Doctors Paid to Make You Sick

The 800,000 physicians in the US comprise a large and intensely managed partner program for the drug companies.  We are about to find out how intensely managed as the Affordable Health Care Act (AHCA aka Obamacare) now requires the drug companies to disclose how much they pay your doctor to prescribe drugs to you.  It should not be a surprise that the drug companies pay doctors quite a bit, and those payments change doctor behavior.  So it should be no surprise to find that some people may be diagnosed with ailments they don’t actually have -- so the doctor can prescribe the pills and get the money.

Sales managers know that salespeople are “coin operated”.  Better performance from salespeople is purchased with commission plans that compensate for more sales, more upsells, more referrals, more attached sales, more anything.  Since our business is technology sales, and specifically channel partner programs, we think a lot about how to properly incent our client’s partners to sell more.  We have seen this produce intended (improved sales) and unintended (systemic cheating) outcomes.  Broadly speaking, generalized incentives are better than highly specific incentives when it comes to getting a constructive result.  Sure if you have to move one product by the end of the quarter and you don’t care about the long term effects – a specific incentive will do the job.  But if you want customers satisfied and loyal for the long term, working with partners to grow their business for the long term is better than quick hits.

Over incenting salespeople in technology might result in a consumer or company with an overly large hard disk or a bigger video card or a router with enough capacity for 10 years of growth.  Over incenting doctors might result in a generation of kids on Ritalin, parents on anti depressants, and in the worst case, deaths.  Here is more reading on the subject should you be interested:

• On The Media:  Great overview segment from yesterday’s show.
• ProPublica:  Building a database of the payments to doctors.
• NY Times:  Article on the subject
• 2009 Report to Congress on Physicians’ financial relationships
• NY Review of Books:  The Epidemic of Mental Illness
• Medicine.Net:  10 most prescribed drugs
• IMS Institute for Healthcare and Informatics:  The Use of Medicines in the United States

Update one week later:  Great article in the NY Times today about the 3 million children on Ritalin -- and how there is not evidence that it helps!

China Buys the New York Times

Even though I am a conservative at heart, my favorite newspaper is the New York Times.  They have always been the one newspaper that is actually trying to do a good job – until now. 

I recently converted my digital only subscription to digital plus Sunday delivery and I have been surprised to see twice in the last month that the China Daily has purchased two page advertising spreads in the Sunday edition (these advertisements do not appear in the digital editions).  China followers are quick to dismiss this a as a cheap trick, but those who are less likely to realize the extent the Chinese government (who prints the China Daily) will go to deceive its readers will not. I am surprised that there has not been more of an outcry from the protectors of Journalism.  Is this old news or something?  Here is the only article I could find.

Just as Goldman Sachs will likely be successful with its new philanthropy campaign, the Chinese government will likely win over many readers with its New York Times partnership.  Until now I had hoped there would be customers who the New York Times would actually not take money from.  We should all brace ourselves for what comes next, because if the precarious state of the newspaper industry has brought us this, next we will get something even worse.

If there is a newspaper with a “Chinese wall” (ha ha) between advertising sales and editorial decision making, it should be the New York Times.  Recently, this article appeared.  I wonder what kind of phone calls it generated. 

Michael Lewis recently pointed out in Boomerang that Germans by their nature believe in order and process and cannot escape the idea that everyone else does too.  When Moody’s said that the bonds were AAA – the Germans actually believed it.  When they turned out to be toxic junk – the Germans were actually surprised.

The Chinese believe that their paper is full of lies, and when they find out that Americans actually believe what is printed in their paper – they will be surprised.  The Chinese also believe that when you pay someone money, they do what you ask them to do.  So when the China Daily calls up the New York times and asks that they no longer print negative articles about China – they will actually be surprised when the New York Times says they will not.

Well, I am still a subscriber.  But I will be getting my China news somewhere else.  Anyone have any suggestions?  Al Jezerra English?

Update:  Post from the Nieman Lab at Harvard on the subject.

My New Newspaper Route

Readers of this blog know that I am a big fan of the NY Times.  Some people would say that I am more of a Wall Street Journal guy, and in fact I started reading the NY Times some 25 years ago because I wanted to understand the more liberal perspective.  Over the years the NY Times has gotten better and I might pick up the Wall Street Journal every couple of weeks.  In short, the opinion pieces in the NY Times are well written and thought provoking, those in the WSJ just sound like screaming.  I am not sure if it is the owner coming through or if it was always like that but now I rarely read the WSJ Opinion pages.  I suppose they would be a good source for humor if it didn’t make me feel just plain depressed about our country.

