Friday, August 31, 2007

Peter Agre Decides Not to Run for Senate in Minnesota

Today's Strib announced:

"News reports last June revealed my intention to explore a possible run in the 2008 election for the U.S. Senate seat from my home state of Minnesota. After much deliberation, I've concluded that this is not the right time for me to enter the race." (Peter Agre)

This is unfortunate. I am not sure that Al Franken can unseat Senator Blowdry. So that leaves Mike Ceresi. Given Senator Blowdry's close association with Shrub, it is hard to believe that he can't be defeated. But politics is very scary.


Thursday, August 30, 2007

Honor Roll – Best Hospitals (2007)

Those rankers at US News are at it again. Not only have they annoyed a lot of college and university presidents, they probably annoy many hospital administrators. These seem to have been cajoled into cooperation by the fact that getting a single specialty ranked in the top fifty allows them to claim that they are one of the top hospitals. The next post will discuss ways to game the system.

But for now, a list of the strongest hospitals follows. To achieve this rating a hospital must be very strong in a large number of specialties. Certainly the hospitals in this list are outstanding institutions and Minnesotans should be proud that the Mayo Clinic is, in fact, worthy of its reputation. Five of the eighteen are public university related hospitals. This is also very encouraging. As an old Pittsbugher, whose first scientific job was at Pitt, Mr. B. is very proud of Pitt being on the list.

There will be two further posts on the US News 2007 rankings. Part I will compare the performance of Minnesota hospitals judged to be noteworthy: Mayo Clinic, University of Minnesota, Abbot-Northwestern, Childrens Hospital of Minneapolis, Hennepin County Medical Center, and St. Cloud Hospital. Part II will chart the performance of the University of Minnesota hospital over the last three years.

Ciao, Bonzo

1 Johns Hopkins Hospital, Baltimore
30 points in 15 specialties

2 Mayo Clinic, Rochester, Minn.
29 points in 15 specialties

3 UCLA Medical Center, Los Angeles
25 points in 15 specialties

4 Cleveland Clinic
25 points in 13 specialties

5 Massachusetts General Hospital, Boston
23 points in 12 specialties

6 New York-Presbyterian Univ. Hosp. of Columbia and Cornell
21 points in 11 specialties

7 Duke University Medical Center, Durham, N.C.
18 points in 10 specialties

7 University of California, San Francisco Medical Center
18 points in 10 specialties

9 Barnes-Jewish Hospital/Washington University, St. Louis
17 points in 11 specialties

10 Brigham and Women's Hospital, Boston
16 points in 10 specialties

11 University of Washington Medical Center, Seattle
15 points in 9 specialties

12 Hospital of the University of Pennsylvania, Philadelphia
11 points in 8 specialties

13 University of Pittsburgh Medical Center
10 points in 7 specialties

14 University of Michigan Hospitals and Health Centers, Ann Arbor
9 points in 7 specialties

15 Stanford Hospital and Clinics, Stanford, Calif.
8 points in 6 specialties

15 Yale-New Haven Hospital, New Haven, Conn.
8 points in 6 specialties

17 Cedars-Sinai Medical Center, Los Angeles
7 points in 6 specialties

17 University of Chicago Medical Center
7 points in 6 specialties

Tuesday, August 28, 2007

St. Kate's Makes a Major Move in the Allied Health Area

Here is an interesting development that may have implications for the Academic Health Center at BigU. From the Strib:

School of Health to open at College of St. Catherine

St. Kate's says it wants to help meet the growing demand for health care as Minnesota's population ages.

Sister Andrea Lee called it perhaps the most important initiative she will lead as the president of the College of St. Catherine.

On Tuesday morning, Lee announced to faculty and staff that St. Kate's will open a School of Health, expanding a health education program that dates to the late 1800s. The school's board of trustees unanimously approved the move at a meeting last week.

The hope is that the school will provide quality graduates in areas where demand for trained workers is great, including in areas in which the school doesn't currently have programs. At the same time, St. Kate's wants its teaching approach to be more integrated than at most schools nationally.

"We're in a critical situation with health care in Minnesota," Lee said. "We have a changing population, an aging population of baby boomers, and we have demographic changes.

"We have a responsibility here, we have the capacity and we have the will."

While St. Kate's is very much a liberal arts institution for women -- something Lee said won't change -- only the University of Minnesota produces more health profession graduates annually. The school said more than 11,000 of its graduates are health care workers currently employed in the state.

St. Kate's already offers 21 health care programs, where about 40 percent of its students study. Six more programs, ranging from a graduate program in transition nursing to a doctorate in occupational therapy, are in the development stage. Eighteen more programs have been proposed.

College of St. Catherine officials had been quietly working on the expansion of health education for nearly two years, before the University of St. Thomas' recent announcement that it is considering opening a small medical school.

David Page, the retiring president and CEO of Fairview Health Services, approves of this new direction for St. Kate's.

"The move away from just the pieces, the mosaic of patchwork quilt health care and going to a continuum is exactly what the [health care] industry needs," said Page, one of St. Kate's advisers and a member of the school's board of trustees. "For instance, in patient safety, we're learning that one of the key elements of having good, safe medical care is a team concept.

