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Digital health records would be a great thing for the U.S. healthcare system, should doctors and hospitals ever adopt them widely. (Among other things, they’d likely cut down on medical errors and improve the quality of medical care.) Yet only about 10 percent of smaller physicians’ offices use them, because the upfront costs of implementing an electronic-records system are so daunting — and because the doctors themselves won’t tend to reap benefits from the investment for years, if not longer.

So it’s encouraging to see the federal Medicare program stepping up with a pilot program to offer higher reimbursements to doctors who go paperless in their record-keeping. The program will pay doctors extra when they order prescriptions or submit lab tests online, with the highest payments going to the most aggressive users of the technology.

New digital-record systems can cost $20,000 to $40,000 to implement, but the cost savings of such systems tend to flow to insurers and hospitals, not to physicians themselves. The new Medicare program, which will involve about 1,200 doctors, could boost reimbursements to these doctors by several thousands of dollars a year. Those funds, Medicare insists, will be recouped through improved care and greater prevention of chronic conditions.

Whether or not that’s true — and I suspect such savings will only materialize over the long term — it’s great to see Medicare tacking the financial disincentives associated with electronic-record adoption head-on. Now, if they can just expand this program as quickly as possible — and perhaps offer some standards guidance along the way, to ensure we don’t create an electronic Babel of incompatible systems — then maybe we’ll finally be getting somewhere.

(UPDATED: See below.)

No sooner does the NYT run a significant piece on health-info efforts at Google and Microsoft than someone decides to leak the “preview” of the site to Google Blogoscoped. (Site author Philipp Lenssen confirms that it wasn’t an authorized disclosure.)

Based on the ten screenshots available at Lenssen’s site, this preliminary version of Google Health is indeed laser-beam focused on creating a personal electronic health record — a digital version of the paper files your doctor probably keeps in one of those vertical filing cabinets. Given the unlikelihood that users will be able to simply upload their information from their doctor — as I seem to be repeating a lot these days, fully three-quarters of U.S. doctors still keep medical records on paper — the initial emphasis is on getting users to enter as much of their personal information as they feel comfortable providing.

To that end, the early version of Google Health offers the standard spare-but-clean Google interface. As you can see from this screenshot, the section is divided into “Profile” and “Medical Contacts” tabs. “Profile” is where you’d enter your medical details — everything from straightforward descriptive details (age, sex, height) to immunizations to current medications, surgeries, and family history. Presumably Google will refine some of these options over time — this screenshot (duplicated below) of the “Conditions and Symptoms” tab, for instance, offers choices such as “head and neck angioedema” and “head and neck carcinoma,” which ordinary people aren’t likely to understand unless they already have these conditions. (Angioedema is a fluid-based swelling of the skin and mucus membranes, while a carcinoma is a type of cancer.)

One of the cooler features hinted at in this preview is a customized “health guide” the site will put together once you’ve entered enough information. As the site text reads, “When you add some information to your profile, Google Health will search trusted medical sources and create a health guide targeted for you.” In other words, Google plans to offer some preliminary diagnoses for users who trust it with their medical details. This part of the site is currently built in collaboration with SafeMed, an automated-diagnosis startup that we covered briefly here. It will be interesting to see how medical authorities react to this sort of automated, personalized diagnosis, as it might skirt fairly close to the actual practice of medicine in some states. The preview site does urge users to “[b]e sure to discuss questions about your medical care with your doctor or medical provider before making changes.”

The remainder of the preview site is fairly straightforward so far as health information goes. The “Medical Contacts” page turns out to be a blank box that offers the option of searching the “Google Doctor Directory” to add your current physician or physicians. There’s no sign as to whether that directory actually exists or not, or whether it will be compiled with human oversight or automatically assembled in the fashion of other Google directories.

Overall, it seems a solid but unremarkable effort, one that probably wouldn’t even merit much attention were it not from Google. Of course, that makes all the difference, since a groundswell of patients who want their doctors to use Google medical records might actually encourage more doctors to adopt electronic systems.

In the meantime, for comparison, you might check out some other early efforts to do something similar, such as the OpenHealthRecord or the more sophisticated but less user-friendly HealthCapture PHR.

UPDATE: Tom Salemi of the In Vivo Blog has an even more dyspeptic take on both the NYT story and the Google Health preview — not to mention a decent joke based on one of my favorite bands — here.

