Home Health Care Choose Wisely

Friday, July 27, 2012
Many people don't think about it until it's too late, but home health care is something that you should consider before hospitals or nursing homes become your only option. Realistically, wouldn't you want your children to keep you around after you are unable to take care of yourself, in the comfort of your own home?If you have not run across the idea of home health care yet in your travels, it combines the best of many worlds of care. The same quality of care a patient would get in a hospital is transferred to a private residence, where the patient is the sole focus of a trained professional on hand.The person will be trained in many basic and advanced parts of the treatment process, including having knowledge of nutrition, IV's, patient and caregiver processes, occupational and dietary therapy, and a consistent knowledge of anything medically related that specific person needs to be health and safe in the home environment.If medical agencies are smart, they always have an arm of their service that includes the ability of their staff to go on home health care assignments. This is because is can be beneficial to all parties involved, as the correct utilization of resources saves everyone time and money, and people use that to their advantage.If you are worried about certain conditions for your parent, here are some things that home health care deals with as well - helping them eat and drink properly, basic cooking and cleaning, checking temperature and breathing, if they need assistance getting into and out of bed, if they need a helping hand with things like bathing or using the bathroom.One of the first things that you should discuss is the plan of care. That is a document that details all of the daily, short term, and long term aspects of the care, from who is going to take care of what, to the types of medical equipment that needs to be on hand, to deciding which treatments are going to take how long and when results should be seen.Staff should always be determined to improve their service as well. If you have noticed that your home health care provided has become lazy or does not take as much interest in the client as they should, you should immediately start shopping around for a better place to hire from. Improvement is always the key.It's not an easy decision sending a loved one to a hospital or nursing home, so make the right choice and instead have the hospital come to you. The service can be excellent, and you'll feel more connected instead of guilty as time goes by and your parents are still happy.

Bay Area Home Care Services Always the Right Choice for Home Health Care!

Sunday, July 22, 2012
How To Stop The Hands Of Time And Prevent Aging Aging is a process everything and everyone goes through. From a fine wine, to an elegant older woman, there are many plus sides to aging. There are down sides as well. As with anything there are always two sides. Things and people that age gracefully are generally preferred by everyone.

Memory Tips As you age, it is important to reassess your nutritional needs, in order to compensate for natural losses of some nutrients, as well as an increased need for others. For example, iron deficiencies are extremely common in the elderly and good daily intake of calcium is crucial to fighting osteoporosis. A key to aging well is to maintain a good relationship with your physician. By getting yearly preventative checkups as well as any checkups that are necessary in between, you are taking a proactive approach to aging. There are many diseases that when caught early are highly treatable. Early disease treatment will definitely slow down your aging process. Aging does not mean that you can't live a fulfilling life. Go to parties and gatherings as much as possible because socializing is the best way to keep your mind nimble. Exercise whenever possible even if it means walking to the mail box more than five times a day. Visit SF Bay Area Home Care Services to find out how we can assist you in your home health care sercices needs. An easy trick to slow the aging process that we cause to ourselves is to pat dry your face after washing. Over time we pull our skin and stretch it out when we rub down with the towel after washing. Instead just pat dry your face to prevent adding to the effects of gravity.

Memory Tips If you are caring for an aging parent, make sure you are realistic regarding their conditions and limitations. To avoid accidents and other problems, take them to a physician for an evaluation to make sure you are able to provide the care and safety an ill or elderly adult needs. Talk to your healthcare provider about the potential benefits of hormone therapy. As you age your hormone levels change, and some stop altogether. Your doctor will be the one who can tell you if you need to investigate hormone therapy, or if you should avoid it. Do not start anything without consultation. Don't get caught feeling and acting old! Spend time with children! Volunteer at a daycare or a church nursery where you can feel useful and engage in childish activities. Keep in touch often with grandkids and have them visit often. Children will make you feel young and joyful again! When you get older, you tend to want to hold onto the past and resist change, but you should really embrace this change as the whole part of the process of getting older. It's all in the attitude. Look forward to them, and think of them as a new adventure. If you want to age well, ignore the numbers that aren't necessary for you to focus on. This means that you should not think about your age, your weight or your height. Your physician can keep track of those things and let you know if there are any problems; otherwise, you will feel better, younger and healthier if you don't keep track of the numbers. While it is probably something one would rather not think about as one ages, it can be beneficial to be aware of one's mortality. In what sense? The purpose of this is not to dwell on the "end", but rather to make us realize that every day is important, and that life is a gift we should take advantage of in every capacity. Home Health Care

Memory Tips Many elderly people suffer from the pain of arthritis. But few understand the emotional pain it can cause. Pre-plan for the time when you are going to need senior services. This may be planning for your retirement home, nursing home or home health care. If you take the time to plan it while you are able to, you are sure to end up in the place that you want to and that will bring you peace. To age brings troubles, sure, but with every trouble there is generally a plus side. For instance, your wine may have had to age for years before being enjoyed, which is troublesome because you have to wait for a long time to enjoy it. But when you do get to savor the experience of that wine aging, it is well worth it. Visit SF Bay Area Home Care Services to find out how we can assist you in your home health care sercices needs.

