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Wednesday, 6 May 2015

Princess Health and MBA-holding Informatics Fellow's Portfolio: Revolutionizing Healthcare Through Plagiarism. Princessiccia

Gusty 08:11 Add Comment

I highlighted the MBA culture at least once before on this site, on April 16, 2010 at "Healthcare IT Corporate Ethics 101: 'A Strategy for Cerner Corporation to Address the HIT Stimulus Plan'", http://hcrenewal.blogspot.com/2010/04/healthcare-it-corporate-ethics-101.html.

In that post, I noted MBA candidates/Cerner employees happily conspiring in a paper at Duke's Fuqua School of Business towards combination in restraint of trade through "recommending that Cerner collaborate with other incumbent vendors to establish high regulatory standards, effectively creating a barrier to new firm entry. "

Combination in restraint of trade: An illegal compact between two or more persons to unjustly restrict competition and monopolize commerce in goods or services by controlling their production, distribution, and price or through other unlawful means. Such combinations are prohibited by the provisions of the Sherman Anti-Trust Act and other antitrust acts.

The paper was highlighted at professor David Ridley's page "Duke University Fuqua School of Business: Past Papers" - that is, until a few days after my blog post went up and he was informed of it. You can see cached copies of the paper and page at the post at link above.

Today, I've had another experience with an MBA holder who has decided to enter the field of Medical Informatics.

I received an unsolicited Cc: of an email, sent by a professional in my field I do not know at a university in Australia. The email was directed at a postdoctoral fellow at a U.S. medical informatics program in the Midwest, advising the fellow that his 'Portfolio' brag page page was plagiarized directly almost verbatim from a personal essay I'd written ca. 1999 and now archived at my current Drexel site at http://cci.drexel.edu/faculty/ssilverstein/informaticsmd/infordef1.htm, and that plagiarism was bad for informatics careers:

Date: Tue, May 5, 2015 10:28 pm
To: [Name of recipient MBA-holding informatics fellow redacted - ed.]

I was disappointed to find the following three paragraphs on the homepage of your site ([URL redacted] - ed.)

"It became apparent to me and many informatics professionals that significant confusion and misconceptions exist in hospitals, industry, and the world at large about what medical informatics is, and what experts in medical informatics do (and are able to do if given the opportunity). Also, there is confusion as to what medical informatics is not.

"The available quantity of information in most subject areas ("domains") has grown rapidly in recent decades. Issues about information and its use have become quite complex, and the issues themselves have undergone scientific study. Informatics is information science. In other words, informatics is a scientific discipline that studies information and its use.

"Both theoretical and practical issues are studied. Examples of theoretical issues include terminology, semantics (term meaning), term relationships, and information mapping (translation). Practical issues include information capture, indexing, retrieval, interpretation, and dissemination. Medical informatics, an informatics subspecialty, is the scholarly study of these information issues in the domain of biomedicine."

This text is an almost perfect copy of the introduction to Scott Silverstein�s page (http://cci.drexel.edu/faculty/ssilverstein/informaticsmd/infordef1.htm).

Plagiarism has no place in Medical Informatics, and could harm your career. I would appreciate it if you could rewrite or remove this content on your site

Best Regards

[Professor name redacted - ed.]

There was other copied material after these paragraphs as well; almost the entire page was my words and ideas. The page shamelessly concluded with this:

Shamelessly copied from http://cci.drexel.edu/faculty/ssilverstein/informaticsmd/infordef1.htm#importance

I do not know how the Australian professor detected the plagiarism, if he had involvement with the fellow, or the context of the interaction.

This fellow had an MBA and the title of his "portfolio" page was about his passion for 'revolutionizing healthcare.'

It's clear he thought his stealing my words and ideas would never be noticed. In other words, exploiting my creativity for his own gain and image-enhancement was fine.

Obviously in our connected world, plagiarism is not a good idea. Perhaps not so obvious are the predatory values of the MBA degree and the damaging effects on all our healthcare when such individuals 'revolutionize' it.

I sent a demand for the material's immediate removal along with a polite suggestion of unpleasantness if he does not comply.

I am not naming the postdoc due to having bigger fish to fry.

-- SS

Update 5/6/2015:

The fellow has removed about 3/4 of my material from the webpage in question, but a passage remains verbatim.

I've sent another request backed by a screenshot and link to my material, and a rather more direct consequence of failure of complete removal.

Between the IT invasion of health IT and the MBA invasion, perhaps patients need to hire fulltime medical advocates for everything more serious then getting a boil lanced.

-- SS

Additional thought 5/7/2015:

I should add the misleading credentials exaggeration of minimal exposure to informatics (a seminar or AMIA short course at best) leading to a claim of a non-existent "American Medical Informatics Certification for Health Information Technology" by an erstwhile NextGen VP who also apparently holds a MBA with a concentration in Health Administration, see http://hcrenewal.blogspot.com/2009/02/nextgen-and-vendordoctor-dialog-yet.html.

