Project follows the race to make bagged salad safer
The latest investigation by California HealthCare Foundation Center for Health Reporting’s Deborah Schoch will make you think twice before ripping into a sack of spring mix, but her work about the myriad food safety challenges posed by bagged salads examines the industry’s struggle to develop technology powerful enough to overcome the existential threat posed by E. coli and friends.
The industry has made great strides since a 2006 outbreak linked to tainted spinach, she writes, but “It’s impossible to stop all pathogens from landing on lettuce and spinach leaves.” And once they’re on the leaves, it seems as if their spread is almost inevitable. They hide in gooey biofilms and resist powerful washes.
Thousands upon thousands of salad leaves are taken to a central plant, washed together, bagged and shipped. Even if only a few leaves are tainted, harmful pathogens can spread in the wash water — the modern salad version of the old adage that one bad apple spoils the whole barrel.
“I would think of it as swimming in a swimming pool in Las Vegas with a thousand people I didn’t know,” said William Marler, a prominent Seattle-based food safety attorney.
Plenty of public and industry money has been aimed at the problem, Schoch writes. “The Center for Produce Safety at UC Davis, founded in response to the spinach outbreak as an industry-public partnership, has pumped more than $9 million into 54 research projects at 18 universities.”
Even the best research can’t reduce the risk of contaminated greens by 100%, scientists said. At Earthbound, Daniels says the ultimate goal is to achieve what scientists call a “5 log reduction,” the equivalent of pasteurizing milk. In short, if an unwashed lettuce contained 100,000 pathogens, the perfect wash system would knock off five “0s” and reduce the pathogen count to 1.
An added bonus? Schoch’s column on whether she (and the experts she talked to) feel like it’s important, or even salutary, to wash their bagged greens.
Poet’s piece on bias against elderly people serves as reminder to reporters
Anyone writing about older people with any seriousness will eventually confront the phenomenon known as “ageism.”
The great gerontologist Dr. Robert Butler, the first director of the National Institute on Aging, coined this term in 1968 to refer to prejudice against older people fueled by stereotypes about aging that often lead to discriminatory practices.
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 phenomenon that pervades medicine, as it does institutions across our society.
Think of a doctor who speaks to a middle-aged daughter who’s accompanied her elderly mother to a medical appointment, not to the older woman herself. It happens all the time.
Think of a hospital nurse who ignores an 80-something man’s increasing agitation and disorientation because of the assumption that it’s natural for older people to be irritable and confused. Talk to families and you’ll hear such stories.
Think of all the people 65 and above – the numbers are untold – who have been told over the years that their medical problems are to be expected because, after all, they’re old and there’s not much to be done about that.
I’ve found myself thinking about all this because of a four-page article by the great American poet Donald Hall in the Jan. 23 issue of The New Yorker.
It’s a lyrical piece about reaching the age of 83, coming to know the rhythms of this stage of life, and feeling connected with others who have traveled the journey of age before him.
Intermingled with Hall’s memories of his mother in her final years are his unsparing observations about himself:
“Each season, my balance gets worse, and sometimes I fall. I no longer cook for myself but microwave widower food, mostly Stouffer’s. My fingers are clumsy and slow with buttons. … For years, I drove slowly and cautiously, but when I was eighty I had two accidents. I stopped driving before I kill somebody … New poems no longer come to me, with their prodigies of metaphor and assonance. Prose endures. I feel the circles grow smaller, and old age is a ceremony of losses.”
Becoming advanced in years, Hall writes, involves a process of becoming an “alien” – another type of life form, different from everybody else. He doesn’t use the word “ageism” but describes its effect.
“When we turn eighty, we understand that we are extraterrestrial. If we forget for a moment that we are old, we are reminded when we try to stand up, or when we encounter someone young, who appears to observe green skin, extra heads, and protuberances.
“People’s response to our separateness can be callous, can be good-hearted, and is always condescending.”
