Sunday, April 26, 2015

Purported Medical Wizard of Oz

This month, 10 “Distinguished Physicians, “ fired off a letter to the Dean of Columbia Medical School, asking him to oust Mehmet Oz, M.D., a 54 year old Turkish-American cardiovascular surgeon, author, and principal of the Dr. Oz television show from the Columbia faculty.

The physicians portrayed Dr. Oz as a modern day Wizard of Oz, a quack and a fraud, a deserter from the medical scientific ranks.

But as an Op-Ed New York Times piece of April 26, 2015, says in a headline, “Dr. Oz Is No Wizard, But No Quack, Either”.

Oz is a tenured professor and co-chairman of Columbia University’s department of surgery and director of Columbia’s Cardiovascular Institute and Integrative Medical Program.

In his TV show, since 2004, he has spoken openly, often, and sometimes inaccurately aboutnon-scientific controversial subjects such as homeopathy, faith healing, naturopathy, acupuncture, vaccines and autism, genetically modified foods, and a host of health and wellness products – health foods, dietary supplements, low testosterone therapies, probiotics, fruits and vegetables in pill form, antioxidants, herbs, home remedies , and sensitive sensitive things bowel movements, menopause, and body fat.

This dual role has landed him in scientific hot water. The British Medical Journal has reported that only 33% of 80 of his recommendations stand up under scientific scrutiny and are “believable.” This kind of negative publicity prompted the leaeder among 10 well-known physicians to write the following public letter to the dean of Columbia medical school.

“I am writing to you on behalf of myself and the undersigned colleagues below, all of whom are distinguished physicians.”

“We are surprised and dismayed that Columbia University’s College of Physicians and Surgeons would permit Dr. Mehmet Oz to occupy a faculty appointment, let alone a senior administrative position in the Department of Surgery.”

“As described here and here, as well as in other publications, Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine, as well as baseless and relentless opposition to the genetic engineering of food crops. Worst of all, he has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”

“Thus, Dr. Oz is guilty of either outrageous conflicts of interest or flawed judgments about what constitutes appropriate medical treatments, or both. Whatever the nature of his pathology, members of the public are being misled and endangered, which makes Dr. Oz’s presence on the faculty of a prestigious medical institution unacceptable.”

Dropping Doctor Oz from the faculty will be had to do.

1. According to the first amendment, he has the right of free speech.

2. He says he has never received any reimbursement for endorsing or promoting a product.

3. He is the best known physician in America because of his syndicated television program.

4. He is a tenured professor of surgery , which means he would be difficult to fire.

5. While a resident at Columbia , he was the four-time winner of the prestigious Blakemore research prize, which went to the most outstanding surgery resident. He has 11 patents for inventing methods and devices involved in heart surgeries and transplants. This includes helping to research and develop the left ventricular assist device, or LVAD, which helps keep people alive while they’re awaiting a heart transplant. Oz had a hand in turning the hospital’s LVAD program into one of the biggest and most active in the world.

6. More than 50% of Americans use products or treatments of CAM (Complimentary and Alternative Medicine), which is $34 billion dollar industry. Many prestigious organizations like the Mayo Clinic deem CAM worthy of serious scientific discussion, and many University medial centers have established “Integrative" medical centers , e.g. using acupuncture and meditation techniques to supplement scientific medicine.

Given these facts and factors, it is hard to dismiss Dr. Oz as a “”quack,”defined as a fraudulent or ignorant pretender to medical skill. He may be injudicious and should strive to be more guarded in promoting or evaluating products that have not gone through double-blind and controlled scientific trials, but with the vast array of products available that would be impractical. Perhaps he should cut back on his free-wheeling and engaging personal style, but that is what appeals to millions of TV watchers.

Dr. Oz is not ignorant, nor is he a fraud. He received an undergraduate degree from Harvard and his MD and MBA from the University of Pennsylvania. His views may not pass the scientific "smell test", but he knows what the public wants to know about alternative, complementary, and integrative products, approaches, and techniques. Oz claims discussing the boundaries of conventional vs. alternative care are better coming from a physician than elsewhere. During the 10 years of his TV program, he has made a fortune, but by doing so has "suffered the slings and arrows of outrageous fortune"(Hamlet) from the physician establishment.

One hundred and fifteen years after Frank Baum published his epic book The Wizard of Os in 1900 about a charlatan hiding behind a curtain. According to some physicians, Oz is supposedly a modeern Wizard of Oz who has emerged to lead people down another yellow brick road. This road may turn into a blind alley. There is room beyond peer reviewed journals and scientific proof to discuss alternative health issues that are not scientifically proven but widely used and sought after among Americans.