UPDATE REDUX: Another underwhelming review is up at MedGadget, while at Over My Med Body!, Graham Walker — a third-year Stanford med student — rails that “Patients should not control their medical record,” and then explains why. The comments to Walker’s post further expand on the issue of just how good an idea it is to let people enter their own medical information, and whether that should complement doctor-provided information or even override it if the patient so chooses.

(UPDATED: See below.)

Venture capitalists are throwing scads of money at online health-information startups, figuring that at least one of them might eventually emerge a powerhouse in community-building, health-related search, electronic medical records, or even some combination of the three. Today, the NYT’s Steve Lohr weighs in to argue that the biggest battles in this space might just involve the two familiar names Google and Microsoft.

Of all these opportunities, electronic health records probably have the greatest potential to transform and improve U.S. healthcare, although they’ve so far made little headway in our fragmented medical system. Lohr covered that issue far more thoroughly in this June piece. Here, his Google-Microsoft story is kind of heavy on atmospherics and light on detail, and devotes lots of space high up to the looming clash between online titans, consumer fears about trusting big companies with their health records, and the opportunity created by the slowness of doctors and healthcare providers to adopt electronic records themselves.

When the story does get down to details, however, they’re fairly interesting. Google sees creating, maintaining and providing access to electronic health records as the core of its online health strategy. A prototype of Google Health that Lohr viewed takes a consumer-oriented tack, promising people the ability to control their medical information and to give access to “health care providers, family members or whoever they choose.” Additional pages include:

a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors.

Microsoft, by contrast, seems to be taking its classic technology-first approach. Steve Shihadeh, general manager of Microsoft’s health solutions group, emphasizes the “grand scale” that will be required to handle “data storage, software and networking” necessary to implement a workable electronic-records system, and brags that Microsoft software is already present in hospitals, clinical labs and doctors’ offices and that the most popular electronic-records systems already in place were also built with Microsoft software and programming tools. It’s not clear to me if that’s a boast or a threat, actually, although it’s sure got a familiar Microsoft cadence to it.

Shihadeh adds that Microsoft is building a “broad consumer health platform” and dismisses electronic medical records as “just scratching the surface.” Microsoft’s health effort is due to be launched this fall, while Google’s has apparently been put off until next year.

It’s entirely possible that both giants may fall on their respective faces, of course. Neither has made much headway in health-specific search, an area where companies like Healthline have done well, although the NYT does note a recent Juniper report that found 58 percent of people looking for online health information started with a general search engine like Google.

More to the point, Lohr fails to even raise two important questions. The first is exactly how much control these companies envision handing consumers over their electronic health records. Could, for instance, an individual on the Microsoft service pick up her records and take them to Google? Maybe it’s passé to think of tech giants trying to “lock in” their customers with proprietary formats in this Web 2.0 age, but Microsoft’s seeming inability to stop touting its software ubiquity can’t help but make me wonder what the Redmond giant has in mind. Bear in mind also that competing health-record setups at hospitals and doctors’ offices aren’t particularly compatible with each other, either — another factor that has slowed adoption.

The second question is what, if anything, Google and Microsoft plan to encourage the healthcare system itself to adopt electronic records. Consumers, for instance, might embrace either service — or both — and yet have nowhere to take their nifty new portable records, simply because three-quarters of all doctors don’t use them. Fixing that means finding a way to overcome the financial disincentives most small medical practices face in installing and maintaining electronic-record systems, and that could tax the resources — not to mention the patiences — even of these tech titans.

UPDATE: Google Someone apparently took the occasion of the NYT piece to “preview” some elements of Google Health on the Web. See, for instance, these screenshots and related descriptions at Google Blogoscoped.

Dan Kaplan also has a post on Google’s nascent health initiative up at the main VentureBeat page, although he’s considerably more optimistic about the business opportunities here than I am. Medicine does move a lot more slowly than the tech industry, or you’d have considerably more than 25 percent of doctors’ offices wired for electronic health records already. What’s more, the expansion in healthcare’s share of GDP is almost all slated to come in the cost of treatment and compensation for healthcare workers, with relatively little slated for technology. Tech companies may yet find a way to make money from the healthcare sector, but outside a few niches, the pickings have been pretty slim so far.

