A provision in the big US stimulus bill passed by the US Senate to fund comparative effectiveness research has generated considerable criticism. As Alicia Mundy, reporting in the Wall Street Journal, wrote:

The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing.

The $1.1 billion in research funding would be doled out to the National Institutes of Health and other government bodies. ‘We should focus on producing the ideal unbiased science possible,’ stated Rep. Henry Waxman (D., Calif.), a strong proponent of the Home language.

Mr. Obama supported research into comparative effectiveness during his campaign. Administration officials and leading Democrats in Congress say the idea will help government programs direct their dollars to treatments that are worth the money.

Officially, drug and device makers don’t object to that sentiment. But they warn of a slippery slope where the government ends up axing useful treatments just because they cost too much. They’ve lined up patient groups that get industry funding to lobby Capitol Hill.

A coalition called the Partnership to Improve Patient Care includes the lobbying arms of the drug, device and biotechnology industries as well as patient-advocacy groups and medical-professional societies. Coalition spokesman David Di Martino says the research envisioned in the House bill might be used ‘in an inappropriate manner that might limit treatment options for patients.’

A public-relations firm that is part of one of Washington’s most influential lobby shops, Barbour Griffith Rogers, is representing the coalition. A major goal is to give industry a seat at the table when federal officials decide what to research with the $1.1 billion.

In an op-ed column for Bloomberg News that got wide attention, Betsy McCaughey, who is described as, “former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute,” wrote:

Tragically, no one from either celebration is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they’re hazardous to your health.

In his book, Daschle proposed an appointed body with vast powers to make the ‘tough’ decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs.

The elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council.

And a Wall Street Journal editorial warned:

The true political goal is cost control. For the Pete Stark Democrats whose ambition is Medicare for all — no exceptions — giving government exclusive control over electronic health information and reporting is a step toward “comparative effectiveness” research. That in turn will be used to impose price controls and deny some types of medical treatment and drugs. And because government is able to skew the whole health system through Medicare and Medicaid, comparative effectiveness could end up micromanaging the practice of medicine.

Of course, it is one thing to put comparative effectiveness research funding in a bill, and another thing to implement those funds to support research. There are all sorts of ways comparative effectiveness could go wrong. There’s room for debate about how it ought to be done.

However, comparative effectiveness research, done right, has the potential to help doctors make better decisions that’ll help patients have better outcomes of care. As I’ve argued before,

Doctors spend a lot of time trying to figure out the best treatments for particular patients’ problems. Doing so is often hard. In many situations, there are several plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the ideal available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only studies done compared individual treatments to placebos, and when even those were restricted to narrow patient populations unlike those patient usually seen in daily practice, doctors are left juggling oranges, tomatoes, and carburetors.

Comparative effectiveness studies are simply studies that compare plausible treatments that could be used for patients with particular problems, and which are designed to be generalizable to the sorts of patients usually seen in practice. As a doctor, I welcome such studies, because they might provide very useful information that could help me select the optimal treatments for individual patients.

It may be that some who protest comparative effectiveness are more worried about promoting products which good comparative effectiveness research might find are not as effective as their advertising states they are, than about doctors being hassled and micro-managed. We posted previously (here and here) about some particularly poorly crafted arguments against comparative effectiveness research. Some especially illogical arguments against it were made by people with important, albeit sometimes indirect financial relationships with health care corporations whose products may not prove so comparatively effective (here and here).

As Alicia Mundy’s article noted above, the Partnership to Improve Patient Care seems to be at least partially controlled and funded by elements of the pharmaceutical, biotechnology, and device industries. Not only does its steering committee include the Advanced Medical Technology Association, the Biotechnology Industry Organization, and the Pharmaceutical Research and Manufacturers of America (PhRMA), but spot checks reveal that several of the disease advocacy organizations in its steering committee have significant relationships with pharmaceutical, biotechnology and/or device companies. For example, the 2007 annual report from the Alliance for Aging Research listed the organization’s board as including executives of Omnicare Clinical Research, GlaxoSmithKline, Procter & Gamble, Guidant, Merck, Johnson & Johnson, and Novartis. The 2007 annual report of the National Alliance for Mental Illness (NAMI) lists corporate partners including Abbott Laboratories, AstraZeneca, Bristol-Myers-Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen (part of Johnson & Johnson), McNeil, Otsuka America Pharmaceutical, Pfizer, PhRMA, Solvay Pharmaceuticals, Vanda Pharmaceuticals, and Wyeth.

