TOMMY THOMPSON

What he really wanted was to be Transportation Secretary. Instead, Wisconsin Governor Tommy G. Thompson will, once confirmed, take the place of Donna Shalala as the Secretary of Health and Human Services. George W. says so.

Gov. Thompson has no experience in health, but he is the chairman of the Amtrak board. Trains, brains, drains, what's the diff?

He'll be responsible for a budget of $400 billion, overseeing and balancing the interests of the National Institutes of Health, the FDA, the Centers for Disease Control and Prevention, and the Health Services and Research Administration, among others. He'll drape his transportation expertise over Medicare, Medicaid, and Head Start, too.

Okay, class. If train "A" leaves Bridgeport, Connecticut, carrying twenty-five low-income Medicaid recipients and sixty senior citizens, how fast does it have to travel to arrive at solvency by 2005? Who can answer? Children? Tommy Thompson, you tell me the answer! Do we all need another nap?

Hmm. Well, if the guy's autobiography is any indication, he won't be exerting much of his newfound influence. He wrote about how common sense cannot flourish in an America where Washington calls all the shots. Washington, the city that he has referred to as Disneyland East.

Thompson doesn't like Federal government and has won his reputation converting federal power into state power, attempting to secure waivers from HHS that allow states to use federal money the way they want to, rather than the way the Fed envisioned. He is best known for the Wisconsin welfare reform plan which eventually became a model for a similar Federal program.

It will be interesting to see what he chooses to do with his newfound power. Perhaps he will tuck the past away in his sock drawer and embrace his new Federal-ness. Or maybe he will open his sock drawer and fling his policy perspective all over Donna Shalala's former turf, bringing new discretion and power to a state to choose how it spends Federal healthcare funds.

Letters to the Editor regarding this article:

1/9/01
In all respect, Tommy Thompson certainly has experience with governance and he could likely out perform Ms. Shalala blindfolded. -- Dan M. Spengler

1/9/01
Wow, all this news and liberal political commentary, as well. It's like watching Dan Rather! Actually, since Welfare Reform is second only to Education Reform of the concerns of most American Voters (see any poll not taken by John McCain during the election), Mr. Thompson has a much greater mandate at HHS than he would at Transportation, given his very successful tenure in Wisconsin with that state's welfare reform measures. Ms. Shalala, on the other hand, I believe, had only her liberal credentials as a university headmistress and her own sexual orientation to qualify her for Sec HHS, hardly a resume for any job, except maybe Dean of Students at Welsley.
-- William Brendle Glomb, MD

1/8/01
To add to your information, he also has close ties to the Tobacco Industry. Do you think he will act in the best health interest of the country? or in the best interest of the people who add to the ill health of the country? Too bad the upcoming administration didn't check into these "smokey" ties, or maybe they did...Something to think about. -- Name Withheld

1/9/01
I must take some issue with your report on Tommy Thompson. I have been a great fan of Mr. Thompson's for years. His brand of conservatism is what our nation needs. His welfare reform plan for Wisconson became the model for the national welfare reform that Clinton was forced to embrace.

My politics are very conservative. I'm not sure the bias (if any) of this publication, but if there is ANY liberal bias to this, I don't care to receive it at all. Listening to liberals find fault with common sense values just bores and irritates me.

Hopefully, the article on Mr. Thompson was just humorous prose (and it was well written and amusing). Donna Shalala has been a joke as has most of the Clinton Administration. Thank God those people will be gone!

I have NO DOUBT that Mr. Thompson will be an excellent Secretary as he has been an excellent governor and statesman. As President-Elect Bush seems to be trying to surround himself with the best conservative appointments possible, there are liberals poking fun at each one and trying to cast doubt on them. Let's give the guy a chance. -- Robert M. Bowers, MD FAAEM

1/9/00
Since when do you have to have any experience or expertise in healthcare to have an administrative position? How many goverment officials who dictate Medicaid and Medicare (HCFA) policies have any idea about delivering competent patient care? For those of you who may not know this, HCFA regulations have nothing to with patient care but everything to do with how not to pay for those services. And let's not forget
about Bill Clinton's healthcare taskforce which was headed by Hiliary Clinton. Last time I checked, she had not received her M.D. yet. In fact, there was not a single physician on this taskforce. Which brings
me to my first point...who needs experience in healthcare to make policies about healthcare? -- Name Withheld

1/9/01
Could you explain to me what Donna Shalala's previous experience in health was prior to her appointment? I fail to appreciate how Tommy Thompson is less well qualified. -- Robert Replogle, MD