Describing his reaction to a woman who has written to the local newspaper calling Hall a “nice old gentleman,” Hall says, “Old is true enough, and she lets us know that I am not a grumpy old fart, but ‘nice’ and ‘gentleman’ put me in a box where she can rub my head and hear me purr. Or maybe she would prefer me to wag my tail, lick her hand, and make ingratiating dog noises.”
Yes, there is a note of bitterness, as in several other incidents of being unconsciously ignored or put down that Hall relates. It’s the sharpness of his voice here – a contrast to the poetic sensibility that pervades the rest of his piece – that reached out and grabbed me and made me realize, yes, this slicing, grating, isolating sense of otherness is what ageism feels like.
As reporters, be aware of this potential for treading on feelings when you speak to older people. Don’t patronize, don’t be condescending. Try to understand their experiences from their point of view, not your own. Learn about what their lives are like by listening with respect and attentiveness. And watch out for ageism in the institutions and professionals you cover and in the words that you write.
Study: Good press releases contribute to good health journalism
Thanks to Gary Schwitzer for drawing attention to a study, published in BMJ, which analyzes the impact medical journal press releases have on actual press coverage of studies.
The authors begin with a somewhat gratifying hypothesis, writing that “Although it is easy to blame journalists for poor quality reporting, problems with coverage could begin with the journalists’ sources,” and positing that difficult-to-decipher studies and misleading press releases could lead to low-caliber health reporting.
They looked at 100 studies from five major journals, as well as a sample of 348 news stories based on those studies. In general they found that higher-quality press releases led to higher-quality coverage. Unfortunately, they also found that the inverse was true. Here’s an excerpt from the “Discussion” subheading (also highlighted by Schwitzer).
…Higher quality press releases issued by medical journals were associated with higher quality reporting in subsequent newspaper stories. In fact, the influence of press releases on subsequent newspaper stories was generally stronger than that of journal abstracts. Fundamental information such as absolute risks, harms, and limitations was more likely to be reported in newspaper stories when this information appeared in a medical journal press release than when it was missing from the press release or if no press release was issued. Furthermore, our data suggest that poor quality press releases were worse than no press release being issued: fundamental information was less likely to be reported in newspaper stories when it was missing from the press release than where no press release was issued at all.
Reporters looking for a Health News Review-style “how do I ensure my story clears their quality bar?” checklist can just scroll down to the “Quality Assessment” subheading. For the record, the metrics found there apply equally well to the PR professionals who write the releases.
Programming errors led to overdoses with pain-medicine pumps
Building off a state health department report showing that, as The Morning Call’s Tim Darragh wrote, “Nurses at St. Luke’s Hospital three times in 2010 and 2011 improperly programmed patient-controlled pumps to deliver pain medication, causing patients to overdose themselves,” Darragh dug deep into each incident, uncovering patient details and adding perspective to the errors, which were severe enough that the feds decided the hospital’s patients were in “immediate jeopardy” until steps were taken.
Photo by Felix42 via Flickr.In each of those cases and in three others, the nursing staff failed to document the errors properly, state investigators found.
Employees told the investigators that St. Luke’s did not require annual competency training on the pumps. Unnamed employees offered conflicting statements about when and whether all the staff had received retraining in 2010.
For their part, hospital officials say they have bought new patient-controlled pumps, developed a restricted dosage plan and retrained staff.
“When St. Luke’s nursing staff members identified the dosing pump programming issues, the events were promptly reported to all the appropriate individuals and regulatory agencies as outlined in our Network Patient Safety Plan,” said Carol Kuplen, chief nursing officer for St. Luke’s Hospital & Health Network.
“There was complete transparency in these events,” she said in an interview Thursday.
Related
Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, appeared at a newsmaker briefing at Health Journalism 2010 to announce an FDA initiative to reduce risks associated with infusion pumps. Log in to the AHCJ website to see his presentation and listen to his announcement.
