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HEALTH PLANS: KP Gadlfy update and my commentary

The Gadlfy gets some good press in a Bay Area blog called SFist which notes her side of the story and not Kaisers. The story is called David Versus Goliath — And Goliath’s Bigger Brothers, Backed By The Persian Army –to give you an idea of where it’s coming from. They also credit THCB for fair and balanced coverage, and frankly I think I’m the only one calling for reason and moderation in this whole thing.

But what’s been the damage to a great non-profit health care institution?  Perhaps nothing, but now rightly or wrongly they’ve been castigated as a bad employer, they’ve had their proprietary data on the Health Connect program up for all their competitors and potentially hackers to see, and worse they’ve had to admit in court to a patient privacy violation that they waited at least 5 months and maybe much longer to reveal to the  patients concerned. And this says nothing about trying to rather brazenly blame the whole thing on the Gadfly — not that she’s blameless, but she couldn’t have done this without their sloppiness.

Kaiser should be getting great kudos for its roles in promoting IT in health care and running disease management programs. But instead what happens if you do a Google news search about KP? You get basically a page of stories about this incident?  And it could all have been avoided with a decent handling by middle management and HR of the exit of the Gadfly, which included a small settlement and a no-sue confidentiality agreement. Dumb, dumb, dumb.

BLOGS: Alter-lanche

Wow, my hit counter is going crazy.  If you’re coming over from Eric Alterman’s blog, welcome & please take a look around.  This blog combines health care business and health care policy, and tries to tell the truth about the present, while highlighting big issues for the future. And in health care, the present is very, very messy. If you want more on health care policy, please fell free to peruse the policy and policy/politics categories on the left column — there’s plenty there for all types, but I am very cynical about the practical prospects for "market reform", particularly if it leaves out a large segment of the population.

INDUSTRY/TECHNOLOGY: How GE Medical helped boost offshoring to India, with UPDATE

This is a great article from the WSJ (but reprinted in another paper so you can see it) about how outsourcing to India was  in part driven by the medical products group of GE. I am not in general an opponent of outsourcing per se. There is obviously pain and dislocation for workers in richer nations as their jobs get sent to poorer one, and in the US  both government and corporations (as if there’s any difference any more) do a shoddy job in retraining and softening the blow to workers here. But moving up the value curve is part of Schumpeter’s creative destruction.  And of course India needs the money more than we do. How we distribute the money (and the work remaining here) is a political decision.

Meanwhile I recall that my colleague David Hansen wrote an article in the 1995 Institute for the Future 10 Year Forecast suggesting that significant chunks of the then growing high-tech economy in the US would find that their jobs could be moved off-shore due to the very technology that they were creating.

Recently I’ve been investigating working with some research companies in India.  Many major research companies are already outsourcing large parts of their research activities to India (after all Google works there too!).  And although the rates are cheaper than in the US, they’re not that much cheaper.  So methinks this trend overall will level off.
On a related topic, at the excellent HIS Talk blog, read what one CEO of a transcription company has to say about the future of medical transcription being done overseas.  He thinks that trend is ending too.The transcription part is only a piece of long and fascinating interview. Kudos to the HIS Talk blog for getting this type of informed opinion out there.

UPDATE: David Hansen has sent me copies of the two articles he wrote for the 1995 IFTF Ten Year Forecast.  One is about India called India Strides Into The Information Age
Dragging One Foot In Its Past and the other is a wildcard called InfoSerfing that suggests that US white collar workers might find their incomes dropping dramatically due to the exporting of their jobs to similarly skilled people in other countries (just as happened to factory workers). Both pretty prescient articles given that we’re ten years on now.

PHARMA: Some funnies from the Pharma Marketing list-serv

Over on the pharma-mkting list serv there’s been some fun with those slighly misspelt words that make more sense than the original — apparently this started in the Washington Post’s Mensa Invitational.  Well the pharma marketing folks got into it and I saved them all meaning to compile  them on a rainy day.  John Mack has published these already over on his Pharma Marketing Blog but as we don’t share too many readers I thought some of you might like to see them. (I’ve also had them cluttering up my in-tray for a while and I’m up late uncluttering it! (Author is listed after definition).

Adhorence – deep hatred of advertising (John Mack)

Relationslip Marketing:  Establishing an initial connection with a consumer and then never doing anything meaningful with it.

Derail Aid:  A tool to confuse physicians (both David Reim)

DTC advertising: Direct to courthouse (James Gardner)

Salety Study: Which proves that the drug is worth selling, whether safe or not.

Generich Companies: Which make plenty of $ with somebody else’s innovations.

