its entire budget — $1.7 million — from the center to help pass a state ballot measure that aimed to block President Obama's healthcare overhaul.</blockquote> Support for Political Organizations, not Health Care Advocacy Even more curiously, despite its name, the most of the Center's spending was not for advocacy about health care reform, but went to organizations that  seemed to have little or nothing directly to do with health.  As the Times reported, <blockquote class="tr_bq">During the 2010 midterm election, the center sent more than $55 million to 26 GOP [Grand Old Party, that is, Republican Party] -allied groups, tax filings show, funding opaque outfits such as American Future Fund, 60 Plus and Americans for Job Security that were behind a coordinated campaign against Democratic congressional candidates.</blockquote>It seemed that these grants were used for nothing that directly related to health.  For example, <blockquote class="tr_bq">The largest share of the center's money went to American Future Fund, a Des Moines-based group started by onetime GOP congressional aide Nick Ryan. The fund, which ran campaigns against two dozen Democrats in the 2010 election cycle, spent $23 million that period, tax filings show, with nearly $13 million coming from the center. Its biggest target was an up-and-coming Iowa Democrat, Rep. Bruce Braley. In August 2010, American Future Fund launched an ad falsely claiming that Braley supported building a mosque at the former World Trade Center site in New York — the beginning of a $2-million fusillade that included radio ads, robo-calls and nine mailers. </blockquote> A list of the recipients of the Center's 2010 grants was also publised in the LA Times <a href="http://spreadsheets.latimes.com/cppr-funding/">here</a>. Where Did the Center Get its Support? Just before this week's US election, the plot thickened.  The LA Times <a href="http://articles.latimes.com/2012/nov/05/local/la-me-secret-donors-20121106">reported </a>that because of the Center's obviously political activities in California, an effort was made to determine its source of funding, but that came up short. <blockquote class="tr_bq">After a frantic court battle, state election officials succeeded Monday in forcing an Arizona group to disclose the identities of contributors that provided $11 million to a California campaign fund. But the revelations added little clarity for voters. The mystery donors turned out to be other nonprofits, whose individual contributors remained secret. The money started with the Virginia-based Americans for Job Security and was transferred to a group called the Center to Protect Patient Rights. Over the course of a few days in October it was sent to the Arizona group, Americans for Responsible Leadership, and then transferred again to California. Finding the source of the money 'becomes daunting,' said Derek Cressman of Common Cause, an activist organization that filed the original complaint about the donation. 'How many layers can you drill through?'</blockquote> Note that in 2010, the Center for Protection of Patient Rights gave money to the Americans for Job Security, but in 2012, the latter organization gave money to the former - curiouser and curiouser.  Allegations of Illegalities, Including Money Laundering It turns out the Americans for Job Security has been in trouble before for activities that seemed contrary to state election law: <blockquote class="tr_bq">Americans for Job Security, one of the nonprofits involved in the $11-million donation, was investigated by Alaskan officials for its role in a 2008 mining referendum. Authorities concluded that the organization's 'sole purpose is to allow individuals and corporations to financially support various causes without having to disclose that financial support.' That investigation showed how a wealthy landowner sent $2 million to the group, which then funneled most of it back to Alaska to try to fend off construction of a mine near the landowner's property. Americans for Job Security agreed to a settlement, paying a $20,000 fine and pledging 'not to engage in similar activity' again in Alaska.</blockquote> In addition, the Mercury News<a href="http://www.mercurynews.com/elections/ci_21932215/fppc-releases-names-donors-who-made-secret-11"> reported</a> allegations that the fund transfers by the Committee for the Protection of Patient Rights were illegal. <blockquote class="tr_bq">two conservative groups, Americans for Job Security and the Center to Protect Patient Rights, are part of a tangled web of so-called dark donors who operate largely out of public view, shielded by their status as nonprofit advocacy groups that are supposedly not involved primarily in politics. While the groups have been identified, however, individual donors who have bankrolled them remain a mystery. But 'this isn't going to stop here,' said Ann Ravel, chairwoman of the Fair Political Practices Commission, the state's political watchdog. 'They admitted to money laundering. We agreed to do this without an audit because we wanted to get information to the public before the election. But we in no way agreed this would preclude further action.' The FPPC determined that the Arizona group, Americans for Responsible Leadership, had violated California campaign law. Money laundering -- sending money through multiple sources to conceal the original donor -- is a misdemeanor. But a conspiracy to commit money laundering is a felony. It was not clear Monday whether the FPPC or the state Attorney General's Office will pursue criminal charges.</blockquote> Summary So the answer to the question posed in the title of this post is unknown.  At this point, there is nothing public that indicates for whom the Center for Protection of Patient Rights advocates.  However, it is hard to conceive that its advocacy is for patients.  So rather than merely being an astroturf organization (a health care policy advocacy group funded by industry money), the benignly named Center for the Protection of Patient Rights appears to be a dark money group whose goals may have allegedly included money laundering to facilitate vast monetary influence on political campaigns by people and organizations whose identities remain secret. We have often discussed the role of deception in health care, including <a href="http://hcrenewal.blogspot.com/search/label/stealth%20marketing">stealth marketing</a>, <a href="http://hcrenewal.blogspot.com/search/label/stealth%20health%20policy%20advocacy">stealth public policy advocacy</a>, and <a href="http://hcrenewal.blogspot.com/search/label/stealth%20lobbying">stealth lobbying</a>.  Now we see health care being used as a vehicle for political deception, stealth political campaigns being disguised as stealth public relations campaigns.  The convolutions of the deceptions induce dizziness.  Of course, this is the opposite of the sorts of transparency health care professionals and academics ought to support, and patients and the public ought to demand.  How will we ever improve health care when health care organizations are used to hide layer upon layer of deception? Real improvements in health care require health care leadership dedicated to transparency, honesty, and accountability.