This 52 year old is a Senior Citizen Health & Wellness Counselor in the San Francisco Bay Area. Visit http://www.bayareahomecareservices.com to find out more about senior health care services in the SF Bay Area

Attention Home Health Care Now You Can Easily Get New Ways To Observing Chair Raiser Daily Living

If you or a cherished one have difficulty getting up and moving about or alternatively from sitting furnishings, buying a well made chair raiser invariably is an easy and affordable answer to the issue. Boosting your chair's position makes it way more easily accessible and comfy to those having personal injury or perhaps ailments. It is another good way to help make the elderly more comfortable inside their dwelling. Managing limited range of motion does not require being a struggle. Disability aids like chair raiser packages, equip people who have personal injury as well as capability to move challenges to maintain completely full and individual lives. Getting completely new household furniture will be expensive but not a necessity. You might be in need of assistance or you have a dearly loved one that must have particular pieces of furniture, using a high quality chair raiser with each and every piece of furniture leg is most likely the simplest way to improve regular furniture in to tailored chairs for individuals that are experiencing physical troubles.

Compared to a good number of different types of disability products or custom-made household furniture, a good chair raiser set up is amazingly reasonably priced and also available for most people of all net income grades. In case you intend to get more complicated disability appliances sometime soon, utilizing chair raisers before you pay for it is just a fantastic non-permanent option. When they've non-permanent problems and even a particular continuing health problem, making use of chair furniture is one of the more common issues among the people who have constrained flexibility. Raising house furniture is likely to make sitting down then standing right up much simpler and less risky.

Extra pillows are often times employed as being some sort of way to heighten sitting furniture pieces, but they are not really sensible or maybe a risk-free remedy when it comes to elderly people and / or people who have bodily issues. Added special pillows can certainly make sitting not comfortable and then cut short the amount of the gap relating to the seating elevation and arm rests. Armrests make arising less difficult and provide protection from accidental stumbling, so they really really should not be hindered with soft cushions. Simply by using a professionally created chair raiser can be a greater solution since it helps make chair home furnishings much more accessible without transforming the way is visually or perhaps feels.

Chair raiser sets can be bought in lots of brands and styles by way of individual pieces to interlocked raisers. It is important to look for a product which won't slip all-around on the ground and also that can provide the elevation you are searching for. Simply because furniture pieces can be changed and then people's actual requirements can change, it is better to obtain chair raisers that could be adjusted as appropriate. Superior is the one other ingredient that you need to think about when deciding on a chair raiser. To protect yourself from acquiring terribly manufactured merchandise, it is much better to shop within professional stores or maybe internet sites that offer a guarantee with level of quality.

The On-line World gives a wide variety of options in terms of disability appliances. Buckingham Healthcare is among the most among the most trusted providers of disability aids like chair raisers. Buckingham raisers can be utilized with many different types of pieces of furniture like seats, bedrooms plus couches. A single chair raiser set contains 4 individual pieces that can be adapted to adjust to the unique requirements of all of the people who have constrained capability to move. When you have an actual impairment or possibly have got a significant other that wishes assistance going around his or her residence, getting a Buckingham chair raiser set can certainly make a big difference. There's lots on this info at Buckingham Chair Raiser as well as the actual Chair Raisers blog in which you will certainly find out quite a few exceptional assets along with tips.

Alternative Financing Options - Home Health Care Factoring

Specifically, Credit Unions, Community Development Financial Institutions (CDFIs), Micro Lenders and Accounts Receivable Factoring Firms all said YES to the majority of their small business financing applications while most larger banks repeatedly said NO.Although a home healthcare agency owner could be approved for financing by any of the alternative lenders listed above, the best alternative financing option for them is to work with a home healthcare factor, and here's why:1. Home Health Care Factoring Creates Positive Cash FlowSome Medicaid waiver programs can take up to a month to reimburse an agency for its pre-approved non-medical in-home services.

