Princess Health and Do Living Wills Save the Government Money?. Princessiccia

Princess Health and Do Living Wills Save the Government Money?. Princessiccia

Gusty 12:40 Add Comment

The Washington Post ran a follow-up on the story of how US Health and Human Services Secretary Leavitt appeared to be encouraging people to sign living wills in order to save Medicare money. (See our previous post here.)
The follow-up includes comments from several experts, including the National Institutes of Health Bioethics Chair Ezekiel Emanuel, denying that living wills in fact would save much money. Ezekiel said, "I'm a big advocate of living wills because they give people the power to make decisions." However, "I am not a big advocate of living wills because they save money." (We have mentioned Emanuel before, in his role as an advocate for relaxing the proposed NIH conflict of interest rules.)
Leavitt appeared to retreat a bit too. A spokesperson said that he "regrets if the comment was inaccurate. He did not intend to link living wills to the issue of costs."
Fair enough. There may be little evidence that living wills save money.
What is lacking in these responses is any concern that the highest ranking US health official apparently urged the elderly to accept less health care because he thought it would save the US government money. One editorialist did allow that Leavitt's speech sounded "ghoulish." Worse, it seems on the slippery slope towards the government labeling certain citizens as undeserving of health care.

Princess Health and Do Living Wills Save the Government Money?.Princessiccia

Princess Health and Do Living Wills Save the Government Money?.Princessiccia

Gusty 12:40 Add Comment

The Washington Post ran a follow-up on the story of how US Health and Human Services Secretary Leavitt appeared to be encouraging people to sign living wills in order to save Medicare money. (See our previous post here.)
The follow-up includes comments from several experts, including the National Institutes of Health Bioethics Chair Ezekiel Emanuel, denying that living wills in fact would save much money. Ezekiel said, "I'm a big advocate of living wills because they give people the power to make decisions." However, "I am not a big advocate of living wills because they save money." (We have mentioned Emanuel before, in his role as an advocate for relaxing the proposed NIH conflict of interest rules.)
Leavitt appeared to retreat a bit too. A spokesperson said that he "regrets if the comment was inaccurate. He did not intend to link living wills to the issue of costs."
Fair enough. There may be little evidence that living wills save money.
What is lacking in these responses is any concern that the highest ranking US health official apparently urged the elderly to accept less health care because he thought it would save the US government money. One editorialist did allow that Leavitt's speech sounded "ghoulish." Worse, it seems on the slippery slope towards the government labeling certain citizens as undeserving of health care.

Princess Health and Congressional Hearings on Misleading Marketing of Vioxx. Princessiccia

Princess Health and Congressional Hearings on Misleading Marketing of Vioxx. Princessiccia

deception marketing Merck Vioxx

Gusty 11:58 Add Comment

Yet more bad news about Merck, in addition to the issues summarized in our recent post about the resignation of its CEO...
There is an excellent summary, which includes multiple relevant links, from the Kaiser Foundation daily Health Policy Report of the results of a US House of Representatives Committee investigation into how Merck marketed Vioxx. In short, the Committee charged that Merck trained its sales representatives to distract physicians from any concerns they had about Vioxx's adverse effects, and especially from the published results of the VIGOR trial that showed that Vioxx was associated with a higher risk of cardiovascular events then was naproxen. Representatives were instructed not to bring up the trial, and if asked about it, to refuse to discuss it.
The report concluded, "when concerns about Vioxx's safety arose, Merck appeared to use this highly trained force to present a misleading picture to physicians about the drug's cardiovascular risks."
It is tragic how a company once known for good science and good ethics descended to this level.
Undoubtably, this sort of dishonesty has had bad effects on patients, physicians, and the whole health cares system.
I'm still waiting for health care researchers to become interested in how concentration and abuse of power, and the resulting perverse financial incentives; cross-fires and double-binds; deception, disinformation, and propaganda; and coercion and intimidation have hurt patients, physicians, and the health care system.
But it's certainly time for more physicians, at least, to raise their weary heads from the trenches and start protesting these sorts of abuses. If we don't speak up, who will?

