Princess Health and Another day, another EHR outage: MEDSTAR EHR goes dark for days. Princessiccia

Princess Health and Another day, another EHR outage: MEDSTAR EHR goes dark for days. Princessiccia

healthcare IT crash healthcare IT outage MedStar Health Patient care has not been compromised Politico

Gusty 08:59 Add Comment

At my March 2, 2015 post "Rideout Hospital, California: CEO Pinocchio on quality of patient care during hospital computer crash" (http://hcrenewal.blogspot.com/2015/03/rideout-hospital-california-ceo.html) I highlighted a stunning example of when the light shone through the corporate B.S. about health IT outages, thanks to a letter to the editor by a family member of an affected patient:

Letter: Re: Rideout Hospital computer problems

http://www.appeal-democrat.com/opinion/letter-re-rideout-computer-problems/article_4a408cc0-be47-11e4-9b7b-93c22da930d4.html 

Friday, February 27, 2015 

I am writing in regard to comments made by the CEO of Rideout Hospital regarding its recent computer crash. 

He said quality of care for patients had not been compromised during this incident. He is lying.

My spouse went to Rideout almost two weeks ago and had a Lexiscan of her heart when the computer system went down. The hospital doctor released her and assured her that if anything were wrong, the radiology department would spot it and she would inform us.

Here it is two weeks later and now they are saying because of the computer problem the entire test didn't get to her cardiologist until today. They think she may have had a minor heart attack and needs further cardiac intervention.

 Is this the new "open and improved" truths we are getting from this hospital? Rideout CEO Robert Chason misinformed us all. 

I am sure my spouse, who has fallen through the cracks during this inexcusable lapse in Rideout's technical policies, is not the only patient suffering similar situations. 

Shame on Chason for minimizing the effects of this catastrophe at our local hospital. 

Edward Ferreira 
Yuba City

I am aware of another major EHR outage via Politico.com:

4/9/15
http://www.politico.com/morningehealth/0415/morningehealth17818.html

MEDSTAR EHR GOES DARK FOR DAYS: MedStar�s outpatient clinics in the D.C. and Baltimore area lost access to their EHRs Monday and Tuesday when the GE Centricity EHR system crashed. The system went offline for scheduled maintenance on Friday and had come back on Monday when it suffered a �severe� malfunction, according to an email from Medstar management that was shared with Morning eHealth.

�All of a sudden the screens lit up with a giant text warning telling us to log off immediately,� a doctor said. �They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.�

This doctor told us that the outage was �disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do.

But of course we didn�t have access to any notes or medication history, and that was problematic.� MedStar notified clinicians in the email that any information entered in the EHR after Friday was lost.

I do not know if corporate issued the standard "patient safety was not compromised" line, but can almost predict it was uttered somewhere along the line.

MedStar is a big healthcare system.  An outage for several days at its outpatient clinics is disruptive and will lead to harms in the short term, but also in the long term, that cannot be effectively tallied, due to lost information. 

That includes information put on backup paper that fails to get entered when an EHR goes back up, as well as outright computer data loss as occurred here.

Note the doctor's comments about the "liberating" aspect of being freed from health IT.  He/she could actually practice medicine, not computer babysitting.

How many harms will come of this "major malfunction?"  There is no way to know.  However, hospitals cannot have it both ways.  If these systems are touted as improving safety, then safety is affected when they are down and emergency measures are put into place, resulting in chaos; and certainly when information simply goes to the "bit bucket."

The answer?  Either far more redundancy, or far less reliance on "paperless" systems.

There also needs to be mandatory reporting of EHR outages and root cause analysis so the incidence and the reasons can be studied, at the very least.

-- SS

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

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

cerner David Ridley Duke Fuqua School of Bsuiness health care ethics MBA medical ethics medical informatics NextGen plagiarism

Gusty 08:11 Add Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

Best Regards 

[Professor name redacted - ed.]

