Update: How to Challenge Health Care Corruption Under a Corrupt Regime
Summary: the Corruption of Health Care Leadership as a Major Cause of Health Care DysfunctionAs we wrote in August, 2017, Transparency International (TI) defines corruption asAbuse of entrusted power for private gainIn 2006,TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.the scale of corruption is vast in both rich and poor countries.Also,Corruption might mean the difference between life and death for those in need of urgent care. It is invariably the poor in society who are affected most by corruptio...
Source: Health Care Renewal - October 17, 2018 Category: Health Management Tags: anechoic effect conflicts of interest Donald Trump health care corruption regulatory capture Source Type: blogs

The Politicization of Pharma, and Other Health Care Corporations - Walk on the Dark (Money) Side
DiscussionThis is now the fourth time we have discussed the role of dark money in health care.  In 2012 wediscussed a case of "dark money" being used to conceal sources of support for particular health policy and political positions.  Earlier this year,  wediscussed the case of huge pharmacy chain CVS,which proclaims its " social responsibility, " and its policy of only making charitable contributions to improve " health and healthcare nationwide. "  Yet CVS was donating to America First Policies, a supposed non-profit group devoted to promoting the partisan agenda of Presi...
Source: Health Care Renewal - October 10, 2018 Category: Health Management Tags: Aetna corporatism dark money deception Merck stealth health policy advocacy stealth lobbying Source Type: blogs

New York Times Remembers Dr Bernard Carroll, the " Conscience of Psychiatry "
We atHealth Care Renewal miss Dr Bernard Carroll, who we were proud to count among our bloggers.The New York Times just published akind obituary, which called him " the conscience of psychiatry. "It opened:Dr. Bernard J. Carroll, whose studies of severe depression gave psychiatry the closest thing it has to a'blood test'for a mental disorder, and who later became one of the field ’s most relentless critics, helping to expose pervasive corruption in academic research, died on Sept. 10 at his home in Carmel, Calif. He was 77.It described how he started his " second career " :He and a lifelong friend...
Source: Health Care Renewal - October 5, 2018 Category: Health Management Tags: Bernard Carroll Source Type: blogs

Pharma's Dark Money: Touting Corporate Responsibility and Non-Partisanship, But Using Dark Money to Promote Self-Serving Policies and Partisan Causes
DiscussionSo in three cases, health care corporations, and/or their trade associations, made significant financial contributions todark money organizations, thus avoiding reporting of such fund transfers.  In two cases, these fund transfers went to organizations with clearly partisan, right-wing, pro-Republican and/or pro-Trump agendas.  Yet the corporations and their trade association had publicly committed themselves to social responsibility, putting patients and health care ahead of all other concerns, and had never advertised themselves as partisan, explicitly politically conservative, and/or Republican.This ...
Source: Health Care Renewal - September 30, 2018 Category: Health Management Tags: Amgen Biogen Idec dark money deception health care prices Johnson and Johnson PhRMA ppaca propaganda stealth health policy advocacy stealth lobbying You heard it here first Source Type: blogs

The Mystery of the Ownership of the Trinity School of Medicine
Trinity School of Medicine Vice President Boasts that It Is " Not the Same " As Most Offshore Medical SchoolsApost promoting the Trinity School of Medicine just appeared on the KevinMD blog. It was entitled " Addressing the'ugly truth'about Caribbean medical schools: Why they ’re not all the same. " Its purpose seemed to be to persuade the reader in particular that theTrinity School of Medicine, (located conveniently in St Vincent and the Grenadines, " high on a hillside in the Ratho Mill district of Kingstown, the capital of St. Vincent and the Grenadines, " conveniently near the Young ...
Source: Health Care Renewal - September 20, 2018 Category: Health Management Tags: accountablility boards of trustees medical schools offshore medical schools Source Type: blogs

Remembering Dr Bernard Carroll
Dr Bernard Carroll passed away on September 10, 2018.  Dr Carroll had a distinguished career, so it was a surprise and delight that he also chose to be a stalwartHealth Care Renewal blogger.  He was with us since 2005, contributing insightful, pithy, provocative and important posts.  He also authored some of our most widely read posts.  Most viewed was:JAMA Jumps the Shark.  His most recent post wasCorruption of Clinical Trials Report: A Proposal.  All his posts can be foundhere.His obituary just appearedin the British Medical Journal. It beganA pioneer in biological psychiatry, more...
Source: Health Care Renewal - September 14, 2018 Category: Health Management Tags: Bernard Carroll Source Type: blogs