House-Senate confrontation set over biogenerics – Late last month, a key group of senators reached agreement on legislative provisions that would authorize copycat versions of biotech drugs, which are typically complex proteins manufactured by genetically engineered cells (see details here and here). These provisions would finally put biotech drugs — which don’t face cut-rate competition once their key patents expire — on a par with traditional pharmaceuticals, and have been a long time in coming. They’re not perfect, but they’re about as good a compromise as we’re likely to see any time soon..

The catch is that biogenerics supporters want to attach this langauge to a reauthorization of the FDA’s user-fees act, the awkwardly named PDUFA, which has to pass by September to keep the FDA operating smoothly. The Senate’s version passed in May, whereas the House just approved its version yesterday — but didn’t include a biogenerics pathway. The senators want to add it to their version of the bill, which has to be reconciled with the House version in a conference committee. But key House members, including Energy and Commerce Chairman John Dingell, a Michigan Democrat, appear likely to object, since they haven’t had a chance to weigh in on the provision.

The upshot: Turf wars between the houses of Congress may cost us our best shot at biogenerics legislation in some time. Tying the measure to PDUFA would be one of the best ways to sidestep legislative roadblocks that opponents and their biotech/pharma backers are likely to throw up — but the window is closing rapidly. The WSJ has more here.

Digital medical records are good for your health — or are they? One of the strongest arguements for digitizing medical records is that they’ll help prevent medical errors and improve medical care. A recent review of other studies in the journal Health Services Research gave digitized records a strong vote of confidence when it found that hospitals that switched to electronic drug-ordering systems saw a 66 percent drop in medication errors. (Such mistakes apparently kill 500,000 U.S. hospital patients every year.) Similarly, a report from the Pharmaceutical Care Management Association predicts that electronic prescribing could save Medicare as much as $29 billion over the next two years while preventing two million medication errors.

As with any technology, however, electronic records are no panacea. Another study of walk-in doctor visits found no improvement in treatment quality among practices that used electronic medical records versus those that still relied on paper. The study’s conclusion: Implementing digitized records is just the first step — doctors and medical groups still need to do a lot of work to get the most out of them.

On a related note, a Senate committee recently passed legislation that would offer subsidies to convince doctors to install digital health-record systems.

RNAi is hot, hot, HOT — Once again, it’s boom times for a new drug technology, and this time the spotlight is on RNA interference — a fascinating but largely unproven method for turning off individual genes by using a short stretch of double-stranded RNA to activate ancient gene-silencing machinery inside cells.

The party really got started last year, when Merck paid $1.1 billion to acquire Sirna Therapeutics, a fledgling RNAi company that had barely managed to move a single drug into an early-stage trial. Now things have heated up even further. Last Friday, AstraZeneca struck a $400 million deal with Silence Therapeutics. Then on Tuesday, Roche stepped up to forge a $1 billion deal with Alnylam, an early pioneer in the area.

What’s worth remembering is that no matter how promising a technology like RNAi seems, putting it to practical use almost always takes far longer and costs more than people expect in the early stages. Just take a look at the roll call of other drug technologies that have undergone similar cycles of hype and disappointment — gene therapy, antisense, therapeutic vaccines. All remain promising — but none of them worked the first time out of the gate. Even monoclonal antibodies took close to two decades before anyone could make a reasonable drug with them. Maybe RNAi will be different — but I wouldn’t bet my wallet on it.

Have cancer vaccines gotten a raw deal? A paper in Clinical Cancer Research (described here) argues that regulators and companies may be too quick to dismiss clinical-trial results if they focus on tumor shrinkage rather than long-term outcomes like survival. That may well be true, as tumor shrinkage is a notoriously bad measure of whether drugs work or not, although it’s also worth noting that a reconsideration still wouldn’t have helped Dendreon’s Provenge vaccine, since its survival data was so statistically equivocal. (Separately, the SEC has now opened an informal inquiry into Dendreon’s public disclosures about Provenge this year.)

DNA transplant “transforms” microbial species – J. Craig Venter’s group at his eponymous institute takes the honors, described here in the WaPo. Next up: Transferring an entirely synthetic genome into a DNA-less microbe to create “artificial life,” something Venter says may happen within months. Similarly, here’s the NYT on the new science of “synthetic biology.” Brace yourselves.

Does “pay for performance” improve medical care? A few weeks ago, the WSJ said no, citing a Medicare experiment. Today, the NYT says yes, citing… a Medicare experiment! I’ll have more to say once my head stops hurting.