For Whom Does the Center for the Protection of Patient Rights Advocate?

We have occasionally discussed the cases of some patient advocacy organizations which seem to be influenced by substantial financial suppor...

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Bad Health IT -Yet Another Health IT 'Glitch' - Potential Image Loss in GE Centricity PACS; ECRI Again Reports Health IT a Top Ten Hospital Risk

From my definition of bad health IT (BHIT) <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">at this link</a>: <blockquote class="tr_bq">Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, hard to use, unreliable, loses data or provides incorrect data, causes cognitive overload, slows rather than facilitates users, lacks appropriate alerts, creates the need for hypervigilance (i.e., towards avoiding IT-related mishaps) that increases stress, is lacking in security, compromises patient privacy or otherwise demonstrates suboptimal design and/or implementation.   </blockquote> Considering the problem of lost data (lost x-rays) that affects not one, but two versions ("versions 3.x and 4.x and higher") of a common GE PACS (radiology image management) system, as in the attached memo to hospital radiology and IT executives, one might ask: <ul><li>How long has this been going on before this 'glitch' was discovered? </li></ul><ul><li>What validation and safety testing does GE use before releasing its health IT to production? </li></ul><ul><li>Why was it discovered in several successive versions of PACS systems being used on live patients, instead of in laboratory testing? </li></ul><ul></ul><ul></ul><ul><li>How many delayed diagnoses, injuries and/or deaths might have occurred as a result of this "disappearing image" bug? </li></ul><ul><li>What is the likelihood this "workaround" will be uniformly adopted in short order?  </li></ul><ul><li>What levels of hypervigilance, stress and increased likelihood of error will this temporary "workaround" engender? </li></ul><ul><li>When will it be fixed in all implementations worldwide?</li></ul><ul></ul> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwnvhRrJFx_UdhErl1oGbzG8rJ2QsoWKw8UjUxAJKCtYc1UxFazjHvvW8MdGj776Qp_5lCROBxdnWTqtG-V7tKNWTBJD11Fu28z7lScOk2sOmR2IQqRY5cZkEIELuqFEKDPFTXT1W_28ng/s1600/ge1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwnvhRrJFx_UdhErl1oGbzG8rJ2QsoWKw8UjUxAJKCtYc1UxFazjHvvW8MdGj776Qp_5lCROBxdnWTqtG-V7tKNWTBJD11Fu28z7lScOk2sOmR2IQqRY5cZkEIELuqFEKDPFTXT1W_28ng/s400/ge1.jpg" width="310" /></a></div><div style="text-align: center;"> Beware disappearing x-rays.  Make sure every system user performs this workaround, too (click to enlarge). </div> <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzYZYXgWlFsHXA9aKzHCO7jeeZ6JA-5hBlRE92SpHqGo_rKZS5vMMlAG_Gn7Frx46JsR3oMjRSwMpKWBydYMExyDytO5CRA37w2cZy0BBUWvV_NO3gRbgOX_9EKOcw4_7K_Fo7rv_G4UzO/s1600/ge2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzYZYXgWlFsHXA9aKzHCO7jeeZ6JA-5hBlRE92SpHqGo_rKZS5vMMlAG_Gn7Frx46JsR3oMjRSwMpKWBydYMExyDytO5CRA37w2cZy0BBUWvV_NO3gRbgOX_9EKOcw4_7K_Fo7rv_G4UzO/s320/ge2.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Page 2 (click to enlarge)</td></tr></tbody></table> It's not as if missing x-rays are a trivial matter.  