Not noted in Betsy McCaughey’s op-ed article was that she’s currently on the board of directors of Cantel Medical, a device company, and formerly on the board of Genta, a biotechnology company.

Comparative effectiveness research controlled by government bureaucracies could be done clumsily. Government oversight has the potential to tilt comparative effectiveness research more towards cost-containment than to finding the ideal tests and treatments for individual patients. But if oversight of government comparative effectiveness is transparent, and its leadership excludes people with vested interests in the research producing particular results, we have the ability to be hopeful that its results could be unbiased and helpful.

Up to now, however, we’ve left industry to fund, control, and too often suppress and manipulate clinical research about its own products, so that the results are superior at putting particular products in a good light than providing physicians and patients with the ideal, most unbiased information needed to make decisions. Unless we really make a hash of its leadership and governance, government funded comparative effectiveness research has the potential to improve health and health care.

[Source : Health Care Renewal]

The Associated Press just published a story on the marketing of drugs for fibromyalgia, which provided a window into relationships among pharmaceutical companies and not-for-profit disease advocacy groups. One example was the National Fibromyalgia Association:

The drug industry’s allows also help fill out the budgets of nonprofit disease advocacy groups, which pay for educational programs and patient outreach and also fund some research.

‘If we have a situation where we do not have that funding, medical education is going to come to a screeching halt, and it will impact the kind of care that patients will get,’ stated Lynne Matallana, president of the National Fibromyalgia Association.

Matallana founded the group in 1997 after she was diagnosed with fibromyalgia. A former advertising executive, Matallana stated she visited 37 doctors before learning there was a name for the crushing pain she felt all over her body.

A decade later, her patient advocacy group is a $1.5 million-a-year operation that has successfully lobbied Congress for more research funding for fibromyalgia. Forty percent of the group’s budget comes from corporate donations, such as the funds distributed by Pfizer and Eli Lilly.

Pfizer gave $2.2 million and Lilly gave $3.9 million in allows and donations related to fibromyalgia in the first three quarters of last year, the AP found. Those funds represented 4 percent of Pfizer’s giving and about 9 percent of Eli Lilly’s.

Another example was the National Fibromyalgia Research Association:

Dr. Daniel Clauw of the University of Michigan said pharmaceutical industry market research shows roughly half are undiagnosed. People with fibromyalgia experience widespread muscle pain and other symptoms including fatigue, headache and depression.

Research by the University of Michigan’s Clauw advocates people with fibromyalgia experience pain differently because of abnormalities in their nervous system. Brain scans show unusual activity when the patients experience even minor pain, though there’s no abnormality common to all.

Clauw’s work, however, illustrates the knotty issues of drug company funding. He has done paid consulting work for the drugmakers, and he’s received research funding from the National Fibromyalgia Research Association, which receives money from the drugmakers.

By the way, the National Fibromyalgia Association’s list of sponsors includes quite a few pharmaceutical companies in addition to Pfizer and Lilly:

Acorda Therapeutics
Cause Marketing, LLC
Citrucel
Cuddle Ewe
Eli Lilly
Fibronol
Forest Laboratories, Inc.
Ortho McNeil Pharmaceutical, Inc.
Pacific Life
Pfizer
Wyeth

The National Fibromyalgia Research Association’s web-site isn’t so forthcoming, even though I did find an acknowledgement that Lilly supported one NRFA conference in 2007 in the amount of $46,500.

This case illustrates the willingness of pharmaceutical companies (and likely other health care corporations) to support what appear to be grass-roots, not-for-profit disease advocacy groups when doing so coincides with corporate marketing objectives. Such “astroturf” organizations might help raise the profile of diseases for which the corporations market products, thus also helping to increase the market for these products, and may help further corporate health policy objectives.

With health care in flux due to new leadership in the US, and the global financial meltdown, look for stealth marketing and stealth health policy advocacy to increase.

As I have stated before, I do not have a problem with pharmaceutical and other health care corporations marketing their products, and expressing their views on policy. I do have a problem with corporate marketing or policy advocacy is disguised as grass-roots, not-for-profit education and advocacy.