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

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

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

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

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

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

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

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

-- SS

Update 5/6/2015: 

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

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

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

-- SS

Additional thought 5/7/2015:

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

Princess Health and Second Order Generic Management: Lobbyist Named CEO of American Hospital Association. Princessiccia

Princess Health and Second Order Generic Management: Lobbyist Named CEO of American Hospital Association. Princessiccia

American Hospital Association generic management generic managers hospitals non-profit organizations

Gusty 06:49 Add Comment

A long time ago, in a universe far, far away, hospitals had relatively small administrations, usually lead by a older physician or nurse who served as executive director or superintendent.  Leading a hospital was seen as a calling, not a means to become rich.  With the rise of generic management, hospital management grew, and became dominated by generic managers who were trained as managers, not as health care professionals.

So if hospitals are now usually lead by generic managers, it should be no surprise that hospital organizations are lead by generic managers.  So it should be no surprise that the current CEO of the American Hospital Association, Richard J. Umbdenstock, was formerly " executive vice president of Providence Health & Services and president and chief executive officer of the former Providence Services, Spokane, Washington." (Look here.)

What should be a surprise, however, is what was just reported in Modern Healthcare,

The American Hospital Association has chosen Richard Pollack, its longtime lead lobbyist, to succeed Richard Umbdenstock as CEO. Hospital leaders say Pollack is the right pick, even though he never led a hospital or health system.

Pollack, 59, has been with the AHA for more than three decades and has served as the group's executive vice president for advocacy and public policy since 1991. He will take over the top post in September, the AHA announced Monday during its annual meeting in Washington.

Pollack has developed a sterling reputation for pressing the hospital group's agenda on Capitol Hill and beyond. He's played an integral role in top healthcare policy discussions in recent years, including passage of the Affordable Care Act.

Chip Kahn, president of the Federation of American Hospitals, which represents investor-owned hospitals, called Pollack a 'wise Washington hand.'

In addition,

John Rother, president of the nonpartisan National Coalition on Health Care, noted that it's an unusual pick in the sense that Pollack has not overseen a major hospital system. Before joining the AHA, Pollack served as a lobbyist for the American Nurses Association. The Brooklyn native started his professional career in 1977 as a legislative assistant for Rep. David Obey (D-Wis.)

So, the incoming American Hospital Association CEO is not a doctor or a nurse.  He has not had any known direct experience in patient care.  He has no training or experience in public health or biomedical sciences.  Furthermore, he has no direct experience working, even just as a manager, in a hospital or any organization that provides patient care or for the public health.

His entire experience is in Washington, DC, first as a legislative staffer, and then - not to put too fine a point on it - as a lobbyist.

This would make sense if he were going to lead a lobbying firm.  However, the AHA says:

In summer 1995, after regional policy board (RPB) review, the Board of Trustees approved vision and mission statements:

Vision: The AHA vision is of a society of healthy communities, where all individuals reach their highest potential for health.

Mission: To advance the health of individuals and communities. The AHA leads, represents and serves hospitals, health systems and other related organizations that are accountable to the community and committed to health improvement.

So now we have hospitals largely run by generic managers.  Furthermore, hospital associations, whose members are largely represented by generic managers, now may be run by lobbyists, people even more removed from actual health care.  Hence, perhaps too archly, I suggest that Mr Pollack is the first known example of a second order generic manager.

Summary

 In 1988, Alain Enthoven advocated in Theory and Practice of Managed Competition in Health Care Finance, a book published in the Netherlands, that to decrease health care costs it would be necessary to break up the "physicians' guild" and replace leadership by clinicians with leadership by managers (see 2006 post here). Thus from 1983 to 2000, the number of managers working in the US health care system grew 726%, while the number of physicians grew 39%, so the manager/physician ratio went from roughly one to six to one to one (see 2005 post here). As we noted here, the growth continued, so there are now 10 managers for every US physician.

The managers who first took over health care may have had some health care background.  Now it seems that health care managers are decreasingly likely to have any health care background, and increasingly likely to be from the world of finance.  Meanwhile, for a long time, business schools seem to have been teaching managers that they have a God given right to manage every organization and every aspect of society, regardless how little they know about what the particular context, business, calling, etc involves.  Presumably this is based on a faith or ideology that modern management tools are universally applicable and nigh onto supernatural in their powers.  Of course, there is not much evidence to support this, especially in health care.

We have discussed other examples of bizarre proclamations by generic managers and their supporters that seem to corroborate their belief in such divine powers.  Most recently, there was the multimillionaire hospital system CEO who proclaimed new artificial intelligence technology could replace doctors in short order (look here).   Top hospital managers are regularly lauded as "brilliant," or "extraordinary," often in terms of their managerial skills (look here), but at times because of their supposed ownership of all aspects of patient care, e.g., (look here)

They literally are on call 24/7, 365 days a year and they are running an institution where lives are at stake....

