Florida addicts priced out of private rehab
In the St. Petersburg Times, reporter Leonora LaPeter Anton attempts to reconcile a local paradox: The state has suffered from epidemic of prescription drug abuse, yet Florida’s numerous private drug rehab centers remain empty. Why aren’t supply and demand coming together? The short answer, she found, is price.
… few who succumb to prescription drugs get the treatment they need. A national drug study estimated that just 10 percent of those who need treatment ever get it.
The problem is cost. Those with insurance quickly exhaust meager benefits and most don’t have $5,000 to $20,000 a month for round-the-clock rehab.
And the long answer? It comes back to insurance, then takes a sharp turn toward federal legislation. Insurers are reluctant to cover even 30-day treatment stays these days, Anton writes. “The typical plan at Blue Cross and Blue Shield of Florida, for example, offered $2,500 a year in substance abuse benefits. Anything over that was not covered.”
It’s a gap that the newly implemented Mental Health Parity and Addiction Treatment Act was designed to overcome. The new laws require that issues like substance abuse be covered at the same level that classic “medical” problems are.
Still, the new regulations apply only to companies with 51 or more employees. Though the law will likely improve care and make it more affordable, it won’t change the way insurers decide what is medically necessary. So with the push away from inpatient treatment, many addicts will try outpatient programs, which cost less, experts say.
Perhaps that is why 120 outpatient programs opened across Florida in the past two years. Florida licensed almost 400 new substance abuse treatment programs across the state, including 62 in the Tampa Bay area. Many focus on intervention, detox and the use of weaning medications such as Suboxone and methadone.
11 chosen as 2010-11 AHCJ-CDC Health Journalism Fellows
The Association of Health Care Journalists has announced the selection of the third class of AHCJ-CDC Health Journalism Fellows. The 11 journalists will spend a week studying a variety of public health issues at two Atlanta campuses of the Centers for Disease Control and Prevention.
The fellowship program will include presentations, roundtable discussions and lab tours on epidemiology, global disease prevention efforts, obesity, vaccine safety, pandemic flu preparedness, autism and many other topics.
The 2010-11 AHCJ-CDC fellows are:
- Ruby de Luna, KUOW-Seattle Public Radio
- Felice Freyer, The Providence Journal
- Raymond Hainer, Health.com / Time Inc.
- Katherine Harmon, Scientific American
- Margaret Haskell, Bangor Daily News
- Jori Lewis, freelance journalist & radio producer
- Rong Lin II, Los Angeles Times
- Meredith Matthews, Current Health Teens magazine/Weekly Reader
- Kevin McCarthy, Consumer Reports/Consumers Union
- Lara Salahi, ABC News
- Miranda Van Gelder, Martha Stewart Living
Fellows will tour the CDC director’s National Emergency Operations Center, meet sources on policy and research and learn how to tap the agency’s abundant resources to produce better stories. The training will take place in December at CDC’s Atlanta and Chamblee campuses.
The CDC is charged with protecting public health and safety by preventing and controlling diseases and injuries; enhancing health decisions by providing credible information on critical health issues; and promoting healthy living through strong partnerships with local, national and international organizations.
AHCJ is a nonprofit membership organization of more than 1,000 journalists interested in health and health care. It conducts training and creates other educational materials through its Center for Excellence in Health Care Journalism. AHCJ is housed at the Missouri School of Journalism.
Lieberman: Election is evidence media got reform coverage wrong
Filed under: Health care reform, Health journalism
In her column on CJRorg, AHCJ Immediate Past President Trudy Lieberman writes that this week’s elections showed just how thoroughly the media missed the mark on health care reform coverage.
After the economy (62 percent), health care (19 percent) was the second most important issue to voters. And while the media (and the administration) trumpeted the benefits of health reform and “glossed over” the drawbacks, public opinion soured. The biggest oversight, Lieberman writes, was the national insurance mandate, a policy that was more Republican than Democrat.
Lieberman says it best:
If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media.
She doesn’t explicitly frame it as such, but Lieberman’s column leaves me with the distinct impression that with the health care debate reignited by a Republican landslide, journalists are being given a second chance to provide the public with a clear understanding of what’s going on in Washington, an impression that’s cemented with her final sentence:
Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.