- Press release: FDA Launches Initiative to Reduce Infusion Pump Risks
- FDA page on infusion pumps and FDA’s new safety initiative
- White Paper: Infusion Pump Improvement Initiative
- Guidance for Industry and FDA Staff - Total Product Life Cycle: Infusion Pump - Premarket Notification [510(k)] Submissions
- Letter to Infusion Pump Manufacturers
- Public Meeting: Infusion Pump Workshop, May 25-26, 2010
- Generic Infusion Pump Project
Experts offer story ideas for covering health reform
Filed under: Health care reform, Health journalism
More than 30 attendees heard local experts sketch the particular challenges and issues presented by the Affordable Care Act in California in the latest “Implementing health reform in the states” panel, hosted by AHCJ’s San Francisco Bay Area chapter on Wednesday night at the San Francisco Chronicle.
The panel, one of a series sponsored by AHCJ, the Alliance for Health Reform and the Robert Wood Johnson Foundation, began with an explanation of exchanges and what’s happening with their implementation (or lack thereof) around the country by Larry Levitt of the Kaiser Family Foundation.
He posed some story ideas, such as: How vigorously will the states promote enrollment through the exchanges? What sort of variations to the ACA might emerge once states have the ability to ask for waivers in 2017?
Kim Belshe, a board member of the California exchange, and Marian Mulkey of the California HealthCare Foundation discussed the California scene, with lots of detail, touching on the state’s large undocumented immigrant population, the challenge of getting people enrolled (since the law of the land is now “performance” – which means maximum participation), new opportunities for medical professions, such as nurses, to fill gaps in care delivery, and how to ensure coordinated care during the transition period to exchanges so no patient is harmed. This is the accountability part of the ACA, and needs thought and new procedures, Belshe stressed.
Belshe noted that Medicaid (Medi-Cal) is the foundation of reform, a subject which reporters sometimes overlook. Both she and Mulkey noted that California is a national pacesetter when it comes to reform implementation - a story idea in itself.
The session was moderated by Ed Howard, executive vice president of the Alliance for Health Reform.
On Tuesday night, a similar briefing was held at the University of Southern California, featuring Walter Zelman, Ph.D., a professor and director of health science at California State University-Los Angeles; Daniel Zingale, senior vice president of the Healthy California program at The California Endowment; Anthony Wright, executive director for Health Access, a California health care consumer advocacy coalition; and Deborah Crowe, the health care and biotechnology industry reporter for the Los Angeles Business Journal. Howard, of the Alliance for Health Reform, moderated the session.
Zelman posed a number of questions about reform, mostly about exchanges. To a reporter from Orange County, he suggested a story about the origin of the individual mandate – an idea championed by Republicans early on, he noted, and opposed by Obama and many Democrats. To a question about accountable care organizations and bundling, he suggested stories about how fee-for-service medicine is anything but dead.
Wright offered a look at what’s happening in Sacramento, including a hearing held just a few hours before the briefing.
Zingale mentioned the importance of prevention, and how the ACA encourages prevention. He too pointed out how nonprofits in the state can team up with reporters to educate people about the ACA. He said that the more people know about the law, the better they like it.
From a reporter’s perspective, Crowe offered several practical story ideas that reporters can start writing about today.
John Gonzales of the California HealthCare Foundation Center for Health Reporting wrote about the panel and Michelle Levander of the California Endowment Health Journalism Fellowships program offers some of the story ideas mentioned by the panelists.
Special thanks to Colleen Paretty, chair of the Bay Area chapter, and Bill Erwin, of the Alliance for Health Reform, for contributing details about the panel discussions for this post.
Recognizing best health journalism can be inspiring
One of the best things about working at AHCJ is the chance to see the broad range of really strong coverage our members produce.
Whether I’m reading stories about the ways money influences how medicine is practiced, uncovering the mistreatment of vulnerable people, looking at how pollution is affecting public health or investigating flawed health care systems, I am consistently awed by the work health journalists are doing.
