Reporter examines W.Va.’s drug epidemic
Filed under: Hot Health Headline, Pharmaceuticals, Public health
The Charleston (W.Va.) Gazette’s Alison Knezevich has geared an in-depth series around the fact that West Virginia has the highest rate of drug deaths in the nation. The overwhelming majority of those drug deaths involved prescription drugs.
In subsequent stories, Knezevich shifted her focus from the abusers to the medical community, beginning with those gatekeepers whose prescription pads are constant reminders that “nearly two-thirds of West Virginians who misuse pain relievers get them from friends or relatives for free.”
The tightrope walk between managing real pain and supplying addicts is such an exhausting one that some doctors fear employment in rural West Virginia clinics. It’s a dilemma faced even by those physicians who specialize in rehab, thanks to a newly popular brand-name drug for recovering addicts.
Reporter looks at black infant mortality in Wis.
Filed under: Children, Health data, Hot Health Headline
The Milwaukee Journal Sentinel’s Crocker Stephenson took a look at disparities in infant mortality in that area and explored both their cases and ramifications. In Wisconsin, black babies die at twice the rate of white babies, a finding which may just be the tip of the iceberg. For national and international comparisons, see the companion infographic. According to Stephenson, infant mortality rates are an early indicator of a community’s degeneration. When mortality rises, so do other dire indicators.
The bottom third - the group of ZIP codes with the most poverty and lowest college graduation rates - had the highest infant mortality rate.
It also had the highest premature death rate, chlamydia rate, HIV rate and teen birthrate.
It had the greatest percentage of low birth weights; preterm births; uninsured adults; people who hadn’t seen a dentist in a year; births to mothers who received no prenatal care during their first trimester; smokers; pregnant smokers; obesity; violent assaults within the past year; single-parent households; and children who tested positive for lead poisoning.
Milwaukee’s health commissioner called it a “crisis,” one that Stephenson found is as much a social matter as it is one of access to proper care. For more, see the “Problem Areas” section of the story.
More antipsychotics prescribed to foster children
Filed under: Children, Government, Health policy, Hot Health Headline, Pharmaceuticals
Need To Know, the PBS newsmagazine, recently took a look at the use of antipsychotics in foster children. Shoshana Guy’s piece opens with an anecdote about one 10-year-old foster child (now adopted) in Texas and expands from there. In nine years as a ward of the state, the boy was prescribed 20 different drugs by nine different doctors. After his adoption, a new, private physician diagnosed him only with ADHD, treatable with a single medication.
Antipsychotics are designed primarily to treat bipolar disorder and schizophrenia, diseases which affect about 3 percent of the population. Yet somehow, they’re the top selling class of drugs in the United States with $14.6 billion in sales in 2009.
Specific numbers on foster children are hard to come by, but the 2010 paper cited in the broadcast, Antipsychotic Medication use in Medicaid Children and Adolescents (48-page PDF), is a good start. Broader forces, such as pharmaceutical marketing and the increasing frequency of mental illness diagnoses for children are at work here, Guy found, but that doesn’t mean that the foster care environment itself isn’t also a factor. It’s a system in which people are frequently looking for ways to “manage” problematic children. Judging by a companion post on Need to Know, this sounds like a story that will develop significantly in the coming year.
…foster care children are prescribed drugs at a rate much greater than that of other kids. Concern over their well-being — not to mention the amount it costs to treat them — has prompted the Government Accountability Office to investigate potentially abusive prescribing practices in America’s state foster care systems. The GAO findings are expected to come out later this year.
Watch the full episode. See more Need To Know.
You can find Need to Know’s health stories on this landing page, but as of yet I haven’t been able to find a health-specific RSS feed.
Critics point out issues in patient satisfaction ratings
Filed under: Health data, Hospitals, Hot Health Headline
On the heels of a government proposal to tie hospital incentive payments to patient satisfaction ratings, a few outlets have started looking at the validity of such measurements.
At HealthLeaders Media, Cheryl Clark reports that regional differences in tendency to be satisfied (the numbers show that New Yorkers are harder to please than Midwesterners and New Englanders, for instance) mean that any absolute number thresholds issued by the feds would penalize hospitals in parts of the country where folks are less likely to respond well to surveys.
And on KevinMD.com, William Sullivan, D.O., J.D., takes a few swings of his own, first taking aim at the ratings’ sampling and statistical grounding, then moving on to what he says is hospitals’ over-reliance on percentile quality ratings.
