Princess Health and ZUMBA� Welcome Offer. Princessiccia

Princess Health and ZUMBA� Welcome Offer. Princessiccia

Gusty 15:01 Add Comment

Imagine burning up to 1000 calories per class,

getting fit,

and having fun at the same time...

Our ZUMBA classes are available in:

? Dublin City Centre

? Rathmines

? Terenure

? Dundrum / Ballinteer

? Tallaght

?Dun Laoghaire

? Bray

New Customers' WELCOME OFFER 

BETTER than HALF PRICE SPECIAL

(If you've never been to any of our classes)

5 Zumba classes - �29

19 Zumba classes - �99

(above passes are fully flexible; start them anytime; you can mix and match between the locations; they have no expiry date; classes don't have to be consecutive)

2 months Unlimited ZUMBA - �69

6 months Unlimited ZUMBA - �149

(these passes allow you to attend as many classes as you want for the chosen period of time, counting from the day you start your pass, not from the day of purchase. Start when you want.)

Venues and times:

Zumba� in DUBLIN CITY CENTRE 

Monday - 7pm - Carmelite Community Centre

(56 Aungier Street, Dublin 2)

Tuesday - 6pm - Carmelite Community Centre

(56 Aungier Street, Dublin 2)

Wednesday - 6 pm - Archbishop Byrne Hall (Girl Guides Hall), Dublin 2 / 8

(36/37 Harrington Street, please note: entrance is from Synge street)

Thursday - 6pm - Gloucester Street Sports Centre

(29-30 Gloucester Street South, Dublin 2)

Saturday - 11am - Scoil Chaitriona Baggot Street

(59 Baggot Street Lower, Dublin 2)

Zumba� in RATHMINES - Dublin 6 

Tuesday - 7pm - St Mary's Senior College

(73-79 Rathmines Road Lower, Dublin 6)

Zumba� in TERENURE - Dublin 6W 

Wednesday - 7pm - Terenure College

(6 Templeogue Road, Dublin 6W)

Zumba� in DUNDRUM / BALLINTEER - Dublin 14 / 16 

Tuesday - 7pm - Wesley College

(Ballinteer Road, Dublin 16)

Zumba� in TALLAGHT - Dublin 24

Monday - 7pm - Saint Maelruain's Church of Ireland Parish Hall

(Main Street, Tallaght Village, Dublin 24)

Thursday - 7pm - Saint Maelruain's Church of Ireland

(Main Street, Tallaght Village, Dublin 24)

Zumba� in DUN LAOGHAIRE 

Monday - 7 pm - Dominican Convent Primary School

(Convent Road, Dun Laoghaire)

Wednesday - 7pm - Dominican Convent Primary School

(Convent Road, Dun Laoghaire)

Zumba� in BRAY

Tuesday - 8pm - Wolfe Tone & District Youth Club

(Vevay Road, Bray)

Wednesday - 7pm - St Thomas Sports Complex - St Thomas Community College - BIFE 

(Novara Avenue, Bray)

All passes are valid at all locations!

Here is what others say:

"I absolutely love the classes. They are addictive! No matter how tough a day I've had I always go and always feel amazing afterwards. It's been great for stress busting, mood lifting and my fitness." -Tania  

"I haven't done any fitness classes before this, only yoga. So this is a real change and it is such a positive one. I'm not a very co-ordinated dancer, but I relax so much in the class - it's the perfect antidote to a long work week at my computer. Thank you."-Emilie

It is YOUR turn now to try our classes!

Money-Back-Guarantee:

We give your money back, if you tell us after your first class, that you didn't like it. And nope, there is no small print here. 

Offer ends:

Friday, 24th June 2016

Buy now, and collect your pass at your first class (Please show the payment confirmation email at arrival) Choose an option:

5 Zumba classes �29.00 EUR 19 Zumba classes �99.00 EUR 2 months Unlimited Zumba �69.00 EUR 6 months Unlimited Zumba �149.00 EUR

Need more reasons to join?
Here are only 12 of the countless of benefits 
you will experience:

1. Better mood
2. Gorgeous skin
3. 600-1000 calories burned in a class
4. 'Bye-bye' sugar cravings
5. Increased self-confidence
6. Toned and fit body
7. Strong heart and healthy lungs
8. Better coordination
9. Strong muscles and healthy bones
10. Better body composition
11. Increased energy levels
12. Falling in love with exercise

Don't hesitate, just scroll up and 
grab the offer now!

Princess Health andAt roundtable on food and agriculture, Prince Charles says we need to reconnect with the food system and nature, keep stock.Princessiccia

Princess Health andAt roundtable on food and agriculture, Prince Charles says we need to reconnect with the food system and nature, keep stock.Princessiccia

agriculture food local food nutrition

Gusty 07:47 Add Comment

Prince Charles "called for urgent restructuring of local and global economies to save humanity from itself" in a whirlwind visit to Louisville on Friday, James Bruggers reports for The Courier-Journal.

In addition to a speech at the Cathedral of the Assumption, the heir to the British throne briefly participated in a roundtable on health and the environment and a similar gathering about food and agriculture, at which he said people need to become "intimately acquainted again with the food system and nature," as The Courier-Journal put it.

"I am very keen on connecting people to school gardens," he said, "and encouraging them to keep their own chickens and the occasional pig." Here's The C-J's raw video from the roundtable:

Princess Health andEarth can't afford to keep supporting our consumerist society as it now exists, Prince Charles tells Louisville audience.Princessiccia

Princess Health andEarth can't afford to keep supporting our consumerist society as it now exists, Prince Charles tells Louisville audience.Princessiccia

Gusty 18:13 Add Comment

Kentucky Health News

Transcript of The Prince of Wales�s speech at the Cathedral of the Assumption, Louisville, following an introduction by Wendell Berry (subheads added)

Ladies and gentlemen, it has been an immense pleasure to spend our last day in the United States here in Louisville, guided by a very special lady. Christy Brown, if I may say so, is one of the most remarkable people I have come across; a true force of nature, with an unbounded enthusiasm to bring people together across a whole range of important issues, and with the determined tenacity to make things happen. I know from my own experience, it is very hard to say "no" to Christy Brown! It was she who asked me to articulate the principles of harmony which I have long believed to lie at the heart of how we respond to the immense challenges and dangers facing humanity. So I can only hope you are all prepared to put up with such articulation.