I have the opportunity to see this work day in and day out, which is what helps keep me optimistic about the future of journalism. No doubt, we face many challenges, but take a look at the winners of last year’s Awards for Excellence in Health Care Journalism and I promise you will feel better about our business.
That’s why I want to encourage everyone to submit entries for this year’s contest. We re-vamped the categories this year to reflect changes in how news content is being delivered. We recognize that great reporting is being done across platforms and through new partnerships and collaborations.
We want to honor that reporting and make sure the rest of the world sees the value in independent, quality coverage of health and health care issues. Please consider entering your best work of 2011 and encourage your colleagues to do so as well so we can share it and we can learn from it.
Entries must be submitted by 5 p.m. ET this Friday, Feb. 3. Our online entry system makes it easier than ever and our contest committee is standing by to answer last-minute questions.
Leaded aviation fuel a threat to public health, children
Filed under: Children, Health data, Hot Health Headline, Public health, Public records
KUOW’s John Ryan used federal data and a few key sources to delve deep into issues surrounding one of the few remaining sources of airborne lead in the United States, a leaded aviation fuel known as “avgas.” In the process, he reveals damage that even low levels of lead exposure could be doing to children.
Avgas accounts for less than 1 percent of the nation’s liquid fuel use. Yet enough piston–engine planes fly enough miles on avgas to belch out half of all the lead going into the nation’s air.
Lead paint in old buildings remains a bigger threat, but even low levels of childhood exposure, one source tells Ryan, can manifest itself in “Decreases in IQ, changes in test scores, changes in attention, hearing threshold, all sorts of things like that.”
Earlier this month (January), an expert panel advising the Centers for Disease Control and Prevention cut in half the levels of lead in children that should alarm parents or doctors. Researchers have yet to find any level of lead exposure that doesn’t cause harm.
Michael Kosnett, a medical toxicologist at the University of Colorado, told Ryan, “In any one child, it’s not something that’s going to necessarily cause them to display any kind of signs and symptoms. But if you can lower the lead exposure of a population of children, you’re going to give that population more of an opportunity to have gifted children and to have children who have higher IQs, and that’s certainly a desirable public health goal.”
Marie Lynn Miranda, an environmental health scientist and a dean at the University of Michigan, points out that “Living close to an airport can increase your blood lead level anywhere from 2 to 4 percent,” acknowledging that is a small amount but that evidence indicates even small amounts of lead are bad. She also notes that “lead is especially a problem for the low–income families that are most likely to live near airports.”
Pilots who still use avgas say their businesses would be dead in the water if they couldn’t get the leaded fuel, an argument Ryan contrasts with quotes from a Europe-based lead-free avgas producer, who sells it for 40 cents less a gallon, but hasn’t been able to break into the U.S. market “Because no one thinks that there will be demand for an unleaded–grade aviation gasoline.”
The federal database Ryan used, The National Emissions Inventory, is posted online by the EPA.
Investigation delves into Wash.’s prescription drug problem
Filed under: Aging, Children, Europe, Government, Health care reform, Health data, Health policy, Hot Health Headline, Pharmaceuticals, Public health, Public records
Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.
Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.
The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”
Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.
Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”
She drills down into many of those causes, with my personal favorites being two key origin stories:
- How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
- How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”
See the upper right-hand sidebar for more stories from the six-month investigation.
Article looks at reform concepts put into practice
Filed under: Health care reform, Hot Health Headline
Here’s a recent story that touches on a whole lot of themes in health reform – without getting bogged down in a lot of jargon. Value-based purchasing. Evidence-based medicine. Shared decision-making.
Jackie Crosby of the Minneapolis Star-Tribune writes about how a Minnesota insurer, HealthPartners, has introduced a new approach for patients with low back pain. Before they get surgery, they have to get a consult on nonsurgical alternatives.
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. If they still opt for surgery, they can have it. But the thinking is (based on what other health systems have learned) that many will opt for physical therapy and rehabilitation once they learn more about the pros and cons, risks and benefits, of all their options.