Monday, 21 September 2009

Princess Health and Wyeth, Ghostwriting, Dr. Joseph Camardo and a Big Liquor Store With a Little Grocery Department. Princessiccia

ghost writing health care ethics Wyeth

Gusty 06:32 Add Comment

Ghostwriting is a topic covered extensively at Healthcare Renewal, including at my post "Wyeth: Ghostwritten Papers Fake, But Accurate" here, Roy Poses' "Wyeth's Industrial Scale Ghost-Writing" here, and many others about Wyeth and other pharmas that can be viewed via this link: http://hcrenewal.blogspot.com/search/label/ghost writing.

A story in the Philadelphia Inquirer yesterday about Wyeth and ghostwriting brought to mind my medical school days at Boston University, in a metaphorical and rather negative way, regarding an oddity reflecting today's pharma industry.

In those years I lived next to Boston City Hospital on the top floor of a 29-story high rise at 35 Northampton Street, at that time one of the toughest and highest crime neighborhoods in the region if not the country (I was careful and lucky, and only got mugged at gunpoint once.) I had an excellent bird's-eye view of the urban decay in the area, reflective of ethical decay in the community.

35 Northampton St., next to Boston Medical Center (formerly Boston City Hospital)

Across the street from the high rise was an oddity - a very large liquor store named Blanchard's. Inside Blanchard's was a very small grocery department of all things. Have a snack with your booze! (I went in only twice; once to see what it was all about, and again during the Blizzard of '78 to get some needed food when all transit in the city was shut down and several feet of snow -- and neighborhood guns -- inhibited foot travel.)

The area has much improved in the past three decades, but according to Google street view the liquor store is still there:

In the 1970's "Liquor Land" was a large liquor store with a small grocery department named "Blanchard's." Click to enlarge.

Why does this odd store remind me of Wyeth, and more generally today's pharmaceutical industry?

Because that industry has turned from what used to be a biomedical research & development industry with decent ethics and a small marketing arm, to large marketing industry with poor ethics and a small R&D arm.

(Or, perhaps more accurately, a large marketing industry with poor ethics and a busywork section disguised to look like R&D. As a colleague noted in my post "Pfizer/Wyeth Merger And Sacrificing The Future: Laying Off Scientific Staff All Over The Place" here, a small fraction of prime scientist intellectual horsepower and time is actually spent on true R&D today, the rest wasted on feeding the bureaucratic corpulence that is the modern pharma research lab. He observed that "what we today call pharmaceutical R&D is in reality busywork disguised to look like R&D, in effect a well engineered, well managed, massively expensive failure.")

Here is what led to my "pharmas have become large marketing firms with a small R&D effort" metaphor. It was a story in the local newspaper on ghostwriting.

The glib quotes from Dr. Joseph Camardo, Wyeth's senior vice president of global medical affairs, on the practice of ghostwriting are simply stunning:

Philadelphia Inquirer

Ghosts in the medical machine

Was drug research infected by ghostwriters? With Paxil suit in court, a Chadds Ford firm says it was ethical.

Sun, Sep. 20, 2009

By Miriam Hill
Inquirer Staff Writer

When GlaxoSmithKline P.L.C. marketers looked for doctors to promote the antidepressant Paxil, they called the project CASPPER. The name was more than just an offbeat tribute to the friendly cartoon ghost. It was a wink and a nod to "ghostwriting," a questionable practice in which scientists put their names on research written by someone else, usually a writer paid by a drugmaker.

Ghostwriting critics say it disguises marketing material as scientific research.

Charges of ghostwriting have been lobbed against many companies in recent years, including Glaxo, Wyeth, AstraZeneca P.L.C., and Merck & Co. Inc., often arising in lawsuits from consumers claiming a drug hurt them.
... Documents released in connection with 8,000 lawsuits filed against Wyeth over Premarin and Prempro show that the company, which employs several thousand people in Collegeville, paid a medical-writing firm to produce articles from 1998 to 2005 that allegedly downplayed the risks of hormone treatment and emphasized benefits.

In 2002, researchers stopped a landmark federal study after finding that menopausal women who took certain hormones had an increased risk of breast cancer, heart disease, and stroke.

"Ghostwriting was used to sway physician opinions to favor hormone use as disease prevention long after that was a scientifically defensible position," Fugh-Berman [writer Adriane Fugh-Berman - ed.] said.

Joseph Camardo, Wyeth's senior vice president of global medical affairs, called Fugh-Berman's view "baseless." Medical opinion evolves, he said, and the papers in question reflected scientific understanding then. He also said the authors alone controlled the content and writing of the papers, though some did have outside help paid for by Wyeth.

