Thursday, October 24, 2013

UnitedHealth & Simon Stevens: Your NHS! Your Money!

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© Am Ang Zhang 2009





Simon Stevens: now with UnitedHealth

Now Stevens is to play a crucial role in presenting the more responsible face of American healthcare and in persuading the key players in Britain that they need to allow companies such as his into the NHS. Recently UnitedHealth's European division won the right to take over two GP practices, in Normanton and Cresswell in Derbyshire. Stevens, who was running the European division at the time, was key to winning the contracts.

The company is a huge force within US healthcare, with 70 million Americans on its books, employing 400,000 doctors in 4,000 hospitals. UnitedHealth is America's biggest health insurer. And it's growing in influence in Britain.
It already runs two GP practices in Derbyshire and now the government has given the green light to 14 companies, including United, to bid for potentially much bigger contracts from the primary care trusts that run hospitals. They would be paid for providing data analysis and research, giving trusts a clearer idea of how to manage patients with chronic conditions such as diabetes.
But their role may be bigger than that. Companies may also be invited in to act as middlemen, negotiating with hospitals on the trusts' behalf to reduce costs, ushering in the prospect that some patients may find their care plan managed not by a doctor but by an American insurance company.
Allowing UnitedHealth and others into the NHS fills the unions and many health workers with horror. That dismay will be amplified when they watch Michael Moore's latest film, Sicko, which alleges that United and other big US insurers routinely deny care for patients who may be critically ill.

In the WSJ there was a report:
“……UnitedHealth Group Inc. (UNH) agreed to pay $912 million to settle two class-action lawsuits regarding its stock-options practices……”

Rewind to last year in the New York Times:
“In one of the largest corporate pay give-backs ever, William W. McGuire, the former chief executive of UnitedHealth Group, has agreed to forfeit at least $418 million to settle claims related to back-dated stock options.”
How very sad! $418 million is a lot of money!
“The payback is on top of roughly $198 million that Mr. McGuire, an entrepreneur who built UnitedHealth, had previously agreed to return to his former employer.”
An entrepreneur! This reminded me of Dr Crippen’s blog about NHS entrepreneurs, and I duly alerted him. UnitedHealth is said to cover the Health Insurance of 70 million US Citizens.
“As part of the settlement with the S.E.C., Mr. McGuire will pay a $7 million fine and will be barred from serving as a director of a public company for 10 years.”
Oh, no, another $7 million and 10 years! You must feel sorry for him.
“He will, however, be allowed to keep stock options valued at more than $800 million, including many that have been sharply criticized.”


Jul 20, 2010
UnitedHealth Profit Jumps as Medicare, Medicaid Grow
UnitedHealth Group Inc., the biggest U.S. health insurer by sales, raised its full-year profit forecast after increased enrollments and lower-than-projected medical costs lifted second-quarter earnings 30 percent.

The insurer forecast 2010 profit of $3.40 to $3.60 a share compared with a previous projection of $3.15 to $3.35, citing growth in sales or membership for all business units. Net income rose to $1.12 billion, or 99 cents a share, for the quarter, from $859 million, or 73 cents, a year earlier, the company said today. The earnings and forecast topped estimates.

Chief Executive Officer Stephen Hemsley boosted enrollment in Medicare Advantage, the U.S.-backed program for the elderly. Weakness in the economic recovery in the U.S. also helped, by keeping people away from doctors and hospitals, said Jason Gurda, a Leerink Swann & Co. analyst in New York. UnitedHealth did better than expected for commercial enrollment, taking business from rival insurers, he said.

October 18, 2006
UnitedHealth's Options Scandal Shows Familiar Symptoms

Stephen Hemsley, who upon being hired in June 1997 was presented with 400,000 stock options with an issue date of five months earlier. Hemsley told the Wilmer Hale lawyers that he "didn't recall focusing at the time" on the $2.9 million gimme he'd just been handed as a result of the backdating.

You might say that Hemsley comes honestly to his lack of focus and ethical sensitivity. Before coming to UnitedHealth -- I'm not making this up -- he'd spent the previous 23 years at Arthur Andersen, rising to chief financial officer. That's the same accounting firm that helped bring you Enron, WorldCom and Freddie Mac. And, you'll be shocked to learn, it's the same Arthur Andersen that served as a consultant to Spears and other members of UnitedHealth's compensation committee.

Hemsley was rewarded for his lack of focus by being named to succeed McGuire as chief executive. He was also directed to root out the senior executives in the legal, accounting and personnel departments who provided the bad advice on which the board and chief executive now say they have relied. Hemsley, too, has volunteered to reprice his options.

