I was recently interviewed by Dr. Elizabeth Saenger for The Center for Rehabilitation and Recovery regarding use of healthcare information technology in provision of mental health services.
The Center, part of the Coalition of Behavorial Health Agencies Inc., provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.
The interview is here:
http://coalitionny.org/the_center/recovere-works/RECOVERe-worksApril2013.html#DrSilverstein
The themes I discussed will be familiar to readers of this blog.
-- SS
Sabtu, 04 Mei 2013
Repost: Health IT Ten Commandments (1970) v. Health IT Truisms (2012)
I believe this Oct. 2012 post bears repeating, especially in view of the recent ECRI Deep Dive study of health IT risk (36 hospitals/9 weeks/volunteer reporting/171 health IT-related problems/8 incidents of harm/3 possible deaths):
In 1970, health IT pioneer Dr. Octo Barnett at Harvard/MGH wrote his "Health IT Ten Commandments" (from Collen's "A history of Medical Informatics in the United States, 1950-1990"):
Four decades later, I write the following 2012 "Health IT Truisms" (perhaps more to follow). Many of the points summarized here can be found in the past 8 years of my writing on this blog:
Had Dr. Barnett's Ten Commandments not been disobeyed in favor of cybernetic idolatry, the Health IT Truisms in 2012 would appear far different.
-- SS
In 1970, health IT pioneer Dr. Octo Barnett at Harvard/MGH wrote his "Health IT Ten Commandments" (from Collen's "A history of Medical Informatics in the United States, 1950-1990"):
1. Thou shall know what you want to do
2. Thou shall construct modular systems - given chaotic nature of hospitals
3. Thou shall build a computer system that can evolve in a graceful fashion
4. Thou shall build a system that allows easy and rapid programming development and modification
5. Thou shall build a system that has consistently rapid response time and is easy for the non-computernik to use
6. Thou shall have duplicate hardware systems
7. Thou shall build and implement your system in a joint effort with real users in a real situation with real problems
8. Thou shall be concerned with realities of the cost and projected benefit of the computer system
9. Innovation in computer technology is not enough; there must be a commitment to the potentials of radical change in other aspects of healthcare delivery, particularly those having to do with organization and manpower utilization
10. Be optimistic about the future, supportive of good work that is being done, passionate in your commitment, but always guided by a fundamental skepticism.
Four decades later, I write the following 2012 "Health IT Truisms" (perhaps more to follow). Many of the points summarized here can be found in the past 8 years of my writing on this blog:
1. Health IT in 2012 remains experimental, not proven effective or safe, with actual results conflicting.
2. Health IT is costly, not money-saving, diverting scarce healthcare resources away from actual healthcare provision to the IT industry.
3. "EHR" is an anachronistic term (that disarms the uninformed, who "see" an innocuous file system) for what is now an enterprise medical resource and workflow control system.
4. The proper framework in which to view "resistance" to health IT is not Luddite clinicians vs. IT modernists. It's pragmatist clinicians (with ethical and legal obligations and responsibilities), vs. IT hyper-enthusiasts who ignore or are blinded to the ethical considerations and downsides, and whose actions are based not on science, but on faith in technology and self interest.
5. HIT can be partitioned into good health IT (GHIT) and bad HIT (BHIT) - see definitions at the introduction to http://www.ischool.drexel.edu/faculty/ssilverstein/cases.
6. BHIT prevails due to its being far cheaper to produce than GHIT and due to lack of meaningful industry regulation of quality, usability and safety.
7. The lack of HIT regulation, post-market surveillance, formal validation and accountability is a special accommodation that is unprecedented in modern medicine.
8. Underlying HITECH and "Meaningful use" is the assumption that all HIT is good HIT.
9. A good or even average paper system is better for patients than a bad health IT system.
10. The incentives and coercive aspects of HITECH would not be needed if GHIT prevailed.
11. The coercive force of government should have been directed not at users, but at sellers, to produce GHIT and to abolish BHIT.
12. The term "meaningful use" is political rhetoric whose criteria were decided by committee and industry influence; nobody knows if meeting the criteria will prove truly "meaningful" or not. (That medical informaticists placidly accepted the term is a disgrace to a field that strives for terminological precision; "good faith use" would have been precise.)
13. Human research protections are given the blind eye with respect to commercial health IT.
14. Health IT being used safely is currently by happenstance and via compensation for flaws by clinicians who improvise (which itself introduces risk and is stressful), not by design.