Phate III: Which concludes that the drug can be sold, the fate of a certain % of the target population being left to a higher power. (all Sanjay Virmani)

Charmaceutical:  An SSRI taken by someone who thinks they have a genuine diagnosis, but in reality are simply unpleasant.

Byotech:  A small, specialty pharmaceutical company whose stock rises paradoxically whenever they announce failed clinical trials.

Contrasindication:  A DTC ad deliberately designed to generate controversy, so as to get aired on cable news 10 times for every paid slot. (all Paul McNiven)

DTP-Direct to Plaintiff:  The art and science of creating plaintiffs with puffery enticing them to try dangereous drugs they would be better off without. (Terry Nugent)

Antibositics: Therapies undertaken to antagonise bosses’ criticism. (Kamran Shamsi)

Adverstising: The fine art of promoting adverse reactions through the use of realistic images of afflicted patients to target audiences consisting of physicians and consumers in a repulsive, yet memorable fashion. (Mario Nacinovich)

CEA: A term used to describe a ranking officer whose public utterances remind one of a pejorative or disdainful reference to a bodily part normally used to express intense disagreement with another’s expressed opinion. (Harry Sweeney)

Complieance — what patients tell their doctors about whether they are taking their pills (Me)

Pharmochondria: a morbid condition characterised by depressed spirits
and fancies of ill health induced by pharmaceutical "awareness"
campigns and advertising (Michael Lascelles)

and my favorite

Pharmasuitickle:- An overall pleasant tingling a personal trial attorney gets when contacted by a former Vioxx patient. (Jim Weidert)

And finally from Bob Iles (?), these are not misspellings but "daffynitions" from his Dictionary of Pharmaceutical Research.

Conclusions — What you designed your study to prove.

Informed consent — A document lawyers, doctors and administrators took weeks to write and revise but which a 100-IQ patient is expected to read, understand and sign within minutes before getting the drug, needle, knife and/or shaft.

Insight — The innate ability I have to see the clinical importance of my data. Called bias in those who disagree with me.

Null hypothesis — Conclusion you do not want to prove but which you strive mightily to reach. Makes as much sense as anything else in statistics.   

Strategy — The name you give after the fact to any series of random events that ended in your favor.

Statistics — [From Sanskrit "sadistics," meaning confounding verbiage] A means of getting people to argue about numbers instead of whether the test drug worked.

HEALTH PLANS: Kaiser/Gadfly update

So the court case was held this morning, and the court issued an injunction telling the Gadfly to take down the pages with the patient information (and I assume the system diagrams too).  That’s pretty much what I expected, althought the Gadfly is a little upset about what she perceives to be biased treatment from the court in her Corporate Ethics blog. 

The real question is whether the Department of Managed Health Care looks into this further, as it said it would — it claimed that it would have a hearing in the notice it issued to the Gadfly if she asked for one. I don’t know as yet whether the Gadfly is requesting such a hearing, but as she’s done all the work already for the KP hearing I suspect that she will. In the same press release the DMCH said that "DMHC authorities are also examining Ms.Cooper’s claims that Kaiser Permanente’s computer systems previously allowed public access to the same patient information." If I was KP I’d be hoping that this would all go away, as the threat of that latter investigation is probably most damaging to them–if of course it actually happens. I just hope that I don’t get supoenaed because I’d have to plead the Fifth (that’s an inside joke for you Ali G fans).

POLICY: Yet another shoddy article on single payer

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The major outlets of the SCLM (so called liberal media) tend to give lots of column inches to conservatives like William Safire, Debra Saunders, and now Tucker Carlson on NPR and you don’t see the reciprocal placing of Michael Moore on Fox News or the Wall Street Journal. This week’s wingnut is Jeff Jacoby writing in the Boston Globe about how single payer would suck.  There may be a valid conversation about the merits of single payer, but this ain’t it. If the only people Jacoby can quote in his favor are the CDHP flacks at the NCPA and the appallingly biased Fraser Institute, he really needs to get a real education in this subject before he starts wasting column inches in a great newspaper.

Did he bother talking with anyone who knows something just across the Charles from Boston, like Bob Blendon or Marc Roberts at Harvard, both of whom are able to give an unbiased overview of the issues.  Did he even get America’s leading single payer advocate Steffi Woolhandler to tell her side of the story? It was all a cab ride away.  Even Bill O’Reilly’s had her on.

And he brought out a laundry list of where health care systems abroad are in trouble, and are resorting to rationing. No shit.  I can find him a much much longer list of bad things going on here, but why bother when the Wall Street Journal ran a whole series on rationing in the US in 2003.  Wasn’t Jacoby reading his fellow travelers’ stuff?  He never bothers to mention that the universal health care nations pay far less for their health care and get better population outcomes. Did he even know that?