This lag in payments makes it difficult for new or growing agencies to be able to meet payroll and other financial obligations. However, when agency owners sell their Medicaid receivables to a home care funding firm, funds can be directly deposited into their bank account within hours. Instead of waiting weeks or months, factoring your home care business gives business owners immediate access to cash.2. Home Health Care Factoring Helps Eliminate OverheadIn addition to providing capital, home health care factors provide invoice processing services, which include the following: posting invoices to a computer, depositing checks, entering payments, following-up on past-due invoices and producing consistent reports. Agency owners can greatly reduce their current overhead costs associated with processing invoices and eliminate the overhead cost of handling collections when they work with a factoring firm. Moreover, agency owners can use the time they used to spend on collections, administration, bookkeeping, talking to banks, etc. to focus on marketing, sales and other business-growing activities.3. Factoring Medicaid Receivables Helps Home Health Care Agencies Build CreditAs was previously discussed, home health care factoring provides agency owners with adequate cash flow.

This new found access to capital gives agency owners the ability to pay its vendors on time, helping them to establish a good credit rating. Having good credit will make it easier for vendors and other financial institutions to extend credit to the agency in the future. In addition, factoring home health care allows agency owners to take advantage of early payment discounts. For example, some vendors will offer a two percent discount if a home health care agency owner pays its bills within ten days. This savings can then be used to offset the cost of factoring.Eventually, the big banks will start lending again. In the meantime, home health care factoring is a great alternative financing option for agency owners to utilize. Specifically, home health care funding generates a positive cash flow, eliminates overhead costs and helps home health care agency owners build credit.

All For One Home Health Home Health Care For Pediatric Clients

Saturday, July 14, 2012
When we hear the words home health care, what comes to our mind is the care given at home for old and aged individuals. What we don't know is that pediatric home health care is also widely being practiced on most part of the country. This type of home health care specializes on the needs of pediatric clients or those aged 18 and below. See that there are also individuals specifically the kids and infants who are in need of special care and treatment at home. Certain agencies like All For One Home Health provide these types of services without you weekly visiting the hospital. Right at the comfort of your own home, all care can be provided at its best. Compared to adult home health care, pediatric care at home is more crucial and significant because one mistake can end the life of the newly born or growing up patient. People on a very young age are very much susceptible to health damages like infections as they are not yet fully grown up to fight all bacteria and viruses lingering around our environment. They are also the most common victims of congenital anomalies which subject them from being incapable of doing all things that a normal child can do. Utmost medical care is also needed for young ones as they are still on the developmental task of their lives that one mistake can lead to unacceptable social behaviors. These are just some of the most common cases in which a child requires pediatric home health care assistance.

When choosing a home health care agency, you need to consider several things in mind because not all of them are proficient on giving pediatric care at home. Take a look at this list created by All For One Home Health which is a well rounded home health care agency and make sure to check each and every one of these things upon looking for a pediatric home health care agency for they bear much importance to the health and wellness of your child. 1. Make sure that all medical staffs are trained to handle pediatric cases - not all nurses, therapists, workers and all other medical professionals are well adept on pediatric cases. Make sure that the agency holds certified and well trained medical staffs; you can easily assess this by asking for pediatric trainings and certifications. 2. Choose trusted and well established pediatric home health care agencies - as with elderly home health care agencies, you need to choose well established and dependable partners like All For One Home Health Care whom you can trust as your child requires not just ordinary health care needs but particular medical interventions.

3. Go for agencies that offers wide variety of medical services - the primary thing that makes you decide to go for home health care assistance is the fact that you need someone readily available to provide all your child's medical needs without going back and forth to the hospital. Hence, choose an agency that offers not just few medical services but as much as possible almost all of them. This will save you both time and effort by avoiding frequent visits to the hospital. Always remember that your child needs twice more care and importance than elderly ones. They cannot tell you face to face which body part is aching, they cannot say loud and clear that they need food, and most of all they cannot command you to give them utmost care and attention so it is your job to fulfill these needs by hiring a professional pediatric home health care agency.

About Home Health Care

Numerous seniors that are older than sixty five years old have difficulty maintaining their lifestyle because of sickness or feeling weak. As with young kids, they have providers that arrive in-home to help them out. These home health care assistants come during the day, or some stay overnight to help with regular day time duties. The most typical responsibilities these assistants do are listed below in this article.Preparing meals is definitely an important responsibility since it retains your family member's health. A good health care aide will ensure that seniors consume a well balanced diet plan. A wellness assistant can make breakfast every day, lunch, as well as supper before they leave. This can also be based on the recommendations of a physician, when the elderly patient has certain health conditions or even allergic reactions to certain foods.Housekeeping may be a premise for some aides, though not all, just like what a babysitter would do. A few examples would be vacuuming, laundry or dishwashing. If not, you may need the help of a house cleaner too.Incontinence is really a common medical problem amongst senior citizens and several may need to stay in diapers.

