Myths obscure lack of health care for some Asians
Filed under: Health journalism, Hot Health Headline
A focus on “ethnic disparities” can obscure the fact that racial designations are so broad that the disparities within them are just as great as those without.
The latest example? The paper “Barriers to healthcare among Asian Americans,” [press release] by two SUNY Buffalo sociologists. The paper takes on the myth that Asian-Americans are a well-adjusted, monolithic “model minority,” particularly when it comes to access to health care. Instead, language, health literacy, health insurance and immigrant status all conspire to push certain groups of Asian-Americans well below the national average.
Tapped’s Jamelle Bouie discusses the post, then adds a demographic summary to point out how Asian-American economic status can vary based on country of origin.
While Chinese, Japanese, and Korean Americans tend to do well when compared to their white counterparts, the same can’t be said of Vietnamese, Pacific Islanders, and Cambodians, as well as Hmong and Laotians. Among Vietnamese, for example, per capita income is $23,080 – compared with just over $30,000 for whites – with an overall poverty rate of 13.3 percent, compared to 10.5 percent for whites. Likewise, only 13.3 percent of Cambodians and a scant 9.3 percent of Laotians have a bachelor’s degree or higher, compared to nearly 30 percent of whites.
Indiana numbers show preventable errors down
The Indianapolis Star’s Daniel Lee reports that, according to the state’s newly released 2009 numbers, preventable medical errors are down in Indiana. There were 94 reported errors last year, down from 105 each in 2007 and 2008.
Part of the decline can be attributed to the health department’s Indiana Pressure Ulcer Initiative, which appears to have helped bring bed sore occurrences down 33 percent from 2008.
The initiative, which began in June 2008 and runs through September, focuses on improving hospitals’ systems for assessing risk factors for patients developing bed sores. Efforts have included in-person and online prevention training for hospital personnel.
The real story is the Indiana error numbers, which are wonderfully extensive. They’re broken down by condition (28 different serious errors), location and specific facility.
Related
- More on medical errors
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- Tip sheet: A road map for covering your local hospital’s quality
Conference presentations
- Arrogance without accountability? Where is the media? [Peter Pronovost | Watch an excerpt of his keynote address]
- The National Healthcare Reports, Ernest Moy
- How a Hospital Failed a Boy Who Didn’t Have to Die, Helen Haskell
- Citizens for Patient Safety, Patty Skolnik
- MRSA Survivors Network, Jeanine Thomas
- Improving patient safety through health information technology
AHCJ articles
- Medical misconnections: Patient-safety problems [About the project | Contest questionnaire]
- Experts discuss benefits, dangers of telemedicine
- Hospital patient safety initiatives borrow from transportation industry
- Specialty hospitals, surgery centers call 911 in emergencies
- Reporter documents surgical errors through public records
Is California’s prison health system really fixed?
Filed under: Health journalism, Hot Health Headline
After years of failing to prevent preventable inmate deaths, the California Department of Corrections health system was placed under a federal receivership in 2005. Soon after, state officials claimed that the system had reached an “acceptable standard,” and that they were ready to take control back from the feds.
Over the course of a year, Southern California Public Radio’s Julie Small has been digging deep into the system to determine if it’s really as acceptable as the Schwarzenegger administration claims. You can see the whole series here. There are five main installments, four of which come with sidebars. Everything comes in text and audio with a little video and photo mixed in.
- Part 1: California’s budget woes thwart improvements to prison medicine
- Part 2: Chino prison sees some improvements in medical care
- Part 3: California inmates still suffer from lapses in prison medical care
- Part 4: Vacaville’s California Medical Facility – The ‘gold standard’ for prison medical care in California
- Part 5: Fewer improvements planned for prison medical care
Chino Prison’s medical system from 89.3 KPCC on Vimeo.
ReportingOnHealth.org has a conversation with Small about the subject.
Related
Hear Small talk about her reporting process and the difficulties of covering prison health with our friends at Reporting on Health, and check out this related Q and A.
