Princess Health and A Scathing Commentary on California's New Institute for Regenerative Medicine. Princessiccia

Princess Health and A Scathing Commentary on California's New Institute for Regenerative Medicine. Princessiccia

California Institute for Regenerative Medicine ill-informed management

Gusty 11:40 Add Comment

The Los Angeles Times included a scathing commentary on California's new stem cell research agency. Author Michael Hitzik charged that "the California Institute for Regenerative Medicine has behaved not like the state agency it is, but with the arrogance of a private corporation that happens to be playing with the taxpayers' cash." Hitzik charged that the agency has not yet developed ethical rules or financial disclosure requirements, but it has hired a private lobbying firm, "perhaps the only state agency that pays an outside lobbyist to battle the Legistlature." In addition, Hitzik alleged that the chairman of the agency, "Bay Area real estate developer Robert Klein II.... often seems to assume that anyone who criticizes himself of his agency must be fanatically hostile to embryonic stem cell research, or worse." Furthermore, in challenging lawsuits filed against the agency, Klein claimed that "over half of all California families ... have a member who might benefit from stem cell research." Since no one yet knows what the practical outcomes of stem cell research will be, this claim about how many people will benefit from it is obviously unsubstantiated, and thus is not the sort of claim that should be made by the head of a biomedical research organization. Finally, Hitzik claimed that the Institute "seems determined to start issuing grants within the next few months, possibly before it has in place an operational budget, a full sheaf of ethical standards and conflict-of-interest rules, or, indeed, bond money."
This appears not to be an auspicious start for the leadership of this Institute.

Princess Health and A Scathing Commentary on California's New Institute for Regenerative Medicine.Princessiccia

Princess Health and A Scathing Commentary on California's New Institute for Regenerative Medicine.Princessiccia

California Institute for Regenerative Medicine ill-informed management

Gusty 11:40 Add Comment

The Los Angeles Times included a scathing commentary on California's new stem cell research agency. Author Michael Hitzik charged that "the California Institute for Regenerative Medicine has behaved not like the state agency it is, but with the arrogance of a private corporation that happens to be playing with the taxpayers' cash." Hitzik charged that the agency has not yet developed ethical rules or financial disclosure requirements, but it has hired a private lobbying firm, "perhaps the only state agency that pays an outside lobbyist to battle the Legistlature." In addition, Hitzik alleged that the chairman of the agency, "Bay Area real estate developer Robert Klein II.... often seems to assume that anyone who criticizes himself of his agency must be fanatically hostile to embryonic stem cell research, or worse." Furthermore, in challenging lawsuits filed against the agency, Klein claimed that "over half of all California families ... have a member who might benefit from stem cell research." Since no one yet knows what the practical outcomes of stem cell research will be, this claim about how many people will benefit from it is obviously unsubstantiated, and thus is not the sort of claim that should be made by the head of a biomedical research organization. Finally, Hitzik claimed that the Institute "seems determined to start issuing grants within the next few months, possibly before it has in place an operational budget, a full sheaf of ethical standards and conflict-of-interest rules, or, indeed, bond money."
This appears not to be an auspicious start for the leadership of this Institute.

Princess Health and UK Family Doctors' Salaries. Princessiccia

Princess Health and UK Family Doctors' Salaries. Princessiccia

Gusty 20:04 Add Comment

The May 14-20 issue of the Economist has a fascinating short article, entitled "Practice Makes Perfect," detailing an extraorindary average boost of 50% since 2002-2003 in UK family doctors' pay.

Why, the reporter asks, is this happening? Because the Labour government and the NHS believe it should. The notion that markets can't level every playing field is still abroad, apparently, in some places where the state takes a role in managing some sector of healthcare.

Which leads one to ask: what's the trajectory in a "purer" market economy--ours--where CMS and other agencies determine so much of what we do, but have no purchase over the maldistribution of specialties. And no purchase, no controls (or none they're willing to exert) over training and retention of primary care physicians.

(Except for, historically, the early Bureau of Health Manpower's decisions, under the Johnson and Nixon administrations, to punch up sheer numbers of trainees, through bricks-and-mortar creation of new schools. Supposedly to address maldistribution, but of course, it didn't work out that way.)

Or are we just out of sync with our UK brethren?

The reason this article is so appealing is that it eliminates a counterfactual I've pondered for years. I noticed a pecking order among specialties--like cardiologists crowing about being the "internist's internist"--based always on cognitive-technical claims, never on greed-fed notions of "grab the brass ring, win prestige."