Just like an infant, a grownup sitter will even carry out these types of responsibilities. In case your mother or father is affected by incontinence, it is crucial to describe this throughout the job interview, to ensure applicants understand this particular responsibility.Transport service may also be provided. It's no secret that senior citizens need to stay active and maintain some semblance of a normal life. That's why if you can keep up with them taking excursions, doing chores, or even going shopping, by all means do. Some assistants will be a driver, a cook and serve multiple roles.In the end, being able to move around is actually a part of why individuals feel liberated. Having the ability to maneuver any place you want, is one thing which everybody may connect with, as well as value. Therefore, make sure to give this support for getting your parents as much freedom to move around as possible, instead of limiting them.Healthcare providers can perform health services, such as giving insulin for diabetes sufferers, altering catheters, as well as periodic screenings. A competent home health care assistant should be comfortable with this, so you don't have to worry about your parent getting medications or checkups on time.The similarities between kid care and grownup care are extremely comparable. A home health care agent is going to care for someone dear to you. Given that babies as well as senior citizens require a lot of attention, be sure to prudently select one who will treat your mother or father like their own.

Giant GSK Settlement Provides Reminder of the Pervasiveness of Stealth Marketing

Thursday, July 5, 2012
The latest  and biggest legal settlement involving health care to hit the news, that of GlaxoSmithKline (GSK) and the US government, has many familiar elements. As summarized by the New York Times,
In the largest settlement involving a pharmaceutical company, the British drugmaker GlaxoSmithKline agreed to plead guilty to criminal charges and pay $3 billion in fines for promoting its best-selling antidepressants for unapproved uses and failing to report safety data about a top diabetes drug, federal prosecutors announced Monday. The agreement also includes civil penalties for improper marketing of a half-dozen other drugs.

As was the case for nearly every other legal settlement we have discussed,
No individuals have been charged in any of these cases.
Thus, how well even such a large settlement will deter future wrong-doing is not clear.

Nonetheless, the documents released with it provide good documentation about how pervasive systematic, deceptive stealth marketing campaigns have become in health care. 

In particular, the official "complaint" filed by the US Department of Justice emphasized all these elements in the stealth marketing of paroxetine (Paxil, Seroxat in the UK) to adolescents.

Manipulation of Clinical Research

We have frequently discussed how health care corporations, particularly pharmaceutical, biotechnology and device companies, now sponsor  the majority of clinical research.  Their control of the design, implementation, analysis and dissemination of clinical research allows manipulation that increases the likelihood that the results will be favorable to their vested interests, usually the products and services they sell. 

We have previously discussed the manipulation of Study 329 to promote the marketing of Paxil (look here and here).  However, the US DOJ document makes these concerns more official.  It included:

Manipulation of Study Endpoints

Study 329 was a randomized controlled trial of Paxil vs imipramine vs placebo for depression in adolescents. The two primary endpoints pre-specified to the US Food and Drug Administration were "the degree to which a patient's Hamilton Rating Scale for Depression ('HAM-D') total score changed from baseline"; and "the patient's 'response' to medication, as defined as (a) a 50% or greater reduction in the patient's HAMD-D score, or (b) a HAM-D score of less than or equal to 8." However, initial analysis by GSK failed to show that Paxil improved either of these two end-points. The company concluded "it would be commercially unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile of [Paxil]."

So the analysis emphasized secondary outcomes, the "Study 329 investigators later added several additional efficacy measures not specified in the protocol. Paxil separate statistically from placebo on certain of these measures." Adding numerous post-hoc measures increased the likelihood of finding a difference on at least one due to chance alone.

Manipulation of Data

Initial analysis of the data suggested that patients given Paxil experienced 11 serious adverse events, including five that appeared related to suicidal ideation or action. When the FDA later reexamined the data, "upon closer examination the number of possible suicide-related events among the Study 329 Paxil patients increased beyond the five patients GSK described in the JACAAP article as having 'emotional lability.' While collecting saftey information for the FDA, GSK admitted that there were four more possible suicide-related events among Paxil patients in Study 329. In addition the FDA later identified yet another possible suicide-related event in the Study 329 Paxil patients, which was also not among the 11 serious advents listed in the JAACAP article. Thus, altogether, 10 of the 93 Paxil patients in Study 329 experienced a possible suicidal event, compared to one in 87 patients on placebo. This is a fundamentally different picture of Paxil's pediatric safety profile than the one painted by the JAACAP article...." 

Manipulation of Dissemination

The report describing the results of Study 329 (Keller MB, Ryan ND, Strober M et al.  Efficacy of paroxetine in the treatment of adolescent major depression: a randomized controlled trial.  J Am Acad Child Adolescent Psychiatry 2001; 40: 762-772.  Link here. ) was written under the control of GSK. "In April 1998, GSK hired Scientific Therapeutics Information, Inc (STI) to prepare a journal article about Study 329. GSK worked closely with STI on the article by providing a draft clinical report to 'serve as a template for the proposed publication.'"