Princess Health and Congressional Hearings on Misleading Marketing of Vioxx.Princessiccia

Princess Health and Congressional Hearings on Misleading Marketing of Vioxx.Princessiccia

deception marketing Merck Vioxx

Gusty 11:58 Add Comment

Yet more bad news about Merck, in addition to the issues summarized in our recent post about the resignation of its CEO...
There is an excellent summary, which includes multiple relevant links, from the Kaiser Foundation daily Health Policy Report of the results of a US House of Representatives Committee investigation into how Merck marketed Vioxx. In short, the Committee charged that Merck trained its sales representatives to distract physicians from any concerns they had about Vioxx's adverse effects, and especially from the published results of the VIGOR trial that showed that Vioxx was associated with a higher risk of cardiovascular events then was naproxen. Representatives were instructed not to bring up the trial, and if asked about it, to refuse to discuss it.
The report concluded, "when concerns about Vioxx's safety arose, Merck appeared to use this highly trained force to present a misleading picture to physicians about the drug's cardiovascular risks."
It is tragic how a company once known for good science and good ethics descended to this level.
Undoubtably, this sort of dishonesty has had bad effects on patients, physicians, and the whole health cares system.
I'm still waiting for health care researchers to become interested in how concentration and abuse of power, and the resulting perverse financial incentives; cross-fires and double-binds; deception, disinformation, and propaganda; and coercion and intimidation have hurt patients, physicians, and the health care system.
But it's certainly time for more physicians, at least, to raise their weary heads from the trenches and start protesting these sorts of abuses. If we don't speak up, who will?

Princess Health and How About A Drugmaker for Merck?. Princessiccia

Princess Health and How About A Drugmaker for Merck?. Princessiccia

Gusty 15:09 Add Comment

In many of my writings and postings I've called for leadership of clinical IT by people who understand both medicine and computing. The same requirement for domain expertise holds true for all areas of healthcare.

It seems Forbes understands the concept of leaders actually knowing what they're leading. In my mind, 1,000 generic people following the finest of process will aways be outperformed by one person who actually knows what they're doing (i.e., has expertise in their domain).

How About A Drugmaker for Merck?
David A. Andelman, 05.05.05, 1:45 PM ET

It's all about the buzz. A flashy resume and some star quality seem to be the most sought-after line on executive r�sum�s these days when it comes to choosing a new leader for a company in trouble. The latest example is Richard Clark, onetime head of Merck pharmacy spinoff Medco. While he has a long tenure at the parent company, most of it was in marketing and manufacturing. He left new drug creation to others. Just like longtime Merck CEO Raymond Gilmartin, an electrical engineer by training, Clark will be leaning heavily on Merck's chief of research, Peter Kim, for the next generation of drugs that may help to put the Vioxx catastrophe behind the drugmaker.

Indeed, investors seemed underwhelmed by the choice. Merck shares were off a dime at midday Thursday. Whatever happened to the old corporate model--in which the guy who ran the company at least understood the ingredients of what it was making? Steve Jobs and his partner Steve Wozniak are legendary for cobbling together their first Apple in a Silicon Valley garage, not far from the garage where David Packard and William Hewlett had already launched Hewlett-Packard.

Bill Gates got his start writing software code in his dorm room at Harvard before he decided he'd be better off doing that for a living rather than going for a diploma. Jobs managed, by sheer genius and force of personality, or perhaps by transmogrification into a marketer, to avoid having someone hijack his company. Packard and Hewlett weren't quite so lucky. Their idea had to suffer through the hubris of a marketing guru named Carly Fiorina--and we all know what happened to her.

(Other examples cited)

... The moral of this story? It's the medium, not the message. Matching the man or woman with the mission is the essence of success in the corporate suite. In the final analysis, the prescription Merck [and other pharmas] really needs just may be someone who knows how to create drugs.

I agree.

Then again, another industry observer writes:

Noting that Mr. Clark does not have a medical or research background, Dr. Moskowitz [David Moskowitz, an analyst with Friedman, Billings, Ramsey & Co.] added, �In the past, Merck�s pride came from its research labs; however, the choice for CEO may indicate a different focus.�

This would likely mean acquisitions (or being acquired) rather than home-grown research. If this is true, it is a shame considering the historical reputation of the company as world-class research innovator. However, the recent closure of one of the two major internal science research libraries would fit with Moskowitz' analysis. (On the topic of leadership expertise, not long before the 2003 layoffs I had to explain to a computer executive with significant control over research support resources, including the libraries, why the discovery of the thiazide diuretics in the 1950's was so important.)

-- SS

Princess Health and How About A Drugmaker for Merck?.Princessiccia

Princess Health and How About A Drugmaker for Merck?.Princessiccia

Gusty 15:09 Add Comment

In many of my writings and postings I've called for leadership of clinical IT by people who understand both medicine and computing. The same requirement for domain expertise holds true for all areas of healthcare.

It seems Forbes understands the concept of leaders actually knowing what they're leading. In my mind, 1,000 generic people following the finest of process will aways be outperformed by one person who actually knows what they're doing (i.e., has expertise in their domain).

