Honolulu Advertiser examines nursing homes
Filed under: Health journalism, Hot Health Headline
The Honolulu Advertiser put together a multimedia package about nursing home deficiencies that includes text, video, a questionnaire to help patients and families choose homes, a nursing home databases and inspection reports.
The package’s second day, which focuses on sanctioning flawed nursing homes, is anchored by Rob Perez’ story on lax enforcement, reinforced by their daily collection of case studies and supplemented by a number of other stories and videos.
Other days focus on flaws in the system, how lobbyists prevail over advocates for the elderly and help in finding a care facility.
Slim guide: Covering the Health of Local Nursing Homes
This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
• Untold stories remain in nursing homes
• More investigations of nursing homes
• Aging Nation: Troublesome Health Care Issues
• Headlines an advocate for seniors would like to see
• The impact of aging upon health care
• Covering nursing homes and other issues of aging
• How will retiring boomers affect the national health agenda?
• You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
• Biology of Aging: Sources and Resources
Tanning beds: What do the numbers really mean?
This is a guest post from Ivan Oransky, M.D., editor of Reuters Health and AHCJ’s treasurer, has written at my invitation.
May has been declared “Melanoma Awareness Month” or “Skin Cancer Awareness Month“ – depending on which group is pitching you – and reporters are doubtlessly receiving press releases and announcements from a number of groups, including the Melanoma Research Foundation, the Skin Cancer Foundation, hospitals, doctors and other organizations.
Those press releases often point to the World Health Organization, which reports that “use of sunbeds before the age of 35 is associated with a 75% increase in the risk of melanoma” – a statistic often repeated in news stories about tanning beds.
Photo by Whatsername? via Flickr
But what does that really mean? Is it 75 percent greater than an already-high risk, or a tiny one? If you read the FDA’s “Indoor Tanning: The Risks of Ultraviolet Rays,” or a number of other documents from the WHO and skin cancer foundations, you won’t find your actual risk.
That led AHCJ member Hiran Ratnayake to look into the issue in March for The (Wilmington, Del.) News Journal, after Delaware passed laws limiting teens’ access to tanning salons. The 75 percent figure is based on a review of a number of studies, Ratnayake learned. The strongest such study was one that followed more than 100,000 women over eight years.
But as Ratnayake noted, that study “found that less than three-tenths of 1 percent who tanned frequently developed melanoma while less than two-tenths of 1 percent who didn’t tan developed melanoma.” That’s actually about a 55 percent increase, but when the study was pooled with others, the average was a 75 percent increase. In other words, even if the risk of melanoma was 75 percent greater than two-tenths of one percent, rather than 55 percent greater, it would still be far below one percent.
For some perspective on those numbers, Ratnayake interviewed Lisa Schwartz, M.D.,M.S., whose work on statistical problems in studies and media reports is probably familiar to many AHCJ members. “Melanoma is pretty rare and almost all the time, the way to make it look scarier is to present the relative change, the 75 percent increase, rather than to point out that it is still really rare,” Schwartz, a general internist at Veterans Affairs Medical Center in White River Junction, Vt., told him.
In a nutshell, the difference between skin doctors’ point of view and Schwartz’s is the difference between relative risk and absolute risk. Absolute risk just tells you the chance of something happening, while relative risk tells you how that risk compares to another risk, as a ratio. If a risk doubles, for example, that’s a relative risk of 2, or 200 percent. If it halves, it’s .5, or 50 percent. Generally, when you’re dealing with small absolute risks, as we are with melanoma, the relative risk differences will seem much greater than the absolute risk differences. You can see how if someone is lobbying to ban something – or, in the case of a new drug, trying to show a dramatic effect – they would probably want to use the relative risk.
This is not an argument for or against tanning beds. It’s an argument for clear explanations of the data behind policy decisions. For some people, the cosmetic benefits of tanning beds – and the benefit of vitamin D, for which there are, of course, other sources – might be worth a tiny increase in the risk of melanoma. For others, any increased risk of skin cancer is unacceptable. (And of course, for the tanning industry, the benefits can be measured in other ways – dollars.) But if reporters leave things at “a 75 percent increase,” you’re not giving your readers the most important information they need to judge for themselves.
