Esophageal cancer screening could lead to runaway health costs

Reuters’ Frederik Joelving reports that a new, easier method of taking biopsies to detect esophogeal cancer, called TSA, has opened a up a whole new profit center for folks pushing cancer screening, despite the fact that, as Joelving writes, “there is no research showing that routine screening for esophageal cancer lowers the risk of dying from the disease. Specialist medical groups recommend against it, as does the American Cancer Society.”

Joelving’s report focuses on one physician, Dr. Jonathan Aviv, who has peddled the screening with particular vigor, recommending it for anyone over age 50. Here he is with talk show host Dr. Mehmet Oz:

Folks in the know are not nearly as impressed as the TV doctor.

While the cost of TNE is lower on a per-patient basis than traditional endoscopy, critics say testing millions of people would needlessly add billions of dollars to the already bloated U.S. national health bill and lead to lifelong follow-up testing for many people who would never get the disease.

“You are going to end up hurting a lot of people, and it’s not clear to me you’re going to help very many,” says Dr. Otis Brawley, chief medical officer of the American Cancer Society and author of “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.” “The simple, ‘Let’s find it early, let’s not pay any attention to the potential for harm’ – that same thought process is what started prostate cancer screening.”

Joelving even goes so far as to compare the test’s business potential to PSA, the well-known antigen screening for prostate cancer that costs the American health system at least $3 billion a year, and which one of its discoverers described as resulting in “a hugely expensive public health disaster.”

And, speaking of conflicts of interest, Joelving found Aviv has plenty.

At different times over the past decade, he was a paid consultant to three companies that make or sell TNE scopes and related equipment: Minneapolis-based Medtronic Inc, Pentax — now known as KayPentax, based in Montvale, New Jersey – and Vision-Sciences Inc, of Orangeburg, New York. Aviv says he is no longer a paid consultant to any of the companies, though he owns several thousand shares in Vision-Sciences and uses its equipment. The company’s systems cost between $30,000 and $60,000.

Watch the AHCJ Health Reform Core Topic pages for an upcoming feature by Joelving about how he reported this story. For more about screenings and comparative effectiveness research, see our recent article by Rochelle Sharp.

Experts share challenges of setting up state insurance exchanges

Setting up a state insurance exchange is a complicated endeavor – made more so by the bitter politics of health reform and the uncertainty over the Supreme Court ruling. Some states, like Maryland, are proceeding with enthusiasm. Others are fighting the health law in court – but quietly doing some of the ground work for an exchange anyway. Other states say they just aren’t going to set one up, no way, no how – meaning the federal government is supposed to be ready to step in with a backup exchange plan.

At the panel on state exchanges at Health Journalism 2012, we heard from two experts – Maryland Health Secretary Josh Sharfstein, who is coordinating his state’s exchange efforts as the head of its exchange board, and Heather Howard, the director of the State Health Reform Assistance Network, based in Princeton. (For her snapshot maps of where states stand in exchange development as of April 2012, click here.)

One point Sharfstein made: Even in a state as committed to reform as Maryland, setting up the exchange is no simple task. Much of the challenge arises from updating and revamping – and adding – to the state’s information technology capacities. When exchange builders talk about IT, they aren’t referring to the electronic health records you’ve been hearing about. This is a system to help people shop in the exchanges, (for individual or small group coverage), figure out whether they belong in Medicaid, CHIP or the exchange and, if in the exchange, whether they qualify for federal subsidies – and how much. It’s not just the very poor who qualify, there are subsidies available on a sliding scale up to 400 percent of poverty, currently around $90,000 for a family of four. These complex IT systems will also have to deal with what happens if people’s income changes – whether the subsidies rise, or whether they have to give some of it back. If it doesn’t sound easy – it’s not.

“On the topographical map of anxiety, this is a skyscraper,” Sharfstein said of the IT challenge.

One question that came up is why it matters whether the state or the federal government runs the exchange. Both speakers had a long list of reasons – including making decisions (based on the specific dynamics and demographics of a given state’s insurance market)about whether to merge or keep separate the individual and small group markets, the role of brokers and navigators, conditions for a health plan for participating in the exchange (including some requirements affecting their business outside the exchange – where people can still buy policies but not get subsidies) how to finance the exchange, the type of governing board the exchange should have, and who should (or should not) serve on it. (Another big issue facing states is how to define the essential benefits package – but I’ll post separately on that soon.) In fact, the federal government has left so many decisions up to the states that it threatens to overwhelm some of the states, or create paralysis, Howard said.

