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May 30, 2010

What really ails American healthcare?

From the Boston Globe:

By Douglas S. Brown May 30, 2010

In his latest book, How the Mighty Fall, Jim Collins outlines the five stages of decline of once-great companies. Stage 1 is what he calls Hubris Born of Success. He details companies whose leaders became a little too proud of what they had accomplished. They started to believe too deeply in their own greatness. They became complacent.

That is my diagnosis for American medicine.

And though health care reform is now law, we will not see transformational change until we address this collective arrogance that infects our system.

In a 2008 survey by the Harvard University School of Public Health and Harris Interactive, 55 percent of US respondents said patients in America received better care than those in Canada, Great Britain, and France. Perhaps this is why Americans have been so ambivalent about reform. But the facts suggest we do not have better care than other countries; not even close. In 2007, a report by the private foundation the Commonwealth Fund compared the United States with Australia, Canada, Germany, New Zealand, and Great Britain and found our system ranks last or next to last in the categories of quality, access, and efficiency.

In 1999,
the nonprofit Institute of Medicine issued a seminal report estimating that as many as 98,000 Americans were dying in hospitals each year as a result of preventable errors. That was supposed to be a wake-up call. But apparently we are still groggy. A recent study published in the journal Health Affairs found that 10 years later there was only modest improvement. When Toyota makes mistakes that possibly result in dozens of deaths, the country is outraged. When hospitals make mistakes that result in some 100,000 deaths per year, we shrug.

And while most doctors are incredibly compassionate and want to have meaningful relationships with their patients, they are being asked to manage care in a complicated system full of broken processes and disappointing outcomes. Their journey to becoming a physician clashes with the reality of being one. The result is often frustration and, increasingly, poor behavior.

Medical schools train doctors to be independent artisans who excel at their craft. Autonomy is a sacred value. But in today's complex system, this model is outdated and becoming dangerous. Recently, the Lucian Leape Institute, composed of patient safety experts, called for serious reform of the medical school curriculum to teach "a different model - one that emphasizes collaborative practice and inter-professional teamwork." Yet, medical schools are slow to change. Why? The report singles out "professional egocentricity" as one obstacle.

It's time for administrators, physicians, and educators alike to take a hard look in the mirror. The new health care reform law won't solve the problem; you cannot legislate humility. This change must come from within.


Douglas S. Brown is senior vice president and general counsel of UMass Memorial Health Care in Worcester.

May 22, 2010

Are University of Minnesota Committees Subject to the Open Meeting Law?

A pdf is available for download.

MinnPost15May10.pdf

May 21, 2010

Withdrawn -> Censorship On University of Minnesota Medical School Dialogue Site?

My comments have appeared on the Med School web site so this post is withdrawn. I leave this up, because there are some stray links to it out there, and so I'd like people to know that the problem has been taken care of.

May 19, 2010

Are U of M Committees Subject to the Open Meeting Law?

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From Minnpost:


During the past few months the Faculty Consultative Committee (FCC) at the University of Minnesota has met in secret. This was done twice during meetings at which members of the administration of the University of Minnesota were present.

Upon asking for justification for this action, I received a response from the chair of the committee attempting to justify these secret meetings. They are presented below along with my response.

1. The Open Meeting Law (Chapter 13D of the Minnesota Statutes) does not apply to advisory committees.

It is true that the scope of paragraph (b) of Minn. Stat. 13D.01 subd. 1 is limited to meetings of the governing body of a public body. However, paragraph (c) requires that meetings of ANY COMMITTEE of a public body must be open to the public. Unlike paragraph (b), paragraph (c) does not limit its scope to a "governing" committee.

2. The bylaws of the University Senate authorize closed meetings of committees of the Senate.

In the Star Tribune case, the Minnesota Supreme Court rejected the argument of the Regents that the Open Meeting Law does not apply to the university. Neither the Regents nor the University Senate can override the statute. So the only closed meetings that may lawfully be held are those that are authorized by the statute. None of the topics discussed at the April 15 meeting of the FCC is of a nature that may be discussed in secret.

3. It is necessary to hold closed meetings in order to have an effective and candid exchange of information between the administration and the FCC.

