Dander Up, Down, and All Around

Today's topics: VA health care politics; a clear-eyed and sane report from a bastion of managerialism, with related observations on innovators trying to create real bottom-up value.


It's the last day of the year, so let's get this done. Owing to various largely unforeseen challenges, happily now largely behind us, this "Dander" series was interrupted for some time. Apologies to anyone who

The Demise of the Trump Foundation, an Extreme Example of Elite "Do-Gooding" to Prop Up the "Broken System" that Benefits Them

Big foundations often claim that they are out to improve society.  For example, the Robert Wood Johnson Foundation claims to be


the nation’s largest philanthropy dedicated solely to health.

Its goal is to improve health care for all, that is,


help raise the health of everyone in the United States to the level that a great nation deserves, by placing well-being at the center of every aspect

Johnson and Johnson's Latest Ethical Misadventures: Settled Kickback Allegations, Reportedly Concealed Knowledge of Adverse Effects of a "Sacred Cow" Product

Giant pharmaceutical/ biotechnology/ device company Johnson & Johnson has its famous "credo" which starts with


We believe our first responsibility is to the doctors, nurses and
patients, to mothers and fathers and all others who use our products and
services.  In meeting their needs everything we do must be of high quality..
Nonetheless, the company has a long history of ethical

Mission-Hostile Hospital Management: Quieter, but Still Pernicious After All These Years

Hospitals exist to take care of sick people, with the goal of making them better.  Hospitals employ and work with health care professionals, again who are sworn to put taking care of patients ahead of all other concerns.

However, since we founded Health Care Renewal, we have noted striking examples of hospital leaders threatening their hospitals' fundamental mission and/or health care

The Perils of CEO Worship - What Happens When the Leader Becomes Demented?

Introduction: the Cult of the CEO

Although the US and most developed countries are nominally democratic, many of us seem to be again yearning for a man on a white horse, and in the current era, the horse ridden is corporate.
On Health Care Renewal, we having been talking about this pheonomenon for a long time. We have written about it in terms of the messianic (or visionary, or charistmatic)

From Russia with Money - Harvard Medical School Accepts $200 Million from Russian Emigre with Ties to Russian Oligarchs and Putin, and Who Is Under Investigation for US Election Meddling

On Health Care Renewal we have frequently written about individual and institutional conflicts of interest.  The landmark but often ignored 2009 report by the Institute of Medicine on Conflicts of Interest in Medical Education, Research and Practice defined institutional conflicts of interest as arising when


an institution's own financial interests or those of its senior officials pose risks of

Pharmaceutical and Other Health Care Corporations Funnel Dark Money to Republicans to Defeat "Leftward" Democratic Candidates - Partisanship Trumps Social Responsibility

Introduction - Health Care Corporations Profess Social Responsibility

As we noted recently, large health corporations, which must deal with
patients, health professionals, and government regulators, usually
profess their social resonsibility.  For example,

Biotechnology firm Genentech, now a subsidiary of giant Swiss biotechnology and pharmaceutical company Roche, has an elaborate web page

Nonsense-Based Health Care - in the Service of Political Ideology and Sectarian Beliefs

As an advocate for evidence-based medicine, I am used to disagreeing with officials at US government health agencies on the finer points of evidence and its interpretation.  However, it's 2018, and things are very different.  Now the current regime, and those who back it, have produced a rising tide of outright nonsensical assertions about medicine and health care used seemingly in service of 

Issues at the 18th International Anti-Corruption Conference

Many issues brought up at the 18th International Anti-Corruption Conference (IACC) in Copenhagen,
Denmark, were relevant to the problems of conflicts of interest,
crime and corruption in health care which we often discuss on Health Care Renewal, and hence bear repeating here.





The discussion certainly got at the complexity of fighting corruption, seemingly one of many necessities that has

Update: How to Challenge Health Care Corruption Under a Corrupt Regime

Summary: the Corruption of Health Care Leadership as a Major Cause of Health Care Dysfunction

As we wrote in August, 2017, Transparency International (TI) defines corruption as


Abuse of entrusted power for private gain

In 2006, TI published a report
on health care corruption, which asserted that corruption is widespread
throughout the world, serious, and causes severe harm to patients and

The Politicization of Pharma, and Other Health Care Corporations - Walk on the Dark (Money) Side

Introduction - Health Care Corporations Profess Social Responsibility

As we noted recently, large health corporations, which deal with patients, health professionals, and government regulators, usually profess their social resonsibility.  For example,

Giant health care insurance company Aetna advertises its social corporate responsibility, including


As a health care leader, we believe that

New York Times Remembers Dr Bernard Carroll, the "Conscience of Psychiatry"

We at Health Care Renewal miss Dr Bernard Carroll, who we were proud to count among our bloggers.