This is a complex and difficult argument, but any rational analysis (like my rather good one about Canada!) shows that our system has at least as many problems as those abroad, and considerably more than those countries with a sensible public/private mix like France and Germany.

POLICY/POLITICS: Arnie, what a screw-up and what a disappointment

It’s incredible what a useless governor Arnie has been. Here was a guy from way outside the political establishment who had the chance to really change politics in California, so what has he done?

  1. He ran non-stop adverts all through the recall campaign saying that he would cut the state deficit by having a "full audit" (or in Arnie-speak "Foorl Ordit".  He then increased the deficit by canceling the $4bn increase to the car tax, and when, surprise, surprise, the Foorl Ordit didn’t miraculously find $15bn of waste to get rid of he simply borrowed the money by changing the law and issuing bonds.  Some budget hawk, eh.
  2. He ran as an outsider and used at least some of his own money in the campaign. But after  he won he paid his own account back from new political contributions — those are called bribes in less polite society — which came from not "special interests" like the ones from whom that Grey Davis guy used to get his cash from.  Oh no — Arnie’s money came from "powerful interests".  And who might they be?  Well apart from the Spanos real estate family that owns most of central California, it also includes a lot of money from big pharma after Arnie vetoed a bill trying to legalize Canadian imports into California.  No pay-off there
  3. And while we’re on the pay-off theme, several of us felt that the most despicable part of the Gray Davis regime was its ownership by the appalling prison guards union.  This is a state where a prison guard earns way, way more than a teacher, and where the CCOA (California Correctional Officers Association) in vehement on insisting that instead of spending money on education now instead of prisons later, we spend on prisons now and prisons later.  So a funny thing happens just before the Nov 2004 election. Arnie takes the prison guards cash, just like Davis did, and then comes out against the modest reform of the worst injustices of the 3-Strikes measure, turning it from a moderate winner to a very close loser — and costing the taxpayer a boatload more in the future.
  4. And to confirm his total moral bankruptcy, instead of standing as a decent Republican alternative to the clowns running the nation in DC, he decides to emulate them. While the Bush Administration has been putting out fake news stories and become a laughing stock along the way, now Arnie has decided to copy it.  What does this mean? Yes, you and I the taxpayer are paying for fake news propaganda to oppose the nurse staffing law which was passed with a fair measure of popular support, and was recently reaffirmed by a state judge.  And of course some dumb TV stations have been running the stories, which look like real news (in as much as "real news" is ever seen on local TV station news — I suspect the people who watch that stuff get the "news" they deserve.

There’s more fun stuff from www.Arnoldwatch.org including a fun video of protesters getting thrown out of an Arnie fundraiser.

BLOGS & BLOGGING: Excellent HIS blog

Somehow I’ve managed to miss until today the very interesting HIS talk blog, which has lots of nuggets about the health information systems business.

It’s been going as long as THCB, so I don’t know how I managed to avoid mention of it!

OFF-TOPIC: More dumbness in dealing with disgruntled ex-“employee”

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Of so this one is not about the the Gadfly and Kaiser, or about health care at all.  but it is about another Bay Area institution being unnecessarily dragged into the press and the courts.  So Barry Bonds was having an affair (and I admit that I went to the story to check out what the girl looked like!).  And apparently he "forced" the woman to move to Arizona, sort of paid for her house down-payment and may have done that with money he didn’t pay tax on, and also told her that he took steroids before he later allegedly told a grand jury that he wasn’t taking steroids at that time. (Aren’t grand jury trials supposed to be secret?)  Here’s all the gory details along with some pictures of the protagonists (and I can see why Mr Bonds was interested!).

Apparently he mightily pissed her off, and then only offered her $20,000 to go away when she said that she’d lost $100,000 on the move to Arizona and had to become a bar-maid to make ends meet. So now she’s testifying to his perjury and she’s writing a book.  Given that she knew two potentially very damaging things about him, couldn’t someone in the Bonds’ empire have perhaps suggested to Barry that he ought to pay her to keep quiet. I suspect a few hundred thousand dollars in return for a confidentiality agreement would have been money very well spent out of Bonds’ $17m annual salary!  But like that other bay area institution KP (and for that matter that East Coast institution Martha Stewart), he’s happy to take huge risks for no apparent gain by not managing his dis-engagements properly. 

And what the hell was his superstar agent Scott Boras thinking in all this? I saw a talk he gave (and very dull it was too) where he said that he told Bonds in 1999 that he needed to improve his performance.  Perhaps it was that suggestion that got him on the juice in the first place? Shouldn’t Boras have been on tap to deal with this?

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