Conflicts of interest + off-label use = Blockbuster
Filed under: Conflicts of interest, Health journalism, Hot Health Headline
Medtronic is back at the FDA, asking for approval of another spine fusion product. Not coincidentally, the Journal Sentinel’s John Fauber is also hard at work, this time exposing the conflicts of interest and off-label applications which helped make Medtronic’s first spine fuser, Infuse, into a dubious blockbuster.
First approved for a relatively narrow application, Infuse now succeeds thanks to widespread off-label use. It’s key component is BMP-2, a protein which “essentially turned whatever it touched into bone,” Fauber writes.
One recent study found a fourfold increase in the use of all BMP products in five years, from 24,000 procedures in 2003 to 103,000 in 2007. About 85% of that was off-label use, according to the study, which was presented in March at an orthopedic surgery meeting.
If you’re wondering what problems could result from all of these applications, Fauber’s got a story for that too.
According to Fauber, the 2002 Infuse introduction was straight out of the classic drug industry playbook:
First, a buzz is created about a potential new therapy. Then, research - often by doctors with financial ties to the product - is presented to the FDA for a specific use in a narrow group of people. Once the product is on the market, other uses for it are promoted in articles and presentations, often by doctors with financial ties to the company.
And it’s those financial ties, of course, that Fauber is determined to ferret out. He starts with a man whose name (and photo) will already be familiar to Fauber fans: Thomas Zdeblick.
Conflicts of interest involving Thomas Zdeblick, a prominent surgeon at the University of Wisconsin-Madison, are at the heart of the BMP-2 story. He and a small group of doctors from around the country with financial ties to Medtronic have paved the way toward the product’s approval and widespread use.
Zdeblick holds patent rights to a key component of the product and has received more than $22 million dollars in royalties and other payments from Medtronic since 2002. He also is co-author of research reports about the pivotal FDA clinical trial that led to the approval of Infuse.
When Infuse was first approved, it was noted that physicians with financial ties to Medtronic produced results twice as good as those of their independent counterparts. At the time, the panel dismissed it with a joke about how every physician should have a stake in Medtronic, as it sure seemed to improve outcomes. When Fauber tried to find out more about these early concerns and disclosures, however, he ran up against a wall of FDA obfuscation, intentional or otherwise.
The FDA redacted sections of its 2001 file listing the financial disclosures of the Infuse investigators, and it repeatedly told the Journal Sentinel that information no longer was available.
An FDA spokesman first e-mailed this reply: “The information you are asking for was part of the sponsor’s presentation and FDA did not require submission nor did the agency maintain copies.”
Then Friday, a different FDA official said the agency erred and the records were available, but they would be difficult to find.
With a similar BMP-2 based Medtronic product, Amplify, now under consideration, the story of Infuse is more relevant than ever.
Related
- Article looks at evidence behind back surgery
- Uncovering conflicts of interest in medicine, research
- Journalists encounter obstacles in identifying conflicts of interest in medical research
‘Main Street’ informed, skeptical on health reform
In her blog on CJR.org, AHCJ Immediate Past President Trudy Lieberman updates what is becoming an annual franchise: Her summer man-on-the-street column gauging popular opinion on health reform. Just like last year, Lieberman found her subjects on the streets of Columbia, Mo., a town that’s about as close to the (population) center of the United States as you can get.
The common thread? Missourians were pretty sure health care reform wasn’t all it was cracked up to be, but still weren’t willing to vote “yes” in the state’s referendum on opting out of the individual mandate.
Lieberman added a concrete dimension to her main street opinions by prying details on income and expenses from her sources, numbers and ideas which she then used to link their stories to the larger themes surrounding reform implementation.
Keep an eye out for part two of the column, which should be coming soon.