Anyway, back to the NY Times and its pay-wall.  Hard to tell I know but that is what I am writing about in this post.  Like I said, I am a big fan of the Paper of Record and would give them money just because I appreciate them.  Dave Winer and Jay Rosen had an interesting point in their Rebooting the News podcast last week about putting shortened links in Twitter that go to the NY Times.  It seems that some people do not like to be surprised by shortened links in Twitter to the NY Times because it tricks them into using up one of their 20 free articles per month.  This could produce a trend in Twitter etiquette to indicate NYT before the shortened link so people could decide in advance if they wanted to spend one of their 20 articles per month before clicking.  I know I used to send out dozens of links to the NY Times before the paywall and have not sent out any since.  I also never link to the WSJ – because I don’t want my readers to link to a subscription screen.

Dave Winer goes on in the podcast to say that NYT Columnist Paul Krugman negotiated that his column would not be hidden behind any paywall ever.  Krugman posted on his NYT blog on 3/18 that his readers can always link to his column through twitter without “spending” one of the 20 free articles per month.  I do think the columnists are the most important factor in this debate.  About a year ago I predicted that the paywall would hasten the decline of the NY Times and I still think so.  I also still think we will know the NY Times is in big trouble when the columnists leave for more visibility elsewhere.  Again, I love the NY Times so I don’t want to see this happen. 

Since the paywall started on 3/28 I have done a little experiment on one subject – myself.  I have tried to go without my favorite new source for a while.  Well, not completely cold turkey, but not subscribing.  I wanted to see what it would be like for someone who was an occasional reader of the paper, but not a subscriber.  I learned that there are a bunch of great news sources out there that I never had taken the time to visit.  I put the Reuters and AP apps on my iPad – so anytime I wanted to make sure I was not missing something big I could scan the headlines.  I started going to Al Jazeera English more often.  The Washington Post and the Guardian web sites all got more regular visits from me.  I spent more time looking at my RSS feeds.  None of these captured my attention like the NY Times used to.  In fact, I think I have a better sense for the news without the NY Times.  My newspaper route changed.  Before I went to the NY Times, and ran out of time before I went anywhere else.  Now I take in a number of sources – sometimes including the NY Times, and sometimes not.  I also spent more time with one of my other favorite publications, The Economist.  When it comes to thoughtful essays it is hard to beat the Economist.  I can never get all of the way through one issue before the next one hits – so more time with this publication is a good thing for me.

So to sum it up, I can absolutely live without the NY Times.  So here is My New Newspaper Route:

• Scan the headlines at Reuters and AP for headlines – only rarely do I read beyond the first paragraph
• Scan The Guardian, and sometimes the Washington Post – again for headlines
• Scan Al Jazeera English and maybe read something
• Go to my RSS feeds and read a few things
• Go to The Economist and read a few things – every few days
• Go to the NY Times and read the columns – every few days; also I have returned to buying the NY Times Sunday edition in printed form at the store and reading it all week – like I used to 5 years ago.

It is interesting to note that my perception of the NY Times paywall impacted my behavior more than the reality.  I was never actually able to hit my 20 article limit.  One time I got the warning that I only had 5 left and I tried like crazy to get it to stop me at 20 and could not.  Maybe it is because I have multiple machines, stopped signing into the web page (as part of my experiment), or who knows what.  Either way, the paywall never actually stopped me from reading, I stopped me from reading.

After all of this, today I signed up for the full digital subscription.  Like I said, I really value the NY Times and I want them to be successful and according the the NY Times, over 100,000 new digital subscribers have signed up.  The special deal gives me full access for a month for 99 cents.  So I am not helping them very much!  After that it goes to $35 per month.  I don’t know how long I will last at over $400 per year unless my paper route changes back to the NY Times at the top of the list and I stop getting all of my news from those other places.

The Phone is Dead... Again

Last month there was this interesting article in the New York Times about how we are using the telephone differently now.  For those of us in the business to business marketing industry there are several choice one liners in the article including "The telephone has a very rude propensity to interrupt people." and “I remember when I was growing up, the rule was, ‘Don’t call anyone after 10 p.m.,’ ” Mr. Adler said. “Now the rule is, ‘Don’t call anyone. Ever.’ ”

This is particularly interesting to us at CSG because a very big part of what we do is talk to our client's channel partners: on the phone.  As the article points out, people are more sensitive to the interrupting nature of the phone call, so we do this with ever increasing number of our calls scheduled in advance through other means.

