Gates Foundation pledges $10 billion for vaccines

Bloomberg’s Phil Serafino and Yuriy Humber reported on Bill and Melinda Gates’ pledge to commit $10 billion of their foundation’s resources over the coming decade to developing vaccines for the world’s poorest countries. It will come in addition to the $4.5 billion the foundation has already committed to vaccine research and delivery. Gates called on governments and other organizations to join the effort, using a Johns Hopkins model to predict significant impacts.

By vaccinating 90 percent of the population in developing countries, the deaths of about 7.6 million children under the age of 5 could be prevented in the next decade, according to the Gates foundation. An additional 1.1 million lives would be saved by the introduction of a malaria vaccine beginning in 2014, the foundation said.

That malaria vaccination, developed by GlaxoSmithKline, is expected to be ready for patent by 2012.

Related

As part of a string of interviews that accompanied the release of Gates’ annual foundation letter, the heavyweight philanthropist told CNET’s Ina Fried that he has been surprised to find that vaccine distribution has turned out to be every bit as challenging as vaccine development. He also discussed his wide-ranging foundation-related travels and initiatives.

Neurosurgery conference ditches paper for iPods

The Philadelphia Inquirer’s Stacey Burling reports that neurosurgeons will be skipping the paper for their next meeting, relying instead on iPod Touches pre-loaded with conference materials.

It will be only the second conference to have done so (a group of Canadian filmmakers was the first). Registration fees were hiked by $100 to cover the cost of the devices, and local Apple staff will be on hand to answer questions. Burling describes the process:

When they register at the American Association of Neurological Surgeons meeting, the doctors will be given iPod touches already loaded with everything they’ll need, including the program (165 pages last year), summaries of research presented at the meeting, advertising and information from exhibitors. Doctors will be able to use the iPods for messaging and for interacting with presenters during meetings. The convention also attracts 3,500 exhibitors and guests who will not be given the devices.

More vets come home as result of psychiatric issues

On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.

The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.

… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”

“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”

Related AHCJ articles

Interviewing ‘profoundly affected’ soldiers
Tips for interviewing service members returning from Iraq, the Middle East or Afghanistan

1 in 5 nursing homes pull consistently bad ratings

USA Today’s Jack Gillum crunched the numbers and found that one-fifth of U.S. nursing homes have received two consecutive poor (one- or two-star) ratings in the federal Nursing Home Compare database since its launch in 2008.

Gillum looked for homes that started with a poor rating, then received at least one more within the past year. Among other things, Gillum found that “Nearly all homes that repeatedly received few overall stars — one or two stars — were owned by for-profit corporations,” and that “the lowest-rated homes had an average of 14 deficiencies per facility.” Consistent poor-performers can be found in all 50 states.

Gillum found that one of the reasons homes weren’t improving from year to year is that they’re often given little incentive to improve their ratings unless consumers are actively using Nursing Home Compare to inform their decisions.

Medicare spokeswoman Mary Kahn says a one-star nursing home is not necessarily a terrible facility. Even the lowest-rated homes must still meet baseline Medicare conditions, she says.
…
“If homes are not motivated to get better, chances are they won’t, and you’ll wind up in homes in poor-quality purgatory,” (Larry Minnix, CEO of American Association of Homes and Services for the Aging) says. “There should be two types of homes: the excellent and the non-existent.”

Debate over M.D. reporters in Haiti continues

Discussion and debate continues about the ethics of reporters also serving as doctors in Haiti. [Earlier post]

The Washington Post’s Paul Farhi spoke to some network officials - including Paul Friedman, executive vice president of CBS News, who “says that competitive issues have factored in boosting [Dr. Jennifer] Ashton’s role since [CNN's Dr. Sanjay] Gupta became a star.”

In Baltimore, The Sun’s Kelly Brewington posted the question of whether doctors can also be reporters to readers in that paper’s “Picture of Health” blog.. Curtis Brainerd, on the Columbia Journalism Review’s Web site, wrote about the concerns being raised over the dual roles doctor/reporters are serving in.