The New York Times just published a kind obituary, which called him "the conscience of psychiatry."

It opened:


Dr. Bernard J. Carroll, whose studies of severe depression gave psychiatry the closest thing it has to a 'blood test' for a mental disorder, and who later became one of the field’s

Pharma's Dark Money: Touting Corporate Responsibility and Non-Partisanship, But Using Dark Money to Promote Self-Serving Policies and Partisan Causes

Health Care Corporations Promote Their Social Responsibility

The US health care system's extreme dsyfnctionality is now a cliche.  So it's no wonder that everyone seems to want to make things better.  Big health care corporations in particular tout their socially responsible ideas for health care reform.

For example, PhRMA, the trade organization for drug and biotechnology firms, describes its

The Mystery of the Ownership of the Trinity School of Medicine

Trinity School of Medicine Vice President Boasts that It Is "Not the Same" As Most Offshore Medical Schools

A post promoting the Trinity School of Medicine just appeared on the KevinMD blog. It was entitled "Addressing the 'ugly truth' about Caribbean medical schools: Why they’re not all the same." Its purpose seemed to be to persuade the reader in particular that the Trinity School of

Remembering Dr Bernard Carroll

Dr Bernard Carroll passed away on September 10, 2018.  Dr Carroll had a distinguished career, so it was a surprise and delight that he also chose to be a stalwart Health Care Renewal blogger.  He was with us since 2005, contributing insightful, pithy, provocative and important posts.  He also authored some of our most widely read posts.  Most viewed was: JAMA Jumps the Shark.   His most

Fake Reform Foisted on Us by Those who Benefit Most from the Current Dysfunction

Introduction - No Funding for You

To better understand health care dysfunction, I interviewed doctors and health
professionals, and published the results in Poses RM.   A cautionary
tale: the dysfunction of American health care.  Eur J Int Med 2003; 14(2): 123-130. (link here). 
In that article, I postulated that US physicians were demoralized
because their core values were under threat,

Michael Fine's Health Care Revolt

Michael Fine, M.D., HealthCare Revolt: How to Organize, Build a Health Care System, and Resuscitate Democracy – All at the Same Time (Oakland, CA: PM Press, 2018).



Dr. Michael Fine is a man on fire. He’s on fire with anger
about a healthcare marketplace that serves well to maximize the profits of
investors and CEOs, but violates the values of many of those working in it.
He’s on fire with

Apologizing for Problems with Commenting

My apologies!

I discovered a few days ago that our Google overlords had stopped notifying me about pending comments some months ago.  No indicator of the number of pending comments appears on my Blogger dashboard. 

I just realized I had a large backlog of pending comments, most of which were spam, but some of which were not.  I just posted all those that were not obvious spam.  I am now

EHR evidentiary mayhem

A short post.

I am encountering, in my legal work, electronic medical records
systems that either allow ex post facto note alterations by clinicians -
for example, after a catastrophe - and/or alteration of the apparent
date/time a note was entered. The alterations (e.g., a version history) or fake times don't
appear on the printed records, and usually are not in the audit trails as well.

Dander Still Up, And Also Down, All Over the Place. What Gives?

A. The Present Moment.

I've started this piece a whole bunch of times. So in fairness to you, reader, you have a few paths through it. If you don't feel like starting by sharing some navel-staring about today's bizarre predicament, please skip to 'D.' Or 'B,' or 'C.' Wouldn't blame you in the least.

I've still got my dander up about what's happening in the many troubled reaches of health care

Making Abusive Contracts Great Again - Non-Disclosure Agreements, Which Have Bedeviled Employed Physicians, Go From Anechoic to Viral Courtesy Omarosa

Introduction: Confidentiality Clauses, Non-Disclosure Agreements, Non-Disparagement Clauses

In 2016, Dr Wally Smith and I published an article on how contracts employed physicians sign may threaten their patients and professionalism.(1)  At the time, we wrote,


clauses in the contracts that physicians sign with their employers or that their employers sign with third parties may be part of a

#WHISTLEBLOWER tonight on CBS at 9 pm: Brendan Delaney and Electronic Medical Records

I received this today. I have been writing on healthcare information technology problems for 20 years, on this site since 2004 and others since the late 1990s. This eClinicalWorks EHR story is the worst-case scenario: bad health IT, and vendor cheating in the (already weak) "certification" process to get the EHR to market without consideration of the severe harms that could result, Ford

Make Asbestos Great Again? - Trump Once Claimed "Movement Against by Asbestos was Led by the Mob," Now EPA Wants to Relax Asbestos Regulation

Introduction:  An Old Public Health Menace

This is somewhat personal.  In the early 1980s, as a general internal medicine fellow, I gave a series of talks about important medical problems that generalist physicians often missed.  One was asbestos related disease.  Although asbestos had been heavily regulated since 1973, there were stilll large numbers of people exposed to it alive in the 1980s.

