Generic Management of Health Care Non-Profits, Brought to You by Leaders of (Sometimes Failed, or Bailed Out) Finance on the Board?
Introduction - Managerialism  We have frequently posted about what we have called generic management, the manager's coup d'etat, and mission-hostile management. Managerialism wraps these concepts up into a single package.  The idea is that all organizations, including health care organizations, ought to be run people with generic management training and background, not necessarily by people with specific backgrounds or training in the organizations' areas of operation.  Thus, for example, hospitals ought to be run by MBAs, not doctors, nurses, or public health experts.  Furthermore, all organizations ou...
Source: Health Care Renewal - January 7, 2016 Category: Health Management Tags: boards of trustees finance generic management generic managers managerialism Source Type: blogs

Stealth Public Relations and Health Advocacy, Special Pleadings and the Opposition to Guidelines Discouraging Overuse of Narcotics
As I have written before as a physician who saw too many dire results of intravenous drug abuse, I was amazed how narcotics were pushed as the treatment of choice for chronic pain in the 1990s, with the result that the US was once again engulfed in an epidemic of narcotic abuse and its effects.  In mid-December, 2015, as reported in the Washington Post,The nation continues to suffer through a widespread epidemic to prescription opioids and their illegal cousin, heroin. The CDC estimated that 20 percent of patients who complain about acute or chronic pain that is not from cancer are prescribed opioids. Health-care prov...
Source: Health Care Renewal - January 4, 2016 Category: Health Management Tags: CDC Cephalon conflicts of interest deception Endo Health Solutions Johnson and Johnson narcotics public relations Purdue Pharma stealth health policy advocacy Source Type: blogs

How Managerialists Turned Housestaff Training into a Zero-Sum Game: the Continuing Saga of the FIRST and iCompare Studies
Conclusion: the Problem is Managerialism    While the ongoing trials of housestaff sleep deprivation have been largely anechoic, the recent Washington Post commentary by Clark and Harari make questions about why in the world medical academics would have set up such trials and continue to defend them even more stark.But it seems that medical academics are boxed in, playing a zero-sum game.  They may know that there housestaff are overworked and sleep deprived, a situation that endangers the housestaff and their patients.  Yet every reasonable way one could imagined improving the situation would require s...
Source: Health Care Renewal - December 22, 2015 Category: Health Management Tags: academic medical centers amphetamines clinical trials generic managers managerialism medical ethics post-graduate medical education resident sleep deprivation Source Type: blogs

How Managerialsm/ Generic Management Damaged the American Red Cross
The American Red Cross is a storied non-profit organization.  It provides disaster relief, provides a major part of the US blood supply, and has important public health teaching functions, such as teaching cardio-pulmonary resuscitation (look here).  Nonetheless, its operations have become increasingly controversial.  ProPublica has been investigating them for years.  The latest ProPublica report, entitled "The Corporate Takeover of the Red Cross," showed how this renowned organization has suffered under generic management/ managerialism, providing another case study showing how bad generic ma...
Source: Health Care Renewal - December 16, 2015 Category: Health Management Tags: executive compensation generic management generic managers managerialism ' coup d etat marketing Red Cross Source Type: blogs

A Small Challenge to Impunity - Lawsuit Against Former Synthes CEO Proceeds
ConclusionsThe just revealed story of the lawsuit against the extremely rich former CEO of Synthes does suggest that perhaps individuals injured by our curent dysfunctional health care system could use the legal system to try to challenge those who get rich from enabling such injuries.  Or not, because the outcome of this lawsuit is uncertain.Furthermore, the initiation of this lawsuit again reminds us that those who lead large health care organizations, and may profit mightily from them, regardless of the effects on patients' and the public's health, remain beyond the law.  It is not clear why the US Department ...
Source: Health Care Renewal - December 10, 2015 Category: Health Management Tags: anechoic effect impunity Johnson and Johnson legal settlements Synthes Source Type: blogs

Drinking the Managerialists' Kool-Aid? - Why Did Medical Educators Launch Trials of Increased Sleep Deprivation of Physician Trainees Apparently in Violation of the Nuremberg Code?
It all seemed so bizarre.  In 2014, with little fanfare, two large trials that imposed longer work hours and sleep deprivation on physician-trainees (interns and residents), ostensibly to combat the problem of excess hand-offs of patients among physicians.  Both trials involved multiple academic medical centers, including some of the most prestigious in the US.  Within a year, the American Medical Student Association (AMSA) and Public Citizen called for a federal investigation of the trials, calling them "highly unethical."This unprecented conflict between prestigious academic medical institutions ...
Source: Health Care Renewal - December 3, 2015 Category: Health Management Tags: clinical trials informed consent logical fallacies managerialism medical ethics nuremberg code resident sleep deprivation Source Type: blogs

