Normally, the sorts of people who are responsible for health policy for the US government are not the most flamboyant in the world. Government advisers and officials show up on the Health Care Renewal, an equal-opportunity offender, usually because of conflicts of interest issues, particularly the revolving door. But left unsaid is that even those we criticize are usually well-informed, capable and sane.
We live, however, in interesting times. Over the past few days, a number of stories about advisers for the Trump transition have appeared that go beyond the usual. I will present them in approximate order of outre-ness, low too high.
Rick Scott, Governor of Florida, Health Care Adviser, Presided Over $1.7 HCA Fraud, Guilty Plea by Company
Gov Scott was one of then Mr Trump's early fans (see Miami Herald, March 16, 2016). On Jan 7, the Miami NBC affiliate announced Gov Scott would advise Mr Trump:
Florida Governor Rick Scott told NBC2 exclusively he will have a hand in the health care reform process with the new Health and Human Services Director to improve Florida’s healthcare.
Scott, who once once rumored to be a potential pick for Health and Human Services Director in the Donald Trump administration, said he’s working with Dr. Tom Price.
'I’m going to work with Congressman Price, who is going to be the Health and Human Services Secretary to come up with a plan that is one, going to improve our Medicaid program in our state,' the governor said. 'We’ll have more flexibility.'
Scott, a former health care CEO, said reforming the ACA is personal.
Gov Scott was a former health care CEO, to be sure. However, the brief news item omitted that his experience ended badly.
As we discussed most recently in a 2011 post, Mr Scott was once the CEO of what was then called Columbia/ HCA, a for-profit hospital system. While he was CEO, the company took actions that later resulted in the largest health care fraud case in history. As described by the Department of Justice in 2003:
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today.Just to underline: the company pleaded guilty to criminal charges. The allegations included fraud and kickbacks to physicians. Mr Scott was in charge of the company.
This settlement marks the conclusion of the most comprehensive health care fraud investigation ever undertaken by the Justice Department, working with the Departments of Health and Human Services and Defense, the Office of Personnel Management and the states. The settlement announced today resolves HCA's civil liability for false claims resulting from a variety of allegedly unlawful practices, including cost report fraud and the payment of kickbacks to physicians.
Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation.
We reviewed these events in 2010, when Scott was running for Governor. Scott was not criminally charged at the time (but recall that in the last 10 years, almost all top managers of large health care organizations in the US have demonstrated impunity.) Surely, as CEO, he should have been held accountable for its actions. He was not, however, and now, after once presiding over the largest health care fraud in history (at the time), will be advising the Trump administration on health care reform. While his record as HCA manager was surely tainted, his big qualification for this advisory position seemed to be his early political support of Trump.
Katy Talento, member of the Whitehouse Domestic Policy Council, Evidence Denier
Per the TalkingPointsMemo, January 5,
Katy Talento, who will serve on Trump's Domestic Policy Council working on healthcare policy is 'an infectious disease epidemiologist with nearly 20 years of experience in public health and health policy, as well as government oversight and investigations and program evaluation,' according to the announcement by the Trump transition team. She has served the Trump campaign since July 2016 and has spent 12 years working in the Senate.
Ms Talento was known for her less than evidence-based advocacy against birth control.
Talento's advocacy against birth control was first surfaced when she has hired as a legislative director for Sen. Thom Tillis (R-SC). In an article she published at The Federalist in January 2015, Talento preached about the risks of birth control, some of which are founded in facts, like the risk of cardiovascular problems. But she also made bogus claims, including that birth control pills may cause miscarriages.
'Preventing a fertilized egg (i.e. after conception) from hunkering down in the wall of the uterus, where it can grow normally,' she wrote. 'Progestin in birth control thins the endometrial lining (uterine wall), but a fertilized egg needs a thick, fluffy, blood-rich uterine wall to attach to and begin growth. Without it, the embryo can’t survive, and a miscarriage occurs.'
What she wrote seems to be a description about how birth control works to prevent conception, but does not explain how previous use of birth control could cause future miscarriages, let alone prove that it does. The TPM article also noted,
There is no link between miscarriages and taking birth control pills before a pregnancy, according to The American College of Obstetrics and Gynecology.
Talento also claimed in the article that birth control may limit a person's ability to have children in the future.
'Let’s say your life stage changes and you’re ready to try to have a baby," she wrote. 'You go off the Pill or the intrauterine device or whatever you’re taking. It takes a few months for the effects of the birth control to wear off and then you’re good to go, right? Wrong.'
Talento cited one study from 2012, but most other studies and experts have found no link between taking birth control and getting pregnant once going off the pill.
Note that the first article cited above was about the effect of long-term birth control on endometrial thickness. While endometrial thickness might predict future fertility, the article did not provide evidence that birth control could cause infertility.
So this Trump health care policy adviser was known for advocating clinical/ policy positions that were hardly evidence-based, although were perhaps justified in her mind by ideology or religious beliefs.