Last week, the Society of Professional Journalists released a statement cautioning journalists to not become part of the story. When some people, including new media professor and blogger Jeff Jarvis, interpreted that to mean reporter/doctors should not treat patients, the discussion became more heated. Blogger Tyler Dukes took on Jarvis’ denigration of SPJ’s statement, saying that Jarvis “chose to argue his points with hyperbole and distortion.”

The Canadian Broadcasting Corporation discussed the issue on the Jan. 21 edition of its “As it Happens” show.  [Listen]

On Jan. 27, National Public Radio’s media correspondent David Folkenflik appeared on New Hampshire Public Radio’s Word of Mouth and talked about how much of a role should a reporter perform in the midst of a story.

Folkenflik, who has spoken to ABC’s Dr. Richard Besser and NBC’s Dr. Nancy Snyderman, says, “The real question is ‘Is it required for them to tell those stories through their own experiences? Are they somehow diverting attention from those who might need it most by focusing their camera and their aid on these, these people and are they in some ways subtley changing the nature of outcomes there?”

Folkenflik says, “Nobody’s saying these people shouldn’t help” but that “The question is ‘Is there any need to keep the camera rolling while they do it?’ I think that’s fundamentally the issue.”

NPR’s On the Media delved into the topic on Jan. 22, with Neal Shapiro, president of WNET Public Television in New York and former president of NBC News; AHCJ member Gary Schwitzer, of the University of Minnesota and publisher of Health News Review; Bob Steele, a journalism ethicist at DePaul University and member of the Poynter Institute’s faculty; and Dr. Bob Arnot, former chief medical correspondent for NBC News.

Arnot, who has intervened medically while on assignment - without the cameras rolling - pinpointed some of the concerns of performing medical procedures on camera:

DR. BOB ARNOT: Look, the real risk is here that your producer calls up and says, hey we just saw the other network’s doctor deliver a baby, could you do an amputation. There’s a real risk that doctors could be pushed into things they shouldn’t be doing because of the pressure of the suits or the producers, to just get better ratings.

BOB GARFIELD: Things they shouldn’t do, he says, such as treating somebody in the street who can just as easily and more safely be attended to at a clinic or hospital, and such as exploiting the pain of an earthquake victim, not to mention the emotions of the audience, for three minutes of drama, genuine or otherwise.

DR. BOB ARNOT: Absolutely, I mean, look-it. If this happened on the streets of New York, do you think you could do that with the current HIPAA regulations? So, sure, you’re potentially exploiting the patient, and you are becoming more of a showman than you are a medical doctor out there.

Oransky: Medical study embargoes serve whom?

Embargoes, a fairly frequent topic of discussion on Covering Health, seem to bring out strong feelings in some people.

In one recent example allegedly involving embargoes, TheStreet.com’s Adam Feuerstein attempted to combat a rumor that the New England Journal of Medicine would be publishing an article about the experimental lung cancer drug seliciclib - a rumor that was seemingly driving up the stock price of Cyclacel Pharmaceuticals.

Feuerstein looked at his advance copy of NEJM and reported that no such article was coming out. He was immediately accused by a commenter on the story of having broken the NEJM’s embargo.

As Reuters Health Executive Editor - and AHCJ board member - Ivan Oransky asked, “Is saying what’s NOT in an embargoed journal breaking the embargo?” Oransky concluded that it was not a case of breaking an embargo. The ensuing discussion on Twitter and in the comments on Feuerstein’s article is interesting. For the record, the NEJM apparently sided with Feuerstein, according to a commenter on the story.

Today, Oransky weighs in on the wider topic of who is served by embargoes on medical studies:

Two weekends ago, at ScienceOnline2010, I heard an interesting thing about embargoes. Connie St. Louis, who directs the science journalism masters’ program at City University, London, told an audience that one of the reasons for embargoes on scientific journal studies is that with more eyeballs on the study before publication, it’s more likely researchers will catch flaws in papers, which can then be pulled.