Ross Koppel challenges feckless academics on poor health IT design
The academic health IT community has spent the past decade (at least) burying their collective ostrich heads in the sand about the crappy software that is called health IT.A few, though, have taken on the health IT industry at the heart of bad health IT design (including yours truly, which sadly was not enough to save my own mother from health IT design defects).Probably the bravest soul on these issues, however, is Penn sociologist Ross Koppel.  In a critique of the latest from the medical informatics academic community on reigning in the hazards of this technology, an article by Sittig and Singh at U. Texas, he wrot...
Source: Health Care Renewal - November 27, 2015 Category: Health Management Tags: dean sittig healthcare it design defects healthcare IT risk ross koppel Source Type: blogs

Their Cheating Hearts - Latest Allergan Settlement Is a Reminder of Merger Participants' Sketchy Pasts
A Huge, but Sketchy Merger The announced merger and "tax inversion" of Pfizer and Allergan would be one of the largest corporate marriages in US history.  It has drawn more than its share of criticism.  For example, per the Los Angeles Times, former US Senator and Secretary of State, and current presidential candidate Hilary Clinton said "this proposed merger, and so-called inversions by other companies, will leave U.S. taxpayers holding the bag." By creating the world's largest drug company, it could certainly further consolidate the US and global pharmaceutical market and raise already high ...
Source: Health Care Renewal - November 24, 2015 Category: Health Management Tags: Allergan crime deception fraud impunity kickbacks legal settlements obstruction of justice Pfizer RICO Source Type: blogs

What Revolving Door? - An Unprecedented Endorsement of a Political Appointment by the "Gold Standard" Medical Journal
An Unprecedented Endorsement  It's deja vu all over again.  In the spring of 2015, the New England Journal, the most prestigious US medical journal, published a remarkable series of opinion pieces extrolling physician-industry collaborations, and minimizing the significance of resulting conflicts of interest.  More remarkable was the extent that the articles' argument were bolstered by logical fallacies (look here).Doubling down, the New England Journal of Medicine appeared to make its first ever endorsement of a nominee for federal office.  On October 28, 2015, the NEJM published an editorial with the ...
Source: Health Care Renewal - November 19, 2015 Category: Health Management Tags: conflicts of interest FDA medical journals NEJM New England Journal of Medicine revolving doors Source Type: blogs

Health Care Renewal Bloggers in Print on Conflicts of Interest and Health Care Corruption
Not to toot our own horn too loudly, but in the last week, Health Care Renewal bloggers have appeared in print three times.Prevalence of Board Level Conflicts of InterestWe recently posted on a British Medical Journal article on the prevalence of what we originally termed "a new species of conflicts of interest," that is, conflicts of interest involving membership in boards of directors of for-profit health care corporations.  A shortened version of this just appeared as a (not very) "rapid response" in the BMJ here.  (Note though that the official date of the response was October 3.)The New E...
Source: Health Care Renewal - November 17, 2015 Category: Health Management Tags: boards of directors conflicts of interest health care corruption Source Type: blogs

"Dreaming On" - The Illusions of the Leaders of Large Health Organizations, as Illustrated by Medtronic's Founder
On Health Care Renewal, we have posted story after story about amazingly well paid leaders of big organizations presiding over amazingly bad organizational behavior (including subversion of mission, conflicts of interest, deception, fraud, kickbacks, various other crimes and outright corruption).  Yet the leaders often seem curiously disconnected from what occurs on their watches, while they are sometimes hailed as "visionaries," and at times exude messianic confidence.Medtronic's Founder on its Sacred Mission A recent article appearing in an unexpected place provides an example of leaders' excess confidence...
Source: Health Care Renewal - November 12, 2015 Category: Health Management Tags: CEO disease deception legal settlements Medtronic mission-hostile management Source Type: blogs

What They Really Think of Us (Swiss Version) - Novartis CEO Would Not Commit to Changing Company Behavior After Latest of Multiple Legal Settlements
The huge corporations which now dominate global health care are creating amazing records of repeated ethical misadventures.  We last discussed multinational Swiss based pharmaceutical manufacturer Novartis' escapades in early 2014.   Since then, the legal settlements and other legal findings just keep on coming, capped with a big one in late October, 2015.We will summarize them in chronological order.Japanese Health, Labor and Welfare Ministry Found that Novartis Concealed Serious Adverse EffectsIn August, 2014, per the Japan Times, but apparently not reported widely outside of that country.Novartis Pharma K...
Source: Health Care Renewal - November 5, 2015 Category: Health Management Tags: corporate integrity agreement deception Express Scripts impunity kickbacks legal settlements Novartis Switzerland what they really think of us Source Type: blogs

The Corporate Physicians' Dilemma - Three Hospital Systems Settle Cases Alleging Pressure on Employed Physicians to Refer Patients Within the System
Physicians are sworn to provide the best possible care to each individual patient.  Yet in the US, physicians increasingly practice as employees of large organizations, sometime for-profit corporations.  Physicians may be in a bind when their bosses pressure them to make patient level decisions so as to increase revenue, regardless of their effects on the patients.In particular, physicians' oaths may suggest that patients who require referrals for consultation, diagnosis or treatment should go to the professionals and facilities best suited to their particular problems.  However, physicians bosses may want p...
Source: Health Care Renewal - October 27, 2015 Category: Health Management Tags: Adventist Health System Broward Health corporate physician crime Stark Law Tuomey Healthcare System Source Type: blogs

