Diet soda and stroke: A reminder on reporting preliminary studies
Filed under: Health journalism, Hot Health Headline, Studies
Over at the NeuroLogica blog, Steven Novella, M.D., explores the absurdity of a poster presentation at the American Stroke Association International Stroke Conference, one obviously intended to showcase raw preliminary research on soda consumption, somehow making headlines in health and science sections around the world. The poster in question, of course, was one that reported a 61 percent increase in self-reported cardiovascular disease among those who drank diet soda versus those who drank no soda whatsoever.
It’s the sort of headline that should set off alarms in the subconscious of a health journalist, and Novella is quick to acknowledge its flaws: It was observational, self-reporting, didn’t control for many obvious confounds and only measured a single point in time. However, Novella writes, that doesn’t necessarily make it a bad study. It just makes it a preliminary one. One suited for something like a poster presentation. Which is exactly what it was. (Emphasis mine.)
While this study has serious flaws that preclude any confident interpretation, it is a reasonable preliminary study – the kind of study that gets presented as a poster at a meeting, rather than published in a high-impact peer-reviewed journal. Such preliminary research is mostly an exercise in data dredging – looking at data sets for any interesting signals. The purpose of such preliminary research is to determine whether or not more definitive follow up research is worth the time and effort. If there were no signal in this data, then don’t bother designing and executing a tightly controlled several year prospective trial.
So if the study was just a necessary but early step in the research process, how did things get so out of hand? Frequent consumers of health media criticism already know what’s coming next.
The problem is in the reporting of these studies. The mainstream media probably should just ignore any study that is deemed preliminary, especially if it’s just an isolated study. Perhaps in a thorough feature article it would be reasonable to give an overview of the state of the research into a question, including preliminary studies, because in a feature time can be taken to put the evidence into perspective. But reporting a single preliminary study as science news is a highly problematic approach.
Novella points out that people who saw stories about the study – even those stories that included reasonable reporting – will likely just remember the headline linking diet sodas and stroke risk. He also reminds us that “Over-reporting of preliminary results also has the effect of confusing the public with lots of noisy information, most of which is not true.”
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.
MSNBC: FDA had concerns 2 years before alcohol wipe outbreak, didn’t act
Filed under: Government, Health journalism, Hot Health Headline
JoNel Aleccia and the folks at MSNBC.com have dug in deep on news of the FDA’s Jan. 5 recall of tainted alcohol wipes, spurred on by the death of a Texas toddler and complaints from across the country. Aleccia’s findings seem to indicate that, more than a month after the recall, the case of Triad Groups’ trainted products and related failures of FDA oversight may run far deeper than the original notice implied.
Aleccia’s been helped in the follow-up investigation by unofficial access to FDA records, validated by outside sources, that indicate inspectors detected problems in 2009, and again in 2010, but didn’t act until this year’s recall.
Documents show that FDA officials expressed concerns following visits to the Triad plantfrom July 15 to July 17, 2009, and again from April 19 to May 18, 2010. Inspectors reported that the company could not validate the processes used to ensure quality or sterility not only of alcohol prep pads and wipes, but also other products used for intimate care.
…
The inspection documents, known as FDA Form 483s, were obtained by msnbc.com from a confidential source and confirmed by FDAzilla.com, an independent Web site that monitors the FDA. Copies of the documents were sent to the FDA for review; the agency did not deny their authenticity.
For a thorough roundup of all the points at which warnings surfaced, or at which the FDA could have intervened, check out Aleccia’s full report.
Speaking of FDAzilla.com, it might be a site worth checking out if you’re interested in the FDA’s activities. It’s free and says it has “made millions of pages of FDA data (MAUDE, devices, drugs, 483s listing, FDA employees) more usable and searchable.” The FAQ says most of its data is automatically updated nightly from files posted on FDA.gov.
Gates’ funding of journalism raises ethical questions
Filed under: Conflicts of interest, Europe, Health journalism, Hot Health Headline
In our coverage of the Kaiser Family Foundation’s report on the present and future of the global health beat, we noted the influx of the Bill and Melinda Gates Foundation’s largesse ($1 billion in the past decade) [correction] into that particular sphere of the health journalism world. The foundation has gone beyond supporting the training for journalists to now funding specific reporting enterprises – such as a recent ABC News special “on an incubator to boost preemie survival in Africa and a new machine to diagnose tuberculosis in the developing world.”
Now, Seattle Times reporters Sandi Doughton and Kristi Heim look at the logical question brought about by all that money: “Does Gates funding of media taint objectivity?”
I don’t think there’s a journalist among us who will be able to resist reading the whole thing, if only to see just how much certain organizations have been given and which stories the foundation has been pushing. Nonetheless, I’ll run through a few of the highlights.