Pre-implantation genetic diagnosis may harm fertility – Or so say the authors of a Dutch study described by the WSJ here. Several researchers seem to think the results need to be verified elsewhere before abandoning the procedure, in which a single cell is extracted from an IVF embryo for genetic analysis.

Stem cells tailor their own environments — At least according to Canadian researchers, who explored the specifics of how embryonic stem cells communicate with the cells around them. The Globe and Mail has the story.

Simple enzyme short-circuits bacterial drug resistance – Basically, it prevents bacteria from swapping the genes that confer resistance to antibiotics.

High-throughput output –

• Vermont sets up a Web site comparing pharmacy drug prices (Kaiser)
• Researchers discover molecule that may promote food allergies (BBC)
• Breast-cancer risk genes may not influence survival (WSJ)
• Congressional Democrats want to know who muzzled the former surgeon general (Bloomberg)
• Scientists identify gene linked to autism (BBC)
• Robotics help stroke patients regain function (NYT)

(NOTE: This item originally incorrectly stated that J. Craig Venter’s company, Synthetic Genomics, was involved in the research that transplanted one microbe’s genome into another. In fact, it was Venter’s own research institute, the J. Craig Venter Institute.)

(UPDATED with additional information on the fundraising, venture interest in the online healthcare-info sector, and a note of caution about these new ventures.)

You can’t swing a dead cat among venture businesses these days without hitting a new online site devoted to healthcare information of one sort or another. Over the last few months, we’ve seen a parade of major announcements — many of them big on vision but vague on particulars — from the likes of Steve Case’s Revolution Health, MedBillManager, TauMed, DailyStrength, and other sites that offer some mix of searchable health information, social networking, doctor comparisons, medical-bill management or digitized health records designed for people who want to make sure that doctors of their choice have access to their medical information. (See previous coverage of the space by Matt Marshall and Dan Kaplan here, here and here.)

The latest entrant is HealthCare.com, which just announced $6.1 million in a seed funding. The company’s site is currently an “alpha” version, according to HealthCare.com Chairman Robert Monster, but it gives you a sense of what the company plans to offer. The site’s core lies in its searchable disease and drug database, which Monster says will aggregate the “best information” on health available across some 70,000 other Web sites. HealthCare.com also plans a “symptom checker” that allows users to zero in on potential diagnoses via clickable Flash animations of the human body, and individual accounts for patients and doctors, which for patients means personalized health information and management of electronic health records, insurance information, and online prescriptions. For doctors, the site plans to provide personalized Web sites, blogging tools, some form of network for doctor-to-doctor story-swapping, and “knowledge boards, forums and surveys.”

Without question, this online-healthcare stampede indicates that venture capitalists are intensely interested in the area. It’s equally clear, at least to me, that this space is already in danger of overcrowding, since it’s difficult to imagine that any of these services can succeed unless they attract a critical mass among their desired audience, whether patients, doctors, large healthcare providers or insurers (and sometimes all four).

More fundamental, however, is the question of whether these services are really addressing pressing needs. The medical social-networking promised by the likes of DailyStrength, for instance, sounds a great deal like the sort of thing patient-support groups have offered on various disease-specific Internet sites for some time. It’s not at all clear to me what patients have to gain by re-creating those communities on a single site, since cross-talk between people with very different health problems is generally pretty rare — cancer patients and people with back problems, for instance, don’t generally have much to say to one another.

There are, of course exceptions, such as various autoimmune conditions and certain related cancers. It’s also possible that advancing knowledge of the molecular basis of disease — that is, for instance, the genetic mutations that drive particular cancers or different forms of heart disease — may eventually break apart today’s disease categories in ways that an integrated community site might be better poised to exploit. All that is still some ways off, however, and in the meantime it looks like the traditional diagnostic categories are going to hold sway.

The idea of helping patients manage electronic health records, by contrast, is very attractive, but it faces a number of hurdles that most of these companies scarcely acknowledge. For instance, the NYT recently noted that fully three-quarters of all doctors aren’t using electronic health records — a number that goes up to 95 percent if you look only at offices with five or fewer doctors. One major reason: Doctors generally don’t have a financial incentive to invest in the necessary technology.