"The Scourge of Managerialism" - Generic Management, the Manager's Coup D'Etat, Mission-Hostile Management Rolled Up, as Described by Some Men from Down Under
I just found an important article that in the June, 2015 issue of the Medical Journal of Australia(1) that sums up many of ways the leadership of medical (and most other organizations) have gone wrong.  It provides a clear, organized summary of "managerialism" in health care, which roughly rolls up what we have called generic management, the manager's coup d'etat, and aspects of mission-hostile management into a very troubling but coherent package.  I will summarize the main points, giving relevant quotes.Recent Developments in Business Management Dogma Have Gravely Affected Health CareMany health pract...
Source: Health Care Renewal - October 20, 2015 Category: Health Management Tags: economism generic managers global health managerialism ' coup d etat market fundamentalism Medical Journal of Australia neoliberalism Source Type: blogs

Phooled Again - More Settlements Suggesting Bad Behavior by Big Pharma/ Biotech
Once again, here is a roundup of cases showing big multi-national pharmaceutical and biotechnology companies are up to their usual tricks.Presented in alphabetical order...Bristol-Myers Squibb Settles Charges of Bribery of Chinese Hospitals.The best version of this I could find was in USA Today, in early October, 2015,Pharmaceutical manufacturer Bristol-Myers Squibb has agreed to pay more than $14 million in fines to settle charges that its joint venture in China paid cash and other benefits to state-owned hospitals in exchange for prescription sales, the Securities and Exchange Commission announced Monday.After its invest...
Source: Health Care Renewal - October 15, 2015 Category: Health Management Tags: adulterated devices bribery Bristol-Myers-Squibb crime deception deferred prosecution agreement Genzyme intimidation legal settlements Pfizer Sanofi-Aventis Source Type: blogs

Fatal Fraud? - More Settlements by Commercial Hospices of Allegations They Enrolled Non-Terminal Patients
DiscussionThere are more cases being reported in which hospices, particularly those owned and run by for-profit corporations, have enrolled patients who were not terminally ill.  These enrollments may be motivated by the desire for more money, but they put patients at risk.  Hospice patients may receive large doses of psychoactive drugs and narcotics, which may lead to adverse effects up to and including death.  Hospice patients may not, however, receive treatments for new acute problems, even if those problems are potentially curable.  Therefore, hospice patients may die from untreated infections that ...
Source: Health Care Renewal - October 7, 2015 Category: Health Management Tags: hospices Oak Hill Capital Partners private equity Source Type: blogs

Academic Medical Leaders as Directors of For-Profit Health Care Corporations: the Prevalence of This "New Species" of Conflict of Interest Documented in the BMJ
Discussion As we have suggested, Anderson et al stated that being on the board of directors of a for-profit health care corporation creates conflicts of interest beyond those created by simply having a financial relationship with a health care company, e.g., by participating in a commercially sponsored research project or acting as a consultant to a company.Similar to individuals engaging in consulting relationships, directors on industry boards enter a formal contract with the company and receive financial payment for services; however, they are subject to two important differences. Firstly, unlike consultants who are com...
Source: Health Care Renewal - September 30, 2015 Category: Health Management Tags: academic medical centers boards of directors conflicts of interest institutional conflicts of interest medical schools Source Type: blogs

Cambridge University Hospitals Trust IT Failures: An Open Letter to Queen Elizabeth II on Repeated EHR Failures, Even After £12.7bn Wasted in Failed NHS National IT Programme
In conclusion, Your Highness, it might benefit your citizens (and those of the U.S.) if a national re-education programme were instituted to de-condition your leaders from unfettered belief in cybernetic miracles in medicine, a mental state they attain in large part due to mass EHR vendor and pundit propaganda.A more sober mindset is recommended by your subject Shaun Goldfinch in "Pessimism, Computer Failure, and Information Systems Development in the Public Sector" (Public Administration Review 67;5:917-929, Sept/Oct. 2007, then at the University of Otago, New Zealand):  The majority of information systems ...
Source: Health Care Renewal - September 24, 2015 Category: Health Management Tags: Addenbrooke Hospital Cambridge University Hospitals healthcare IT dangers healthcare IT risks Mismanagement NPfIT Patient care has not been compromised Rosie hospital Source Type: blogs

Turn That Door Around - A Physician Substantially Tied to the Pharmaceutical Industry Nominated to Run the FDA
It seems to be the season of the revolving door in health care.  The latest version got some media attention, because it involves one of the most important health care leadership positions in the US government, the Director of the Food and Drug Administration (FDA).  However, the case actually seems much more serious than what the media has recently reported.The BasicsFor an introduction, we turn to the Wall Street Journal from September 15, 2015:President Barack Obama plans to nominate the prominent cardiologist and medical researcher Robert Califf as the next commissioner of the Food and Drug Administration, th...
Source: Health Care Renewal - September 24, 2015 Category: Health Management Tags: boards of directors CME conflicts of interest FDA key opinion leaders logical fallacies revolving doors Source Type: blogs