1/9/01
Just a bit of feedback on Governor Thompson: he is a great candidate for Secretary of HHS. Please research his record. Wisconsin has among the lowest rates of uninsured in the country. Significant efforts to expand coverage to children and families were initiated by Governor Thompson, but initially blocked at the federal level due to simple politics. Please more fact finding before commenting. -- Paul Spaude

1/10/01
I really enjoyed the newsletter. However, as a risk manager, I really have concerns about docs giving advice via e-mail. I see it as a liability exposure--s/he doesn't know to whom s/he's speaking, who else could read it, who can hack into it, etc., etc, etc. I also caution about giving telephone advice without being able to assess the patient. Has nothing to do with billing, just isn't good practice. Anyhow, look forward to future issues. --Marie Conti

A deal to sell the data from the famous Framingham Heart Study has fallen apart. Boston University had agreed to sell patient data from the publicly funded study to a private company --partially owned by the University. The company wanted exclusive rights to the information for a period of time before it was released to the public, however, and that was a deal breaker. The data was gathered using public funds.

PHYSICIAN, SQUEAL THYSELF

This week, Modern Healthcare tells us that accredited hospitals will be required to make doctors tell patients when they have received substandard care, according to new hospital accreditation standards adopted by the Joint Commission on Accreditation of Healthcare Organizations.

All I can say is, somebody call Judith Martin! She needs to start working on her next weighty volume. I suggest: "Miss MD-Manners' Twenty-First Century Guide To Docs Eating Crow." It might go something like this ...

It should do wonders for the doctor/patient relationship.

GREED AND DISEASE

Erdam Cantekin told the world back in 1986 that antibiotics weren't helpful for kids with ear infections. His research partner, Charles Bluestone, said that they were. Both scientists were looking at the same data --data that they had jointly collected-- but they arrived at absolutely different conclusions. Dr. Cantekin said that Dr. Bluestone was looking at the data with money-colored glasses. Money, he said, that came from antibiotics manufacturers.

Dr. Cantekin found the scientific community virtually unwilling to hear his claim. He was branded as a whistleblower and lost his reputation. He has spent the last 15 years fighting a mostly losing battle to see his scientific claims legitimized, and he still feels that Dr. Bluestone was compromised by corporate money.

Meanwhile, during the same 15 years, other researchers have independently come to the conclusion that antibiotics aren't the answer for kids with ear infections after all. And the overuse of antibiotics has spawned a new population of antibiotic-resistant bacteria. It's starting to look like Dr. Cantekin was right, and if the world had listened to him 15 years ago, perhaps we wouldn't find ourselves heading as quickly towards an antibiotics crisis.

It also looks like their research wouldn't have happened at all if it weren't for the private money that was the source of conflict.

This all comes from a story in the Wall Street Journal, a shrine for capitalist sentiment. But in typical WSJ fashion, fact is more important than sentiment, and the fact is, we need to start worrying about greed and disease.

A few days ago, the French government decided to hasten its implementation of a screening program for Bovine Spongiform Encephalopathy, or Mad Cow Disease, in cows destined for consumption. The European Union agreed to put this program into effect in July, but France says they want it to happen now. Eighty people have died in Britain from Creutzfeldt-Jakob disease in recent years, which in these cases is believed to be linked to beef from cows infected with Mad Cow Disease.

Scientists think that the spread of Mad Cow Disease is perhaps due to the practice of feeding leftover cow parts to other cows. Paul Brown of America's National Institutes of Health told the Wall Street Journal that the brain and spinal tissue, in particular, is shown to have a high level of infectivity.

It's cheap to feed cow parts that can't be sold back to other cows. Cow brain and spinal tissue is also found in cheap hamburgers, meat pies, and pet food.

Cheap, cheep. What about chickens and Salmonella? It used to be easier to control than it is these days. Seems the widespread use of antibiotics in livestock has caused some salmonella to become resistant to ceftriaxone, a potent and widely used antibiotic in humans. Why are we using so many antibiotics in livestock?

Have we bred them recklessly and produced susceptibility to disease? Are we raising them in overcrowded conditions that promote disease? Are we using prophylactic antibiotics because it is cheaper than providing a cleaner, more spacious, and less stressful atmosphere for these doomed creatures?

And are we pushing the boundaries of natural law in the name of profit?

E-coli has always been around, but suddenly, a few years ago, a bunch of people died from eating e-coli saturated hamburgers. Cost-cutting by meat processors was blamed for the outbreak.

