Scary secrets about ghostwriting in journals
Just in time for Halloween, an anonymous medical ghostwriter spoke to Phil Davis over at the Scholarly Kitchen about the scary world of ghostwriting.
He reveals how much ghostwriters are paid, how the process works, where his work has been published, how to detect ghostwritten material and more.
The Scholarly Kitchen is a blog from the Society for Scholarly Publishing.
(Hat tip to Scott Hensley.)
GAO evaluates FDA’s overseas inspectors
Filed under: Europe, Government, Pharmaceuticals, Public health
A couple of new GAO reports are seeking to shed some light on the FDA’s overseas regulatory efforts. The first is part overview, part progress report (52-page PDF). It’ll answer your basic questions.
An FDA chemist tests food for antigens of Salmonella. (Photo: Black Star/Michael Falco for FDA)
In 2008 and 2009, the FDA sent 42 staffers overseas to establish foreign offices. The staff are on two-year overseas rotations, though it’s been difficult to find qualified workers for certain locations, especially since some of them had to take a pay cut. There’s a map of all 11 offices on the 12th page of the PDF.
According to the GAO, what do FDA overseas offices do?
- Build relationships with foreign regulators and stakeholders, and with other U.S. agencies that are overseas
- Gather information about regulated products
- Inspect overseas facilities which are exporting to the U.S. (China and India only)
- Train foreign stakeholders to better understand FDA regulations and systems
The second report is focused specifically upon inspections of overseas drug manufacturers producing for the U.S. market. The FDA has prioritized a list of such facilities that it would like its inspectors to visit, and the overseas agents managed to check off 11 percent of that list last year. At that rate, it will take about nine years for them to cover everything. For domestic facilities, that turnover rate is about 2.5 years.
AHCJ issues call for entries in annual contest
New this year: Submit your entries online
Early-bird (discounted entry fee): Dec. 24
Regular: Jan. 28, 2011
Since 2004, the Awards for Excellence in Health Care Journalism have recognized the best health reporting in print, broadcast and online media. For the first time, AHCJ is now accepting contest entries online. 
That means a streamlined entry process, quick and efficient access to entries for judges, and less paper consumed. Entrants will no longer have to submit paper copies of articles and, with the exception of unusually large electronic files, face no shipping costs.
“We’re pleased to launch our online contest portal for the 2010 Awards for Excellence in Health Care Journalism,” said Julie Appleby, Kaiser Health News reporter and chair of the AHCJ Contest Committee. “It will make it easier for journalists to submit their work, without the hassle of paper entries. It will also allow judges to review entries online and make it a more efficient contest.”
Entries can include a wide range of health coverage including public health, consumer health, medical research, the business of health care and health ethics. The contest was created by journalists for journalists and is not influenced or funded by commercial or special-interest groups.
First-place winners earn $500, a framed certificate and complimentary lodging for two nights and registration for the annual conference, to be April 14-27, 2011, in Philadelphia. First-place winners will be recognized at the conference and will be encouraged to appear on panels to discuss their winning work.
New website features center’s health reporting
A new website marks the first anniversary of the California HealthCare Foundation Center for Health Reporting, which partners with local news organizations to produce in-depth reporting projects on health-related topics.
David Westphal, the Center’s editor-in-chief, reports it has done 17 projects that have appeared in 31 California newspapers.
The project, funded by the California HealthCare Foundation and based at the USC Annenberg School for Communication & Journalism, is an example of the growing trend in new models of journalism organizations.
“We think this is a model that will grow, and may well have applications in other locales and other sectors,” Westphal says.
The new website features “roughly 175 stories written by reporters working for the center or our newspaper partners; and scores of photographs and multimedia elements.”
Related
- Calif. organization names AHCJ members to staff
- Calif. foundation backs new model; will be hiring
- Nonprofit, paper team up for project on med school
- Project launches test of a new model for health journalism
Researchers surprised by concussion study
Filed under: Health data, Hot Health Headline, Public health, Studies
Writing for Sports Illustrated, David Epstein tells the story of a small-scale Indiana football concussion study in which in which the youth in the control group unexpectedly became the headliners. The researchers were using functional MRIs and the popular ImPACT test, along with helmet-mounted accelerometers, to figure out what sort of hits cause concussions and how the consequences of such hits vary.