A Quiet Turn of the Revolving Door - Director of NIMH to Go Directly to Google Life Sciences
Amidst a lot of health care news, the job plans of Dr Thomas Insel, currently the director of the National Institute of Mental Health (part of the US National Institute of Health) made a very small splash.  The most comprehensive account was in the New York Times.Dr. Thomas R. Insel, the director of the National Institute of Mental Health, announced on Tuesday that he planned to step down in November, ending his 13-year tenure at the helm of the world’s leading funder of behavioral-health research to join Google Life Sciences, which seeks to develop technologies for early detection and treatment of health proble...
Source: Health Care Renewal - September 18, 2015 Category: Health Management Tags: NIH NIMH revolving doors Thomas Insel Source Type: blogs

Politico 2015: EHR sellers using “gag clauses” (despite Koppel/Kreda's 2009 JAMA article on EHR nondisclosure clauses, and my 2009 JAMA Letter to the Editor on how these clauses violate Joint Commission safety standards)
I have not blogged on EHR issues in some time, despite some interesting source material such as:"Evidence Summary: Electronic Health Records (EHRs)" at http://www.ohri.ca/kta/docs/KTA-EHR-Evidence-Review.pdf ; "Electronic Health Records Software Often Written without Doctors' Input" at http://www.scientificamerican.com/article/electronic-health-records-software-often-written-without-doctors-input/ ; and"Avoiding Expensive And Consequential Health Care Decisions Based On Weak Research Designs" [e.g., EHR expansion - ed.] at http://healthaffairs.org/blog/2015/08/31/avoiding-expensive-and-co...
Source: Health Care Renewal - September 14, 2015 Category: Health Management Tags: Darius Tahir david kreda defects nondisclosure clause gag clause healthcare IT risks hold harmless clause Politico ross koppel Source Type: blogs

Pfizer's Latest International Pfiascos - Charges of Anti-Competitive Practices, Inflated Prices, Deception and Secrecy
Many big health care organizations seem to just be unable to keep out of trouble, and the bigger they are, the more kinds of trouble.  Pfizer Inc, considered to be one of the world's largest pharmaceutical companies, has supplied us with plenty of stories.  Enough new stories about Pfizer have accumulated since last year to do a roundup.    Presented in chronological order....Italy Demands Damages from Pfizer for Anti-Trust ViolationsThis story came out in May, 2014, via Reuters,Italy said on Wednesday it was seeking more than a billion euros in damages from multinational drug companies following a...
Source: Health Care Renewal - September 13, 2015 Category: Health Management Tags: adverse effects antitrust deception executive compensation health care prices legal settlements marketing Pfizer suppression of medical research vaccines Source Type: blogs

Round and Round It Goes - Former US Secretary of Health and Human Services Joins Humacyte Board
The latest example of the health care revolving door was made barely public just before the US Labor Day holiday.  Per the Triangle Business Journal,Humacyte Inc., a biotechnology company based in Research Triangle Park, has beefed up its board of directors by adding former U.S. Secretary of Health and Human Services Kathleen Sebelius and life sciences industry veteran Dale Sander.The 11-year-old Humacyte develops novel human tissue-based investigational products that are being developed for potential commercialization for applications in regenerative medicine and vascular surgery. Sebelius adds a significant amount o...
Source: Health Care Renewal - September 4, 2015 Category: Health Management Tags: anechoic effect conflicts of interest corporatism DHHS revolving doors Source Type: blogs

Northwestern Upholds its "Brand," Never Mind Free Speech and Academic Freedom
Threats to free speech and academic freedom in health care were a major concern when we started Health Care Renewal.  Such threats may now be less anechoic, but do not seem to have diminished.Censorship and the Resignation of Alice Dreger The latest example was at Northwestern University. The basics of the case appeared in the Chronicle of Higher Education. Alice Dreger just resigned her position of 10 years as "a clinical professor of medical humanities and bioethics."What prompted her departure was the fallout over an article by William Peace, who at the time was a visiting professor in the humanities at ...
Source: Health Care Renewal - September 2, 2015 Category: Health Management Tags: academic freedom anechoic effect bioethics censorship free speech mission-hostile management Northwestern University Source Type: blogs

You Can Check Out Any Time You Like, But You Can Never Leave - Duke and UNC Allegedly Agreed Not to Hire Each Other's Faculty
We have intermittently discussed the worsening plight of physicians trying to provide clinical care as employees of large organizations.  Such corporate physicians are likely to be squeezed between professional values that put the patient first, and management that puts revenue first.   Physicians employed by large corporations may find their values increasingly at risk as these organizations adapt the tactics of the robber barons.Now it appears that even ostensibly genteel academic medical institutions may be adapting these tactics.Allegations of Anti-Competitive Faculty Employment Practices at Duke and Uni...
Source: Health Care Renewal - August 27, 2015 Category: Health Management Tags: antitrust corporate physician Duke University economism market fundamentalism medical schools University of North Carolina Source Type: blogs

