Why Texas is failing to privatize mental health care
Filed under: Health care reform, Health policy, Hot Health Headline
In 2003, Texas passed a law that sought to turn mental health care in the state into a competitive marketplace. It’s 2010, and that marketplace still hasn’t materialized. The Texas Tribune’s Brian Thevenot tried to find out why. Thevenot describes it as “a textbook case of legislative intent crashing on the rocks of bureaucratic maneuvering and logistical realities.”
The state’s local Mental Health and Mental Retardation authorities are supposed to become “providers of last resort,” who turned most direct medical services over to networks of private providers. Instead, the state has remained among the nation’s worst in terms of mental health funding and, as Thevenot reports, the prison system and not the mental health infrastructure, has served as the real provider of last resort for Texas’ mentally ill.
Delivery room fight shows structural problems in Italian health care
Filed under: Europe, Health care reform, Health data, Hospitals, Hot Health Headline, Member news
Over at BMJ’s Open blog, Fabio Turone explains the systemic issues behind the particularly sensational headline that, as he wrote, “a woman lost her uterus, and her newborn is in a coma because two obstetrician gynaecologists went into a fistfight in the delivery room of a university hospital in Sicily.” Turone is an AHCJ member and founder of Science Writers in Italy.
Photo by JohnBurke via FlickrIt’s really a story of two obstetricians and one malfunctioning medical system. Understand those two doctors and you understand a key dilemma in Italian health care.
Consider:
Obstetrician one is a senior staff doctor, who’s nominally in charge in this situation.
Obstetrician two is a young physician who, for all intents and purposes, works at the hospital as well. He’s being “paid” with a scholarship and isn’t supposed to treat patients, though, like all his peers, he does anyway. To further complicate matters, he’d also entered into a private financial relationship with the woman – something that’s also par for the course in Italy.
In this case the woman paid the doctor privately because this was the only way for her to be sure of being looked after by the same specialist all through the pregnancy, including the delivery, in the public hospital (when a woman is looked after privately by someone working in the hospital, the colleague in charge on the day of delivery usually doesn’t interfere: it’s standard practice, and it is considered fair play).
So, it was a matter of seniority within the hospital running head-on into an outside doctor-patient relationship. Ironically, Turone said, the government had already taken measures to end such fuzzy relationships in 2007 – but then delayed their implementation until 2012.
For more about health journalism in Europe, see AHCJ’s new “Covering Europe” initiative. The effort is coordinated by veteran English health journalist John Lister.
How ghostwriters sold hormone replacement
Filed under: Health journalism, Hot Health Headline, Studies
Writing in PLoS Medicine, Adriane J. Fugh-Berman, M.D., demonstrates the cynical art of “publication planning” and the use of academic journals as an avenue for unregulated drug promotion by showing, with the help of documents from a major drug manufacturer, how ghostwriting was used to sell hormone replacement therapy.
The documents in question come from the lawsuits against Wyeth over the development of breast cancer during treatment with the hormone replacer Prempro, and were brought to light, according to Fugh-Berman, “when PLoS Medicine and The New York Times intervened in the litigation. Both intervenors successfully argued that ghostwriting undermines public health and that documents proving the practice should be unsealed.”
Fugh-Berman was a paid expert witness in the trial, and thus was familiar with the documents before their release. Her conclusion?
… the pharmaceutical company Wyeth used ghostwritten articles to mitigate the perceived risks of breast cancer associated with HT (menopausal hormone therapy), to defend the unsupported cardiovascular “benefits” of HT, and to promote off-label, unproven uses of HT such as the prevention of dementia, Parkinson’s disease, vision problems, and wrinkles.
According to Fugh-Berman, the effects of this careful campaign seem to have outweighed the preponderance of evidence, at least in the minds of some doctors.
Today, despite definitive scientific data to the contrary, many gynecologists still believe that the benefits of HT outweigh the risks in asymptomatic women. This non-evidence–based perception may be the result of decades of carefully orchestrated corporate influence on medical literature.
Through the course of the article, Fugh-Berman lays out the entire ghostwriting/marketing process, complete with instructive details and damning examples. There’s a lot to take in, but you’ll emerge with a far better understanding of the mundane mechanics that make ghostwriting work.
Related
- Ghostwriting: Journals’ dirty, not-so-little secret
- Wyeth paid university for ghostwritten articles
- Unsealed papers prove Wyeth was behind articles
- Journal editor linked to spinal implant royalties
- How the pharma research ’sausage’ is made
- Archive offers drug industry documents online
- Grassley digs into journal ghostwriting practices
- Grassley compares ghostwriting, plagiarism
- Institute of Medicine prescribes ethics overhaul
Assessing acute care in America
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
The New York Times‘ Kevin Sack reports on a Health Affairs study that explores “acute medical care,” particularly initial visits for the fever and cough type of stuff that would traditionally go to a primary care physician. While 42 percent of such visits were still handled by a patient’s personal physician, a full 28 percent took place in emergency rooms. According to Sack, that number includes almost all visits made outside of typical office hours, as well as most visits made by patients without insurance.