15. Business IT a/k/a MIS personnel have far too narrow an education and experience to make pronouncements about health IT "transforming" medicine.
16. IT personnel should be part of the medical team, including liability for IT-related failure.
17. The commercial health IT sector is not an evidence-based domain.
18. A cybernetic "Libby Zion" catastrophe is unavoidable, and probably the only way to "transform" the health IT industry into an evidence-based industry - essential before that industry can even begin to "transform" (i.e., facilitate improvement of) medicine.
Had Dr. Barnett's Ten Commandments not been disobeyed in favor of cybernetic idolatry, the Health IT Truisms in 2012 would appear far different.
-- SS
Jumat, 03 Mei 2013
UnitedHealth CEO Continues to Prosper While His Company's Behavior Appears to Contradict its Mission Statement
Tis spring, the season in the US for legal settlements, government findings, and proxy statements revealing executive compensation. Therefore, maybe there should be no surprise that we are seeing a series of cases in which health care corporate leaders continue to enrich themselves while their organizations' behavior raises ethical questions.
Following on the Amgen example, we now present the latest UnitedHealth example (in a post organized similarly.)
The CEO Gets Richer
Last week, the Associated Press (via the Washington Post) summarized UnitedHealth CEO Stephen J Hemsley's growing pile of money:
At the same time, Hemsley continued to cash in stock options which also added to his riches:
The Mission Promises Much but the Company Delivers Less
On one hand, the rate of rise of Hemsley's compensation at least seemed comparable to the company's financial performance:
On the other hand, the largess given to the CEO ought to be contrasted with the how UnitedHealth failed to deliver what its mission promised.
Most recently, a jury found the company failed to live up to its legal obligation (in the state of Nevada) to review the quality of the clinicians on its panel. As reported by Bloomberg,
Note that the state of Nevada does explicitly hold managed care organizations accountable for the clinical quality of its health care professionals' practice,
Also note that managed care organizations and other health insurers often boast about the quality of their provider panels.
For example, see the UnitedHealth mission statement:
It seems reasonable to interpret the italicized parts above as a statement of accountability for the quality of care provided by the health care professionals within the United network.
To reinforce that accountability, a subsequent Bloomberg story added,
Furthermore, the lofty UnitedHealth mission statement should be compared to two recent government findings.
In the state of California, as reported by the Los Angeles Times,
Such behavior seems to contradict the mission statement's assurance that the company will seek to provide health care at "an affordable price."
Meanwhile, Bloomberg just published a story about how UnitedHealth has been running an insurance program for US military families.
This behavior seemed to contradict the mission statement's assurance that the company seeks to "expand access to quality health care."
The Song Remains the Same
Of course, UnitedHealth actually has a very long record of preaching about its aspirational mission, while paying its top hired managers extraordinary amounts and contradicting that mission, and at times ethical norms. Our posts on UnitedHealth are here. Recently we wrote,
UnitedHealth would be the company whose CEO once was worth over a billion dollars due to back dated stock options, some of which he had to give back, but despite all the resulting legal actions, was still the ninth best paid CEO in the US for the first decade of the 21st century (look here). UnitedHealth would be the company whose then CEO made a cool $106 million in 2009 (look here).
Moreover, UnitedHealth would also be the company known for a string of ethical lapses:
- as reported by the Hartford Courant, "UnitedHealth Group Inc., the largest U.S. health insurer, will refund $50 million to small businesses that New York state officials said were overcharged in 2006."
- UnitedHalth promised its investors it would continue to raise premiums, even if that priced increasing numbers of people out of its policies (see post here);
- UnitedHealth's acquisition of Pacificare in California allegedly lead to a "meltdown" of its claims paying mechanisms (see post here);
- UnitedHealth's acquisition of Sierra Health Services allegedly gave it a monopoly in Utah, while the company allegedly was transferring much of its revenue out of the state of Rhode Island, rather than using it to pay claims (see post here)
- UnitedHealth frequently violated Nebraska insurance laws (see post here);
- UnitedHealth settled charges that its Ingenix subsidiaries manipulation of data lead to underpaying patients who received out-of-network care (see post here).
- UnitedHealth was accused of hiding the fact that the physicians it is now employing through its Optum subsidiary in fact work for a for-profit company, not directly for their patients (see post here).