“Patients can still see a surgeon if they wish. But after this visit, they’ll be better informed about all of their options, and can make decisions more aligned with their own values,” the story quoted Dr. Thomas Marr, HealthPartners’ medical director of clinical relations as saying.
“In general, it’s a bad thing when the doctor and patient can’t determine the treatment without interference from the insurance company or the government,” spine surgeon Jeffrey Dick was quoted as saying. But this is an exception, he said. Surgery is appropriate for only about one out of eight low back pain patients he sees. Getting them into appropriate care from the start can save money – not to mention years of lingering back pain.
“These aren’t HealthPartners criteria,” he added. “These are treatment algorithms for low-back pain that we all should be following – but maybe haven’t been by all practitioners.”
The story also noted how HealthPartners is working with stakeholders and monitoring patient reaction and satisfaction to minimize criticism and misunderstandings.
So what are those health reform themes?
Value-based purchasing – loosely translated – is paying for what works.
Evidence-based medicine is what it sounds like – and the evidence is that a lot of back surgery is unnecessary. Sounds simple but it’s not always practiced – even in those cases where the evidence is strong. Sometimes it’s even derided as “cookbook medicine.” Financial incentives are certainly one big impediment: surgeons, hospitals, etc., make money from procedures that may not always be the best choice for the patient. Practice patterns – how physicians are taught and what’s done in the medical culture of a given hospital or community – play a role. And patients often want treatments they don’t need because they don’t understand that it’s not necessary, or they think surgery is a reliable quick fix.
Some researchers exploring medical decision-making have found that physicians are a lot more likely to talk about why to have a certain procedure, including back surgery, than why not. Clinicians and researchers are beginning to develop models for “shared decision-making” and there’s even a bit of language in the health reform law to promote it.
So are there programs like this rolling out in your local hospitals or health plans? We’d like to hear more. It will be interesting, too, to watch how people react to the HealthPartners and similar ventures. Will patient/beneficiary attitudes begin to change? Will they come to understand that more isn’t always better? Will they be glad to find out they really don’t need surgery? Or will there be a backlash about choice and control. The answer may depend on whether patients feel the decision is shared, or imposed.
On balance: Lazar explains a little-discussed fundamental fact of aging
It’s not easy to write well about the nitty-gritty details of aging – the wear and tear on bones and joints, the deterioration of seeing and hearing, the gradual onset of frailty in barely observable increments.
But everyone encounters this when they’ve lived long enough; physical decline is a fundamental part of the aging experience.
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.
That’s why Kay Lazar of The Boston Globe deserves kudos for her story on balance problems in older adults, a common, seemingly mundane condition that hasn’t received much attention.
The consequences can be serious: when balance is compromised, seniors become at risk of losing their mobility or falling, potentially precipitating a cascade of other medical problems.
Lazar’s explanation of why older people become unsteady on their feet is graceful and easy to understand:
“A person’s sense of balance relies on an exquisite interplay of three regions, your vision, a maze-like structure in the inner ear which includes microscopic cells that resemble little hairs, and the muscles and joints running from your feet, up through your spine, that sense your body’s position.
All three areas send signals to your brain, which processes the information, and helps give you a sense of spatial orientation - your balance.
As we age, eyesight fades, as do our muscles’ ability to sense surroundings. Meanwhile, the hair cells in the inner ear die off and do not regenerate. These declines combine to throw off the signals to your brain about your balance.”
Her description of “four flavors of dizzy” - the feeling of blacking out, unsteadiness, spinning, or lightheadness - almost surely will help older adults and their families recognize symptoms that may require medical assistance.
That’s why a story like this is valuable. By talking openly about a problem that usually passes under the radar screen, it expands our sense of alertness to older people and difficulties they may experience. It makes seniors visible, not invisible as they so often seem to others.
Next time I see an older person hesitate at a curb before stepping down or stand stiffly in a crowd, nervous about moving in tight, confined spaces, I’ll think about Lazar’s article.
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
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- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- 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