The Real Dark Side of Health Care: Health Care Corruption
The editors of the prestigious Annals of Internal Medicine just stated they they were shocked, shocked to find out that physicians occasionally express disrespect for patients when the patients cannot hear or see them.  The occasion was an editorial signed by three editors whose title included the phrase, "shining a light on the dark side of health care."(1)  The editorial referred to an anonymous narrative that recounted two incidents from the past.(2)Two Alleged Incidents of Physicians' Expression of Disrespect for Patients The first incident, discussed second hand, was of a obstetrician who made a se...
Source: Health Care Renewal - August 25, 2015 Category: Health Management Tags: anechoic effect Annals of Internal Medicine health care corruption medical journals professionalism Source Type: blogs

Once More with Feeling - Amgen Again Settles Allegations of Misbranding, But Why Bother?
DiscussionIn the case of Amgen, the large 2012 settlement for misbranding resulted in the only guilty plea made and the largest fine paid by the company.  From my informal perusal of legal settlements made by drug, biotechnology and device companies, misbranding seems to be one of the more frequent allegations, and often the only one resulting in admissions of guilt.  It may be that it is easier to prove misbranding than other charges, and companies may admit to misbranding in settlements because the charge is not well understood by the general public and hence may carry less of a stigma than other charges, for e...
Source: Health Care Renewal - August 20, 2015 Category: Health Management Tags: Amgen bribery deception kickbacks legal settlements marketing Source Type: blogs

With 10 Health Care Executives on it Board, US Chamber of Commerce Defends Big Tobacco Abroad
DiscussionUS health care is increasingly dominated by large organizations.  Most of these organizations like to portray themselves as warm and fuzzy supporters of individual and population health.  For example, Pfizer has a statement of responsibility which beginsAs a member of today’s rapidly changing global community, we are striving to adapt to the evolving needs of society and contribute to the overall health and wellness of our world.Anthem's statement includesAnthem is dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our com...
Source: Health Care Renewal - August 17, 2015 Category: Health Management Tags: Abbott Celgene mission-hostile management Pfizer Sanofi-Aventis Steward Health Care tobacco US Chamber of Commerce WellPoint Source Type: blogs

The Latest Example of the Anechoic Effect - AllTrials US Initiative Launches to Deafening Media Silence
Every now and then, someone tries to persuade me how much more open discussion of various kinds of recent unpleasantness in health care has become in the US. I admit there has been more media attention to certain issues, but unfortunately must maintain that the issues most likely to be make those who profit the most from our current health care system uncomfortable remains anechoic. Now I have my latest exampleAllTrials AllTrials is a UK based organization that advocates for registration and public reporting of all clinical trials.  AllTrials explains the reasons for this simply:Clinical trials are the best way we hav...
Source: Health Care Renewal - August 10, 2015 Category: Health Management Tags: AllTrials anechoic effect suppression of medical research Source Type: blogs

Praluent, the Next Expensive "Game Changer," Blockbuster," "New Hope," - But Not Yet Shown to Benefit Patients
ConclusionsThe NEJM study was accompanied by an editorial by Stone and Lloyd-Jones(2) which documented that drugs previously shown to lower cholesterol were never proved to do any good for patients, and concluded,it would be premature to endorse these drugs for widespread use before the ongoing randomized trials, appropriately powered for primary end-point analysis and safety assessment, are available. After an FDA advisory committee recommended approval of aliromucab and another PCSK9 inhibitor in June, 2015, John Mandrola entitled a Medscape article,Dear FDA: Resist the Urge on PCSK9 DrugsHis reasons included lack o...
Source: Health Care Renewal - August 5, 2015 Category: Health Management Tags: aliromucab evidence-based medicine health care prices manipulating clinical research PCSK9 inhibitor Praluent Regeneron Sanofi-Aventis Source Type: blogs

60% of the CEOs of America's "Great Health Systems" Have No Educational Background in Health Care
We have noted that US health care has been taken over by generic managers.  A recent article about the CEOs of purportedly some of America's best hospitals provides some quantitative data.A few days ago, Becker's Hospital Review published a list of the educational background of the CEOs of the "50 great health systems to know | 2015," (at least according to Becker's.  The article noted that their educational experiences took place at, Ivy League schools, small liberal arts colleges, Big Ten universities, law schools, medical schools and more.That is nice, but I decided to simply look at how many of the ...
Source: Health Care Renewal - July 31, 2015 Category: Health Management Tags: generic managers hospital systems Source Type: blogs