"[The plan] is unique, it's forward-thinking."

Mr. B. taught at St. Catherine many years ago. There are a lot of smart, hard-working people over there and the students are very bright and motivated. Watch out!

Monday, August 27, 2007

Gonzo Gone

From the New York Times:

WACO, Tex., Aug. 27 — Attorney General Alberto R. Gonzales, whose tenure has been marred by controversy and accusations of perjury before Congress, has resigned. A senior administration official said he would announce the decision later this morning in Washington.

Rove, Wolfie, and now Gonzo...
Mr. B. has posted before about Gonzo's exploits.

Oh happy day, Bonzo

Attention: PhD wannabes in the Sciences, People Puzzled about BigTime Athletics at GridIron State

An excellent post and informative comments for people interested in pursuing a PhD in the sciences may be found at the website of Pharyngula - "The Most Daunting Numbers I've Seen."

This article is about the ugly situation for biology PhDs seeking academic jobs, but anyone thinking about a PhD in the sciences would do well to read it.

Those trying to puzzle out the relationship of BigTime Athletics to academic excellence will find the Higher Ed interview of Confessions of a Spoilsport author William Dowling of great interest. The always readable UD sniffed ths one out.

Ciao, Bonzo

Sunday, August 26, 2007

Some Pigs
More Equal
Than Other Pigs

AFSCME voted (73% favorable) to turn down BigU's latest contract offer. Thus it appears that a strike may occur on the first day of fall semester classes at the University of Minnesota. Clerical and technical workers are not happy with the proposed salary increase.

OurLeader's response:

Bruininks acknowledged that a first-day-of-school strike "would not be pleasant." He also said that the university would have to adjust its budgets if the AFSCME workers are given a larger contract.

"We would have to go back and make some appropriate adjustments to [other employee groups'] compensation," Bruininks said. "When you start to multiply the impact of this, the impact could be very great.

Ah, the old divide and conquer technique. Rather ham-handed, don't you think? But then Bruininks is a self-described 'dirty player' and apparently proud of it.

"The only way it could happen would be by cutting budgets and, inevitably, that means laying people off. [Could this be a threat?] I don't think it's a very good bargain and I'm not willing to enter into one that will weaken the university at this time."

Mr. B. notes that president Bruininks is perhaps not the best person to be making such comments given his own large salary increases, platinum parachute, and recent purchase of a million condo downtown.

It's a beautiful day in the neighborhood. Ciao, Bonzo

Friday, August 24, 2007

Further Bumps on the Road

To Economic Reality

BTN Is Not Going to Save Gopher Sports After All

Mr. B. has previously commented on the solicitation of OurLeader and the AD – Joltin' Joel on behalf of the BigTenNetwork (BTN) a conglomerate of the eleven BigTen schools who own half of it and Fox who owns the rest. So let's see, that means that BigU's cut will be ~5%.

The BTN was planning on making a killing by offering Comcast the opportunity to put it on basic cable so that everyone could pay. Comcast would rather put it on a separate grouping where only those interested in watching would pay. Needless to say BTN is not too happy with this suggestion because they would make far less money.

The latest word is:

Big Ten: Comcast deal unlikely

Minneapolis / St. Paul Business Journal - 3:51 PM CDT Friday, August 24, 2007

by John Vomhof Jr.

The Big Ten Network is scheduled to launch Aug. 30, but many University of Minnesota sports fans won't be able to catch any of the action.

Network officials said Thursday that they do not expect to reach a deal with Comcast Communications.

"The fact is that Comcast is unwilling to negotiate with us, and it is now clear that it's highly unlikely any agreement will be achieved prior to launch," said Bob Thompson, president of Fox National Cable Sports Networks, in a statement. Fox Sports is partnering with the Big Ten Conference to start the network.

Comcast officials, on the other hand, say they are willing to negotiate, but the Big Ten Network is being unreasonable.

The network wants to be part of Comcast's basic cable package, but Comcast wants to include it in its more expensive sports package. Comcast says the network also wants it to pay $1.10 per subscriber to carry the channel. Comcast has about 5 million subscribers in eight Big Ten States: Minnesota, Iowa, Wisconsin, Illinois, Indiana, Michigan, Ohio and Pennsylvania.

"Our first priority is to protect our customers and to make the Big Ten Network available in the fairest way to all our customers... We simply can not allow Fox and the Big Ten to burden all of our customers -- the vast majority of whom have no interest in Big Ten sports," said Bill Connors, president of Comcast's midwest division, in a statement.

Mr. B. is shocked, shocked.

Comcast has reserved channel 255 for the Big Ten Network and remains hopeful of reaching a deal to carry the network, said Mary Beth Shubert, a local spokeswoman for the cable operator.

The Big Ten Network is slated to broadcast 60 to 70 Gophers athletics events during the 2007-08 season, including a number of women's events.

"Anyone who lives in an area serviced by Comcast who wants to make sure they don't miss a game had better make alternative plans," Thompson said.