Hospitalist: What health journalists should know
R. W. Donnell, an Arkansas hospitalist with a long-running blog and a few burrs in his saddle, has outlined what amounts to an exam for health care journalists. It’s based on the assumption that journalists should have some prerequisite knowledge before tackling difficult scientific issues. But, instead of just grumbling about the “lay press,” the man who calls himself “Dr. RW” takes the next step and actually writes the first draft of such an exam. As you might expect, it’s an eclectic document.
Photo by thegirlsmoma via FlickrMost of the questions address specific pieces of scientific knowledge and vocabulary, presumably the bits that Donnell has found to be most difficult for journalists, including:
- Scientific method
- DNA vs. RNA
- Define and distinguish: humoral immunity, cell mediated immunity, innate immunity, acquired immunity
- Describe Medicare’s prospective payment system and the financial conflict of interest it causes
Mixed in with the pop-quiz style questions are a few broader queries that seem to be staples of just about any AHCJ gathering, as they point to the fundamental dilemmas of the profession:
- Explain the hazards of examining scientific questions in the arena of public debate.
- Explain why scientific progress does not lend itself to sound bite reporting or “news of the day” journalism.
Likewise, there are others that should be familiar to any member who’s heard one of AHCJ’s leading voices deliver an introduction to health journalism:
- Define: relative risk reduction, absolute risk reduction, number needed to treat.
- Explain the difference between clinical significance and statistical significance in clinical trial results.
- Explain why consideration of biologic plausibility is important in the evaluation of health claims and why evidence based medicine often fails when biologic plausibility is not taken into account.
In the end, he admits that the list “is by no means comprehensive or even realistic,” and invites others to contribute. It’s a goofy mix of questions, but I’d be surprised if I was the only one who was mentally grading himself throughout the entire exercise.
Society ‘snookered’ by research that isn’t new
Peggy Peck of MedPage Today found that research presented as new at the European Society of Cardiology’s annual meeting this weekend was actually published in July, despite the society’s requirement that information submitted for presentation must be new, unpublished data.
When asked by MedPage Today to point out the “news” in the Hot Line presentation, STAR lead investigator Bodo-Eckehard Strauer, MD, of the Heinrich Heine University of Düsseldorf, Germany, said the news was that bone marrow cell therapy significantly improved survival in patients with chronic cardiomyopathy, which he illustrated with a slide showing a Kaplan-Meier curve – the same graph that was published in the July issue of the European Journal of Heart Failure. Moreover, every data slide in Strauer’s presentation matched the tables in the published paper.
Following questions from MedPage Today, the organization acknowledged its error and has announced the researcher will not be allowed to present at its meetings for two years. Roberto Ferrari, M.D., president of the society, said the research had been accepted for presentation because they thought it had new data but that “We were snookered.”
Gays excluded from clinical trials
Thanks to an awards announcement from the National Lesbian & Gay Journalists Association, we just noticed Jen Colletta’s story in the Philadelphia Gay News about the exclusion of gays from clinical trials. Colletta won an Excellence in News Writing Award. The exclusion of gays in clinical trials is an issue that hasn’t received much mainstream attention, apart from a letter from Colletta’s sources in NEJM, a write-up by Ed Silverman and a story in The Philadelphia Inquirer.
According to Colletta, the data behind the story grew out of a chance discovery by researchers at the Fox Chase Cancer Center in Philadelphia.
“We review all the different trials that are proposed here, and they don’t necessarily open here, but a lot of them are multi-center trials so we do look at them. And I saw that we had been looking at a number of clinical trials that explicitly excluded gay people, and they didn’t necessarily open at Fox Chase, but I started to become more attuned to this and realized that this is a bigger, national issue,” (Brian Egleston, assistant research professor of biostatistics at the center) said.
The researchers analyzed trials listed in the ClinicalTrials.gov database, maintained by the National Institutes of Health and the Food and Drug Administration.