So when you read a study that says something doubles the risk of some terrible disease, ask: Doubles from what to what?
Related
These numbers also might come up in reporting about the health reform bill as it does in “Indoor Tanning Getting Moment in the Sun” (March 26, 2010). From the story:
Over the past decade, indoor tanning has increasingly been likened to other maligned habits, cigarette smoking in particular.
And with the passage of the new health care bill, government officials are prepared to take that comparison one step further. A 10 percent tax could be levied on indoor tanning as early as July, in an effort to offset some of the health care bill’s multi-billion-dollar budget.
AHCJ resources on writing about medical studies:
- Evidence-based medical reporting
- Understanding the scientific article
- Understanding medical publications
- Statistical errors even you can find
- What you need to know about risks, rates and ratios
- Medicine 101: Words, numbers and journals
In addition, look for a slim guide about covering medical studies that AHCJ will publish this summer.
Agenda indicates federal health priorities
Filed under: Health care reform, Health policy, Public health
This week, OMB Watch brought our attention to the recently released “Current Unified Agenda of Regulatory and Deregulatory Actions,” which serves as a sort of broad outline of the priorities of federal agencies.
It comes out twice a year, and OMB Watch found the latest edition to packed with health-related items from departments across the board. A few highlights, all summarized from the hard work of the folks at OMB Watch:
EPA Proposed labeling BPA and phthalates as “Chemicals of Concern” Proposed standards for “nanoscale materials” Updated air quality standards Department of Labor A prevention-oriented OSHA plan that would require employers to create and maintain plans to protect workers Proposal for limiting workers exposure to silica dust FDA For the first time, the FDA will begin asserting its newfound jurisdiction over tobacco.
OMB Watch points out that, while the agenda has not been a useful tool because agencies tend to miss the timelines, it “can be a useful planning and accountability tool to measure the Obama administration’s efforts to solve long-neglected health and safety problems.”
Medical groups voluntarily tighten ethics rules
Filed under: Health data, Health journalism, Hot Health Headline
Writing for NPR’s health blog, Maggie Mertens reports that while recently passed reform legislation includes the “Physician Payments Sunshine Act” (PDF) that will require companies to report any payments or gifts to physicians over $10 in value starting in 2012 (and reported and made available in a public database in 2013), some groups are getting a jump on the rules and voluntarily tightening their own conflict of interest policies.
Take, for instance, the recent decision by a bunch of medical specialty groups to stop taking industry money when coming up with guidelines for treatment. The Council of Medical Specialty Sciences, representing groups like the American College of Physicians, the American College of Cardiology and the American Society of Clinical Oncology, unveiled new rules on conflicts of interest last week. Thirteen of the member groups have adopted them so far, with the others saying they aren’t far behind. The rules also require that all funding from pharmaceutical and device-making companies to board members or groups will be publicly disclosed. Swag at medical conferences becomes a no-no, although big drugmakers had said a few years back they were going to stop the giveaways of medicine-branded pens, logoed tote bags and that sort of thing anyway.
For a discussion of the challenges reporters face when investigating conflicts of interest, read Elizabeth Bahm’s AHCJ article about a related panel at the recent Health Journalism 2010 conference, and this related article by John Fauber.
WSJ: Small hospitals get little benefit from device
In The Wall Street Journal, John Carreyrou uses the problems of a small New Hampshire hospital to illustrate how difficult it is for small hospitals to attain the cost and safety savings promised by the DaVinci surgical device’s manufacturers, a fact which has not deterred 131 of them from shelling out at least $1 million (plus maintenance and replacement fees) to own one.
“There’s a medical arms race,” says Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston. “Technologies are being adopted and becoming widespread based on the marketing prowess of equipment makers and suppliers, not necessarily on the public good.”