The Big Ten Network has carriage commitments from national providers DirecTV and AT&T, as well as roughly 100 smaller Midwest cable operators.

And the moral of the story is: Don't count your chickens until after they've roosted. Very few schools have a football program that is self-supporting. To claim that this will ever happen at BigU is delusional. Mr. B. has no interest in television. But he points out that BTN won't even be showing the Big Kahuna games. They are already sold to someone else. Very few people outside of Ohio will want to see Ohio State play Akron. The Indiana / NU game? Even as an NU grad, I'd pass on that one.

Ciao, Bonzo

Another Academic Year at the BigU MedSchool

Mr. B. was not surprised to see the chickens coming home to roost in the form of a blanket email by the Dean, oddly enough called Dialog with the Dean.

Wherein it is related:

"In sum, this class is mainly Minnesotan, performed even better than past years on GPAs and MCATs, and is about 10 percent larger than our usual number."

Interesting. As Saul Alinsky once said (approximately): "If you can't get them to do the right thing for the right reasons, then get them to do it for the wrong ones." Thank you Allina/St. Thomas. Does this mean that from somewhere came twenty million dollars? The cost per medical student, according to Dr. Cerra, is about a million a head. Dr. Frank Cerra is the VP of the AHC at the University of Minnesota, a surgeon, and a former BigU MedSchool Dean.

"Our educational leaders already are talking about how to make the larger class size work two years from now. We may be seeking more clerkship sites in the Twin Cities and Duluth and recruiting more preceptors for the Rural Physician Associate Program. We don't have all the answers today. Yet I am glad we have such a talented and diverse new class, one that responds to community concerns about a potential shortage of physicians."

But, again according to Dr. Cerra, I thought that there wasn't a shortage? (It's all the fault of those darned, agitating, osteopaths.) To repeat: Thank you Allina/St. Thomas.

"While each of you as faculty, center directors, and department heads is keenly aware of budgetary challenges in your own area, when we look at the Medical School as a whole, we recognize a structural deficit of $29 million over the next three years. To deal with this looming deficit, and to address our goals of moving the Medical School into the top 20 in NIH funding and the University into the top ranks of public research universities, we must develop an ambitious work plan, and we must explore new models as well."

Hmm.. According to Dr. Cerra we were to be in the top 20. I don't remember the part about "in NIH funding." But OK. We are now 31 and there are a lot of good schools ahead of us. How is this going to happen? {See recent post on the Red Queen Effect.}

"To develop the strategies that will move us where we need to be, I recently established a Medical School Advancement Project steering committee, chaired by Roby Thompson, and including Tim Ebner and Terry Bock from Dr. Cerra's office. The project also has three subcommittees: financing, chaired by Leo Furcht; clinical alignment, chaired by Selwyn Vickers; and, research, chaired by Harry Orr."

That's an interesting lineup. The immortal phrase, the usual suspects, comes to mind. With the exception of Dr. Vickers, these are all familiar faces – the Old Guard, so to speak. The people who have gotten us to where we are today. Why Dr. Furcht was even involved in the ill-fated attempt to do away with tenure during his VP for reengineering days. Fortunately, this consultant-driven effort was a failure, but it started the decline of the med school - along with the consequences of NIH-related malfeasance. Maybe it is time for some of these old timers to move on and be replaced by younger people with new ideas and a little more idealism? We keep hearing that change is good. But if you are a BigU administrator? As Lotte Lenya would say: "Guess not.."

"These leaders and the more than 30 faculty and staff serving on these task forces are taking on a great deal of intense effort in a short period of time. Our deadline for reports is Oct. 15. I recognize that everyone involved already is very busy and I am grateful for their commitment to the future of this Medical School. We hope that the University might consider a major request to the legislature on behalf of the Medical School. That's an opportunity we have to seize."

My, my… Things have been going downhill for years and we are just going to knock out something by the 15th of October to fix them. Isn't that interesting? If it were so easy to do, one might ask why this has not been taken care of a lot earlier. Another example of the good old BigU "make it so, Spock" attitude.

"In a Dialogue earlier this year, I mentioned the need for a conflict of interest task force. Thank you to each of you who expressed an interest in serving. This month, I named as co-chairs for this task force Leo Furcht and Denis Clohisy. In the coming weeks, I expect them to call a committee who will address the weighty and complex issues of conflict of interest in academic medicine. Their discussions will impact our faculty, students, and patients, as well as our friends and advocates in the wider community."

I hope that this group looks into conflict of interest of all types, including Dean Deborah Powell's board of directors membership with Pepsi. To anyone who has been around BigU's med school for any length of time, this last paragraph is telling. I certainly hope that the mystery of the photoshopped figures at the U of M is cleared up soon, before anyone does too much pontificating.

Ciao, Bonzo

Thursday, August 23, 2007

Troubles At The Big House

Senator Charles Grassley Goes After Dr. Zerhouni, NIH Chief

The Scientist reports in an article "Trouble Brewing At NIH Agency" on the continuing saga of the under siege NIEHS director David Shwarz:

More than 100 tenured and tenure-track scientists at the NIH's environmental agency say they no longer have confidence in the leadership of David Schwartz, embattled director of the National Institute of Environmental Health Sciences (NIEHS).