So the administration will sometimes provide accurate and truthful information only in closed meetings? What kind of administration is that? What of the duty of the FCC "to report on matters that should be brought to the attention of the University at large?" See Article II, section 5, part I of the Senate bylaws. The FCC is supposed to be the representative of the faculty, not a co-conspirator with the administration in conducting the business of the university in secret!

In the Star Tribune case the Minnesota Supreme Court rejected this rationale for evading the Open Meeting Law:

"The purpose of [the state constitutional provision] empowering the Regents with the management of the University was to put academic and university management issues in the hands of the Regents. The Data Practices Act and the Open Meeting Law do not tread on those types of issues. These statutes address broader concerns of the relationship and information-flow between public institutions and the people whom they serve.

"The Date Practices Act and the Open Meeting Law are intended to promote the general welfare by making government information accessible to the people. Both statutes are applicable to the University." -- Star Tribune Co. vs. University of Minnesota Board of Regents, 683 N.W.2d at 284-285, 286 (Minn. 2004)

These are perilous times at the University of Minnesota. It is necessary for the faculty, staff, and students to have knowledge of important issues at the university. It is also necessary to have such information available to the Legislature and the citizens so that they may make informed decisions about appropriate levels of funding for the university.

President Robert Bruininks has claimed in a public address to the university community:

"Everything we do at the University of Minnesota is out in the open."

It is time to make these words fact.

William B. Gleason is an associate professor in the Department of Laboratory Medicine & Pathology, University of Minnesota, and a 1973 alumnus.

May 15, 2010

Save our Northrop from being gutted and shrunk

Northrop.png

Once again, the Morrill Hall Gang is engaged in a campaign based on a false premise. One of the over-the-top statements in support of an $80 million dollar proposed project to both gut Northrop and shrink the auditorium is the following:

"... the reconfigured facility will be a physical embodiment of the University's "Transforming the U" and "Driven to Discover" initiatives."

Sadly, in the midst of our current fiscal chaos, the Board of Regents have allowed the Morrill Hall Gang to take approximately two million dollars from University reserves and started the ball-rolling on spending $80 million. Once again, the objectives and priorities here have NOT been discussed throughout the community. This is typical strategy. Get a toe in the water using discretionary or private funds - using the source of the funds as an excuse for lack of scrutiny. Then do what you want without proper scrutiny or discussion by the community.

For anyone interested in some history and a discussion of the U's current plans there is an excellent document, written by one of our undergrads, Jennifer Dens, that nicely lays out the Northrop issues. I post her paper and her UROP poster here so that I can refer to it in future discussions. But I'd encourage anyone with a serious interest in the Northrop matter, to download and look at both of these documents:

1) UROP Symposium Paper 09.pdf

2) UROP Symposium Poster Final.pdf

May 12, 2010

What the competition is doing: New Illinois president

From the Daily Illini:


CHICAGO, Ill. --The University of Illinois today announced that its 18th president will be Michael J. Hogan, pending formal approval by the Board of Trustees at its next meeting on May 20 in Chicago. Hogan would take office effective July 1.

Hogan, president of the University of Connecticut since September 2007, brings the experience of a four-decade career in public higher education that includes progressively senior administrative appointments at The Ohio State University and the University of Iowa before joining UConn.

An acclaimed historian who served as dean of the arts and sciences at The Ohio State University before becoming executive vice president and provost at the University of Iowa, Hogan is grounded in the experience of Big Ten public research universities.

During his career, Hogan has led high performing teaching and research universities, managed university-based health science centers and hospitals, engaged in fundraising and alumni relations and overseen major intercollegiate athletics.

A specialist in post-World War II diplomatic history and the Cold War, Hogan continues his teaching, research and writing even while serving in administrative roles. His faculty experience includes Miami University in Oxford, Ohio; Stony Brook University in New York; University of Texas at Austin; and Purdue University.

As UConn president, Hogan successfully managed financial strains similar to those he will confront in Illinois. He also grew the UConn research portfolio by 25 percent over three years; worked with the legislature to secure a capital spending plan; partnered with the Connecticut governor and General Assembly, the congressional delegation and area hospitals on a $352 million initiative to improve access to quality health care, including the construction of a new hospital; and raised academic standards at UConn as measured by test scores, diversity and retention rates.