Smaller hospitals, which Carreyrou defines as those with fewer than 200 beds, simply don’t have the volume to gain the DaVinci cost efficiencies promised by manufacturer Intuitive Surgical.
One study published in the Journal of Urology found that a hospital needs to do at least 520 surgeries a year with the robot to bring its costs in line with traditional surgery. That’s seven times the number of robotic surgeries Wentworth-Douglass has been averaging.
And while it’s unfortunate that they don’t even use the device enough to save money, it’s far worse that they also don’t use it often enough to master its steep learning curve. Surgeons at the New Hampshire hospital got two days of training and began operating unassisted after four cases.
Jim Hu, a surgeon at Brigham and Women’s Hospital in Boston who has done more than 1,000 surgeries with the robot, says it takes a urologist anywhere from 250 to 700 cases to master it. Dr. Hu considers the da Vinci a clear benefit for experienced surgeons, saying, “You can do a better job.” But he cautions it can do more harm than good when used without adequate training.
In New Hampshire, the hospital’s four urologists were pressured to use the device, but resisted because they felt more training was needed, Carreyrou writes. Three of them eventually left the hospital.
Network promises ESPN-style surgery coverage
MDiTV, a new online network with several AHCJ members on its roster, has been in the works for a while and officially launched on April 28.
It aims to provide high production value, TV-style medical news segments each day, as well as more in-depth offerings. In addition to its video-heavy main site, MDiTV also has a regularly updated blog. AHCJ board member Andrew Holtz is the site’s senior editor and chief anchor, and AHCJ members Michael Ingram, Tim Park and Amira Dughri are also part of the effort.
Ben Comer of Medical Marketing & Media profiled the new organization.
The network will also present long-format programming, such as the Charlie Rose-inspired “Second Opinion” program, hosted by MDiTV founder and CEO Robert Lazzara, a cardiac surgeon. “Natural Forces,” a weekly health program hosted by Kelly Godell, will cover nutrition, food and healthy eating.
MDiTV will also add slightly less traditional programming, including events which sound like they’ve been inspired by a mix of CSPAN and ESPN.
MDiTV also hopes to premiere live surgeries through partnerships with “founding member hospitals,” and will broadcast medical meetings live, according to Lazzara. Surgeries and medical meetings will be presented in a way similar to how ESPN presents a sporting event, said Lazzara.
Lazzara told Comer the site would add advertising (likely broadcast-style commercials) within 60 days, but that they were currently focused on creating original content. Lazzara said he plans to market the station to patients and providers using a combination of traditional and social media.
Boulton explains comparative effectiveness
Filed under: Government, Health data, Health policy, Hot Health Headline
Next time somebody asks why the stimulus plan included $1.1 billion for comparative effectiveness research (and where all that money’s going), point them to Guy Boulton’s latest explanatory piece in the Milwaukee Journal Sentinel.
In this first installment, Boulton lays a strong foundation for the rest of his “occasional series” on comparative effectiveness by thoroughly answering the “how” and “why” of the massive research effort with carefully selected examples, experts and statistics. No word yet on where the series will go from here, but it’s a promising start.
Tip sheet for AHCJ members
Tracking health-related stimulus money: By Michael Grabell, ProPublica
24,000 Memphis patients rated their doctors
The Healthy Memphis Common Table is an effort to help patients and providers take charge of improving the city’s health. It includes the results of about 24,000 patient ratings of 430 local primary care doctors, all conducted by the nonprofit Consumers’ Checkbook.
Manoj Jain, M.D., M.P.H., (bio) is on the table’s advisory committee and he, as part of its mission to publicize the effort, wrote a three-part series in the The (Memphis) Commercial Appeal on the results and potential of the survey. The first installment is the one with the broadest appeal, as it discusses survey results and consequences.
In the second installment, Jain profiles a highly rated doctor and includes his own musings on what makes a physician great. Jain then wraps up the series with anonymous profiles of two poorly rated doctors and further musings on how their ratings might be improved. Interestingly, Jain’s suggestions almost always focus on non-clinical factors such as office staff quality and communication skills.
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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