Toward the end of the session, I asked how many people in the audience thought their state would be ready to run the exchange on Jan. 1, 2014. Not a whole lot of hands went up. And, logically, when I asked how many thought their state would not be ready, a whole lot of hands shot up. So I asked Howard to explain the “hybrid” that HHS has offered to create. Basically, this means that the federal government and the state will divvy up the exchange responsibilities, with the state doing what it can and the feds backstopping the rest. This is supposed to be a sort of a temporary bridge, with the state eventually assuming full responsibility. With states – and the court – in flux, no one really knows exactly how many states will end up going for this hybrid option, but some experts estimate it could be about half. It’s just too soon to know for sure.

Two other big state issues that I’ll post on separately soon: How the states are deciding on the essential benefits package, and what options do states have if the Supreme Court kills the mandate, but leaves most of the health law intact. Shoot me an e-mail if you see good local coverage on this so we can link to it.

Final note: here’s the best one-stop shop for information on state exchange building and some state-specific funding information is here. The National Council of State Legislatures also is a good resource.

Investigative reports lead to Senate investigation into painkiller promotion

Following up on reporting efforts from the Milwaukee Journal Sentinel/MedPage Today and ProPublica, a Senate committee has launched investigation into the pharmaceutical industry’s conflict-of-interest-laden promotion of pain management drugs, one of which may or may not be related to one pharma-tied patient organization’s Tuesday announcement that is was closing up shop “due to irreparable economic circumstances.”

Thus far, the investigation has consisted of strongly worded rebukes and requests for further disclosure to the abovementioned American Pain Foundation, among others, in the form of letters from Sens. Max Baucus and Charles Grassley. PDFs of the relevant letters can be found in this press release from Baucus’ Senate finance committee.

In the letters, the senators directly cite the investigative efforts of AHCJ members Charles Ornstein, Tracy Weber and John Fauber.

Ornstein, AHCJ’s board president, and Tracy Weber, his fellow ProPublica senior reporter, published their investigation into the American Pain Foundation in ProPublica and The Washington Post in December. As they write in their post on the foundation’s demise, “The group received 90 percent of its $5 million in funding in 2010 from the drug and medical-device industry, ProPublica found, and its guides for patients, journalists and policymakers had played down the risks associated with opioid painkillers while exaggerating the benefits.”

Fauber’s reporting, the result of a partnership between the Milwaukee Journal Sentinel and MedPage Today, focused on the tangled web of money, organizations and influence through which the pharmaceutical industry helped propel the runaway growth of painkiller prescriptions over the past decade and a half.

In his report on the senate investigation he helped inspire, Fauber writes that the finance committee is “seeking financial and marketing records from three companies that make opioid drugs, including Oxycontin and Vicodin, and seven national organizations.” The legislators are seeking records of financial transactions between pharmaceutical manufacturers and patient groups from as far back as 1997, as well as details on any federal funding provided to the groups.

Attention to complex emotions around caregiving can add depth to stories

If we’re lucky as we cross the threshold into old age, people who we love – our spouses, our children, our nieces and nephews, friends and neighbors – start becoming our caregivers.

When we stop driving, they take us to the doctor. When we need a prescription, they go to the pharmacy and pick it up. When we can’t make sense of medical bills, they come by and plow through the paperwork. And when we stop getting out much, they visit us, talk to us, sit by our side.

It’s an intimate act, this decision to care for someone who is sick, old, or frail – to accompany them on their journey into life’s last stage.

Much has been written about the burdens of caregiving: the juggle for families raising young children and tending to aging parents, the demands on time and finances, the emotional roller coaster as relationships are redefined, the stress of confronting illness, debility and impending death. As health reporters, this is the side of caregiving we usually examine.

Less discussed and far less well appreciated are the benefits of sharing this vulnerable time of life with someone.

There are few experiences in life that similarly call upon our humanity and our empathy. If cuddling an infant is an act of joy, then attending to an older person who’s weakening, physically and perhaps psychologically, is an act of commitment, an assertion of ties that bind us and refuse to be broken. Though you don’t hear about it, people who become caregivers often end up feeling they get as much (appreciation, satisfaction, a sense of their own decency) as they give.

What better way to convey this than through photography, that medium that says what words alone can’t capture?