He also hired the largest class of new faculty of color at Iowa and recruited the largest class of students of color. At Ohio State, he established an institute for the study of race and ethnicity and enhanced diversity in the College of Humanities. In his term at UConn, Hogan increased student diversity and also improved undergraduate retention and graduation rates.

Selected from a field of 208 candidates for the University of Illinois presidency,
Hogan emerged as the top choice in the seven-month search because of his uncommon combination of scholarship, university leadership experience and achievement, according to Board of Trustees Chairman, Christopher G. Kennedy.

"Michael Hogan's entire career to this point has prepared him to lead a major public university. He has held nearly every management and executive position in academia, steadily rising through the ranks on the merits of his scholarship, commitment and leadership," Kennedy said

"I'm delighted to be returning to the Midwest to lead the University of Illinois, a top-tier institution and center of outstanding research and scholarship," Hogan said. "I grew up in the Midwest, earned my degrees here and started my family here. I couldn't be more pleased to return to my roots as president of this world-class university."

"The search that yielded Hogan included an exceptional field of candidates, a testament to the quality and prestige the University of Illinois maintains within American higher education," committee chair Trustee Pamela Strobel said.

"We could not be more pleased with the search process and its excellent outcome. Our search committee did an outstanding job of working together, considering an incredibly well-qualified field of candidates, and coming to a recommendation," Strobel said. "I know that both the committee and the board are truly thrilled with the announcement of Mike Hogan as the next president of the U of I."

Chancellor Paula Allen-Meares of UIC, where health science colleges, the College of Medicine and the university hospital are concentrated, said Hogan's work with academic medical centers at Iowa and UConn is significant. "He brings a breadth of experience that bodes well for Illinois' great land-grant university and three campuses with distinct missions," Allen-Meares said.

As Iowa provost, the university's chief academic officer, Hogan developed a new strategic plan, "The Iowa Promise," focused on revitalizing management of the university's enrollment; established management and investment principles to advance research priorities; and established policies that resulted in improved gender and race diversity in enrollment and employment.

During his OSU career from 1986 to 2003, Hogan was a recipient of the highest faculty award for scholarly distinction, chaired the department of history, served as dean of the College of Humanities, and became executive dean of the Colleges of the Arts and Sciences. The five colleges enroll 17,000 undergraduate and graduate students, employ 1,000 faculty and account for 60 percent of the credit hours taught at Ohio State.

Sounds like he would have been an excellent candidate for the U of M job... Perhaps if the job had opened a little earlier it would have been better for all?

Given the availability of people like this on the market and the fact that our actual BigTen competition regularly hires outsiders, I'd suggest we do the same thing this time. I can't think of a person at the U of M right now who could hold a candle to Dr. Hogan's record. It is especially noteworthy that he comes from the liberal arts side of the university AND has significant experience dealing with medical school related issues. Some knowledgeable leadership on this front in Morrill Hall would be a great improvement.


May 6, 2010

President Bruininks Throws in the Towel, Sort of...

BobBails.jpg

Bob Bails

From a blanket campus email:

Dear Colleagues and Students,

For the past two years, I have said publicly that next year (the 2010-11 academic year) will be my last as president of the University of Minnesota. I have informed the Board of Regents that I intend to step down as president at the end of my current contract, which expires June 30, 2011. I have truly treasured this opportunity to serve for the past 13 years as provost and president, but I look forward to returning to the best job I have ever had at this great University--that of professor--and Susan and I look forward to pursuing our personal interests and spending time with family, including our grandchildren.

I made this announcement early to provide more time for planning this leadership transition. This is a time of substantial change and numerous challenges on our campuses statewide, and I believe that setting a clear direction for my own future will help the institution plan for its needs and priorities in the coming months.

[But not early enough. Given the financial disaster that will occur at the U coincident with the President leaving, this is an example of incredibly bad succession planning.]

On Thursday, May 13, the Board of Regents will convene a work session to discuss its plans for conducting the search for the next president of the University of Minnesota. It is the Board's responsibility to oversee and administer the search, which will be managed by the Board office. I am certain that many of you will be engaged in the process. This is a critically important opportunity to shape the University's future, and I encourage all of you to offer your best advice to the Regents as the search commences.