Summary
The US dysfunctional health care system has produced a long string of big corporations that promise warm and fuzzy health care yet deliver something less, all the while mightily enriching their top hired managers. Given the deadly serious nature of the health care system, these companies' promises, marketing, public relations and mission statements cannot be dismissed as fluff and puffery. Market fundamentalists and executive apologists have touted our system as market based. If patients must act as consumers, they cannot make good consuming decisions if they are awash with deceptive marketing and advertising. It is one thing for Hollywood to advertise blockbuster movies that are duds. It is another for health care corporations to advertise quality care and deliver bad care.
As we have said far too many times, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.
Following on the Amgen example, we now present the latest UnitedHealth example (in a post organized similarly.)
The CEO Gets Richer
Last week, the Associated Press (via the Washington Post) summarized UnitedHealth CEO Stephen J Hemsley's growing pile of money:
UnitedHealth Group Inc. kept CEO Stephen J. Hemsley’s salary stable in 2012 but bumped up his total compensation for a year in which the nation’s largest health insurer grew earnings and enrollment and launched a major acquisition.
The Minnetonka, Minn., insurer gave its top executive a compensation package valued at about $13.9 million last year, according to the company’s proxy statement filed with the Securities and Exchange Commission. That’s up 4 percent from the $13.4 million total he received last year.
Hemsley, 60, received a $1.3 million annual salary in 2012, like he has the past several years. He also received $7 million in stock awards, which is the same total as 2011. But his performance-based bonus climbed 7 percent to $5.3 million, and he received $287,443 in other compensation, up from $154,804 in 2011.
Other compensation included savings plan contributions and a $125,000 Hart-Scott-Rodino Antitrust Improvement Act filing fee payment UnitedHealth made on behalf of the CEO so he could maintain and increase his stock ownership in the company.
At the same time, Hemsley continued to cash in stock options which also added to his riches:
Outside AP’s calculation of his 2012 total compensation, Hemsley also acquired 284,836 shares that had vested with a value of $15.3 million. He also exercised options to acquire 600,000 shares and realized a value of $12.5 million. Those options and stock awards had been previously given to the executive.
The proxy said Hemsley directly owned UnitedHealth shares valued at about $140 million, as of March 1.
The Mission Promises Much but the Company Delivers Less
On one hand, the rate of rise of Hemsley's compensation at least seemed comparable to the company's financial performance:
Overall, UnitedHealth shares climbed 7 percent to close 2012 at $54.24, a smaller gain than the 13.4 percent advance from the Standard & Poor’s 500 index.
On the other hand, the largess given to the CEO ought to be contrasted with the how UnitedHealth failed to deliver what its mission promised.
Most recently, a jury found the company failed to live up to its legal obligation (in the state of Nevada) to review the quality of the clinicians on its panel. As reported by Bloomberg,
Two UnitedHealth Group Inc (UNH) units must pay $24 million in damages for failing to properly monitor a doctor who gave two colonoscopy patients hepatitis C by employing substandard medical practices, a Nevada jury ruled.
Jurors in state court in Las Vegas deliberated about five hours over two days before finding officials of Health Plan of Nevada and Sierra Health Services were negligent in their oversight of Dipek Desai. The former gastroenterologist has been blamed for infecting patients with hepatitis C by reusing vials of the anesthetic Propofol and failing to sterilize equipment.
The panel ordered the two UnitedHealth units to pay $15 million in compensatory damages to Bonnie Brunson and her husband and $9 million to Helen Meyer. The two women contend they got hepatitis during colonoscopy procedures at Desai’s clinic. Their lawyers said earlier in the case they may ask the jury to award more than $1 billion in punitive damages.
The verdict reflects 'what’s wrong with health insurance companies in the U.S.' Robert Eglet, Brunson’s lawyer, said in an interview after the verdict was announced. 'They put profit before patient safety.'
Note that the state of Nevada does explicitly hold managed care organizations accountable for the clinical quality of its health care professionals' practice,
Meyer and Brunson sued under a Nevada law requiring HMOs to file annual reports showing officials reviewed the quality of health services provided to their members.
The women’s lawyers argued officials of the UnitedHealth units knew Desai had a reputation for sloppy practice before giving him a contract to handle colonoscopies and then didn’t check the quality of his work. At one point, Desai was a member of Nevada's Board of Medical Examiners, which oversees the licensing of doctors in the state.