I must say, it is also very special to have been introduced by such a great advocate of harmony, Wendell Berry, who I am incredibly touched said those wonderful words about me. He is a very special son of Kentucky. I only wish I had time to visit his farm. I will now embarrass him by telling you that he has long been a hero of mine. I remember him once describing his farm here in Kentucky. Half of it, he said, sits at the top of a hill and the other half at the bottom, which, as he put it, "is what you call a learning situation�"

Now, to return to Christy's request: In the 1960�s, as I remember so well, a frenzy of change swept the world in the wave of post-war �Modernism.� There was an eagerness to embark upon a new age of radical experimentation in every area of human experience which caused many traditional ideas to be discarded in a fit of uncontrollable enthusiasm � ideas that will always be of timeless value for every generation confronting the actual realities of life on this Earth. I remember it only too well � and even as a teenager I felt deeply about what seemed to me a dangerously short-sighted approach, whether in terms of the built or natural environment, agriculture, healthcare or education. In all cases we were losing something of vital importance � we were disconnecting ourselves from the wealth of traditional knowledge that had guided countless generations to understand the significance of Nature�s processes and cyclical economy. It always seemed to me that in this period of change some subtle balance was being tragically lost, without which we would find ourselves in an increasingly difficult and exposed position. As, indeed, we have.

I have been trying to point out ever since where I feel the balance needs righting and where some of the discarded, but timeless principles of operating need to be reintroduced in order to create a more integrated approach. It has turned out to be a peculiarly hazardous pastime. But I have come to the inescapable conclusion that the legacy of Modernism in our so-called post-Modern age has brought us to a crucial moment in history; prompting a lot of uncomfortable questions.

The first question I want to ask is how we have landed ourselves and the rest of the world in the mess that it now struggles to overcome? We have more than enough scientific evidence that proves this to be so. But what is it that drives us on to exacerbate the problems? Why do we tip the balance of the Earth�s delicate systems with yet more destruction, even though we know in our heart of hearts that in doing so we will most likely risk bringing everything down around us? In the thirty years or so that I have been attempting to understand and address the many related problems, I have tried to ask myself what it is in our general attitude to the world that is ultimately at fault? In doing so, of course, it must have appeared as though I was just flitting from one subject to another � from agriculture to architecture, from education to healthcare � but I was merely trying to point out where the imbalance was most acute; where the essential unity of things, as reflected in nature, was being dangerously fragmented and deconstructed.

The harmonious system of nature is collapsing

The question that should surely keep us all awake at nights is what happens if you go on deconstructing? I fear the answer is all too plain. We summon up more and more chaos. I have also spent a long time wondering that if we could identify the key fault, would it be possible to fix it? And if we could, what would that �fix� amount to in practical as well as philosophical terms? What worries me is that at the moment there is not a lot of attention given to the way we perceive the world. We take our mechanistic view of it for granted and believe that the language of scientific empiricism which so dominates our discussion is the only form of language we need to guide us. So let�s be clear � whereas the empirical view of the world makes observational deductions about the laws of nature, the philosophical deals with the meaning of things; and the religious concerns itself with the sacred presence in things. They each have a role to play.

The way in which empirical enquiry has developed to this position of dominance since the Enlightenment has certainly enabled us to improve the material realm of the human condition. But let us also recognize that this progress was only possible because of an earlier and crucial shift which took us away from a traditional sense of participation in nature to the claim of mastery and exploitation over the natural order that has reaped such a troubling and bitter harvest. That earlier shift, away from seeing ourselves within nature to us standing apart from it, gradually undermined what I have always felt, deep down, to be the true situation � that if we wish to maintain our civilizations, then we must look after the Earth and actively maintain its many intricate states of balance so that it achieves the necessary, active state of harmony which is the prerequisite for the health of everything in creation. In other words, that which sustains us must also itself be sustained.

But we are not keeping to our side of the bargain and, consequently, the sustainability of the entire harmonious system is collapsing � in failing the Earth we are failing humanity. We are standing at a moment of substantial transition where we face the dual challenges of a world view and an economic system that seem to have enormous shortcomings, together with an environmental crisis � including that of climate change � which threatens to engulf us all.

Of course, we have achieved extraordinary prosperity since the advent of the Industrial Revolution. People live longer, have access to universal education, better healthcare and the promise of pensions. We also have more leisure time; opportunities to travel � the list is endless. But on the debit side, we in the industrialized world have increased our consumption of the Earth�s resources in the last thirty years to such an extent that, as a result, our collective demands on nature�s capacity for renewal are being exceeded annually by some 25 per cent.

Back in the 1950�s and right up to the 1990�s it seemed credible to argue that the human will was the master of creation; that the only acceptable way of thinking was a mechanistic way of thinking; that the Earth�s natural resources were just that � resources � to be plundered because they were there for our use, without limit. But for all its achievements, our consumerist society comes at an enormous cost to the Earth and we must face up to the fact that the Earth cannot afford to support it.

Just as our banking sector has been struggling with its debts � and paradoxically also facing calls for a return to so-called �old-fashioned,� traditional banking � so nature�s life-support systems are failing to cope with the debts we have built up there too. If we don�t face up to this, then nature, the biggest bank of all, could go bust. And no amount of quantitative easing will revive it. It seems to me a self-evident truth that we cannot have any form of capitalism without capital. But we must remember that the ultimate source of all economic capital is nature�s capital. Our ability to adapt to the effects of climate change, and then perhaps even to reduce those effects, depends upon us adapting our pursuit of �unlimited� economic growth to that of �sustainable� economic growth. And that depends upon basing our approach on the fundamental resilience of our ecosystems. Ecosystem resilience leads to economic resilience. If we carry on destroying our marine and forest ecosystems as we are doing, then we will rob them of their natural resilience and so end up destroying our own.

We are not separate from nature

No matter how sophisticated our technology has become, the simple fact is that we are not separate from nature � like everything else, we are nature. The more you understand this fact the more you see how our mechanistic way of thinking causes such confusion. Modern agri-industry, for instance, may have made enormous strides to feed the burgeoning world�s population, but at a huge and unsustainable cost to ecosystems, through massive use of artificial fertilizers, herbicides, pesticides and water. It is a reductive approach to one issue that is patently not durable because it sustains nothing but its own decline, solving one problem by creating countless others.

This, of course, is not the way nature operates. In nature the entire system is a complex unfolding of inter-dependent, multi-faceted relationships and to understand them, we have to use �joined-up� thinking. The ancient Greek word for the process of joining things up was �harmonia.� So, �joined-up thinking� seeks to create harmony, which is a very specific state of affairs. In fact, it is the very prerequisite of health and well-being. Our bodies have to be in harmony if they are to be healthy, just as an entire ecosystem has to be. This is the way nature operates. Natural sciences like microbiology and botany tell us very clearly that every kind of organism, be it big or microscopic, is a complex system of interrelated and interdependent parts � which makes each organism a microcosm of its local environment; the very essence of it, in fact. The sum of these parts builds and maintains a coherence � an active, harmonic unity � with no waste. No one part operates either in isolation or beyond the limits set by the whole.