The vote of no confidence, cast during a secret ballot held from August 13 to August 20 at the request of NIEHS Assembly of Scientists members, follows a series of controversies at the agency, including its proposal to privatize and cut funding for Environmental Health Perspectives, the agency's open-access, peer-reviewed scientific journal, in September, 2005.

Senator Charles Grassley (R-IA), a ranking member of the Senate's Committee on Finance, has also accused Schwartz of mismanagement.

In a June 21 letter that cited several internal NIEHS Emails provided to the Finance Committee, Grassley detailed several allegations levied against Schwartz. The letter charged that Schwartz, a researcher and physician specializing in environmental lung care at Duke University prior to his NIEHS appointment, acted as an expert witness or a medical expert for two law firms involved in asbestos cases and obtained permission to partake of these activities from NIH officials.

In two more recent letters, Grassley asked for more information from Zerhouni regarding Schwartz's activities as NIEHS director. In a letter dated July 25, 2007, Grassley noted, again citing internal documents by anonymous NIEHS staffers, that Schwartz overshot the $1.82 million budget for his laboratory by more than $4 million in 2006. The letter alleged that Schwartz may have diverted funding from other NIEHS researchers to fund his own lab.

An August 20, 2007, letter from Grassley to Zerhouni requested information from the NIH chief regarding a form allegedly sent around to rank-and-file NIEHS employees which they must fill out to report Congressional inquiries. The form, in which employees are to list the name of the legislator and details of the specific time and date of the inquiry, is intended to "flush out whistleblowers," the letter charged.

According to an Email from Grassley's spokesperson, NIH has not provided a "complete response" to the allegations outlined in the two letters.

In response to an Email to Zerhouni requesting comment, an NIH spokesperson told The Scientist, "Most of the concerns that have been raised recently were identified and corrective actions were taken internally by the NIH Office of the Director prior to Congressional inquiries. Our conflict of interest policies, which were overhauled and strengthened in February 2005, are stringent and clear. All Directors must submit a signed affidavit that says they received them, understand them, and agree with them."

The senior NIEHS researcher interviewed by The Scientist said that ethical problems extend all the way to the top of the NIH hierarchy. "The things that Dr. Schwartz did, he got approval for," the researcher said.

Grassley's latest letter to Zerhouni has been made public. Clearly he is annoyed with Dr. Z.

During the course of my investigation of problems at NIH, I received a copy of a form that has been passed around recently to employees at NIEHS. This form asks employees to report if they have been contacted by Congress. However, this form looks more like something people in NIH congressional affairs would use to log requests for information from Congress. It doesn't appear to be something that would be handed out to regular NIEHS employees or employees at any of the other NIH institutes. In fact, handing this form out to rank and file NIEHS employees during the course of a congressional investigation could cause these employees to feel that management is attempting to flush out whistleblowers or any other individual assisting me with my inquiry.

Dr. Zerhouni, I co-authored the Whistleblower Protection Act of 1989 and helped to include whistleblower protections in Sarbanes-Oxley legislation. I did this because whistleblowers are some of the most patriotic people I know — men and women who labor, often anonymously, to let me know when the system is broken. So I'm a little confused about how passing out this form, during this congressional investigation, fits within your stated belief that the NIH is "committed to the letter and spirit of the federal whistleblower protection statutes."

Let me also say that there are many forms of retaliation and intimidation and during my years in Congress I have encountered quite a few forms of this behavior. As I am sure you know, requiring NIEHS employees to fill out the attached form places each employee who may be assisting the Committee in a precarious position. For example, an NIEHS employee working with the Committee could decide not to complete the form and not report their contact with the Committee, which could lead to them being charged with insubordination. On the other hand, an NIEHS employee working with the Committee could decide to fill out the form and report their contact with my Committee, and that would surely make them a target for retaliation if they had not earlier reported such contact.

Once again Dr. Zerhouni, I would like to remind you that attempts to interfere with a Congressional inquiry is against the law. I have attached a copy of 18 U.S.C. § 1505 to this letter for your reference.

That law states in pertinent part that:

Whoever corruptly, or by threats or force, or by any threatening letter or communication influences, obstructs, or impedes or endeavors to influence, obstruct, or impede the due and proper administration of the law under which any pending proceeding is being had before any department or agency of the United States, or the due and proper exercise of the power of inquiry under which any inquiry or investigation is being had by either House, or any committee of either House or any joint committee of the Congress-- Shall be fined under this title, imprisoned not more than 5 years or, if the offense involves nternational or domestic terrorism (as defined in section 2331), imprisoned not more than 8 years, or both.

NIH employees have the right to talk to Congress. Hopefully, the intent of this form was not to discourage or intimidate NIEHS employees from talking to Congress; but I must admit, the timing is curious.

To help me better understand why this form was handed out, I would like you to personally answer the following questions. Please respond to each question by first repeating the question, followed by the appropriate response. Please explain why this form was passed out to NIEHS employees during multiple, ongoing congressional investigations.