[Source : Health Care Renewal]

I want to call HCR readers’ attention to a recent, disturbing post on Science-Based Medicine by one of my fellow bloggers, David Kroll:

I’m a graduate of the institution known formerly as the Philadelphia College of Pharmacy and Science (PCP&S) - the first college of pharmacy in North America, established in 1821. The college, now called University of the Sciences in Philadelphia, counts among its alumni John Wyeth, Silas M. Burroughs, Sir Henry Wellcome, several members of the Eli Lilly and McNeil families, and other historical figures in pharmacy among founders of what have now become large pharmaceutical companies.

Although I was among the 35% of students in the “and Science” side of PCP&S, earning a BS in Toxicology, I was there at a time before Huge Pharma had acquired much of the bad name it often carries today and we took great pride in our college’s rich history and contributions to modern medicine. In particular PCP&S graduates were critical players in combating snake oil hucksters in the early 1900s and establishing chemical standards, safety, and efficacy guidelines for therapeutic agents.

So it is with disbelief that I learned my alma mater plans to award an Honorary Doctorate of Science to a major leader in homeopathy - on Founders’ Day, no less. The press release is here.

Dr. Kroll’s letter to University President Philip P. Gerbino and Provost Russell J. DiGate can be found here. Dr. Gerbino’s disappointing response and Dr. Kroll’s comments are here. Dr. Kroll also received a disappointing response from the president of the student government.

[Source : Health Care Renewal]

Up on Drudge Report right now is this red banner:

“‘NATIONAL COORDINATOR OF HEALTH INFORMATION TECHNOLOGY’ SLIPPED IN TO STIMULUS…“

It links to a story at Bloomberg.com, also covered by Rush Limbaugh this day entitled “Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey.”

The gist of McCaughey’s article is that the Administration slipped HIT provisions into H.R. 1 EH, a.k.a. the Economic Recovery Act of 2009, and is misleading the public on HIT, using it as a “backdoor” or Trojan Horse to help usher in socialized medicine. See Div. B Title IV, Health Information Technology (Word file extract) to review the Act’s proposed text on HIT.

More on who is misleading who later…

First, health IT provisions might or might not constitute “economic stimulus” of the type needed for the country at this point in time. I’ll not address that issue here. I cannot do anything about their inclusion. The Act is what it is.

McCaughey pointed out by number of potentially ominous issues regarding H.R. 1 EH.

Ominous issues such as:

Senators should read these provisions and vote against them because they are hazardous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, physicians have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and physicians that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That’ll be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your physician from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

Readers of HC Renewal will probably understand I have somewhat different concerns than HIT being used as a tool of control by government IT overlords.

I expressed them in the following letter to Ms. McCaughey, and forwarded to Rush Limbaugh as well:

To: Betsymross@aol.com
From: MedInformaticsMD
Date: 02/09/2009 11:39PM
Subject: Re: National Coordinator of Health IT

Betsy, I am a clinical information technology professional (real deal - postdoctoral fellowship in same).

Yes, I looked over HR1 - title IV Health IT and am concerned by the heavy government hand I see being put on HIT, in a manner suggestive of Health IT becoming just a tool to accomplish turning docs into pecuniary slaves of Big Brother.

I should add the the Office of the National Coordinator was created in 2004 but was largely an advisory role, and toothless.

My major point, though, is that we probably need to worry more about putting $20 billion down the drain and deployment of unusable systems than Health IT turning physicians into slaves.

I’ve been writing for ten years on the severe mismanagement that goes on in health IT - poor design, chaotic implementation, lack of proper leadership by non clinical business computing personnel, and general mayhem when personal meets clinic. My website on HIT difficulty is here (http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/)

I’ve recently been joined in these warnings by higher authorities: the US Joint Commission for accreditation of hospitals, the National Research Council (NRC) and the UK Home of Commons Accounts Committee!

Health IT (with a few exceptions) is largely a disaster area and I’m more concerned about mega-pricey “IT misadventure” than IT-empowered takeover of medicine!

See “Joint Commission Sentinel Event Alert” on HIT : http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm

See the NRC Press Release ” Current Approaches to U.S. Health Care Information Technology are Insufficient ” at Current Approaches to U.S. Health Care Information Technology are Insufficient

See the UK Home of Commons report on major problems in their national Electronic Medical Records program (largely caused by US companies!) at The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee

Widespread health IT by 2014?

Ha!