Facing the future, therefore, requires a shift from a reductive, mechanistic approach to one that is more balanced and integrated with nature�s complexity � one that recognizes not just the build-up of financial capital, but the equal importance of what we already have � environmental capital and, crucially, what I might best call �community capital.� That is, the networks of people and organizations, the post offices and bars, the churches and community halls, the mosques, temples and bazaars � the wealth that holds our communities together; that enriches people�s lives through mutual support, love, loyalty and identity.

Just as we have no way of accounting for the loss of the natural world, contemporary economics has no way of accounting for the loss of this community capital. This is why we need to ask ourselves whether the present form of globalization is entirely appropriate, given the circumstances confronting us. There are, clearly, benefits, but we need to ask whether it requires adaptation so that it also enables, as it were, globalization from the bottom up. This, after all, is the way nature operates! At the moment we operate under a form of globalization that tends to render down all the rich diversity of a culture into a uniform, homogenized mono-culture. This is where the Modernist paradigm needs to be called into question before the damage being done is irretrievable. �

One of the chief architects of our present economic model was Adam Smith. Interestingly, he was another who recognized that, although individual freedom is rooted in our impulse for self-reliance, it must be balanced by the limits imposed by natural law. As he prepared his book, The Theory of Moral Sentiments, he moved away from the notion that we are born with a moral sense and preferred the principle of there being a sympathy in all things. It is this sympathy that binds communities together. But there is little chance of such sympathy if what people need is provided through commercial structures that place an ever greater distance between the supplier and the consumer, because economies of scale can destroy the economics of localness. It has become, again, a purely mechanical process with no room for the complexity and multi-faceted dimensions of a proper local relationship between a community and the suppliers that serve it.

A balance between the market and society

Once again, there has to be a balance between the market on the one hand and society on the other, otherwise real problems occur. � This is why city-level policy to encourage healthy local food systems could scarcely be more important. It is a way to ensure a harmonious relationship between the city and its hinterland, fostering greater understanding and respect for the services that the rural environment and economy provide. It is also a means by which a circular economy can be generated where wastes become resources rather than pollution.

So, with that in mind, how could we better empower all sorts of communities to create a much more participative economic model that safeguards their identity, cohesion and diversity � one that makes a clear distinction between the maintenance of Nature�s capital reserves and the income it produces? That is the challenge we face, it seems to me � to see nature�s capital and her processes as the very basis of a new form of economics and to engage communities at the grass roots to put those processes first. If we can do that, then we have an approach that acts locally by thinking globally, just as nature does � all parts operating locally to establish the coherence of the whole.

Here in Louisville, for instance, I met with representatives of your major food and drink manufacturers, and also spent time with farmers and food producers at what, I would suggest, is a very significant idea � the creation of the Food Hub and the development of the area around that proposed site. Re-localizing your food systems and encouraging the many small and medium-sized farms that surround your city to consider how best to offer locally produced food would make a tremendous difference to the long term sustainability of your economy, especially if real attention was paid to the health of the soil. A long time ago it was President [Franklin] Roosevelt who gave a very prescient warning when he said - "a nation that destroys its soils destroys itself." So, of central importance will be how to reconcile our urban and rural development. The actions of leading cities like Louisville can provide a demonstration of what can be done that is of value not only to the United States, but also globally.

Likewise, as far as human health is concerned, I was alarmed to hear from your leading cardiologist here, Dr. Bhatnagar, just how directly the high rates of air pollution you struggle with are related to the high levels of cardiovascular disease. If you recognize that the quality of the air is not just an "environmental" issue, but a very serious economic issue, then you can see that the health of people directly affects the health of an economy. So perhaps, at the end of the day, it might be cheaper to join up the dots and put paid to the pollution, rather than pursue the more expensive option of encouraging people to take yet more pills to help their hearts?

So, having spent the day here in Louisville, I can only offer my warmest congratulations not only for what you have already achieved, but also what you are striving for in the future � a model of truly integrated and holistic thinking on a city scale and a beacon of inspiration for others to learn from � for instance, your work in helping build communities such as at the African American Heritage Centre, the boldness of the vision for the Food Hub project (why wouldn't we all want to shorten the links between consumer and producer?); the remarkable potential of a new discussion between the health insurance companies and your major food companies who, of course, would love to become more sustainable if only the financial climate allowed them.

Could this, then, be part of the solution to the problems we face? Could it be one that might give us hope, for we do still have within our societies and within our existing technologies the solutions that will enable us to transcend our current predicament. All we lack, perhaps, is the will to establish a more entire and connected perspective. There are many examples where communities have replaced the short-term impulse with the long-term plan. But part of that strategy � to my mind at least at the heart of it � is the need for a new public and private-sector partnership which includes NGO [non-governmental organizations] and community participation. It seems to me that for this to work we need to ensure that community and environmental capital is indeed put alongside the requirements of financial capital and that we also develop transparent means to measure the social and environmental impact of our actions.

We certainly need to refine our ability to measure what we do so that we become more aware of our responsibility. This validates the need for �accounting for sustainability,� which has since become known elsewhere as true-cost accounting � a method by which businesses can take proper account of the cost to the Earth of their products and services, and which I initiated and developed 11 years ago. It is encouraging that this approach is being tested by a range of companies, government departments and agencies, and I hope that it can be adopted more generally so that well-being and sustainability can be measured, rather than merely growth in consumption.

We also need, dare I say it, new forms of international collaboration to value ecosystem services. For instance, the world must recognize the absolutely vital utility that the rainforests provide by generating a real income for rainforest countries � where, incidentally, some 1.4 billion of the poorest people on Earth rely in some way on the rainforests for their livelihoods � an income which can be used to finance an integrated, low-carbon development model. Paradoxically, the answer to deforestation lies not solely or even mainly in the forestry sector, but rather in the agricultural and energy sectors.

It is also increasingly possible to enhance efficiency and economic rates of return by linking different sectors together in what are called �virtuous circles.� You can see this in the relationship between the waste, energy and water sectors where the waste product of one process becomes the raw material of another, thereby mimicking nature�s cyclical process of waste-free recycling.

Alternatives need to become mainstream

The trouble is, at the moment, so many of these brilliant ideas sit on the fringes of our economy. They are seen as �alternatives� when they need to become mainstream. But for this to happen and for such alternatives to be effective, it will require a system of long-term consistent and coherent financial incentives and disincentives; otherwise, how else will we achieve the urgent response we need to rectify the situation we face?

Another example of an alternative that needs to become mainstream, and which would enhance both community and environmental capital, lies in the way we plan, design and build our settlements. I have talked long and hard about this for what seems rather a long time � and look what it�s done to me! � but it is yet another case where a rediscovery of so-called �old fashioned,� traditional virtues can lead to the development of sustainable urbanism. This approach emphasizes the integration of mixed-use buildings and the use of local materials to create local identity which, when combined with cutting-edge developments in building technology, can enhance a sense of place and real community.