1. Did you personally approve the distribution of this form to NIEHS employees? If not, please identify who did.

2. Since June 2003, has this form been handed out to employees at other NIH institutes? If so, please provide dates and the corresponding institute, as well as the reason for handing out the form to NIH employees other than those in congressional affairs.

3. Please list each employee at NIEHS who received a copy of this form.

4. Dr. Zerhouni, why do you think that employees at the NIEHS feel more comfortable contacting my investigators instead of people in your office when there are problems at NIEHS?

5. Can you please describe the rationale for having this type of form at all?

I request your prompt attention to this matter and your continued cooperation. I also request that the response to this letter contain your personal signature.

Mr. B. suspects that there will be a new NIH director after the next election.


Tuesday, August 21, 2007


I guess as long as you admit that you are taking money from a drug company, that makes the conflict of interest go away?

Mr. B. has previously posted on the formation of a task force at BigU to probe doctors on the dole.

Judging by two recent news items, I hope that this task force is hard at work as I write, because they have a lot to do and it is important. As I mentioned in an earlier post:

It is a little hard to take advice from an institution that seems to be reluctant to discuss its own apparent ethical problems. Let's just hope that the doctors heading the task force are people respected throughout the community for their integrity, fairness, and independence. Otherwise such a task force is not going to be particularly credible.”

From the Pioneer Press:

Minnesota / Lilly link to state program questioned

Critics see a conflict of interest in drugmaker's health plan role

Pioneer Press

Article Last Updated:08/20/2007 12:06:07 AM CDT

One of the nation's largest drug companies is helping Minnesota cut costs and reduce questionable prescriptions of psychiatric drugs to poor and disabled residents.

While Eli Lilly provides this guidance without charge, critics believe it's the "fox watching the henhouse," because the company has a financial interest in encouraging state policies that increase drug sales.

If the state "asks Eli Lilly to help decide how to buy prescription drugs, or even General Motors to help decide how to buy a car, I guess I'm going to be concerned about that," said Ronald Hadsall, assistant dean of the University of Minnesota College of Pharmacy. "That just smacks of conflict to me."

Officials with the Minnesota Department of Human Services defended the program, which is funded by Lilly but run by an independent contractor, Comprehensive NeuroScience. State officials believe CNS has saved money for Minnesota's fee-for-service health plans, but more important, it has corrected some questionable prescriptions of expensive and powerful psychiatric drugs.

"Cost is an issue, certainly, but what is most important is that we get the right health care for patients," said Brian Osberg, assistant commissioner of the human services department.

Twenty states have contracts with CNS, which identifies doctors who are prescribing psychiatric drugs outside of recommended guidelines for safety and effectiveness. A common problem is patients taking two or three antipsychotic drugs at once, despite an increased risk of side effects and no evidence that patients benefit by taking multiple drugs.

The states then send warning letters to doctors, who can decide whether to alter their prescriptions.

Opponents believe states are paying Lilly back for this help by keeping its drugs off prior-authorization lists. Such lists prohibit doctors from prescribing drugs without first gaining permission from the state.

Lilly is the manufacturer of Zyprexa, a top-selling antipsychotic drug. Minnesota's fee-for-service health plans spent more than $28 million on Zyprexa in 2005, and $103 million on antipsychotics in general. That more than doubled the 2000 total of $43 million for the plans, which cover 200,000 poor and disabled Minnesotans.

While other states have used prior authorization to curb these soaring costs, Minnesota has not. In fact, none of the states with Lilly partnerships use prior authorization to manage antipsychotic drugs.

Wisconsin had a contract with Lilly until last year, when the state's Medicaid agency placed antipsychotic drugs, including Zyprexa, on the prior authorization list. State officials were informed shortly thereafter that Lilly was canceling the program.

A Lilly spokeswoman acknowledged that the company is trying to discourage states from using prior authorization. "We just feel the doctor should be in the driver's seat as far as picking the best medication, especially an antipsychotic," said Janice Chavers. "It's not like taking a cold medication."

In opposing prior authorization, Lilly has a long list of allies, including doctors and patients who feel it disrupts their relationship. Mental health advocates also argue that prior authorization cuts off drugs from needy patients, who then end up needing more expensive hospital care.

There is little question prior authorization reduces drug costs, though. Wisconsin saved $4 million after placing restrictions on antipsychotics, despite losing its contract with Lilly.

Some states have reported savings with the Lilly partnership as well. Michigan's spending on mental health drugs dropped 21 percent in six months.

Even if states benefit, there is little question Lilly has a profit motive, said Tom Croghan, a former Lilly executive who conducts health policy research for Mathematica Inc. Drug companies are happy to prevent excessive prescribing of pills to some people, he said, if they can encourage state policies that keep the drugs widely available to others.

"Drug companies are interested in selling their pills and selling as many as they can," he said.

The Lilly program targets what one Minnesota psychiatrist referred to as "lazy" prescribing.