Now in our 14th year of doing a majority of our business over the telephone, we have seen the predictions of the end of the telephone before.  Here are a few of them:

• The email killed the phone
• The web killed the phone
• Cell Phones killed the phone (AT&T’s service is so bad that people just stopped calling)
• Skype killed the phone (Skype is pretty cool and will continue to take over)
• Social Media killed the phone (Really? I don't buy it)

The way we use the phone is indeed changing. However, I spend more time on the phone now than ever before.  Just about all of the calls are scheduled on my calendar as meetings for a specific time and duration. In many cases the phone calls include more than one other party, and often are aided by shared online workspaces or presentations.  These calls are much more productive than the old calls, and even when all of the participants live in my city they consume much less time than in person meetings.  

There are many reasons this is happening.  Here are a few examples:

• People are more sensitive to interruptions 
• People seem less likely to meet face to face
• The conference bridge brings in multiple people
• Desktop sharing creates a rich experience

In the middle of all of this is the phone.  I guess the reports of the phone's death have been somewhat exaggerated.

Who is Hiring the Black Hats?

Ever since David Segal wrote his great piece in the NY Times last month about JC Penney’s black hat antics of SEO, I have been thinking – really?  JC Penney intentionally gaming Google!  There has got to be more to this story.  Danny Sullivan followed up with an insider’s take on it – but I still thought – where is the rest of the story?  The web lit up with all kinds of commentary including this from SearchEngineWatch, and this from SearchMarketingWisdom, who also posted this response from JC Penney with an enthusiastic corporate speak counter argument to the New York Times. 

All of this has contributed immensely to the celebrity status of Matt Cutts, the guy at Google who fights search spam and swiftly pounded JC Penney’s search results into the ground.  The story continued with this good piece on NPR’s On the Media show with Bob Garfield last week.

I think we live in a country where the good guys, the white hats, win in the end.  Who knows, if Libya’s citizens prevail, maybe we live in a world where the bad guys, the black hats, are more readily punished.  In following this saga however, I have still not encountered what I have been looking for as the rest of the story;  who is hiring the black hats?  So I am going to propose this hypothesis:  the black hats exist because the white hats hire them.  It is the laundering of bad behavior through the presumed respectability of the good guys. After all, the US military hires Blackwater (now Xe Services because their reputation got so black they had to abandon their old brand) to do it’s black hat stuff.

We see this from time in our industry.  In the marketing services business we have encountered competitors who produce false reporting – and amazingly they don’t get fired by their clients.  They don’t get fired as long as the reports continue because the good people who hired them need the “results” to keep their budget or their jobs. 

It is a competitive world out there and marketing is getting more and more focussed on measurable results.  It is not hard to imagine a good, well intentioned, marketing services firm getting desperate and going to the bad guys -- just to boost the number -- just this one time.  Then, well, you know the rest of that story.

Maybe our industry needs a black hat amnesty day.  A day that all performance expectations can be re-set so our industry can purge the black hats and get back to doing the work of the good guys.

Sarah Palin vs Tina Fey for President

The New York Times is all about Sarah Palin today with a good post from Frank Rich and the cover story in the Magazine both proclaiming that not only could she run for the highest office, but she could be a contender!

Given the following she has on social media, and the fact that she is getting paid millions to campaign in her TV show where most competitors have to pay for TV ads -- she does seem formidable even if her competence makes it hard to think she could win.

What to do?  Let's get Tina Fey to run against her!  Tina has all of the same assets and she would probably be a better president.  Not only that, it could really confuse the electorate.  Imagine the 18% of voters that think Obama was not born in the US -- trying to remember which one was which.  The debates would be awesome.  Tina could employ spies to figure out what Sarah was going to wear, dress the same, and siphon off half of the Tea Party votes.

Next I have to figure out what country to move to should Sarah Palin actually win.  Any suggestions?

Our Standard of Living

We put a good deal of weight behind averages.  Whether it is GDP, GDP per capita, inflation rate, cost of living, or even the cost of gas -- these numbers are national averages that only tell part of the story.  There was a good opinion piece in the NY Times (from Reuters Breakingviews) yesterday about how Americans have gotten used to continual increases in living standards and how the wind has now turned against that trend.