Take a look at this set of caregiving photographs recently published by NPR and think about what the faces captured here express. I see dignity and acceptance, patience, warmth, boredom, independence, distance, closeness, and resignation – emotions that people might not admit feeling if they were asked directly. The photos were taken by Annabel Clark, daughter of the actress Lynn Redgrave. NPR gives some background on how Clark got interested in the subject here.

What’s the message for health reporters? When you’re writing or producing a piece about caregiving, pay close attention to gestures, expressions and actions that hint at what people are experiencing but not willing or able to articulate. Listen for the silences, when you get the feeling that words are falling away and something important lies beneath. If you pick up on these clues, you may be able to take an interview to the next level and write a story with details that will capture your readers’ hearts.

Look for a tip sheet on caregiving in the Aging Core Topic section of AHCJ’s website this fall. It will be full of good information about data, reports and sources who can walk you through this topic. But the people and families who give caregiving depth and complexity, those you’ll need to find for yourselves.

Update: I wrote this before the New York Times‘ story on Sunday, May 6, “When Illness Makes a Spouse a Stranger,” about frontotemporal dementia. Denise Grady, the article’s author, does a brilliant job of portraying both sides of the caregiving story: the depths of love and commitment that Ruth French feels for her afflicted husband, Michael, and the depths of despair that she undergoes as his personality changes and his care becomes demanding beyond all measure. Look at how the tension in the story is complemented by the photograph that accompanies it of Ruth and Michael spooning in bed. And watch the video, so aptly titled “in love and loss,” for more heart-rending images that add extraordinary depth and emotion to this piece.

Investigation finds hospital’s leader spent public money on personal interests

Reese Dunklin and Sue Goetinck Ambrose of The Dallas Morning News document how Kern Wildenthal, the former UT Southwestern Medical Center president and its current chief fundraiser, spent hundreds of thousands in public dollars in recent years to build campus wine cellars, pay for his opera interests and travel to paradises around the world.

The investigation details a collapse in controls over taxpayer dollars and triggered a University of Texas System internal inquiry that found many of the same problems. Two auditors were jettisoned in response, Wildenthal will be forced to pay restitution and reforms are being considered. Read more

Reuters explains Big Food’s remarkable lobbying success

Investigating for Reuters, Duff Wilson and Janet Roberts analyzed lobbying records and found that, in the past few years, the food industry has dramatically stepped up its spending in Washington and, they write, “largely dominated policymaking – pledging voluntary action while defeating government proposals aimed at changing the nation’s diet.” They give examples.

After aggressive lobbying, Congress declared pizza a vegetable to protect it from a nutritional overhaul of the school lunch program this year. The White House kept silent last year as Congress killed a plan by four federal agencies to reduce sugar, salt and fat in food marketed to children.

And during the past two years, each of the 24 states and five cities that considered “soda taxes” to discourage consumption of sugary drinks has seen the efforts dropped or defeated.

At every level of government, the food and beverage industries won fight after fight during the last decade. They have never lost a significant political battle in the United States despite mounting scientific evidence of the role of unhealthy food and children’s marketing in obesity.

That success has come through what the authors imply is a sort of big-tobacco model, in which the industry combines promises of self-regulation with huge amounts of money, and thus creates an irresistible package for lawmakers. For a blow-by-blow on how the lobbying muscle swayed the decision-makers in recent battles, I strongly recommend you read the full piece, which draws heavily from both data and extensive interviews. Particularly interesting? The examples of how the Citizens United decision has impacted far more than just election politics.

Comprehensive series on N.C. hospitals includes national context, effects of reform

The (Raleigh, N.C.) News & Observer and The Charlotte (N.C.) Observer just combined forces to do a terrific five-part series on hospitals called “Prognosis: Profits.”

It’s not just a great expose/explainer/data analysis/narrative that tells readers about the state of the hospital industry in North Carolina and its national context. With lots of examples, data and sidebars that break down some complex policy ideas, it’s also a great primer for anyone who wants an easy to understand but multifaceted Hospitals 101 (without being Hospitals for Dummies). For you multimedia fans out there, it also has a video component.

In a nutshell, the series – a collaboration of investigative and health care writers - found that some of the hospitals make a ton of money and charge more than hospitals elsewhere and that the charity care many of them provide is worth less than the tax-breaks they get ostensibly for providing care to the community. And yes, it gets into many of the complexities of charity care versus community benefit versus cost-shifting versus bad debt. (We’ve written about some of that on this blog.)

They write:

During the Great Recession, their profits have stayed strong, and they’ve raised their prices. Top executives enjoy million-dollar compensation packages as they expand, buy expensive technology and build lavish facilities. Their customers buy the services before they know the cost, and they often don’t understand the bills.

