This case is already all over the web [starting here], but it has an unusual health care slant which has heretofore not been covered, so....

The University of Delaware, a large, state-supported US university, which includes a College of Health Sciences, recently instituted a new "treatment"program for university students, described in the draft of a detailed report. [Following page references are from that report.] (References to the program, also described as a curriculum, as a "treatment" are on page 8, 10, and 14) Subjects will be exposed to educational and behavioral interventions, the latter described in one document as that which will "leave a mental footprint on their consciousness." An example of one behavioral intervention requires subjects to line up, then step forward or backward in response to questions about their social identities [see p. 2 of this letter.]. The program will be subject to "action research" [p. 3], which "is generally distinguished by being practioner based, focused on actual existing practices, and using data to improve existing practices," [p. 4] and possibly also "summative, research style studies" [p. 3] Outcomes to be assessed include "behavioral changes in reaction to ... educational strategies." [p. 5] Data collection methods include "surveys, formal inteviews, focus group[s]" [p. 11] Subjects with the worst outcomes in particular groups would be individually identified, and subject to additional interventions [see p. 3 of this letter.] The investigators claimed the research "would qualify for an exemption from full [institutional review] board review." [p. 12]

So far, this sounds unremarkable, but, just has been extensively reported by the Foundation for Individual Rights in Education (FIRE), the subjects of this "treatment" program are all students living in all University of Delaware dormitories, not patients with any defined conditions or diseases. Furthermore, as the FIRE case file makes very clear, participation is mandatory. Not only is consent not required for participation, students must participate in the "treatment" and in the associated "action research" study whether or not they want to.

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We have done a long series of posts about the troubles at the University of Medicine and Dentistry of New Jersey (UMDNJ), the largest US health care university. The university now is operating under a federal deferred prosecution agreement under the supervision of a federal monitor (see most recent posts here, here, here, here and here.)

We had previously discussed allegations that UMDNJ had offered no-bid contracts, at times requiring no work, to the politically connected; had paid for lobbyists and made political contributions, even though UMDNJ is a state institution; and seemed to be run by political bosses rather than health care professionals. (See posts here, and here, with links to previous posts.) A recent development (see post here with links to previous posts) was that UMDNJ apparently gave paid part-time faculty positions to some community cardiologists in exchange for their referrals to the University's cardiac surgery program, but not in exchange for any major academic responsibilities. Another was some amazingly wasteful decisions by UMDNJ managers leading to spending millions of dollars for real-estate that now stands vacant (see post here). Another was the indictment of a powerful NJ politician for getting a no-work job in the system, and the indictment of the former dean of the university's osteopathic medicine school for giving him the job (see post here). Most recently, we found out that UMDNJ had named one of its teaching hospitals for a pharmaceutical company in 2001 (see post here), and that the federal monitor accused the dean of one of the UMDNJ campuses of fixing students' grades (see post here).

In response to this debacle, the New Jersey State Commission of Investigation (SCI) investigated financial practices at multiple state institutions of higher education, including UMDNJ. As compiled from articles in the (central New Jersey) Home News Tribune, and the (North Jersey) Record, the main points were

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On the Carlat Psychiatry Blog, Dr Daniel Carlat argues how porous is the firewall between commercial medical education and communication companies (MECCs) and commercial continuing medical education (CME) providers.

The US Public Broadcasting Service (PBS) television network just aired a three-part series called "The Mysterious Human Heart." One of our intrepid scouts suggested we should look into it, since it seemed to be funded by two companies which had commercial interests in the subject matter.

Indeed, the PBS Ombudsman was already involved in this case. In his column, Michael Getler wrote,

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Several Connecticut newspapers have reported on findings against prestigious Yale-New Haven Hospital, the main teaching hospital for Yale University, by an independent arbitrator. Per the Hartfourd Courant,

Arbitrator Margaret Kern said the hospital ruined any chance for a fair election by intimidating union supporters and spreading misinformation.

She ordered the hospital to pay SEIU $2.3 million, to cover its organizing expenses and $2.2 million to about 1,700 hospital employees eligible to vote in the election. The second figure is the amount Yale-New Haven paid to IRI Consultants to Management Inc., the company it hired to coordinate its campaign against the union.

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On the GoozNews blog, Merrill Goozner discusses the Institute of Medicine's new panel which will develop new guidelines for managing conflicts of interest. According to Goozner, the panel includes three people who were given their own conflict of interest waivers because of their financial ties to drug or device companies, and one other whose ties Goozner claims were not disclosed. The panel includes no prominent advocates of a harder line against conflicts. Goozner asks, "sound fair and balanced to you?"

I have commented in the past about the overuse of "metrics" from often ill-conceived efforts or biased efforts to find justification for cavalier activities that ignore common sense, but this story may represent a new milestone:

Battle over a key heart procedure (link)

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I have written a number of times on this blog such as here, here, here, here, here, here, here and here about difficulties Medical Informatics specialists have in securing positions with a future: that is, positions with career advancement opportunities into higher levels of healthcare management, and roles that ensure some degree of stability instead of fancy-sounding titles that translate to "[cheap] internal consultant."

The "Director of Informatics" role has been transformed into numerous fancy sounding titles including "CMIO" (Chief Medical Informatics Officer), "VP of Informatics", "Senior Informatics Specialist", etc. However, as I wrote several years ago:

Rule 3 [for CMIO's]: Avoid 'internal consultant' positions, a way for organizations to get expert help cheap (i.e., at your expense, with limited career advancement opportunities).

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It seems I can't escape clinical IT issues, even on personal business.

I took my 81 y.o. mother to see her internist at a hospital in which I'd had some training, a large regional center, for a followup to her recent ED admission and hospitalization. Her internist is part of a large multispecialty group.

There had been a new EHR system in the E.D. where she'd been admitted. I'd watched medical and nursing staff in the ED, some of whom I knew and one who'd been a high school classmate struggle and complain (to me) about a UI that was cognitively overwhelming -- I'm being generous -- as well as undersized monitors (15" and 17" is passe today, no?) compounding the difficulty, and other issues. However, one item I could easily read was the name of every patient in the ED and basic information about them, since many of the monitors faced outward into the ED corridors where people (patients, clinical staff, family) walk.

For my mother's followup visit, in my pocket was a document I'd received a few days prior in the mail. The document was an x-ray report of an orbital injury suffered by a female patient, that had been ordered by me, with my name & address at the top. It was bound for my former residency director, now Chief of Staff.

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The New York Times today included an op-ed piece by Peter Pitts which raised the alarm about comparative effectiveness research on one of the world's most prominent opinion pages. Pitts was identified as President of the Center for Medicine in the Public Interest, "a nonprofit organization that receives financing from the pharmaceutical industry."

If Congress overrides President Bush's veto of the State Children's Health Insurance Program, a little-known provision of the original House bill could be revived.

As written, the provision would allocate $300 million to create a Center for Comparative Effectiveness that would test whether newer, more expensive drugs work better than their older and cheaper counterparts. Medicare would use the center's findings to help decide which drugs to cover. If the center found that a newer, pricier pill was no more effective than the older, cheaper version, Medicare would probably refuse to pay for it.

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