As the NYT reported:

The experience of Dr. Richard Baron, who practices with three other physicians in an office in Philadelphia, provides a glimpse into the predicament. In 2004, Dr. Baron and his colleagues made the transition from ink and paper to computers and electronic health records. They were doing what health care reformers had been advocating for years. But the arithmetic of investing in health-information technology is daunting, especially for small practices like Dr. Baron’s. His office spent $140,000 on personal computers, including tablet PCs, servers, software and installation.

The office’s annual technology costs, he said, were about $50,000, including maintenance and technical support, and he plans to upgrade the three-year-old computers at a cost of $54,000. Those costs do not include the lost productivity in the first year, when the staff was learning to use the new technology.

Dr. Baron’s office has saved money — in transcribing medical reports, for example — and his practice now handles its 6,000 patients with three fewer office employees. He described other benefits, mainly the ability to find information quickly for patients, hospitals, insurers and labs with a few keystrokes.

The technology, Dr. Baron said, has also helped make him become a more adept physician. But it has not yet paid off in dollars and cents: the savings in salaries is less than the costs entailed in computerization. “It is a high-risk venture,” he said, “and you do it at your own financial peril.”

Until those incentives change — and don’t hold your breath on that one — it’s hard to see how online services focused on electronic health records are going to have much impact.

Of course, there’s also the question of how sites like HealthCare.com plan to make money. Monster says the site aims to be the “Google of healthcare” — now, where have we heard that before? — and emphasizes that the company’s founders, Matias de Tezanos and Jose Vargas, are executives with “deep experience in digital media.” (See their bios here; interestingly enough, neither seems to have any background in healthcare.) Monster, who peppers his spiel about the company with Web 2.0 buzzwords, says the site will “add value to the integrated agenda for enabling patient-centered healthcare,” whatever that means, and adds that HealthCare.com will take a “global approach” as opposed to the supposedly U.S.-centric efforts of its competitors. Stay tuned for how all that plays out.

HealthCare.com, which has offices in Miami and Bellevue, Wash., raised $1.2 million from Robert Monster’s new venture firm, Monster Venture Partners. The company’s founders and two “high net-worth individuals” from Latin America joined in the funding, Monster says, with founder contributions accounting for more than half of the $6.1 million. The Seattle Post-Intelligencer’s venture blog has some additional details here.

Having survived prostate cancer and now facing a mild form of Parkinson’s disease, former Intel chairman Andy Grove has turned his analytical eye on the increasingly dysfunctional U.S. healthcare system.

Unfortunately, his recommendations are disappointingly small-scale and reflective of the inordinate faith that many high-tech aficionados place in technological “fixes” for complex social phenomena. I’ll explain why in a moment.

To Grove’s tremendous credit, he argues in a recent interview with Wired News that the most pressing issue facing the U.S. healthcare system is the growing number of uninsured Americans — 44.8 million, or nearly one-sixth of the population, according to the latest Census Bureau data — and the subsequent stress that treatment of the uninsured puts on the nation’s emergency rooms.

As he says:

As the population ages, people are being thrown out of the insurance boat at a faster and faster rate and it’s the forgotten part of medicine.

We have the Human Genome Project, personalized medicine, war on cancer, CyberKnife, stem cell research on one hand — no doctor to be found or to take care of your sore throat on the other. That’s a pretty ugly picture. It’s pretty ugly today but it’s going to be uglier five years from now.

Now Grove is one of the smartest people around, and it’s refreshing to see him diagnose the failure of U.S. healthcare so succinctly. It’s equally hard to argue with his preference for breaking this hairball of a problem into manageable chunks while favoring “doability as opposed to desirability.” And, of course, the Wired News interview may not have fully captured the depth of his thinking on the subject.

That said, Grove’s proposed solutions strike me as so much whistling past the graveyard. At best, his ideas might improve access to healthcare on the margins, but without really addressing the plight of the uninsured, the breakdown of employer-provided insurance or soaring healthcare costs. At worst, they might even aggravate some of the trends he deplores.

Starting from the top, Grove dismisses the notion of universal health care on the grounds that it would disenfranchise insurance companies and that no one knows exactly how to bring healthcare cost inflation under control. No one doubts that insurance companies would fight any plan that threatened their role in the system, although Grove doesn’t acknowledge that some universal-coverage plans envision a prominent — in some cases, even central — role for insurers. (Whether that’s a good idea or not is a subject for another day.)