"It's really being misrepresented as something we wrote and paid for that said what we thought it should say," Camardo said. "But the authors were not paid, and the authors had the final say."

... Studies on ghostwriting have suggested that anywhere from 8 percent to 75 percent of articles in medical journals may involve the practice.

Aside from the point I raised in my post "Has Ghostwriting Infected The Experts With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?" here regarding possible severe contamination of the literature and therefore of "expert knowledge" as it exists today, Camardo's response raises a cornucopia of questions.

Regarding "Medical opinion evolves, he said, and the papers in question reflected scientific understanding then":

Whose scientific opinion do they reflect, exactly?
Does Camardo believe these ghostwritten papers, usually written by party "A" but with authorship claimed by party "B" (usually prominent academic physicians often nurtured by the industry into the role of "key opinion leaders", KOL's) are objective?
Does Camardo actually believe most of the content comes from party "B" rather than party "A" in these papers?
Does Camardo understand that paying a MECC (Medical education & communications company) or other firm to write scientific papers puts the author(s) of those papers in a conflict of interest position relative to the paying sponsor, injurious to objectivity?
Is Camardo that naive to believe a paid writer would "diss" the holder of his or her paycheck?

Regarding "the authors alone controlled the content and writing of the papers, though some did have outside help paid for by Wyeth":

Which authors is he referring to?
The ghostwriters?
Wyeth scientists?
Academics claiming authorship?
Was the "outside help" from Wyeth "authors" to the ghosts, or from the ghosts to Wyeth "authors", or from Wyeth to the academics claiming authorship, or what?
Can Camardo produce statistics on what % of article content on ghostwritten articles Wyeth sponsored were written by the ghost vs. written by Wyeth scientists and/or the claimed academic author? If not, why not? And if not, why should any intelligent person not assume the papers are, say, 99% the product of the hired guns?

Regarding "the authors were not paid, and the authors had the final say":

Again, which author(s) is he referring to?
In terms of the ghosts, I assume they were not working for the MECC's for free.
In terms of the academics and KOL's claiming authorship, they (maybe!) were not paid in money, but instead in the valuable academic currency of a publication in a major biomedical journal.

To claim the KOL's were "not paid" is disingenuous. In fact, I find his entire argument disingenuous, a play on words, PR "spin" completely callous to the needs for scientific objectivity, the advancement of science, and ultimately to patient's lives.

This is marketing, with poor ethics, in the extreme.

Being somewhat familiar with authorship issues as former Director of Published Scientific Information Resources and The Merck Index (of Chemicals, Drugs & Biologicals), 13th ed. at Merck Research Labs, I further pointed out in my post "Wyeth: Ghostwritten Papers Fake, But Accurate" here, that:

... in addition to the violation of accepted practices of authorship, such as specified by NIH and the International Committee of Medical Journal Editors, among others, such lucky authors [i.e., those who claim authorship of ghostwritten papers] get to "count" such papers in their academic portfolios, presumably also in violation of their own institutional policies and guidelines for fair attribution and intellectual honesty, e.g., here [Harvard - ed.]

These industry practices and Camardo's position may be based on:

Ignorance of accepted practices of authorship of the NIH, the International Committee of Medical Journal Editors, and most academic institutions, or perhaps:
Cavalier dismissal of these practices for pecuniary reasons.

Is Camardo informed and upfront? Inept? Disingenuous and dishonest? That is up to the reader to decide.

In my aforementioned post "Wyeth: Fake but Accurate" I'd also noted Wyeth attorney Stephen Urbanczyk acknowledging that the ghostwritten articles were part of a marketing effort. But he said that they were also "fair, balanced, and scientific." More spin.

This raises the following observation. It is said that you can judge people by the company they keep. I also believe that:

You can judge companies by the people they keep.

This raises the following very serious questions:

Is the presence of a senior vice president of global medical affairs and a lawyer with such views on ghostwriting representative of the senior executive leadership's views on dissemination of biomedical scientific information?
Is their presence reflective of the views of Wyeth's Board of Directors?

If so, then the objectivity of any article about Wyeth drugs is called into question, and physicians and patients should utilize Wyeth drugs (and literature on them) with great caution.

-- SS

Addendum: this from the Medical Ethics blog:

Recently released court documents in a lawsuit against drug giant Wyeth, thanks to a court action by the New York Times and PLoS Medicine, are now searchable at a University of California, San Francisco web site.
The Wyeth documents are the latest made searchable at the Drug Industry Document Archive, or DIDA, which archives the documents from several high-profile cases.
... The documents were first made available last month on the PLoS web site, but were not searchable and difficult to sort through. The DIDA site now make it possible to search for documents by name, type or content.

