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How Institutional Conflicts of Interest Exacerbate the Anechoic Effect - the Example of ASCO Fearing "Biting the Hand that Feeds You"
As we recently discussed (here, here, here and here), in May, 2015, the New England Journal of Medicine, arguably the world's foremost medical journal, published an editorial and a three-part commentary arguing that current concerns about the effects of financial conflicts of interest (COI) on health care are overblown(1-4).  On June 1, the Wall Street Journal published a report on the 2015 meeting of the American Society of Clinical Oncology (ASCO) that provided a vivid example of why these concerns should not be dismissed.Questioning Drug Prices at the ASCO MeetingThe main issue in the article was:In a sign of growi...
Source: Health Care Renewal - June 26, 2015 Category: Health Management Tags: American Society of Clinical Oncology anechoic effect conflicts of interest health care prices institutional conflicts of interest medical societies You heard it here first Source Type: blogs

Follow the Money: Non-Profit Hospital CEOs Quietly Collect Their Millions While US Health Care Reform Battle Rages
ConclusionsThe current inflamed discussion of " Obamacare " and Republican attempts to " repeal and replace " it focuses on the costs of care and how they affect individual patients.  Examples include concerns about health insurance premiums that are or could be unaffordable for the typical person; insurance that fails to cover many costs, and thus may leave patients at risk of bankruptcy due to severe illness; poor people unable to or who might become unable to obtain any insurance, and perhaps any health care.  Yet there is little discussion of what really drives high and ever increasing health care costs (whil...
Source: Health Care Renewal - June 22, 2017 Category: Health Management Tags: boards of trustees executive compensation health care reform hospital systems hospitals non-profit organizations Source Type: blogs

The Long Con - "Charitable" Hospitals Make Multimillionaires out of Their CEOs
The CEOs of ostensibly charitable hospitals founded to serve the poor continue to become rich.   The latest reminders are in two articles from Maryland, from DelMarVaNow, and from the Baltimore Sun,.and one from the Boston Globe.All this diligent reporting showed multimillion dollar executive compensation,  as usual not justified by evidence or logic, but also how executive compensation is becoming divorced from the ostensible charitable mission of non-profit hospitals.   Most Hospital CEOs are Paid a LotSo jin Maryland, we found via DelMarVaNow,Peninsula Regional Medical Center paid its top executive and he...
Source: Health Care Renewal - August 23, 2013 Category: Health Medicine and Bioethics Commentators Tags: hospitals executive compensation deception perverse incentives mission-hostile management non-profit organizations hospital systems Source Type: blogs

Market Fundamentalism and the Denial of Conflicts of Interest, and of Worse Offenses
While we often point out the pervasiveness of conflicts of interest in medicine and health care, and the likely ill effects of this state of affairs, it seems that the powers that be in health care tend to airily dismiss conflicts of interest as at most a minor problem that needs management (e.g., look here.)  How Market Fundamentalist Ideology Nullifies the Concept of Conflicts of InterestOn the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody discussed how application of the reigning orthodoxy in economics, sometimes called neoliberalism, market fundamentalism, or economism, can be used to dismiss the conce...
Source: Health Care Renewal - September 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: market fundamentalism economism conflicts of interest Source Type: blogs

"Engaging Excellence" while Engaging Secret Paychecks - The Rise and Fall of the Upstate Medical University President
Yet another leader of a big health care organization seems to have acquired the excessively entitled CEO syndrome.Another Brilliant, Fearless Leader When Dr David R Smith was appointed President of Upstate Medical University, a part of the State University of New York (SUNY) system located in Syracuse, he got the usual rave reviews from the school's board of trustees, according to a university press release: 'David Smith rose to national prominence through his leadership ability, experience in children’s medicine, public health policy, and as the chancellor of the Texas Tech University system. We are very pleased to have...
Source: Health Care Renewal - November 8, 2013 Category: Health Medicine and Bioethics Commentators Tags: conflicts of interest executive compensation public relations SUNY Upstate Medical University Source Type: blogs

Merging Finance and Health Care Leadership - Robert Rubin Proteges Running DHHS, Spouse of Hedge Fund Magnate Running the FDA
Hidden between the lines of some not very prominent news stories were reminders of how close health care and financial leadership have become in these times of continuing economic unrest after the global financial collapse/ great recession.After the events of 2008, it became more apparent that the dysfunction in academics and health care  paralleled that seen in finance.  One reason may have been the overlapping leadership of finance and health care.  For example, in 2008 we first posted about how Robert Rubin, who was then a Fellow of the Harvard Corporation, the top group responsible for the governance of ...
Source: Health Care Renewal - August 19, 2014 Category: Health Management Tags: Citigroup DHHS FDA finance financialization generic management generic managers hedge funds market fundamentalism Renaissance Technologies You heard it here first Source Type: blogs