The Wall Street Journal and I share a fierce belief in the power of capitalism. The direct relationship between effort and reward is what promotes innovation and keeps souls alive. Researchers like Drs. Bluestone and Cantekin frequently derive their livelihoods at least in part from corporate investment. But there ought to be a clear distinction in our minds between a straightforward reward for our effort and the compromised reward we get when we cheat. And we are trying to cheat nature when we feed cows to cows. We are trying to cheat nature when we soak chickens in antibiotics to avoid the effects of reckless breeding.

And we are cheating nature when we deliberately interpret the results of research in a self-serving, instead of science-serving, way. When greed overtakes us, we are weakened and become vulnerable.

"Too much of a good thing," my grandmother would have called it.

Letter to the Editor regarding this article:

1/11/01
I thoroughly support your sentiments regarding greed and disease. Thank you for sharing with your wide audience the information about the massively important health issues resulting from modern factory farming, from mad cow disease to salmonella to the misuse of antibiotics. This is very important information that the animal livestock industries don't want us to know. Thank you for spreading the news to the health community. -- Carol Sue Janes

E-MAIL A LIABILITY? NOPE, IT'S MUCH SIMPLER THAN THAT

If you are reading this Bulletin right now (and I defy you to suggest that you are not), you probably received an e-mail from me with a summary of this month's stories and followed the link to find yourself here. Last month, after I sent out the e-mail announcement, I got a call from a physician.

"How did you get my e-mail address?" He was worried.

I told him that I was out surfing the web, came across his e-mail address, and shot him an e-mail. We do this newsletter as a public service, and since it's free and has no advertising, I don't feel too bad about sending an e-mail to someone like this. Some say that makes me a spammer, I have learned recently, but that's another story.

Anyway, this person was genuinely upset. He said, "I deliberately haven't put my e-mail address on the web. It's a liability issue for me. I mustn't get e-mails from patients."

He explained that if a patient were to write to him, and were he not to respond, or perhaps if his response was misinterpreted or delayed, or if the response wasn't really from him, he could be liable for malpractice damages. Interesting point.

I told him where I had come across his name. He thanked me and moved on to investigate the matter himself. It made me think.

Is e-mail dangerous? In San Francisco, AP tells us, the state's third-largest health insurer violated patient confidentiality by accidentally e-mailing the names of 12,000 patients to the wrong doctors. Health Net blamed it on a computer error. Five thousand doctors received e-mails with lists of other doctor's patients.

That's pretty bad. Not to mention, further, that even properly sent e-mails are not perfectly secure. But even with all this in mind --accidents happen in every industry-- isn't e-mail a great potential tool for doctors? Why was the physician who called me so upset?

A story in the Washington Post described a study which showed that more than half of physicians would use e-mail to communicate with patients if it weren't for some pesky "barriers" inherent in the process. Most doctors aren't paid for e-mail -we didn't need a study to tell us that- and as Dr. Edward Fotsch told the Post, e-mail can create a paper trail in legal actions against a doctor. His company, Medem, conducted the study.

I read the article, hungry for more evidence that e-mail was a potential risk for physicians. But the more I read, and the more I thought about it, the more I realized that if we accept this argument --that to give advice is too risky if the patient is not sitting in front of us-- we dismiss entirely the nature of the doctor/patient relationship. Why bother being a physician at all if you are scared to give advice? Nah, potential liability ain't the issue.

My telephone pal may have been worried about liability. Maybe he's that kind of guy. But for the rest of 'em the real issue is just what Medem found: doctors don't want to consult with their patients if they aren't compensated for it. And rightfully so. Advice is a doctor's business.

So with the help of Medem, Dionne Warwick, and the Psychic Friends Network I make the following prediction: Doctors will e-mail their advice when they can figure out how to be paid for it, and they will figure out how to make it safe.