And the hospitals enjoy a perk worth millions each year: They pay no income, property or sales taxes.

The series describes what it’s like to be poor and sick and have a collection agency come after what little you have to pay a big bill for a medical emergency. It describes the million-dollar plus compensation packages of hospital execs. (One got $8.7 million, including a big retirement trust payment.)

The articles blend individual patient stories with policy context and a lot of hospital financial data (which readers can search in an online database that includes total and operating margins for every hospital in the state). The fifth and final installment (as well as some of the fourth) looks at some of the solutions that have been put forth, by state legislators and patient and consumer advocates.

The series avoids one of the pitfalls that drives me crazy in some otherwise good hard-hitting reporting. It describes a problem – deeply and accessibly. But it also goes beyond looking at a snapshot of where things stand today. It connects today’s reality, today’s system, to the many underreported provisions of the Affordable Care Act that may create new tools and forces and legal and financial and cultural shifts that can bring about change – depending on the Supreme Court, the politicians, and on how much the health sector (and patients) embraces versus resists change. (That’s a sidebar in part 3.) Among the relevant elements of the health law it identifies (and the sidebar gives more specifics than I’m including here):

• Hospitals must develop financial assistance policies and the criteria for receiving the help.
• An end to the widespread practice of charging the uninsured who qualify for financial assistance more than they charge the insured
• A ban on nonprofits engaging in “extraordinary collection actions”
• A requirement that they assess community health needs every three years, and devise a plan to meet them

The series has gotten the attention of federal and state legislators. We’ll see if they stay engaged. And how that matters.

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

Plenty of stories in how ACA could affect veterans’ health care

While preparing for a veterans health panel I moderated at the recent AHCJ conference in Atlanta, I remembered an article in the Journal of the American Medical Association that AHJC’s Pia Christensen had sent me on what the health reform law would do for veterans. It’s behind a pay wall, but AHCJ members get free access. It’s written by Kenneth Kizer, who is at the University of California, Davis, but used to run the Veterans Health Administration (better known as the VA) - which is the nation’s largest health care system – when he was under secretary for health in the Department of Veterans Affairs.

There are more than 22 million veterans and the number is obviously growing. About one-third (37 percent in 2011) were enrolled in the VA, which usually means they either have a service-connected disability and/or are low income. Most (80 percent) are covered by Medicare starting at age 65. Most have some kind of coverage or mix of coverage (private insurance, Medicaid, or TRICARE, which also covers military retirees and their dependents). Only about 7 percent - well under the national average and most states’ rates - are uninsured, which in most cases means they are poor but not poor enough to get into the VA.

The Affordable Care Act (assuming it survives the Supreme Court) doesn’t affect the VA per se – although one could argue that some of the VA’s initiatives on care coordination and its early adoption of electronic medical records did affect the shape of the ACA. But not affecting the VA doesn’t mean it won’t affect veterans. Kizer expects that to be a mixed blessing.

For that 7 percent who are uninsured (and for those who may be paying a lot for insurance that may or may not be comprehensive in the individual or small group markets) the coverage expansion could make a big difference. Some may qualify for the expanded Medicaid. Other will be able to get insurance, often with a federal subsidy, in the new state-based insurance exchanges. And that’s a gain.

Those options will be open, too, to some veterans who are VA eligible. This is where Kizer argues the benefits aren’t so clear cut. On one hand, it gives veterans more choices, and they may be able to get care that is more convenient and timely. The drawback, though, is the care may be more fragmented and disconnected once they venture outside the VA’s closed system of coordinated care.

“Fragmentation of care is of concern because it diminishes continuity and coordination of care, resulting in more emergency department use, hospitalizations, diagnostic interventions, and adverse events. The VA serves an especially large number of persons with chronic medical conditions or behavioral health diagnoses – populations especially vulnerable to untoward consequences resulting from fragmented care,” Kizer wrote.

There is even some data suggesting that vets who get some care in the VA and some outside are more likely to be rehospitalized and die within a year than VA-only users, although the data is limited. The new choices by expanded coverage options could also mean more veterans end up getting care outside the VA system – from doctors who may not be as well-versed in the medical problems prevalent among vets (including PTSD) or the resources available to help them. There could be some good local stories on this aspect – and on the broader issue of whether mental health providers in the community are plugged into the needs of veterans, whether or not they are eligible for the VA itself.

