With state funds gone, Okla. dental programs still serve needy
Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”
Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.
“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”
For more on NPR’s StateImpact project and a list of current participants, check out their lab.
Survivor goes undercover in Tijuana cancer clinics
Filed under: Health journalism, Hot Health Headline
Reporting for Al Jazeera English’s People & Power, Sarah Macdonald tells how her own battle with breast cancer led her to shave her head, hide a camera and go undercover to investigate south-of-the-border clinics touting alternative cancer therapies.
The thriving sub-industry of alternative Tijuana cancer clinics relies primarily on palliative care licenses to operate, a end-of-life-care-focused designation that seems somewhat sinister when it’s hidden behind promises of miracle cures. In looking beyond those promises, MacDonald’s investigation finds an interesting mix of chicanery and genuine good intentions, but ends on a familiar, cautionary note.
I have been fortunate in that I have successfully emerged from my own treatment for breast cancer, so I completely understand the desperation that people will feel when they are told their condition is terminal. It is a death sentence. I understand why many patients or their families will begin to scour the internet in search of a cure and will seize on anything that offers hope. However, as our investigation has shown, at least some of the Tijuana clinics are offering nothing but false hope. There is little or no evidence to support their claims that their strange therapies actually work and there is plenty of evidence that vulnerable people have parted with large sums of money for no reason.
Share your thoughts on database design for tracking pharma payments to doctors
Filed under: Government, Health care reform, Health data
Curtis Brainard of Columbia Journalism Review reminds reporters that their input is needed on the design of a federal database that will track payments from drug and device makers to doctors.
Investigations and databases, such as Dollars for Docs by Propublica, have revealed payments to doctors who had been accused of professional misconduct, had been disciplined or lacked credentials. Researchers have found evidence that payments can influence doctors’ treatment decisions (PDF).
Provisions in the Affordable Care Act mean that companies will have to report such payments to the Centers for Medicare & Medicaid Services, which will post the data on a public website. CMS has asked for “comments on how to structure this Web site for ultimate usability.”
There are a number of ways to submit your comments, detailed in this Federal Register announcement. Comments must be received by 5 p.m. EST on Feb. 17.
PLoS Medicine article advocates using legal system to stem ghostwriting
An essay published by PLoS Medicine makes the case that the “guest” authors of ghostwritten articles – typically academic researchers who provide little or no input – in medical journals should be held legally liable for damages or deaths caused by the drug or device that is the subject of articles they sign their names to.
The article points out that ghostwriting “openly infringes academic standards and … contributes to fraud” but that journal editors have been ineffective at putting a stop to it.
We argue that when an injured patient’s physician directly or indirectly relied upon a journal article containing false/manipulated safety and efficacy data, then pursuant to the legal authority outlined above, the authors of that article, including guest authors, are legally liable for patient injuries and could be named as defendants.
Xavier Bosch, Bijan Esfandiari and Leemon McHenry, authors of the PLoS Medicine piece, even endorse the theory that the Racketeer Influenced and Corrupt Organizations Act (RICO) could be used, something that was mentioned in an article last year. Other recourses the authors recommend include the False Claims Act and the Anti-Kickback Statute.
Web outlet pumps out dozens of stories on prescription drug abuse
Filed under: Health journalism, Health policy, Hot Health Headline, Pharmaceuticals, Public health
In partnership with USC’s Annenberg School for Communication & Journalism and a number of other organizations, Santa Barbara online news outfit Noozhawk (about), put together “Prescription for Abuse,” an exploration of the misuse and abuse of prescription drugs in the Santa Barbara area.
In the extensive, online-only series, the reporters take a look at the problem and its underlying causes, then go a step further by exploring possible solutions as well.