Photo by Les_Stockton via Flickr
Their first discovery? That “no particular magnitude of hit correlated with a concussion.” In fact, the youth they studied were suffering from very few concussions. It wasn’t until they started testing the unconcussed youth, as a sort of control, that they started seeing the results that have come to define their study, the full text of which is available online. Epstein again:
Of those eight [unconcussed youth], four nevertheless showed significant declines in visual memory. In fact, the players with the most impaired visual memory skills were not coming from the concussed group but from a group that in the week preceding the test had taken a large numbers of hits—around 150—mostly in the 40 to 80 G range
If the test scores were accurate, the researchers had inadvertently documented, in real time, a new classification of high school athlete: a player who was never concussed, was not verbally impaired and was asymptomatic even as far as his parents could tell, but whose visual memory was more impaired than his amnesic, headachy, light-sensitive, concussed teammates.
Researchers discovered one other surprise: The players who were asymptomatic but had impaired visual memory had suffered hits to the upper forehead, “which houses the dorsolateral prefrontal cortex – where linemen get hit, play in and play out,” as opposed to the heavy hits to the side of the helmet that most of us associate with concussions.
It’s a very small-scale study – only 21 boys completed the study conducted over one football season – but the researchers are expanding their work this season. Nevertheless, Epstein indulges in some speculation:
Consider this: Concussions as we know them involve a hit that rattles a part of the brain involved in language processing or motor skills. Hits to the forehead that might be every bit as damaging hide their nefarious effects in the frontal lobe, a part of the brain primarily involved in visual memory, planning and cognition, rather than motor or sensory function, and thus not taxed by sideline concussion exams. Indeed, it’s possible that all along, while brain trauma questions have focused on concussions, the real damage is being inflicted by minor impacts that chip away at the brain.
In another piece in Sports Illustrated, Peter King looks at recent violent hits in the National Football League that have attracted attention, the NFL’s attempts to make the game safer and the fans’ and players’ attitudes about the game.
Online guide focuses on covering medical studies
Reporters are inundated with lures to cover the latest medical study or scientific conference paper. And there are some significant milestones being reached in medical research. But, more often, the information reaching the public is way too preliminary or even misleading, say those behind a new AHCJ reporting guide on covering health studies.
The guide will help journalists analyze and write about health and medical research studies. It offers advice on recognizing and reporting the problems, limitations and backstory of a study, as well as publication biases in medical journals and it includes 10 questions you should answer to produce a meaningful and appropriately skeptical report. This guide, supported by the Robert Wood Johnson Foundation, will be a road map to help you do a better job of explaining research results for your audience.
Formula 1 pit crews inspire physicians
In American Medical News, Kevin O’Reilly examines a study of the lessons physicians have learned from the high-speed ballet of precision-drilled Formula 1 pit crews. After all, those tire-changing automatons have perfected the sort of routine that medicine’s checklist advocates have been preaching for some time. Because their actions are so specific, the F1 crews provide a seductive example of the efficiency that can be gained through practice, databases and, of course, checklists.
“At the moment, we kind of say, ‘Well, we do it this way.’ Everybody thinks they know really what happens, but not everyone does,” (lead author Ken Catchpole, PhD) said. “There is lots of individual variation that creeps into these things. Sometimes that’s good, and it’s responsive to individual patients. But often that creates these uncertainties that increase the opportunities for errors to happen.”
Catchpole has helped physicians at London’s Great Ormond Street Hospital for Children use F1 techniques to improve their handoff of pediatric heart surgery patients to intensive care, with results first published in the May 2007 issue of Pediatric Anesthesia. New protocols developed in response to video examination of pit stops and visits with F1 racing crews helped cut the duration of patient handoffs and reduced omissions of critical information and technical errors by 67%, the study showed.
For more, see Fierce Healthcare’s Dan Bowman to brief exploration of medicine’s fascination with Formula 1.
Conflicts abound for private food inspectors
Filed under: Conflicts of interest, Government, Hot Health Headline, Public health
The Washington Post’s Lena H. Sun has gathered, in one story, a laundry list of all the shortcomings, loopholes and conflicts of interest plaguing an American food inspection system so flawed that foodborne disease outbreaks are routinely caused by facilities with “superior” safety ratings (See Wright County Egg and the Peanut Corporation of America).
Here, I’ve cherry-picked Sun’s basic points. They echo much of what we’ve heard from previous food-safety investigations, despite the fact that each story always seems to end with the FDA pledging to reform the system. Her first observation is also the most fundamental, and will be familiar to anyone following the role of independent credit rating agencies in the financial crisis.
“… auditors are typically paid by the companies they are inspecting, creating a conflict of interest for inspectors who might fear they will lose business if they don’t give high ratings.”
“Food companies often choose the cheapest auditors to minimize the added expense of inspections, which range from about $1,000 to more than $25,000.”
