NLM workshop in Ohio tests waters for possible chapter
Filed under: Health journalism, Member news, Tools
This post was contributed by AHCJ member Eileen Beal.
On Oct. 9, health care journalists, a couple of journalism professors, a couple of local medical librarians – a total of 15 – turned out for the free National Library of Medicine Workshop that NLM senior staffer Robert Logan presented at the Cleveland Heights Library on Cleveland’s east side. Logan was formerly a journalist and professor of journalism at the University of Missouri-Colombia. Currently, he is with NLM’ s Office of Communications and Public Liaison and chair of NLM’s Consumer Health Informatics Research Interest Group.
The 2 ½-hour workshop accomplished two goals. It taught attendees how to access several of the National Library of Medicine’s on-line databases (PubMed, Clinical Trials.gov, and Medline Plus) and it provided hands-on training on how use the MeSH feature on NLM’s website to better-target research and databases searches. Feedback indicated that the workshop was, as one person put it, “well worth giving up a sunny Saturday morning for.” (A few copies of the workshop handout are still available.)
In addition, the workshop tested the waters in the health-writer-rich Cleveland-Akron area (home to several large newspapers, Advanstar Communications, Penton Media, Inc., MedCity News and a host of health care institutions) about interest in forming a local chapter of AHCJ to provide opportunities for more education/training events and networking.
Feedback on this was also good, so, if you live in Northeast Ohio, contact AHCJ member Eileen Beal (eojb@visn.net) for more information about forming a local chapter.
ProPublica investigates pharma payments to doctors
Filed under: Conflicts of interest, Health care reform, Health data, Health journalism, Hot Health Headline, Pharmaceuticals, Public records, Tools
ProPublica’s massive investigation into the hefty fees pharmaceutical companies have paid doctors with dubious track records stamps an exclamation point on what has been a banner year for high-profile assaults on pharma-paid physician/marketers.
Books like Daniel Carlat’s Unhinged and Carl Elliot’s White Coat, Black Hat, and the promotional tours that came with them, led the charge and raised awareness of an issue that reporters Charles Ornstein (you may know him as AHCJ’s president), Tracy Weber and Dan Nguyen have driven home with tens of thousands of carefully researched data points and one flagship story.
The ProPublica database is built upon the voluntary disclosures of seven drug manufacturers (Eli Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer) which represent about 36 percent of the market. Reform law requires the other manufacturers to make similar disclosures by 2013. The package uncovered a bucket of horror stories — that mug shot of high-earner Dr. Donald Ray Taylor next to the paragraph describing why he was disciplined is the very definition of “disturbing” — yet also distinguished itself by giving doctors who rep pharma the opportunity to explain both their work and their motivation.
In its examination of pharma payments, the investigation goes beyond a simple database match with disciplinary records. Some physician/marketers had clearly earned their stripes and displayed impressive resumes and relevant research records, the reporters found, but others had disciplinary records, lacked any board certification or publications or appeared to have been manufactured by the drug-makers themselves.
“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.
“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”
If you can’t get enough of the investigation, see the work by ProPublica’s partners at The Boston Globe, Consumer Reports, the Chicago Tribune, Nightly Business Report and NPR.
Finally, don’t miss the comments on the article, headlined by a lengthy response from the leading pharmaceutical industry group.
More patients aren’t filling brand-name prescriptions
It hasn’t had quite as much impact as some earlier health-related recession trend stories, but the rise in prescription abandonment rates, detailed in this post by Pharmalot’s Ed Silverman, is starting to snag a few headlines.
According to market research agency Wolters Kluwer, the number of prescriptions for brand-name submitted to a pharmacy but never picked up as crossed the 10 percent threshold, with patients now skipping out on twice as many prescriptions as they did before the recession. The number has been on the rise for a while now, as you can see in this Wall Street Journal graph. The agency releases the numbers every six months.
For more on the issue, I recommend the comment section of this related Pharmalot post.
Who monitors pharmacies’ systems to curb pseudoephedrine sales?
CVS Pharmacy has been in the news recently after it agreed to pay $75 million in penalties and forfeit $2.6 million in profits made from illegally selling pseudoephedrine. Scott Hensley did a nice job of explaining why the retailer got in trouble, which boils down to a defect in the electronic system the chain used.