[My best advice is to get someone from outside. That is how the big boys and girls do it. But there is a soft underbelly of about 40 people with vice-president in their title who would probably prefer that an insider be picked, again.]

In the meantime, we have much to do, and I plan to work diligently with you to strengthen the academic mission and resources of the University, to finalize and approve a new budget, and to refine and begin to implement a long-term financial plan. During the next 14 months, my focus will continue to be on strengthening the University's academic excellence and financial vitality as outlined in this year's State of the University Address. We must set priorities, both locally and at the all-University level; reduce overhead and operating costs; improve service and productivity; redesign academic and support programs and services; and eliminate activities that are not producing significant return on investment in terms of the University's core academic mission of education, research, and outreach. The changes we have yet to make are neither easy nor obvious and will require all of us to be fully engaged in making decisions that advance the University of Minnesota as a whole--as an academic community and a statewide system.

[Rather hard to engage the academic community and the legislature as a lame duck president?]

We also have other significant changes to manage--including the transitions of Senior Vice President Frank Cerra and University of Minnesota Duluth Chancellor Kathryn Martin, as well as the departure of Vice President Rusty Barcelo to become a college president. With regard to these changes, I will work to maintain strong leadership for our public mission while ensuring that my successor has an appropriate level of engagement and flexibility in shaping the University's senior management team.

[These are contradictory statements. You should not be involved with the replacement of Frank Cerra. This should be the responsibility of the next president as he or she will have to work with this replacement and you will not.]

I take pride in what we have accomplished together. I want to thank you all--faculty, staff, students, alumni, friends and Regents--for your hard work, especially in these challenging times, and for your continued support of the University of Minnesota. All of you continue to make the University of Minnesota one of the best public research and land-grant university systems in the world.

[Bob, this last statement is an example of the hubris that has gotten us in trouble in the first place. My hope is that we be one of the best schools in the BigTen. You've called me a "doubter" for saying this. Wake up. I think most of the people in the state would endorse such a goal and try to help us in achieving it. Your "ambitious aspirations to be one of the top public research universities in the world [sic]" are a major reason why we are in the mess we're in. Time to start taking care of business in the here and now?]

Sincerely,

Robert H. Bruininks
President

I sincerely hope you enjoy your retirement, President Bruininks. It is several years overdue.

May 5, 2010

Is the University of Minnesota Violating the Open Meeting Law, Again?

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[For Part I., please see my earlier post (link)].

May 5, 2010

Professor Marti Hope Gonzales
Chair
Faculty Consultative Committee

Dear Professor Gonzales:

This is a formal response to your email reply to my earlier letter on the question of whether the Minnesota Open Meeting Law is applicable to meetings of the Faculty Consultative Committee.

Let us look at the three reasons you gave for conducting closed meetings:

1. The Open Meeting Law (Chapter 13D of the Minnesota Statutes) does not apply to advisory committees.

It is true that the scope of paragraph (b) of Minn. Stat. 13D.01 subd. 1 is limited to meetings of the governing body of a public body. However, paragraph (c) requires that meetings of ANY COMMITTEE of a public body must be open to the public. Unlike paragraph (b), paragraph (c) does NOT limit its scope to a "governing" committee.

2. The bylaws of the University Senate authorize closed meetings of committees of the Senate.

In the Star Tribune case the Minnesota Supreme Court rejected the argument of the Regents that the Open Meeting Law does not apply to the University. Neither the Regents nor the University Senate can override the statute. So the only closed meetings that may lawfully be held are those that are authorized by the statute. None of the topics discussed at the April 15 meeting of the FCC is of a nature that may be discussed in secret.

3. It is necessary to hold closed meetings in order to have an effective and candid exchange of information between the administration and the FCC.

So the administration will sometimes provide accurate and truthful information only in closed meetings? What kind of administration is that? What of the duty of the FCC "to report on matters that should be brought to the attention of the University at large?" See Article II, section 5, part I of the Senate bylaws. The FCC is supposed to be the representative of the faculty--not a co-conspirator with the administration in conducting the business of the University in secret!

In the Star Tribune case the Minnesota Supreme Court rejected this rationale for evading the Open Meeting Law:

"The purpose of [the state constitutional provision] empowering the Regents with the management of the University was to put academic and university management issues in the hands of the Regents. The Data Practices Act and the Open Meeting Law do not tread on those types of issues. These statutes address broader concerns of the relationship and information-flow between public institutions and the people whom they serve.