“… foodmakers can prepare for audits because they often know when inspectors will show up.”
“… auditors have a range of experience and qualifications, from recent college graduates to retired food industry veterans. They sometimes walk through a plant, ticking off a checklist to produce a score, Samadpour said. Basic inspections do not typically include microbial sampling for bacteria.”
“The FDA has the authority but not the resources to routinely inspect the estimated 150,000 food-processing plants in the United States or the 250,000 facilities abroad that supply U.S. consumers.”
Study considers role of impact factor, income in journal editors’ decisions
A newly published study looks at medical journals and whether the publication of industry-supported trials might cause a conflict of interest by improving the journals’ importance or income.
Researchers looked at “impact factor” – a measure of a journal’s importance based on how often its articles are cited – and they looked at income from the sale of reprints to drug companies.
While they found that the publication of industry-supported randomized controlled trials is associated with an increase in both the impact factor and income from reprints, they do not conclude that editors’ decisions are affected by those increases.
Importantly, these findings do not imply that the decisions of editors are affected by the possibility that the publication of an industry-supported trial might improve their journal’s impact factor or income.
Despite that conclusion, the researchers do suggest that journals routinely disclose information on the source and amount of income they receive.
In that spirit, PLoS Medicine discloses its sources of income for 2009 and the editors discuss the issue in an editorial.
Related
More about conflicts of interest in publishing
WSJ explains why Medicare data is hidden
Filed under: Government, Health data, Health journalism, Hot Health Headline
In The Wall Street Journal, reporters Mark Schoofs and Maurice Tamman have pulled off an impressive feat, weaving a tale of freedom of information and databases so compelling that it’s already attracted hundreds of comments and attention from all over. At its heart, it’s the tale of why public Medicare payment data does not identify the doctors and individual providers who receive about an eighth of its annual disbursements. If the practitioners were identified, the authors argue, the public and press would be better equipped to expose and deter fraud.
The Medicare claims database, partially available for around $18,300 a year, is one of the most powerful health data resources in the world. It’s also hamstrung:
While the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers. The reason is that the American Medical Association, the doctors’ trade group, successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare. The AMA has continued to defend this ruling, including in two cases in which federal appeals courts issued decisions last year.
This time around, The Wall Street Journal and the Center for Public Integrity took the AMA on. For health journalists, their description of what followed is really the crux of the story:
The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain the database. As part of the effort, the CPI filed a lawsuit against the Department of Health and Human Services, which houses the Medicare program. The Journal and CPI wanted the data at no cost; the government wanted $100,000 for eight years of data. In a settlement, The Journal and CPI obtained the requested data at a substantially reduced fee. They later obtained a decryption key to identify individual providers but signed a contract agreeing not to publish such identities in most cases.
The database, technically known as the Carrier Standard Analytic File, focuses on doctors and others paid on a fee-for-service basis. It contains 5% of all beneficiaries, and includes all doctor claims that Medicare paid directly in association with their care.
There’s far more to the story including information about the Consumers’ Checkbook lawsuit and the penultimate paragraphs on just how clear-cut fraud cases can be, once you know what to look for. An article on the Center for Public Integrity’s website promises more reporting, presumably based on the database, of “some of the questionable spending that occurs in the Medicare program.”
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Physician Panel Prescribes the Fees Paid by Medicare
Seniors more vulnerable to painkillers’ risks
Filed under: Health data, Hot Health Headline, Pharmaceuticals
Mary Shedden, of The Tampa Tribune, delves into the dangers of prescription medicines in older people, whose bodies may be weaker and process medications differently than younger people.
She tells the story of a 62-year-old woman who says she was diligent about controlling her use of oxycodone following back surgery. Despite her efforts, she was found nearly comatose and, after a visit to the emergency room, had to spend several days detoxifying because of a buildup of prescription medications in her body. “As [Susan] Schubert’s body was getting older, its physiological ability to efficiently process medications was weakening and changing.”
Aging bodies can become more sensitive to the effects of drugs and some drugs can build up in the body.
Designed to heal, prescription drugs also carry certain risks, depending on a person’s health, weight, gender and, yes, age. Seniors accustomed to taking a drug for years may think changes are unnecessary, but human aging and an increased tolerance to a medication can alter its effect.
As Shedden explains, “drugs known to make a person drowsy can affect focus, balance and cognitive abilities already weakened by age.”
Shedden’s story, published before yesterday’s report from the Agency for Healthcare Research and Quality about the increase in medication- and drug-related hospital visits in people older than 45, is an interesting look into some challenges of geriatric pain management and drug dependence in an aging population.
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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