The problem, according to Sullivan? Overall patient satisfaction is quite high, thus doctors’ ratings cluster tightly around the low 90s on a 100-point scale. That means even a small shift in absolute rating will cause a huge jump in percentile. On at least one system, a 4-percentage-point absolute drop will take a doctor from the 90th percentile to the 50th. And, thanks to the aforementioned sampling issues, that drop can be caused by a handful of particularly ornery patients. Patients who, Sullivan writes, are thus given massive leverage.
With our employment and our compensation hinging on every “5” we can get, doctors are being coerced into giving patients whatever they want, regardless of medical appropriateness. When we cater to satisfaction scores more than we cater to proper medical care, we are violating our oath, devaluing our education, and potentially harming our patients.
AHCJ Resource:Analyze patient satisfaction surveys for your local hospitals
“Numbers can be a start - not the end - of a story,” the AHCJ website notes. Remember that patient satisfaction scores only mean so much. Sometimes the best doctors have gruff demeanors while those with inferior skills have great bedside manners. Patients may not recommend hospitals to friends because they dislike the food or think their roommates were too loud. But if patients report that doctors or nurses didn’t communicate well, that very well could affect the care the patients received. Using data can give you a valuable tip sheet to generate ideas and questions in your pursuit of a story.
For hospital overall survey results, AHCJ includes comparison of data first released in March 2008 then updated quarterly, allowing journalists to compare overall survey results over a lengthy timeline.
WSJ sues for release of Medicare provider data
Filed under: Government, Health journalism, Public records
If successful, a legal move by The Wall Street Journal could open a flood of now-confidential Medicare data about providers to the public and journalists.
The filing, by parent Dow Jones & Company, seeks to overturn an injunction that “prevents the public from knowing how much taxpayer money individual doctors receive from the Medicare program,” according to a press release.
The Journal has been running a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. To report the series, the paper and the Center for Public Integrity obtained the data from the U.S. Department of Health and Human Services but is barred from using the identities of individual providers.
Information about doctors in the Medicare claims database is kept confidential as a result of a lawsuit brought by the American Medical Association more than 30 years ago.
A press kit about the suit includes statements from reporters Maurice Tamman and Mark Schoofs and editor Michael Allen, as well as documents in the case and links to the WSJ series.
For more information, see “WSJ explains why Medicare data is hidden and “WSJ exposes flaws of Medicare’s pay now, investigate later culture.
Update
The board of directors of the Association of Health Care Journalists has released this statement:
AHCJ strongly supports the release of Medicare payment data that can help journalists better cover both the quality of care provided to patients and the finances of this critical government program. Publicly available information should include physician names connected to these payments. We see little reason why information on payments to doctors should be subjected to greater secrecy than payments to hospitals and nursing homes. The Wall Street Journal’s coverage demonstrates that data linked to doctors would help inform the public and likely would expose fraud and abuse in the program.
The Leona M. and Harry B. Helmsley Charitable Trust awards $1.1 million grant to support health journalists
The Center for Excellence in Health Care Journalism, the educational arm of the Association of Health Care Journalists, has been awarded a grant of nearly $1.1 million to improve training resources for health journalists.
The Leona M. and Harry B. Helmsley Charitable Trust made the three-year grant of $1,097,000 to the Missouri-based center to increase the range of training opportunities for current journalists and to help develop new health journalists across the country.
“The real stories on the state of health care can be found at the local level,” said Len Bruzzese, executive director of AHCJ. “The Helmsley Trust’s generous support will allow us to expand our training in underserved geographic areas and in underreported topic areas to better assist local reporters in telling those stories.”
The funding will support the annual conference of the association, starting with Health Journalism 2011 this spring in Philadelphia; regional workshops on niche health topics; an annual rural health journalism workshop; and three conference fellowship programs assisting ethnic media, rural reporters and journalists on non-health beats who routinely face health-related stories, such as education, environment, business and government.
Significantly, the funding will allow the continuation - and expansion - of an intense regional fellowship program that has trained dozens of journalists in Kansas and Missouri over the past four years. Each year, the new AHCJ-Regional Health Journalism Fellowships program will select 10-12 reporters, editors and producers from a different region of the country for customized training. The yearlong fellowships are meant to improve abilities to provide meaningful coverage of critical issues and assist and motivate fellows to increase such coverage.
The funding also will allow updates to the technology used to produce the association’s website, www.healthjournalism.org, and to increase the resources available there. The site assists reporters working on health-related stories with tip sheets, reporting guides, government data, training presentations and resource links.