The reward:
Chief executive Stephen Hemsley pulled in $102 million in 2009, with $98.6 million coming from exercised stock options, according to a filing with the Securities and Exchange Commission Wednesday.    Star Tribune

Friday 16 July 2010
The Minnesota-based firm beat Bupa and Humana to win the contract from the health department to advise PCTs

The Minnesota-based UnitedHealth has already become a key adviser to primary care trusts (PCTs) on commissioning health services and operating bids to run GP practices. Earlier this month it beat Bupa and Humana, another US health insurer, to win the contract from the health department to advise PCTs.

The decision follows successful bids to run two GP practices in Derbyshire in 2006 and three practices in central London in 2008, taking over from the Brunswick Group. In April the company announced a 21% increase in profits for the first three months of the year to $1.2bn (£784m).

United said it brought high level management expertise and efficient provision of services to the UKhealth service but it has faced accusations of overcharging and malpractice in a series of legal suits.

New York Settlement:
January 15, 2009 
UnitedHealth Group Inc., the biggest U.S. health insurer, said it will spend $400 million to settle allegations it has manipulated payments to doctors and patients for the last 15 years.
The company agreed to put $350 million into a class-action restitution fund to pay physicians and policyholders for services provided by out-of-network providers, the company said in a statement today. On Jan. 13, the Minnetonka, Minnesota-based insurer settled allegations from New York Attorney General Andrew Cuomo by paying $50 million and transferring to a nonprofit group its database that set the amount to be reimbursed when patients used doctors outside their network.
UnitedHealth has been battling the largest physician group, the American Medical Association, over out-of-network costs since 2000. The settlement affects less than 10 percent of health benefits because most policyholders use their health plan’s network providers to minimize out-of-pocket expenses. Still, the AMA said it stopped rampant cheating Its California subsidiary was fined a record $3.5m in the same year for mishandled claims against patients and doctors. In 2006 The UnitedHealth chief executive William McGuire resigned after an investigation "concluded he had received stock option grants 'likely backdated' to allow insiders to maximise financial gains." During his tenure as chief executive, McGuire was granted more than $1.6bn in stock options. In 2007, McGuire avoided trial after he agreed to repay $468m.


In one example, Cuomo’s office said that when $200 was a fair-market rate for a 15-minute doctor’s visit for a common illness, Ingenix said it was $77. UnitedHealth would pay $62 when it should have paid $160, leaving the consumer with a $138 bill.


Forbes:

I recently learned that this month a class-action lawsuit has been filed against California United Behavioral Health (UBH), along with United Healthcare Insurance Company and US Behavioral Plan, alleging these companies improperly denied coverage for mental health care.
According to the class action lawsuit, United Behavioral Health violated California’s Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnosis according to “the same terms and conditions” applied to medical conditions. Specifically, the insurer is accused of denying and improperly limiting mental health coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions.

The British Medical Association may now have a new role.




The future is here now:




Ex-NHS:

Patricia Hewitt: now with Cinven (Bupa Hospitals)






Related:





Tuesday, October 22, 2013

Grand Central: 100 Years!

©2013 Am Ang Zhang

©2013 Am Ang Zhang
22 million visitors a year.

10 million oysters a year at Grand Central Oyster Bar.

Book:

Saturday, October 12, 2013

Hello Autumn: BBG1 & Eugene Onegin!

Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 

Book:
Netrebko describes the challenge of Tchaikovsky’s deceptive simplicity in this score. When she was first learning the Letter Scene a decade ago with Gergiev, “he told me: ‘There are four phrases with the same melody, but you have to sing them in different ways!’ It ultimately sounds very simple, but that’s the hardest part of all. But I love the Letter Scene because, as challenging as it is, it’s so full of color and internal feelings, impressions, experience.” 


Hello Summer: BBG 2.
Hello Summer: BBG 3.

Hello Summer: BBG4.


GSK & Opera: From Ribena to China

As GSK hit the news again and despite promises they seem to carry on from Ribena days.




One of the most troubling lapses — a problem the report labeled “critical” — involved a drug known as ozanezumab, which was being developed to treat patients with multiple sclerosis and Lou Gehrig’s disease.

The report revealed that the drug’s project leader belatedly learned the results of three studies of ozanezumab in mice. During their investigation, auditors came across six studies whose results had not been reported, even though early trials in humans were already under way.

Reporting such information is crucial, ethicists said, because animal studies can identify safety risks and are among the main factors drug companies use to decide whether to pursue human trials.


“If that’s true, it’s a mortal sin in research requirements,” said Arthur L. Caplan, the head of the division of medical ethics at NYU Langone Medical Center. He served as the chairman of an advisory committee on bioethics at Glaxo from 2005 to 2008. “No one could approve human trials without having that information available, scientifically or ethically. That’s kind of a Rock-of-Gibraltar-sized ethics violation.”