As noted above, if the new generic managers work in offices that are physically, intellectually and spiritually distant from the real world of health care, a lobbyist running a hospital association would be at best distant even from the management suite.

It is way past time for health care professionals to take back health care from generic managers.  True health care reform would restore leadership by people who understand the health care context, uphold health professionals' values, are willing to be held accountable, and put patients' and the public's health ahead of self-interest.

Princess Health andMost Kentucky hospitals did average or better in new patient satisfaction ratings; seven got top rating and six got bottom rating.Princessiccia

Princess Health andMost Kentucky hospitals did average or better in new patient satisfaction ratings; seven got top rating and six got bottom rating.Princessiccia

hosptials Medicare rankings

Gusty 21:19 Add Comment

Most of the Kentucky hospitals that were rated on a newly released five-star scale for patient satisfaction got three and four stars. Seven of them got a five-star rating and six got a two-star rating, the lowest rating given to any of the Kentucky hospitals that were evaluated.

The star ratings can be found on Medicare's Hospital Compare website and are based on a patient satisfaction survey given to randomly selected patients, not just those on Medicare, at nearly 3,500 Medicare-certified acute care hospitals across the country. The ratings are based on patient admissions between July 2013 and June 2014. Hospitals were not included if they did not have enough surveys completed during that period.

The survey, also known as Hospital Consumer Assessment of Healthcare Providers and Systems Survey, includes questions about patient satisfaction related to how their doctors, nurses and hospital staff communicated with them, how well their pain was addressed during their hospital stay, how well they were prepared to go home, cleanliness of the hospital and if they would recommend the hospital to others.

Kaiser Health News analyzed the data from the Centers for Medicare & Medicaid Services and found that 76 Kentucky hospitals were included in the patient satisfaction star ratings and 17 Kentucky hospitals were not. Kaiser found that the average for all of the rated hospitals in Kentucky was 3.4 stars, one-third, or 25, got four stars; half, or 38, got three.

HealthWatch USA, a non-profit organization that promotes health care transparency and patient advocacy based in Somerset, further analyzed the data and named the hospitals in each state by its star rating.

The seven with five-star ratings are: Clinton County Hospital, Marshall County Hospital, Westlake Regional Hospital, Saint Joseph Martin, Rockcastle County Hospital, Pikeville Medical Center and Russell County Hospital.

The six with two-star ratings are: Georgetown Community Hospital, Harlan ARH Hospital, Hazard ARH Regional Medical Center, Spring View Hospital in Lebanon, University of Louisville Hospital and Lake Cumberland Regional Hospital in Somerset.

The Centers for Medicare and Medicaid Services reminds consumers that these patient satisfaction star ratings are just one tool to help decide which hospital to use, and encourages them to use multiple factors to make this decision, including clinical outcomes, their health-care providers opinion and other publicly reported data.

Princess Health andStudy finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed.Princessiccia

Princess Health andStudy finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed.Princessiccia

food deserts food stamps nutrition research rural-urban disparities

Gusty 21:12 Add Comment

A study has found that nutritious foods are more expensive in impoverished rural counties than in urban counties, a phenomenon that doesn't help public health officials who teach healthy eating as a proven, effective strategy to prevent chronic diseases to rural Kentuckians.

"The results of this study find that individuals living in rural areas, particularly food desserts, may be at increased risk of negative health effects as a result of more limited access to higher quality foods compared to those living in urban areas," says the report of the University of Kentucky study, "Food Cost Disparities in Rural Communities," published in Health Promotion Practice.

Researchers analyzed the per-serving cost of 92 foods four times over a 10-month period in the primary grocery stores in four Kentucky counties, two rural and two urban. One rural county was considered a food desert, meaning that fresh produce isn't relatively available. The commonly purchased foods in the study were assigned to one of four categories based on their nutritional value.

Not surprisingly, the cheapest foods were those with the least nutritional value, such as canned fruit in heavy syrup, cereals with high-fructose corn syrup, and processed meats.

