Glaxo Drug Tests Put on Hold for Multiple Sclerosis After Claims of Fraud In Scientific Paper–Researcher Fired in China

Glaxo in the UK was reviewing the data on the drug which was in early clinical trials.  Someone gave Glaxo a tip on the data and information being misrepresented and fired the researcher.  The company has not stopped tests and will continue to study for use with other auto-immune diseases.  The researcher denies falsifying any data in the reports. 

We have heard this time after time with science and medical journals. so much to the point to where PLOS one published a paper on who to look for P Values that have been “fiddled” with in the area of showing value.  BD

PLOS One Abstract–Methodology for Detecting Manipulation of “P Values” To Show Significant Statistical Value, “Inappropriate Fiddling” Which Can Lead to “Algo Duping” Situations And Numbers

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GlaxoSmithKline has put on hold tests on human volunteers of an experimental compound for multiple sclerosis, after claims of fraud in a scientific paper that led it to dismiss its top researcher in China.

The UK company said it was reviewing the data on GSK 2618960, which was in early stage clinical trials as a compound using a mechanism identified in the paper published in 2010 in the journal Nature Medicine.

Despite the apparent falsification, research has confirmed the potential for the possible drug which is being studied by GSK and other pharmaceutical companies

http://www.ft.com/intl/cms/s/0/f9531616-d379-11e2-b3ff-00144feab7de.html#axzz2W2kQRDDR

US Surgeon General Regina Benjamin Resigns

There’s no big story here with her resignation other than the fact that she plans to return to Alabama and donate time at a rural clinic as she was doing before being appointed.  Like every other government entity the office had plenty of apps and does provide a PHR, which for some reason or another doesn’t get a lot of attention and I asked if the doctor was a user herself at one point.  There was actually a lot of coding done to have the PHR integrate with other systems but at least in the media, it never really took off.  It is still there if you want to use it as your choice of a PHR and integrates with HealthVault.  BD

Surgeon General Announces Yet Another App Contest Maybe to Promote Their PHR “My Family Health Portrait”? Does She Use The PHR Personally?

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U.S. Surgeon General Regina Benjamin said she would step down next month.

“We are grateful for her leadership and service,” said Dori Salcido, a Department of Health and Human Services spokeswoman.

Dr. Benjamin has served in the post since being named by President Barack Obama in 2009. During her tenure as “America’s doctor,” she has promoted physical activity and efforts to prevent and stop smoking by children and adolescents.

The U.S. Public Health Service Commissioned Corps, which is overseen by the surgeon general, is made up of about 6,500 people who work in several government agencies including the National Institutes of Health and the Food and Drug Administration.

http://blogs.wsj.com/washwire/2013/06/12/surgeon-general-to-step-down/

United Healthcare Referral Algorithms Not Working Well With Tri-Care, Company Moving Their Subsidiary Execs Around, DOD Could Fine The Company Later–Subsidiary Watch

This company has more subsidiaries than Carter has pills.  Due to doctor and patient complaints on referrals, the DOD is keeping a close watch and United said they are getting things in order.  Well moving a CEO from one subsidiary to another should do it, right..not really it’s the automated algorithmic processes that need to work but to show they were addressing the situation they moved people around.  I was not aware of the UnitedHealthcare Military & Veterans Inc. that was created just to go after Tri-Care contracts..and they did..they sued the government in a long drawn out affair for the west after they lost the bid on the south portion of the Tri-Care area of the US.  If you read more about the LHI subsidiary maybe this had something to do with the lawsuit as it also is contracted to the military and the VA and they wanted LHI and Tri-Care to work with both subs?