The published report of Study 329 "mischaracterized the results." "Although the ... article identified the study's two primary endpoints in the abstract, the article did not explicitly state that Paxil failed to show superiority to placebo on either of the primary efficacy measures." Also, "the article did not explicitly identify the two protocol-specified primary outcome measures - or that Paxil failed to show superiority to placebo on these two measures. Instead the article claimed that there were eight efficacy measures and that Paxil was statistically superior to placebo on four of them." In addition, "while the article listed the five protocol-defined secondary endpoints, the text of the article omitted any discussion regarding three of the secondary measures on which Paxil failed to statistically demonstrate its superiority to placebo and instead focused on the five secondary measures that GSK added belatedly and never incorporated into the Study 329 protocol. The article claimed that these finve secondary measures had been identified 'a priori,' therefore incorrectly suggesting that all secondary endpoints had been part of the original study protocol." In other words, the final published articles contained multiple outright falsehoods about the drug's efficacy that exaggerated that efficacy.

Furthermore, initial analysis showed that patients given Paxil had more serious adverse events than others. An initial draft of the study article stated, "serious adverse events occurred in 11 patients in the paroxetine group, 5 in the imipramine group, and 2 in the placebo group." These included "headache during down-titration(1 patient), and various psychiatric events (10 patients): worsening depression (2); emotional lability (e.g., suicidal ideation/ gestures, overdoses), (5); conduct problems or hostility (e.g., aggressiveness, behavioral disturbance in school) (2); and mania (1)." As noted above, the number of suicide related events was actually double that noted in this draft as "emotional lability."  However, the published version of the report "falsely state[d] that only one of the 11 serious adverse events in Paxil patients was considered related to treatment...."  Nor did it mention the true number of events related to suicidal ideation or action.

The article only "listed at most five possibly suicidal events among Paxil patients, brushed those off as unrelated to Paxil, and conclude that treating children with Paxil was safe."

Later, GSK marketing materials described the results of the study thus,
This 'cutting-edge,' landmark study is the first to compare efficacy of an SSRI and a TCA with placebo in the treatment of major depression in adolescents. Paxil demonstrates REMARKABLE Efficacy and Safety in the treatment of adolescent depression."
Thus the conrol exerted by GSK over the published article, despite its apparent academic authorship, enabled it to promote a drug that was not efficacious and had major adverse events as remarkably safe and effective, a totally deceptive result that would mislead any health care professional who used the article to guide clinical practice. 

Suppression of Clinical Research

GSK sponsored two other studies of Paxil in pediatric populations, Studies 377 and 701. As stated in the Department of Justice's Criminal Complaint against GSK,
GSK Did Not Publicize the Results of Studies 377 and 701
43. GSK learned the results of Study 377 in 1998 and the results of Study 701 in 2001. Paxil failed to demonstrate efficacy on any of the endpoints of either study.
44. GSK did not hire a contractor to help write medical articles about the results of Studies 377 and 701, as it had with Study 329.
45. GSK did not inform its sales representatives about the results of Studies 377 and 701.
Thus, GSK managed to conceal the fact that the majority of the studies it sponsored about Paxil used for adolescent patients showed no evidence that the drug worked, again seriously distorting the evidence-base on which clinicians made decisions, and doubtless leading to the use of a dangerous, ineffective drug by numerous vulnerable patients.

Bribing Physicians to Prescribe

GSK's sales representative reflected in their call notes their use of money, gifts, entertainment and other kickbacks to induct doctors to prescribe GSK drugs....

One really creative way to pay physicians to be exposed to marketing:
For example, in or about 2000 or 2001, GSK used 'Reprint Mastery Training Programs' or 'RMTS' to further promote drugs by purporting to pay physicians to train sales representative to review reprints of studies. Although the training was purportedly for the representatives, in fact, the sales force was already familiar with the materials. GSK typically paid physicians $250 to $500 to review the reprints.
Thus GSK simply paid physicians to use its drug, a practice characterized as kickbacks in the official complaint.  An article in the Guardian noted that the US Attorney involved in the case put it even more bluntly,
The sales force bribed physicians to prescribe GSK products using every imaginable form of high-priced entertainment, from Hawaiian vacations [and] paying doctors millions of dollars to go on speaking tours, to tickets to Madonna concerts.

Use of Key Opinion Leaders as Disguised Marketers

GSK also created a group of national 'key opinion leaders' ('KOLs') who were paid generous consulting fees. GSK selected many of these physicians based on their prescribing habits and influence within the community and used the speaker fees paid to these physicians to induce and reward prescribing of GSK's products. GSK used these individual to communicate marketing messages focused on the drug's marketing campaigns at the time, including off-label uses. Some physicians on GSK's speaker's board have been paid more than a million dollars for speaking on behalf of the company and recommending its drugs.