In other words, just as the FDA requires drug companies to monitor drug side effects in large populations once a drug is approved, in what’s called post-marketing surveillance or phase 4 testing, because such side effects may not show up in relatively small trials, this is a sort of post-acceptance peer review. So if a reviewer doesn’t catch an error during the normal course of peer review, journals can use the embargo period as a backstop.

I hadn’t heard that before, and I consider myself fairly well-acquainted with the arguments for and against embargoes. But it reminded me again that for all the talk of embargoes serving the public by allowing reporters to write more-informed stories, there are serious questions about whether journals are the group that gains most from embargoes.

As it turned out, I was in the midst of another episode that reminded me of that. Last week, the Cochrane Library published their quarterly set of reviews. Among them was a review of whether opioid drugs, when used as prescribed, carried a high rate of addiction. Cochrane researchers found that they don’t. That’s not the biggest research finding ever, but when you run a health news wire service filled with dozens of stories a day, like I do, it’s something worth covering. Plus, opioid dependence remains a big issue, for celebrities and lawmakers alike.

That study was embargoed for 7 p.m. Eastern on the 19th. Around the same time I was reviewing it, the Annals of Internal Medicine press packet hit my desk. That packet — embargoed until 5 p.m. Eastern Monday the 18th — included a paper that said high doses of opioids, even if prescribed, increased the risk of overdose. Again, not the most shocking study ever, but researchers and advocates continue to debate whether these drugs, when used in prescribed doses, are dangerous.

I figured the best way to serve our readers would be a story that included both of these studies, both as context for the other. Trouble was, if I ran one based on the Annals study, I couldn’t mention the Cochrane review. And if I waited for the Cochrane review’s embargo to lift, a competitor might run the other story. (Yes, we think about these things.)

So I emailed Jennifer Beal, who runs media relations for the Cochrane Library’s publisher, Wiley, explaining the situation, and asking her if she would consider moving the embargo. She returned my message right away, saying politely that she couldn’t, and explaining why, in a message that I found thoughtful.

“We thought about it very carefully but felt that our guiding principle with embargoes is that we are giving media an opportunity to investigate a story fully without the pressure to publish immediately, so that the story is still ‘new’ on the day the research gets published, and is therefore available for public consumption,” she wrote. “If we were to agree to a moved embargo, it would mean that you…would be writing about a story where the research was not available for the public to read if they wish and make up their own minds.”

The opioid study, she noted, was “one of approximately 160 articles publishing on Wednesday; this is a big operation where the publication schedule is planned out a long way in advance, so it is not possible to move forward the publication date.” (In a long-planned move, Cochrane is now going monthly, which will distribute the reviews more evenly.)

Based on resource constraints, I decided we could only run one story on opioid addiction or overdose last week. We ended up running a story on the Annals study, which seemed a bit more newsworthy than the Cochrane review. As it turns out, a number of news organizations covered the Annals study — Seattle’s LocalHealthGuide ran an item, which the Seattle Times picked up; The Seattle Post-Intelligencer, and our competitors HealthDay and Bloomberg, among others. As far as I can tell, only a site called MedIndia ran a story by the Health Behavior News Service pegged to the Cochrane review.*

(I should say here that I’m a big fan of the Cochrane Library, access to which is an AHCJ benefit. Some have criticized them for rejecting everything other than randomized double-blinded controlled clinical trials, but I’d rather see more rigor than less, given how often hype and poor evidence tend to rule the day. So this isn’t really about a problem at Cochrane. It’s about how embargo policies, whether well-intentioned or not, often make me wonder whether they serve the public.)

So whom did this Cochrane embargo serve? I’d argue it didn’t serve the public, because we and others couldn’t include news of it in the story we did decide to run. You might even say it didn’t serve Cochrane either, since I’m guessing many of my colleagues decided not to run something on it for similar reasons. And their rationale for not moving the embargo at least had the public in mind.

