Friday, 10 June 2005

Princess Health and Government officials who "get it". Princessiccia

Princess Health and Government officials who "get it". Princessiccia

I heard Department of Health and Human Services Secretary Michael Leavitt speak at the AHRQ Annual Patient Safety and Health Information Technology conference this week. The linked article summarizes his plans for spearheading standardization on electronic medical records data.

It is with great pleasure that I can report this government official seems to know the issues, challenges and benefits of such an initiative quite well.

US moves to spur digital health records nationwide
By Lisa Richwine
Mon Jun 6, 5:11 PM ET

The U.S. government is taking steps to help spawn a nationwide network of electronic medical records that are easily accessible but protect patient privacy, Health and Human Services Secretary Michael Leavitt said on Monday.

A new advisory panel will make recommendations aimed at prodding the private sector to establish standards so medical records can be shared throughout the health-care system, Leavitt said.

"In order for health IT (information technology) to move forward, we have to have interoperable standards ... creating a system where information is digital, privacy protected and interchangeable," Leavitt said in an interview ... the new panel, announced by Leavitt at a health IT meeting in New York, will have 17 government and private sector members, plus Leavitt as chairman. The group will give recommendations on how to make health records compatible among varying computer systems while keeping patient information secure. The panel will exist for at least two years and possibly as long as five years ... President Bush has set a goal for most Americans to have electronic health records by 2014.

The last paragraph was particularly interesting:

Leavitt said the technology also would be a boost to the Food and Drug Administration's efforts to monitor drug side effects because reports from throughout the country could be gathered quickly for analysis.

Then there's this from the New York Times:

Drug Safety System Is Broken, a Top F.D.A. Official Says
By Gardiner Harris

WASHINGTON, June 8 - A top federal drug official told a medical advisory board on Wednesday that the nation's drug safety system had "pretty much broken down" and that there was room for "a lot of improvement" in the government's approach to uncovering dangers in drugs already on the market.

The official, Dr. Janet Woodcock, deputy commissioner of operations at the Food and Drug Administration, made her remarks before a committee of experts at the Institute of Medicine, who had been asked by the agency to suggest safety improvements after a year of well-publicized troubles, including the withdrawal of two big-selling painkillers.

... She said the drug agency had long known that it needed to improve systems for learning about problems with drugs on the market. One way to do that, she said, is to take advantage of electronic health records from managed-care organizations.

As I wrote here, I agree with these assessments. Unfortunately, based on my experiences in pharma (where my experience in EMR and views on its use for drug safety surveillance were quite completely ignored, or perhaps I should say discarded), I predict there will be significant initial opposition by pharma to use of data collected on adverse drug events from EMR's. It is not data from a RCT, after all, and will invariably cause major headaches after the rollout of new drugs.

-- SS

Princess Health and  Government officials who "get it".Princessiccia

Princess Health and Government officials who "get it".Princessiccia

I heard Department of Health and Human Services Secretary Michael Leavitt speak at the AHRQ Annual Patient Safety and Health Information Technology conference this week. The linked article summarizes his plans for spearheading standardization on electronic medical records data.

It is with great pleasure that I can report this government official seems to know the issues, challenges and benefits of such an initiative quite well.

US moves to spur digital health records nationwide
By Lisa Richwine
Mon Jun 6, 5:11 PM ET

The U.S. government is taking steps to help spawn a nationwide network of electronic medical records that are easily accessible but protect patient privacy, Health and Human Services Secretary Michael Leavitt said on Monday.

A new advisory panel will make recommendations aimed at prodding the private sector to establish standards so medical records can be shared throughout the health-care system, Leavitt said.

"In order for health IT (information technology) to move forward, we have to have interoperable standards ... creating a system where information is digital, privacy protected and interchangeable," Leavitt said in an interview ... the new panel, announced by Leavitt at a health IT meeting in New York, will have 17 government and private sector members, plus Leavitt as chairman. The group will give recommendations on how to make health records compatible among varying computer systems while keeping patient information secure. The panel will exist for at least two years and possibly as long as five years ... President Bush has set a goal for most Americans to have electronic health records by 2014.

The last paragraph was particularly interesting:

Leavitt said the technology also would be a boost to the Food and Drug Administration's efforts to monitor drug side effects because reports from throughout the country could be gathered quickly for analysis.

Then there's this from the New York Times:

Drug Safety System Is Broken, a Top F.D.A. Official Says
By Gardiner Harris

WASHINGTON, June 8 - A top federal drug official told a medical advisory board on Wednesday that the nation's drug safety system had "pretty much broken down" and that there was room for "a lot of improvement" in the government's approach to uncovering dangers in drugs already on the market.

The official, Dr. Janet Woodcock, deputy commissioner of operations at the Food and Drug Administration, made her remarks before a committee of experts at the Institute of Medicine, who had been asked by the agency to suggest safety improvements after a year of well-publicized troubles, including the withdrawal of two big-selling painkillers.

... She said the drug agency had long known that it needed to improve systems for learning about problems with drugs on the market. One way to do that, she said, is to take advantage of electronic health records from managed-care organizations.