As most allergy sufferers know, federal laws (and some state laws) limit how much pseudoephedrine consumers can buy. Retailers are left with the chore of monitoring who buys how much of the drug, which also can be used to make methamphetamine.
As the CVS case seems to show, and my personal experience backs up, retailers apparently can set up their own systems for tracking the sale of pseudoephedrine as long as they meet some basic requirements:
Regulated sellers are required to maintain a logbook, written or electronic, to record sales of products containing ephedrine, pseudoephedrine, or phenylpropanolamine. The seller must enter into the logbook the name of the product, and quantity sold. The customer must write or enter into the logbook their name, address, date, and time of sale. The customer must also sign the logbook. You may not sell the product unless these requirements are met.
What isn’t clear is who is regulating those systems.
If a retailer’s system doesn’t prevent someone from making multiple pseudoephedrine buys and exceeding the federal limit – as happened at CVS – or if a retailer’s computer program mistakenly calculates the wrong amount of pseudoephedrine contained in a medication, then the system is failing. In the case of CVS, the problem happened for more than a year at multiple locations.
Now, for that personal experience I mentioned earlier …
After recently being told I had met my limit of pseudoephedrine at a neighborhood pharmacy, despite the fact that I take less than the maximum dosage to control my allergies, I asked to look at the store’s records.
A sympathetic pharmacist showed me the log of my purchases and I discovered that when I bought a package of 18 pills, the store’s computer recorded it as a package of 18 pills, but it calculated the amount of pseudoephedrine in that package to be the same as what would be in a 36-count package. That amount of pseudoephedrine was what triggered the computer to tell the pharmacy not to sell any more to me.
Once I pointed out the error, the pharmacist got out a calculator and eventually concluded I was right. He was rather incredulous that the error could happen. He tells me that he’s put in a request with the company’s help desk to fix the problem.
However, I’m left wondering whether my name is flagged in a computer database somewhere because of the store’s error and how many other innocent people are also flagged. Not to mention how many allergy sufferers have been left unable to breathe properly because computer systems show they’ve bought more pseudoephedrine than they actually have.
Perhaps more importantly, what about the methamphetamine criminal cases that have been brought as a result of authorities examining these records? There was recently a large raid on meth labs in my area based on pharmacy records and the pharmacist I talked to said he’d been in court testifying recently in meth cases. Could errors in pharmacy records be a defense attorney’s dream?
Schwitzer on the future of health journalism
When HealthNewsReview.org publisher Gary Schwitzer writes on the future of health journalism, his words carry the weight of a database loaded with more than 1,000 reviewed stories. Like Charles Darwin’s long study of barnacles, Schwitzer’s micro-level scrutiny of the industry has left him uniquely equipped to tackle the big picture stuff as well. Which is why, when he draws a line in the sand, as he did in an essay published in a German public health journal, we should probably listen.
Schwitzer uses three examples: the hyper-expensive radiation treatments, comparative effectiveness research and good-old-fashioned disease mongering. In each, he asks reporters to be skeptical, and to push past the claims of vested interests. It’s easy to see where he stands, and he doesn’t pull any punches, as you can probably infer from this final sentence:
The future of health journalism will be determined by which roles journalists choose for themselves: cheerleader or watchdog, fear-mongerer or evidence-based reporter, part of the solution, or part of the problem.
Rural health on the frontier
A defining feature of reporter David Wahlberg’s ongoing look at rural health care for the Wisconsin State Journal has been his willingness to look beyond the state’s borders, as with his recent piece on health care navigators in Kentucky.
In his latest installment, he looks to Montana, not just for a model, but for perspective. In Montana, he finds that all rural health challenges are created equally, and that the rural areas of the Mountain West and western Great Plains are so remote that the term “rural health” just doesn’t do their situation justice. Instead, they deal with “frontier health,” where the only hospital in driving distance can’t afford to deliver babies, and hospitals have to fly patients hundreds of miles just so they can have access to adequate blood supplies.
Only 4 percent of Wisconsin residents live in frontier counties. In Montana, that number is 54 percent. Wyoming is even higher. “Frontier” counties are generally considered to be those with a population density of fewer than seven people per square mile. For those interested, the State Journal included a map of such counties alongside the story.
Canadians fight for disclosure of medical treatment
It took eight years, a whistleblower and intervention from a state commissioner to uncover a fatal medical error in a Newfoundland hospital, one committed by a doctor with an (undisclosed) record of such actions. As Canadian broadcaster CTV reports, Canada’s free access to health care doesn’t translate to free access to information.