Fake Reform Foisted on Us by Those who Benefit Most from the Current Dysfunction
ConclusionGiridharadas suggested inan interview in New York Magazine,What all that does is create this moral glow. And under the haze created by that glow, they ’re able to create a probable monopoly that has harmed the most sacred thing in America, which is our electoral process, while gutting the other most sacred thing in America, our free press. And they do itunder the cover of changing the world.Unfortunately, he apparently has not come up with what to do about this problem.  The best conclusion I can reach derives from the end of areview of his book by Joseph Stiglitz in the New York Times,Democracy and hi...
Source: Health Care Renewal - September 5, 2018 Category: Health Management Tags: conflicts of interest Gates Foundation health care foundations health care reform Johnson and Johnson Robert Wood Johnson Foundation Source Type: blogs

Michael Fine's Health Care Revolt
Michael Fine, M.D., HealthCare Revolt: How to Organize, Build a Health Care System, and ResuscitateDemocracy – All at the Same Time (Oakland, CA: PM Press, 2018). Dr. Michael Fine is a man on fire. He ’s on fire with anger about a healthcare marketplace that serves well to maximize the profits of investors and CEOs, but violates the values of many of those working in it. He’s on fire with enthusiasm about the potential of public health and prevention and about the value of integrated primary care. He’s on fire with determination to work to change our scattered health care marketplace into an actual ...
Source: Health Care Renewal - September 3, 2018 Category: Health Management Source Type: blogs

Apologizing for Problems with Commenting
My apologies!I discovered a few days ago that our Google overlords had stopped notifying me about pending comments some months ago.  No indicator of the number of pending comments appears on my Blogger dashboard. I just realized I had a large backlog of pending comments, most of which were spam, but some of which were not.  I just posted all those that were not obvious spam.  I am now getting notified of new comments again, so I hope that your submitted comments going forward will not be unduly delayed. Sorry again (Source: Health Care Renewal)
Source: Health Care Renewal - September 2, 2018 Category: Health Management Source Type: blogs

EHR evidentiary mayhem
A short post.I am encountering, in my legal work, electronic medical records systems that either allow ex post facto note alterations by clinicians - for example, after a catastrophe - and/or alteration of the apparent date/time a note was entered. The alterations (e.g., a version history) or fake times don't appear on the printed records, and usually are not in the audit trails as well.Some of the systems don't even bother saving prior versions of edited notes, AND/OR defense attorneys make production of the the note version history and actual times of entry very difficult to obtain, AND/OR judges do not understand the is...
Source: Health Care Renewal - September 2, 2018 Category: Health Management Source Type: blogs

Dander Still Up, And Also Down, All OVer the Place. What Gives?
A.I've started this piece a whole bunch of times. So in fairness to you, reader, you have a few paths through it. If you don't feel like starting by sharing some navel-staring about today's bizarre predicament, please skip to'D.'Or'B,'or'C.'Wouldn't blame you in the least.I've still got my dander up about what's happening in the many troubled reaches of health care in the United States. OK, truth to tell, also about what's up world-wide. Scary stuff. Readers have no doubt waited patiently for me to recover from confusion about this sudden mess, much of said predicament stemming from various delayedreactions to the 2008 dis...
Source: Health Care Renewal - August 24, 2018 Category: Health Management Source Type: blogs

Making Abusive Contracts Great Again - Non-Disclosure Agreements, Which Have Bedeviled Employed Physicians, Go From Anechoic to Viral Courtesy Omarosa
DiscussionIn 2016 we published an article decrying the requirement that employed physicians sign contracts containing confidentiality clauses as well as other obnoxious provisions in order to practice.  We asserted the confidentiality clauses, also known as non-disclosure agreements, did no good for physicians or their patients, but did allow the managers of the physicians'corporate employers to hide embarassing information, poor quality care, and malfeasance.  At the time we urged physicians to carefully review their contracts and get legal advice before signing.  But we worried that little could be done to...
Source: Health Care Renewal - August 19, 2018 Category: Health Management Tags: confidentiality clause corporate physician free speech secrecy transparency Source Type: blogs

#WHISTLEBLOWER tonight on CBS at 9 pm: Brendan Delaney and Electronic Medical Records
I received this today. This type of scenario is not what the pioneers intended, and is an example of how some in the healthcare information technology industry may have less of the altruism and responsibility that clinicians feel towards the medical mission. Settlement information is here:https://www.healthcareitnews.com/news/eclinicalworks-pay-155-million-settle-suit-alleging-it-faked-meaningful-use-certification---------------------------------------------------hashtag#WHISTLEBLOWER tonight on CBS at 9 pm: Brendan Delaney and Electronic Medical Records Tune in tonight to hear Brendan Delaney ’s Medical Records Whis...
Source: Health Care Renewal - August 17, 2018 Category: Health Management Tags: Brendan Delaney CBS eClinicalWorks fraud healthcare IT fraud Martha Spanninger Source Type: blogs