The plaintiffs contend the insurer didn’t properly monitor Desai’s practices and procedures even though they received complaints about his practices.
During the trial, witnesses said Desai adopted a cavalier attitude toward patient safety, speeding through procedures so he could see as many as 20 patients in a three-hour period.
The women’s lawyers argued the insurers’ executives had an obligation to insure Desai was providing quality care to their HMO members and were required to vet his practices before hiring him.
Also note that managed care organizations and other health insurers often boast about the quality of their provider panels.
For example, see the UnitedHealth mission statement:
- Our mission is to help people live healthier lives. Our role is to help make health care work for everyone.
- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities.
- We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price.
- We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.
It seems reasonable to interpret the italicized parts above as a statement of accountability for the quality of care provided by the health care professionals within the United network.
To reinforce that accountability, a subsequent Bloomberg story added,
Two UnitedHealth Group Inc (UNH) units must pay $500 million in punitive damages for failing to oversee a doctor blamed for giving colonoscopy patients hepatitis C through shoddy medical practices, a Nevada jury found.
Jurors in state court in Las Vegas deliberated more than six hours yesterday before handing down the punitive-damages award against Health Plan of Nevada and Sierra Health Services for turning a blind eye to Dipak Desai's actions.
Furthermore, the lofty UnitedHealth mission statement should be compared to two recent government findings.
In the state of California, as reported by the Los Angeles Times,
California Insurance Commissioner Dave Jones said the nation's largest health insurer, UnitedHealth Group Inc., is imposing unreasonable rate hikes on about 5,000 small businesses.
Jones said Wednesday that UnitedHealth couldn't justify the average annual increase of nearly 8%, which reflects both higher premiums and a reduction in benefits. He said the rate hike, which went into effect Wednesday, affects up to 45,000 small-business employees and dependents and represents $12.5 million in higher costs.
'At a time when small businesses are struggling to survive, UnitedHealthcare's rate increase is just one more unwarranted economic burden on California's small business owners and their employees,' Jones said.
Such behavior seems to contradict the mission statement's assurance that the company will seek to provide health care at "an affordable price."
Meanwhile, Bloomberg just published a story about how UnitedHealth has been running an insurance program for US military families.
The Pentagon rebuked UnitedHealth (UNH) Group Inc, the nation’s largest insurer, after military families began experiencing long delays getting medical-care referrals from the company.
The backlogs occurred almost as soon as Minnetonka, Minnesota-based UnitedHealth took over a contract, valued as much as $20.5 billion, from TriWest Healthcare Alliance Corp. It assumed responsibility on April 1 for the western region of the military’s health-care system, known as Tricare.
UnitedHealth’s 'failure to meet contractor requirements' has prevented a large number of beneficiaries in one Tricare health plan from obtaining timely access to specialty care, Jonathan Woodson, assistant secretary of defense for health affairs, said in a memo yesterday to other military leaders.
Woodson, calling the situation 'extraordinary,' said the Pentagon stepped in to grant a temporary waiver so the plan’s members in the western region could get specialty care without UnitedHealth’s authorization and not incur penalties..
This behavior seemed to contradict the mission statement's assurance that the company seeks to "expand access to quality health care."
The Song Remains the Same
Of course, UnitedHealth actually has a very long record of preaching about its aspirational mission, while paying its top hired managers extraordinary amounts and contradicting that mission, and at times ethical norms. Our posts on UnitedHealth are here. Recently we wrote,
UnitedHealth would be the company whose CEO once was worth over a billion dollars due to back dated stock options, some of which he had to give back, but despite all the resulting legal actions, was still the ninth best paid CEO in the US for the first decade of the 21st century (look here). UnitedHealth would be the company whose then CEO made a cool $106 million in 2009 (look here).
Moreover, UnitedHealth would also be the company known for a string of ethical lapses:
- as reported by the Hartford Courant, "UnitedHealth Group Inc., the largest U.S. health insurer, will refund $50 million to small businesses that New York state officials said were overcharged in 2006."