“As America struggles with access and the rising cost of health care, it is important that the information on choice and cost is available to the consumers. New technology allows consumers to manage their healthcare closer to home and at less cost. Giving journalists access to information on those technologies is important to the Helmsley Charitable Trust,” noted Rural Healthcare Program Director Shelley Stingley. Read more
Exploring ethics, standards in science blogging
Filed under: Conflicts of interest, Health journalism
As a follow up to ScienceOnline 2011, independent journalist Maryn McKenna writes about bringing the standards of journalism to blogging.
Maryn McKenna
At the annual meeting that brings together scientists, journalists, bloggers and others interested in communicating about science, McKenna took part in a discussion about ethics and credibility.
Regular readers of Covering Health will remember last year’s ScienceBlogs controversy as well as health journalist Mary Knudson’s decision to not blog for U.S. News & World Report when she noticed her first post had been studded with sponsored hyperlinks.
McKenna, who is a member of AHCJ’s board of directors, outlines how she has brought her own “best practices” to blogging and outlines them. She also highlights several points from AHCJ’s statement of principles that specifically deal with issues medical and science writers face.
Of course, as some people at the meeting noted, not everyone who blogs is – or wants to be – a journalist. But many of them do see the need for standards and transparency, as science writer Ed Yong points out. Science journalist Dave Mosher, of Wired.com, also explores the topic.
Joint Commission makes more accreditation details available on website
Filed under: Health data, Health journalism, Hospitals
Angie C. Marek, a member of AHCJ’s Right to Know Committee, contributed this update.
The Joint Commission, the largest nonprofit organization to accredit hospitals in the United States, has improved the quality of information available to consumers and journalists on its website. 
In response to a request by AHCJ’s Right to Know Committee, the agency has made it easy to tell whether a facility has recently lost accreditation or is in danger of losing it.
In the site’s Quality Check section, the search page now has a filter allowing viewers to select “Type of accreditation.” (The filter only appears in areas where there are hospitals that are not fully accredited.) Previously, to find hospitals with less-than-full accreditation, users had to examine each hospital’s record individually. Now the few that have not met standards can be quickly located.
“We’re pleased that the Joint Commission responded to our suggestion to make its website more useful,” said Charles Ornstein, president of AHCJ’s board of directors. “Reporters and consumers will now find it somewhat easier to learn about the institutions to which they entrust their health.”
Guidelines for releasing information in public health crisis still in the works
Filed under: Health journalism, Health policy, Public health, Public records
When North Carolina officials recently announced the death of a teenager as a result of the flu but gave out little other information, reporter Rose Hoban, R.N., of North Carolina Public Radio, had a sense of deja vu. Hoban is a member of AHCJ’s Right to Know Committee, which has dealt with exactly this issue.
Some background:
During the H1N1 pandemic, reporters found a wide variation in what information local and state health officials were disclosing about H1N1 deaths. As a result, representatives of AHCJ, including Hoban, met with health officials representing the Association of State and Territorial Health Officials and the group agreed on flexible guidelines specifying what information should be released about victims in a public health crisis.
Last week, Hoban filed an update about the issue on her blog with comments from Gene Matthews, who is a senior fellow at the North Carolina Institute of Public Health and was the lead counsel for the CDC for 25 years. She also checked with ASTHO about the status of the draft guidelines and was told, “I don’t think it’s going to disappear, fall into oblivion …”
Program for disabled kids has unintended effects
Patricia Wen, of The Boston Globe, examines the Supplemental Security Income (SSI) program for children and finds the program “has gone seriously astray” and describes it as “a fast-growing alternative welfare system.”
And once a family gets on SSI, it can be very hard to let go. The attraction of up to $700 a month in payments, and the near-automatic Medicaid coverage that comes with SSI approval, leads some families to count on a child’s remaining classified as disabled, even as his or her condition may be improving.
Wen found that the program, which was intended to serve children with severe physical disabilities, now mainly serves children with behavioral, learning and mental conditions and carries financial incentives to put children on psychotropic drugs. She writes that preschoolers are the fastest-growing group to qualify for SSI, “largely because of a 12-fold spike in cases of speech delay. The government is aggressively trying to help these young children, but spends little time to see if they’re getting any better.”
Another, unintended, effect of the program is that teenagers on the program are declining to take part-time jobs despite their desire to start careers and not be dependent on the government. Wen explains “they fear working will jeopardize their disability checks. Their families are poor and need the money.”
Of interest to reporters interested in localizing the story, the package contains a data-driven interactive map that shows how many children in each state are receiving SSI assistance, the percentage who became eligible because of mental disabilities and the top five diagnostic categories.
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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