Avandia:
Looks like GlaxoSmithKline has now settled: NY Times
Published: November 3, 2011

The British drug company GlaxoSmithKline said Thursday that it had agreed to pay $3 billion to settle United States government civil and criminal investigations into its sales practices for numerous drugs.

The settlement would be the largest yet in a wave of federal cases against pharmaceutical companies accused of illegal marketing, surpassing the previous record of $2.3 billion paid by Pfizer in 2009. In recent years, drug companies have been prime targets of federal fraud investigations, which have recovered tens of billions of dollars for Medicaid and Medicare.

The cases against GlaxoSmithKline include illegal marketing of Avandia, a diabetes drug that was severely restricted last year after it was linked to heart risks. Federal prosecutors said the company had paid doctors and manipulated medical research to promote the drug.

It is sad that the warnings came from one of the most respected Clinics and it took so many years and so many deaths before something was done.

In The Cockroach Catcher, Dr Am Ang Zhang had an interesting discussion with his Junior who had just transferred from one of the top London teaching hospitals:

“Do you agree that Leroy has Social Phobia ? Everything fitted in with the criteria in DSM IV.” My junior plucked up courage to ask me during supervision.

It was good to keep oneself on one’s toes with juniors who had just arrived from London and who read up on everything.

“What’s wrong with shyness?” I joked, “Do you want me to put him on SSRI (Selective serotonin reuptake inhibitors)?”
“It is supposed to work.”
“If he starts taking SSRI at thirteen, what is he going to do for the rest of his life?!”
“The newer short acting ones are supposed to be better.”
“Take one advice from me; think the opposite, the opposite to what the big Pharmas tell you. In pharmacology, shorter acting drugs are more addictive. That was what I learned in Medical Schooland is still true if you think carefully about it.”

Today’s Times headline: No prosecution on suicide-risk drug.
“A report suggested that GlaxoSmithKline (GSK) knew about safety risks but failed to report them to the medicines safety watchdog for five years.”
The drug concerned is Paroxetine and in the UK marketed as Seroxat and in the US as Paxil.
“GSK submitted data from clinical trials to the MHRA in May 2003 showing that patients under 18 had a six or sevenfold increased risk of suicidal behaviour if they were treated with Seroxat than if they received a placebo. Data also showed that the drug was not effective for treating depression in children and adolescents. Leaked documents suggested that GSK had known about these results as early as 1998.”
Keen eyed bloggers would have noticed Paxil CR in a previous posting of mine about how GlaxoSmithKline had all their Paxil CR and Avandamet seized in the U.S.

Now the story of Ribena has to be one of those sweet (sorry) stories one remembers for a long, long time.


Wagner, it would seem is as up to date as ever.


Looks like the modern Rheinmaidens are male and collected their gold from GSK.



                                                                 Intermezzo
Four former GlaxoSmithKline employees will share up to $250m (£159m) after their evidence helped US authorities secure a record settlement with the UK drug company for mispromoting drugs.

Greg Thorpe, Blair Hamrick, Thomas Gerahty and Matthew Burke are in line to receive the payout under the Federal False Claims Act, a US law dating back to the Civil War that allows whistleblowers to receive a portion of money the government recovers when prosecuting fraud.

The dark side of the gods: (it is sometimes easier if one take GODS in the Ring to mean those in POWER. For the characters read here.) In fact, the gods need not work at all, the Nibelungs work almost all the time.

Disrespectful Wotan is hardly revered unanimously, and even he acknowledges higher authorities. Erda knows things he doesn't; his almost bureaucratic dominance derives solely from treaties engraved in runes on his spear, treaties to which he is subservient.

Born liarsCharacters lie as it suits them. Events are initiated by Wotan's spurious promise to the Giants to pay them by giving them Freia in exchange for building Valhalla, a promise he knows he cannot keep, as she is the indispensable symbol of love whose golden apples keep the gods alive. His shady ally, Loge, is defined as a double-dealing trickster. Brünnhilde breaks her promise to her father to allow Siegmund to be killed in combat. Mime makes dissembling a veritable life's work, ably carried forward by his nephew, Hagen, in Götterdämmerung. 

Contemptuous
Brünnhilde disobeys Wotan, and his grandson Siegfried destroys his power. Mime, who raises Siegfried from infancy and even makes him toys, is treated with disturbingly cruel contempt by the bumptious hero. Hagen, whom Alberich sired via gold-empowered lust as a tool to retrieve the Ring for him, mutters that if he succeeds he will keep it, not hand it over to his Nibelung father.

Thieving & Misappropriation 
……. misappropriation, of persons or of things, provides much of the plot machinery. First, Alberich plunders the Rhinegold, and afterward, theft of others' possessions, including the Ring, motivates action upon action. 