Make Asbestos Great Again? - Trump Once Claimed " Movement Against by Asbestos was Led by the Mob, " Now is EPA Wants to Relax Asbestos Regulation
Introduction:  An Old Public Health MenaceThis is somewhat personal.  In the early 1980s, as a general internal medicine fellow, I gave a series of talks about important medical problems that generalist physicians often missed.  One was asbestos related disease.  Although asbestos had been heavily regulated since 1973, there were stilll large numbers of people exposed to it alive in the 1980s.  One of my primitive slides, seemingly a picture of type writing, stated that around then, 2 to 4 million people who had histories of significant asbestos exposure were likely alive.  Asbestos is known t...
Source: Health Care Renewal - August 10, 2018 Category: Health Management Tags: asbestos cancer conflicts of interest Donald Trump public health Source Type: blogs

Ill-informed, Mission-Hostile Health Care Leadership... in the White House and the US Department of Health and Human Services
Introduction - What Has Gone Wrong with the Leadership of Health Care OrganizationsA major focus ofHealth Care Renewal has been problems in leadership and governance of health care organizations, which we believe became major causes of health care dysfunction.  For example, we have discussed how leadership is oftenill-informed.  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research as professional managers largely supplanted health care professionals as le...
Source: Health Care Renewal - August 5, 2018 Category: Health Management Tags: conflicts of interest crime DHHS ill-informed management mission-hostile management narcotics White House Source Type: blogs

Spin it Again - Four More Go Through the Revolving Door From the World of Corporate Health Care to Top US Government Leadership Positions
DiscussionSo this round of revolving door transitions featured a top pharmaceutical company researcher going to a leadership position at the NIH, which was considered long ago as a producer or unbiased science; and one physician-manager and two pure managers going from big management consultancies to DHHS.  All these consultancies seem to have thriving businesses working with big commercial health care firms. So the Trump regime continues to stock top health care leadership positions with people from the commercial health care world.  These leadership positions will allow them to to control contracting with, poli...
Source: Health Care Renewal - July 27, 2018 Category: Health Management Tags: CMS conflicts of interest DHHS Donald Trump Eli Lilly McKinsey NIH revolving doors Veterans Affairs Source Type: blogs

Chipping Away at the Anechoic Effect: Now the New York Times Protests the Demise of the AHRQ National Guidelines Clearinghouse
DiscussionMany people bemoan the current political situation, but some feel there is nothing they could possibly do the improve things.  We have been publishing this blog since 2004 with the hopes that chipping away at the anechoic effect which has hid the severity and nature of health care dysfunction might actually help to improve things.  However, at times we wondered if we were having any effect.  What good are individual actions like blog posts? It seems that most of us have little individual power.   Collectively, though we may have more than we realize.  Small individual actions ca...
Source: Health Care Renewal - July 20, 2018 Category: Health Management Tags: AHRQ anechoic effect Donald Trump evidence-based medicine guidelines news media Source Type: blogs

A Physician Who Had Run Clinics Which Proselytized Patients is Now a Government Health Care Leader Positioned to Enforce Her Religious Beliefs on Patients and Citizens Who Do Not Hold Such Beliefs
DiscussionDr Foley is certainly entitled to her religious views.  She is also entitled as a physician to avoid situations in which normal standards of care would push her to provide services to patients that conflict with her religious conviction.  But she is not entitled as a physician to proselytize in the guise of medical practice.Furthermore, as a leader in a government health agency, she is not entitled to use that agency's power to enforce her personal religious beliefs on patients who do not hold such beliefs.  Given her career, though, there is every reason to worry that she will do so.  Further...
Source: Health Care Renewal - July 15, 2018 Category: Health Management Tags: core values deception DHHS Donald Trump mission-hostile management Source Type: blogs

" Hope in a Bottle " - Components of Purdue Pharma Stealth Marketing Campaign for Oxycontin Revealed by Legal Documents from Tennessee
Introduction: Disinformation and Stealth Marketing CampaignsBack in the distant past the US government made some attempt to hold big health care corporations to account for misleading marketing practices.  We learned a lot about these practices from documents revealed in the resulting litigation, and in particular, about stealthy, deceptive systematicmarketing,lobbying, andpolicy advocacy campaigns on behalf of big health care organizations, often pharmaceutical, biotechnology and medical device companies.  For example, in 2012 wefound out about the stealth marketing campaign used by GlaxoSmithKline to sell its a...
Source: Health Care Renewal - July 8, 2018 Category: Health Management Tags: deception disinformation narcotics perverse incentives propaganda public relations Purdue Pharma stealth marketing Source Type: blogs

