Report focuses on researchers’ conflicts of interest
Filed under: Conflicts of interest, Government, Studies
There are vulnerabilities in how financial conflicts of interest are handled by NIH-funded researchers, according to a report (PDF, 46 pages) released today by the Department of Health and Human Services’ Office of the Inspector General. Among the findings:
- 90 percent of the grantee institutions rely solely on the researchers’ discretion to determine which financial interests are required to be reported
- because nearly half of the grantee institutions do not require researchers to provide specific amounts of equity or compensation on their financial disclosure forms, specific financial interests of NIH-funded researchers are often unknown
- grantee institutions do not routinely verify the information submitted by researchers about their financial interests
- some grantee institutions lack documentation to support their oversight of financial conflicts of interest
- the majority of grantee institutions do not have policies and procedures that address subgrantee compliance with federal regulations regarding financial conflicts of interest
- conflicts were not reported by grantee institutions to NIH in a consistent format
- grantee institutions are not required to report to NIH any financial interests that they have with outside companies
The inspector general’s review focused on the 41 grantee institutions that submitted financial conflict-of-interest reports to NIH in fiscal year 2006.
The review found that the most common financial conflict of interest is equity ownership (including stock and stock options) in companies in which the researchers’ financial interests could significantly affect the grant research.
Other financial conflicts of interest among researchers involved inventing technology, consulting, or holding positions with outside companies. To manage financial conflicts of interest, grantee institutions often require researchers to disclose conflicts in research publications; however, grantee institutions rarely reduce or eliminate financial conflicts of interest.
The report includes a number of recommendations – that it has previously recommended – to improve the reporting of financial conflicts of interest.
Med school prof: Dartmouth Atlas is ‘malarkey’
Filed under: Conflicts of interest, Health data, Hot Health Headline
In a story done in collaboration with The Philadelphia Inquirer, Kaiser Health News’ Jordan Rau’s report on a leading physician’s provocative attack on the Dartmouth Atlas gets off to a lively start:
As he raced through the U.S. Capitol this fall, Dr. Richard “Buz” Cooper, a 73-year-old University of Pennsylvania medical school professor, didn’t mince words. He denounced as “malarkey” a reigning premise of the health care debate – that one-third of the nation’s $2.5 trillion in annual health spending is unnecessary – and said that the idea came from “a bunch of clowns.”
Digging beyond these inflammatory comments, Rau finds that Cooper’s argument revolves around one idea: That the research “doesn’t take into account the high cost of helping the impoverished, who often spend more time in hospitals because they don’t have people to care for them at home and often return to the hospital when they can’t afford needed medications.”
Meanwhile, the Atlas folks’ response has been as blunt as Cooper’s attacks. They say the Penn researcher is wrong and doesn’t adequately understand Dartmouth’s statistical controls.
“It’s impossible to carry on a debate with somebody who does not understand statistics, and seems uninterested in learning,” Jonathan Skinner, a senior author of the Atlas, says of Cooper.
Most experts seem to be lining up on the Dartmouth side of the dispute, and Rau digs past the “clowns” and “malarkey” and helps readers understand the validity of Cooper’s criticism and the Atlas.
Related
To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.
- Covering Health: How hysterectomies spurred Dartmouth Atlas’ birth
- Covering Health: Poor, rural hospitals have higher death rates
- Covering Health: Dartmouth Atlas: Powerful when used right
- Covering Health: Why health costs in McAllen, Texas, resonate
Ind. TV station uncovers underground ‘dentist’
Bob Segall of WHTR-Indianapolis chronicles the results of an investigation in which the station uncovered a “dentist” who has been operating under the radar in the United States without a license for 14 years. The man in question, who said his name is Alex Galiano, said he received dental training in Honduras before he left that country at age 22 and worked out of his apartment, charging rock-bottom prices and catering to Hispanic immigrants who did not have health coverage.
Segall talked to a patient named Julia who had been hospitalized with a bone infection related to the phony dentist’s handiwork. Julia said the man’s apartment didn’t even have dental chairs or lights: “‘He opened the window to be able to look at my tooth because there weren’t any other lights,’ she said.” Lights weren’t the only thing missing from the office of a man who said he cleaned his instruments with cotton balls:
Julia says during the procedure, the dentist did not wear gloves and did not give her water to rinse blood from her mouth. Bleeding heavily, she was told to spit into a garbage can filled with food scraps. The dentist tried to stop her bleeding by using napkins he got from the apartment’s kitchen.