Thus key opinion leaders were paid specifically to market drugs, and as a reward, a bribe for prescribing drugs.

Consulting Fees as Kickbacks

In general,
In order to induce physicians to prescribe and recommend its drugs, GSK paid kickbacks to health professionals in various forms, including speaking or consulting fees, travel, entertainment, gifts, grants, and sham advisory boards, training,....

In particular,
During 2000 and 2001 at least, GSK also utilized events termed 'advisory boards' or consultant meetings and forums to disseminate its promotional message. Although these boards were purportedly composed of 'thought leaders' for the purpose of obtaining advice from the physicians, in fact, the 'advisory boards' were little more than promotional events coupled with financial inducement to prescribing and influential physicians.

GSK typically paid the physician between $250 and $750 to attend each local 'advisory' meeting. The payments did not reflect the value of services. The physician was not required to do anything but show up. GSK had no legitimate business reason to hire thousands of 'advisors' to 'consult' with the company about a single drug.

Manipulation of Continuing Medical Education

GSK also used so-called CME and CME Express programs and other sham training for marketing purposes, and to promote off-labe uses for the GSK prescription drugs.

These CME programs purported to be independent eduaction free of company influence, but in fact functioned as GSK promotional programs disguised as medical education. GSK maintained control and influence over the purportedly independent CME programs through speaker selection, and influence over content and audience, among other things. Although third party vendors were usually also involved, they served only as artificial 'firewalls' that did not insulate the program from GSK's influence.


The legal documentation of the GSK settlement demonstrated how one drug company used an integrated, systematic campaign incorporating deception and bribery to sell drugs. Its elements included manipulation and suppression of the clinical research it sponsored, paying key opinion leaders to be disguised drug marketers, outright payments to physicians to prescribe drugs, and manipulation, again using payments to physicians, of supposedly independent continuing medical education. 

Note that while I summarized the elements of the stealth marketing campaign to sell Paxil, particularly for use in pediatric patients, the US government complaint also documents similar activities used to sell other drugs.  Furthermore, other stealth marketing campaigns have come to light through legal action, and many other instances of manipulation and suppression of clinical research, use of KOLs as disguised marketers, kickbacks and bribes, and manipulation of CME have been documented.

This means that any claims that:
- commercially sponsored clinical research provides clear, unbiased data that should drive clinical decisions
- health care professionals and academics paid as consultants by commercial health care firms are not influenced by these payments, and can provide clear, unbiased opinions
- commercially sponsored medical education provides clear, unbiased teaching
unfortunately must be viewed with extreme skepticism. This is particularly unfortunate given that most clinical research is now supported by commercial sponsors, and the majority of influential academics in medicine get some form of payments from the health care industry (look here).

Of course, there are some physicians who consult for commercial firms who actually provide clinical or scientific advice or assistance, and some commercially sponsored activities are honest. But we must wonder what garden path all those advocates for increasing industry "collaboration" to promote "innovation," and who regard conflicts of interest as "inevitable" and "manageable" are taking us down (e.g., look here and here).

Although the current settlement will require a huge payment, as I have said many times before (as early as 2008, here), do not expect such settlements to deter future bad behavior like that listed above.  The cost of the settlement will actually be spread among all company shareholders, all company employees, and likely patients and taxpayers.  However, the settlement will entail no specific negative consequences to the people who authorized, directed, or implemented the bad behavior.  In particular, executives whose remuneration was swollen by proceeds from the sales of affected drugs, and the health care professionals who willingly accepted what the US Attorney called bribes will not pay any sort of penalty.  The bad behavior listed above was doubtless personally very profitable for some people.  Unless people who indulge in such behavior face the possibility of penalties worse than their expected gains, expect such bad behavior to continue.

In fact, as the New York Times reported,
critics argue that even large fines are not enough to deter drug companies from unlawful behavior. Only when prosecutors single out individual executives for punishment, they say, will practices begin to change.

'What we’re learning is that money doesn’t deter corporate malfeasance,' said Eliot Spitzer, who, as New York’s attorney general, sued GlaxoSmithKline in 2004 over similar accusations involving Paxil. 'The only thing that will work in my view is C.E.O.’s and officials being forced to resign and individual culpability being enforced.'

True health care reform would strive to eliminate important conflicts of interest affecting clinical research and medical education.  Specifically, it would prevent corporations that sell health care products or services from controlling clinical research meant to evaluate these products or services.  It would seek to eliminate serious conflicts of interest affecting health care professionals.  Finally, it would prevent vested interests from controlling medical education.  Not that I expect any such reform in the near future, it would be too threatening to those who have personally benefited from the current system.