- UnitedHalth promised its investors it would continue to raise premiums, even if that priced increasing numbers of people out of its policies (see post here);
- UnitedHealth's acquisition of Pacificare in California allegedly lead to a "meltdown" of its claims paying mechanisms (see post here);
- UnitedHealth's acquisition of Sierra Health Services allegedly gave it a monopoly in Utah, while the company allegedly was transferring much of its revenue out of the state of Rhode Island, rather than using it to pay claims (see post here)
- UnitedHealth frequently violated Nebraska insurance laws (see post here);
- UnitedHealth settled charges that its Ingenix subsidiaries manipulation of data lead to underpaying patients who received out-of-network care (see post here).
- UnitedHealth was accused of hiding the fact that the physicians it is now employing through its Optum subsidiary in fact work for a for-profit company, not directly for their patients (see post here).
Summary
The US dysfunctional health care system has produced a long string of big corporations that promise warm and fuzzy health care yet deliver something less, all the while mightily enriching their top hired managers. Given the deadly serious nature of the health care system, these companies' promises, marketing, public relations and mission statements cannot be dismissed as fluff and puffery. Market fundamentalists and executive apologists have touted our system as market based. If patients must act as consumers, they cannot make good consuming decisions if they are awash with deceptive marketing and advertising. It is one thing for Hollywood to advertise blockbuster movies that are duds. It is another for health care corporations to advertise quality care and deliver bad care.
As we have said far too many times, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.
Kamis, 02 Mei 2013
Speaking at AHS13
The 2013 Ancestral Health Symposium will be held in Atlanta, GA, August 14-17. Last year was a great conference, and I look forward to more informative talks and networking. Tickets go fast, so reserve yours now if you plan to attend!
This year, I'll be speaking on insulin and obesity. My talk will be titled "Insulin and Obesity: Reconciling Conflicting Evidence". In this talk, I'll present the evidence for and against the idea that elevated insulin contributes to the development of obesity. One hypothesis states that elevated insulin contributes to obesity, while the other states that elevated insulin is caused by obesity and does not contribute to it. Both sides of the debate present evidence that appears compelling, and it often seems like each side is talking past the other rather than trying to incorporate all of the evidence into a larger, more powerful model.
There's a lot evidence that can be brought to bear on this question, but much of it hasn't reached the public yet. I'll explore a broad swath of evidence from clinical case studies, observational studies, controlled trials, animal research, physiology, and cell biology to test the two competing hypotheses and outline a model that can explain all of the seemingly conflicting data. Much of this information hasn't appeared on this blog. My goal is to put together a talk that will be informative to a researcher but also accessible to an informed layperson.
On a separate note, my AHS12 talk "Digestive Health, Inflammation and the Metabolic Syndrome" has not been posted online because the video recording of my talk has mysteriously disappeared. I think many WHS readers would be interested in the talk, since it covers research on the important and interdependent influence of gut health, inflammation, and psychological stress on the metabolic syndrome (the quintessential modern metabolic disorder). I'm going to try to find time to make a narrated slideshow so I can post it on YouTube.
This year, I'll be speaking on insulin and obesity. My talk will be titled "Insulin and Obesity: Reconciling Conflicting Evidence". In this talk, I'll present the evidence for and against the idea that elevated insulin contributes to the development of obesity. One hypothesis states that elevated insulin contributes to obesity, while the other states that elevated insulin is caused by obesity and does not contribute to it. Both sides of the debate present evidence that appears compelling, and it often seems like each side is talking past the other rather than trying to incorporate all of the evidence into a larger, more powerful model.
There's a lot evidence that can be brought to bear on this question, but much of it hasn't reached the public yet. I'll explore a broad swath of evidence from clinical case studies, observational studies, controlled trials, animal research, physiology, and cell biology to test the two competing hypotheses and outline a model that can explain all of the seemingly conflicting data. Much of this information hasn't appeared on this blog. My goal is to put together a talk that will be informative to a researcher but also accessible to an informed layperson.
On a separate note, my AHS12 talk "Digestive Health, Inflammation and the Metabolic Syndrome" has not been posted online because the video recording of my talk has mysteriously disappeared. I think many WHS readers would be interested in the talk, since it covers research on the important and interdependent influence of gut health, inflammation, and psychological stress on the metabolic syndrome (the quintessential modern metabolic disorder). I'm going to try to find time to make a narrated slideshow so I can post it on YouTube.
Amgen CEOs Prosper Despite (or Because of) Continuing Ethical Questions
This is becoming a familiar narrative on Health Care Renewal: top health care leaders continue to enrich themselves while their organizations' behavior continues to raise ethical questions.