Of course the article is citing the average living standard.  With the polarization of incomes becoming ever more dramatic, the average living standard does not tell the whole story.  Some people are doing better, the wealthiest 10 percent of households got 35% of income in 1980 and got 48% in 2008.  And the other end of the spectrum are the unemployed, now numbering 20 million.  Here is a good article on this subject in Businessweek if you want to read more.

The rising tide is not raising all of the ships.  Those in the knowledge economy that can compete on the world market will do well.  Anyone that wants to earn 10 times what someone offshore earns -- had better figure out how to contribute 10 times as much.

More Fuel for the Cloud

In the last 24 hours I have come across three stories in the media that give the cloud movement even more reason to be gaining momentum.  If you are following the cloud acceptance / cloud vs desktop story, you may want to check them out.

NPR On the Media - Laptop Searches at the Border:  The segment is towards the end, but the rest of the show is also worth listening to.  The story highlights the work of the ACLU in pursuit of the US Government for overly aggressive search and seizure of laptops at the borer.  This is a very good reason to use cloud services and not keep any data on your laptop.  I suspect the government is tracking activities on the cloud as well, so if you are up to no good -- you are probably no better off there.  But if you are a law abiding citizen worried about getting caught in the government's web -- the cloud is probably safer.

NY Times:  Microsoft + Russian Government against activists:  Unfortunately for Microsoft there is a very disturbing story on the front page of the NY Times today about how the Russian government is using Microsoft piracy claims to seize computers of people they don't like.  I suspect that if the Russian government wants to take your computer -- they are going to take your computer.  So again, the cloud would be a good place to put your data.  And for Microsoft -- any type of collaboration with the Russian government is likely to end badly (ouch!).

Dell Gets Blasted by the Haggler:  Again in today's NY Times the typical tale of woe.  Hard drive fails, sent back to Dell, lost again, lost again, in a Sisyphean tragedy we all know too well.  Same remedy, keep your data in the cloud and access it with multiple machines or devices or even someone else's machine.  Then you can still get your work done even while *insert vendor name here* is doing whatever they can to make your life miserable.

Maybe there is something to this cloud computing thing.

Re-Entering Civiliziation

I have been out on vacation for the last couple of weeks and to my surprise was able to just about disconnect from the news stream.  Today I am reconnecting through one of my favorite activities -- reading the Sunday NY Times.  This has sparked a string of maybe a dozen blog post ideas, some of which I will just rip out here and then come back and dig into deeper in the days ahead.

What is China Going to do in Afghanistan?

China is not even in Afghanistan!  Well, the British were there a hundred years ago, and it contributed to their fall from world leadership, the Russians were there in the '80s and it drained their coffers, and we are getting humbled there now as detailed in the Wikileaks story of last week.  So could it be that China's rising star will land there next?

Waste and Corruption are the Same Thing

Following this thought, if we were to assess corruption by a the single measurement of money wasted, the US would be the most corrupt country on the planet.  The big numbers of course are: $1T on military spending and unneeded wars, $1T on the half of healthcare that makes our system cost twice as much as the next one on the list and without any incremental benefit, $1T of bail outs of banks and other institutions that don't reform, and $500B in trade deficits created by buying more from others than we can convince them to buy from us.   I am not sure how to parse the interest we pay on past debts, and undoubtedly there are many smaller numbers to add up.  So let's just call it $5 trillion wasted every year -- no one can top that!

The Internet as Border Town

From the NY Times piece on Mexico today: "In 1958, Orson Welles used the border as backdrop for his classic noir film “Touch of Evil.” (“This isn’t the real Mexico,” says the character Mike Vargas. “You know that. All border towns bring out the worst in a country."  

The story goes on to list all of the bad stuff you can do in Tijuana -- all of which you can get on the Internet quite easily: porn, sex, gambling, danger... maybe not drugs so much but I am sure if you looked hard enough you could.

Crowd Vindicated

A couple of days ago I posted that the most emailed article on the NY times was about dishwasher detergent -- and how that disqualified the crowd from picking the most valuable stories. Well today the pendulum swung back towards the crowd as David Brook's column hit the top of the list.

It is quite a good column by the way.  I know I am not alone thinking that our country is in a bad way, and I would argue that one of our biggest problems is that we are still a considerable distance from rock bottom.  

We are smart and creative problem solvers.  We just don't think the problem is big enough yet.