Here’s my summary of the story’s key events, as I understand them:
- A woman in Newfoundland dies soon after her ER doctor misdiagnosed a blood clot in her lung and gave her treatment that a colleague said would have been equivalent to a “lethal injection.”
- The victim’s family doesn’t know that anything was out of the ordinary until six years later, when the colleague contacted the family directly to explain what he believed to be a mistake.
- The family approaches the hospital for information, and gets a few treatment records, but is denied access to records from an internal investigation of the incident.
- Using the province’s FOI laws, the family again pushes for the investigation information. Their request is denied.
- Finally, “the family appealed to the province’s Information Commissioner, who ordered Eastern Health to hand over the records.”
- A year later, the records were disclosed – but key EKG information was not. Thus, the family’s fight for disclosure continues unabated.
Understanding the administrative side of implementation
Coverage of health care reform implementation has generally focused on the issues and effects of the roll-out, rather than the arcane governmental mechanisms involved. It makes sense, of course, as “here’s how you can now get coverage despite your pre-existing condition” is significantly more relevant to most readers than “23 states miss federal 90-day deadline for creation of high-risk pools, partly because already established pools don’t always conform to reform requirements, and partly because it’s too much hassle and they’d rather let the feds do it for them.”
Service-oriented as it may be, this focus has led to a few gaps in my understanding of the administrative moving parts involved in implementation. Which is why the Robert Wood Johnson Foundation’s guide to state and federal roles in the implementation of health care reform is such a handy document. It’s worth a quick scan, if only to give all those implementation stories a little context. It’s got everything from “how informal rulemaking becomes law” (hint: it involves both “notice” and “comment”), to the aforementioned business about why some states ceded control of their high-risk pools to the federal government. And it’s only four pages long.
Trade group says conflicts negate GPOs’ leverage
A recent GAO report looked at group purchasing organizations and established that they were pervasive, and that they’d adopted some internal ethics rules. It did not, however, substantially evaluate charges that GPOs can increase cost and stifle innovation.
However, a medical device trade group picked up where the GAO left off. According to a study published last week by the Medical Device Manufacturers Association (53-page PDF), repealing the special GPO exemption to a general ban on kickbacks in situations where federal health spending is involved would result in as much as $25 billion in annual savings. The study’s a quick, forceful and engaging read, but it comes, of course, from an organization that clearly has a dog in the fight.
The Health Industry Group Purchasing Association, a trade association representing 16 GPOs, has – not surprisingly – a different view, evidenced by its website, GPOsSaveMoney.org.
Innovative approaches to malpractice, errors
Filed under: Government, Health care reform, Health data, Health journalism, Health policy, Hospitals, Studies, Tools
American Medical News reporter Kevin O’Reilly writes about a presentation by David Mayer, M.D., University of Illinois at Chicago Institute for Patient Safety Excellence co-director, at an AHCJ Chicago chapter event. The event shed light on some ways to tackle malpractice and errors in a way that will benefit both physicians and their patients.
David Mayer, M.D.
Mayer talked about turning doctors away from the “deny and defend” approach to malpractice and toward an open disclosure of medical errors. He seeks to reduce malpractice suits through a “seven pillars” approach. Here’s a quick summary of how things work:
- Patient safety incident reporting: Push for fast reporting of possible incidents
- Investigation: Figure out if something really went wrong.
- Communication and disclosure: Keep patient and family informed during the entire process. Even if it involves very bad news.
- Apology and remediation: Don’t just apologize, tell them how you’re going to fix the damage and/or offer compensation.
- System improvement: Change the system to prevent it from happening again, invite the patient and family to participate.
- Data tracking and performance evaluation: Keep a massive database of all safety incidents and use it with impunity, even for public outreach.
- Education and training: Carefully monitored continuing education that is informed and directed by error monitoring and in-house incidents.
Meyer’s pillars are going to be implemented in nine Chicago-area hospitals, thanks to a $3 million grant from the HHS Agency for Healthcare Research and Quality. The grant is one of seven “demonstration grants” the AHRQ awarded as part of its program to evaluate “Patient Safety and Medical Liability” projects. The agency also awarded 13 smaller planning grants.
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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
