Category Archives: Business

Priming the pump: Biopharma contributions and prescribing patterns

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

How in control are we of the decisions we make every day?  How sure are we of our judgement, how we feel, what we believe?  I think many people would say they feel very in control and very certain.  I suspect many people are wrong.  Studies in behavioral psychology have begun identifying the effect of priming–how a subtle stimulus can affect how people, behave or think.  The field of priming is not without ongoing controversy, but at the same time the effect of priming has been seen in many studies (like this one) and appears to be a real phenomenon, albeit one that is still very challenging to clearly describe, test and validate.

Its in this context that a recent report describing physician prescribing patterns is particularly interesting.  And disturbing.  The study by Joseph Engelberg, Christopher Parsons and Nathan Tefft looked at the effect of Biopharma payments to what drugs doctors prescribe.  To quote from their introduction for some context:  “While such rent-seeking behavior [such as pushing more expensive merchandise by salespeople] might not surprise many people…that financial conflicts of interest could influence their doctor’s advice might be both less expected and more worrisome…intrinsic motivation is thought to be important in medicine, with the goal of optimizing patient health being a paramount objective.”  The null hypothesis would be that prescribing patterns would be related solely to health condition, general information about drug efficacy, and price to the patient.  That’s not what was found. Continue reading →

Mulally and Microsoft

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

When news broke on Tuesday that some groups were lobbying for Alan Mulally to get a look as the next CEO of Microsoft, I was pretty positive.  Since then Jon Talton has written a more nuanced and cautionary view of this, suggesting, among other things, that celebrity CEOs are not always able to perform the miracles people are hoping for, and also that the history of CEOs switching fields and succeeding is sketchy.  These are good points, but I still find myself in the Mulally camp for two reasons.

One, in turning around Ford, Mulally demonstrated the ability to do what I think is one of the most important things a CEO can do.  He changed the culture.  To illustrate this let me relate a story that Mulally told at a lunch benefit for Leadership Tomorrow last year (disclosure: I’m on the board of Leadership Tomorrow, and Alan Mulally is one of the more well-known graduates of the program).  He related how when he came to Ford he was introduced to their weekly  status meeting, in which management representatives across the globe phoned in to a telecon for a status report.  And, in familiar corporate fashion, each representative was to indicate, via a green-yellow-red chart, how things were going with his or her domain.  At the first meeting, everything was green.  This from a company that was losing billions.  At that meeting Mulally stressed that what he wanted was the real story, and that no heads would roll because of it. Continue reading →

Jeff Bezos is the anti-unbundler or, can the founder of Amazon make us eat our greens?

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All opinions are may own and do not necessarily reflect those of Novo Nordisk.

h/t to @Frank_S_David for tweeting the link.

People have wondered and speculated and analyzed why exactly Jeff Bezos decided to buy the Washington Post.  Late last week Timothy B. Lee of the Washington Post offered some clues.  He reported how Bezos, in remarks to the Post staff, described wanting to get back to “that glorious bundle that the paper did so well.”  What Bezos wants is to find a way to make the Post such a destination that people will choose to visit regularly and not just read individual articles but stay and scan through many, presumably in one sitting, as people used to do as their morning ritual.

Timothy Lee is skeptical and I’ll just briefly summarize his points and urge you to go read his great article for the details.  Lee points out that news distribution has become unbundled due to the influence of the internet.  (For some nice posts on the concept of unbundling see this one by Leigh Drogan and this one by Frank David).  People consume news in individual article-sized chunks, often following links provided by friends and colleagues and search engines, without much loyalty to specific outlets or writers.  Lee also points out that while the Post has excellent writers, they’re still a miniscule fraction of the writers on the internet and most of the best writers are not on the Post’s staff.  Lee uses this as a launching point to talk about the increasingly important skillset of attracting clicks, largely through evocative headlines.  You know, like the one I tried to write for this post.  Did it work?

Jeff Bezos’ ambition is quite interesting on a couple of different levels.  The first is the basic question of why Bezos thinks he can do this?

The answer, I believe, is that he already succeeded once.

Continue reading →

The “good,” the “difficult” and the “reality”: patients in the digital age

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

With apologies to Sergio Leone.  And to you, for making you read that really bad pun.  Just move along.

In an engaging and thought-provoking perspective piece in the New England Journal of Medicine, Dr. Louise Aronson described her experience in getting treatment for her father, who was suffering from low blood pressure and other health issues.  Her father was admitted to the hospital and went through examinations and fluctuations in his health during his stay.  He seemed to stabilize but then his blood pressure dropped again and Dr. Aronson asked for someone to come and check on him.  The staff was polite but non-committal and she decided to perform an exam on him herself to check if he had internal bleeding.  He did, she obtained evidence, and her father received rapid care to prevent further blood loss. 

She relayed this story in the context of how health care providers often bin patients and their support networks into “good” and “difficult” categories, based on how much and how often those patients acquiesce rather than challenge or even seek information about ongoing treatments.  As she describes it, the staff “were polite, but their unspoken message was that they were working hard, my father wasn’t their only patient, and they had appropriately prioritized their tasks. ” Her message was that the medical profession needs a cultural shift,in which patients and their families whom are more actively engaged in their care are seen as an asset, not a detriment to medical practice.  She also suggested some practical elements that would help this, including tracking more clearly when patient engagement occurs and rewarding it through changes in billing codes and practices. Continue reading →

What $85 million could get the NFL: thinking about the NFL concussion settlement

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

Yesterday the NFL and the NFL Players Association reached a settlement concerning compensation for concussions and other football-related injuries.  The impending lawsuit was brought by former NFL players who claimed, among other things, that the NFL downplayed the risk of concussions despite having knowledge of their effects and also did not do all it could to help former players.

The total amount earmarked for the settlement is reported to be $765 million dollars, with the vast majority ($675 million) in a fund to support former players and families in dealing with the aftermath of concussions.  Commentators have noted that this appears to be a great victory for the NFL.  First, the amount of money is less than many expected even with a settlement.  Second, the NFL did not have to go through discovery, which would have laid open exactly what the NFL did know about concussions and possible side effects, as well as potentially other damaging information that, once released in court, could never be private again.

It seems likely that those who were bringing forward the suit settled because they were motivated to help the most needy members of their group.  Many former NFL players are suffering dementia and lingering aftereffects from their playing days.  Some families of deceased players will also benefit.  The former player pool can’t really afford to wait for the long protracted time a trial and subsequent appeals would take since in the interim many would fall into poverty and even poorer health; some could also die. Continue reading →