Our need for these solutions is going to grow exponentially as our global population rises and our ecological and economic crises deepen. Is this not a rationale for investing massively in these new and more integrated approaches which, thereby, could help to create the kind of �virtuous circles� based on environmental and community capital that I have mentioned this evening? Such investment would also, I can�t help thinking, have the added benefit of creating many new jobs.

But are we prepared to take such a step? As Mahatma Gandhi pointed out, �The difference between what we do and what we are capable of doing would suffice to solve most of the world�s problems.� The starting point is to see things differently from the current, dominant world view which in so many ways is no longer relevant to the situation in which we find ourselves. The worst course would be to continue with �business as usual� as this will only compound the problem. We must see that we are part of the natural order rather than isolated from it; to see that nature operates according to an organic �grammar� of harmony and which is infused with an awareness of its own being, making it anchored by consciousness. It is an interconnected, interdependent function of creation with harmony existing between all things.

We are, ladies and gentlemen, at an historic moment � because we face a future where there is a real prospect that if we fail the Earth, we fail humanity. And I don't know about all of you but, as a grandfather, I have no intention of failing my, or anyone else's, grandchildren.

Princess Health andAs part of Louisville visit, Prince Charles attends roundtable on health and the environment with health and environmental leaders.Princessiccia

Princess Health andAs part of Louisville visit, Prince Charles attends roundtable on health and the environment with health and environmental leaders.Princessiccia

built environment environment environmental health

Gusty 13:37 Add Comment

Press pool report by Al Cross, Kentucky Health News

His Royal Highness the Prince of Wales arrived at the foot of the Big Four Bridge, an old railroad bridge recently converted into a pedestrian bridge, at 3:07 p.m. He was accompanied by Louisville Mayor Greg Fischer and was greeted by U.S. Rep. John Yarmuth, D-Louisville. They ascended a stairway leading to the pedestrian ramp and had a discussion on the ramp. Your pool could hear only snatches of conversation, but it was clear that Fischer and Yarmuth were describing the bridge project, which links Louisville to Jeffersonville, Ind.

Dr. Elliott Antman, in sunglasses, speaks as Prince Charles and other participants listen

The group descended the ramp and entered a plastic-and-canvas tent, joining a health-and-environment roundtable that had been in progress for about an hour. The pool was present for introductory remarks by the mayor and by Dr. Elliott Antman, president of the American Heart Association, but there was no amplification and the pool was kept at such a distance that he could not be heard clearly, and we were shuffled out after just a few minutes. Through the opening and the clear plastic we could see that HRH was animatedly engaged in conversation with the participants.

Yarmuth said afterward that the conversation was �about how the health care system by itself, the medical system, is not the thing we should be concerned about in trying to be concerned about the general health and well-being of society,� but rather how to prevent people from entering that system, �and there are so many entities that have role� in doing that.

Gordon Garner, former director of the Metropolitan Sewer District and president of the Kentucky Waterways Alliance, said the broad message of the meeting was �the linkage to both the built and natural environment� when it comes to health. �The big message would be � the overwhelming need we have as a society to raise our level of stewardship .. that public awareness is way, way behind what the needs are. We�ve got to develop some kind of stewardship commitment that we currently don�t have.�

According to an email from Chuck Lambert of Humana Inc. to the participants, a copy of which your pool reporter obtained, following are the invited participants. It could not be confirmed whether all on the list were actually at the roundtable.

INVITEES to roundtable (other than Antman, mentioned above):

Dr. Aruni Bhatnagar, Ph.D., Institute of Molecular Cardiology, University of Louisville

Lt. Gen. Patricia Horoho, 43^rdU.S. Army Surgeon General

Meredith Barrett, vice president of science and research, Propeller Health

Dr. Alonzo Plough, vice president of research, evaluation and learning and chief science officer, Robert Wood Johnson Foundation

Dr. Sharmila Makhija, chair of ob/gyn and women�s health, Albert Einstein College of Medicine, The Bronx, N.Y. (formerly at U of L)

Tom FitzGerald, director, Kentucky Resources Council (Kentucky�s leading environmental lobbyist)

Dr. Ted Smith, executive director, Institute for Healthy Air, Water and Soil; and chief of civic innovation, Metro Louisville government

Peter Crane, dean, Yale School of Forestry and Environmental Studies

Mary Gwen wheeler, executive director, 55,000 Degrees (program aimed at expanding number of college graduates in Louisville)

Dr. James Sublett, president, American College of Allergy, Asthma and Immunology

Hugh Archer, executive director, Kentucky Natural Lands Trust

Barry Barker, executive director, Transit Authority of River City

Margaret �Peggy� Plympton, deputy chairman, National Endowment for the Humanities

Dr. Mahendra Sunkara, director, Conn Center for Renewable Energy Research, U of L

Burt Lauderdale, executive director, Kentuckians for the Commonwealth (environmental and social justice group)

Timothy (Tim) State, enterprise vice president, associate health and well-being, Humana Inc.

Barry Gottschalk, president and CEO, American Lung Association of the Midland States

David Tandy, president. Louisville Metro Council

Craig Anthony Arnold, chair, Center for Land Use and Environmental Responsibility, U of L

Dr Cary Sennett, president and CEO, Asthma and Allergy Foundation of America

OBSERVERS:

Charles �Chuck� Lambert, Humana VP and chair, Louisville Sustainability Council

David VanSIckle, cofounder and CEO, Propeller Health

Paul Tarini, senior program officer, Robert Wood Johnson Foundation

Ben Reno-Weber, director, Greater Louisvile Project

Tad Waddington, CEO, lasting Contribution Inc.

Gordon Garner, president, Kentucky Waterways Alliance

Andrew Smith, student

Stephanie Sido, aide-de-camp, Gen. Horoho

Robert Connolly, chair, Stites & Harbison law firm

Wes Jackson, president, The Land Institute

Deena Adams, development manager, American Lung Association in Kentucky

Dr. Rose Marie Robertson, chief science officer, American Heart Association

Dr. John Johnston, co-director, Norton Hospital Leatherman Spine Center

Princess Health and A $6.6 Million CEO Dreams of a "Doctor-Less" Future. Princessiccia

Princess Health and A $6.6 Million CEO Dreams of a "Doctor-Less" Future. Princessiccia

generic managers Jeffrey Romoff UPMC

Gusty 12:06 Add Comment

The CEO of giant hospital system UPMC, Mr Jeffrey Romoff, has been one of the best compensated CEOs of ostensibly non-profit hospital systems.  As we noted here, his 2013-14 compensation was $6.6 million.  UPMC has become so big and its top managers so rich that a former Mayor of the city of Pittsburgh sued the organization claiming it was not really not-for-profit (look here and here).  The leadership of UPMC has previously supplied us with some interesting examples of conflicts of interest (look here and here). 