When a patient is hospitalized, the inpatient psychiatrist might prescribe a new antipsychotic but won't take the patient off the old one, said Dr. David Adson of the University of Minnesota. Then the outpatient doctor simply leaves the patient on multiple drugs.

As the clinical lead of the CNS project, Adson signs each letter sent by the state to doctors with questionable prescriptions, including unusually high or low doses, or hasty switches from one drug to another.

The number of patients on three or more antipsychotics dropped from 76 in November 2005 to 27 in August 2006, according to a state review of the program.

A state study of the program suggests doctors change questionable prescriptions more quickly when they receive the warning letters. However, the doctors still change the prescriptions over time without the letters. The study also found only modest cost savings.

A Michigan critic believes Lilly is profiting from its partnership with Minnesota. In February, Minnesota encouraged patients to split cheaper double-strength pills instead of taking multiple smaller-dose pills, which can save money for the state at the expense of drugmakers.

The "dose optimization" strategy was required for Abilify, Geodon and Seroquel - which are competing antipsychotic drugs - but not for Zyprexa.

"Pure coincidence that dose optimization and tablet splitting are utilized exclusively for Eli Lilly's competitors?" asked Ben Hansen, who has sued to expose Michigan's partnership with Lilly. "I don't think so."

Human services officials replied that there was no financial benefit to placing Zyprexa on the pill-splitting list.

The Lilly contract ends in February, but may be renewed. While the program hasn't cut drug costs, state officials are studying whether it saved administrative costs and reduced spending on mental health services.

(In the interest of fairness the tennis game is faithfully reported marred only by Mr. B.’s text bolding.)

Along the above lines further information has surfaced, this time involving some more major money and even a BigU pharmacy prof. Excerpted from the AP:

A groundbreaking Minnesota law is shining a rare light into the big money that drug companies spend on members of state advisory panels who help select which drugs are used in Medicaid programs for the poor and disabled.

An Associated Press review of records in Minnesota found that a doctor and a pharmacist on the eight-member state panel simultaneously got big checks _ more than $350,000 to one _ from pharmaceutical companies for speaking about their products.

The two members said the money did not influence their work on the panel, and the lack of recorded votes in meeting minutes makes it difficult to track any link between the payments and policy.

But ethical experts said the Minnesota data raise questions about the possibility of similar financial ties between the pharmaceutical industry and advisers in other states.

"In the absence of disclosure laws, there's certainly no way to know," said Jack Hoadley, a research professor specializing in Medicaid at Georgetown University in Washington. "There are a lot of physicians in general who have at least some contract or grant funding out of pharmaceutical companies, and additional (who) do speaking engagements."

John E. Simon, a psychiatrist appointed to the panel in 2004, earned more than $350,000 from drug companies between 2004 and 2006. Pharmacist Robert Straka served from 2000 to 2006 and collected $78,000 from various drug makers during that time.

Both men, and the committee chairman, said the payments did not influence their work with the committee.

But state officials said they would examine the panel's past actions for any bias tied to the payments, and they will start screening appointees to more than two dozen advisory councils for similar links to the drug industry.

They will also require the Drug Formulary Committee to begin recording how each member votes at its meetings.

The top drugs for Minnesota Medicaid patients covered by the panel's advice in recent years have been schizophrenia treatments from Eli Lilly & Co. and AstraZeneca PLC _ Lilly's Zyprexa from 2000 to 2004, followed by AstraZeneca's Seroquel in 2005 and 2006. About a third of the drugs on the state's preferred drug listare made by companies that paid Simon, Straka or both.

A medical ethicist said state drug advisers should not take pharmaceutical companies' money because of the power the panel exercises over the poorest, most vulnerable patients.

"This is a high-stakes committee," said Dr. Arthur Caplan, chairman of medical ethics at the University of Pennsylvania School of Medicine. "If you're going to have your hand on that tiller, you don't want to think that anybody is trying to push it."

Some other states have taken tough measures to guard against that. Nevada bars anyone from serving on its Pharmacy and Therapeutics Committee who is in any way paid by or affiliated with a corporation that makes prescription drugs.

"It's as clean as we can get or we can dream up," said Charles Duarte, the state's Medicaid administrator.

In Idaho, committee members can be fired on the spot for failing to disclose a conflict of interest.


Here's what the Minnesota records show:

Simon, a Minneapolis psychiatrist, earned $354,700 from companies including Eli Lilly and AstraZeneca from 2004 to 2006 in honoraria, speaker's and consulting fees, and other payments ranging from $500 to $93,012. His stint on the formulary committee began in June 2004.

Simon said he should be able to vote on drugs made by the companies that pay him, as long as they don't come from the neuroscience or psychiatric divisions that pay him. But, he said, he would not oppose a stricter standard.

"There's absolutely no record of my biasing in favor of one company or another or any of them," Simon said. "I figure the preferred drug should be the one that cuts the best deal with the state."

Spokesmen for Eli Lilly and AstraZeneca said their companies' relationships with Simon had nothing to do with his role on the panel.

Lilly spokesman Phil Belt said Simon even voted against Lilly products, including a growthhormone and an insulin.