For our latest example we return to the ongoing adventures of biotechnology giant Amgen.
CEOs Get Richer
An AP story (via the LA Times) documented the continuing enrichment of its current CEO:
The former CEO also did very well in his final year in office.
You would think they could both afford financial planning on their own.
Legal Settlements Pile Up
Keep in mind that as we discussed in late 2012 and early 2013, Amgen pleaded guilty to a charge of misbranding for promoting its epoetin drug Aranesp for unapproved indications, and settled allegations of giving kickbacks to physicians to increase the drug's use, among other charges, for a total of $762 million.
Furthermore, soon after the CEOs' compensation was announced, tiny articles in local media announced two more settlements by Amgen.
A small AP story (again via the LA Times) noted another settlement regarding allegations of unethical promotion of Aranesp:
Then a few days ago, a story in the San Fernando Valley Business Journal described yet another Amgen settlement:
Keep in mind that all these recent settlements involved allegations of efforts made to oversell Aranesp. As we noted previously, this drug carries a "black box" warning about serious and potentially fatal side effects. The official Aranesp label states (in a black box warning, in capital letters):
So the overselling of Aranesp not only appeared unethical, it seemed to put short term revenue ahead of patient safety, and could conceivably have lead to patients dying so that the company could make more money.
Summary
So while the evidence mounts that health care organizations, and in this case, Amgen, continue to aggressively pursue short-term revenue even is their means of doing so endangers patients. However, legal efforts to challenge such reckless practices continue to fail to impose any negative consequences on those who personally profited from this behavior, and particularly those corporate executives who authorized and directed the bad behavior. Moreover, while such evidence mounts, the top leaders of these organizations continue to pile up riches. It seems that CEOs of health care organizations continue to prosper despite, or perhaps because of their organizations' continuing unethical and dangerous behavior.
As we have said far too many times, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.
For our latest example we return to the ongoing adventures of biotechnology giant Amgen.
CEOs Get Richer
An AP story (via the LA Times) documented the continuing enrichment of its current CEO:
Amgen Inc's new chief executive, Robert A. Bradway, received total compensation of $13.6 million in 2012, more than his predecessor, according to an analysis of a company regulatory filing.
Bradway, who was promoted from chief operating officer to chief executive May 23, saw his compensation nearly double from $7.1 million in 2011.
Last year Bradway, 50, was paid a salary of $1.26 million and received stock awards worth $8.57 million, incentive payments of $3.32 million and miscellaneous compensation totaling $420,059. That included nearly $314,000 in retirement plan contributions, $65,000 for personal use of company aircraft, more than $20,000 for his personal expenses and those of guests during business travel, and $15,000 for financial planning services.
The former CEO also did very well in his final year in office.
Former CEO Kevin W. Sharer, who stepped down from his seat on Amgen's board when he retired Dec. 31, received compensation totaling $9.13 million last year.
Sharer was paid a 2012 salary of $1.81 million and received stock awards worth $3.66 million, incentive payments of $2.31 million and miscellaneous compensation totaling $1.36 million. That included $801,000 in retirement plan contributions, nearly $262,000 for personal use of company aircraft, more than $38,000 for his personal expenses and those of guests during business travel, $15,000 for financial planning services and more than $255,000 for secretarial, information technology and travel support. Much of that support runs through 2017.
You would think they could both afford financial planning on their own.
Legal Settlements Pile Up
Keep in mind that as we discussed in late 2012 and early 2013, Amgen pleaded guilty to a charge of misbranding for promoting its epoetin drug Aranesp for unapproved indications, and settled allegations of giving kickbacks to physicians to increase the drug's use, among other charges, for a total of $762 million.
Furthermore, soon after the CEOs' compensation was announced, tiny articles in local media announced two more settlements by Amgen.
A small AP story (again via the LA Times) noted another settlement regarding allegations of unethical promotion of Aranesp:
The US Department of Justice said Tuesday that biotech drug maker Amgen Inc. will pay $24.9 million to resolve claims it paid kickbacks to increase sales of its anemia drug Aranesp.
The Justice Department said Amgen paid kickbacks to Omnicare Inc. and PharMerica Corp., which sell drugs to long-term care providers such as nursing homes and hospitals, and Kindred Healthcare Inc., which runs long-term acute-care hospitals and nursing and rehabilitation centers.