Saturday, April 25, 2015

Single Payer – The Dream Never Dies

At some point, perhaps 5 to 10 years from now, as the size and scope of Medicare, Medicaid and the ACA subsidy structure balloon far beyond today’s larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states – and no time soon.

John E. McDonough, Dr. P,H, M.P.A, Democrat activist and professor at the Harvard School of Public Health, “The Demise of Vermont’s Single-Payer Plan, New England Journal of Medicine, April 23, 2015. In 2011, McDonough was author of Inside National Health Reform, University of California Press, the inside story of how ObamaCare came to be

Friday, April 24, 2015

Health Care Transformation: The Big Ideas:

Hint: It’s All About Data, IT Disruption, and Consolidation

In God we trust, all others use data.

W. Edwards Deming (1900-1993) , Management Consultant

This morning I ran across “Special Report: The Transformation of Health Care Delivery.” The report appeared in and was sponsored by PriceWaterHouseCooper, the consulting powerhouse.

In essence, the report is about using IT technologies to:

Do away with “archaic “ clinical paper files.

Go digital, collect data from electronic health records.

Use data to disrupt current physician and hospital arrangements.

Transform that data into digital from to measure outcomes, improve quality, lower costs, capture more market share, increase efficiencies, raise revenues.

Consolidate health systems and physicians into larger “congruent” integrated organizations capable of increasing individual and population health and enhancing outcomes.

Transforming health delivery from individual physician and hospital practices to corporations has been going on for at least 45 years as I reported in my 1988 book And Who Shall Care for the Sick; The Corporate Transformation of Medicine in Minnesota.

What has changed is the speed of change, as facilitated by the Internet, the formation of companies like Microsoft and Google, spread of the social media through Facebook and Twitter, and the widespread adoption of electronic health records.

Almost overnight, in historical perspective, we are up to our hips, armpits, and brains with data, and the need for larger organizations to harness and deploy masses of data for achieve useful goals.

The Special Report , through an 11 member panel of editors, versed in organizational transformational matters, including 5 MDs, reaches certain conclusions, which they present in revealing bar graphs with these percentages

What’s important in carrying out the health delivery transformation are: data provided by clinical information technologies 26%, EHRs 26%, and data analytics 21%.

Types of data needed are EHRs 95%, patient demographics 91%, and 85% aggregated EHR and patient data.

The best use of the data is to improve quality 90%, to identify gaps in quality 84%, to lower costs 83%.

Types of organizations desired to gain physician buy-in through mergers, acquisitions, or partnerships 50%, to merge with other hospitals 36%, to establish new physician arrangement with health systems, 26%.

Merger objectives are to improve position in population health management 70%, to improve efficiency 65%, to improve clinical integration 61%.

To improve finances by expanding outside of hospitals, 63% , by enhancing strategic marketing 43%, by developing Accountable Care Organization or other sharing entities, and by merging services with with physicians 36%.

None of this will be easy. It will require disruptive technologies, creative destruction of existing hospital and physician organizations, and harnessing the data for useful clinical use. It will also demand a blind trust in data to provide “ evidence-based” clinical value and the partial sacrifice of one-on-one clinical autonomy
For Health Care Transformation: EHR Data and Physician Practice Acquisition

To achieve health care delivery potential.

maximal use of clinical data is essential.

Say health leaders and management sages.

Data can’t come from archaic print pages.

It must come from the electronic health record,

It must come from doctors on their own accord,

Working together or for a health system,

to provide value, to avoid data mayhem.

Only through more digital information,

can we attain health care transformation,

can we provide evidence-based facts,

which the current systems so sadly lacks

“Special Report: The Transformation of Health Care Delivery, “, April 22, 2015

Wednesday, April 22, 2015

Health Reform Metaphors

The greatest thing in style is have command of the metaphor.


I am a sucker for metaphors that crystallize what is happening to the U.S. economy related to health reform.

I was reminded of my weakness by this concluding paragraph in yeterday's WSJ Op-Ed piece by Phil Gramm, former Republican Senator from Texas:

“With better economic policies America was like the fabled farmer with the goose that laid golden eggs. He kept the pond clean and full, threw out corn for the goose and every day the goose laid a golden egg. Mr. Obama has drained the pond, burned down the coop and let the dogs loose to chase the goose around the barnyard. Now that the goose has stopped laying golden eggs – the administration’s apologist – arguing that we are now in ‘secular stagnation’ – add insult to injury by suggesting that something is wrong with he goose.’