Foods that are a bit more nutritional, but mainly processed convenience foods, were more expensive in rural counties than urban counties.

Foods that were considered nutritious, but not the most nutritious, such as white rice, oats, whole-grain bran cereals and frozen fish, cost the most in the rural county with the highest poverty rate.

The cost of the most nutritional items varied by county, with the "most striking finding" being that "the rural food desert had significantly higher per-serving costs among the most nutritious food items, compared to the other three counties," 6 to 8 cents higher per item, the report said.

Within each county, the study did not find much difference in food cost among the foods in each of the four nutrition categories.

However, it did find that highly processed convenience foods in urban counties were more expensive than more nutritional foods, and suggested that those living in urban areas could afford more plant-based foods and fewer processed foods as an "effective strategy to improve overall dietary quality without increasing food budgets."

The study draws attention to the SNAP or food-stamp program, which makes no allowances for food cost differences between regions or counties, and suggests that its model be changed to be more like the Women, Infants and Children program, which uses a portion-based system: Participants buy a set number of ounces or servings of dairy products, whole grains, and fresh produce each month, irrespective of price. This approach "has the potential to adequately meet all participants' nutritional needs, irrespective of differences in food prices," wrote the researchers, Frances Hardin-Fanning and Mary Kay Rayens of the UK College of Nursing.

Princess Health andMay 2nd-3rd Race Weekend.Princessiccia

Princess Health andMay 2nd-3rd Race Weekend.Princessiccia

Gusty 15:00 Add Comment

The team was all over the place this weekend competing in a plethora of different races.  Here's how we did!

Goodlife Marathon

• Kailey Haddock ran her first marathon EVER, running an outstanding 3:22 Boston qualifier and placing 15th OA for females!
• Mike suffered with some serious knee problems during the race, but still managed a solid 3:26!

Goodlife Half Marathon

• Johana had an OUTSTANDING return from Kenya.  He posted a stellar 1:08 half marathon and won the race.
• Brendan, who had almost no long runs in training, could not refuse a free entry!  He still posted a solid 1:20 and placed 15th OA.

Mississauga Marathon

• Colin Calvert posted a very strong 3:18.

Mississauga Half Marathon

• RunnerRob, using this as a primer race, stuck to the plan and ran 1:20, good enough for 14th OA.
• Nick Burt ran a solid new PB of 1:26
• Graham also came in with a new PB of 1:29.
• Tracey, one of our masters all-stars, posted an outstanding 1:41!

Mudpuppy 5K

Lots of H+Pers lit up the Mudpuppy Chase!  Here's how we did:

• Luke Ehgoetz ran an outstanding PB of - 7th OA and 3rd in AG
• Steve Schmidt pushed a very solid PB of 19:31- 15th OA and 1st in AG
• Brian Wetzler came in at  - 20:58- 2nd in AG
• Ed Shrigley was just off his PB at 24:41 - 3rd in AG
• Candice Shrigley ran one of her best times ever, 24:45 - 1st in AG

Mudpuppy 3K

• Olivia Hergott ran an OUTSTANDING 19:46
• Samara Hergott was just behind her with a very speedy 19:57

Mudpuppy 600m 

• Miles Hergott pushed a very hard pace, and finished the course in 3:55!

Bear Mountain 50K

• Dave Rutherford tackled the very tough and technical course in a respectable 6:08 and 4th in his AG.

Rock the Ridge 50M

• Vicki had an outstanding performance, running 7:39, placing 2nd out of females, 7th OA, and recording the second fastest time by a female EVER!

In Ohio, our ultimate Mileage Man (Steve Parke) was ripping it up all weekend.  He won yet another 24 hour event, setting a new course record of 127 miles.

In Vermont, Chris Goldsworthy was back in action running a half marathon- his first race since the LA full earlier this year.  He ran 1:25, placing 8th OA and 2nd in his AG.

What a great two days.  Onwards to the next race weekend!

#cantwontstop

Princess Health and Innovations form the Safra Center Ending iCorruption Conference. Princessiccia

Princess Health and Innovations form the Safra Center Ending iCorruption Conference. Princessiccia

conflicts of interest health care corruption hospital systems pharmaceuticals regulatory capture

Gusty 12:23 Add Comment

I had the pleasure of attending the Ending iCorruption Conference, the capstone conference for the Edmond J Safra Research Lab on Institutional Corruption, held at the Harvard Law School on May 1-2, 2015.  The conference included much material relevant to health care corruption and related topics, and provided some innovative approaches that could be used to address these issues.  I list these below, with citations or links when available.  At some point in the future, all conference proceedings should be available on video from the Safra Center.