Amgen wanted the companies to switch Medicare and Medicaid beneficiaries to Aranesp from competing drugs and tried to get consultant pharmacists and nursing home staffers to encourage the use of Aranesp in patients who didn't have anemia associated with kidney failure, the Justice Department said.
The Thousand Oaks company made payments based on the sales volume or market share of Aranesp, the agency said.
Then a few days ago, a story in the San Fernando Valley Business Journal described yet another Amgen settlement:
Thousand Oaks biotech Amgen Inc. has reached an $11 million settlement with 36 states over charges it inflated pricing data and caused Medicaid to overpay for six of its drugs, the New York State Attorney General said Monday.
The charges allege Amgen inflated cost benchmarks for drugs used to treat kidney disease and cancer patients. The drugs involved were Aranesp, Enbrel, Epogen, Neulasta, Neupogen and Sensipar. Those benchmarks are used to set pharmacy reimbursement rates for drugs dispensed to state Medicaid beneficiaries.
Keep in mind that all these recent settlements involved allegations of efforts made to oversell Aranesp. As we noted previously, this drug carries a "black box" warning about serious and potentially fatal side effects. The official Aranesp label states (in a black box warning, in capital letters):
ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE
So the overselling of Aranesp not only appeared unethical, it seemed to put short term revenue ahead of patient safety, and could conceivably have lead to patients dying so that the company could make more money.
Summary
So while the evidence mounts that health care organizations, and in this case, Amgen, continue to aggressively pursue short-term revenue even is their means of doing so endangers patients. However, legal efforts to challenge such reckless practices continue to fail to impose any negative consequences on those who personally profited from this behavior, and particularly those corporate executives who authorized and directed the bad behavior. Moreover, while such evidence mounts, the top leaders of these organizations continue to pile up riches. It seems that CEOs of health care organizations continue to prosper despite, or perhaps because of their organizations' continuing unethical and dangerous behavior.
As we have said far too many times, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences. Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.
Hair Diary || Summer Regimen of Wash-n-gos and Braid-outs
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| (LEFT) Wash-n-go puffs. No gel. (RIGHT) Braid-out on flat-ironed hair. |
Alright, so I want to wear my hair out this summer (after years of protective styling ~99% of the time). I will largely wear a mix of braid-outs on low-heat flat-ironed hair AND wash-n-gos. Here are more details:
MY WASH-N-GOS (inspired by long-haired type 4 Cynthiarf):
So I first tried Cynthiarf's method a few months ago, and was surprised at how little my hair became tangled from daily wash-n-gos. And to think that after my hair grew past shoulder-length (years ago), that that was the end of wash-n-gos for me. Well, I was wrong after having tried this lady's technique.
Here's my wash-n-go regimen for the summer:
- Pre-poo overnight with Extra Virgin Coconut Oil (EVCO)
- Shampoo weekly (Desert Essence Tea Tree Shampoo) followed by quick conditioner
- Co-wash daily (Suave, Tresemme)
- Finger comb while co-washing (view Cynthiarf's tutorial of this process)
- Shake and go
MY BRAID-OUTS ON STRAIGHT HAIR (inspired by long-haired type 4 JoStylin):
Now, JoStylin does her braid-outs on blow-dried hair, but I am not a fan of blow drying on my hair (more on this another time). Instead, I will do my braid-outs on lightly flat-ironed hair (i.e., 300 degrees F). Other than this change, I love her simple routine as well as how she leaves a few braids in the back. (Read my previous post about JoStylin.)
Here's my braid-out regimen for the summer:
- Pre-poo overnight with EVCO
- Shampoo then deep condition (ORS Replenishing Pak, Tresemme Split Ends)
- Moisturize/seal with Shea Butter Mixture
- Air-dry in big braids/twists
- Flat-iron on low heat (300 degrees F, Proclaim Heat Protectant though I prefer Carol's Daughter)
- Put in 6-8 big braids for braid-out
- Re-braid nightly; Rock hair for 2-3 weeks
And that's it! Now for more hair photos:
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| Wash-n-go puff with flash. Cottony. |
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| Wash-n-go after air-drying throughout the day. I swear I can enter a shrinkage contest. Where's the application? |
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| Flat-iron (~340 F) before my previous braid-out. Future flat-iron jobs will be 300 F max. This is because I plan to flat-iron a little more frequently this summer (for the braid-out regimen). |
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