The RUC. "an Independent Group of Physicians?" - But It Includes Executives and Board Members of For-Profit Health Care Corporations and Large Hospital Systems
Introduction We just discussed how a major story in Politico has once again drawn attention to the opaque RUC (Resource Based Relative Value System Update Committee) and its important role in determining what physicians are paid for different kinds of services, and hence the incentives that have helped make the US health care system so procedurally oriented.  (See the end of our last post for a summary of the complex issues that swirl around the RUC.)The Politico article covered most of the bases, but notably omitted how the RUC may be tied to various large health care organizations, especially for-profit, and how the...
Source: Health Care Renewal - August 28, 2014 Category: Health Management Tags: AMA boards of directors conflicts of interest health care prices healthcare executive hospital systems perverse incentives regulatory capture RUC Source Type: blogs

Northwestern Upholds its "Brand," Never Mind Free Speech and Academic Freedom
Threats to free speech and academic freedom in health care were a major concern when we started Health Care Renewal.  Such threats may now be less anechoic, but do not seem to have diminished.Censorship and the Resignation of Alice Dreger The latest example was at Northwestern University. The basics of the case appeared in the Chronicle of Higher Education. Alice Dreger just resigned her position of 10 years as "a clinical professor of medical humanities and bioethics."What prompted her departure was the fallout over an article by William Peace, who at the time was a visiting professor in the humanities at Syracuse U...
Source: Health Care Renewal - September 2, 2015 Category: Health Management Tags: academic freedom anechoic effect bioethics censorship free speech mission-hostile management Northwestern University Source Type: blogs

Not Going to Take it Anymore - Doctors in the Pacific Northwest Unionize, Begin Collective Bargaining with Hospital Systems
We have posted about the plight of the corporate physician.  In the US, home of the most commercialized health care system among developed countries, physicians increasingly practice as employees of large organizations, usually hospitals and hospital systems, sometimes for-profit.  The leaders of such systems meanwhile are now often generic managers, people trained as managers without specific training or experience in medicine or health care, and "managerialists" who apply generic management theory and dogma to medicine and health care just as it might be applied to building widgets or selling soap.We have also ...
Source: Health Care Renewal - January 18, 2016 Category: Health Management Tags: concentration of power corporate physician generic management generic managers labor unions managerialism PeaceHealth University of Washington Source Type: blogs

New Jersey Confidential: the Almost Secret Membership of the RWJ Barnabas Health Board
A Hospital System Tries to Hide its Board of Trustees The US Internal Revenue Service mandates disclosure of the membership of boards of trustees of non-profit corporations.  Nonetheless, as reported by New Brunswick (NJ) Today, the leadership of the newly formed RWJ Barnabas Health system has been doing their best to keep the membership of its board of trustees secret.The new organization created to function as the state's largest hospital chain is refusing to tell the public who serves on their Board of Trustees,...To elaborate,The two hospital networks officially combined to form a new conglomerate, the state's sec...
Source: Health Care Renewal - May 15, 2016 Category: Health Management Tags: anechoic effect boards of trustees conflicts of interest hospital systems RWJ Barnabas Health UMDNJ Source Type: blogs

Heads They Win, Tails We Lose - Non-Profit Hospital ExecutivesPaid Generously After They Were Shown the Door
OnHealth Care Renewal, we have been decrying American health care dysfunction since 2004.  For years, the US consistently has had the most expensive health care system of any developed country.  For that exhorbitant price, it provides at best medicocre access to and quality of care.  Thelatest (2017) international comparison of health systems produced by the Commonwealth Fund shows that the US spends about 16% of its gross domestic product (GDP) on health care, compared to less than 12% spent by 10 other countries.  The US ranked no better than fifth on performance rankings measuring care process, acces...
Source: Health Care Renewal - December 10, 2017 Category: Health Management Tags: Broward Health contracts executive compensation generic managers intimidation managerialism ' coup d etat non-disparagement clause perverse incentives quality University of North Carolina Source Type: blogs

Heads They Win, Tails We Lose - Non-Profit Hospital Executives Paid Generously After They Were Shown the Door
OnHealth Care Renewal, we have been decrying American health care dysfunction since 2004.  For years, the US consistently has had the most expensive health care system of any developed country.  For that exhorbitant price, it provides at best medicocre access to and quality of care.  Thelatest (2017) international comparison of health systems produced by the Commonwealth Fund shows that the US spends about 16% of its gross domestic product (GDP) on health care, compared to less than 12% spent by 10 other countries.  The US ranked no better than fifth on performance rankings measuring care process, acces...
Source: Health Care Renewal - December 10, 2017 Category: Health Management Tags: Broward Health contracts executive compensation generic managers intimidation managerialism ' coup d etat non-disparagement clause perverse incentives quality University of North Carolina Source Type: blogs

The Two-Fold Intimidation of Dr Bornstein, as Orchestrated by Donald Trump, Apparently to Conceal Something About Trump ' s Medical History
DiscussionAs noted above, we have seen many cases in which health care professionals were pressured to violate their core values and ethical norms by outside parties, most often large health care organizations seeking financial gain.Now, in this new case, we see a single health care professional twice pressured to violate core values and ethical norms by a patient, a wealthy billionaire corporate CEO who became President of the United States.  Thus we are now in a situation in which the President of the US, to whom all federal health care regulatory and law enforcement agencies at least nominally report, has shown con...
Source: Health Care Renewal - May 4, 2018 Category: Health Management Tags: core values Donald Trump fraud intimidation medical ethics medical record confidentiality Source Type: blogs