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

UnitedHealth Loses Tri-Care Protest Again With Contract Awarded to Humana in the South-Now Protesting Contracts Awarded In Both the South and the Western States

The company is moving a person over from the LHI United Subsidiary over to the Military and Veterans subsidiary.  The LHI subsidiary of United conducts VA DEM disability exams and is looking for more doctors to enroll in the program and they have a website set up to where the exam information is entered (one more thing for a participating physician to learn) and the results are populated directly to the VA records via the web service, so I guess this means that this subsidiary of United can populate a VA chart?  It sounds that way from what I am reading here.  So in addition to Tri-Care services, United also appears to be making money with the VA and other areas of the military with the LHI subsidiary in having a contract to help the VA catch up with their disability claims. 

From the website it appears the government is one of the main clients of LHI (or maybe the only one) as the company comes in and does an “event” on location for physicals, etc. for the military.  You can read more about this United Healthcare subsidiary and their services they provide to the VA here with their contract to provide clinical disability exams for the vets.  I swear this company with their subsidiaries is every where getting a part of the action and in the world of insurers, do we have a too big to fail company here?  The corporation has board members sitting around all over the corporate world too and some come from subsidiaries. 

“We have administered private occupational health services in support of various federal agencies including the Centers for Disease Control and Prevention (CDC), Federal Occupational Health Service (FOHS), Department of Defense (DoD) and the Veterans Health Administration (VHA). We support a wide variety of customers, including: National Institute for Occupational Safety and Health (NIOSH), U.S. Army Medical Command (MEDCOM), the Army Reserve, Army National Guard, Air Force Reserve, Air National Guard, Army Dental Command, Navy Reserve, Army Corps of Engineers, Coast Guard, Military Sealift Command and other Federal agencies. LHI also supports a number of private sector clients with occupational health services, including four of the Class 1 railroads operating in the United States.”

The military has given United another month to address the problems with the United Healthcare Military subsidiary and has until June 18th to clean things up or United could get yet another extension.  BD

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UnitedHealthcare Military & Veterans Inc. has changed leaders after encountering serious problems administering a new $20.5 billion federal contract to provide health care to active military members, retirees and their families in 21 states, including Minnesota.

Tina Jonas, a former undersecretary of defense now presiding over a UnitedHealth Group subsidiary called Logistics Health Inc., will take a newly created position of president at UnitedHealthcare Military & Veterans, said Bruce Jasurda, the company’s vice president of communications. The company did not name a CEO.

“We have substantially processed the pending referrals and authorizations, largely clearing the previously existing queue,” Jasurda said. “We are confident that we will continue to process referrals and authorizations after the June 18 waiver expiration in a timely manner consistent with DoD [Department of Defense] guidelines.”

UnitedHealth formed UnitedHealthcare Military & Veterans Inc. in 2007 specifically to go after Tricare contracts. McDougal, who has been working at UnitedHealth since 1983, was originally named chief operating officer. She became CEO in early 2008.

http://www.startribune.com/business/211121181.html?page=1&c=y

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

This was written into their contracts…and I agree with the Supreme Court on this one for sure and it has plagued physicians for years.  This contract provision is probably the works of one of the United big lobbyists groups.  They are everywhere and United even hired Steve Larson from HHS and made him a VP at the Optum division.  Steve Larsen is credited with writing most of the healthcare reform law.  The decision is final and no reruns for Oxford.  This goes back to 2003 and if you look at the little guys up against the big guys with millions to spend on legal cases this is a nice victory for the doctors as insurers knew that arbitrating against one MD at a time improved their chances by allowing under payments to continue as well as contract violations.

We can also reflect back on the under payments lawsuit settled by the AMA with United and the other major insurers that licensed their algorithms to short pay doctors and hospitals for 15 years. 

AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)

Here’s where Aetna just settled their 15 years of short payments using algorithms from Ingenix, now called Optum.  If this is not about context and using an advantage of data over one physician at a time, I don’t know what is. 

Aetna Payment of $120 Million To Settle 15 Year Ingenix/United HealthCare Out of Network Erroneous Payment Algorithms Cuts Income for 4th Quarter

In addition there are still quite a few lawsuits floating around out there relative to the AMA class action suit that take up the 15 years of short pay, but are their own lawsuits. 