Entresto: Blockbuster, or Just Over Hyped? - Whatever, It Will Cost $4500 a Year
The newest drug for congestive heart failure, Entresto, a fixed combination of valsartan and sacubitril, has just hit the market at an elevated price.  Like other drugs recently introduced as blockbusters, the high price does not seem clearly justified by clinical evidence about the drug's benefits and harms.   Questions Raised by the One Big Published Controlled Trial Last year, we discussed the hoopla around a study of a new drug for congestive heart failure (CHF),(1) a fixed combination of valsartan and sacubitril. Also, on the now defunct CardioExchange blog, Dr Vinay Prasad discussed the same study (look her...
Source: Health Care Renewal - July 30, 2015 Category: Health Management Tags: CHF clinical trials Entresto evidence-based medicine manipulating clinical research Novartis sacubitril Source Type: blogs

What They Really Think of Us, UK Version - Health Secretary Derides NHS Doctors for Not Working Enough on Weekends
A new story from the UK suggests what top leaders of health care really think about health care professionals.  I realize that I risk showing my shallow understanding of UK politics when I comment on this, but I believe that the story is straightforward enough for someone from the US to understand, and has  lessons for the US and other countries.UK Health Secretary Says Doctors Do Not Work Enough on Weekends The story started earlier in July, 2016, when the current UK Health Secretary within the current Conservative government told National Health System (NHS) doctors they must work seven days a week, as reported...
Source: Health Care Renewal - July 26, 2015 Category: Health Management Tags: generic managers ill-informed management NHS UK Source Type: blogs

Turn, Turn, Turn - from Columbia/ HCA Executive, to Virginia Secretary of Health and Human Resources, to Director of the Center for Medicare and Medicaid Services (CMS), to America's Healt Insurance Plans (AHIP)
ConclusionsSo now Marilyn Tavenner shows she is securely within that club of insiders that run health care in the US.  Some celebrate the US health care "free market," in which one might expect for-profit insurers will fight with provider organizations, like for-profit hospital chains, over payment policies, overseen by government's impartial regulators.  Yet it appears that many of these organizations' leaders come out of the same pool of insider managers, and that individuals can lead or govern organizations that are supposed to be negotiating at arm's length.  For example, note that now Ms Taven...
Source: Health Care Renewal - July 16, 2015 Category: Health Management Tags: AHIP Centers for Medicare and Medicaid Services CMS HCA revolving doors Source Type: blogs

Turn, Turn, Turn - from Colubia/ HCA Executive, to Virginia Secretary of Health and Human Resources, to Director of the Center for Medicare and Medicaid Services (CMS), to America's Healt Insurance Plans (AHIP)
ConclusionsSo now Marilyn Tavenner shows she is securely within that club of insiders that run health care in the US.  Some celebrate the US health care "free market," in which one might expect for-profit insurers will fight with provider organizations, like for-profit hospital chains, over payment policies, overseen by government's impartial regulators.  Yet it appears that many of these organizations' leaders come out of the same pool of insider managers, and that individuals can lead or govern organizations that are supposed to be negotiating at arm's length.  For example, note that now Ms Taven...
Source: Health Care Renewal - July 16, 2015 Category: Health Management Tags: AHIP Centers for Medicare and Medicaid Services CMS HCA revolving doors Source Type: blogs

Who Benefits? - Rising Generic Drug Prices and the Case of Mylan's Conflicted Property Purchases
Rising Generic Drug PricesHealth care costs in the US continue their seemingly inexorable rise.  Even the parts of health care that used to seem reasonably priced now are affected.  As Ed Silverman discussed on PharmaLotprices for many generic drugs have been climbing, prompting concerns that a low-cost staple of the U.S. health care system might soon strain budgets.Generic drugs, like practically every other part of US health care, have become big business.  As a Forbes article pointed out, the industry is becoming more consolidated, and more likely to suffer from manufacturing and regulatory issues.  ...
Source: Health Care Renewal - July 9, 2015 Category: Health Management Tags: boards of directors conflicts of interest executive compensation mission-hostile management Mylan perverse incentives Source Type: blogs

Bill Clinton, Paid to Speak to Biotech Conference, Extolled $1000 Pill to Prevent "Liver Rot," Despite Lack of Evidence that It Does
ConclusionHow distorted is health care these days.  Misinformation, even disinformation seems to dominate evidence and logic.  Concerns about health care dysfunction are suppressed by the anechoic effect.  Perhaps inspired by the generic managers who now run health care organizations, everyone seems to have become a health care expert, and so the reach of viewpoints on health care seems to be more about the celebrity of their proponents rather than their knowledge, or the logic and evidence underlying their views.As a start, true health care reform has to somehow liberate good clinical evidence from where it...
Source: Health Care Renewal - July 1, 2015 Category: Health Management Tags: Clinton Foundation evidence-based medicine Gilead hepatitis C Sovaldi Source Type: blogs