Also see "Ghostwriting: Why they do it" at that blog.

-- SS

Saturday, 2 April 2005

Princess Health and Major ACPE Survey on Unethical Business Practices in US Health Care. Princessiccia

health care ethics surveys

Gusty 13:41 Add Comment

The results of a very important survey have just been published by the American College of
Physician Executives (ACPE). A summary of survey data is here. The full article, entitled "Unethical Business Practices in US Health Care Alarm Physician Leaders," is here. An American Medical News article summarizing some aspects of the results is here.
Basically the ACPE designed the survey to determine "how have physicians - along with other health care providers - responded to the universal seep of commercial imperatives into the modern practice of medicine." It surveyed about 1500 ACPE members (a 21% response rate). Of those responding, 10.1% were CEOs or the like, 28.8% were at the vice-president, CMO, COO, CIO level or similar, 17.9% were medical directors, 24.5% had academic leadership positions, and 18.6% were practicing physicians, consultants, or house-staff.
The results that were most striking and relevant to the issue of external threats to physicians' professionalism were as follows.

A large majority of respondents were quite concerned about "unethical business practices affecting US health care today." (54.6% were very concerned, 35.6% were moderately concerned).
Significant proportions of responders were concerned about unethical business practices within their own organization. (33.1% thought that there were one or more physicians in the organization "involved in unethical business practices;" 11% thought there was a board member "involved in unethical business practices;" 14.2% thought there was a non-physician administrator "involved in unethical business practices.")
The majority, 53.8%, could identify another health care organization in their community "involved in unethical business practices."
Although most, 70.1%, said that their organization had a written code of ethical behavior, only 59.7% of them said the code was actually enforced.
A large majority, 80.8% agreed that "professional organizations need to promote tougher ethical standards."
Most respondents evinced concern about a variety of unethical practices by physicians. In addition, most were concerned about board members or non-physician executives with conflicts of interest (33% very concerned, 33% moderately concerned about the former, 34% and 32%, the latter.) Most were concerned about board members or non-physician executives accepting gifts from vendors (27% and 29% re the former, 34% and 32% re the latter.)
Finally, when asked who was responsible "for sowing the minefield through which today's physicians have to try to pick a righteous path," they named a variety of types of large health care organizations, health care plans and health insurers, pharmaceutical and device manufacturers, hospitals and health system, and malpractice attorneys.
Finally, respondents provided some pithy comments."Our health care system is designed to encourage unethical behavior by its misplaced financial priorities." "Current medical practice on a corporate level is schizophrenic." "Ultimately, the bottom line corrupts absolutely!" "'Business ethics'... an oxymoron?"

In summary, although its small response rate is a limitation, this survey begins to quantitate the scope of some of the issues we have discussed on Health Care Renewal. It suggests that our concerns about threats to physicians' professionalism due to concentration and abuse of power are not exaggerated. If physician executives are this worried, it suggests that doctors in the trenches may be even more so.
Now the question is how can we get the folks with these concerns together, and figure out what to do about them?

Princess Health and Major ACPE Survey on Unethical Business Practices in US Health Care.Princessiccia

health care ethics surveys

Gusty 13:41 Add Comment

A large majority of respondents were quite concerned about "unethical business practices affecting US health care today." (54.6% were very concerned, 35.6% were moderately concerned).
Significant proportions of responders were concerned about unethical business practices within their own organization. (33.1% thought that there were one or more physicians in the organization "involved in unethical business practices;" 11% thought there was a board member "involved in unethical business practices;" 14.2% thought there was a non-physician administrator "involved in unethical business practices.")
The majority, 53.8%, could identify another health care organization in their community "involved in unethical business practices."
Although most, 70.1%, said that their organization had a written code of ethical behavior, only 59.7% of them said the code was actually enforced.
A large majority, 80.8% agreed that "professional organizations need to promote tougher ethical standards."
Most respondents evinced concern about a variety of unethical practices by physicians. In addition, most were concerned about board members or non-physician executives with conflicts of interest (33% very concerned, 33% moderately concerned about the former, 34% and 32%, the latter.) Most were concerned about board members or non-physician executives accepting gifts from vendors (27% and 29% re the former, 34% and 32% re the latter.)
Finally, when asked who was responsible "for sowing the minefield through which today's physicians have to try to pick a righteous path," they named a variety of types of large health care organizations, health care plans and health insurers, pharmaceutical and device manufacturers, hospitals and health system, and malpractice attorneys.
Finally, respondents provided some pithy comments."Our health care system is designed to encourage unethical behavior by its misplaced financial priorities." "Current medical practice on a corporate level is schizophrenic." "Ultimately, the bottom line corrupts absolutely!" "'Business ethics'... an oxymoron?"