Ill-informed, Mission-Hostile Health Care Leadership... in the White House and the US Department of Health and Human Services

Introduction - What Has Gone Wrong with the Leadership of Health Care Organizations

A major focus of Health Care Renewal has been problems in leadership and governance of health care organizations, which we believe became major causes of health care dysfunction.  For example, we have discussed how leadership is often ill-informed. 
More and more people leading non-profit, for-profit and

Spin it Again - Four More Go Through the Revolving Door From the World of Corporate Health Care to Top US Government Leadership Positions

While we were distracted by the daily onslaught of news, it appears that the revolving door continues to spin.





This month there has been a flurry of transitions from big health care and health care related corporations to the federal government.  So it appeared to be time for another revolving door update.


We start with a transition from a few months ago that we had not previously

Chipping Away at the Anechoic Effect: Now the New York Times Protests the Demise of the AHRQ National Guidelines Clearinghouse

Background: the Quiet Announcement of the Death of the Clearinghouse

On June 1, 2018, we wrote:

Apparently as of late April, a terse announcement appeared on the website of the US AHRQ National Guideline Clearinghouse:



The AHRQ
National Guideline Clearinghouse (NGC, guideline.gov) Web site will not
be available after July 16, 2018 because federal funding through AHRQ
will no longer be

A Physician Who Had Run Clinics Which Proselytized Patients is Now a Government Health Care Leader Positioned to Enforce Her Religious Beliefs on Patients and Citizens Who Do Not Hold Such Beliefs

Introduction: Physicians' Values and Organizational Missions

Physicians professional values require them to put the interests of their individual patients ahead of all else, including the physicians' self interest.  The AMA Principles of Medical Ethics, for example, includes


VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

Similarly, in

"Hope in a Bottle" - Components of Purdue Pharma Stealth Marketing Campaign for Oxycontin Revealed by Legal Documents from Tennessee

Introduction: Disinformation and Stealth Marketing Campaigns

Back in the distant past the US government made some attempt to hold big health care corporations to account for misleading marketing practices.  We learned a lot about these practices from documents revealed in the resulting litigation, and in particular, about stealthy, deceptive systematic marketing, lobbying, and policy advocacy

Growing Health Care and Grand Governmental Corruption - But Still Anechoic After All These Years

Here we go again.  We have long been concerned about health care corruption as a major cause of health care dysfunction. Our last post on the topic was in January, 2018.


Summary: the Corruption of Health Care Leadership as a Major Cause of Health Care Dysfunction

As we wrote in August, 2017, Transparency International (TI) defines corruption as

Abuse of entrusted power for private gain

In

Have They Finally Got to You? - the Firing of Dr Gu

Introduction - Dr Gu's History of Activism Made Him Unpopular at Vanderbilt

We first wrote in February, 2018, about the plight of Dr Eugene Gu, a surgical resident at Vanderbilt University Medical Center (VUMC).  Dr Gu has a history of political activism, resulting in being  blocked on Twitter by President Trump after Dr Gu criticized him online, until a court forced Trump to unblock him on

Dander Still Up. Drowning in Great Dismal Swamp. Film at Eleven.

Maybe this is the last in my series of dander-raising essays, as recent national and world events have most definitely left so many of us with a raging case of TDS. (Trump Derangement Syndrome, look it up it's a thing).

So many damned browser tabs sitting there open. So little time.

Or maybe not. Who knows. Where are all these suicides coming from?

My editor keeps telling me, "don't let it

Why Did CVS Health Betray its Charitable Giving Policy and Social Responsibility Agenda to Donate to a Sketchy Non-Profit Devoted to Trump's Agenda?

Many big health care organizations, including for-profit corporations, have high-minded mission statements, and proclaim their social responsibility.  Unfortunately, we have shown that many leaders of such organizations seem indifferent to these seemingly exemplary goals, and even exhibit mission-hostile management.

A recent example involving CVS Health provided an unprecedented example of

The Stealth Shutdown of the US Agency for Healthcare Quality and Research (AHRQ) National Guideline Clearinghouse

The Quiet Announcement of the Shut Down

Apparently as of late April, a terse announcement appeared on the website of the US AHRQ National Guideline Clearinghouse:


The AHRQ National Guideline Clearinghouse (NGC, guideline.gov) Web site will not be available after July 16, 2018 because federal funding through AHRQ will no longer be available to support the NGC as of that date. AHRQ is receiving

The March of Legal Settlements Made by Pharmaceutical Companies is Diminishing - Presaging Even Less Accountablity for Top Health Care Organizational Leaders?