The episode reminded me of the CDC-autism embargo fiasco last fall, in which the CDC and the journal Pediatrics refused to lift an embargo on autism rate data that many in the autism advocacy community had already reported on. To me, the Cochrane decision was more justifiable, even if I didn’t like it.

Many have questioned embargoes, notably Vincent Kiernan, in his 2006 book “Embargoed Science.” Kiernan makes a convincing argument that embargoes serve journals most, by giving reporters something to cover every month or every week. Nowadays, that’s even more true, I think, as I see an increase in papers embargoed just 1-2 days, rather than the typical 5-6.

Still, when you run a high-volume news service, as much as you’d like to, it’s not reasonable to reject all embargoes in favor of 100% enterprising reporting. Our clients would be very unhappy, and justifiably so. Instead, we can try to cover studies with as much skepticism and context as possible. But when I hear yet another reason why embargoes might help journals, as I did at ScienceOnline2010, I’m only encouraged more to challenge the idea that embargoes are there for the public, and at least force journals to defend how they handle them.

Ivan Oransky, M.D., is executive editor of Reuters Health and AHCJ treasurer. Follow him on Twitter, where he periodically gets into debates about embargoes, among other things.

*Update:

After this post was published, we heard from Lisa Esposito, editor of the Health Behavior News Service, who tells us that Medscape and Elsevier Global Medical News did cover the Cochrane opioid review.

Is U.S. ready for Haiti-style mass casualty event?

The GAO’s latest release, “State Efforts to Plan for Medical Surge Could Benefit from Shared Guidance for Allocating Scarce Medical Resources (20-page PDF),” is the result of an evaluation of the nation’s medical capacity to deal with “mass casualty events,” a response they refer to as a “medical surge.” Read the one-page summary here. The release is a summary of a similarly titled 2008 report, but it has gained extra relevance in the light of the U.S. response to the similar circumstances of the 2010 Haiti earthquake.

The report found that states were making good progress in developing bed reporting systems and coordinating with military and veterans hospitals, as well as in selecting alternate care sites and registering medical volunteers. It also noticed that they were lagging when it came to planning for altered standards of care.

Related

IoM: We need clear guidelines for disaster triage
What really happened at Memorial after Katrina?
AHCJ presentation: How prepared is your city for a health disaster? (Audio)
Protecting the Public’s Health from Disease, Disasters, and Bioterrorism

Report details errors in waiting-room death

The Philadelphia Inquirer’s Tom Avril reports on how hospital errors led to the death of a 63-year-old north Philadelphia guidance counselor. Avril opens his story by painting a picture of hospital operations, one based on documents released after a state investigation.

Twice, when an emergency-room nurse called out the name of Joaquin Rivera and he did not respond, she had no idea he’d already suffered a massive heart attack.

The reason: The nurse did not venture beyond the waiting-room doorway and simply did not see him where he sat, unattended, for nearly an hour.

Avril reported that the hospital has already taken steps to prevent a similar occurrence in the future, including:

• Increasing security by more than 30 percent
• Creating new training for registration staff, with an emphasis on communication with nurses
• Instituting a policy of calling patient names every 10 minutes if they don’t answer at first
• Identifying a location on the waiting-room floor from which all parts of the room can be seen and marking it with tape so that triage nurses know where to stand when calling out names
• Hiring an architectural firm to see if further improvements can be made

Gawande, Google and health systems analysis

Earlier this month, New Yorker writer and surgeon Atul Gawande brought his checklist gospel (video) to the President’s Council of Advisors on Science and Technology. Writing for AAAS’ science-policy blog ScienceInsider, Jeffrey Mervis chronicled the encounter, paying special attention to the observations of council member and Google CEO Eric Schmidt.

To Schmidt, the challenge of creating a system that synthesizes patient history and creates a list of standardized recommendations boils down to a simple “platform database problem,” something he says computer scientists are very good at.