Julia has filed an official complaint against the rogue dentist, who said he also operates in Kentucky.
An undercover WHTR producer who visited Galiano saw dental instruments and vials of liquid anesthetic. Galiano told the producer that he sterilizes everything using cotton balls and alcohol – a procedure that is not considered adequate by experts. The producer also purchased a prescription antibiotic that is not approved in the United States.
When quality matters to boards, hospitals do better
In Health Affairs, Ashish K. Jha and Arnold M. Epstein have released a study in which they found a link between hospital boards that focused on quality of care and hospital quality ratings. They also found that quality isn’t a top priority for most hospital boards. The researchers hope their findings will help those who want to improve hospital quality by demonstrating just how much influence a hospital board can have.
Jha and Epstein surveyed 1,000 board chairs from a wide sample of not-for-profit acute-care hospitals in the United States. For quality ratings, they relied on the Hospital Quality Alliance.
Related
AHCJ President Charles Ornstein, whose hospital quality coverage has earned national recognition, recently updated his comprehensive “Road map for covering your local hospital’s quality” tip sheet.
AHCJ article: Making sense of hospital quality reports
Book: Covering the Quality of Health Care: A Resource Guide for Journalists
Slim guide: Covering Hospitals: Using Tools on the Web
Free online training
On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality
Data
Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.
Tip sheets
- How to cover your local hospital - Overview of many organizations that offer hospital quality ratings
- Sorting out hospital rankings
- Intro to investigating health data using spreadsheets
- Computer-assisted reporting basics: Investigating health data using spreadsheets
Reports
- Study: Hospital quality comparisons are inconsistent
- Performance data may not affect patient decisions
- GAO report on reliability of hospital quality data reported to CMS
- 2007 state quality data available
- Hospital quality resources by state
Hot Health Headlines
- Rating Hospital Heart Care
- Government releases new hospital death rates
- Mortality data and its use in quality improvement efforts
- Surgery death rates going public in U.K.
- Ranking Hospitals on Bang for the Buck
Covering Health: First year’s most popular posts
With a year of posts behind us, we thought it would be a good time to look back and see what posts proved to be the most popular – or at least the most read:
- Lewin group linked to private insurers
- Autism news raises question: When is an embargo not an embargo?
- Hensley joins NPR’s expanding health team
- Report: $25,000 buys access to Post’s health reporters
- CDC monitors H1N1 swine flu-human reassortment
- Oransky to take helm at Reuters Health
- Top N.Y. neurosurgeons suspended, sued
- Pharma industry still finding its way in social media
- Hospital says it gives content to short-staffed media
- Kuklo scandal spotlights DoD/Medtronic ties
- ‘Playing through’ concussions is damaging
- Where to find the facts on health care reform
- CBS questions CDC’s H1N1 prevalence estimates
- VA officials seize reporter’s audio recording
- Oprah’s health advice needs a shot in the arm
- Autism and vaccines: A failure to communicate
- Will pharmacists play a role in H1N1 vaccinations?
- Covering Obama’s stance on stem cell research
- Appleby to report for Kaiser Health News
- Prevention vs. treatment in global health
- FDA staff calls for end to corruption, wrongdoing
- Mentally ill patients, elderly mix in nursing homes
- Three health-care issues Obama, Congress will face
- Jost discusses consumer-driven health plans
- Tim Tebow’s head fuels concussion debate
Grassley compares ghostwriting, plagiarism
Filed under: Conflicts of interest, Government, Pharmaceuticals, Studies
Sen/ Charles Grassley (R-Iowa) continues his investigation of “medical ghostwriting” with a letter to 10 medical schools asking “what they are doing about professors who put their names on ghostwritten articles in medical journals — and why that practice was any different from plagiarism by students.”
Sen. Charles Grassley
At issue is the practice in which a writer — sometimes paid by a pharmaceutical or other involved company — works on an article intended for publication without being named while a less-involved researcher receives credit.
Journals, medical associations and even pharmaceutical companies have called for an end to the practice but medical schools have been slower to respond.