The announcement of a new alliance of Pittsburgh organizations provided an interesting insight into the thinking for which such a CEO is paid the big bucks.  Leaders of three big organizations, UPMC, the University of Pittsburgh (with which UPMC is affiliated), and Carnegie-Mellon University announced an alliance to use "big data" in health care (see this article in the Pittsburgh Post-Gazette).

UPMC, the University of Pittsburgh and Carnegie Mellon University on Monday announced the formation of the Pittsburgh Health Data Alliance to 'revolutionize health care and wellness' by using data to detect potential outbreaks as well as create health care innovations that will spawn spinoff companies.

The clinical goal, the leaders of the three institutions said, is to remake health care so that it is at once more computerized, yet more personalized, using millions of gigabytes of accumulated health records to predict and treat patients� health issues in a manner far more specific than is possible today.

Big data now seems to be the latest rage in business schools and among the high-tech crowd, never mind the failures of fancy statistical modeling based on big data that helped lead to the global financial collapse of 2008.  Similarly, despite at least 30 years of research, multivariate prediction and diagnostic modeling in medicine has never lived up to its expectations.  Few models have been demonstrated to be better than mediocre predictors when tested in real-life clinical settings.  Finally, there are numerous concerns about privacy and data security when patients' data is being avidly traded back and forth.

The most striking talk in this meeting, however, was by UPMC CEO Jeffrey Romoff.  The Pittsburgh Post-Gazette noted,

Mr. Romoff said he envisioned 'doctor-less health care,' which is not to say there will be no doctors in the future, but they will be greatly aided by computerized diagnoses, by biometric data gathered on smartphones and transmitted in real time, and by a patient�s own genome. It could result in a new form of  'artificial intelligence,' he said.

The reporter, however, seemed to have edited Mr Romoff to take the edge off what he said.  A video of that part of the conference can be found, for the moment, here.  I transcribed, I believe accurately, Mr Romoff's three most relevant sentences.

The majority of healthcare that everybody receives will be accessible on their handheld device.

We will be thinking about 'doctor-less' healthcare.

We will in fact create an artificial intelligence better than the superb level of intelligence we now have among our physicians and our healthcare professionals.

So, in my humble opinion, it did not sound like Mr Romoff was just envisioning that physicians someday may actually have access to diagnostic or predictive models that are highly accurate for real patients.  He was envisioning replacing physicians with machines, with artificial intelligence. 

Again, never mind that despite years of work and billions of dollars, artificial intelligence so far has proved remarkably dumb.

So furthermore, in my humble opinion, this provided a glimpse into how health care managers now think.  Mr Romoff appears to be a generic manager.  He is not a health care professional, and has no apparent experience taking care of patients (see his official bio, listing his most advanced degree as a Masters in Philosophy).  Generic managers now often seem to think of themselves as some sort of new aristocracy, far removed from the peasants who work for them.  Would not it be easier for such aristocracy to avoid working with such peasants at all?  Machines would be so much neater and cleaner, would not ask for raises or think of unionizing or rebelling (at least outside of the world of Terminator movies).

Leaving aside such fantasies for the moment, the most concerning problem with Mr Romoff's dream of robotic doctors is that anyone who has ever had any direct involvement in health care knows that doctors need to do much more than crunch data and make predictions and diagnoses.  Doctors and other health care professionals have sworn to put patients' interests first.  That implies that doctors must talk to, endeavor to understand, and be empathetic towards their patients.  Many times we doctors may not do this anywhere near perfectly.  But we are human, so can at least try.  Artificial intelligence may be getting closer to making better health care predictions and diagnoses, but does anyone seriously think we are close to making an understanding, empathetic machine?

I believe that Mr Romoff has unwittingly made another argument why he and his fellow generic managers should not be leading health care.  Health care should be lead by people who understand the actual care of patients, uphold health care professionals' values, and are willing to be accountable for putting patients' and the public's health first. 

Princess Health and Same Old, Same Old - Johnson and Johnson Settles Charges it Concealed Adverse Effects of Risperdal, Vaginal Mesh Device, Pleads Guilty to Selling Adulterated Tylenol, Announces CEO Got 48% Raise to $25 Million. Princessiccia

Princess Health and Same Old, Same Old - Johnson and Johnson Settles Charges it Concealed Adverse Effects of Risperdal, Vaginal Mesh Device, Pleads Guilty to Selling Adulterated Tylenol, Announces CEO Got 48% Raise to $25 Million. Princessiccia

adulterated drugs adverse effects Alex Gorsky crime deception Johnson and Johnson legal settlements manufacturing problems William Weldon

Gusty 12:11 Add Comment

We have devoted a lot of bytes over the years to the stream of allegations and ethical questions about Johnson and Johnson, the giant pharmaceutical/ biotechnology/ device company, and resulting legal actions.  Meanwhile, the company has bestowed a gushing stream of money on its top executives.  Its almost spring, 2015, and it seems nothing has changed.

Johnson and Johnson's Latest Legal Misadventures

Jury Verdict that Company Concealed Harms of Risperdal

Let us start with the latest legal news about J&J.  In late February, 2015, as reported on the PharmaLot blog by Ed Silverman,

In a setback to Johnson & Johnson , a Philadelphia jury decided the health care giant must pay $2.5 million in damages for failing to warn that its Risperdal antipsychotic could cause gynecomastia, which is abnormal development of breasts in males. The lawsuit was brought by the family of an autistic boy who took the drug in 2002 and later developed size 46 DD breasts, according to a lawyer for the family.

The case has drawn attention for a few reasons. For one, this was the first lawsuit claiming J&J hid the risks of gynecomastia to go to trial after a handful of cases were settled in recent years. The trial also served as a reminder that J&J paid $2.2 billion two years ago to resolve criminal and civil allegations of illegally marketing Risperdal to children and the elderly.

Moreover, former FDA commissioner David Kessler served as a paid expert witness for the family and testified that J&J knew about the risks associated with Risperdal, but failed to disclose the data showing the extent to which youngsters may develop gynecomastia. In a report prepared for a 2012 case that was settled, Kessler wrote that J&J�s Janssen unit, which marketed the drug, had violated the law.

Note that the central allegation in this case was not simply that the drug had adverse effects, but that the company knew about these effects, and hid them.  In my humble opinion, since we entrust pharmaceutical companies to provide safe and effective products, withholding information about adverse effects is a fundamental violation of this trust. 

As noted above, this follows on another case with a much bigger financial settlement about questionable marketing of Risperdal. In addition, as the PharmaLot post noted, there are many more individual cases like this one waiting in the wings, "J&J says there are about 1,200 such lawsuits filed in courts around the country,..."