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana

Skins game with dermatology offices in California – Ingenix

When I write about articles like this today, I think of Snowden..it’s all about context and with doctors not allowing to group and arbitrate as a group this is as about as close as to what I would call the “bully” effect as when you line up a huge corporation with tons of lawyers on board against one MD and with a big bankroll for court appearance, how do they stand a chance?  We get this too as consumers as well in other areas of healthcare so nice to see the Supreme Court cut the bullies down a little with contract provisions.  We already know that United and their subsidiaries makes millions selling our data as well. 

Contract provisions can easily be taken out of context in court as we see it all the time.  This contract provision is could be classified as “corporate algorithm balls” in my opinion.  BD

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Washington, D.C. – The American Medical Association (AMA) and the Medical Society of New Jersey (MSNJ) heralded yesterday’s decision by the U.S. Supreme Court allowing individual physicians to come together as a group to fight the unfair business practices of large health insurance companies.

“This important ruling allows thousands of physicians to use class arbitration against a health insurer that has underpaid them for more than a decade,” said AMA President Jeremy A. Lazarus, M.D.  “Without this broad-scale arbitration, physicians would have no practical means of challenging a health insurer's unfair payment practices.”

“It is a sad commentary that it took a decade for Dr. Sutter and other New Jersey physicians to exercise the dispute mechanism allowed by their contracts,” said MSNJ General Counsel Melinda Martinson. “A timely class-arbitration would have allowed them to have their payment disputes resolved more expeditiously and cost-effectively. The decision is welcome news to physicians in New Jersey and all who are concerned with reducing the cost of medicine in this country.”

The decision in Sutter v. Oxford Health Plans concludes a dispute dating back to September 2003 when New Jersey pediatrician John Sutter, M.D., alleged that Oxford Health Plans had systematically bundled, down coded and delayed payments for his services and those of 20,000 other physicians in its network. Oxford Health Plans had challenged legal decisions supporting class arbitration of the dispute and appealed the case to the U.S. Supreme Court.

The high court’s ruling in favor of physicians gives a boost to the medical profession’s efforts to address unfair corporate policies of large health insurers that are bad for patients and physicians.

http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-11-supreme-court-arbitration-health-insurer.page

Healthcare Reform Continues to Expand and Grow CEO and Executive Compensation in the Millions…

Everyone out there is getting hurt in some way, the sequester, budgets, you name it, all but the CEOs of health insurance companies. $47 Million was the topper at United Healthcare, which pretty much doesn’t even resemble the way the company operated just 15 years ago with so many subsidiaries and analytics divisions.  Have you also noticed that most are not participating in many state insurance exchanges with the exception of Blue Cross? 

I have been in Phoenix for a few weeks and boy I can certainly see the changes here with health insurance buildings now lining the sky line and I guess they need to have places to put all the new data miners insurers are hiring right and left too.  I haven’t heard of any of these folks donating either to the HHS campaign to help with healthcare reform come to think of it.  BD

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The highest-paid executive at each of the "Big Five'' health insurers -- UnitedHealth Group, Aetna Inc., WellPoint Inc., Humana Inc. and Cigna Corp. -- made more than $8 million each in 2012, according to filings this spring with the Securities and Exchange Commission. The CEO of EmblemHealth Inc., a nonprofit that owns ConnectiCare, also had total compensation at that level in 2011, the last year for which information is available.

Pay for top management teams -- the five highest-paid executives at each company -- ranged from $21 million at Humana to $47 million at United Health. Compensation includes salary, bonus, stock gifts and options granted that year, non-equity pay and benefits.