As for his second point, there’s no shortage of ideas — good, bad or indifferent — for cost control, such as allowing Medicare to bargain down drug prices or limiting the use of costly, intrusive and frequently wasteful medical procedures on elderly patients near the end of their lives. What’s more, most other industrial nations have already implemented some form of cost control, which helps account for the fact that their per capita healthcare spending is so much lower than in the U.S.

Instead, Grove favors tinkering around the edges of the system. He suggests that “retail clinics” — essentially nurse-practitioner-staffed outlets in Wal-Marts or drugstore chains designed to handle everyday ailments quickly and without fuss — might be a “disruptive technology” that could solve the emergency-room crowding problem. For instance, Grove says:

There is an incredible need of medical help for the 70 (percent) or 80 percent of medical care that is routine … where the diagnosis is straightforward and treatment is basically codified. They are conveniently located to where people live or shop or show up for emergency care. And by concentrating on effective delivery of standard care, they can do it conveniently but also much less expensively than doing the standard production. That’s the complex manufacturing logic…. You wouldn’t think about building a toy on the same production line as putting up airplanes. The factories will be different and the cost structure will be different.

Well, retail clinics are certainly on their way, so we’ll presumably know soon enough if they can lower healthcare costs by treating large numbers of people cheaply and effectively. On the other hand, the major problems facing the uninsured have less to do with the inability to see a doctor when they have the sniffles than with the crippling hospital bills they can face after a severe accident or the onset of an unexpected health problem like heart trouble or diabetes.

What’s more, some experts already worry that the spread of these clinics might further erode the financial health of community hospitals by drawing off healthier — meaning “cheaper to treat” — patients. Hospitals tend to subsidize care for the uninsured by charging higher prices to insured patients. If healthier insured folks take off for retail clinics, that means less money to cover expensive conditions of the uninsured that no clinic can touch.

Furthermore, the bulk of U.S. healthcare spending covers the treatment of a minority of chronically ill and typically elderly patients who won’t be candidates for these clinics in the first place. Here, Grove has another solution: Advanced sensor and communications technology with which to wire up the homes of the elderly. This would allow them to stay home, with medical personnel monitoring them remotely and reminding them to take their meds, instead of moving to long-term care facilities. So far as it goes, that vision is laudable and humane — assuming, of course, that you’re willing to overlook exactly how long the tech industry has been promising us the sort of “ubiquitous computing” that would be necessary to make it work. According to Wired News, Grove estimates that shifting one-fourth of the nursing-home population back home could save $12 billion a year.

Let’s extend the benefit of the doubt and assume that those savings are net of the expense of building out this information infrastructure in the first place. They’re still a drop in the bucket compared to the $207 billion spent on U.S. long-term care in 2005, according to Georgetown University’s Long-Term Care Financing Project. (Of that, $130 billion went for nursing-home care, the rest for home care.) Unless there’s something very screwy in the numbers here, the overall cost impact of wiring up seniors’ homes seems likely to be negligible.

Grove’s final idea is another technological fix — standardized, Web-based electronic health records that any doctor could access once a patient “unlocks” them. Once again, assuming it satisfies relatively straightforward privacy and reliability concerns, there’s nothing at all wrong with this idea. Theoretically, at least, electronic health records could promote cooperation between medical specialists, reduce medical errors and improve the long-term health of patients via better preventive care.

At the moment, however, few players in the healthcare system have a financial incentive to implement such a system, which is one of the main reasons it doesn’t yet exist. Any insurer that invests in an electronic-record system — which, even with off-the-shelf technologies, will generally cost more and work less well than expected — is likely to bear the costs without reaping many of the benefits. That’s because many of its presumably healthier customers are likely to change jobs at some point and move on to competitor health plans, who will then garner any savings. Nor do the competitive insurance and hospital industries have much reason to adopt the universally compatible, Internet-based systems Grove favors, since that would just make it easier for their customers or patients to take their records — and their business — elsewhere. Grove doesn’t even seem to acknowledge these fundamental adoption issues, much less address them.

Since last November, Grove has apparently offered similar thoughts to a variety of audiences, including a Stanford lecture crowd and my former WSJ colleague Lee Gomes. Which is too bad, in a way, because it suggests to me that no one has seriously challenged his rather glib prescriptions in that time. The healthcare crisis is real and urgent, and we could all benefit from the best thinking of a sharp-witted “rational capitalist” of Grove’s stature. Unfortunately, I don’t think he’s really offered it to us yet.