In a uniquely meta twist, the series even looks at how journalism such is advancing public health goals and explains how the project came together. The series features at least 36 individual articles, by my count, and every health journalist who takes the time to browse the full catalog will come across at least a few easily localizable ideas, but in this space I’ll just highlight those stories that deal directly with the series itself:
- USC, California Endowment Unite to Support Health Journalism at the Source
- Bill Macfadyen: Prescription for Abuse Project Is a Series of Opportunities
- Santa Barbara Teen News Network Adds Another Dimension to Prescription Drug Abuse Series
- Annenberg Fellowships Take a Diverse Approach to Community Health Journalism
- Bill Macfadyen: Noozhawk Earns a USC Annenberg Health Journalism Fellowship
- Noozhawk Journalists Recount Lessons Learned from Prescription Drug Abuse Series
‘Every day is an improvisation’ when caring for aging relatives
How many of us have seen problems with older relatives that we’ve looked away from, not wanting to acknowledge their seriousness or fully face the consequences?
There’s a word for this: denial. And there’s a good example of how it can affect family decision making in the current issue of the Journal of the American Medical Association. [Note: AHCJ members have free access to JAMA.]
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
It’s a personal story written by Carolyn Cannuscio, a social epidemiologist who studies aging, about her beloved 96-year-old grandmother, Nana.
After a nasty fall, Cannuscio and her mother move Nana from Florida to a Pennsylvania assisted-living facility that they had visited often and checked out with some degree of thoughtfulness.
“We grilled the staff about their services, the environment, and the nature, costs and limits of care my grandmother would receive there,” Cannuscio writes. “We were assured by the credible marketing director on multiple occasions that this would be the last move Nana would ever have to make.”
What a reassuring promise. If only it were true.
Cannuscio and her mom soon find that the facility is unprepared for Nana’s arrival, with “no clear plan for her daily care, no bedroom door, and – most importantly – no grab bars in the bathroom.” What? They didn’t make sure these plans were in place before Nana stepped on the airplane that took her away from Florida?
It gets worse – right from the start.
We quickly learned that the facility was so understaffed that Nana would be neglected on the standard care plan. We saw residents stranded in wheelchairs in random spots in the hallway, hoping for a generous guest or a more able-bodied resident to guide them to dinner. We then accompanied Nana to dinner ourselves and saw residents waiting unattended and unfed for long stretches, until they were addressed rudely by the harried wait staff.
Where were these alarming signs when Cannuscio and family members visited the facility in advance of her grandmother’s move?
As it turns out, they were hiding in plain sight. Searching the Internet, Cannuscio had come across a report from the state health department that apparently showed problems with the facility’s sanitary practices. And during a visit, she’d been taken to an apartment reeking of “cat excrement” that was home to a “disoriented, disheveled man who clearly needed more help than he was getting.”
Yet, hope prevailed: hope that this squalid apartment was an aberration, that Nana would get the care she needed, that this difficult move would prove satisfactory in the end.
Hope such as this is entirely understandable. But in this case, it led to denial: a refusal to give adequate consideration to evidence that this assisted-living facility wasn’t what it was claiming to be. After Cannuscio acknowledged that, she was distressed to discover that no federal standards govern assisted-living facilities.
In the end, however, she lays blame on “my fantasy that all of our elder care problems would be solved” with the move to assisted living.
Indeed. As older people become frail, like Nana, problems abound and there is no foolproof solution. Not if the older person is cared for at home, not if they’re in assisted living, not if they’ve moved to a nursing home. Daily challenges exist in all these settings and, as Cannuscio notes at the beginning of her piece, “every day is an improvisation.”
It’s our job as journalists to bring these challenges into the public realm, where they can be seen clearly and understood in context. Our hope is that the material going up now and in the months ahead on AHCJ’s aging web resource – information about assisted living facilities and nursing homes, on long-term care and caregiving, on aging-in-place and home care – will help as you pursue these kinds of stories in your communities and make it harder to deny the very real problems that so many seniors face.
NYT series digs into overprescription and developmentally disabled adults
Filed under: Health journalism, Health policy, Hot Health Headline, Pharmaceuticals, Public health, Public records
In the series Abused and Used, New York Times reporter Danny Hakim and a host of his colleagues have been investigating how public resources are used to treat developmentally disabled New Yorkers. The series is ongoing, but hit an inflection point with the publication of Hakim’s piece on the few-strings-attached use of very powerful drugs to treat some of the state’s most vulnerable adult residents.