One routine x-ray lost to followup resulted in the needless and rather horrible death of an infant, and a $1.5 million settlement, as at the June 2011 link "<a href="http://www.chicagotribune.com/health/ct-met-technology-errors-20110627,0,5447654.story">Babies' deaths spotlight safety risks linked to computerized systems</a>" (case #2). Patient safety is being compromised. Lack of regulation of health IT, and lack of reporting and accountability, needless to say, are major contributors to the prevalence of BHIT. I also note for several years running, including in the latest report of 2013, the <a href="https://www.ecri.org/Pages/default.aspx" target="_blank">ECRI Institute</a> (an independent tester of healthcare technology) reports health IT-related problems as among the top ten technology problems in hospitals (<a href="https://www.ecri.org/Press/Pages/2012_Top_Ten_Hazards.aspx" target="_blank">link</a><a href="https://www.ecri.org/Press/Pages/2012_Top_Ten_Hazards.aspx" target="_blank"> to report</a>): <blockquote class="tr_bq">...Five of the top 10 hazards explained in ECRI Institute’s [2013] report are:     1.  Alarm hazards     2.  Medication administration errors using infusion pumps     3.  Unnecessary radiation exposures and radiation burns during diagnostic radiology          procedures     4.  Patient/data mismatches in EHRs and other health IT (HIT) systems     5.  Interoperability failures with medical devices and health IT systems Three of the ten topics on the 2013 list are directly associated with the still-maturing [i.e., experimental - ed.] health IT field where the interplay between complexity and effectiveness and potential harm is most evident; several of the other topics are peripherally related to HIT issues. “The inherent complexity of HIT-related medical technologies, their potential to introduce new failure modes, and the possibility that such failures will affect many patients before being noticed—combined with federal incentives to meet Meaningful Use requirements—leads us to encourage healthcare facilities to pay particular attention to health IT when prioritizing their safety initiatives for 2013,” says James P. Keller, Jr., vice president, health technology evaluation and safety, ECRI Institute. The hazards included in the 2013 list, published in the November 2012 issue of ECRI Institute’s Health Devices journal, met one or all of the following criteria: it has resulted in injury or death; it has occurred frequently; it can affect a large number of individuals; it is difficult to recognize; it’s had high-profile, widespread news coverage. </blockquote> -- SS

Bad Health IT -Yet Another Health IT 'Glitch' - Potential Image Loss in GE Centricity PACS; ECRI Again Reports Health IT a Top Ten Hospital Risk

From my definition of bad health IT (BHIT) at this link : Bad Health IT ("BHIT") is defined as IT that is ill-suited to purpose, ...

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"Phony Consulting and Royalty Agreements," "Chocolate" Bribes, a Sales Representative Doubling as a Stripper, Oh My - Three Settlements for Othrofix