Gawande’s take is that programmers don’t quite understand the vagaries of a typical clinical encounter. The technological capability may exist, but it’s going to be hard to make an information system that is able to generate recommendations brief and practical enough to be of use to a typical super-busy physician who has to suss out six different problems in one 15-minute visit.

In the course of the discussion, Gawande and the council also bemoaned the relatively low status of the health systems analyst and brainstormed ways to raise the profile and effectiveness of the specialization.

Open government directive bears fruit, databases

In December, 2009 Peter Orszag, director of the White House’s Office of Management and Budget, issued an Open Government Directive (original PDF here) requiring a number of agencies to “identify and publish online in an open format at least three high-value data sets” on Data.gov within 45 days. That deadline came on Jan. 22, and the resulting data sets have all been posted online. The beefiest and most immediately useful are those from the Department of Veterans Affairs, but we’ve also included other sets which could prove useful for health care journalists. Descriptions are taken directly from Data.gov.

Department of Veterans Affairs

Veterans hospital report cards and safety reports
The VA has divided report cards (11 categories) and safety reports (4 categories) into topic-specific files, from Infrastructure to Nosocomial Infections. The best way to find what you’re looking for is to visit the Open Government Directive site and then scroll down to “Department of Veterans Affairs.”

FY08 Veterans Compensation and Pension by County
The Compensation and Pension by County dataset is a count of the number of veterans receiving disability compensation or pension payments from the Department of Veterans Affairs. The data is reported at the county level, by age group and by % disability rating.

Social Security disability claims

SSA Disability Claim Data
The dataset includes fiscal year data for initial claims for SSA disability benefits that were referred to a state agency for a disability determination. Specific data elements for each year and state include receipts, determinations, eligible population, and favorable determination rates.

SSA State Agency Workload Data
The dataset includes monthly data from October 2000 onwards concerning initial claims for SSA disability benefits that were referred to a state agency for a disability determination.

USDA nutrition data

MyPyramid Food Raw Data
MyPyramid Food Data provides information on the total calories; calories from solid fats, added sugars, and alcohol (extras); MyPyramid food group and subgroup amounts; and saturated fat content of over 1,000 commonly eaten foods with corresponding commonly used portion amounts.

USDA National Nutrient Database for Standard Reference
The USDA Nutrient Database for Standard Reference, Release 22 (SR22) is the major source of food composition data in the United States and provides the foundation for most public and private sector databases. SR22 contains nutrient data for over 7,500 food items for up to 143 food components, such as vitamins, minerals, amino acids, and fatty acids.

Medicare

CY 2009 MTM Contact List
CMS approved contact list of Part D Sponsors in Medication Therapy Management Program (MTMP) which is in their plans’ benefit structure.

Office of Medicare Hearings and Appeals Claims Listed by State
Total count of Claims received by Region, State and fiscal year. Appeals can be found here.

Part B National Summary Data File
The Medicare Part B National datasets are summarized by meaningful Health Care Common Procedure Coding/Current Procedural Terminology, (HCPC/CPT), code ranges. Each dataset displays the allowed services, allowed charges and payment amounts by HCPC/CPT codes and prominent modifiers.

Other

OSHA Data Initiative - Establishment Specific Injury and Illness Rates
Each year the Occupational Safety and Health Administration (OSHA) collects work-related injury and illness data from employers within specific industry and employment size specifications. This data collection is called the OSHA Data Initiative or ODI. The data provided is used by OSHA to calculate establishment specific injury and illness incidence rates.

What else is there?

The “Tools” section of the site includes widgets and data-mining and extraction tools, applications, and other services to “provide the public with simple, application-driven access to Federal data with hyperlinks.” The “Geodata” section includes federal geospatial data with metadata and links to more detailed Federal Geographic Data Committee (FGDC) metadata information.

The site is soliciting comments about what datasets should be made available, so you can  suggest more datasets here. The site also offers a tutorial.

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