Developmental disabilities, Hakim writes, often manifest themselves in ways that are easily mistaken for mental illness, and these misdiagnoses can lead to unnecessary or improper medication. “In fact,” Hakim writes, “developmentally disabled residents of group homes in New York are more likely to be given Ativan, an anti-anxiety drug that has a tranquilizing effect, than multivitamins, the records show.”
Hakim’s reporting is rich with both anecdotes and data. These paragraphs from the series will give you an idea of how he approached the issue.
Tens of thousands of powerful pills created to treat serious mental illnesses like schizophrenia are given to developmentally disabled people in the care of New York State every day.
…a review by The Times of previously unreleased records, as well as interviews with state employees, clinicians, family members and outside experts, reveals that the psychotropic medications, which alter the brain’s chemistry, are often dispensed sloppily, without rigorous or regular review, by general practitioners with little expertise in the area.
And low-level workers at state group homes are frequently given discretion to increase the medication “as needed,” despite their lack of significant training.
Psychologists who have worked inside the system describe a culture in which the drugs are used to control the disruptive behavior of the developmentally disabled — people with conditions like autism, Down syndrome and cerebral palsy — an approach increasingly discredited in the field.
Reuters shows how shell companies hide Medicare fraud in plain sight
Filed under: Government, Health care reform, Health data, Health journalism, Hot Health Headline, Public records
Reporting for Reuters, Brian Grow and Matthew Bigg used an analysis of public data to investigate the practice of using shell companies to defraud Medicare of millions while staying a step or two ahead of federal investigators.
While the specific damage inflicted by shell companies has not been tracked, “Last year, ‘improper payments’ resulted in $48 billion in losses to the Medicare program, nearly 10 percent of the $526 billion in payments the program made, according to a Government Accountability Office report last March.”
“Simply by reviewing the incorporation records of Medicare providers in two buildings” in Miami, they write, “reporters uncovered information that one government official said could prompt “a serious criminal investigation” of some of the companies.”
The fraud rings merge stolen doctor and patient data under the auspices of a shell company and then bill Medicare as rapidly as possible. Other shell companies are often layered on top to camouflage the fraud, law enforcement officials say.
Some of the shells purport to be billing companies; they form a buffer between the sham clinics and Medicare. Others pay kickbacks to doctors and patients who sign off on bogus medical claims or sell their Medicare ID numbers to enable the shell company to bill the government. Still other shells act as fronts to launder the profits.
The key to this kind of fraud, known as a “bust-out” scheme, is for each of the fake companies to bill as much as possible before authorities catch on. Shell companies become a tool that helps keep the crooks ahead of the cops.
The Armenian crime ring whose fraud made headlines last year used 118 shell companies in 25 states and bilked the feds out of at least $100 million. Varying incorporation rules make state-hopping and obfuscation “easy,” they write, especially since states don’t check to see if records are legit before they allow a company to incorporate. The reportes found that even a few simple safeguards would go a long way to detecting the boldest frauds.
In Florida, FBI agents say almost every Medicare fraud scheme involves shell companies. There, Reuters scrutinized incorporation documents for firms located in two buildings near the Miami International Airport. In a building with dimly lit corridors, a rickety elevator and almost no one in sight, a host of companies purport to provide services to Medicare recipients. But telltale signs of fraud abound.
Many of the 26 companies in the buildings had replaced corporate officers at least once in the last four years. Some had changed ownership, or their corporate executives represented more than one medical-related company. Law enforcement officials consider such activities to be red flags for fraud.
For its part, CMS told the reporters it simply didn’t have the resources necessary to conduct the widespread audits needed to catch fraud, though the $350 million allocated to such efforts under the 2010 health reform law should help.
Health journalists who will certainly want to review the “methodology” subheading at the end of the story.
See, follow AHCJ’s newest members
Please welcome AHCJ’s newest members. All new AHCJ members are welcome to stop by this post’s comment section to introduce themselves.