Hat tip to Dr Howard Brody whose Hooked: Ethics, Medicine and Pharma blog scooped me on the details of the settlement relevant to study 329.

Fool Us Once, Shame on You, Fool Us Twice, Shame on Us - The Untrustworthy Pronouncements of Aetna's Former CEOs

Monday, July 2, 2012
A small tempest in the larger US health care reform teapot was produced a few weeks ago when Ron Williams, former CEO of Aetna, declared in a Wall Street Journal op-ed that he no longer supported the health insurance mandate.  The "mandate" for all US citizens to buy health insurance, actually a relatively small tax that would be imposed on people without health insurance, was the central point of contention in the lawsuit before the US Supreme Court challenging the Affordable Care Act (ACA). 

Immediate Past-CEO of Aetna Ron Williams' Abrupt Change of Mind on the Individual Mandate

Williams wrote,
Soon the U.S. Supreme Court will rule on the constitutionality of the Affordable Care Act. I am not a lawyer, or an expert on the Constitution. But as the chairman and CEO of a major health plan, I had a ringside seat to the entire health-care reform process. After much reflection, I have concluded that the federal individual mandate, which requires all Americans to purchase health insurance starting in 2014, will not be upheld.

On this, Williams was soon proven wrong. The Supreme Court upheld the law. However, the tempest was not due just to Williams' reversal of his former opinion, but the role he actually played in pushing his former opinion into the passage of the law, which was really far more than being a "ringside" spectator.

In an August 24, 2009 article, "Aetna's Ron Williams on Health Reform," Forbes' Dan Whelan noted,
Williams, 59, is taking a surprisingly visible role in arguing for change in the health care system. He has met with Obama a half-dozen times (he shrugs off the surname gaffe), has testified four times in front of Senate committees this year and participates in shindigs set up by the many trade groups for which he's a director.

Williams' position echoes that of the HMO industry generally: He's against a government-run plan but favors universal coverage and forcing insurers to take all comers.

As Wendell Potter, the former head of public relations for large health for-profit health insurance company Cigna, who is now a strong industry critic, put it on his blog,
Ron Williams who possibly more than anyone else had persuaded the President to reconsider his campaign pledge to enact reform without making people buy coverage from a private insurer. Candidate Obama’s reform platform differed from those of Hillary Clinton’s and John Edwards’ in only one significant way: both Clinton and Edwards embraced the mandate, which Williams was championing, first behind the scenes and then publicly, on behalf of the insurance industry. Candidate Obama said he didn’t believe it was right for people to be forced to buy something they couldn’t afford.

Williams was the industry’s most visible CEO on Capitol Hill during the debate on reform. He testified at numerous congressional hearings about how essential it was to move the millions of uninsured Americans into private health insurance plans and how an individual mandate was necessary to make that happen. He also never missed an opportunity to trash the idea of a 'public option' to compete with private insurance companies, which candidate Obama had said was essential 'to keep private insurers honest.'

Capitol Hill was not the only place Williams was frequenting during the reform debate. In an August 2009 article in Forbes, Williams was quoted as saying that he already had met with the President six times. When I called the White House to confirm that, a top aide told me it was true Williams had been there many times, adding, 'We’ve found him to be one of the more reasonable ones.'

Williams' recent seeming disavowal of the individual mandate raises the question of why anyone, much less President Obama, trusted him in the first place. After all, he was CEO of Aetna.

2001 Aetna CEO John Rowe Blamed Everyone Else for Health Care Problems

In fact, perusal of my memory, and a few file folders suggested several previous cases in which Aetna CEOs issued pronouncements that should not have been trusted.

First I recalled a meeting in 2001 at Brown during which the then Aetna CEO was honored by giving the Paul Levinger Lecture on "Good Health: Can We Afford It?" (See original Brown news release here.) My memory is that of Dr Rowe blaming just about everybody other than the for-profit health care insurance companies for health care's ills. A Brown Daily Herald article (not currently on line, Baskin B. Health care getting harder to afford, Aetna chief tells Brown U. Brown Daily Herald, November 30, 2001) recounted him blaming "cost inflation," (presumably due to doctors and hospitals), and employers, for whom "quality doesn't matter." He only allowed that insurers were to blame for not giving "better service," but not either rising costs or poor quality. I also recall Dr Rowe being treated with great respect by the audience. After all, this was a prestigious lecture.

However, his talk seemed just the least bit self-serving. If the audience had been aware of his record at the time, maybe we would have been more skeptical.