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Letters to the Editor regarding this story :

1/8/01
I briefly visited your website. In particular, if you think doctors won't give email advise because they only want money and should have no reasonable fear of litigation, you are not only wrong but wrong and stubborn which is a bad mix for one giving health care advise him or herself. You can look it up; sucessful litigation at least in the state of Texas dictates that the doctor patient relationship starts with the first contact, which email most certainly is. I myself give, free, email advice but it's with the knowledge that there's a little risk involved. Most of what I read, in fact, appeared to be opinion, not fact. -- Bruce Ehni, MD

1/9/01
I think you missed the boat with your article about doctors using e-mail with their patients. Most doctors I know and work with at the University of Florida are quite comfortable with and competent at e-mail. Their income is not tied directly to patient encounters. Some of us use e-mail often with our patients, print it out, and make it part of the medical record. Failure to make it part of the medical record, however, violates Florida law and could lead to loss of lisensure. Thats a little scary! In addition, if you correspond with a patient with whom you have no prior relationship (therefor no medical record, no signed permission to treat, etc.) you tread on thin ice. We just put an Asthma web page on the Shands Hospital web site. We hope it is accessed by many patients. We intentionally did NOT make e-mail access to our physicians as a link to the page because of concern about liability issues with patients with whom we have no prior relationship. The potential volume of e-mail was also a concern. -- J. Sherman, MD, University of Florida, Department of Pediatrics

When I was in college, I was hired to work at a certain savings and loan. I went out and bought a new dress, a bra, a pair of shoes, and lots of panty hose.

The day before I was supposed to start, I called the branch manager to check in. She sounded surprised. She stammered.

"Uh, we won't be needing you after all. Sorry." I couldn't return the dress or the bra, and I was mad about it for a long time.

Today I read a story about a fellow who was hired by the failed, now-infamous Den.net entertainment website. Apparently, he was hired at a higher-than-ever-before salary after a too-easy interview with a Den.net manager. Soon, however, he met up with another manager who said, oh, no, she didn't have the authority to hire you, let's just put this on hold.

It's always dicey in business when you promise to give somebody something, and then take it back. In the case of WebMD, News Corp, and DuPont, though, it's not clear who should be mad at whom. WebMD, aka The Vortex, subject of countless columns herewith, is prone to wild acquisitions, audacious deals, and games of management musical chairs, all in apparent defiance of the laws of business, scale, and good sense. The Vortex is always up to something. But WebMD, DuPont, and News Corp. made deals. What's not clear is exactly why these deals have fallen apart and at whose prompting. I have a guess: it involves the internet and a short period of mass business hysteria.

The Hollywood Reporter tells us that Rupert Murdoch's News Corp and WebMD are drastically scaling back their $1 billion partnership. News Corp. will be taking a $200 million write off in the fourth quarter, and WebMD will be taking $275 million. News Corp. will reduce its domestic advertising and promotions for WebMD to $205 million from $700 million, and won't be putting up the $100 million in capital or spend the $300 million to promote WebMD overseas like was originally agreed upon.

Shares in the WebMD Vortex have dwindled in value from a high of just over one-hundred to less than ten dollars in recent months.

To add to the dicey-ness, the V. has also fallen out with DuPont, who originally agreed to invest $220 million in WebMD over 5 years. As of the end of 2000, their strategic alliance is over, says the Wall Street Journal.

At the same time, WebMD is telling the Nashville Business Journal that it has decided to expand its presence in Nashville by 300 employees, and a representative of MotleyFool.com told E-Health Business that the outlook for WebMD is good because of the excellent pedigrees of the Vortex CEO and President. I dunno. There are plenty of pedigrees out there and still, an average of three hundred internet workers were laid off each day in December of 2000. The internet remains a dicey place.

Celebrities who are paid to discuss medical conditions in the media

Bart Conner (gymnast) - Paid by Pfizer and GD Searle & Co. to discuss his Arthritis, which he treats with Celebrex

Dorothy Hamill (ice skater)- Paid by Merck & Co. to discuss Vioxx, a treatment for arthritis.

Julie Krone (jockey) - Paid by Pfizer to discuss her depression, which she treats with Zoloft

Bruce Jenner (track & field) - Also paid by Merck & Co. to discuss Vioxx

Bill Parcells (football) and Joe Montana (football) - Paid to discuss high cholesterol awareness for Merck & Co.

Rita Moreno - Paid by Merck & Co. to discuss Osteoporosis awareness

Source: AP / Detroit Free Press

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Number of Americans who contract influenza in an ordinary year: one in five

Number of influenza-stricken Americans who will be hospitalized because of complications of the disease: one in one-hundred

Number of Americans who die each year from complications of influenza: 10,000 - 20,000

Estimated total annual costs of influenza in the US: $14.6 billion - $1.4 billion due to direct medical costs and $13.2 billion from indirect costs like lost earnings and influenza-associated mortality

Source: Medscape Nursing 2000

The NHCQA Bulletin is an official publication of the National Healthcare Cost and Quality Association. Published monthly.