Mr. Gramm is suggesting that if we would simply lower taxes and lift regulations, economic growth would renew and American exceptionalism would reassert itself. Gramm asserts under Obama, “Compared with average postwar recovery, the economy in the past six years has created 12.1 million fewer jobs and $6,175 less income for average for every man, woman and child in the country.’ He goes on to say income tax rates are up 24%, capital gains and and dividends up 59%, estate-taxes up 14%, and the U.S. corporate tax rate is the highest in the world. And, he adds, “With ObamaCare, the government now effectively controls the health-care market.”

I don’t know about his figures, but Gramm certainly is a master of the metaphor. Speaking of the metaphor, in yesterday’s blog, I said in yesterday’s blog that hospital monopolies were “Kings of the Health Care Mountain” in most major markets because of their organizational structure and physicians were “Stray Cats,” difficult to herd because of their lack of structure. I could have added the golden goose of private practice has stopped laying golden eggs, and the employer mandate was killing the golden goose of small business growth, but I did not. But my liberal readers might have objected that what is sauce for the goose is sauce for the gander and that the goose is a greedy bird.

Tuesday, April 21, 2015

Hospitals as Kings of Health Care Mountain

In my reading today, I ran across Doctor Marty Markay’s April 19 WSJ article “The ObamaCare Effect: Hospital Monopolies.” with a subtitle of “Last year saw 95 hospital mergers and acquisitions, a frenzy encouraged by the Affordable Care Act.”

Marty Markay, MD, is a surgeon at Johns Hopkins Hospital and professor of health policy at the Johns Hopkins Bloomberg School of Public Health. He is the author of Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care“(Bloomsbury Press, 2013).

Dr. Markay argues that when you are a hospital monopoly and the only game in town, you can charge whatever you want because every town has to have a hospital, and you can negotiate the price that suits you.

“Today’s frenzy of hospital mergers and physician practice acquisitions is giving hospital systems even greater leverage to inflate opaque “charge-master” medical bills that even hospitals are sometimes unable to itemize sensibly. With no mechanism to allow free-market forces to keep prices in check, this translates into higher health-insurance deductibles and copays for insured Americans, and in the case of Medicare and Medicaid, higher taxes. “

This is not new news. Avik Roy, of the American Enterprise Institute, made be same case back in 2011 in Forbes Magazine in “Hospital Monopolies: The Biggest Drive of Hospital Costs That Nobody Talks About.” And before that, Regina Herzlinger of Harvard Business School in Who Killed Health Care (MaGraw-Hill 2007). More recently, in 2012, Steven Brill, complained bitterly and acidly about how hospitals were soaking the public with his epic book, America’s Bitter Pill: Money, Politics, Back Room Deals, and the Fight to Fix Our Broken Health System.

And even me, yours truly, has been engaged in portraying hospitals as kings of the community health care mountain. In the 1990s, seized by the naive notion that hospitals and doctors could work together harmoniously as equal partners, I formed a national organization The National Association of Physician Hospital Organizations, later renamed the National Association of Integrated Health Organizations. Both floundered because of lack of interest by hospitals and physicians and lack of capital. I even served at chairman of a community PHO, and with James Hawkins. a hospital administrator, wrote a book on Hospital-Physician Relationships, Sailing the Seven “Cs” of Hospital-Physician Relationships: Competence, Convenience, Clarity Continuity, Competition, Control Cash, Finally, I written a series of Medinnovation and Health Reform blogs on the subject : February 22, 2013, “Why the Medical-Industrial Complex Is Killing Us, March 26, 2013, “Hospital Malfeasance: Fees for Services, Fees for Items, Fees for Facilities, and Fees for Physicians” and January 8, 2015, “Quotes from America’s Bitter Pill”.

All to no avail. Hospitals are going their merry monetary way, dominating 80% of metropolitan markets, hiring tens of thousands of physician employees, charging high opaque chargemaster fees, doubling physician fees in practices they own, squashing competition, negotiating higher fees from health plans. Not that I blame them. Obamacare is forcing them to form Accountable Care Organization, paying lower fees for government plans; and penalizing them for re-admissions.

But never mind. Hospitals are the visible beating heart of most communities, have the organizational structure and capital to centralize high technologies, maintain 24 hour emergency rooms, equip their facilities with high-tech wonders, are reaching out with free standing facilities and owned physicians into the communities, are the largest employers in those communities, and have the political clout to block or neutralized competing physician-owned facilities.

Hospitals are kings of the health care mountain, or if you prefer the 800 pound gorillas, in most communities and larger cities, while physicians are stray cats looking for homes in which they can feel secure.