"People don't begrudge good incomes. But when is enough ever enough?" she asked. "Insurers are definitely feeling the pressure. How they will respond is still in question."

http://www.ctpost.com/local/article/Top-health-insurance-bosses-earn-millions-4592322.php#ixzz2Vwl8Ri00

Recommended Reading: “Where’s the Outrage Over Private Snooping?” “The Killer Algorithms Have Teeth & Don’t Care Who They Might Bite

If you read here often enough I talk about privacy and technology quite a bit and in view of the recent NSA issues, you might want to read up here and see what someone else besides me with a full line of credibility as a Quant and Mathematician has to say.  I have featured Cathy O’Neill’s videos here on the blog and one of her PBS videos is in the footer of what I call the education section here to help folks understand what’s going on in the world and the impact of technology today.  It’s not like the old days.  Here’s a couple quotes from what she writes but again read the entire article I think so really dig in here.  When you read the article entirely, she talks about E-scoring which I covered here about a year ago.

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“What gets to me are the countless articles that make a big deal of Facebook or Google sharing private information directly with the government, while never mentioning that Acxiom buys and sells from Facebook on a daily basis much more specific and potentially damning information about people (most people in this country) than the metadata that the government purports to have.

Of course, we really don’t have any idea what the government has or doesn’t have. Let’s assume they are also an Acxiom customer, for that matter, which stands to reason.

Theory 5 6: people just haven’t thought about it enough to get pissed

This is the one I’m hoping for.

I’d love to see this conversation expand to include privacy in general. What’s so bad about asking for data about ourselves to be automatically forgotten, say by Verizon, if we’ve paid our bills and 6 months have gone by? What’s so bad about asking for any personal information about us to have a similar time limit? I for one do not wish mistakes my children make when they’re impetuous teenagers to haunt them when they’re trying to start a family”

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I come back around to the same old world again “context” that myself and others in the tech field use quite a bit as you can take data out of context when trying to prove a point and thereby, even innocently, create a profile that looks not so good.  In healthcare we see this quite a bit with studies even when looking a trending numbers with numbers projected off some model, “what model” we should ask and was the data provided to simulate?  Some do and some don’t, but if it looks like it will get attention, it’s wide spread throughout the media.  Sometimes it’s hard to tell the difference…the news is full of them. 

Namely you can maybe look at the language used with obesity and certainly it needs focus but not to the point to where those who need help are given an “evil twin” type of description and if it isn’t this group it is those who are sedentary.  Sure it all need attention, but reflected more in the area of making education available to help those who need it and not an evil twin type of commentary we see at times today for the sake of marketing or making a buck flipping some profitmaking algorithms. 

Media and Press Releases In Healthcare That Go Nowhere–Marketing to Sell You Analytics With Using Fear and Misplaced Guilt Overtones As a Theme

So she asks a good question in her last theory, is everyone mad enough yet and ready to face what is happening in the digital world and ready to really ask for “real privacy?  Are these proprietary algorithms becoming law?  It is starting to look that way.

I have also posted about our Congress needing a bigger brain to create laws that address the digital world today and without an IT infrastructure spelled out for regulation then you don’t get much bang for you buck.  We could certainly stand for better educated officials on the Hill that we elect. The comments I read in the news made by folks on both sides really showed a need for more digital education with lawmakers, as none of them really “got it”.  I would really much rather see a group of lawmakers work to educate themselves better rather than the rhetoric about abortions we waste time on.

Congress Needs a Bigger Brain–Restore the Office of Technology Assessment And Truly Assess What is Useful And Remove The Algo Duping Permeating In Government–Fantasy Perceptions That Are Not Real Can Be A Dangerous Thing

Instead we get this (link below) and all wondering about where’s the manufacturing in the US, easy, too many are flipping data selling algorithms for profit and manufacturing gets the back seat.  It is an epidemic. 

Nearly Free-Everything Digitally Created Including Money Versus Real World Assets- Imbalance Leading To Our Own Undoing With A Country Full of Leaders Living on Irrational Behavior Instead of Logic-It Bites Back at the NSA

Also, the re-identifying business is alive and well and this should be be a huge surprise as we read about hackers day in and day out, just a new form in a matter of words and only the “Query Master” knows for sure.