Mount Sinai CEO Dr John Rowe Extolled Merger with New York University, Jumped to Become Aetna CEO as Merger Began to Fail

By 1993, Dr Rowe was CEO of Mount Sinai Medical Center, and was seemingly at the vanguard of the movement for health care CEOs to be paid a lot. The New York Times reported that the 1993 Chronicle of Philanthropy survey showed him to be the country's best paid non-profit CEO, bringing in total compensation of over $800,000 in 1993 dollars. By 1998, Dr Rowe's big project was pushing concentration of power in health care in the form of a proposed merger between New York University Medical Center and Mount Sinai. According to the New York Times, the plan would be for Dr Rowe to become CEO of the combined entity. At the time, he said,
The advantages of merging hospitals are so great, they far outweigh any hypothetical potential negative impact.

The bond issue needed to finance the merger, however, ran into trouble by early 2000.  Soon after that, Dr Rowe seemingly demonstrated his lack of faith in it by jumping to the leadership of Aetna. It turned out, according to the Hartford Courant, Aetna's offer was just to rich to turn down.
Rowe got a $2 million sign-on bonus to leave Mount Sinai NYU Health and become chief executive of Aetna's health business, the document says. He will also get a $1.4 million retention bonus on July 3, 2001.

Both bonuses are designed to replace money that Rowe forfeited by leaving the giant New York hospital system, Aetna spokeswoman Joyce Oberdorf said.

In addition, Rowe will get an annual salary of at least $1 million and an annual bonus of $1 million to $3 million, depending on how well goals are met, under a three-year employment agreement with two possible one-year extensions.

Rowe, who already received 25,000 shares of restricted Aetna stock and options on 500,000 shares, will get another 100,000 options. The new options will be granted when Aetna spins off its health business to shareholders, or on Jan. 1, 2001 -- whichever comes first. The exercise price will be about $72.73, or whatever price Aetna stock is trading at the time if it's higher than that.

By 2001, the New York Times referred to the merger as existing "in name only." That year, the campuses resumed separate administration. The merger was officially terminated in 2008. Its failure was documented in an Academic Medicine article. (Kastor JA. Failure of the merger of the Mount Sinai and New York University hospitals and medical schools: part 2. Acad Med 2010; 85: 1828-32. Link here.)

If the Brown audience had known that the merger Dr Rowe extolled with such confidence was already failing, but that he was able to leverage his role in its development to go from the country's best paid non-profit CEO to a multi-million dollar a year insurance CEO, maybe we would have felt less guilt about our responsibility for health care's high cost, low access and poor quality.

Aetna CEO Richard Huber's Failure to "Walk the Walk"

In fact, searching through the files showed an even earlier example of an Aetna CEO talking out of two sides of his mouth.

By 1998, an American Medical News article documented the "rocky relations" between Aetna and physicians. By early 2000, Aetna CEO Richard Huber was known as "the managed care executive physicians love to hate," per the American Medical News. His departure was characterized by then American Medical News Street Smarts columnist Dr Scott Gottlieb, as partly due to how
Huber talked out of one side of his mouth about his company's obsessive quest for 'quality' health care -- while out of the other he was screaming at doctors, hospitals and drug firms about controlling costs. Yet Aetna's medical costs were still creeping up. As Richard Huber learned, you can't talk the talk if you don't walk the walk.


So the unreliability of recent Aetna CEO Ron Williams' advocacy of the "patient mandate," was presaged by similarly untrustworthy pronouncement by two former Aetna CEOs. In each case, the remarks of the particular CEO seemed more designed to promote his immediate self-interest than to provide trustworthy opinion or policy advice.

By the way, this summary should not be viewed as particularly an indictment of Aetna. I am sure I could find equally untrustworthy but self-serving pronouncements from the leaders of many other health care organizations. (Recall the visionary pronouncements of the failed and ultimately jailed CEO of the now vanished Allegheny Health Education and Research Foundation, see post here.)

The recent Ron Williams reversal should serve, however, as a stark reminder that we, meaning physicians, other health care professionals, those who study health care and health policy, policy makers, and the public at large, should be very, very skeptical about any pronouncements about health policy by top executives of health care organizations. They as a group have shown themselves to be remarkably good at doing whatever it takes to buttress their immediate self-interest, including making apparently oracular but ultimately foolish policy pronouncements.

The real question is why these pronouncements continue to be treated with reverence, if not as "visionaries,"  by health care professionals, health care and policy researchers, the news media, health care and medical journals, policy makers, politicians, and the public at large? Why has hardly anyone, besides yours truly, gone back to check the accuracy of their previous pontifications before swooning over their latest ones? Why has hardly anyone examined the accuracy of their predecessors' opinions, given that most executives these days seem to be subject to the same incentives to make things look good in the short term, and never mind the consequences?