More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.
Reform provisions such as medical homes, accountable care organizations and more money for primary care seek to rebalance acute care delivery in the United States, but Sack reports that the study’s authors fear it won’t be enough.
The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”
Remember, free access to Health Affairs is one of many perks enjoyed by AHCJ members.
VA pays for Agent Orange-related illnesses despite lack of evidence
Hundreds of thousands of Vietnam veterans are being compensated by the U.S. Department of Veterans Affairs for illnesses the agency says are related to Agent Orange, as Associated Press reporter Mike Baker found. On the face of it, that might not be particularly surprising. Agent Orange has been convincingly linked to cancer and a number of other ailments. But, and here’s the interesting bit, the illnesses most Agent Orange-exposed veterans are being compensated for – things like diabetes and erectile dysfunction – have never been authoritatively linked to the defoliant.
Because of worries about Agent Orange, about 270,000 Vietnam veterans — more than one-quarter of the 1 million receiving disability checks — are getting compensation for diabetes, according to Department of Veterans Affairs records obtained by The Associated Press through the Freedom of Information Act.
More Vietnam veterans are being compensated for diabetes than for any other malady, including post-traumatic stress disorder, hearing loss or general wounds.
Tens of thousands of other claims for common ailments of age — erectile dysfunction among them — are getting paid as well because of a possible link, direct or indirect, to Agent Orange.
Not only that, but the list is growing. The VA has announced it will add chronic B cell leukemias, Parkinson’s and ischemic heart disease to the list of conditions that it will “presume to be related to Agent Orange and other herbicide exposures.” This means even more common, aging-related illnesses will be covered by the VA, an expensive proposition.
The agency estimates that the new rules, which will go into effect in two months unless Congress intervenes, will cost $42 billion over the next 10 years.
Related
AP’s Marchione wins Victor Cohn Prize
AHCJ member Marilynn Marchione, a senior medical writer at The Associated Press, is the recipient of the 2010 Victor Cohn Prize for Excellence in Medical Science Journalism from the Council for the Advancement of Science Writing.
The award is for a body of work published or broadcast within the past five years. The organization describes Marchione’s work as “compelling and enterprising reporting for a worldwide audience.” The judges were “impressed by Marchione’s authoritative approach to timely medical issues and her ability to juggle the demands of day-to-day wire service coverage with in-depth reporting that is rich in human interest.”
Marchione’s wide-ranging daily and in-depth consumer health coverage has sought to bring medical science findings to readers in a way that is relevant to their own health choices. She was recognized for her insight and narrative skills as reflected in stories on the overuse of diagnostic radiation, the hazards of alternative medicine, the plight of severely wounded U.S. soldiers returning from Iraq, a preview of the world’s first face transplants, and the dangers of soda increasing obesity.
Marchione became a medical writer for AP in 2004 after 28 years as a reporter and editor at metropolitan daily newspapers in Milwaukee, Chicago and Akron, Ohio. In 2000, she had a four-month Knight Journalism Fellowship in epidemiology at the Centers for Disease Control and Prevention. She has had fellowships in public health, genetics and other topics. She moderated a panel at Health Journalism 2010 on “Guidelines for writing about preventive health guidelines” and spoke on a panel about “Assessing claims of functional foods and nutritional supplements.”
The Council for the Advancement of Science Writing is a not-for-profit organization of journalists and scientists committed to improving the quality of science news reaching the public. The Cohn award was established in 2000 and honors the late Washington Post medical writer and health columnist Victor Cohn.
Related
- Suggested dos and don’ts and resource for reporting on supplements, by Marilynn Marchione
- Experts acknowledge difficulty of writing about preventive health guidelines
Ethics audits of health-related agencies available
Filed under: Conflicts of interest, Government, Health data, Public records
Every year, the federal Office of Government Ethics audits ethics programs at a few federal agencies and departments. The targeted agencies are all over the map – in fiscal 2010 they’ve already hit the Broadcasting Board of Governors and NASA’s Johnson Space center, among others – but include plenty that will interest health care journalists. The audit reports are about eight to 10 pages long and can be obtained with a FOIA request.
The Project on Government Oversight commented recently on the reports:
The Office of Government Ethics (OGE) used to publish these periodic reviews of agency ethics programs, but now only releases them in response to Freedom of Information Act (FOIA) requests. Given recent concerns about certain agencies’ ethics programs (we’re looking at you, Interior), now might be a good time for agencies to take a more proactive approach.