As I wrote here, I agree with these assessments. Unfortunately, based on my experiences in pharma (where my experience in EMR and views on its use for drug safety surveillance were quite completely ignored, or perhaps I should say discarded), I predict there will be significant initial opposition by pharma to use of data collected on adverse drug events from EMR's. It is not data from a RCT, after all, and will invariably cause major headaches after the rollout of new drugs.

-- SS

Thursday, 9 June 2005

Princess Health and "Scientists Behaving Badly" and "Unreasonable Managerial Demands". Princessiccia

Princess Health and "Scientists Behaving Badly" and "Unreasonable Managerial Demands". Princessiccia

An article in Nature reports on "Scientists Behaving Badly."(1) This was a broadly based anonymous survey, with a 52% response rate, and a sample size of 3247. Of note, the numbers of respondents who reported engaging in the following behaviors in the last three years were:
  • Falsifying or "cooking" research data - 0.3%
  • Ignoring major aspects of human-subject requirements - 0.3%
  • Failing to present data that contradicts one's own previous research - 6.0%
  • Improperly assigning authorship credit - 10.0%
  • Changing the design, methodology, or results of a study in response to pressure from a funding source - 15.5%
The authors noted "a proper understanding of misbehaviour requires that attention be given to the negative aspects of the research environment. The modern scientist faces intense competition, and is further burdened by difficult, sometimes unreasonable, regulation, social, and managerial demands."
This assertion was probably written before the publication in the New England Journal of Medicine of an article that showed what a large proportion of medical schools and academic medical centers are willing to sign away faculty members' control of their research to research sponsors (see our previous post here.) That article showed that about 2/3 of schools and medical centers were willing to sign away their faculty members' ability to alter research methods specified by the sponsor, and about 1/2 were willing to let the sponsor write up the research reports, which faculty could comment on, but not change, even though they were likely to be listed as principle authors. The data in the NEJM article is certainly compatible with the proportion of respondents to the Nature study who noted "pressure from a funding source." Thus, the "managerial" demands that researchers face may often go beyond merely being difficult, or even unreasonable.
This is just another reminder of the spectre of powerful health care organizations acting in conflict with physicians' and medical researchers' core values.
How much more evidence will be needed before something is done about how such organizations are lead?
Reference
1. Martinson BC, Anderson MS, deVries R. Scientists behaving badly. Nature 2005; 435: 737-8.
Princess Health and  "Scientists Behaving Badly" and "Unreasonable Managerial Demands".Princessiccia

Princess Health and "Scientists Behaving Badly" and "Unreasonable Managerial Demands".Princessiccia

An article in Nature reports on "Scientists Behaving Badly."(1) This was a broadly based anonymous survey, with a 52% response rate, and a sample size of 3247. Of note, the numbers of respondents who reported engaging in the following behaviors in the last three years were:
  • Falsifying or "cooking" research data - 0.3%
  • Ignoring major aspects of human-subject requirements - 0.3%
  • Failing to present data that contradicts one's own previous research - 6.0%
  • Improperly assigning authorship credit - 10.0%
  • Changing the design, methodology, or results of a study in response to pressure from a funding source - 15.5%
The authors noted "a proper understanding of misbehaviour requires that attention be given to the negative aspects of the research environment. The modern scientist faces intense competition, and is further burdened by difficult, sometimes unreasonable, regulation, social, and managerial demands."
This assertion was probably written before the publication in the New England Journal of Medicine of an article that showed what a large proportion of medical schools and academic medical centers are willing to sign away faculty members' control of their research to research sponsors (see our previous post here.) That article showed that about 2/3 of schools and medical centers were willing to sign away their faculty members' ability to alter research methods specified by the sponsor, and about 1/2 were willing to let the sponsor write up the research reports, which faculty could comment on, but not change, even though they were likely to be listed as principle authors. The data in the NEJM article is certainly compatible with the proportion of respondents to the Nature study who noted "pressure from a funding source." Thus, the "managerial" demands that researchers face may often go beyond merely being difficult, or even unreasonable.
This is just another reminder of the spectre of powerful health care organizations acting in conflict with physicians' and medical researchers' core values.
How much more evidence will be needed before something is done about how such organizations are lead?
Reference
1. Martinson BC, Anderson MS, deVries R. Scientists behaving badly. Nature 2005; 435: 737-8.
Princess Health and Pfizer Dissident Unplugged. Princessiccia

Princess Health and Pfizer Dissident Unplugged. Princessiccia

The New York Times reported that Dr. Peter Rost, a Pfizer executive who publicly spoke out in favor of importation of low cost drugs, lost his company email and cell-phone service after he appeared on "60 Minutes," again speaking in favor of drug importation.
A Pfizer spokesman, Paul Fitzhenry, implied that Dr. Rost's communication problems were technical, "there have been cases, through a change of vendor, where some employees have lost service for a period of time." However, Rost also claimed that he no longer has employees who report to him, a secretary, or an identified supervisor, and he now works out an isolated office next to the company security department.
After Rost first publicly came out in favor of drug importation, a Pfizer spokesperson had said, "Dr. Rost has no qualifications to speak on importation."
Rost formerly worked for Pharmacia until it was acquired by Pfizer. He was in charge of the marketing of genotropin.
Rost must have thought he was on the faculty of a university, and thus had free speech and academic freedom (but then again, a look at the FIRE web-site might suggest that university faculty may not always be so privileged either.)