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Health Care Revolving Door Roundup

Increasingly, the regulatory and law enforcement functions of the US government in the health care sphere seem to be blending with the management of large health care organizations.  One mechanism for this is the "revolving door," the constant interchange of personnel between government agencies and corporate management. 


Here is a list of some of this year's interesting cases of people transiting the revolving door between US government agencies that are supposed to regulate health care organizations or enforce the relevant laws and the organizations subject to these regulations and laws.   Note that this list may not be complete.  It is difficult to keep track of these transitions. 

Leader of Health Care Fraud Section of Philadelphia US Attorney's Office to Teva Pharmaceuticals

Via MainJustice.org in March, 2013,

John Pease, who led the government and health care fraud section in the U.S. Attorney's Office in Philadelphia, has left the Justice Department for a job with a pharmaceutical company.

Pease, 45, is a new senior counsel at Teva Pharmaceuticals, where he oversees government investigations of the company for the Americas.  'I was just ready to try something different,' Pease said in an interview.

 Leader of US Department of Justice Fraud Section in Charge of Health Care Issues to Law Firm as Defender of Companies and Senior Executives

The initial notice again was via MainJustice.org in March, 2013

Sam Sheldon, the deputy chief in the Criminal Division's Fraud Section who oversaw health care fraud prosecutions, is leaving the Justice Department to join Quinn Emanuel Urquhart & Sullivan LLP.

Mr Sheldon's new job was made clear on the firm's website,

Sam Sheldon is head of the firm’s Health Care Practice Group.  He is a trial lawyer who represents companies and senior executives in litigation before the United States federal government including Department of Justice and Department of Health and Human Services, and other law enforcement and regulatory agencies.

FDA Deputy Commissioner for Global Regulatory Operations and Policy to Mylan

This story, in April, actually made it (briefly) to Reuters,

 Generic drugmaker Mylan Inc said on Tuesday it hired Deborah Autor, deputy commissioner for global regulatory operations and policy at the U.S. Food and Drug Administration, to help oversee its global regulatory strategy.

Leader of Health Care Fraud Enforcement of Philadelphia US Attorney's Office to Law Firm as Industry Defender

From Bloomberg, in August, 2013,

Marilyn May, a False Claims Act litigator at the U.S. Justice Department, joined Arnold & Porter LLP’s Washington office as litigation counsel with a focus on healthcare, pharmaceutical and medical device industry defense work. 

May was the head of healthcare fraud enforcement in the U.S. Attorney’s Office in the Eastern District of Pennsylvania. She coordinated healthcare fraud cases and investigations as well as handled False Claims Act cases involving pharmaceutical and medical device companies, hospitals, nursing homes and other healthcare providers, the firm said. 

The law firm's website states,

 Her litigation practice focuses on pharmaceutical, medical device and healthcare defense matters.

Summary

In each of these cases, a person with responsibility for regulation of and/or law enforcement for health care organizations went through the revolving door to either work for health care corporations subject to such regulation and/or law enforcement, or work for legal firms that specialize in defending such corporations and their leaders in regulatory and law enforcement actions.

As far as I know, none of these instances was the least bit illegal.  However, like previous examples of the revolving door, they raise the concern that people in government regulation or law enforcement who think that they may have future lucrative job prospects helping health care organizations attenuate regulation and law enforcement may not be the most enthusiastic, aggressive, or persistent regulators or law enforcers.  Why would one want to upset one's future employer?

While these cases of the revolving door are legal, they are clearly conflicts of interest in the sense that the prospect of such future employment likely may increase the risk of compromising a government official's devotion to serving the public and enforcing the law, if not in the legal sense.  In some particular case, the revolving door may actually lead to corruption according to the Transparency International definition, abuse of entrusted power for private gain, if not according to the legal definition.  Thus the continuing occurrence of government officials blithely transiting the revolving door no doubt was a reason that more than 40% of the public consider the US health care sector to be corrupt (see this post.)

True health care reform would require curtailing the severe sorts of conflicts of interest created by the revolving door.  This might require both improving pay and working conditions for government regulators and law enforcers, and specific laws to prevent immediate transitions from being a regulator/ law enforcer to handling corporate responses to or defenses of such regulation and enforcement.