Jury Verdict that Company Concealed Harms of  Vaginal Mesh Device

Similarly, as reported by Reuters in early March, 2015,

A California jury on Thursday ordered Johnson & Johnson's Ethicon Inc unit to pay $5.7 million in the first trial over injuries blamed on the TVT Abbrevo, one of numerous transvaginal mesh products that are the subject of thousands of lawsuits.

Following more than three days of deliberations in Kern County, California, jurors found Ethicon liable for problems with the TVT Abbrevo's design and for failing to warn about its risks, according to a lawyer for plaintiff Coleen Perry.

Perry was awarded $700,000 in compensatory damages and an additional $5 million in punitive damages after jurors in the Bakersfield court found Ethicon's conduct amounted to 'malice,' her lawyer said.

Again, note that this lawsuit was not merely about the adverse effects of, in this case, a device, but about allegations that the company knew about these effects, but hid them.  My comments about violation of a fundamental trust above apply. 

Again, this is but one of the earlier cases of a cohort that may number 36,000.

Company Pleads Guilty to Selling Adulterated Tylenol

Finally, as reported in mid-March, 2015, by Reuters,

A Johnson & Johnson subsidiary pleaded guilty on Tuesday to selling liquid medicine contaminated with metal and agreed to pay $25 million to resolve the case, the U.S. Department of Justice said on Tuesday.

The subsidiary, McNeil Consumer Healthcare, pleaded guilty to one federal criminal charge in the case.

In 2010, the company launched mass recalls of certain children's over-the-counter-medicines, including Infants' Tylenol and Children's Motrin, made at its Fort Washington, Pennsylvania plant.

It was the latest in a series of recalls at the time. There were far-reaching multiple recalls from 2008 to 2010 involving hundreds of millions of bottles and packages of consumer brands such as Tylenol, Motrin, Rolaids, Benadryl and other products due to faulty manufacturing. The recalls kept widely used products such as Children's Tylenol off pharmacy shelves and seriously tarnished J&J's once-sterling reputation.

In addition to metal particles getting into liquid medicines, there were moldy odors and labeling problems.

Furthermore, as emphasized in a report in the Philadelphia Business Journal, this case also involved allegations that the company seemed to conceal the problem.

McNeil, after receiving the consumer complaint, did not initiate or complete a 'corrective action preventive action' plan as required by the federal government.

The federal government also alleged other instances in which McNeil found metal particles in bottles of infants' Tylenol at its Fort Washington facility, but failed to initiate or complete a corrective action plan.

Note that in this case, the company pleaded guilty and so could not claim it was merely settling to put the case behind it.  Furthermore, note that this was not the first case arising from charges that the company sold adulterated products made in the Pennsylvania and other factories (for example, see this post.)   We posted frequently about a long string of recalls of presumed defective or adulterated Johnson and Johnson products (here, here, here and here).  Again, in my humble opinion, we we trust drug companies to sell pure, unadulterated products.  Selling adulterated products again fundamentally violates this trust.

Unfortunately, these three cases, like many of the legal settlements we discuss, involved relatively small penalties that only accrued to the company as a whole.  The monetary penalties, while they may seem large to regular citizens, could appear as relatively trivial costs of doing business to company management.  Furthermore, no individual who authorized, directed, or implemented the behavior identified in these cases suffered any kind of penalty.  So these cases added to the many examples of the impunity of managers of large corporations who almost never seem to bear any legal responsibility for their actions.  In the case of Johnson and Johnson managers, this is all the more striking, since the current cases are just the latest in a very long string.  (See Appendix below for a list of Johnson and Johnson legal misadventures we have discussed since 2010.)


Johnson and Johnson CEO's Latest Raise


Finally, a day later, the Wall Street Journal reported on the continuing good fortune of the Johnson and Johnson CEO, to be contrasted with the company's poor fortunes in the courts of law.

Johnson & Johnson said Chairman and Chief Executive Alex Gorsky�s total compensation jumped 48% to $25 million last year, lifted by an increase in stock and option awards. Mr. Gorsky�s stock and option awards rose to a total value of $13.6 million from $8.7 million a year earlier. The board also raised Mr. Gorsky�s base salary to $1.5 million from $1.45 million in 2013, and the CEO also benefited from a jump in pension value.

In a filing Wednesday, the pharmaceutical giant said Mr. Gorsky�s compensation increase was based on the board�s conclusion that J&J successfully executed near-term priorities, exceeded financial goals and built on momentum in its pharmaceutical business.

As a result, J&J awarded Mr. Gorsky an annual performance bonus of 135% of target and long-term incentives at 130% of target. Awards at J&J are capped at 200% of target.

The article noted that at least one other top Johnson and Johnson manager also was raking it in.

Paulus Stoffels, world-wide chairman of Pharmaceuticals, made $18.3 million last year, more than double his 2013 total compensation, boosted by a stock award of $10.7 million.

Funny, the board's rosy view of Mr Gorsky's performance seemed totally uninformed by the company's latest legal misadventures.

(By the way, to anyone who would argue that many of these misadventures were the results of behavior that occurred before Mr Gorsky became CEO, note that his official company biography stated that he joined the company's Executive Committee in 2009, implying some shared responsibility for overall company management since then.)

Same Old, Same Old

A few weeks back, one of our commentators complained that our posts have a certain sameness.  Unfortunately, we agree.  We keep seeing variants of the same sorts of outrageous stories in the news media that we began to post about in 2004.   The problems are not getting better.  Perhaps they are getting worse.

In particular, we have previously contrasted this particular company's recurrent legal and ethical problems with its top managers' accumulating wealth.  In 2011 we posted about the contrast between previous Johnson and Johnson CEO William Weldon's enlarging fortune and political influence with some of the earlier legal cases that raised questions about the trustworthiness of the company.

But the point of this blog is not to come up with titillating stories to make people chuckle.  The point is to challenge the continuing, severe problems afflicting the leadership and governance of health care, the resulting incompetent, unethical, and sometimes criminal behavior, and the downstream effects on patients' and the public's health.  Do not blame the messenger for the sameness of the problem.  Blame those who are getting wealthy and powerful from the ongoing decline in health care. 

If we truly want to see more accessible, more effective, less costly health care in our life times, we need to first call out the bad leadership that has kept such aspirations at bay for so long, and second start to hold current leadership accountable for the mess they have made.