How Institutional Conflicts of Interest Exacerbate the Anechoic Effect - the Example of ASCO Fearing "Biting the Hand that Feeds You"
As we recently discussed (here, here, here and here), in May, 2015, the New England Journal of Medicine, arguably the world's foremost medical journal, published an editorial and a three-part commentary arguing that current concerns about the effects of financial conflicts of interest (COI) on health care are overblown(1-4).  On June 1, the Wall Street Journal published a report on the 2015 meeting of the American Society of Clinical Oncology (ASCO) that provided a vivid example of why these concerns should not be dismissed.Questioning Drug Prices at the ASCO MeetingThe main issue in the article was:In a sign of growi...
Source: Health Care Renewal - June 26, 2015 Category: Health Management Tags: American Society of Clinical Oncology anechoic effect conflicts of interest health care prices institutional conflicts of interest medical societies You heard it here first Source Type: blogs

Childish, petty and vindictive: UPMC hospitals ban sale of Post-Gazette from their gift shops
Here's a new angle on how a healthcare organization might react to unfavorable press:Ban the sale of the newspaper in question from their territory:UPMC hospitals ban sale of Post-Gazette from their gift shopsJune 24, 2015 12:00 AMhttp://www.post-gazette.com/business/pittsburgh-company-news/2015/06/24/UPMC-hospitals-ban-sale-of-Post-Gazette-from-their-gift-shops/stories/201506240066By Steve Twedt / Pittsburgh Post-GazetteSome UPMC hospitals are banning the Post-Gazette from sale in their gift shops, a move UPMC spokesman Paul Wood said was precipitated by “fairness issues” in the newspaper’s coverage of t...
Source: Health Care Renewal - June 25, 2015 Category: Health Management Tags: anechoic effect free speech Pittsburgh Post-Gazette University of Pittsburgh Medical Center UPMC Source Type: blogs

The US' Multinational Trade Negotiations - Trading Away Its Own and Other Countries' Current and Future Restraints on Drug Prices?
Trade Agreements More about Deregulation than Trade International trade negotiations, especially their more technical aspects, seem far removed from health care and health policy, and unrelated to health care dysfunction.  However, it seems that such trade negotiations have become a back door route to affect health policy, especially national efforts to regulate health care intended to improve patients' and the public's health.   We recently discussed how current multinational trade negotiations seem to be more about changing regulation in favor of big corporations than broadly advancing trade.  Some of the ...
Source: Health Care Renewal - June 17, 2015 Category: Health Management Tags: CMS health care prices Medicare pharmaceuticals regulatory capture revolving doors trade policy US Trade Representative Source Type: blogs

Challenging the meme that [yes, there are all these drastic flaws and problems - BUT] ... EHRs improve patient safety
One of the most persistent memes in healthcare IT is that, for all their deficits, bugs, flaws, interferences in care, and so forth, these systems "improve patient safety."I find the meme remarkable. 37 medical societies can issue a complaint letter about how EHR systems interfere in care and pose patient risk (http://hcrenewal.blogspot.com/2015/01/meaningful-use-not-so-meaningul.html).  The Joint Commission can issue a detailed Sentinel Event Alert outlining the myriad ways that these systems "introduce new kinds of risks into an already complex health care environment where both technical and social f...
Source: Health Care Renewal - June 15, 2015 Category: Health Management Tags: ACP ECRI Deep Dive Study healthcare IT safety Politico Source Type: blogs

The 2015 PharmedOut Meeting
The 2015 PharmedOut.org meeting is now in the history books.  It featured many presentations and considerable formal and informal discussion about issues relevant to Health Care Renewal, including adverse effects of drugs, manipulation and suppression of research, deceptive marketing, disease mongering, etc.  The schedule is here.  The abstracts are here.  The new PharmedOut.org video makes some of the main points with some irony and humor.  It is available on their main page, and belowThe new PharmedOut.org promotional video, (Source: Health Care Renewal)
Source: Health Care Renewal - June 13, 2015 Category: Health Management Tags: PharmedOut Source Type: blogs

Who Benefits? - Despite Data Breaches, Staff Cuts, Vulnerable Patients' Coverage Cuts, Transplant Program Probation, Multi-Million Dollar Executive Compensation Persists at UPMC
There are so many things wrong with US and global health care that it is easy to get lost in the details, and despair of finding solutions.  Keep in mind, however, that the intractability of many of the problems may be quite man made.  Many problems may persist because the status quo is so beneficial to some people.The Current Troubles at UPMC Consider, for example, the troubles that have recently plagued UPMC, the giant health care system in western Pennsylvania.  In the last month, the following reports have appeared.Electronic Data Breach Affected 2200 PatientsOn May 15, the Pittsburgh Tribune-Review repo...
Source: Health Care Renewal - June 9, 2015 Category: Health Management Tags: executive compensation hospital systems legal misconduct medical record confidentiality mission-hostile management UPMC Source Type: blogs