On this US election day, we seem to be in a mini-squall of cases involving unethical, deceptive, and now very colorful marketing practices used to push drugs and devices.  We recently discussed a settlement of allegations of deceptive marketing practices and kickbacks by pharmaceutical company Boehringer-Ingelheim (<a href="http://hcrenewal.blogspot.com/2012/10/just-another-day-at-office-boehringer.html">here</a>), a US congressional report alleging deceptive influence by Medtronic marketers over ostensibly scholarly publications (<a href="http://hcrenewal.blogspot.com/2012/10/marketers-systemic-influence-over.html">here</a>), a study of documents released after litigation that appear to show how Pfizer had a systemic marketing campaign that used controlled trials as deceptive marketing vehicles (<a href="http://hcrenewal.blogspot.com/2012/10/when-clinical-trials-are-meant-for.html">here</a>), Now three separate settlements by device/ biotechnology company Orthofix have come to light. Settlement 1 - "Phony Consulting and Royalty Agreements," and Prostitution as Kickbacks, and a Sales Representative as Stripper A Bloomberg <a href="http://www.bloomberg.com/news/2012-11-02/orthofix-will-pay-u-s-30-million-to-settle-kickbacks.html">article</a> outlined Orthofix's two latest settlements.  The newest seems the most audacious, or bodacious, <blockquote class="tr_bq">Orthofix International NV, (OFIX) a maker of spinal implants, agreed to pay the U.S. $30 million to settle claims that a subsidiary paid illegal kickbacks and provided prostitutes to doctors in return for orders. The subsidiary, Blackstone Medical Inc., paid kickbacks to spinal surgeons in the form of phony consulting and royalty agreements, and travel and entertainment to entice them to use its products, the U.S. Justice Department said in a statement today. </blockquote> This case adds to the mounting pile of evidence that many of the financial relationships among physicians and health care academics and drug, device, biotechnology and other health care corporations are not merely conflicts of interest incidental to innovation.  In particular, Bloomberg reported, <blockquote class="tr_bq">[Whistle blower Susan] Hutcheson alleged that officials of Blackstone, purchased by Orthofix in 2006, violated kickback and false-claim laws by setting up a system to compensate doctors under sham consulting agreements and phony research grants, according to court filings. The sales executive said the company also offered lavish travel opportunities to doctors who implanted its products, the filing said. Some doctors were paid as much as $8,000 a month under the fictitious consulting agreements, Hutcheson said in her suit, filed in federal court in Massachusetts. Orthofix’s U.S. unit is based in Lewisville, Texas. Some also received phony research grants for as much as $18,000, the suit added. </blockquote> Then there was this colorful detail, <blockquote class="tr_bq">Blackstone salespeople also were urged to take surgeons out for expensive dinners, escort them to strip clubs and pay for liaisons with prostitutes to get their business, Hutcheson said in the suit. One female sales manager in Dallas agreed to disrobe and join strippers on stage at the request of two surgeons to whom she was pitching the company’s products, Hutcheson said in her suit. The sales manager was demoted, not fired, over the incident, Hutcheson said in the suit. </blockquote> We often hear from drug, device, and biotechnology companies that their sales efforts are all about providing needed information to physicians, information they could not otherwise obtain.  In this case, the information appeared to be rather anatomical, but also rather personal. The AP <a href="http://www.businessweek.com/ap/2012-11-02/orthofix-paying-30m-to-settle-kickbacks-case">coverage </a>of this store (here, via Businessweek) also noted that the settlement involved a corporate integrity agreement.  Neither story mentioned any admissions made by the company.  As far as I could tell, no corporate executives suffered any consequences as part of this settlement. Settlement 2 - Fraud, Obstructing the US Government, and Less Colorful Kickbacks to Promote Bone Growth Stimulators The article did nor provide any helpful photographs, but it did note that Orthofix recently made a second settlement. <blockquote class="tr_bq">The settlement’s approval comes after Orthofix officials agreed to pay $42 million to resolve a separate whistle-blower suit and a criminal probe of allegations it paid kickbacks to doctors who used its bone-growth stimulators. One of its units will plead guilty in federal court in Boston federal court to a single felony count of obstructing a U.S. government audit and pay a $7.8 million fine, according to a June 7 regulatory filing. Orthofix also will pay $34.2 million to resolve whistle-blower claims that the company defrauded the federal Medicare program over bone-growth stimulators, which patients wear after surgery to speed healing.