"It just wouldn't be appropriate to assume or imply that our relationship with him is in any way a product of or influenced by his role on the Drug Formulary Committee," Belt said.

Straka, a University of Minnesota pharmacy professor, earned $78,100 in honoraria and other fees from 2000 to 2006, including $36,745 from Schering-Plough Corp. and $24,623 from Merck & Co. He served on the panel from September 2000 to March 2006.

Straka said he was paid for educational talks usually arranged by medical groups who lined up the sponsors. He said he routinely discloses his ties with drug makers and did so as a formulary committeemember, both verbally and in writing.

"I have no problem with the issue of fully disclosing things. I do that all the time," Straka said.

But a public records request by the AP turned up no information about Straka making such disclosures. Nor do such statements appear in the committee's minutes going back to February 2001. Other committee members and staff interviewed by AP could not recall him disclosing compensation from drug makers.

The information about Straka's earnings might not have come out at all, because drug companies are not required to disclose payments to pharmacists under the Minnesota law. Many did so anyway in his case, withsome listing him as an "M.D." in their reports.

Dr. William Korchik, the panel's chairman, said he supports disclosure of committee members' relationships with drug companies, "whether it's stock, research or speaker's fees."

Korchik said he didn't know the extent of the financial relationships until contacted by AP. But Korchik defended the panel's work, saying the ties did not bias a group that works mainly by consensus.

"This whole thing may be an issue of appearance of conflict, but I really feel comfortable that the committee has not been hoodwinked," he said.

Al Heaton, a pharmacist who has served on the committee since the early 1990s, is the only panel member mentioned in the last six years of minutes for disclosing a potential conflict of interest and abstaining from a vote _ on bone drugs he had gotten funding to research years earlier.

"I think that's important to know," said Heaton, the director of pharmacy at Blue Cross and Blue Shield of Minnesota.

"An individual may be perfectly honest and totally objective, but finding it out afterward, then you always wonder were they or were they not?"

Sorting out the good guys from the bad is left as an exercise for the reader. No doubt the great ethical thinkers at BigU's medical school will soon have it all sorted out.

Ciao, Bonzo

BigU’s Ambitious Aspirations
and the Red Queen Effect

"It takes all the running you can do to keep in place!"

The latest college rankings by US News for national universities have just hit the ether. It's bad news - what else - for the ambitious aspirations of BigU to become one of the "top three research universities in the world." [sic]

Mr. B. tries to keep in mind Mr. E’s wise counsel:

“Not everything that can be counted counts,

and not everything that counts can be counted.”

Albert Einstein (attributed)
However, this Clever Hans trick always reminds him of:
“In Iowa there is so much corn that they eat what they can and what they can’t, they can.”
In order to keep things manageable, the following simplified table may be useful. Rather than worry about every institution in the world, let's worry about the BigTen. That is all that Mr. B.'s small brain can currently handle. If we aren't even in the top half of the BigTen then babbling on about being number three in the world is just as annoying as claiming that the Gopher football team has high academic standards. Even OurLeader may eventually figure this out.
First note that Northwestern – Mr. B’s undergrad school – is private and thus will be eliminated from discussion. The 2007 ranking is taken as baseline. The first column under 2007 is the ranking of all schools in the US, both public and private. The second column is the ranking of the schools in the BigTen. So in 2008 Northwestern actually dropped two spots in the beauty pageant, but still remained the top school in the BigTen. If a ranking improves it is marked in green, stays the same – yellow, gets worse – red.

12 (1)
14 (1)
25 (2)
25 (2)
34 (3)
38 (3)
42 (4)
38 (3)
Penn State
48 (5)
48 (5)
Ohio State
60 (6)
57 (6)
60 (6)
64 (7)
60 (6)
64 (7)
Michigan State
74 (9)
71 (9)
74 (9)
71 (9)
74 (9)
75 (11)

The striking thing is that rapid changes are uncommon due to institutional inertia, the lag time between real and perceived change, and probably due to the Red Queen effect. We may be striving to improve, but so are our competitors, so our relative positions remain pretty much the same.

No doubt seven years from now will find NU out of sight and Michigan first among the public BigTens. Illinois and Wisconsin will duke it out with my money on Illinois given what has been going on in Badgerland lately. Penn State will stay solidly in the middle. Purdue, Ohio State, and Iowa are in a tight competitive band. Ohio State will pull ahead over time as will Iowa. Purdue is handicapped by not having a medical school.

And finally Michigan State, Minnesota, and Indiana will be fighting to stay out of the cellar. My money is on the Gophers but you can forget about them ever being the number three public research university in the world. As Perry Como used to sing: "Dream Along With Me."

One could argue that it is too early to judge that BigU is running in place. If a dramatic improvement in our position is to occur, then some very unlikely changes need to happen soon.

OurLeader and his boatswain should fear the clock as did Hook and Smee. However, by the time the crocodile shows up for a piece of OurLeader he will have declared victory and ridden off on his hobby horse. Who knows maybe Smee would be a good captain? This has happened before on the good ship Gopher. Who would know better how to carry out Hook's fantasies than Smee?
Ciao, Bonzo, who is enjoying a break and looking forward to September and exciting things in the lab. During Fall Semester there should be six undergrads and a grad student in the lab to keep Mr. B. out of trouble. There are also lectures to give in med chem, biochem, and possibly clinical chem.