Appendix - Johnson and Johnson Legal Record since 2010-
2010
- Convictions in two different states for misleading marketing of Risperdal
- A guilty plea for misbranding Topamax
2011
- Guilty pleas to bribery in Europe  by Johnson and Johnson's DePuy subsidiary
- A guilty plea for marketing Risperdal for unapproved uses  (see this link for all of the above)
- A guilty plea to misbranding Natrecor by J+J subsidiary Scios (see post here)
2012 
 - Testimony in a trial of allegations of unethical marketing of the drug Risperdal (risperidone) by the Janssen subsidiary revealed a systemic, deceptive stealth marketing campaign that fostered suppression of research whose results were unfavorable to the company, ghostwriting, the use of key opinion leaders as marketers in the guise of academics and professionals, and intimidation of whistleblowers. After these revelations, the company abruptly settled the case (see post here).
-  Johnson & Johnson was fined $1.1 billion by a judge in Arkansas for deceiving patients and physicians again about Risperdal (look here).
-  Johnson & Johnson announced it would pay $181 million to resolve claims of deceptive advertising again about Risperdal (see this post).
2013
-  Johnson & Johnson settled case by shareholders alleging that management made misleading statements and withheld material information about manufacturing problems (see this post)
-  Johnson & Johnson Janssen subsidiary pleaded guilty to a charge of misbranding Risperdal, and settled for a total of $2.2 billion allegations that it promoted the drug for elderly demented patients and adolescents without an indication, and despite evidence of its harms (see this post).
 -  Johnson & Johnson DePuy subsidiary agreed to settle with multiple plaintiffs for $2.5 billion allegations that it sold defective mental-on-metal artificial hip, and hid evidence of its harms .
- Johnson & Johnsonn Janssen subsidiary was found by two juries to have concealed harms of its drug Topamax (see this post for this and above case).
- Johnson & Johnson Ethicon subsidiary's Advanced Surgical Products and two of its executives agreed to settle charges by US FDA that is sold mislabeled products used to sterilize equipment such as endoscopes (see this post).
- Johnson & Johnson fined by European Commission for anticompetitive practices, that is, collusion with Novartis to delay marketing generic version of Fentanyl (see this post).
2014 
- Johnson & Johnson DePuy subsidiary settled Oregan state charges that it marketed the ASR XL metal-on-metal hip joint prosthesis without disclosing its high failure rate (see this post). 

Princess Health and Increasing Bad Press for Today's Healthcare Information Technology - Deserved and Overdue. Princessiccia

Princess Health and Increasing Bad Press for Today's Healthcare Information Technology - Deserved and Overdue. Princessiccia

forbes health affairs healthcare IT difficulties healthcare IT risks HealthcareDive.com

Gusty 11:09 Add Comment

Here are three candid, quite revealing articles about the distaste for today's health IT that appeared recently.  I will address each,

The first seems like pure deja vu (see my June 4, 2009 post "If The Military Can't Get Electronic Health Records Right, Why Would We Think Conflicted EHR Companies And IT-Backwater Hospitals Can?" at http://hcrenewal.blogspot.com/2009/06/if-military-cant-get-electronic-health.html):

1.  Forbes:  Pentagon's $11 Billion Healthcare Record System Will Be Obsolete Before It's Even Built -  March 3, 2015
http://www.forbes.com/sites/lorenthompson/2015/03/03/military-healthcare-11-billion-record-system-will-be-obsolete-before-its-even-built/

... No doubt about it, the project managers understand how to speak the language of acquisition reform.  However, a close look at what their site proposes to do for the 9.6 million active-duty warfighters and dependents in the military healthcare system reveals that this effort is going to fail.  It will probably be better than what it replaces, but it will lag far, far behind the kind of performance that users of internet-based technologies have come to expect.  So soldiers and sailors and airmen and marines � and their dependents � aren�t going to get the quality of care they deserve, and some will suffer mightily as a result.

In order to understand why the modernization initiative is doomed to failure, you need only grasp the significance of two key phrases the program office uses in its approach to industry for proposals.  First, it says it is seeking a �state-of-the-market� electronic health record system.  Second, it says whatever it selects will be an �off-the-shelf� product.  In other words, it is seeking to acquire an electronic health record system that already exists in an industry noted for its antiquated approach to the movement of information.  Furthermore, despite the program office�s insistence that it will avoid getting locked into reliance on a single monopolistic vendor, the project manager told Politico he envisions the contract as �an extensive prenup and no divorce.�

In other words, what I have described for years as a "business computing" oriented approach to clinical computing - an approach as guaranteed to fail as confusing psychiatry with neurosurgery because they both treat brain disorders, and trying to treat a brain tumor with psychotherapy or a personality disorder with a scalpel.  Specifics matter.

Sounds like vendor lock to me.  The business model the program is pursuing resembles a proprietary enterprise software system of the sort that many major hospitals have installed.

If you don�t know what an enterprise software system is, the first sentence in Wikipedia�s entry on the subject gets to the point: �Enterprise software�is purpose-designed computer software used to satisfy the needs of an organization rather than individual users.�  Got that � rather than individual users?  This approach to information system design is a throwback to the pre-internet days of mainframe computers.  In fact, the dominant version currently in use by private healthcare providers relies on upgrades to software developed nearly half a century ago at the Massachusetts General Hospital.

It's not a throwback to the mainframe era.  It represents the now-obsolete but still dominant, defective control-mentality acculturation and over-empowerment of information technologists (e.g., http://dl.acm.org/citation.cfm?id=563354&coll=portal&dl=ACM).  This acculturation is a remnant not of mainframe days but of the card tabulator data processing era (http://hcrenewal.blogspot.com/2008/05/seedie-society-for-exorbitantly.html).

2.  Health Affairs:  Where Is HITECH�s $35 Billion Dollar Investment Going? - March 4, 2015
http://m.healthaffairs.org/blog/2015/03/04/where-is-hitechs-35-billion-dollar-investment-going/

by Sen. John Thune, Sen. Lamar Alexander, Sen. Pat Roberts, Sen. Richard Burr, and Sen. Mike Enzi
 
On April 16, 2013, we released �REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT,� outlining concerns with implementation of the Health Information Technology and Economic and Clinical Health (HITECH) Act. Specifically, we asked: What have the American people gotten for their $35 billion dollar investment?

Two years after releasing the white paper, and six years since enactment of the HITECH Act, the question remains. There is inconclusive evidence that the program has achieved its goals of increasing efficiency, reducing costs, and improving the quality of care.

I note that the statement "there is inconclusive evidence that the program has achieved its goals of increasing efficiency, reducing costs, and improving the quality of care" is a euphemistic way of saying "there is conclusive evidence that the program has not achieved its goals of increasing efficiency, reducing costs, and improving the quality of car."

We have been candid about the key reason for the lackluster performance of this stimulus program: the lack of progress toward interoperability. Countless electronic health record vendors, hospital leaders, physicians, researchers, and thought leaders have told us time and again that interoperability is necessary to achieve the promise of a more efficient health system for patients, providers, and taxpayers.