</blockquote> Amazingly, unlike the first settlement, and unlike most settlements we have discussed, <blockquote class="tr_bq">Five Orthofix employees have pleaded guilty to criminal charges in connection with probes of the kickback allegations. Thomas Guerrieri, an Orthofix vice president, pleaded guilty in April to violating the federal anti-kickback statute by setting up fake consulting agreements for doctors who used the company’s products.</blockquote> Note that we discussed a surgeon who pleaded guilty to accepting kickbacks from multiple device companies, including the Blackstone subsidiary of Orthofix, <a href="http://hcrenewal.blogspot.com/2008/01/neurosurgeon-admits-kickbacks-from.html">here</a> in 2008. Settlement 3 - "Chocolate" Bribes to Mexican Government Officials Finally, the AP story noted in passing "the recent resolution of a federal Foreign Corrupt Practices action" against the company.  I could not find any news coverage of that, but in July there did appear a <a href="http://www.sec.gov/news/press/2012/2012-133.htm">SEC press release</a>. <blockquote class="tr_bq">The Securities and Exchange Commission today charged Texas-based medical device company Orthofix International N.V. with violating the Foreign Corrupt Practices Act (FCPA) when a subsidiary paid routine bribes referred to as 'chocolates' to Mexican officials in order to obtain lucrative sales contracts with government hospitals. The SEC alleges that Orthofix’s Mexican subsidiary Promeca S.A. de C.V. bribed officials at Mexico’s government-owned health care and social services institution Instituto Mexicano del Seguro Social (IMSS). The 'chocolates' came in the form of cash, laptop computers, televisions, and appliances that were provided directly to Mexican government officials or indirectly through front companies that the officials owned. The bribery scheme lasted for several years and yielded nearly $5 million in illegal profits for the Orthofix subsidiary. Orthofix agreed to pay $5.2 million to settle the SEC's charges.</blockquote>Also, <blockquote class="tr_bq">Orthofix also disclosed today in an 8-K filing that it has reached an agreement with the U.S. Department of Justice to pay a $2.22 million penalty in a related action.</blockquote> Summary   So the box score here includes settlements of legal actions alleging bribery and kickbacks, a corporate integrity agreement, a guilty plea by a company subsidiary to obstructing the US government, and multiple guilty pleas by company executives.  The bribes and kickbacks were provided in various colorful forms.   The variety of unethical behaviors unearthed suggests a company with a seriously deranged corporate culture.  Whether the various actions taken against it, including the very unusual punishments meted out to some of its apparently mid-level executives will change its behavior, or serve as a lesson to other companies and their leaders is not clear.  Whether they are sufficient to suggest anyone should trust this company, its leaders, or its products seems questionable.    This story adds to our various compilations of <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">legal settlements</a> and tales of <a href="http://hcrenewal.blogspot.com/search/label/crime">crime</a>, including <a href="http://hcrenewal.blogspot.com/search/label/bribery">bribery</a>, <a href="http://hcrenewal.blogspot.com/search/label/kickbacks">kickbacks</a> and <a href="http://hcrenewal.blogspot.com/search/label/fraud">fraud</a> involving major health care organizations which suggest serious, deep afflictions within the culture of our commercialized health care system.  Yet almost nowhere, except here on <a href="http://hcrenewal.blogspot.com/">Health Care Renewal </a>are there calls for serious reforms to restore trust in our health care organizations and their leaders. As we have said endlessly, up to now, such legal settlements seemingly have had no effect on the bad behavior of big health care organizations, while they continually erode trust in these organizations and their leadership, and trust in physicians to put patients ahead of personal gain. Furthermore, these cases seem to be part of a larger social problem. It seems that nowadays the leadership of large, powerful organizations feels free to promote their own interests using psychologically sophisticated but deceptive marketing and public relations strategies no matter what their effect on the public welfare. Again as we have said all too many times before, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich. Maybe after all the election hoopla dies down here in the US, we can finally have a serious conversation about health care reform that will make our health care system more trustworthy.