How numbers can be used to buttress falsehoods
On The New York Times‘ Well blog, Tara Parker-Pope interviewed NYU journalism professor Charles Seife, author of Proofiness: The Dark Arts of Mathematical Deception. While the book’s not exclusively focused on health care, the interview does touch upon numbers and health journalism.
Once you get past all the goofy catchphrases (proofiness! randumbness!), the basic point Siefe makes in the interview, that correlation is not causation, shouldn’t surprise anyone. Nevertheless, I enjoyed his elegant, health-related illustration of the phenomenon:
We are extraordinary pattern-matchers. Anytime there is something that is happening, we try to find a cause. But sometimes in medicine, sometimes things are absolutely random. Our minds don’t accept that. We must find a cause for every effect.
A really good example is the autism issue. Whenever a parent has a child who ends up being autistic, the parent more than likely says, “What caused it? How did it happen? Is there anything I could have done differently?” This is part of the reason why people have been so down on the M.M.R. vaccine, because that seems like a proximate cause. It’s something that usually happened shortly before the autism symptoms appeared. So our minds immediately leap to the fact that the vaccine causes autism, when in fact the evidence is strong that there is no link between the M.M.R. vaccine or any other vaccines and autism.
One caveat: Covering Health is not in the book review business, and I haven’t yet read Proofiness beyond what’s been excerpted.
Video, presentations from comparative effectiveness conference available online
Filed under: Government, Health care reform, Health data, Public health, Studies, Tools
Earlier this month, ECRI’s 17th annual conference tackled the thorniest detail of comparative effectiveness research, namely that it’s rarely a simple matter of A > B. Groups and individuals respond differently.
With a theme of “Comparative Effectiveness and Personalized Medicine,” the nonprofit and its partners at NIH and Health Affairs, among others, sought to better understand how big research ideas will interface with the person-by-person decisions through which such work will ultimately be implemented.
The conference has a detailed postmortem online, including two days of video (Fair warning: Together, they’re a good 700+ minutes of conference) and slides from a number of the presentations. I strongly recommend using the conference schedule listed on the slides page as a rough guide to finding the most relevant bits of video.
In case you’re looking for a place to start, here are two of the most relevant presentations:
- Keeping the comparative effectiveness debate rational
- Comparative effectiveness research in the Veterans Health Administration (and in Kaiser Permanente, which references patient preference and participation)
The online Q and A is also interesting, though there are only a handful of answers up at present. The most relevant one so far comes from Vivian Coates (Vice President, Information Services and Health Technology Assessment, ECRI Institute), in response to a query about a central listing of comparative effectiveness projects.
The CER inventory contract was awarded to the Lewin Group Center for Comparative Effectiveness Research (CER) in June, 2010. Over the 27 month period of the contract, Lewin will design, build and launch a web-based inventory that catalogs CER outputs and activity, including research studies, relevant research methods, training of researchers, data infrastructure and approaches for dissemination and translation of comparative effectiveness research to health care providers and patients.
In herbal remedies, labels don’t match contents
With the help of researchers who put together herbal DNA barcodes, PBS NewsHour’s Paul Solman found out just how often the actual contents of herbal supplements don’t jive with the words on their labels.
Black cohosh. Photo by Shotaku via Flickr
To make his point, Solman zeroes in on black cohosh, a herb used by some women to treat the symptoms of menopause. In a 26-brand sample, researchers found that 30 percent of the preparations labeled “black cohosh” contained absolutely nothing that could be identified. Apparently, cohosh looks quite similar to many other (non-theraputic) plants in its family. As Dennis Stevenson – the botanist behind the DNA labeling – told Solman, it’s not easy to identify:
Black cohosh is one of these plants that’s collected in the wild and only – if I’m not a trained botanist, I go out: “Oh, it looks like cohosh. I will get a bunch of it and sell it to the supplier, and – and we’re all happy.”
It’s not just the confusing herbs that prove problematic, though, Solman finds. He convinced the lab to test samples he provided of cohosh, ginkgo and ginseng, producing a small but illuminating sample of the mislabeling that appears common in the industry.