This bill might ruin our health, but not for the reasons stated …

Our government is indeed, on this point, suffering from the illusion of hope over experience.

Put more directly, they are deluded about the true difficulty of making Health IT actually work on a massive scale.

Health IT as Machiavellian ploy and Trojan Horse to achieve socialized medicine in the U.S.?

For the expenditure of a mere £12,656,200,000 the UK, which already has socialized medicine - repeat, ALREADY HAS SOCIALIZED MEDICINE - has not accomplished national health IT but instead has a quagmire. (The estimated cost of the national Health IT program at 31 March 2008 comes from the Home of Commons Public Accounts Committee report, Jan. 2009, pg. 14, PDF here.)

Even so, the program’s leaders unbelievably continue to lack formal biomedical and biomedical informatics credentials, helping assure the lack of real progress (ex-CIO of Cadbury Schweppes?) In the post where I made that observation (link) I also raised the question:

Can government really be the sponsor of ambitious health IT projects?

I am not so sure.

I forgot to put in my letter to Betsy McCaughey issues in some other lands:

http://articles.icmcc.org/2009/01/23/dutch-ehr-postponed-are-they-in-good-company/

On January 22 after two months of serious discussion the Dutch health minister Dr. Ab Klink announced in the Dutch parliament that the implementation of a national EHR will be postponed . He did not mention a new target date.

… it does not seem to be a Dutch-only problem. In Germany the introduction of the smart card has been seriously delayed, due to technical and security reasons. In the UK, one of the more advanced countries in the EU for implementation of a nationwide EHR system, serious safety and privacy issues are arising and the implementation has already a delay of over 2 years. The fact that on an almost regular basis electronic information is lost or stolen, doesn’t help either.

(Read the ICMCC story above in its entirety.)

I should also probably have included a link to my three part posting on how hospitals are an IT backwater here.

The new Economic Stimulus bill, to its great credit, does call for research on improving our understanding of designing and implementing health IT (e.g., Section 4202. RESEARCH AND DEVELOPMENT PROGRAMS):

(A) to generate innovative approaches to health care information enterprise integration by conducting slicing-edge, multidisciplinary research on the systems challenges to health care delivery; and

(B) the development and use of health information technologies and other complementary fields.

(4) RESEARCH AREAS- Research areas may include–

(A) interfaces between human information and communications technology systems; [I think they meant interfaces between humans and ICT systems - ed.]
(B) voice-recognition systems;
(C) software that improves interoperability and connectivity among health information systems;
(D) software dependability in systems critical to health care delivery;
(E) measurement of the impact of information technologies on the quality and productivity of health care;
(F) health information enterprise management;
(G) health information technology security and integrity; and
(H) relevant health information technology to reduce medical errors.

Amen to those points. Such research will take quite some time. (See “Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?” by Ford et al. I concur with the assessment of 2024, not 2014, for small practices.)

Hopefully the bulk of funds to conduct this needed research won’t go to the “usual suspects” in the IT and management consulting industries, the same folks who rewarded the UK with such fine results. Let us hope actual health IT experts in the Biomedical Informatics domain get an appropriate “cut.”

In any case, I think my letter to Betsy McCaughey speaks for itself and won’t comment further except for the observation that if some of our government officials have a personal-facilitated medical power grab in their hearts, then I wish them luck. For they’ll need it.

Finally, who is misleading whom on HIT? HIT is a tool to facilitate clinical care, not a cybernetic miracle cure to “revolutionize” medicine. It seems the government has been thoroughly conned by the IT industry that this technology is worth throwing tens of billions of dollars at. The government has bought the “HIT is a Magic Bullet” exuberance hook, line and sinker.

– SS

[Source : Health Care Renewal]

Up on Drudge Report right now is this red banner:

“‘NATIONAL COORDINATOR OF HEALTH INFORMATION TECHNOLOGY’ SLIPPED IN TO STIMULUS…“

It links to a story at Bloomberg.com, also covered by Rush Limbaugh today entitled “Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey.”

Some ominous issues about H.R. 1 EH, a.k.a. the Economic Recovery Act of 2009 were pointed out (see Div. B Title IV, Health Information Technology which I extracted into a Word file).

Ominous issues such as:

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United Says” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, physicians have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping physicians informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and physicians that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That’ll be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your physician from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

Readers of HC Renewal will probably understand I’ve somewhat different concerns than HIT being used as a tool of control by government IT overlords.