Introduction

We have long been discussing the legal settlements made by health care organizations of alllegations like fraud, bribery, and kickbacks.  Despite the unsavory nature of the behaviors revealed by most settlements, which often appeared to risk patient harms, the companies involved usually have had to pay fines that were tiny
relative to their multi-billion dollar revenues.  They

A Higher Impunity - How Can we Reduce Health Care Leadership's Impunity When the President Claims His Own Impunity?

Impunity: an Introduction

We believe that unaccountable leadership is a major cause of health care dysfunction.  Impunity is an extreme form of unaccountable leadership.

We have noted that despite numerous legal settlements made by health care organizations of alllegations like fraud, bribery, and kickbacks,
almost never do top leaders who presided over these actions face any
negative

Novartis' Latest Ethical Misadventure: Did it Pay to Play ... with the US President?

Amidst the news deluge, a story that stood out in the last few days was that of the strange relationships between a consulting firm set up by President Donald Trump's former lawyer and Trump Organization counsel Michael Cohen, and several large corporations.  As reported on May 8, 2018 by the New York Times, the focus was on the payments made to the firm, Essential Consultants LLC, by a financial

More Dander Rising: Ditto to Dr. Poses

Let me second the emotion now recently and repeatedly voiced by Dr. Poses in these pages. It's getting real hard to separate the health policy and malfeasance fecaliths from the general Washington Scheißsturm raining down on all of us. We feel pretty much buffeted non-stop, like (whomp!) badminton shuttlecocks in the corruption game the prevaricator-in-chief seems happily to carry on forever. Or

The Two-Fold Intimidation of Dr Bornstein, as Orchestrated by Donald Trump, Apparently to Conceal Something About Trump's Medical History

Introduction: Pressures on Health Care Professionals to Violate Core Values and Ethical Standards

Our first discussions with health professionals about the causes of health care dysfunction(1) quickly revealed concerns about influences that push professionals towards unethical actions.  We first heard about cases in which physicians were influenced to suppress clinical research whose results

Don't Know Much About Health Care and Public Health, and Don't Care Much About Their Missions - but in Leadership Positions in US Government Health Agencies

Here we go again.  As we  We have frequently discussed how health care leadership is often ill-informed ( look here). 
More and more people leading non-profit, for-profit and government health care organizations have
had no training or experience in actually caring for patients, or in
biomedical, clinical or public health research.  Obviously health care and health policy decisions made by

Through the Revolving Door, with a Few Stumbles - Health Care Corporate Executives and Consultants Continue to Become Leaders of Trump's Department of Health and Human Services

We continue to see a remarkable stream of people transiting the revolving door
from high-level positions in health care corporations to high-level positions in health care policy or regulation for the
Trump administration.  Lately, though, these transitions have not been without missteps. 





The most recent cases we have found, in the order of their public appearance, appear below.


John

Don't Know Much About Health Care and Public Health... but Appointed to Leadership Positions in US Government Health Care Agencies

We have often cited bad leadership and governance of health care organizations as a major causes of health care dysfunction.  In particular, we have discussed how leadership is often ill-informed. 
More and more people leading non-profit, for-profit and government health care organizations have
had no training or experience in actually caring for patients, or in
biomedical, clinical or public

The Dander Riseth Ever Higher: Shulkin Case Emblematic of Dysfunction

What follows is numero sesto if memory serves in a series of what gets one's dander up in this era of dysfunctional health care. Of course it seems these days our news in Health Care Renewal is so often all about focal dysfunction mirroring much broader problems of governmental and societal dysfunction. It's in this context that I learned just now of the current VA Secretary's ouster while

How Do We Counter Health Care Disinformation Under a Disinformer-in-Chief?

"Don't worry, things could be worse.  And sure enough, things got worse."

Disinformation in Medicine and Health Care

Stealthy, deceptive systematic marketing, lobbying, and policy advocacy
campaigns on behalf of big health care organizations, often
pharmaceutical, biotechnology and medical device companies, have long
been a subject of Health Care Renewal.  A relatively recently revealed

And the Dander Keeps On Rising

This is número cinco in our series of attempts to shed some of this dander. But it keeps on rising. Here are two recent reports both relating to the life-on-the-ground of North American rank and file physicians, especially as that life increasingly revolves around data entry and digital madness over and above everything else.

Are physicians suffering from acute, maybe by now chronic, PTSD? In

Mrs. Smith Goes to Washington