Grassley has asked the medical schools to explain their policies on ghostwriting and plagiarism, to list complaints and describe investigations into both practices.
Advocacy group: OSHA falls down on the job
Kirsten Stade, advocacy director for Public Employees for Environmental Responsibility, writes on The Hill’s Congress Blog that the U.S. Occupational Safety & Health Administration has turned a blind eye to widespread underreporting of workplace safety violations. Stade says that OSHA “accepts without question industry reports that paint a rosy picture of workplace health – even for notoriously dangerous industries such as steel plants and poultry factories.”
The piece’s strongest words come from Robert Whitmore, a former OSHA official who Stade says lost his job after speaking out against the agency’s lax standards.
“I contend that the current OSHA Injury and Illness information is inaccurate, due in part to wide scale underreporting by employers and OSHA’s willingness to accept these falsified numbers. There are many reasons why OSHA would accept these numbers, but one important institutional factor has dramatically affected the Agency since 1992, regardless of the political party in power: steady annual declines in the number of workplace injuries and illnesses make it appear that OSHA is fulfilling its mission.”
While advocating for Whitmore’s reinstatement, Stade admits the Obama administration has taken some important steps toward increasing OSHA accountability.
On September 30, 2009, OSHA initiated an “Illness and Injury Recordkeeping National Emphasis Program” that beefs up enforcement of industry reporting rules. It is designed to “test OSHA’s ability to effectively target establishments to identify under-recording of occupational injuries and illnesses”.
As its name might indicate, Public Employees for Environmental Responsibility is a nonprofit environmental advocacy group made up of local, state and federal employees.
Elderly prison population booming
CNN’s Stephanie Chen considers the issues that surround elderly prisoners, a fast-growing group that has generally flown under the radar. According to Chen, “An analysis of Bureau of Justice Statistics data found that the male prison population over age 55 ballooned by 82 percent in eight years, from 48,800 inmates in 1999 to 89,900 in 2007.” 
These older inmates are typically more expensive and in poorer health than their younger peers. In Georgia, Chen reports, “the state spends about $8,500 on medical costs for inmates over 65, compared with about an average of $950 for those who are younger.”
Every inmate here has a medical condition; dementia, hypertension and diabetes are the most common, the warden says. “With the elderly population, we’re beginning to run something comparable to nursing homes,” says Sharon Lewis, medical director for the Georgia Department of Corrections. “This is one of the unhealthiest populations found anywhere. They really lived life hard.”
The boom in geriatric prisoners has stressed state budgets, especially in states where money was already tight. In response, Chen writes, some states are considering softening their stance on older prisoners.
To ease budget woes in California, one bill up for debate would allow nonviolent elderly prisoners to be released into hospice care or monitored with ankle bracelets. In the past few years, Georgia officials say, the state has released more frail and dying inmates on medical reprieve than ever before. Other states, including New York and Virginia, have also allowed early release of ailing elderly inmates.
For tips about reporting on jails and prisons, be sure to read Naseem Sowti Miller’s tip sheet, Covering health care in jails, and her presentation on the topic from the 2008 Urban Health Journalism Workshop. For tips and tools on reporting on America’s graying population, check out reports from last month’s Aging in the 21st Century workshop.
Public broadcasters have H1N1 site for journalists
Public Radio Exchange’s FluPortal.org, funded by the Corporation for Public Broadcasting and done in collaboration with NPR, aims to provide public media with resources for reporting on H1N1.
Led by a regularly updated and authoritative blog, the site also impresses with a selection of Web tools, including widgets and embeddable multimedia, for media outlets to use on their own sites, up-to-date reference materials and examples of what others have done. The portal’s handling of new media and both official and unofficial online sources alone makes it worth a visit, especially given its current update frequency and timeliness.
Members: Millman moves, Hirschman gets award
AHCJ member Christian Millman has been named executive editor of Taste of Home. He had been deputy editor, health and family, at Better Homes & Gardens since fall of 2008. Before that, he was a senior health editor, having joined Better Homes & Gardens in January 2003. He has been an editor at Rodale.
Carolyn Hirschman, an associate member of AHCJ, won a merit award in the 2009 National Health Information Awards for the brochure “Older Adults and Alcohol: You Can Get Help.” The consumer publication was produced for the National Institute on Aging, part of the National Institutes of Health.
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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