Admittedly, our sample size was too small to be statistically significant. But, surely, all the ginkgo would be ginkgo; ginseng, ginseng. And the lab agreed to do the test, so why not?
The results, also reported anonymously. Get this: Only two of our four ginseng samples seemed to contain ginseng, and even that was the Asian species, not the preferred North American variety. The other two contained some complex mixture of DNA, none of which could be confirmed as ginseng.
The four supposed samples of the ubiquitous, unmistakable ginkgo tree? One was legit, another an exact DNA match for common rice, the third a complex mixture of DNA, none of which, the lab report said, resembled ginkgo biloba DNA, and the fourth contained no plant DNA at all.
Our black cohosh samples did better. Seven out of eight did contain the plant, but one didn’t. Of 16 supplements, then, bought at random from major retailers in the Washington, D.C., area, six were suspect or outright frauds, prompting one last question for Dr. Baker.
One caveat: While research on the effectiveness of herbal supplements like cohosh can produces inconsistent results, an official with the National Center for Complementary and Alternative Medicine says blame doesn’t fall on unreliable supplies, at least in the tests his agency has overseen.
(NCAM’s Dr. Jack Killen) says he’s sure his samples were authentic:
“So, I think we have a great deal of confidence that the variability that we see in the research is not attributable to ’sometimes the black cohosh is there and sometimes it isn’t.’”
Other video highlights to watch for: How many herbal teas are cut with chamomile. Or grass clippings. Also, the lack of government regulation in the industry.
Alzheimer’s and caregivers’ difficult decisions
Filed under: Health journalism, Hot Health Headline
Writing for the AARP Bulletin, Chris Woolston drills straight to the core of the pain felt by folks caring for family members with Alzheimer’s by exploring a pivotal moment: the decision to move a loved one to a full-time care facility.
It’s a rich, in-depth package, but you’d be shortchanging yourself if you didn’t enter it through this profile of a brawling coal miner and his wife, including a multimedia piece by Matt Slaby, who recounts the challenges of chronicling such a charged, personal experience.
Companion pieces include:
Help for Alzheimer’s Caregivers
The High Costs of Caring for Alzheimer’s Patients
How My Husband and I Dealt With Alzheimer’s
New Science Sheds Light on the Cause of Alzheimer’s Disease
Remembered: The Alzheimer’s photography project
13 years of warnings, FDA inaction behind seizure
Filed under: Government, Health data, Health policy, Hot Health Headline, Pharmaceuticals
U.S. marshals seized a number of drug products from a small New Jersey pharmaceutical manufacturer called Tri-Med laboratories earlier this month. 
It doesn’t sound like much, and there hasn’t really been any coverage beyond a press release, but Pharmalot’s Ed Silverman has the whole story, one that chronicles 13 years of failed inspections and FDA inaction.
You’d do best to just read Silverman’s post, “Thirteen Years Later, The Feds Seize Some Meds,” but here’s a summary:
In 1997, the FDA inspected and warned TriMed. Seven years later, they did it again. In 2009, it was time for yet another encore. Finally, this month, they took action and seized a few drugs, stating in the release that, as Silverman writes, “Tri-Med has been making and distributing unapproved, misbranded and adulterated drugs with significant manufacturing violations since 1997.” And it only took them several failed inspections (and a recall along the way) to realize it.
Days numbered for UK’s arbiter of comparative effectiveness
Filed under: Europe, Health care reform, Health data, Health policy, Hot Health Headline
While comparative effectiveness research in the United States is booming thanks to the stimulus, a United Kingdom bastion of the discipline may be on the way out. Over at the NPR health blog, Joanne Silberner reports that the National Institute for Health and Clinical Excellence (NICE), which publishes guidelines on treatments and medical devices based on their cost and effectiveness, could be gone by 2013.
At a drug industry trade group meeting in London earlier this week, Health Minister Lord Howe, Under Secretary of State for Quality, said NICE has become “redundant,” and that it should focus on setting quality standards rather than evaluating individual drugs.
Meanwhile, the Cameron administration has disregarded NICE advice on several cancer drugs, and Howe reports that the government is working on a new “value-based pricing system.”
Related
For more European health news, see AHCJ’s Covering Europe initiative.
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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