Incest and other illicit sexThe teasing of Alberich by the Rhinemaidens which leads to his abjuring love--love, not lust. The definitive heroine, Brünnhilde, and her Valkyrie sisters are the offspring of an adulterous liaison between Wotan and Erda; Wotan also illegitimately fathers the Wälsung twins by a mortal. Sieglinde's infidelity is excoriated by marriage-goddess Fricka, as is her violation with Siegmund of an even more basic taboo, incest. But Wotan defends the twins ("…those two are in love") and, like most audience members moved by the ardent love music, views both transgressions kindly. 

Homicidal
Fafner kills his brother Fasolt, the first victim of Alberich's curse, and we are off to the homicide races. Hunding slays Siegmund, only to be destroyed by Wotan's contempt. Siegfried kills Fafner, the Giant-turned-dragon, and then, after realizing that Mime is trying to poison him, kills him as well. By the time the gods' destiny climaxes, Hagen has murdered both Siegfried and Gunther and is himself drowned by the Rhinemaidens. Eventually Brünnhilde sets Valhalla ablaze as part of her self-immolation upon Siegfried's funeral pyre ("Thus do I hurl the torch into Valhalla's proud-standing stronghold") and all the gods die.
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Greed, greed, greed!Finally, "coveting that which is your neighbor's" is pretty much the whole raison d'être for the Ring story, starting with Alberich's desire for the Rhinemaidens, then for the gold they guard. Thereafter everybody seems to want what doesn't belong to him or her: the Ring, a sword, a treasure, someone else's wife, sheer power. 

Yet in spite of Wagner's wholesale abandonment of the Decalogue, the bastion of Western morality, Der Ring des Nibelungen generates explosive ethical and metaphysical impact. He started with the absorption, fusion and reinvention of myriad legendary sources, and layered Schopenhauer's philosophy upon Feuerbach's. In Art and Climate Wagner wrote, "there is no true freedom except that which is common to all mankind... The redeemer is therefore love… starting with sexual love, [it] strides forward through love of children, brothers and friends, to universal love of humanity." The emphasis is his. Yet, some years later he wrote to Mathilde Wesendonck, "I can conceive of only one salvation. It is Rest! ...The stilling of every desire!" 

Wagner once wrote to Röckel, "I have come now to realize how much there is, owing to the whole weight of my poetic aim, that only becomes clear through the music." He later described the discontinuity between his "rationally formed ideas" and "the exquisite unconsciousness of artistic creation… guided by wholly different, infinitely more profound intuition."


Richard Wagner
Götterdämmerung

www.staatsoper.de 


Intermezzo Update: Just one of those Rings

 The world of Götterdämmerung is the 21st century corporation, featuring an anonymous mass of business-suited Gibichungs in a flashy glass and steel edifice.

Production photos can be seen hereherehere and here.


Saturday, October 5, 2013

Ginkgo: Hello Autumn!


 Ginkgo biloba ©Am Ang Zhang 2013

Ginkgo biloba ©Am Ang Zhang 2013

Ginkgo biloba ©Am Ang Zhang 2013

Ginkgo biloba ©Am Ang Zhang 2013

Ginkgo biloba ©Am Ang Zhang 2013

Ginkgo biloba ©Am Ang Zhang 2013

Ginkgo biloba with its romantic botanical history is no longer the Dementia buster it promised to be. (Those who know of the village in Japan where there are loads of Ginkgo trees could have told you that. The village has the highest Alzheimer rates in Japan.)




June 3, 2013
Following a government report that the herbal ingredient Ginkgo biloba causes cancer in lab animals, the nonprofit Center for Science in the Public Interest is urging the Food and Drug Administration to prohibit its use in foods and dietary supplements. The watchdog organization says the FDA should give the industry a reasonable time to comply with such a directive and then seize whatever products remain on shelves to protect consumers.

A March report from the National Toxicology Program found "clear evidence" that Ginkgo caused liver cancer in mice and "some evidence" that Ginkgo caused thyroid cancer in rats. Researchers from NTP told the New York Times that the number of cancers found in the mice exceeded the numbers ever seen before in their lab. While the supplement industry argued that the NTP used an extract of Ginkgo not used in supplements sold in the United States, the NTP says the composition of the extract it tested falls within the range of what is sold.


"It used to be the case that the only problems associated with Ginkgo were the unfounded and deceptive claims by manufacturers that it helped memory," said CSPI executive director Michael F. Jacobson. "Now we know these make-believe benefits are far outweighed by a real risk of cancer."

Looks like the living fossil that lasted 270 million years is going to last a little bit longer and perhaps there was a reason it lasted this long!
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