In particular, Colletta reported, homosexuals are excluded from studies about couples, especially those dealing with erectile dysfunction, which are often related to treatments for prostate cancer. It’s entirely normal for a drug trial to have exclusion criteria, but an oversight in NIH regulations mean that the exclusion of homosexuals, unlike exclusion along racial lines, can be implemented arbitrarily.
In the mid-1990s, Congress mandated that NIH establish a set of guidelines that would prevent it from excluding minorities, such as women and African Americans, from federally funded clinical trials unless there was a significant reason. There are currently no such rules regulating the inclusion of LGBT individuals.
The distribution of exclusionary studies is particularly interesting. To put it in perspective, here’s a quick visualization of the data put forth in the NEJM letter:
Dissecting Gawande’s narrative structure
In a recent post, Not Exactly Rocket Science’s Ed Yong tried to break down Atul Gawande’s work and figure out why it can be so darn compelling. Yong and many thousands of others (myself included) were riveted by Gawande’s latest New Yorker piece, a treatise on palliative care.
Atul Gawande in action. Photo by Center for American Progress via Flickr.
It was a great read, but nothing shocking – much of it reminded me of sections of Gawande’s 2008 book, Better – and it clocked in at a mammoth 12,000 words. Yet, even in the age of bullet points and boldface, that didn’t stop anyone. Why?
Putting aside the fact that Gawande’s a wonderful writer who’s built a powerful brand for himself, Yong instead considered the power of Gawande’s narrative structure. It’s something I’ve noticed throughout the man’s work, and something that he can get away with as a prominent surgeon who writes for magazines: He saves the climax of his key anecdote (the patient’s outcome) for the end, and usually weaves it into several minor peaks and valleys in the course of the story.
These four sections are all obviously united by a common theme. But to hang together in a single feature, they need more than that. Gawande achieves this by using the tale of a terminally ill cancer patient, Sara Monopoli, to frame the four topics. It is obvious enough to use real-life stories to illustrate the theme of death and Gawande’s experience gives him plenty to draw from. But his critical move was to use a single story to frame all of the others.
Identical tubing demonstrates FDA’s inaction
In The New York Times, Gardiner Harris outlines the problem of medical tubing that looks very similar – leading to medical errors – then deftly works his way up the chain in an attempt to find the source of device regulator’s failure to solve a problem that seems entirely solvable.
Many medical device tubing looks the same, which leads to horrific mix-ups like the delivery of food straight into the bloodstream. In 2007, The Wisconsin State Journal’s David Wahlberg earned first place in the medium newspapers category of AHCJ’s Awards for Excellence in Health Care Journalism for his Medical Misconnections series, which detailed the same problems. He even wrote an AHCJ article teaching journalists how to investigate patient safety problems.
Photo by bennylin0724 via FlickrSince then, not much has changed. Which is not all that surprising, when you consider that not much had changed in the decades before Wahlberg’s story either. Harris’ mission is to dig past the finger-pointing and figure out why. In the end, it all seems to point to some remarkable systemic flaws in the FDA’s device approval system, as well as an unwillingness on the industry to change without the threat of brute regulatory force. In addition to compelling analysis, Harris punctuates each argument with a few spicy quotes.
You’ll have to read Harris’ story to truly understand the perversity of the FDA system and how its lent such inertia to the status quo, but here’s a sample:
Dr. Robert Smith, an F.D.A. device reviewer who left the agency on July 31 and was among nine agency employees who in 2009 decried the agency’s device approval process as illegal and dangerous, said that the tubing problem, which has gone on for decades, was another example of how the agency failed to protect the public. “F.D.A. could fix this tubing problem tomorrow, but because the agency is so worried about making industry happy, people continue to die,” Dr. Smith said.
And, from Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who believes that “Nurses should not have to work in an environment where it is even possible to make that kind of [tubing] mistake.”
“The regulators have been waiting for the manufacturers to come up with a solution,” Ms. Pratt said, “and the manufacturers won’t spend the money to design and produce something different until the regulators force them to. And now the international standards organization is taking forever to get the whole world onto the same page.”
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
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