Growing Health Care and Grand Governmental Corruption - But Still Anechoic After All These Years
Here we go again.  We have long been concerned about health care corruption as a major cause of health care dysfunction. Our last post on the topic wasin January, 2018.Summary: the Corruption of Health Care Leadership as a Major Cause of Health Care DysfunctionAs we wrote in August, 2017, Transparency International (TI) defines corruption asAbuse of entrusted power for private gainIn 2006,TI published a report on health care corruption, which asserted that corruption is widespread throughout the world, serious, and causes severe harm to patients and society.the scale of corruption is vast in both rich and poor countri...
Source: Health Care Renewal - July 1, 2018 Category: Health Management Tags: anechoic effect bribery conflicts of interest Donald Trump health care corruption regulatory capture Source Type: blogs

Have They Finally Got to You? - the Firing of Dr Gu
DiscussionThis story suggests that in our current political era, health care professionals, particularly trainees or others at the bottom of the totem pole, may be increasingly beholden to the political sensibilities of their bosses, and hence increasingly wary of espousing political views that run counter to those of their bosses. While it is reasonable for residency programs to require their trainees to be professional, since when did " professional " mean stifling political views that might offend hospital corporate leadership?As we wrote in February, It may not be unreasonable to expect physicians a...
Source: Health Care Renewal - June 22, 2018 Category: Health Management Tags: academic freedom anechoic effect Donald Trump free speech post-graduate medical education Vanderbilt University Source Type: blogs

Dander Still Up. Drowning in Great Dismal Swamp. Film at Eleven.
Maybe this is the last in my series of dander-raising essays, as recent national and world events have most definitely left so many of us with a raging case of TDS. (Trump Derangement Syndrome, look it up it's a thing).So many damned browser tabs open. So little time.Or maybe not. Who knows. Where are all these suicides coming from?My editor keeps telling me, " don't let it make you paralytic. " Hey, I'm trying.Just sensing a kind of coalescence in all the corruption our bloggers keep writing about. How do we even differentiate these activities across so many sectors of society. We were going to see our swamp dra...
Source: Health Care Renewal - June 12, 2018 Category: Health Management Source Type: blogs

Why Did CVS Health Betray its Charitable Giving Policy and Social Responsibility Agenda to Donate to a Sketchy Non-Profit Devoted to Trump's Agenda?
DiscussionCVS Health says it donates to charity to improve health and health care, and that it has a social responsibility agenda to again improve health and keep the planet in balance.  Yet it secretly donated to a " social welfare " organization that explicitly was devoted to upholding the Trump agenda, founded by former Trump campaign officials, at least two with questionable ethics, one of which  pleaded guilty to federal crimes, and which ran a political polling operation that may have been illegal.  When its donation was discovered, and the racist sayings of two, and apparently pro-Nazi sayin...
Source: Health Care Renewal - June 5, 2018 Category: Health Management Tags: bribery conflicts of interest crime CVS Donald Trump fraud health care corruption mission-hostile management Source Type: blogs

The Stealth Shutdown of the US Agency for Healthcare Quality and Research (AHRQ) National Guideline Clearinghouse
DiscussionSo it seems that the report on clinical practice guidelines emphasized two issues highly relevant toHealth Care Renewal, the need fortransparency in guideline development, and the need to avoidconflicts of interest affecting the development process.Perhaps more because than despite that, as we noted above, by 2012 the IOM standards were largely ignored (as discussedhere).  We speculated that these standards may have discomfited many people.  They could have cost a lot of medical societies considerable commercial funding, and a lot of health care professionals on guideline panels considerable person...
Source: Health Care Renewal - June 1, 2018 Category: Health Management Tags: AHRQ anechoic effect Donald Trump evidence-based medicine guidelines Source Type: blogs

The March of Legal Settlements Made by Pharmaceutical Companies is Diminishing - Presaging Even Less Accountablity for Top Health Care Organizational Leaders?
DiscussionSo my perceptions that the number of the sorts of legal settlements of interest to us has likely been diminishing was accurate.  Unfortunately, rather than the decrease being due to better behavior, decresed reporting, or my laxity in case-finding, it now looks that US government efforts to combat bad behavior by big health care corporations and to hold top leaders of these organizations accountable is getting even more lax.So once again, with feeling... We seem to be sliding backwards in efforts to make the leaders of large health care organizations accountable, and particularly to combat the worse man...
Source: Health Care Renewal - May 25, 2018 Category: Health Management Tags: Donald Trump health care prices impunity kickbacks legal settlements Pfizer Source Type: blogs