How About A Drugmaker for Merck?
David A. Andelman, 05.05.05, 1:45 PM ET

It's all about the buzz. A flashy resume and some star quality seem to be the most sought-after line on executive r�sum�s these days when it comes to choosing a new leader for a company in trouble. The latest example is Richard Clark, onetime head of Merck pharmacy spinoff Medco. While he has a long tenure at the parent company, most of it was in marketing and manufacturing. He left new drug creation to others. Just like longtime Merck CEO Raymond Gilmartin, an electrical engineer by training, Clark will be leaning heavily on Merck's chief of research, Peter Kim, for the next generation of drugs that may help to put the Vioxx catastrophe behind the drugmaker.

Indeed, investors seemed underwhelmed by the choice. Merck shares were off a dime at midday Thursday. Whatever happened to the old corporate model--in which the guy who ran the company at least understood the ingredients of what it was making? Steve Jobs and his partner Steve Wozniak are legendary for cobbling together their first Apple in a Silicon Valley garage, not far from the garage where David Packard and William Hewlett had already launched Hewlett-Packard.

Bill Gates got his start writing software code in his dorm room at Harvard before he decided he'd be better off doing that for a living rather than going for a diploma. Jobs managed, by sheer genius and force of personality, or perhaps by transmogrification into a marketer, to avoid having someone hijack his company. Packard and Hewlett weren't quite so lucky. Their idea had to suffer through the hubris of a marketing guru named Carly Fiorina--and we all know what happened to her.

(Other examples cited)

... The moral of this story? It's the medium, not the message. Matching the man or woman with the mission is the essence of success in the corporate suite. In the final analysis, the prescription Merck [and other pharmas] really needs just may be someone who knows how to create drugs.

I agree.

Then again, another industry observer writes:

Noting that Mr. Clark does not have a medical or research background, Dr. Moskowitz [David Moskowitz, an analyst with Friedman, Billings, Ramsey & Co.] added, �In the past, Merck�s pride came from its research labs; however, the choice for CEO may indicate a different focus.�

This would likely mean acquisitions (or being acquired) rather than home-grown research. If this is true, it is a shame considering the historical reputation of the company as world-class research innovator. However, the recent closure of one of the two major internal science research libraries would fit with Moskowitz' analysis. (On the topic of leadership expertise, not long before the 2003 layoffs I had to explain to a computer executive with significant control over research support resources, including the libraries, why the discovery of the thiazide diuretics in the 1950's was so important.)

-- SS

Princess Health and Ghosts of Days Long Past. Princessiccia

Princess Health and Ghosts of Days Long Past. Princessiccia

ghost writing

Gusty 13:06 Add Comment

I have managed to track back the ghost-writing story to at least 1993.
In 1993, an editorial appeared in Lancet entitled "Ghost With a Chance in Publishing Undergrowth." (Anonymous. Ghost with a chance in publishing undergrowth. Lancet 1993; 342: 1498-99.) It clearly describes the ghost-writing phenomenon, "a typical sequence of events beigns with a publisher agreeing to prepare a review article for a drug company to 'raise awareness/profile' of a certain subject that is broadly related to the company's product. " Then, "a staff writer prepares the review to the sponsor's satisfaction, whereuponthe publishing house contacts a doctor with a special interest in the relevant topic to inquire whether he or she would like to be the guest author, subject to approval of the content, for an honorarium." The editorial noted, "negotiations between publishing house and guest author tend to be conducted over the telephone or in person. The final version, when submitted to the journal, may contain no clues about its origin. " Sounds familiar?
In 1994, an editorial in JAMA warned, "there are ghosts lurking in the bylines - shadowy figures who, increasingly, are in fact the actual writers (the authors, some old-fashioned folk would say) of what we editors receive." (Rennie D, Flanigin A. Authorship! authorship! guests, ghosts, grafters and the two-sided coin. JAMA 1994; 271: 469-470.)
A letter in response to the JAMA article briefly described a case very similar to the one Dr. Fugh-Berman described recently in the Journal of General Internal Medicine. (Kasper CK. Authorship! authorship! JAMA 1994; 271: 1904.) In reply, Rennie and Flanigin stated, "it should be obvious that this is both deceptive and disgraceful. The academic whose name appears on the printed paper, and on whose brow no laborious sweat has appeared, must surely know that the exchange of money takes place solely because the deception is seen by some company to be commercially worthwhile."
However, despite these earlier warnings, the practice of ghost-writing seems to have continued, and now involves not only editorials and reviews, but also reports of original research. The practice remains deceptive and disgraceful, and not only the physicians and scientists who serve as "guest authors," but also the shadowy legions of ghost-writers and their even more shadowy sponsors should be ashamed of it.