I always wondered what would happen if, suddenly, magically, people like family doctors and general internists or pediatricians were, in a different universe, compensated as well as or better than their consultant compadres. Would the extraorindary breadth of expertise demanded by these pursuits then, suddenly, magically, begin to attract large numbers of bright people?

This experiment is being carried out right now in the UK. It's the "price signal," baby.

Princess Health and UK Family Doctors' Salaries.Princessiccia

Princess Health and UK Family Doctors' Salaries.Princessiccia

Gusty 20:04 Add Comment

The May 14-20 issue of the Economist has a fascinating short article, entitled "Practice Makes Perfect," detailing an extraorindary average boost of 50% since 2002-2003 in UK family doctors' pay.

Why, the reporter asks, is this happening? Because the Labour government and the NHS believe it should. The notion that markets can't level every playing field is still abroad, apparently, in some places where the state takes a role in managing some sector of healthcare.

Which leads one to ask: what's the trajectory in a "purer" market economy--ours--where CMS and other agencies determine so much of what we do, but have no purchase over the maldistribution of specialties. And no purchase, no controls (or none they're willing to exert) over training and retention of primary care physicians.

(Except for, historically, the early Bureau of Health Manpower's decisions, under the Johnson and Nixon administrations, to punch up sheer numbers of trainees, through bricks-and-mortar creation of new schools. Supposedly to address maldistribution, but of course, it didn't work out that way.)

Or are we just out of sync with our UK brethren?

The reason this article is so appealing is that it eliminates a counterfactual I've pondered for years. I noticed a pecking order among specialties--like cardiologists crowing about being the "internist's internist"--based always on cognitive-technical claims, never on greed-fed notions of "grab the brass ring, win prestige."

I always wondered what would happen if, suddenly, magically, people like family doctors and general internists or pediatricians were, in a different universe, compensated as well as or better than their consultant compadres. Would the extraorindary breadth of expertise demanded by these pursuits then, suddenly, magically, begin to attract large numbers of bright people?

This experiment is being carried out right now in the UK. It's the "price signal," baby.

Princess Health and Guilty Pleas in Another Hospital Construction Fraud Scandal. Princessiccia

Princess Health and Guilty Pleas in Another Hospital Construction Fraud Scandal. Princessiccia

bribery crime kickbacks UPMC

Gusty 19:08 Add Comment

This seems to be a minor epidemic. The Pittsburgh Post-Gazette has reported (here, here, and here) on another scheme involving kickbacks, bribes, and padded construction bills at Mercy and UPMC Shadyside Hospitals. So far, two former managers at Mercy and one at UPMC Shadyside have pleaded guilty.
These may not be particularly spectacular crimes, but they surely must help to drive up costs of health care, diverting money from the actual provision of care to the pockets of the criminals. The extent that each of these cases has a penumbra of demoralization, and hence leads to more costs, and perhaps poorer care and more errors, is unknown, and the issue still is ignored by the health care research and policy communities.

Princess Health and Guilty Pleas in Another Hospital Construction Fraud Scandal.Princessiccia

Princess Health and Guilty Pleas in Another Hospital Construction Fraud Scandal.Princessiccia

bribery crime kickbacks UPMC

Gusty 19:08 Add Comment

This seems to be a minor epidemic. The Pittsburgh Post-Gazette has reported (here, here, and here) on another scheme involving kickbacks, bribes, and padded construction bills at Mercy and UPMC Shadyside Hospitals. So far, two former managers at Mercy and one at UPMC Shadyside have pleaded guilty.
These may not be particularly spectacular crimes, but they surely must help to drive up costs of health care, diverting money from the actual provision of care to the pockets of the criminals. The extent that each of these cases has a penumbra of demoralization, and hence leads to more costs, and perhaps poorer care and more errors, is unknown, and the issue still is ignored by the health care research and policy communities.

Princess Health and Unintended Consequences of Reducing Junior Doctors' Hours. Princessiccia

Princess Health and Unintended Consequences of Reducing Junior Doctors' Hours. Princessiccia

NHS UK

Gusty 18:54 Add Comment

From the Guardian, a reminder about unintended consequences.... The UK now must limit work hours of hospital house staff to the European Union limit of 58 a week. The previous limits were 72 hours "on call," and 56 working a week. Of course, the European Union regulations were not accompanied by any funds to pay for the work that house-staff could no longer do. The Guardian article describes how limitations on hospital staffing at night may mean that emergencies may not be attended by those physicians with the necessary expertise to handle them optimally. For example, the Guardian recounts how a geriatrician was required to attempt the resuscitation fo a newborn baby. Furthermore, some junior doctors charged they were coerced into falsifying reports of hours worked to avoid onerous penalties on their hospitals.