"The Data Practices Act and the Open Meeting Law are intended to promote the general welfare by making government information accessible to the people. Both statutes are applicable not just to the University, but to all state agencies, as well as local government entities.

Star Tribune Co. v. University of Minnesota Board of Regents, 683 N.W.2d
at 284-285, 286 (Minn. 2004)

The requests made in my April 30, 2010 communication stand:

"This is a formal request that the FCC justify any closing of meetings in the future by citing the relevant portion of the open meeting law used to justify such behavior. It is particularly disturbing that the President chose to participate in such a closed meeting, given the legal problems of the University with the open meeting law and the last presidential search. If detailed minutes or recordings from the last meeting are available, this is a formal request, under the open meeting law, that they be provided. This request also applies to detailed minutes or recordings of the FCC meeting with the administration prior to the Faculty Senate meeting on March 25."

Thank you for your immediate attention to this matter.

Sincerely,


William B. Gleason
University of Minnesota Faculty Member


May 4, 2010

At first I thought: "What's the use?"

but then two friends pointed out an article by Marcia Angell about the Pharma/Academic Health Sciences interface. This matter has been consistently ignored by the AHC/Medical School at the University of Minnesota for going on three years.

So I post:

Big Pharma, Bad Medicine

How corporate dollars corrupt research and education

Marcia Angell

In May of 2000, shortly before I stepped down as editor-in-chief of the New England Journal of Medicine, I wrote an editorial entitled, "Is Academic Medicine for Sale?" It was prompted by a clinical trial of an antidepressant called Serzone that was published in the same issue of the Journal.

The authors of that paper had so many financial ties to drug companies, including the maker of Serzone, that a full-disclosure statement would have been about as long as the article itself, so it could appear only on our Web site. The lead author, who was chairman of the department of psychiatry at Brown University (presumably a full-time job), was paid more than half a million dollars in drug-company consulting fees in just one year. Although that particular paper was the immediate reason for the editorial, I wouldn't have bothered to write it if it weren't for the fact that the situation, while extreme, was hardly unique.

Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That's what justifies their tax-exempt status. In contrast, drug companies--like other investor-owned businesses--are charged with increasing the value of their shareholders' stock. That is their fiduciary responsibility, and they would be remiss if they didn't uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don't have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.

This profound difference in missions is often deliberately obscured--by drug companies because it's good public relations to portray themselves as research and educational institutions, and by academics because it means they don't have to face up to what's really going on.

No area of overlap between industry and academia is more important than clinical trials. Unlike basic medical research, which is funded mainly by the National Institutes of Health (NIH), most clinical trials are funded by the pharmaceutical industry. In fact, that is where most pharmaceutical research dollars go.

Since drug companies don't have direct access to human subjects, they've traditionally contracted with academic researchers to conduct the trials on patients in teaching hospitals and clinics. That practice continues, but over the past couple of decades the terms and conditions have changed dramatically.

The major drug companies are now hugely profitable, with net incomes consistently several times the median for Fortune 500 companies. In fact, they make more in profits than they spend on research and development (R&D), despite their rhetoric about high prices being necessary to cover their research costs. (They also spend twice as much on marketing and administration as they do on R&D.) The reasons for the astonishing profitability of these companies aren't relevant here, but suffice it to say that as a result the industry has acquired enormous power and influence. In contrast, medical centers have fallen on difficult times (or so they believe), mainly because of shrinking reimbursements for their educational and clinical missions. To a remarkable extent, then, medical centers have become supplicants to the drug companies, deferring to them in ways that would have been unthinkable even twenty years ago.

Often, academic researchers are little more than hired hands who supply human subjects and collect data according to instructions from corporate paymasters. The sponsors keep the data, analyze it, write the papers, and decide whether and when and where to submit them for publication. In multi-center trials, researchers may not even be allowed to see all of the data, an obvious impediment to science and a perversion of standard practice.

Much of the time, the institutional conflict-of-interest rules ostensibly designed to control these relationships are highly variable, permissive, and loosely enforced. At Harvard Medical School, for example, few conflicts of interest are flatly prohibited; they are only limited in various ways. Like Hollywood, academic medical centers run on a star system, and schools don't want to lose their stars, who are now accustomed to supplementing their incomes through deals with industry.

