Tuesday, December 7, 2010

Making Fast Money


“Don’t touch my brownies! A child nutrition bill on its way to President Barack Obama — and championed by the first lady — gives the government power to limit school bake sales and other fundraisers that health advocates say sometimes replace wholesome meals in the lunchroom…


“‘This could be a real train wreck for school districts,’ Lucy Gettman of the National School Boards Association said Friday, a day after the House cleared the bill. ‘The federal government should not be in the business of regulating this kind of activity at the local level.’…


“Public health groups pushed for the language on fundraisers, which encourages the secretary of Agriculture to allow them only if they are infrequent. The language is broad enough that a president’s administration could even ban bake sales, but Secretary Tom Vilsack signaled in a letter to House Education and Labor Committee Chairman George Miller, D-Calif., this week that he does not intend to do that. The USDA has a year to write rules that decide how frequent is infrequent.’…


“‘These fundraisers are happening all the time,’ Wootan [of the Center for Science in the Public Interest] said. ‘It’s a pizza sale one day, doughnuts the next… It’s endless. This is really about supporting parental choice. Most parents don’t want their kids to use their lunch money to buy junk food. They expect they’ll use their lunch money to buy a balanced school meal.’”


***

“But the spiraling obesity rates Palin mocks are increasingly having an impact on health care costs, which in turn affects the way we must approach and debate reforms to the health care system. Those least able to afford health care disproportionately need it in large part because of the unhealthy food they eat — and that is served to their children in government-run schools. We’ve arrived at a point where inner-city children can’t identify common fresh vegetables and fruits, such as cauliflower, tomatoes, and potatoes.


“Perhaps you regard it as an intolerable violation of personal liberty for government to campaign for nutritional awareness? What then do we call the federal agricultural subsidies that have helped to lower the price of super-abundant junk food? Can you explain why it’s okay for government to campaign against smoking and in favor of seatbelts? Or do you also oppose those life-saving public safety campaigns? Or is it perhaps that you have decided that everything the Obamas do is so intrinsically wrong that criticism of the Twinkie now makes you un-American?…


“Here we come to the heart of the destructive craziness of what begs to be called Junk Food Conservatism. Palin, Limbaugh and the others may sincerely believe that “Big Government” is taking advantage of the increase in child and adult diabetes, heart disease and all-manners of obese-related illnesses to trample on our God-given freedom to guzzle soda and eat candy. But in the end, here’s the political message they are sending from their own wealthy, option-filled, Subzero-equipped enclaves to this country’s poorest and unhealthiest:


“Let them eat Twinkies.”


***

“Don’t get me wrong. I’m not opposed to instilling healthful behaviors in our children. What I’m opposed to is the government mandating those behaviors. It might help the cause further if the First Lady’s White House Task Force on Obesity Report delivered to the president’s desk last May were not filled distortions and mischaracterizations of the childhood obesity epidemic…


“In the meantime, maybe the First Lady and her hubby could set a better example by making their snack attacks—which include scarfing down ice cream, cookies, and fast food burgers—less conspicuous. The accompanying slideshow is made up of just a few of the snapshots taken in the time since Barack Obama was elected president. Healthy appetite, no?”







Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.



But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?



In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.



Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:



Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."



Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.



The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.



If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.



Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".



More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.



How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.



The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.



Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.








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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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“Don’t touch my brownies! A child nutrition bill on its way to President Barack Obama — and championed by the first lady — gives the government power to limit school bake sales and other fundraisers that health advocates say sometimes replace wholesome meals in the lunchroom…


“‘This could be a real train wreck for school districts,’ Lucy Gettman of the National School Boards Association said Friday, a day after the House cleared the bill. ‘The federal government should not be in the business of regulating this kind of activity at the local level.’…


“Public health groups pushed for the language on fundraisers, which encourages the secretary of Agriculture to allow them only if they are infrequent. The language is broad enough that a president’s administration could even ban bake sales, but Secretary Tom Vilsack signaled in a letter to House Education and Labor Committee Chairman George Miller, D-Calif., this week that he does not intend to do that. The USDA has a year to write rules that decide how frequent is infrequent.’…


“‘These fundraisers are happening all the time,’ Wootan [of the Center for Science in the Public Interest] said. ‘It’s a pizza sale one day, doughnuts the next… It’s endless. This is really about supporting parental choice. Most parents don’t want their kids to use their lunch money to buy junk food. They expect they’ll use their lunch money to buy a balanced school meal.’”