Monday, August 20, 2007

Question of the Week

Driven to Discover

"Will there ever be a way to translate animal voice into English?"

Arf! Arf!


Wednesday, August 15, 2007

Another Casualty of the Minneapolis Bridge Collapse

The Center for Interdisciplinary Applications in Magnetic Resonance

A friend pointed this out. From today's Daily:

Tucked into the bluffs alongside the Mississippi River - 50 feet from where the Interstate 35W bridge fell - the researchers at the University's Center for Interdisciplinary Applications in Magnetic Resonance have seen a stark change since the collapse.

CIA-MR has three magnets on site, used for various research projects. A magnet used to simulate different gravity levels is among those at the lab.

There are only three such magnets in the world. The other two are in France and Japan, Hammer said.

Concerns about the future of research are rooted in problems stemming from ground vibrations from the demolition of the remaining bridge structure and construction of the new one, Hammer said.

According to Hammer, the magnet capable of simulating zero gravity presents the greatest level of risk as it is made of a more brittle material than the others.

Each magnet costs $400,000 and there is between $1.5 million and $2 million of equipment in the lab, Hammer said.

While construction of the new bridge will not require the space currently occupied by the lab, the Minnesota Department of Transportation said research will not be able to continue while bridge construction is in progress, University Real Estate Office director Sue Weinberg said.

Moving the lab, if necessary, presents another list of problems, Hammer said. It takes researchers two or three weeks to shut down the magnets and another two to three months to get them back in working order.

Hammer estimated moving the lab would cost $200,000.

Lorelee Wederstrom, director of the office of facilities with the Academic Health Center, said there is currently no vacant space for Hammer's lab through the AHC.

Wederstrom said since research will seemingly be able to continue during demolition, the University has time to find a space to move the lab. Whether the University will build a new lab or try to find an existing structure to house the magnets is still being discussed.

Ray Voelker, director at the Office of Space Management, said the University is "looking at some interim steps, and it's not clear to me whether he'll be able to go back there or not."

"They'd have a very difficult time putting us into an existing building where there's offices close by," he said. "If someone is walking with a pacemaker you don't want that to be affected."

While no single portion of research at the University will hinder the University's strategic positioning plan, Hammer said, a stall in operations at the lab could ultimately be detrimental to that goal.

Rep. Phyllis Kahn, DFL- Minneapolis, said accommodating Hammer and other researchers at the lab should be a major concern of the University.

"I don't think this is an idle threat. If (Hammer) can't do his research for several years, there's no way he would consider staying here," Kahn said. "I think the University should treat this as seriously as it would (the) loss of a top football coach or football player. I would treat it more seriously."

Clearly if BigU took Rep. Kahn's advice, finding space or money would be no problem. In round numbers five million dollars were spent recently on the football/basketball coaching situation. Dr. Kahn, who represents the university district in the state legislature and has worked at BigU, is probably aware of the unlikelihood of BigU equating the importance of the magnet lab's problems with problems in the football program.

Like a moth to a streetlight, Mr. Bonzo cannot resist.

Another Partnership Struck

Coke, Pepsi, Twin City Federal, and Now… The Big Ten Network

Mr. Bonzo is on vacation. This means that he is trying to catch up on neglected tasks at home as well as get his lectures ready for the Fall onslaught and take a whack at a couple of grant proposals…

He had hoped to stay on Mrs. Bonzo's good side by not blogging, except for the infamous Driven to Distraction Question of the Week™. However a communiqué sent to Mr. B. this afternoon on behalf of OurLeader and Joltin' Joel was just too much to resist and so I quote:

"At the request of University President Bob Bruininks and Athletic Director Joel Maturi, we are writing to share news about an exciting partnership between the University of Minnesota and The Big Ten Network.

The Big Ten Network -- a first-of-its-kind partnership between the eleven Big Ten universities and a major television provider -- will launch August 30. Big Ten supporters will have unprecedented access to Big Ten sporting events and the University of Minnesota and the other Big Ten universities will receive increased regional and national exposure. The network creates a stable source of funding to supplement our existing Big Ten contracts with CBS (basketball) and ABC/ESPN (football). For the University of Minnesota this is an opportunity to establish a strong financial foundation for athletics, help reduce athletics' dependency on University general funds, and extend the reach of our programs."

Now Mr. B. is shocked that right there in red it is admitted that athletics has a dependency problem. And he naively thought that there was some strategic goal in spending millions of dollars on new coaches and hundreds of millions of dollars on a new stadium. The revenue producing sports were to support not only themselves but also the non-stupid sports (a phrase shamelessly stolen from comments to a post on the UD site). But never fear. The Big Ten Network will no doubt rake in enough cash so that this ambitious aspiration can be attained. [Note the hedging "help reduce."]

Until after Labor Day, hopefully, Bonzo