Schools, too, have deals with industry. Academic leaders, chairs, and even deans sit on boards of directors of drug companies. Many academic medical centers have set up special offices to offer companies quick soup-to-nuts service. Harvard's Clinical Research Institute (HCRI), for example, originally advertised itself as led by people whose "experience gives HCRI an intimate understanding of industry's needs, and knowledge of how best to meet them"--as though meeting industry's needs is a legitimate purpose of an academic institution.

Much of the rationalization for the pervasive research connections between industry and academia rests on the Bayh-Dole Act of 1980, which has acquired the status of holy writ in academia. Bayh-Dole permits--but does not require, as many researchers claim--universities to patent discoveries that stem from government-funded research and then license them exclusively to companies in return for royalties. (Similar legislation applies to work done at the NIH itself.) In this way, academia and industry are partners, both benefiting from public support.

The result of Bayh-Dole was a sudden, huge increase in the number of patents--if not in their quality. And the most prestigious academic centers now have technology-transfer offices and are ringed by start-up companies. Most technology-transfer offices at academic medical centers don't make much money, but every now and then one strikes it rich. Columbia University, for example, received nearly $300 million in royalties from more than 30 biotech companies during the seventeen-year life of its patent on a method for synthesizing biological products. Patenting and licensing the fruits of academic research has the character of a lottery, and everyone wants to play.

A less-appreciated outcome of Bayh-Dole is that drug companies no longer have to do their own creative, early-stage research. They can, and increasingly do, rely on universities and start-up companies for that. In fact, the big drug companies now concentrate mainly on the late-stage development of drugs they've licensed from other sources, as well as on producing variations of top-selling drugs already on the market--called "me-too" drugs. There is very little innovative research in the modern pharmaceutical industry, despite its claims to the contrary.

Increasingly, industry is setting the research agenda in academic centers, and that agenda has more to do with industry's mission than with the mission of the academy. Researchers and their institutions are focusing too much on targeted, applied research, mainly drug development, and not enough on non-targeted, basic research into the causes, mechanisms, and prevention of disease.

Moreover, drug companies often contract with academic researchers to carry out studies for almost entirely commercial purposes. For example, they sponsor trials of drugs to supplant virtually identical ones that are going off patent. And academic institutions are increasingly focused on the Bayh-Dole lottery. A few years ago, the Dana Farber Cancer Institute sent Harvard faculty an invitation to a workshop called "Forming Science-Based Companies." It began:

So you want to start a company? Join the Provost, Harvard's Office for Technology and Trademark Licensing (OTTL), leading venture capitalists, lawyers and entrepreneurs for a conference on the basics of forming a start-up based on university technology
.

There's a high scientific opportunity cost in serving the aims of the pharmaceutical industry. For example, new antibiotics for treating infections by resistant organisms are an urgent medical need, but are not economically attractive to industry because they are not likely to generate much return on investment.

In addition to distorting the research agenda, there is overwhelming evidence that drug-company influence biases the research itself. Industry-supported research is far more likely to be favorable to the sponsors' products than is NIH-supported research.

An important cause of bias is the suppression of negative results. But clinical trials are also biased through research protocols designed to yield favorable results for sponsors. There are many ways to do that.

Conflicts of interest affect more than research. They also directly shape the way medicine is practiced, through their influence on practice guidelines issued by professional and governmental bodies and through their effects on FDA decisions.

Conflicts of interest are equally troubling in medical education, where industry influence is perhaps greatest and least justified. The pharmaceutical industry devotes much, if not most, of its vast marketing budget to what it calls the "education" of doctors. The reason is obvious: doctors write the prescriptions, so they need to be won over.

Drug companies support educational programs even within our best medical schools and teaching hospitals, and are given virtually unfettered access to young doctors to ply them with gifts and meals and promote their wares. In most states doctors are required to take accredited education courses, called continuing medical education (CME), and drug companies contribute roughly half the support for this education, often indirectly through private investor-owned medical-education companies whose only clients are drug companies. CME is supposed to be free of drug-company influence, but incredibly these private educators have been accredited to provide CME by the American Medical Association's Accreditation Committee for Continuing Medical Education--a case of the fox not only guarding the chicken coop, but living inside it.