There are also a bunch of questions about financing – and these too are worth a local look. If more vets seek care outside the VA, will that mean that some low-volume rural VA services will be cut back? How will that affect the remaining vets who want to get those services from the VA? Will coverage expansion in general – not just for vets – lure more doctors and nurses and physical therapists etc out of the VA to meet the higher demand for health providers among the newly insured? And will the increased options for vets cost the government money? For instance, the government may be making redundant payments now – think about a vet over age 65 who gets some care in the VA and is also enrolled in a government-subsidized Medicare Advantage plan, or is a dual-eligible getting subsidized Medicare, Medicaid - and VA care. Will this kind of duplicative payments rise if vets get subsidized coverage through Medicaid or the exchange – and also draw on VA services? Is anyone in your state even thinking about this? Kizer suggests research needs to be done on this, and says Florida, Texas and California – together home to nearly one in four vets – would be good places to start.

He raises other questions about the health care work force, the safety net, the oft-neglected needs of women vets but concludes with a call to recognize that “providing health care for veterans is an ongoing cost of foreign policy foreign policy and national defense strategies and that the nation has a long-standing social contract with veterans to ensure that those who have experienced harm during military service have ready access to health care.”

Seniors missing out on important wellness exams

As health care reporters, we come across this truth time and again:  insurance coverage doesn’t guarantee high quality medical care.

The latest evidence comes from a survey of 1,028 seniors (age 65 and older) by The John A. Hartford Foundation, whose mission is improving the health of older adults. (Editor’s note: The John A. Hartford Foundation is one of the supporters of AHCJ’s core curriculum on Aging.)

It found that a measly 7 percent of older adults surveyed received seven highly recommended services, including a yearly review of all their medications, screening for depression or other mood disorders, a history and assessment of their risk of falling, evaluation of their ability to perform daily activities of living and care for themselves and referral to resources in the community.

All of these services are covered by Medicare through the program’s new annual wellness visit – a benefit to all beneficiaries on traditional Medicare as of January 2012 – and all are endorsed by geriatric experts.  Yet 52 percent of older adults who participated in the Hartford survey said they had received none or one of the interventions.

“Healthcare isn’t very well adapted to the special needs of older people,” said Christopher Langston, program director at the Hartford Foundation, introducing the findings at a press conference last week.   Most physicians have little if any training in geriatrics and simply apply knowledge of young adults or middle aged adults to seniors, others said.

That’s misguided, since older adults’ changing bodies – different sleep patterns, alterations in metabolism, changes in muscle strength and nutritional requirements, and more – require special attention and special interventions.

Yet, with a few exceptions, medical schools don’t incorporate geriatric training into their curriculums.  And Medicare doesn’t adequately reimburse doctors who treat large numbers of older patients, who tend to require more time and attention because of their complex needs and, often, multiple illnesses.

Rosemary Leipzig, M.D., professor of geriatrics at Mount Sinai School of Medicine in New York City, said it was “really concerning” that one-third of older people surveyed said doctors hadn’t reviewed all their prescriptions and over-the-counter medications, vitamins and supplements over the past year.

Thirty percent of seniors who participated in the survey reported taking five or more prescription medications; another 33 percent were taking up to four medications.

Well-documented harms occur when older adults swallow too many pills with possible adverse side effects, but these can be prevented up to 40 percent of the time with proper oversight, Leipzig said.   The American Geriatrics Society recently published an updated list of medications that can be dangerous for seniors.  (The society’s standards for potentially inappropriate medication use in older adults are known as the Beers criteria.)

Another troubling gap in care arises from doctors’ and nurses’ failure to ask older patients whether they have fallen recently or advise them about how to minimize the risk of falls, as I wrote in a blog post about the Hartford survey.   Dan Kadlec also highlighted the issue in his blog post for Time Moneyland, quoting the Hartford Foundation:

“Falls cause more injury and injury-related death in older people than any other event and cause 90% of all hip fractures, which greatly increase odds of nursing home placement. … Evidence has shown that older people can cut their risk of falling by about 30% by addressing key risk factors.”

For health care reporters, I think the take-home message is that doctors who care for older adults in the community are not doing all they could for this population.  There are several reasons why this is so.  A lack of knowledge about Medicare, inadequate training in geriatric care, harried practices and reimbursement pressures are high on the list.

Also, for their part, older adults don’t really know what kind of care they should be getting, what to ask for from their doctors, and what benefits are available to them under Medicare. (Fifty-four percent of seniors polled by the Lake Research Partners for the Hartford Foundation said they’d never heard of Medicare’s annual wellness visit.)  