- Orly Avitzur, medical editor, Consumer Reports, Tarrytown, N.Y. (@OrlyA)
- Massimo Cecaro, national councillor, Italian Association of Medical Press, Macerato, Italy
- Sylvia Davis, senior editor, WebMD, Atlanta
- Ira Dinerman, independent journalist, Brooklyn, N.Y.
- Marissa Donovan, student, Syracuse, Rensselaer, N.Y. (@MarissaDonovan1)
- Helen Driediger, independent journalist, Bancroft, Ontario, Canada
- Micky Duxbury, independent journalist, Berkeley, Calif. (@mickydux)
- Lisa Eramo, independent journalist, Cranston, R.I. (@Lisa_Eramo)
- Sari Harrar, independent journalist, Quakertown, Pa.
- Laura Kebede, student, University of Missouri, Columbia, Mo. (@kebedefaith)
- Martin Kilgus, editor, SWR Public Radio, Stuttgart, Germany
- Beth Kitchin, assistant professor, University of Birmingham, Nutrition Sciences, Birmingham, Ala.
- Ricki Lewis, independent journalist, Scotia, N.Y. (@rickilewis)
- Teresa Mahoney, student, Columbia University, New York (@TheresaMahoney)
- Matt McMillen, independent journalist, Portland, Ore.
- Becky Oskin, independent journalist, Davis, Calif.
- Bonnie Schultz, independent journalist, Princeton, N.J.
- Lesley Simon, independent journalist, Westfield, N.J.
- Kavin Sundaram, student, University of Iowa, Cedar Falls, Iowa
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.
Journalists should learn about study design, evidence-based medicine
Filed under: Health data, Health journalism, Studies
Earlier this month I saw on Twitter one of those collisions between journalism and wonkdom. Maybe “collision” isn’t the right word; maybe it was some kind of interspecies mating dance. Anyhow, the gist of it was that we, journalists, don’t know how to evaluate evidence and someone should step in and teach us.
So I stuck in my two cents (or, rather, my two tweets) pointing out that, yes, there is a need for training and, yes, there are places to get the training, including through AHCJ. (See more after the Twitter discussion.)
So, before I remind you about those resources, just a word on why we need them:
On the surface, it may seem that AHCJ houses two kinds of health journalists – those of us who report on the science side of things, and those of us who are more in a policy world. But some of us do both – and research/evidence/evaluating science are also becoming an increasing part of the underpinnings of policy beats. Value-based purchasing, comparative effectiveness, benefits of screening/prevention, quality measures, outcome research … these are all part of the health care reform story.
That doesn’t mean all of us must become economists/biologists/epidemiologists/statisticians. Old fashioned reporting – including calling experts who can help us make sense of numbers – is certainly part of the job. But it’s also good to have some sense of what the experts are talking about, what these numbers mean. Why a study on N=16 patients doesn’t really tell us that much. What do we mean by “endpoints,” “outcomes,” “progression?” What’s relative versus absolute risk? Etc.
So for those of you who haven’t taken a cyber-stroll through the AHCJ website, take five minutes and check out tip sheets, resources and slim guides. Of particular relevance to this discussion is Gary Schwitzer’s slim guide, “Covering Medical Research.” There’s also a tip sheet/PDF presentation by Schwitzer on “Understanding studies.” His Health News Watchdog blog is also useful.
Reporting on Health (at USC) also has a lot of useful resources, and this essay “Tricks of the Trade: Finding Nuggets in the River of Medical Studies” is a good entry point to understanding data. It’s by Lauran Neergard, a longtime Associated Press health and science writer.
In addition, there’s a course called Medicine in the Media, sponsored by National Institute of Health’s Office of Medical Applications of Research. It’s free, but you have to apply, and there’s not room for everyone. I know of at least one recent summer (the only one I, personally, could have managed the timing!) it wasn’t given, and as of now, there’s nothing on the website about this year. But you can sign up for email notifications, so if you are interested, do that now because the deadline in past years has been early.
The Poynter Institute has some online modules, too. Lots of the focus is on new media and writing and story telling, but there is a math basics refresher for those of you who haven’t taken it since the SATs, some online Excel training, and a unit on reporting on nonprofits
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Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