If drug companies and medical educators were really providing education, doctors and academic institutions would pay them for their services. When you take piano lessons, you pay the teacher, not the other way around. But in this case, industry pays the academic institutions and faculty, and even the doctors who take the courses. The companies are simply buying access to medical school faculty and to doctors in training and practice.

This is marketing masquerading as education. It is self-evidently absurd to look to companies for critical, unbiased education about products they sell. It's like asking a brewery to teach you about alcoholism, or a Honda dealer for a recommendation about what car to buy.

What should be done about all of this? So many reforms would be necessary to restore integrity to medical research, education, and practice that they can't all be summarized here. Many would involve congressional legislation and changes in the FDA, including its drug-approval process. But the medical profession also needs to wean itself from industry money almost entirely.

For some time now, I've been recommending these three essential reforms:

First, members of medical school faculties who conduct clinical trials should not accept any payments from drug companies except research support, and that support should have no strings attached.

Second, doctors should not accept gifts from drug companies, even small ones, and they should pay for their own meetings and continuing education. Other professions pay their own way, and there is no reason for the medical profession to be different in this regard.

Finally, academic medical centers that patent discoveries should put them in the public domain or license them inexpensively and non-exclusively, as Stanford does with its patent on recombinant DNA technology based on the work of Stanley Cohen and Herbert Boyer. Bayh-Dole is now more a matter of seeking windfalls than of transferring technology. Some have argued that it actually impedes technology transfer by enabling the licensing of early discoveries, which encumbers downstream research. Though the legislation stipulates that drugs licensed from academic institutions be made "available on reasonable terms" to the public, that provision has been ignored by both industry and academia. I believe medical research was every bit as productive before Bayh-Dole as it is now, despite the lack of patents. I'm reminded of Jonas Salk's response when asked whether he had patented the polio vaccine. He seemed amazed at the very notion. The vaccine, he explained, belonged to everybody. "Could you patent the sun?" he asked.

And to those academic researchers who think the current path is just fine,
I have this to say: no, it is not necessary to accept personal payments from drug companies to collaborate on research. There was plenty of innovative research before 1980--at least as much as there is now--when academic researchers began to expect rewards from industry. And no, you are not entitled to anything you want just because you're very smart. Conflicts of interest in academic medicine have serious consequences, and it is time to stop making excuses for them.


Dr. Cerra, how long are you going to ignore common sense?

May 3, 2010

To Those Administrators Who Think That Online Classes = Salvation

Please see the excellent post by Margaret Soltan, Professor of English, at George Washington University concerning the reaction to UCLA's possible entrance into the on-line class business...

There's a nice poem at the end:

TO MY VAST LECTURE

Shall I compare thee to an online class?
Thou art more crowded and more void of meaning.
All bullet'd are the powerpoints, alas;
And time mere play upon my laptop screening.
Sometimes too hot the spyware of professors shines,
And oft their rage at our indifference prick'd,
And every A to F thereby declines,
And makes the cosmos seem inane and derelict.

But thee, sweet online course, shall never fade;
Nor lose possession of that fairest gift:
For I have aced you at the moment my tuition's paid,
And you my credits grant me smooth and swift.
So long as I can cheat, and eyes can't see,
So long lives this, and this gives life to me.

May 2, 2010

Succession Problems at the University

It is becoming more and more obvious that the lame duck position of President Bruininks is a hindrance in handling current and upcoming challenges. It would have been wise, in hindsight, to have started the search last year for his successor. That way the new president would have had a little time to get up to speed before we go over the financial cliff.

Unfortunately waiting this long makes the new job less desirable to an outsider. Perhaps this was actually the idea?

A headhunter comments on situations such as these in a recent edition of the Chronicle of Higher Education:

Dennis Barden, April 25, 1010

[Dennis M. Barden is a senior vice president and director of the higher-education
practice at Witt/Kieffer, an executive-search firm that specializes in searches for
academic and administrative leaders in academe, health care, and nonprofit
organizations.]

Why do presidents stay too long in a job? Why do they risk their accomplishments--and thus, their legacy--by overstaying their welcome? Is it hubris? Self-deception? Duty?