***

“But the spiraling obesity rates Palin mocks are increasingly having an impact on health care costs, which in turn affects the way we must approach and debate reforms to the health care system. Those least able to afford health care disproportionately need it in large part because of the unhealthy food they eat — and that is served to their children in government-run schools. We’ve arrived at a point where inner-city children can’t identify common fresh vegetables and fruits, such as cauliflower, tomatoes, and potatoes.


“Perhaps you regard it as an intolerable violation of personal liberty for government to campaign for nutritional awareness? What then do we call the federal agricultural subsidies that have helped to lower the price of super-abundant junk food? Can you explain why it’s okay for government to campaign against smoking and in favor of seatbelts? Or do you also oppose those life-saving public safety campaigns? Or is it perhaps that you have decided that everything the Obamas do is so intrinsically wrong that criticism of the Twinkie now makes you un-American?…


“Here we come to the heart of the destructive craziness of what begs to be called Junk Food Conservatism. Palin, Limbaugh and the others may sincerely believe that “Big Government” is taking advantage of the increase in child and adult diabetes, heart disease and all-manners of obese-related illnesses to trample on our God-given freedom to guzzle soda and eat candy. But in the end, here’s the political message they are sending from their own wealthy, option-filled, Subzero-equipped enclaves to this country’s poorest and unhealthiest:


“Let them eat Twinkies.”


***

“Don’t get me wrong. I’m not opposed to instilling healthful behaviors in our children. What I’m opposed to is the government mandating those behaviors. It might help the cause further if the First Lady’s White House Task Force on Obesity Report delivered to the president’s desk last May were not filled distortions and mischaracterizations of the childhood obesity epidemic…


“In the meantime, maybe the First Lady and her hubby could set a better example by making their snack attacks—which include scarfing down ice cream, cookies, and fast food burgers—less conspicuous. The accompanying slideshow is made up of just a few of the snapshots taken in the time since Barack Obama was elected president. Healthy appetite, no?”







Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.



But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?



In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.



Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:



Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."



Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.



The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.



If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.



Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".



More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.



How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.



The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.



Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.








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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

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“Don’t touch my brownies! A child nutrition bill on its way to President Barack Obama — and championed by the first lady — gives the government power to limit school bake sales and other fundraisers that health advocates say sometimes replace wholesome meals in the lunchroom…


“‘This could be a real train wreck for school districts,’ Lucy Gettman of the National School Boards Association said Friday, a day after the House cleared the bill. ‘The federal government should not be in the business of regulating this kind of activity at the local level.’…


“Public health groups pushed for the language on fundraisers, which encourages the secretary of Agriculture to allow them only if they are infrequent. The language is broad enough that a president’s administration could even ban bake sales, but Secretary Tom Vilsack signaled in a letter to House Education and Labor Committee Chairman George Miller, D-Calif., this week that he does not intend to do that. The USDA has a year to write rules that decide how frequent is infrequent.’…


“‘These fundraisers are happening all the time,’ Wootan [of the Center for Science in the Public Interest] said. ‘It’s a pizza sale one day, doughnuts the next… It’s endless. This is really about supporting parental choice. Most parents don’t want their kids to use their lunch money to buy junk food. They expect they’ll use their lunch money to buy a balanced school meal.’”


***

“But the spiraling obesity rates Palin mocks are increasingly having an impact on health care costs, which in turn affects the way we must approach and debate reforms to the health care system. Those least able to afford health care disproportionately need it in large part because of the unhealthy food they eat — and that is served to their children in government-run schools. We’ve arrived at a point where inner-city children can’t identify common fresh vegetables and fruits, such as cauliflower, tomatoes, and potatoes.