A Higher Impunity - How Can we Reduce Health Care Leadership's Impunity When the President Claims His Own Impunity?
Impunity: an IntroductionWe believe that unaccountable leadership is a major cause of health care dysfunction. Impunity is an extreme form of unaccountable leadership.We have noted that despite numerous legal settlements made by health care organizations of alllegations likefraud,bribery, andkickbacks, almost never do top leaders who presided over these actions face any negative consequences.  Lack of deterrence caused by such impunity appears to be a major cause of  the epidemic of continuing unethical behavior,crime andcorruption on the part of large health care organizations. How executives got to the poi...
Source: Health Care Renewal - May 20, 2018 Category: Health Management Tags: crime deception Donald Trump fraud impunity kickbacks legal settlements perjury Source Type: blogs

Novartis' Latest Ethical Misadventure: Did it Pay to Play ... with the US President?
DiscussionMost corrupt actions require two parties.  While it is understandable that there has been tremendous recent interest in evidence that the Trump regime is corrupt (lookhere), any such corruption had to have been enabled by unethical actions on the parts of others.  Those others likely included large numbers of leaders of large corporations, including health care corporations.  We have shown repeatedly that top leaders of US health care organizations have enjoyedimpunity that has allowed them to foster a host of unethical actions, includingcrimes such asbribery,fraud, andkickbacks, and truehealth car...
Source: Health Care Renewal - May 11, 2018 Category: Health Management Tags: bribery corporate integrity agreement crime Donald Trump fraud legal settlements Novartis Source Type: blogs

More Dander Rising: Ditto to Dr. Poses
Let me second the emotion now recently and repeatedly voiced by Dr. Poses in these pages. It's getting real hard to separate the health policy and malfeasance fecaliths from the general Washington Schei ßsturm raining down on us. We all feel pretty much buffeted non-stop, like(whomp!)badminton shuttlecocks in the corruption game the prevaricator-in-chief seems happily destined to carry on forever. Or at least until some better angels out there in America rise up to put an end to it. Because it's pretty obvious the party hacks clearly aren't going to. They're way too busy (padre you're fired! padre you'...
Source: Health Care Renewal - May 8, 2018 Category: Health Management Source Type: blogs

The Two-Fold Intimidation of Dr Bornstein, as Orchestrated by Donald Trump, Apparently to Conceal Something About Trump's Medical History
DiscussionAs noted above, we have seen many cases in which health care professionals were pressured to violate their core values and ethical norms by outside parties, most often large health care organizations seeking financial gain.Now, in this new case, we see a single health care professional twice pressured to violate core values and ethical norms by a patient, a wealthy billionaire corporate CEO who became President of the United States.  Thus we are now in a situation in which the President of the US, to whom all federal health care regulatory and law enforcement agencies at least nominally report, has shown con...
Source: Health Care Renewal - May 4, 2018 Category: Health Management Tags: core values Donald Trump fraud intimidation medical ethics medical record confidentiality Source Type: blogs

Don't Know Much About Health Care and Public Health, and Don't Care Much About Their Missions - but in Leadership Positions in US Government Health Agencies
Here we go again.  As we  We have frequently discussed how health care leadership is oftenill-informed ( look here).  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.  Obviously health care and health policy decisions made by ill-informed people could have detrimental effects on patients'and the public's health.Through 2016, our examples of ill-informed leadership in health care tended to be executives of hospital systems (e..g.,in 2014,her...
Source: Health Care Renewal - April 27, 2018 Category: Health Management Tags: DHHS disinformation Donald Trump ill-informed management mission-hostile management propaganda Source Type: blogs

Through the Revolving Door, with a Few Stumbles - Health Care Corporate Executives and Consultants Continue to Become Leaders of Trump's Department of Health and Human Services
We continue to see a remarkable stream of people transiting therevolving door from high-level positions in health care corporations to high-level positions in health care policy or regulation for the Trump administration.  Lately, though, these transitions have not been without missteps. The most recent cases we have found, in the order of their public appearance, appear below.John Bardis, Who Went from MedAssets to Assistant Secretary of Health and Human Services for Administration, Resigned Under FireWe first discussed the appointment of Mr Bardis in May, 2017,here.  We noted then that most recently Mr Bar...
Source: Health Care Renewal - April 18, 2018 Category: Health Management Tags: conflicts of interest CVS Donald Trump finance health care corruption Pfizer revolving doors Source Type: blogs