"Phony Consulting and Royalty Agreements," "Chocolate" Bribes, a Sales Representative Doubling as a Stripper, Oh My - Three Settlements for Othrofix

On this US election day, we seem to be in a mini-squall of cases involving unethical, deceptive, and now very colorful marketing practices u...

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DOES AMERICAN PSYCHIATRY MATTER?

DOES AMERICAN PSYCHIATRY MATTER? The blogmeister of 1boringoldman.com has done it again. A semi-retired psychiatrist in rural Georgia, he has done more than anyone to document the follies and the ethical challenges of contemporary American psychiatry. His site is required reading for all who care about behavioral health issues. In his <a href="http://1boringoldman.com/index.php/2012/11/02/cest-la-vie/">latest posting</a> he compared the domain of American psychiatry to Yugoslavia. Cast Melvin Sabshin as Marshal Tito. Sabshin was the medical director of the American Psychiatric Association in the late 1970s, the period leading up to DSM-III. Tito and Sabshin each strong-armed a confederation of sorts but failed to deal with the conflicts beneath the surface. Both leaders were faced with the prospect of their domains disintegrating – Tito’s at the hands of Moscow and Sabshin’s at the hands of insurance companies. Both persuaded wary stakeholders to sign on to a compromise, for want of anything better and fearing a worse outcome. The domain of psychiatry hasn’t yet reached the stage of ethnic cleansing and genocide that we saw in Yugoslavia after Tito’s death, but it is well on the way. One only has to look at the vicious response of the American Psychiatric Association leaders to Allen Frances and other critics of DSM-5. The APA president in 2009, Alan Schatzberg from Stanford, went out of his way to <a href="http://www.psychi%20imes.com/dsm-5/content/article/10168/1425806atrict">smear</a> Dr. Frances and Robert Spitzer, the architects of DSM-IV and DSM-III because he had no credible scientific response to their criticisms of the directions DSM-5 is taking. He was joined in this low act by David Kupfer and Darrel Regier, who are directing the DSM-5 effort. Where is the comity, Comrades? Where are the shared values? Why is the APA holed up in a bunker? Then we have the unsavory sight of the APA lawyers <a href="http://hcrenewal.blogspot.com/2012/01/self-inflicted-damage.html">threatening</a> a blogfrauchen in the U.K. with a SLAPP lawsuit for alleged infringement on the APA’s intellectual property – as though the APA owns psychiatric classification! Talk about chutzpah. So now the confederation Sabshin cobbled together is breaking up and the stakeholders are starting to go their separate ways – psychologists, counselors, social workers, patient advocacy groups, even many psychiatrists. Christopher Lane in <a href="http://www.psychologytoday.com/blog/side-effects/200912/american-psychiatry-is-facing-civil-war-over-its-diagnostic-manual">Psychology Today</a> has said American psychiatry is facing “Civil War” over its diagnostic manual. Even an international psychiatric journal like British Journal of Psychiatry is <a href="http://bjp.rcpsych.org/content/201/4/334.full">distancing itself</a> from DSM-5 and there is talk of abandoning DSM-5 for the next ICD classification. Why is American psychiatry self destructing? Because the grand bargain forged in 1980 with DSM-III was a sham from the get-go and the promised benefits of diagnostic reliability have not materialized. They knew all along that reliability was a poor substitute for validity, but they settled for half a loaf. That compromise led us into the <a href="http://hcrenewal.blogspot.com/2009/04/in-defense-of-psychiatric-diagnoses-and.html">epistemologic quagmire</a> of today, where there is no solid ground for clinical decisions or clinical research progress or drug development. A stunning absence from the DSMs to date is any statement about treatment. That compromise also led us to diagnostic inflation, which Pharma embraced. Pharma quickly filled the vacuum with <a href="http://www.ncbi.nlm.nih.gov/pubmed/15169734">experimercials</a> that <a href="http://hcrenewal.blogspot.com/2012/10/when-clinical-trials-are-meant-for.html">pretended</a> to be real clinical science, and in the process diverted precious clinical research infrastructure away from genuinely important questions. Just look at the clinical trials er, experimercials, mill operating out of Massachusetts General Hospital at Harvard University. What lies ahead? Stakeholders are going to vote with their feet. DSM-5 is likely to be a footnote in the history of psychiatric classification. The APA will become even less relevant than it is today, much like the American Medical Association, which now commands the loyalty of maybe <a href="http://mediamatters.org/research/2009/06/15/nbcs-guthrie-falsely-suggests-ama-represents-th/151182">30% of U.S. physicians</a>. Mel Sabshin will turn in his grave, the APA will lose revenue, ICD-11 will become the dominant classification of psychiatric disorders, and the quagmire will continue until a new synthesis arises from the ashes. If Yugoslavia is any kind of model, don’t hold your breath.

DOES AMERICAN PSYCHIATRY MATTER?

DOES AMERICAN PSYCHIATRY MATTER? The blogmeister of 1boringoldman.com has done it again. A semi-retired psychiatrist in rural Georgia, he ha...

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