In the past couple of years, I have had two search assignments that derived from
presidents staying too long. In both cases, the incumbents had been viewed as
terrifically successful, especially early in their tenures.

Then they ran out of gas.
They stopped going the extra mile to be personally engaged in campus life. They spent more time with family and friends and less at campus events. Rather than sacrifice their personal lives, they spent less time on the road raising money and making friends for their institutions.

Perhaps most problematically, their circle of advisers became narrower and narrower until key decisions seemed to be coming from only an inner circle of close confidants, or worse, from their own imaginations.

The rest is a familiar story. Key constituents lost track of their relationships with the presidents. Preternatural academic politics began to take the place of open discourse. Conspiracy theories abounded, in some cases urged on by the presidents' detractors. The trustees supported the presidents for a while-- perhaps too long--justly grateful for services rendered in earlier times.

Then why do people hang on past their expiration dates?

I can see various reasons, but they all seem to stem from an eroding sense of self-awareness. Presidents--the vast majority of them, anyway--work like mad to position their institutions for greater success. But that work tends to isolate leaders from key constituencies, particularly internal ones.

Presidents seldom become more accessible as their tenure lengthens. All those factors interfere with a clear-headed sense of the institution and of the self that guided the president at the outset.

  • It is becoming more and more obvious that the lame duck position of President Bruininks is a hindrance in handling current and upcoming challenges. It would have been wise, in hindsight, to have started the search last year for his successor. That way the new president would have had a little time to get up to speed before we go over the financial cliff.
  • Unfortunately waiting this long makes the new job less desirable to an outsider. Perhaps this was actually the idea?
  • A headhunter comments on situations such as these in a recent edition of the Chronicle of Higher Education:
  • Dennis Barden, April 25, 1010
  • [Dennis M. Barden is a senior vice president and director of the higher-education
  • practice at Witt/Kieffer, an executive-search firm that specializes in searches for
  • academic and administrative leaders in academe, health care, and nonprofit
  • organizations.]
  • Why do presidents stay too long in a job? Why do they risk their
  • accomplishments--and thus, their legacy--by overstaying their welcome? Is it
  • hubris? Self-deception? Duty?
  • In the past couple of years, I have had two search assignments that derived from
  • presidents staying too long. In both cases, the incumbents had been viewed as
  • terrifically successful, especially early in their tenures.
  • Then they ran out of gas. They stopped going the extra mile to be personally
  • engaged in campus life. They spent more time with family and friends and less at
  • campus events. Rather than sacrifice their personal lives, they spent less time on
  • the road raising money and making friends for their institutions.
  • Perhaps most problematically, their circle of advisers became narrower and
  • narrower until key decisions seemed to be coming from only an inner circle of
  • close confidants, or worse, from their own imaginations.
  • The rest is a familiar story. Key constituents lost track of their relationships with the
  • presidents. Preternatural academic politics began to take the place of open
  • discourse. Conspiracy theories abounded, in some cases urged on by the
  • presidents' detractors. The trustees supported the presidents for a while--
  • perhaps too long--justly grateful for services rendered in earlier times.
  • Then why do people hang on past their expiration dates?
  • I can see various reasons, but they all seem to stem from an eroding sense of
  • self-awareness. Presidents--the vast majority of them, anyway--work like mad to
  • position their institutions for greater success. But that work tends to isolate leaders
  • from key constituencies, particularly internal ones.
  • Presidents seldom become more accessible as their tenure lengthens. All those
  • factors interfere with a clear-headed sense of the institution and of the self
  • that guided the president at the outset.
  • Presidents need some sort of unfettered, unbiased system of feedback,
  • someone to whisper in their ears, "Remember, thou art mortal. "Presidents need some sort of unfettered, unbiased system of feedback, someone to whisper in their ears, "Remember, thou art mortal."
  • In reality, though, boards work that way all too infrequently. Some are absentee, taking the president's word for conditions on the ground at the institution. A great many possess that most attractive human combination of empathy and gratitude that nonetheless leads all too often to tolerance--and inaction.

The Gospel According to Robert, Part IV. The Apocalypse


Continuing to repeat a statement, contrary to fact, does not make it true...

Our leader dances around the issue of shared governance: