Cooperating for better care.

Lown Institute

Tag Archives

Greed linked to healthcare ‘corporatization’ said to ravage America

“Avarice,” by Jesus Solana.

Vikas Saini, M.D., president of the Lown Institute, and Shannon Brownlee, the healthcare reform organization’s vice president, discuss in the Huffington the massive, greed-fueled corruption in U.S. healthcare that drives up costs to astronomical levels and ravages the economy.

They write:”

“Our health care system is no longer about relieving the suffering of patients… It’s about making money.
“Why? Because our increasingly corporatized healthcare system is driven by an insatiable appetite for profit. Our healthcare system is no longer about relieving the suffering of patients or the intrinsic value of maintaining the health of our population. It’s about making money: for pharmaceutical companies, device manufacturers, hospitals, insurance companies, and increasingly, for doctors. And all of these players are gaming the system and hurting patients in the process.”

“Healthcare spending consumes one-fifth of GDP. While health care does create jobs, it also takes jobs away by reducing spending for other public goods: housing, education, and infrastructure. Healthcare costs bankrupt patients, choke small businesses, contribute to stagnate wages, and force governments at all levels to trim public services.”

To read the piece, please hit this link.

Trying to avoid overuse, underuse of medical care


In this Modern Healthcare interview, Vikas Saini, M.D., president of the Lown Institute,  the healthcare think tank and reform organization, discusses the need to involve patients in decision-making and how to avoid overuse and underuse of medical care patient by patient and achieve “right care”.

He notes:

“The real strength of the “Choosing Wisely” initiative has been clearly establishing the principle that there’s a lot we do for which there’s no evidence and there’s no benefit, and so if you do it, you’re only asking for harms. You’re only asking for either complications or side effects, or waste of money. The broad question is how do we deliver the right care? We came up with close to two dozen or more drivers (of inappropriate care). And these drivers act in complicated ways.”
Then he explains how.On the Affordable Care Act he says:{A} big part of what’s happening with the ACA is that the affordability of insurance on the exchanges depends on a mechanism of high copays and deductibles, which means that patients are being put in the position of having to figure out whether the extra cost to them for any given visit or test or procedure is worth it. I don’t think our patients and communities really have enough knowledge and understanding to make that decision. I think it’s unfair to do it that way. There is a theory that if people have skin in the game, they will make better choices. In healthcare that may be true, but it’s true at the margin if you have the leisure of thinking about it.”
“….Too much of what we do and the kind of interactions we have and the kind of decisions patients have to make, they’re not equipped to do. So what we’re really doing is shifting the cost. Certainly aligning payment incentives is a help. But we can’t succumb to magical thinking that by aligning payment structures things will get better.”

Warning to physicians, researchers: First, don’t fool yourselves


“King Lear and the Fool in the Storm,” by William Dyce

Shannon Brownlee, of the Lown Institute, in a piece about big economic conflicts of interest involving physicians, researchers and the drug and device companies that try to influence them, writes:

“Do I think pharmaceutical and device companies are run entirely by evil people? Of course not. They are working within the rules they’ve been given. Do I think researchers who have conflicts of interest are unethical and greedy? I’m sure some of them are, but most are simply kidding themselves that they can take the money, allow industry to control the agenda, and still conduct unbiased research. As physicist Richard Feynman once said, the first principle of good science is you must not fool yourself, and you are the easiest person to fool.”

Best practices for Do No Harm Project


A look at the Do No Harm Project at the University of Colorado-Denver two and half years into the project.

The Do No Harm Project at the University of Colorado-Denver was started because  founders recognized that healthcare overuse is “an urgent ethical issue,”  said co-founder Brandon Combs, M.D., in a webinar hosted by the Lown Institute.

At the core of the initiative is the idea that clinicians should do “as much as possible for the patient [and] as little as possible to  the patient,” Combs said.

He distinguishes between more obvious patient harms — malpractice and errors–and what he termed “reasonable overuse,” such as ordering unnecessary tests or procedures, that’s harder to define  but can be just has harmful and costly, which is why it’s the focus of the Do No Harm Project.

His best practices for the Do No Harm program include, FierceHealthcare reported:

“Think big, start small. The University of Colorado identified three initial goals in its campaign: recognize harms from overuse, start a conversation about it and change the local culture, Combs said, adding that it’s important for providers to remember that they don’t have to do it all overnight.”

“Find your niche.” The founders focused on clinical vignettes because, he said, “patient stories are very powerful” and can be  rallying cries for change.

“Make it stick. One key to UC-Denver’s success was supportive faculty, particularly its chief medical resident, ”who served as both a facilitator and educator for participants….”

”Don’t underestimate your potential.” The Do No Harm Project extended its reach and credibility far beyond what its founders expected by partnering  withJAMA Internal Medicine to publish the participants’ vignettes  in its “Teachable Moment” series.”

“Measure and celebrate success. ‘If you’re going to take the time, measure the impact to see if it’s important,’ Combs said, adding that it’s also key to share these results as widely as possible so that others can replicate your success.”


Moral or simply economic?

Shannon Brownlee,  at a Lown Institute conference, discusses whether medicine is a “moral endeavor” or simply a  set of ”economic transactions”.


“If we want to get to the right care, we must begin to envision a vastly different system.,” she said. “A just system. A system whose purpose is to serve patients and communities. A system that is not just reformed, but radically transformed.”

Contact Info

(617) 230-4965

Wellesley, Mass