Charles "Chuck" Johnson, Adviser on Appointments, Including for FDA Commissioner, Deceptive Internet Troll
A Forbes columnist wrote on Jan 9,
Charles 'Chuck' Johnson, a controversial blogger and conservative online personality, has been pushing for various political appointees to serve under Donald Trump, according to multiple sources close to the President-elect’s transition team. While Johnson does not have a formal position, FORBES has learned that he is working behind the scenes with members of the transition team’s executive committee, including billionaire Trump donor Peter Thiel, to recommend, vet and give something of a seal of approval to potential nominees....
Beyond recommending candidates, Johnson has also helped set up meetings between potential appointees and transition team members. He has worked with Jim O’Neill, who is being considered to head the Food and Drug Administration and is currently employed by Thiel at San Francisco-based investment firm Mithril Capital. Johnson has tried to arrange for O’Neill to meet with conservative influencers and political groups in an effort to build support for his potential FDA nomination. O’Neill declined to comment.
Recall that we discussed Mr O'Neill's apparent candidacy for leadership of the FDA. Mr O'Neill has no clinical, other direct health care or public health experience, no background in biomedical, health care or public health research, and no background in health care policy. He currently runs a hedge fund, which owned a medical device company, thus creating conflicts of interest for Mr O'Neill should he become FDA Commissioner.
Furthermore, Mr Johnson's qualifications to give advice about executive branch appointments, particularly health care appointments are singular, to say the least. The Forbes article summarized his background,
An internet troll, who was once called 'the most hated man on the internet' and is banned from Twitter....
Furthermore, it called him
a self-described 'journalist, author and debunker of frauds,' who has made a name for himself by peddling false information and right-wing conspiracy theories online. In the months leading up to the election, Johnson, 28, used social media and his website GotNews.com to stump for the President-elect while also publishing misinformation on Trump’s detractors.
While Twitter banned Johnson in May 2015 after threatening a Black Lives Matters activist, he made a name for himself as an internet troll, or an online personality who antagonizes others by posting inflammatory or misleading information. Among his exploits, Johnson has published the home addresses of New York Times reporters, wrongly identified a woman he thought was the source of Rolling Stone’s now-retracted story of an alleged rape at the University of Virginia and claimed that President Barack Obama is gay.
In addition, in 2014, MotherJones did a profile on him, characterizing him as a:
26-year-old provocateur, who is impatient with journalistic ethics and possessed with an insatiable appetite for personal destruction. He is a subject of mockery on the left and the right due to his blustery self-promotion ('I'm making a list, checking it twice, gonna find out who is naughty…'), baseless speculation (he thinks Barack Obama may be secretly gay), and regular face plants. Last week, he mistakenly claimed to have found a photo of Jackie at an anti-rape rally; it was someone else. Still, he defended his 'batting average.' (The woman in the photo says she will sue Johnson.) But he is adept at digging up dirt on public and private figures, and even when he's at his most egregious, he's hard to ignore.
His other recent antics have included suing for access to Mike Brown's juvenile records, making the unproven claim that the Ferguson police shooting victim had once been charged in a second-degree murder. Citing police sources, he accused 'street thug' Eric Garner, the Staten Island man who died after being put in a chokehold by a New York City police officer, of domestic abuse. He incorrectly reported that New Jersey had an Ebola case; he then reported that a nurse quarantined in the state was a 'left-wing Democrat.' He hijacked the Mississippi Republican primary by offering $1,000 for photos of Sen. Thad Cochran's wife, who was in a nursing home. And he's trained his sights on other journalists, such as Wesley Lowery of the Washington Post, whom Johnson said was 'obsessed with race' and had shown 'overt friendliness in his reporting about Michael Brown.' Johnson revealed that Lowery had once received a speeding ticket. 'We are going to use auctions to set the price on the head of each journalist we take down,' he tweeted.
Needless to say, it appears that Mr Johnson has absolutely no knowledge or experience in health care, public health, health policy, or biomedical research, which may partially explain his advocacy of someone only marginally more knowledgeable for leader of the FDA. On the other hand, he did seem to have the qualification of having "published misinformation on Trump's detractors."
People who work in high leadership of advisory positions in government in the health care sphere traditionally have been people who are at least well-informed and knoweldgeable about health care. Yet here are three examples of people who are influential on health care policy during the Trump transition who seem to have been selected more for political loyalty than knowledge about health care. Only one had any experience in related science (but she appears to reject scientific evidence in favor of ideology or religious dogma). One did manage a health care organization, but one that pleaded guilty to crimes, and settled allegations of fraud and kickbacks. One has had no conceivable relationship to health care, but seems to have a talent for deception on the internet. And all three appear to be early Trump political supporters.
One would hope that a government of the people, by the people, for the people would put the people's care and the public health ahead of personal political loyalty. Yet at least based on this limited example, when choosing people to lead and inform health care policy, the incoming administration seems to put loyalty to the new fearless leader ahead of any knowledge about health care, and maybe ahead of honesty and ethics.
True health care reform requires well-informed leaders who uphold health care professionals' values, put patient's and the public's health ahead of all other considerations, avoid self-interest and conflicts of interest, are honest and ethical, and surely are not corrupt. They need to work in the context of a government that is of, by and for the people, not of, by and for a demagogic leader.
Good luck to us. We appear to be with the Bozos on a bus going off a cliff.
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