Don't Know Much About Health Care and Public Health... but Appointed to Leadership Positions in US Government Health Care Agencies
Discussion Again, it stands to reason that people entrusted with running US government health care, public health and health policy should have some level of knowledge of biomedical science, health care, public health and/or health policy.  I dimly remember that before the Trump administration, many such leaders did have such background.  Not any more.This is only the latest examples of amazingly ill-informed people taking important responsibilities in government agencies having to do with health care, public health, and/or health policy.  Remember the brew-master with power over major policies in the V...
Source: Health Care Renewal - April 5, 2018 Category: Health Management Tags: DHHS Donald Trump ill-informed management narcotics Source Type: blogs

The Dander Riseth Ever Higher: Shulkin Case Emblematic of Dysfunction
This isnumero sesto if memory serves in a series of what gets one's dander up in this era of dysfunctional health care. Of course today it's all about the focal dysfunction mirroring the much broader problems of a dysfunctional government. I learned just now of the current VA Secretary's ouster while overseas in a country that does things in many ways much more effectively.Today we blog about this one issue only. It seems to perfectly encapsulate the Reality Show-cum-wrestling match that our Republican leadership has morphed into. Oh, wait, maybe it didn't morph. It was always that way, perhaps, and people are just no...
Source: Health Care Renewal - March 29, 2018 Category: Health Management Source Type: blogs

How Do We Counter Health Care Disinformation Under a Disinformer-in-Chief?
DiscussionAn international organization, Cambridge Analytica/ SCL based in the UK, led by Trump confidantes including his last campaign leader and former White House strategic adviser Steve Bannon, and major Republican donors and hedge fund magnates Robert and Rebekah Mercer, worked with the Trump 2016 campaign, particularly coordinating with digital coordinator Brad Parscale.  Cambridge Analytica/ SCL leveraged Facebook private data on millions of people, obtained from most without their specific permission, to create a " psyops " political disinformation campaign featuring emotional appeals to voters'inter...
Source: Health Care Renewal - March 28, 2018 Category: Health Management Tags: crime disinformation Donald Trump extortion propaganda stealth health policy advocacy stealth lobbying stealth marketing Source Type: blogs

And the Dander Keeps On Rising
This isn úmero cinco in our series of attempts to shed some of this dander. But it keeps on rising. Here are two recent reports both relating to the life-on-the-ground of North American rank and file physicians, especially as that life increasingly revolves around data entry and digital madness over and above everything else.Are physicians suffering from acute, maybe by now chronic, PTSD? In the 20 March 2018 number of the important Boston Globe-affiliated newsfeedSTAT, Elizabeth M étraux, a prolific staffer and author at the eminentorganization Primary Care Progress, gives us another quite useful take o...
Source: Health Care Renewal - March 22, 2018 Category: Health Management Tags: burnout core values EHR managerialism physicians Source Type: blogs

Mrs. Smith Goes to Washington
Newly-appointed Minnesota Senator Tina Smith is off to an energetic start, challenging the powers-that-be in Washington, starting with Big Pharma. She recentlywrote to the CEOs of five drug companies, noting thegigantic tax windfalls reaped by their companies after the fall passage of the tax cut bill, andenquiring whether any of that money might enable them to reduce the skyrocketing prices of prescription drugs.I am sure every one of the five CEOs privately gave a big horse laugh at the very thought. Each of them believes that their duty to the shareholders is precisely to exact themaximum possible amount from the p...
Source: Health Care Renewal - March 20, 2018 Category: Health Management Source Type: blogs

In " Trump Town, " the Revolving Door Runneth Over: Yet More Ex-Lobbyists as Political Appointees at the Department of Health and Human Services
DiscussionOn and on it goes.  The revolving door has been a chronic problem for the US federal government, but the level of revolving door activity in the current regime seems way beyond anything we have seen before.  It seems we chronical multiple instances of people going from important health care corporate positions to government positions that regulate or make policy affecting those same corporations for every instance of someone coming from the previous administrations to industry.So, as I have said before, e.g., in August, 2017,The revolving door is a species ofconflict of interest. Worse, some expert...
Source: Health Care Renewal - March 15, 2018 Category: Health Management Tags: DHHS Donald Trump health care corruption regulatory capture revolving doors Source Type: blogs

Quattro! More from the DOG Patch.
Some more offerings in our fourth effort in these pages to get rid of this damned dander. It's still up! Here in the DOG Patch, D is for Dander, and the dander, in spite of smatterings of good new lately, has still got itself up.Vive le Qu ébec!Nodbody's taking sides in Canadian separatism, if it's still brewing north of the border. But a certain sense of fairness surely prevails, and we have to give them a rousing " jolly good " (whoops) among Canadian physicians. At least in the one province.  As reported by theWaPo,a large group of doctors there have produced a petition (interesting to read&nb...
Source: Health Care Renewal - March 11, 2018 Category: Health Management Source Type: blogs