Health Care Professional Societies Whose Leadership Betrays Their Own Members - the APA Alleged to Have Supported Torture, and Deceived its Members to Collect Money
Health care professionals usually view their professional societies as allies, supporting their values and acting in their professional and their patients' interests.  Increasingly, however, these societies appear to be run more to support the interests of their top leaders. Allegations that the American Psychological Association (APA) Supported Torture The latest example is the American Psychological Association.  As noted by a Washington Post article from May, 2015, "the APA ... represents more than 122,000 doctoral-level psychologists around the world...."  Of these, about 60,000 are licens...
Source: Health Care Renewal - June 5, 2015 Category: Health Management Tags: APA boards of trustees crimes against humanity deception executive compensation legal settlements mission-hostile management Source Type: blogs

Say It Ain't So, Again - a "Push Poll" to Minimize the Hazards of Conflicts of Interest ...in the New England Journal of Medicine?
The New England Journal of Medicine recently published a remarkable series of apologiae for conflicts of interest,(1-4) about which we have published three posts, here, here, and here.  Just to ice the cake, the NEJM also set up a reader poll on the subject. Its introduction stated, we invite you to put yourself in the role of editor and help us decide about the suitability of three hypothetical potential authors of review articles for the Journal. However, as noted first in a post on the HealthNewsReview.org blog, the poll had a curious design.  Each of the three hypothetical experts has some type of financial a...
Source: Health Care Renewal - June 2, 2015 Category: Health Management Tags: conflicts of interest NEJM New England Journal of Medicine propaganda surveys Source Type: blogs

Government backs down on some requirements for digital medical records
EHR utopian dreams have taken some pronounced hits in recent years.In recent months, the hyper-enthusiasts and their government allies have had to eat significant dirt, and scale back their grandiose but risible - to those who actually have the expertise and competence to understand the true challenges of computerization in medicine, and think critically - plans.(At this point I'll give them the benefit of the doubt and not call the utopians and hyper-enthusiasts corrupt, just stupid.) USA Today published this article today outlining the retreat:Government backs down on some requirements for digital medical recordshttp://w...
Source: Health Care Renewal - May 27, 2015 Category: Health Management Tags: Bob Wachter David Blumenthal healthcare IT difficulties healthcare IT dissatisfaction Healthcare IT experiment Jayne O ' Donnell Sally Murphy USA Today Source Type: blogs

Lahey Health: hospital jobs lost, but computer vendors prosper
At numerous posts on this blog I link to stories of health IT expense putting hospital financial stability at risk, e.g., "Monetary losses and layoffs from EHR expenses and EHR mismanagement" (http://hcrenewal.blogspot.com/2013/06/monetary-losses-and-layoffs-from-ehr.html),  "Financial woes at Maine Medical Center: Reading this blog might have saved them millions of dollars, and prevented massive 'cost saving initiatives'" (http://hcrenewal.blogspot.com/2013/05/financial-woes-at-maine-medical-center.html), "In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health N...
Source: Health Care Renewal - May 26, 2015 Category: Health Management Tags: EHR layoffs Lahey health Source Type: blogs

Say It Ain't So: Logical Fallacies in Defense of Conflicts of Interest ... in the New England Journal of Medicine?
IntroductionWe have been viewing with alarm the web of conflicts of interest draped over medicine and health care since we started Health Care Renewal.  We have been particularly concerned about how conflicts of interest may have led to threats to the integrity of clinical research, especially due to manipulation and suppression of clinical research studies.  We have also been concerned about how COIs have led to threats to the integrity of medical education, especially given how health care corporate marketers have paid influential health care professionals and academics to be "key opinion leaders," ma...
Source: Health Care Renewal - May 21, 2015 Category: Health Management Tags: conflicts of interest logical fallacies NEJM Source Type: blogs

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Why is the New England Journal of Medicine Scolding "Pharmascolds"?I, a normally quiet blogger on this site, was disquieted by what may be a backlash aimed at quashing the anti-conflict-of-interest movement.Lisa Rosenbaum just published her second of three treatises in the highly prestigious New England Journal of Medine, scolding "pharmascolds" (see Conflicts of Interest: Understanding Bias — The Case for Careful Study). "Pharmascolds" is the term Rosenbaum and others use for those of us at Health Care Renewal, the Institute of Medicine, and ...
Source: Health Care Renewal - May 18, 2015 Category: Health Management Tags: academic corruption conflict of interest evidence-based medicine institutional conflicts of interest NEJM pharmaceuticals physicians Source Type: blogs

BLOGSCAN - New England Journal of Medicine Scoffs at "Pharmascolds"
The venerable New England Journal of Medicine has now published an editorial,(1) and two commentaries(2-3), with one more promised, hailing physician industry "partnership," as per NEJM editor Jeffrey Drazen,(1) and deploring the "pharmascolds,"(3) who might question the glorious innovations that could arise when industry pays academic and practicing physicians.    In a tweet, Dr Harlan Krumholz said he was "shocked" that a NEJM commentary would "give credence to the 'pharmascold' narrative.   So far, the only more detailed questions about this new direction for the Jo...
Source: Health Care Renewal - May 17, 2015 Category: Health Management Tags: conflicts of interest New England Journal of Medicine pharmaceuticals Source Type: blogs