Uncovering Data on Conflicts of Interest

Unearth: Using PubMed to Uncover Conflicts of Interest Affecting Clinical Research

Unearth is a browser extension now available for Google Chrome, and soon to become available for other browsers, e.g., Firefox.  It works on PubMed searches, scraping funding and conflict of interest data from the body of articles and adding them to abstracts.  We have often discussed such conflicts of interest, and their relationship to manipulation of clinical research.  Unearth could make such conflicts more salient, making it easier to discriminate unconflicted from conflicted research.  (See this post on the Bill of Health blog.)  This application was developed during the Safra Center Hacking iCorruption Event.

Open Think Tanks: Uncovering Think Tank Funding

Think tanks often publish findings on and make recommendations about health care.  However, think tanks are often opaque, and any institutional conflicts of interest they have may not be easily apparent.  Open Think Tanks currently shows donations from government entities outside the US to US based think tanks.  Enhancements to include various kinds of private donations are likely in the future. This application was also developed during the Hacking iCorruption Event.

Finding Unconflicted Academics

As we have discussed, the majority of medical academics have conflicts of interest, which may affect their research, teaching and patient care.  Yet these conflicts are not always disclosed.  Furthermore, finding experts without conflicts is not easy.  ProfessorCert is a website that allows academics who have no conflicts of interest to register as such.  The website was developed by the Academic Independence Project. 

Improving Integrity

Putting Consumers in the FDA and Other Regulatory Agencies

We have frequently discussed regulatory capture, how government health care regulatory agencies, like the US Food and Drug Administration (FDA),  often seem to end up more concerned about the financial health of those they are supposed to regulate than patients' and the public's health.   Harvard Prof Daniel Carpenter, collaborator in Safra Center research,  talked about the problem of  "cultural capture" of regulatory agencies, in which the regulators' thinking is influenced by outside vested interests.  He proposed that regulatory agencies need to put consumers, or presumably other stakeholders like unconflicted health care professionals, "into the room."  

Putting Ethicists in the C- Suite

We have frequently criticized the leadership of hospitals and hospital systems.  In particular, we have discussed instances in which these leaders seem to have gone directly against the mission of their own organizations, which we termed mission hostile management. Safra Lab Network Fellow James Corbett, now Senior Vice President for Centura Health, proposed that ethicists who also understand the language of finance and management be present among the top leadership of hospital systems.  

Licensing Executives

As noted above, a major theme of the Health Care Renewal blog is the shortcomings of the leadership of large health care organizations.  Top leaders often have business training, but may be ill-informed about health care, and ignorant or unsupportive of  or even hostile to its values.  Wellesley College Professor Emerita Ann Congleton's 2014 article in the Journal of Business Ethics, entitled Beyond business ethics: an agenda for the trustworthy teachers and practitioners of business, proposed requiring that corporate executives, including executives of health care corporations, be licensed in order to lead their organizations.  I proposed licensing of leaders of large health care organizations as early as 2008 (here).    

Pharmaceutical Research Uninfluenced by the Pharmaceutical Industry

Because clinical research meant to evaluate drugs or devices sponsored by  manufacturers of the relevant products has shown to be frequently manipulated, or even suppressed, many people have suggested banning such sponsorship and direct influence of such manufacturers.  (For example, see the book and blog, both entitled "Hooked," written by Dr Howard Brody, and see Health Care Renewal blog posts, e.g., here.)
Safra Center Network Fellow and Rowan University Professor Donald Light's book in press, Good Pharma, basically offers proof of the concept that high quality clinical research on pharmaceuticals can be accomplished without industry money or influence, albeit in Italy, at the Mario Negri Institute. 

Summary

The project on institutional corruption at the Safra Center produced a burst of innovation meant to address this pervasive project, and thus provided much of value to those who want to challenge health care corruption.  I hope this innovation will turn out to be truly disruptive.  It is regretful that this project has come to an end.  We can only hope others pick up the banner.