This seems a ripe area for coverage by reporters committed to educating older adults about the components of high quality care and Medicare.

Welcome to AHCJ’s newest members

Please welcome AHCJ’s newest members. All new members are welcome to stop by this post’s comment section to introduce themselves.

• Robert Allen, managing editor, WebMD, Atlanta
• Jennifer Anyaegbunam, medical student, University of Virginia School of Medicine, Charlottesville, Va. (@JenniferAdaeze)
• Dr. Ihsan Azzam, state epidemiologist, Nevada State Health Division, Carson City, Nev.
• Pauline Bartolone, health reporter, Capital Public Radio, Sacramento, Calif. (@CapRadioHealth)
• Bruce Burnett, independent journalist, Ladysmith, British Columbia, Canada (@healthnatural1)
• Zosia Chustecka, news editor, Medscape Oncology, Kent, United Kingdom
• Patricia Collins, independent journalist, Columbus, Ohio
• Hope Cristol, executive editor, Arthritis Today, Georgia
• Reese Dunklin, staff writer, The Dallas Morning News, Dallas
• Walter Eisner, senior writer, Orthopedics This Week, St. Paul, Minn.
• Vivien Fellegi, independent journalist, Toronto
• Christine Frank, publisher, Christine Frank and Associates, Fredricksburg, Va. (@christinefrank)
• Kristen Georgi, independent journalist, Warwick, N.Y.
• Thomas Gionis, president, Aristotle University, Irvine, Calif.
• Christopher Goins, reporter, CNS News, Suitland, Md.
• Carey Goldberg, co-host, WBUR Common Health, Brookline, Mass. (@commonhealth)
• Sharon Guynup, independent journalist, Hoboken, N.J.
• Dirk Hanson, independent journalist, Ely, Minn. (@dirk57)
• Katy Healey, reporter, Omaha World-Herald, Omaha, Neb.
• Patrick Hooper, student, University of Georgia
• Judith Isreal Rosen, publisher, The Medicare News Group, Glencoe, Ill.
• Lorraine L. Janeczko, independent journalist, Atlanta
• Megan C. Johnson, reporter, KOLN/KGIN-Grand Island, Neb.
• Richard Kerr, group editor, Advanstar Communications, North Olmsted, Ohio
• Elizabeth Landau, writer/producer, CNN, Atlanta (@lizlandau)
• Lindsay Lyon, health news editor, U.S. News & World Report, Washington, D.C.
• Hedy Marks, independent journalist, Georgia
• Don Meadows, writer/editor, Morbidity and Mortality Weekly Report, Cumming, Ga.
• Kamal Menghrajani, intern, KQED News-Health Unit, San Francisco
• Anne Messenger, editor, Medical Observer, St Leonards, New South Wales, Australia (@annegmmm)
• Jonathan Mintz, senior health reporter, WebMD, Georgia
• Michael Morton, health & science reporter, Metro West Daily News, Watertown, Mass.
• Ruth Nasrullah, independent journalist, Houston, Texas (@ruthnasrullah)
• Tyurina Natalya, deputy head of department, RIA Novasti, Russia
• Patricia A. Newman-Horm, independent journalist, Annapolis, Md.
• Elise Oberliesen, independent journalist, Westminster, Colo.
• Denis Paiste, independent journalist, Salem, N.H. (@dpaiste)
• Katrina Parker, assistant managing editor, WebMD, Hiram, Ga.
• Jennie Phipps, independent journalist, Gibraltar, Mich. (@jennielp)
• Steve S. Ryan, Ph.D, doctor, A-FiB.com, Malibu, Calif.
• Melissa Schenkman, independent journalist, Atlanta
• Terry Sheridan, independent journalist, North Conway, N.H.
• Sarah Smedley, independent journalist, New York (@ssmedley)
• Trine Tsouderos, science & medical writer, Chicago Tribune, Chicago
• Stephanie Vozza, independent journalist, Rochester Hills, Mich.
• Stephanie Watson, independent journalist, Smyrna, Ga.
• Karen Weintraub, health/science journalist & adjunct professor, Boston University, Cambridge, Mass. (@kweintraub)
• Jennifer White, reporter, The California Advocate, Fresno, Calif.
• Robin Yamakawa, health editor, WebMD, Georgia
• Caroline Young, independent journalist, Atlanta
• Erkan Yuksel, professor, Anadolu University, Turkey

If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.

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