Instead, according to physician surveys, electronic health records (EHRs) are a leading cause of anxiety for physicians across the country. The EHR products are not meaningful to physicians, which is clear when you consider that half of all physicians will have their Medicare payments cut in 2015 for not adopting government benchmarks for EHRs. ... After spending $28 billion so far of the $35 billion total taxpayer investment, significant progress toward interoperability has been elusive.

Sadly, our elected officials still don't quite understand that the largest drawback to today's health IT is not lack of interoperability, but lack of basic operability (usability). 

However, $7 billion of the HITECH $35 billion is still available to waste in order to learn that lesson.

... In listening to the concerns from EHR vendors and EHR users from across the care continuum, ONC has taken an important turn under the leadership of Dr. Karen DeSalvo. The previous ONC leadership did not understand the difficulty and enormity of creating government-approved products in a market that struggled to exist before government incentives arrived.

As a result, our nation�s health care providers are stuck with the huge cost of unwieldy systems trying to conform to government mandates. They are stuck adopting EHR systems which don�t fit into their established workflows. And if they actually want to share their patients� data, they are stuck with even more costs imposed by vendors.

At the center of all this is the patient who must sit quietly in the exam room looking at her physician use a computer instead of directly talking with her, who likely has seen no better access to her own data, and who is struggling to understand why her doctor has such a difficult time getting her lab results.

This is not exactly an endorsement of ONC's prior leaders.  Perhaps the aforementioned "previous ONC leadership" should have read this blog more carefully.  Or the Wall Street Joutnal where I spelled these outcomes out in 2009.  Emphases mine:

http://www.wsj.com/articles/SB123492035330205101

Feb. 18, 2009

Dear WSJ:

You observe that the true political goal is socialized medicine facilitated by health care information technology. You note that the public is being deceived, as the rules behind this takeover were stealthily inserted in the stimulus bill.

I have a different view on who is deceiving whom. In fact, it is the government that has been deceived by the HIT industry and its pundits. Stated directly, the administration is deluded about the true difficulty of making large-scale health IT work. The beneficiaries will largely be the IT industry and IT management consultants.

For �12.7 billion the U.K., which already has socialized medicine, still does not have a working national HIT system, but instead has a major IT quagmire, some of it caused by U.S. HIT vendors.

HIT (with a few exceptions) is largely a disaster. I'm far more concerned about a mega-expensive IT misadventure than an IT-empowered takeover of medicine.

The stimulus bill, to its credit, recognizes the need for research on improving HIT. However this is a tool to facilitate clinical care, not a cybernetic miracle to revolutionize medicine. The government has bought the IT magic bullet exuberance hook, line and sinker.

I can only hope patients get something worthwhile for the $20 billion.

Scot Silverstein, M.D.
Faculty, Biomedical Informatics
Drexel University Institute for Healthcare Informatics
Philadelphia

These were easy predictions to make based on experience and papers such as this.

Finally:

3.  HealthcareDive.com, Has the AMA lost its mojo?  - March 9. 2015
http://www.healthcaredive.com/news/has-the-ama-lost-its-mojo/372532/

As the mainstream media has begun to realize that organized physicians groups are doing all they can to resist adopting EHRs, the coverage of the dispute has revealed just how little impact their efforts�?led by the AMA�?are achieving in accomplishing their goals.

The AMA has come out vehemently against the Meaningful Use program and the high velocity with which the HHS and Congress want doctors to adopt EHRs, and they have written countless letters, position papers and blueprints for reform to announce their displeasure. Moreover, more than 30 other physicians groups have signed on to their copious letters. A recent USA Today piece quoted the incoming chief of the AMA about EHRs.

"Physicians passionately despise their electronic health records," says Lexington, KY, emergency physician Steven Stack, the American Medical Association's president-elect. "We use technology quickly when it works � Electronic health records don't work right now."

A 2013 AMA/RAND study revealed that EHRs are at the root of the modern doctor�s dissatisfaction with his job.

I note that up until relatively recently, the AMA was largely a defender of today's EHR technology.  They certainly got what they wished for...

"Physicians believe in the benefits of electronic health records, and most do not want to go back to paper charts," said Dr. Mark Friedberg, the study's lead author and a natural scientist at RAND, a nonprofit research organization. "But at the same time, they report that electronic systems are deeply problematic in several ways. Physicians are frustrated by systems that force them to do clerical work or distract them from paying close attention to their patients."

In fact, I believe this oft-made statement about "most do not want to go back to paper charts" is incomplete and misleading.  In terms of retrieving data such as labs and images, most probably would not want to go back to paper.  On the other hand, most probably would like to be able to document and enter orders on paper and have clerical personnel transcribe that information into computers - instead of the physicians being the clerical persons themselves, and gratis.

... According to a piece on Wall Street Cheat Sheet, there could be a couple of reasons why the AMA seems to keep getting shut out�?namely the AHA and the Blues.

While the AMA had $19 million to lobby Congress, the American Hospital Association�?which represents providers who took a financial hit after the last ICD-10 adoption delay�?spent $20.75 million last year to lobby lawmakers. Big insurer Blue Cross and Blue Shield, which would also benefit from wide adoption of EHRs and ICD-10, spent $21.3 million in 2014. That's a combined $42 million, more than double the AMA's effort.

Now, factor into that the extreme amount of influence wielded by the tech sector�?Google alone spent $17.5 million in lobbying Congress in 2014�?and the scent in the wind becomes easy to identify. The tech sector stands to make billions from EHR creation and management. Insurers need ICD-10 and EHRs to bring better cost management into their industry, enabling them to spend less as they pay for more care for more patients. Finally, hospitals need the tech because the ACA is bringing millions of new patients into their doors, and the old pegboard and paper systems that doctors are trying to cling to just won't work for hospitals that see tens of thousands of patients each month.

The AMA has set up a showdown on ICD-10 and EHRs that it will lose, and lose big, because it just plain does not carry the muscle it used to.

In other words, medicine has been invaded by the Information Technology industry and the profiteers who stand to benefit from that technology, with the bulk of the work being performed by clinicians, for free and to patient detriment.

This seems a clear formula for clinicians to simply refuse to use health IT altogether for data entry and demand a return to paper data recording with clerical transcription, but alas, it's likely too late for a revolt like that.

As health IT continues to get well-deserved and long-overdue bad press like this, one wonders if our culture will start to recover from the state of health IT delirium it is in.

I am in doubt.

(See my Jan. 20, 2011 post "Healthcare IT delirium" at http://hcrenewal.blogspot.com/2011/01/healthcare-it-delirium.html for more on that issue).

-- SS

3/16/15 Addendum:

A physician actually proposes physicians be paid for clerical work:

Pay doctors and nurses for the time they spend charting
http://www.kevinmd.com/blog/2015/03/pay-doctors-nurses-time-spend-charting.html

-- SS