I expressed them in the following letter to Ms. McCaughey, and forwarded to Rush Limbaugh as well:

To: Betsymross@aol.com
From: MedInformaticsMD
Date: 02/09/2009 11:39PM
Subject: Re: National Coordinator of Health IT

Betsy, I’m a clinical information technology professional (real deal - postdoctoral fellowship in same).

Yes, I looked over HR1 - title IV Health IT and am concerned by the heavy government hand I see being put on HIT, in a manner suggestive of Health IT becoming just a tool to accomplish turning docs into pecuniary slaves of Huge Brother.

I should add the the Office of the National Coordinator was created in 2004 but was largely an advisory role, and toothless.

My major point, though, is that we probably need to worry more about putting $20 billion down the drain and deployment of unusable systems than Health IT turning physicians into slaves.

I have been writing for ten years on the severe mismanagement that goes on in health IT - poor design, chaotic implementation, lack of proper leadership by non clinical business computing personnel, and general mayhem when personal meets clinic. My website on HIT difficulty is here (http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/)

I have recently been joined in these warnings by higher authorities: the US Joint Commission for accreditation of hospitals, the National Research Council (NRC) and the UK Home of Commons Accounts Committee!

Health IT (with a few exceptions) is largely a disaster area and I am more concerned about mega-expensive “IT misadventure” than IT-empowered takeover of medicine!

See “Joint Commission Sentinel Event Alert” on HIT : http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm

See the NRC Press Release ” Current Approaches to U.S. Health Care Information Technology are Insufficient ” at Current Approaches to U.S. Health Care Information Technology are Insufficient

See the UK Home of Commons report on major problems in their national Electronic Medical Records program (largely caused by US companies!) at The National Programme for IT in the NHS: Progress since 2006 - Public Accounts Committee

Widespread health IT by 2014?

Ha!

This bill might ruin our health, but not for the reasons said …

Our government is indeed, on this point, suffering from the illusion of hope over experience.

Put more directly, they are deluded about the true difficulty of making Health IT actually work on a huge scale.

Ideal regards,

Scot Silverstein

I forgot to put in my letter the issue that:

http://articles.icmcc.org/2009/01/23/dutch-ehr-postponed-are-they-in-good-company/

On January 22 after two months of serious discussion the Dutch health minister Dr. Ab Klink announced in the Dutch parliament that the implementation of a national EHR will be postponed . He didn’t mention a new target date.

… it does not seem to be a Dutch-only problem. In Germany the introduction of the smart card has been seriously delayed, due to technical and security reasons. In the UK, one of the more advanced countries in the EU for implementation of a nationwide EHR system, serious safety and privacy issues are arising and the implementation has already a delay of over 2 years. The fact that on an nearly regular basis electronic information is lost or stolen, doesn’t help either.

(Read the ICMCC story above in its entirety.)

The bill, to its great credit, does call for research on improving our understanding of designing and implementing health IT (e.g., Section 4202. RESEARCH AND DEVELOPMENT PROGRAMS):

(A) to generate innovative approaches to health care information enterprise integration by conducting cutting-edge, multidisciplinary research on the systems challenges to health care delivery; and

(B) the development and use of health information technologies and other complementary fields.

(4) RESEARCH AREAS- Research areas may include–

(A) interfaces between human information and communications technology systems; [I think they meant interfaces between humans and ICT systems - ed.]
(B) voice-recognition systems;
(C) software that improves interoperability and connectivity among health information systems;
(D) software dependability in systems critical to health care delivery;
(E) measurement of the impact of information technologies on the quality and productivity of health care;
(F) health information enterprise management;
(G) health information technology security and integrity; and
(H) relevant health information technology to reduce medical errors.

Amen to those points. Such research will take quite some time. Hopefully the bulk of funds to conduct it will not go to the “usual suspects” in the HIT and management consulting industries, the same folks who rewarded the UK with such fine results. Let us hope actual health IT experts in the Biomedical Informatics domain get an appropriate “cut.”

In any case, I think my letter to Betsy McCaughey speaks for itself and will not comment further except for the observation that if some of our government officials have a computer-facilitated medical power grab in their hearts, then I wish them luck. For they will need it.

– SS

[Source : Health Care Renewal]