The Social Medicine Portal

Dr. Martin Donohoe: GE, NY-Presbyterian Hospital & the Hudson River Clean-up

Tuesday, March 24, 2009 brought Dr. Martin Donohoe to Social Medicine Rounds at Montefiore.  Dr. Donohoe, a Portland internist, is an Adjunct Associate Professor Department of Community Health, Portland State University. He is also a prolific writer and the editor of the Public Health & Justice Website (phsj.org).  PHSJ contains a rich variety of materials on health topics such as Activism and Education, Women’s Health,  Beauty, Body Modification, Cosmetic Surgery, & Obesity and Unnecessary Testing, Scams. A previous posting on the Social Medicine Portal discussed his critique of the diamond, gold, and flowers industry (See Alternative Valentine’s Day: No gold, No diamonds, No flowers?)

Tuesday’s talk examined “Corporate Control of Public Health: Case Studies and Call to Action.”  Dr. Donohoe has made the slides available on PHSJ.  In this posting we wanted to discuss one of his cases studies: Bringing Bad Things to Life:  The Alliance between GE Medical Systems and New York Presbyterian Hospital.  This case study is available as a slideshow on the PHSJ website or as an article published in the journal Synthesis/Regeneration.  (A slightly longer version of the article is also posted on PHSJ.org)

The Agreement

On September 8 , 2003, General Electric and New York-Presbyterian Hospital announced “a historic multi-year, several hundred million dollar partnership” between GE Medical Systems and the hospital.  As per the GE press release:

An integral aspect of the engagement will have NewYork-Presbyterian Hospital adopting GE’s acclaimed management development and performance improvement methods. This will help build upon NewYork-Presbyterian Hospital’s strong leadership team and employee base to deliver superior patient care well into the future. NewYork-Presbyterian Hospital will implement leading edge tools for improving management, service quality and operational effectiveness. Employees will be trained in GE’s quality and process improvement programs. This balanced approach is comprised of Six Sigma statistical methodologies, change-management strategies (Change Acceleration Process) and team-based problem solving techniques (Work-Out™).

The GE/NYP deal raised concerns about the corporatization of medicine that were voiced in 2004 in the New England Journal of Medicine by Dr. A. M. Garber (Business and Medicine: Corporate Treatment for the Ills of Academic Medicine).  Garber noted the agreement – said to last ten years and involve $500 million dollars – offered a series of discounts and financing for  GE products that would create an effective lock-in for GE medical equipment.   While noting potentially positive aspects of this relationship, Gerber questioned the wisdom of such a lock-in.  He also noted the potential conflicts of interest arising from  GE’s dual role as management consultant and provider of equipment.  Finally Dr. Garber raised concerns about the multiple ways in which corporate consultants might deal with economic pressures facing hospitals.  He painted an elegant picture of the ways in which corporate thinking can undermine the social mission of the hospital:

But any consultant could also help a hospital’s financial performance by pursuing strategies that do not benefit the public. Many academic hospitals could improve their bottom lines by cutting the amount of uncompensated care they provide and eliminating unprofitable services. They might also promote excessive use of high-margin services. For example, to the extent that physicians induce demand, any hospital that owns a scanner — and any physician who earns fees by interpreting scans — can raise revenues by performing scans for less critical or even dubious indications. Similarly, well-reported phenomena such as “DRG creep,” “upcoding,” and “unbundling” can increase health care expenditures without benefiting patients. Such practices may seem innocuous from the individual patient’s point of view, if they merely raise health expenditures generally. But a physician or hospital that takes advantage of reimbursement anomalies can also jeopardize patients’ health. Physicians and hospitals can be reimbursed more if a candidate for the placement of multiple coronary stents has the procedure divided among two or more hospital admissions than if they are placed as part of a single complex procedure. Is it plausible that clinical needs alone explain why so many patients have stents placed as part of multiple admissions?

Concerns about the deal were also raised in an article in the New York Times entitled:  The Conglomerate Will See You Now; Is What’s Good for G.E. Good for Health Care? which asked:

IMAGINE a small town where one person not only owns the hardware store, but is also the banker and the doctor’s most trusted adviser. In a sense, General Electric is trying to play such a role in the nation’s $2 trillion health care industry.

The New York Times article discussed the possibility that the agreement would foster the use of expensive technology, a major factor in rising health care costs. As noted by Gerber above, expensive diagnostic machines often generate their own demand.

New York Presyterian’s Dr. Herbert Pardes responded to the Garber article in a two paragraph Letter to the Editor (published in February 2005). Pardes stated:  “Our collaboration with GE Medical Systems is based on having access to business skills and cutting-edge equipment that, in our judgment, will benefit our patients and increase our ability to provide cost-effective, high-quality care. We purchase from GE only technology that the hospital deems to be in the best interest of its patients. We will never delegate to a third party any decisions regarding our patients and the manner or method of our delivery of health care.”

Swimming with Sharks

Dr. Pardes’ reassurances ring far less convincing when we know a bit more about General Electric; this is the main topic of Dr. Donohoe’s article.  General Electric is the world’s largest company by market share. In 2007 it had revenues of $168 billion and profits of $21 billion. For a bit of perspective GE’s revenues are larger than the GDP of over 2/3 of the UN member states. The corporation is built upon a diverse set of products and services including media (NBC, Universal Studios, Telemundo), consumer appliances, power, aircraft engines, insurance, transportation, business systems, and medical services/equipment (see the Columbia Journalism Review website).  Through GE Power, the company is a major force in nuclear power.

General Electric does not have a stellar history as a corporate citizen.  GE’s history of corporate malfesance is discussed Dr. Donohoe’s article and also in a 2001 article in The Multinational Monitor entitled “GE: Decades of Misdeeds and Wrongdoing.”

Rather than review this history in detail, we will focus on one of these misdeeds that is particularly close to our home: the pollution of the Hudson River with 1.3 million pounds of polychlorinated biphenyls (PCBs). These PCB’s were released between 1947 and 1977 from two of GE  capacitor manufacturing plants and became a major focus of organizing along the river (discussed in a slideshow from Clearwater and a series of FAQ from Riverkeeper).  Thanks to GE, two hundred miles of the Hudson River are now the EPA’ largest Superfund site (see http://www.epa.gov/hudson/).  Of note this is just of of several GE superfund sites.

PCB’s are good neither for the environment, nor for health.  The EPA states: “PCBs are considered probable human carcinogens and are linked to other adverse health effects such as low birth weight, thyroid disease, and learning, memory, and immune system disorders.“  General Electric has devoted tremendous resources into evading responsibility for the cleanup (see Richard Pollock’s Is GE Mightier Than the Hudson?)  For GI’s side of this story, see their website.

Crade to Grave Care?

Dr. Donohoe closes his article on GE with the following reflection:

It is abhorrent to imagine GE profiting from New York-Presbyterian Hospital requiring that a patient’s developmental anomaly or environmentally-induced cancer (a result of exposure to GE toxins) be diagnosed by a GE scanner and treated with GE-manufactured therapeutic devices. This is a macabre twist on the concept of cradle-to-grave health care.

The question then is whether we should be looking to or partnering with corporations like GE for models on how to run health care.

Posted by Matt Anderson, MD