Of course, I can already hear the protests of those people who decry paying more for government or increasing government regulation.  I can at least hope that the protests are not from those who personally profit from the current seemingly corrupt system.  

3 HABITS FOR HEALTHY FAMILIES

WELLNESS WEDNESDAYS

“It is extraordinarily difficult to fight the headwinds of our society that has promoted obesity in our children.  We have a lot to do to truly tackle this epidemic.”  

                                   --Lawrence J. Cheskin, M.D., F.A.C.P.

Here are some questions to ask yourself:  Where do I buy food?  How much of my weekly food expenses are spent on vegetables, fruits, and whole grains?  How much am I spending on prepared foods that come in boxes?  Is my child getting a healthy meal at school?  How many hours of “screen time” is my child having on average every day?  How often do my child and I exercise together?

We’ve all heard this phrase:  “It takes a village to raise a child.”  I like to say, “It takes an educated village to raise a healthy child.”  Children deserve access to foods that will help them maintain healthy weights.  Children deserve to be surrounded by informed adults who will provide guidance and love to help shape children and youth into healthy and happy adults. 

Improving health literacy of adults is a big part of what we are doing in the Growing Healthy Kids movement to reduce, halt, and prevent childhood obesity.  As Dr. Cheskin said, we have a lot to do to tackle the childhood obesity epidemic in light of all the added sugar, fats, and salts found in packaged foods and the pharmaceutical industry looking to profit from overweight and obese adults and kids who develop high blood pressure, high cholesterol, and diabetes as a result. Here are three habits which can position your family for better health:

HABIT ONE.  Keep a log for 3 days of how much time your child – and you - are spending on “screen time” a day.   Include TV time, computer time, and texting time.  Use the logs to determine if your child is spending too much time watching TV and playing computer games and not enough time outside playing.  How much screen time is too much for children?  Current recommendations from American Academy of Pediatrics are to limit screen time to no more than 1 to 2 hours of quality programming a day. By comparison, a 1999 study found that children spent an average of 6 hours and 32 minutes a day in front of a screen. Click here to read the full statement from American Academy of Pediatrics.

HABIT TWO.  Rate your plate.  Half of your dinner plate should be veggies.  To be able to have fresh vegetables every week, find out what is in season and what your local farmers are growing.  Veggies at the height of their growing season can be bought for the best price.  Click here to find a local farmer near you.

HABIT THREE.  Cut your sugar consumption in half.  Sugar contains what we call “empty calories” – calories with no nutritional value.  Start with sodas and fruit juice.  At the Growing Healthy Kids program, we teach kids two rules:  “Drink water not soda” and “Eat fresh fruit.”  Soda is loaded with sugar.  Become a nutrition detective:  divide the grams of sugar per serving by 4.  The result is the number of teaspoons of sugar one serving contains.  A typical carton of flavored milk served in public schools contains about 7 added teaspoons of sugar.  Start the new school year off right and find out what your kids will be drinking at school by scheduling to have lunch with them at least once a month. 

Kids love to grate the zucchini and carrots!

Zucchini patties with fresh cilatro

As promised to our readers several weeks ago, here is the debut of our newest addition to the Growing Healthy Kids Recipe Collection, featuring zucchini, a great vegetable that is abundant this time of year and easy on the family food budget. These store well for a day or two and make a great healthy lunchbox item!

GROWING HEALTHY KIDS:  Our Recipe Collection

Zucchini Patties

IN A MEDIUM BOWL, place:

• ·  2 cups grated zucchini (about 1 large or 2 medium)
• ·  ½ cup onion, shredded
• ·  1 small carrot, grated finely
• ·  1/2 cup potato flour (I like Bob's Red Mill brand)
• ·  1 teaspoon baking powder
• ·  ½ teaspoon sea salt
• ·  ½ teaspoon pepper
• ·  1 teaspoon Italian seasoning (optional)
• ·  1/3 cup Braggs Nutritional Yeast (or substitute grated Parmesan cheese) (optional)

IN ANOTHER BOWL, whip until they “hold a peak”:

• ·  2 egg whites

FOLD egg whites into zucchini mixture and gently mix well. 

Add a little more flour if mixture is too wet.

MIX in a shallow plate or small bowl:

• ·  1 cup panko bread crumbs
• ·  2 Tablespoons smoked paprika

USING a measuring cup (1/4 cup), scoop batter and roll into balls.  Roll lightly in panko and flatten to about ½ inch.  