How Corporate Health Care Leaders Maintain Their Impunity: The Case of Purdue Pharma's Funding of the Washington Legal Foundation to Attempt to Weaken the Responsible Corporate Officer Doctrine
The ongoing epidemic ofnarcotic (opioid) abuse, and the resulting rise in the deaths due to overdoses, has focused attention on pharmaceutical companies'aggressive promotion of these drugs which minimized their substantial risk.A recent article in the Intercept showed how the leadership of one such company tried to insulate itself from responsibility for such actions even while such promotions were continuing.Background: Impunity of Top Leaders of Big Health Care OrganizationsFor years, we have railed against theimpunity of top leaders of health care organizations.  We have noted that despite numerous legal settlement...
Source: Health Care Renewal - March 6, 2018 Category: Health Management Tags: impunity legal settlements narcotics Purdue Pharma responsible corporate officer doctrine tobacco Source Type: blogs

Dander Gathering Again: Terzo
It's hard these days to rid oneself of the rising dander. DanderOmnium GatherumPatch Numero Terzo. To put it more simply, here are more tales from the DOG Patch. And a smattering of actualgood (how's this possible?) news.Double Back on Politics at the VA.There's a guy now installed under Secretary David Shulkin by the name of Darin Selnick. He carries the title of Senior Advisor, and also works (with the same title) in the White House. Selnick was a California consultant when he fell in with the Koch Brothers and their deep pockets. Together they fostered an organization called Concerned Veterans for America. Check ou...
Source: Health Care Renewal - February 27, 2018 Category: Health Management Source Type: blogs

Tales from the DOG Patch: Numero Deux
A tip of the hat to Dr. Roy Poses, who did a nice job summarizing the first blast from the DOG Patch. (For those who missed it, it's a distillate of all the dander we've mustered in recent health policy debates as they veer more and more toward the utterly surreal.) Danderomnium gatherum, hurled willy-nilly at the gentle readers of HCRenewal. Ready or not, another dispatch from the DOG Patch.Dr. Shulkin at the VA.We commented on the recentposting, also from Dr. Poses, dealing with VA Secretary David Shulkin's " apparently scandalous travel " to Europe way back in July. We've known Shulkin for a long time. He care...
Source: Health Care Renewal - February 21, 2018 Category: Health Management Source Type: blogs

The Case of the Brew Master's Plot - Was the Veterans Affairs Secretary's Travel Spending Scandalous, or Was He Framed in a Plot to Oust a Political Moderate?
DiscussionDr David Shulkin, a holdover appointee of President Obama who was nominated to be Secretary of Veterans Affairs by President Trump, was alleged by the VA Inspector General to have committed various ethical violations involving a trip to Europe the Secretary took with his wife.  This appeared to be just the latest in a string of travel-related scandals by top officials of the Trump administration.When this was first reported, I was inclined to see Dr Shulkin as an entitled, and conflicted  former health care executive who ran afoul of the government's strict ethical standards.  (Dr Shulkin'sofficial...
Source: Health Care Renewal - February 19, 2018 Category: Health Management Tags: Donald Trump ill-informed management mission-hostile management political ideology politics Veterans Affairs Source Type: blogs

Welcome to the DOG Patch: first in a series?
Lately my dander is up so often and so copiously, over what's happening in health care and the world at large, I'm exhausted. Covered with nasty dander. Cowering under the sheets. Others seem to share this dysphoria. But I found if not a cure, at least a palliative. There's so much dander I can scrape it off with a great big shovel and toss as much as I can your way. Here's my first DanderOmnium Gatherum, or DOG, from the Cetona DOG Patch. Remember, these stories are all DOGs.Litmus Test for New HHS Secretary. The new sheriff at Health& Human Services, Alex Azar, has barely had a chance to wipe his feet in front o...
Source: Health Care Renewal - February 15, 2018 Category: Health Management Source Type: blogs

New article in J. of General Internal Medicine calls for simplifying EHRs
At my January 31, 2018 Healthcare Renewal blog post "The inevitable downgrading of burdensome, destructive EHRs back to paper& document imaging" athttp://hcrenewal.blogspot.com/2018/01/the-inevitable-downgrading-of.html, I opined that the downgrading of the clinician-facing components of EHRs was essential and inevitable. A new editorial in the Journal of General Internal Medicine makes similar points:​Electronic Health Records: a " Quadruple Win, " a " Quadruple Failure, " or Simply Time for a Reboot?Journal of General Internal MedicineMichael Hochman05 February 2018https://link.sp...
Source: Health Care Renewal - February 7, 2018 Category: Health Management Tags: healthcare IT simplification Journal of General Internal Medicine Michael Hochman Source Type: blogs