Here’s a selection of some offices that have been audited in recent years:
2010
- National Transportation Safety Board
- United States Nuclear Regulatory Commission
2009
- Rural Development (USDA)
- Naval Hospital Pensacola
- HHS Office of the Secretary and Office of General Counsel
- HHS Centers for Medicare and Medicaid Services
- HHS Health Resources and Service Administration
- USDA - Food Safety and Inspection Service
2008
- Department of Veteran’s Affairs
- Armed Force Retirement Home
2006
- Centers for Disease Control
- U.S. Army Medical Command
2005
- Food and Drug Administration
Looking at most profitable hospitals in U.S.
On Forbes.com, David Whelan directs our attention to the magazine’s listing of the nation’s 25 most profitable hospitals with the irresistible tease that “some American hospitals make 25 cents or more for every $1 in patient revenue they take in.”
Our list, done by the American Hospital Directory, is based on operating income figures that hospitals must report to the federal Medicare program each year. It found that 24 hospitals in the country with over 200 beds make an operating margin of 25% or more.
In fact, we learn later, one Alabama hospital – the national profit leader – enjoyed 53 percent operating margins, though it now disputes those numbers and says it somehow overstated its revenue by $180 million. Of the top 25 on the list, 15 are for-profit hospitals. Of those, 10 belong to the Hospital Corporation of America chain. The dominance of consolidators like HCA likely has quite a bit to do with rising costs.
Hospital charges represent about a third of total health care spending – $718 billion altogether. It’s more than what’s spent on doctors, drugs, nursing homes or any other category-type of care. Hospitals have been quietly consolidating in recent years. Now many hospital “systems” dominate their regional markets, often allowing them to dictate prices to insurers who pay the bill.
Whelan also looks at the possible connection between profitability and quality of care, though there don’t seem to be any hard and fast numbers.
Erdely wins for story of bone marrow donation
AHCJ member Sabrina Rubin Erdely won a 2010 Clarion Award [press release] from the Association for Women in Communications for her piece in Self magazine about bone marrow donation. The award also cites AHCJ member Sara Austin, who is the magazines features director, news and health.
The story, of a bone marrow donor meeting the young woman whose life she helped save, is an arresting one, but the piece’s real strength is its focus on the mechanics of such donations. From the unlikely match to the surprisingly non-invasive extraction, Erdely uses the women’s story to demystify an otherwise intimidating process.
The piece is filled with moments like this, which cause less informed readers (like myself), to read the paragraph again just to make sure we’re understanding it right.
Say the words bone marrow transplant to anyone and the first reaction is probably a wince. “People imagine drilling through bone and pain and a long recovery,” says Katharina Harf, executive vice president and cofounder of the donor-recruitment organization DKMS Americas in New York City. In fact, nearly three quarters of so-called bone marrow donations involve no removal whatsoever of bone marrow—they’re done by extracting blood stem cells intravenously from the arm, like giving plasma. (Some doctors now prefer the term “stem cell transplant,” because both marrow and blood house these vital cells.)
School lunches, obesity and causality
Filed under: Children, Health journalism, Hot Health Headline
Miller-McCune magazine’s Washington correspondent Emily Badger explains how a study found that the National School Lunch program is linked to youth obesity.
Photo by bookgrl via FlickrBadger takes great pains to put that finding into context, and doesn’t put forth the key causal relationship until the tenth paragraph. In the interim, she talks about the correlation between weight and school lunches, and about the methods the researchers used to tease out causation – namely, the kids’ birth weights and the type of meals they likely received at home. Only then does she deliver the kicker.
Controlling for those two factors, they found that children who participate in the school lunch program are more likely to become obese than those who don’t. In a surprising twist, though, the federally subsidized School Breakfast Program has the opposite effect. (And children who eat both school breakfast and lunch are less heavy than those who participate in neither program.)
That said, and with the caveats already out of the way before the key paragraph, Badger then explores the backwards incentives of the a la carte ice cream sandwich and why a school benefits financially from selling piecemeal junk food.
Miller McCune magazine is an effort of the nonprofit Miller-McCune Center and is dedicated to long-form, in-depth reporting on academic research.
Related
Covering Obesity: A Guide for Reporters
The prospect of covering such a broad, engaging and important topic as obesity can be overwhelming. This guide, supported by the Robert Wood Johnson Foundation, is designed to help journalists cover a wide range of stories, whether writing on deadline or researching a multipart series. It offers assistance on calculating body mass index, finding obesity statistics on the state level, gauging the quality of school district wellness policies, finding innovative school nutrition policies and much more.
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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