“Perhaps you regard it as an intolerable violation of personal liberty for government to campaign for nutritional awareness? What then do we call the federal agricultural subsidies that have helped to lower the price of super-abundant junk food? Can you explain why it’s okay for government to campaign against smoking and in favor of seatbelts? Or do you also oppose those life-saving public safety campaigns? Or is it perhaps that you have decided that everything the Obamas do is so intrinsically wrong that criticism of the Twinkie now makes you un-American?…


“Here we come to the heart of the destructive craziness of what begs to be called Junk Food Conservatism. Palin, Limbaugh and the others may sincerely believe that “Big Government” is taking advantage of the increase in child and adult diabetes, heart disease and all-manners of obese-related illnesses to trample on our God-given freedom to guzzle soda and eat candy. But in the end, here’s the political message they are sending from their own wealthy, option-filled, Subzero-equipped enclaves to this country’s poorest and unhealthiest:


“Let them eat Twinkies.”


***

“Don’t get me wrong. I’m not opposed to instilling healthful behaviors in our children. What I’m opposed to is the government mandating those behaviors. It might help the cause further if the First Lady’s White House Task Force on Obesity Report delivered to the president’s desk last May were not filled distortions and mischaracterizations of the childhood obesity epidemic…


“In the meantime, maybe the First Lady and her hubby could set a better example by making their snack attacks—which include scarfing down ice cream, cookies, and fast food burgers—less conspicuous. The accompanying slideshow is made up of just a few of the snapshots taken in the time since Barack Obama was elected president. Healthy appetite, no?”







Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.



But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?



In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.



Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:



Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."



Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.



The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.



If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.



Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".



More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.



How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.



The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.



Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.








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The Solar Dynamics Observatory never fails to deliver absolutely stunning images from the Sun: as of 18:49 UT today, the above picture is what the Sun looked like in the ultraviolet spectrum. The prominence that you are seeing looping ...

Obama Defends Decision To Extend Bush-Era Tax Cuts « CBS Los <b>...</b>

President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

Movie <b>News</b> Quick Hits: Emma Stone&#39;s &#39;Spider-Man&#39; Look, Annie Nods <b>...</b>

Filed under: Trailers and Clips, Movie News, Sundance Film Festival, Cinematical. Email This. -- Emma Stone debuted her Spider-Man look for the first time at Trevor Live in Hollywood over the weekend. Stone, who's usually in films as a ...



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Breaking <b>News</b>: Watch A Gigantic Looping Solar Prominence

The Solar Dynamics Observatory never fails to deliver absolutely stunning images from the Sun: as of 18:49 UT today, the above picture is what the Sun looked like in the ultraviolet spectrum. The prominence that you are seeing looping ...

Obama Defends Decision To Extend Bush-Era Tax Cuts « CBS Los <b>...</b>

President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

Movie <b>News</b> Quick Hits: Emma Stone&#39;s &#39;Spider-Man&#39; Look, Annie Nods <b>...</b>

Filed under: Trailers and Clips, Movie News, Sundance Film Festival, Cinematical. Email This. -- Emma Stone debuted her Spider-Man look for the first time at Trevor Live in Hollywood over the weekend. Stone, who's usually in films as a ...



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Breaking <b>News</b>: Watch A Gigantic Looping Solar Prominence

The Solar Dynamics Observatory never fails to deliver absolutely stunning images from the Sun: as of 18:49 UT today, the above picture is what the Sun looked like in the ultraviolet spectrum. The prominence that you are seeing looping ...

Obama Defends Decision To Extend Bush-Era Tax Cuts « CBS Los <b>...</b>

President Barack Obama on Tuesday staunchly defended his decision to compromise with Republicans and temporarily extend about-to-expire tax cuts for all Americans.

Movie <b>News</b> Quick Hits: Emma Stone&#39;s &#39;Spider-Man&#39; Look, Annie Nods <b>...</b>

Filed under: Trailers and Clips, Movie News, Sundance Film Festival, Cinematical. Email This. -- Emma Stone debuted her Spider-Man look for the first time at Trevor Live in Hollywood over the weekend. Stone, who's usually in films as a ...



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