Re-Identifying Medical Records All Depends on the Query Master and How Much Money Can Be Saved or Made With Adjusting Risk, Up or Down

Not enough yet on the profit side of this, here’s one more where SAP is ready to take the Verizon data they announced they would sell and reorganize it with some algorithms and sell it, and split the profits with Verizon…enough yet?

So Much Money and Profit in the Data Selling, Epidemic, SAP Now Coming in as a Middleman Broker to Interpret Data & Share Profits With Wireless Carriers- Banks/Companies Making Billions

So in essence it is not only the NSA and privacy at hand here, it’s the efforts of private industry that make this happen and they profit big time.  You have probably read in the news that Booz Hamilton makes all their billions from government profits..it’s been all over the news, so give this some thought..and I’ll finish here with once again re-stating my 2 year little campaign on this blog about licensing and excise taxing the data sellers who cash in big.  Private Industry is totally out of control here with the data selling epidemic (one example here) and thus so follows the government in some of of this.  I have no clue why our Consumer protection agency needs to build a data base, I guess so Richard Cordray can learn..better move here, hire some Quants:)

Laws for privacy will fail without an IT infrastructure specially lined  out for regulation and data used out of context stands to be one of the biggest attacks on consumers that we have ever seen.  Here’s a couple back linked posts where I talk about this potential idea.  BD

Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format

Privacy Wanted–So Let’s Require Those Who Sell Web Data to Register and Tax the Transactions and Publicly Disclose Who They Sell To With a Federal Registry

What makes the NSA story news worthy is the fact that I think you have someone working not even at a real high level position that has basically turned the tide without being destructive with dumping data out there to create a witch hunt and telling us all what he can do with a low level security clearance and all the data he has access to.  Anyone getting mad yet?  If not scroll down to the footer for some good videos that are very informative on data mechanics for the layman and visit the Algo Duping page with more vides done by people smarter than me that carry the same message.  PBS also did some very good reporting on Secret America and might make you ask questions, and the interviews with the FBI and NSA are very good for historical purposes on how this evolved.  We live amongst the Killer Algorithms for sure.  BD

http://mathbabe.org/2013/06/11/wheres-the-outrage-over-private-snooping/#comment-30053

Patients at the Cleveland Clinic Will Gain Access to Almost All Their EHR Chart Information By the End of the Year Including Doctor’s Notes

This is a nice move and yes they use Epic medical records as their software but this is a nice move so patients get to see and read the whole story.  It’s a battle that has been going on for a long time and perhaps others will follow in their footsteps and I hope they stay cool and keep any admin fees out of this and truly do it for the patient.  As mentioned, behavioral health though is not included as that is protected by law.  Having a system such as MyChart to where the clinical information is populated for the patient is huge and there’s always the possibility of exporting to a non tethered PHR if a patient leaves their care and moves out of the area for example if they want to.  Patients have options and data, finally. 

They also have the IBM Watson technology in place to help doctors with research and treatment plans.  BD

Cleveland Clinic is Next Medical Center to Enroll IBM Watson–Too Bad Our Lawmakers Won’t Use This Technology to Enhance Research To Make Better Laws

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A half million Cleveland Clinic  patients gained access to more of their healthcare information Thursday – and by the end of the year – they will see all that is in their electronic medical record, including physician notes, via MyChart, the secure online portal.

As Cleveland Clinic officials see it, it’s the right thing to do because it will give patients a more complete picture of their health and empower them to make better, smarter and more economical decisions about their care.

Today patients  can view their after-visit summary, medications list, allergies, immunization records, preventative care details, laboratory results, and radiology reports. If they want to see the rest of their medical records, they must contact the hospital to get hard copies of the EMR.

The new transparent MyChart EMR will give patients access to pathology records, X-ray reports, physician notes, and the list of their current health issues, which physicians use to briefly describe a patient’s health status, recent concerns, and known diagnoses. Patients will be able to view online nearly everything their doctor sees in their EMR, except for behavioral health information, which is prohibited from release by state law.

http://www.healthcareitnews.com/news/cleveland-clinic-opens-emr-patients?single-page=true