Are You With Us, Dr Gu? - Vanderbilt Suspended Surgical Resident Allegedly Due to Patient's Mother's Compaints About His " Taking a Knee " on Social Media
ConclusionsThis case suggested that at least the leadership of one prestigious university medical center is very uncomfortable at best, with its residents publicly expressing certain political opinions, even clearly outside the confines of the hospital.  Whether the leaders felt licensed by the President of the United States, who had banned the person at the center of this case from following him on Twitter, is a reasonable question.It may not be unreasonable to expect physicians and physician-trainees, as medical professionals, to avoid getting into political arguments with patients.  However, it is unreasonable...
Source: Health Care Renewal - February 7, 2018 Category: Health Management Tags: academic freedom anechoic effect free speech post-graduate medical education Vanderbilt University Source Type: blogs

Free Press? Don't Need No Stinkin' Free Press - Center for Medicare and Medicaid Services (CMS) Tries to Intimidate Modern Healthcare Journalist
DiscussionIt appears that  respected reporter for a well-known US health care business publication was barred from participation in CMS conference calls after some rather mild reporting on his part offended CMS leadership.  There seemed to be an attempt to intimidate the reporter by a federal " contractor " paid by CMS, a contractor who was a criminal, that is, who had pleaded guilty to a federal crime of lying to the Conressional Ethics office.  How far have we descended.OnHealth Care Renewal we have been writing aboutattempts to limit free speech or free discussion in the press in the health...
Source: Health Care Renewal - February 5, 2018 Category: Health Management Tags: anechoic effect censorship CMS First Amendment free speech intimidation Source Type: blogs

Fish gotta fly, birds gotta swim: more on the opiate crisis
At so many levels, the current opiate crisis, and the way in which various actors are seeking to cope with it, proves rich in intriguing detail.For starters, it needs to be memorialized that there is a judge in Ohio--like Pennsylvania a fascinating political see-saw state--who's actually trying to do something about this crisis.Daniel Polster, a Clinton appointee and approaching two decades on the bench, hasconvenedall the parties caught up in the current crisis. Metaphorically locking them all in a room and saying " we'll solve this problem and maybe you get outa this room, " he included players not even directl...
Source: Health Care Renewal - February 2, 2018 Category: Health Management Source Type: blogs

Disastrously conceived, managed, and implemented U.S. Coast Guard EHR leaves our Coast Guard heroes safer ... after reversion to paper records
Sometimes, the typical EHR mismanagement debacles that I have been writing about since at least 1999 leave patientssafer.  This is one such example.I note that the contents of this blog, as well as my still-extant Drexel website "Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties" (http://cci.drexel.edu/faculty/ssilverstein/cases/) and many other resources about healthcare IT mismanagement and failure, are available free of cost.  They could have saved the Coast Guard many millions of dollars if their contents had been reviewed an...
Source: Health Care Renewal - February 2, 2018 Category: Health Management Tags: Coast Guard EPIC Fedscoop News health IT failure IHiS Zaid Shorbajee Source Type: blogs

The inevitable downgrading of burdensome, destructive EHRs back to paper & document imaging
In recent days, I've posted about current articles on the destructive nature of today's vastly over-complex, burdensome EHR technology.  These posts included "Physicians Harassed by Overwhelming Levels of Messaging From Electronic Medical Records" athttp://hcrenewal.blogspot.com/2018/01/physicians-harassed-by-onerwhelming.htmland" Medical Economics: Highly experienced physicians lost to medicine over bad health IT " athttp://hcrenewal.blogspot.com/2018/01/medical-economics-highly-experienced.html.There are many other earlier articles of a similar nature discussed on this blog, e.g., the May 2017 po...
Source: Health Care Renewal - January 31, 2018 Category: Health Management Tags: Alexi Wright MD bad health IT burnout Christine A. Sinsky healthcare IT difficulties Healthcare IT failure Ingrid Katz MD NEJM Source Type: blogs

Burnout Returns to Center Stage
A recentMayo Clinic Proceedings guesteditorial, by Yale University physician Kristine Olson, asks the question--to some of us it's far from a rhetorical one--whether burnout among her fellow physicians is in fact " A Leading Indicator of Health System Performance? "Seems to me that her gist is: yes, it surely must be just such an indicator. If she's right, then our system's performance is in a heap of trouble.What is burnout? Our fearless editor, Dr. Poses, has addressed it repeatedly, including a few months agohere in these pages. But burnout is actually hard to delineate and hard to quantify. People quitti...
Source: Health Care Renewal - January 30, 2018 Category: Health Management Source Type: blogs