Fry on griddle, using spray oil.  Patties should be about 3” in diameter. 

  

COOK for about 5 minutes, then flip and cook about 3 more 

minutes.

SERVE with a spoon of fat-free sour cream, salsa, and 

chopped cilantro or flat leaf parsley.  

Hope you enjoy putting these 3 habits to work for your family’s health.  Enjoy the remaining few days and weeks of summer vacation before the kids return to school!  

In gratitude,

Nancy Heinrich

Founder, Growing Healthy Kids, Inc.

Daily Blog #45: Understanding the artifacts: User Assist

Hello Reader,
              Turns out Gmail is very complicated so I need more time to parse through the javascript and css to find the right code that is rendering the array of emails to view-able text. If you've already done this feel free to leave me a note in the comments below or via email dcowen@g-cpartners.com. So to buy myself some time I am going to fill in with a blog series I plan to interject through the year called 'Understanding the artifacts'.

If you remember from the the milestone series I talked about the importance of understanding now only what an artifact means but why its created, in these posts I will go into detail on what I understand the original intent of these data structures are. If you understand why a developer create an artifact that you rely on you can better predict not only what data should be stored in it but what other artifacts may exist.

This post will focus on the 'User Assist' artifact. There are alot of good posts that explain how to interpret the User Assist registry keys, such as http://windowsir.blogspot.com/2007/09/more-on-userassist-keys.html. http://www.4n6k.com/2013/05/userassist-forensics-timelines.html,  http://sploited.blogspot.com/2012/12/sans-forensshic-artifact-6-userassist.html,  http://forensicsfromthesausagefactory.blogspot.com/2010/05/prefetch-and-user-assist.html and http://forensicartifacts.com/2010/07/userassist/ are just a few examples of the dearth of information available on what it contains, how to parse it and how to interpret it. What most posts fail to address is why is it there at all?

Most times when someone first gets introduced to digital forensics their first thought is 'my computer is spying on me!'. This may seem to be true but the facts are much more simple, the developers who created the operating system and applications you rely on want to give you the best experience possible. In trying to create a good experience they want to make it easy for you to access the documents and programs you use the most.

The User Assist key was created to fulfill one purpose, to populate the start menu list of recently executed programs so you can quickly load them again. This is why it tracks the last time of execution, the full path to the executable and the amount of times the program has been executed. All so when you click on the start button a dynamically sorted list can show the approximately 15 (excluding the possibility the user pinned an application) programs that the user executes most frequently.

In order to be more efficient the developer decided not to limit the amount of entries that could be stored in the User Assist key as you don't want false statistics if a program drops off for a couple months and then gets frequent usage again. For instance the user went on vacation and started playing games daily and not executed Microsoft Word when the user goes back to work the start menu would only display games and not his work tools if the developer limited the number of entries rather than just storing all of them and shorting by number of executions and time of last execution.

This is also why there are two sets of registry keys for User Assist one for program execution and the other for shortcut execution as they are displayed at different points to the user.

Joachim Metz points out there can be more than two though:

" There can be more than 2. I've seen at least 3 different UserAssist subkeys on XP and Vista, and about 8 different ones on Win 8."

Each separate subkey should be divided by purpose, it will be interesting to see for Windows 8 what they are.

So what can we learn from this?

1. We can debunk the idea that something is 'spying' on the user
2. We can explain to clear terms why an artifact is created to a judge and jury
3. We can explain that these artifacts exist by default and have to exist unless disabled and the functionality disabling it removes
4. We can predict what data should be contained within it

I'll see if I can get my code review done this evening and continue the Web 2.0 forensics series tomorrow.

Robb Wolf: On Fruit

Fruity? 

Notice that I did not mention fruit. Most folks are battling some kind of metabolic derangement, aka obesity, diabetes, fertility issues, depression, etc. This with a mixed bag of autoimmunity and systemic inflammation. Until you are lean and healthy, you don’t get much fruit. There is no nutrient in fruit that is not available in veggies, and fruit may have too many carbs for you. When we start talking about what constitutes “health,” we will see where on that spectrum you are. For now, just keep things simple and you will reap the greatest rewards.  

~ Robb Wolf, p. 214 The Paleo Solution

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