The Seattle Times reporters touch on some high-profile pieces funded through partnerships between the foundation and top media organizations, but write that the Gates effect runs much deeper than investigations that say “Funded in part by the Bill and Melinda Gates Foundation” at the end. After all, they write, “The Gates Foundation spends more on policy and advocacy than most big foundations — including Rockefeller and MacArthur — spend in total.” It accounts for a tenth of their annual $3 billion budget.
To garner attention for the issues it cares about, the foundation has invested millions in training programs for journalists. It funds research on the most effective ways to craft media messages. Gates-backed think tanks turn out media fact sheets and newspaper opinion pieces. Magazines and scientific journals get Gates money to publish research and articles. Experts coached in Gates-funded programs write columns that appear in media outlets from The New York Times to The Huffington Post, while digital portals blur the line between journalism and spin.
As the reporters note, their sources point that that, “While the aims may be laudable, the ability of one wealthy foundation to shape public discourse is troubling to some.”
“Even if we were to satisfy ourselves that the Gates Foundation were utterly benign, it would still be worrisome that they wield such enormous propaganda power,” said Mark Crispin Miller, professor of media, culture and communications at New York University.
For their part, foundation folks say they’re trying to raise the profile of undercovered issues, not manipulate the world’s media.
“We’re trying to do everything we can to make sure people understand not just the need, but the opportunity, to make a huge difference in the lives of millions of people around the world,” said Joe Cerrell, who oversees the foundation’s policy, advocacy and communications work in Europe. “For us, it’s about making sure that these stories get told.”
For a more critical take, see Humanosphere blogger Tom Paulson’s review. In addition, David Jacobs, director of foundation information management at the Foundation Center, raises the question of whether it’s ethical for media outlets to accept donations from large foundations whose activities they may have to scrutinize one day.
Oh, and by the way, the reporters write, “The Seattle Times received a $15,000 Gates grant through Seattle University for a series of stories on homelessness in 2010.”
Update:
Christopher Williams, senior communications officer of The Gates Foundation, has written to Covering Health to clarify: “In fact, the foundation has spent approximately $50 million on media grants and partnerships over the past decade. We have spent approximately $1 billion on all advocacy efforts, for all of the issues that are important to the foundation. This includes research, policy work, and other advocacy of our issues that is not necessarily media focused.”
Being precise about screening vs. diagnostic tests
Gary Schwitzer, AHCJ member and HealthNewsReview.org publisher, calls for more precise language when describing medical tests and to make a bit of an example of Prevention magazine on his blog. The March issue of the magazine leads with a story titled “4 Screening Tests Women Fear.” The problem? The story’s about mammograms, colonoscopies, endoscopies and MRIs. And two of those things, Schwitzer writes, are not like the others. Emphasis mine.
…Only 2 of the 4 tests discussed are screening tests.
Yes, mammograms and colonoscopies are screening tests - used in an apparently healthy population looking for signs of trouble.
Endoscopies and MRI scans — as discussed by Prevention in this case — are not screening tests but diagnostic tests used to help diagnose what is the problem in people with signs or symptoms of something wrong. Screening tests are for people believed to be healthy. Diagnostic tests are for people believed to have a problem.
Schwitzer’s not just splitting hairs here. As he explains, getting these distinctions right can have real-world health impact.
The semantics are important. Lumping diagnostic tests like endoscopy and MRI in with screening tests like mammograms and colonoscopies can give readers the impression that everyone should consider all of them. And, no, not everyone needs to be worried about when to have their next endoscopy or MRI scan…
AHCJ member publishes book on love, biochemistry
AHCJ member Victoria Costello’s new book, “The Complete Idiot’s Guide to the Chemistry of Love,” is now on the market. Co-authored with evolutionary psychologist Maryanne Fisher, Ph.D., the book explores the “neuroscience of human emotions and relationships.”
For a quick introduction to the book’s subject matter and a frank discussion of how Costello has applied the principles of biochemistry in her own romantic relationship, head on over to her Psychology Today blog post. Costello has also made a preview available online.
Wash. hospital executive salaries may threaten nonprofit status
Filed under: Government, Health journalism, Health policy, Hospitals, Hot Health Headline, Public records
KUOW’s John Ryan, who has been using public records to investigate pay for nonprofit hospital executives, dove deeper into the series when he discovered a law on the state’s books that appears to limit the pay of nonprofit execs to something near that paid to equivalent employees in the public sector. On the face of it, it appears many execs aren’t satisfying this requirement, which may place their hospitals’ tax breaks in jeopardy.
KUOW has learned that 15 hospital executives in Washington made $1 million or more in 2009. That elite group includes 14 nonprofit executives and one head of a government hospital.
For their part, hospital spokespeople pointed out that there may be no equivalent in Washington’s public sector to the work they do, and that some state hospital executives do pretty well for themselves anyway. Those claims haven’t stopped legislators from taking action based on Ryan’s work.
After learning of KUOW’s findings, state senators Cheryl Pflug and Karen Keiser co-sponsored a bill that would require nonprofit hospitals to publish their top executives’ incomes each year. They’d also have to provide proof to tax collectors that the paychecks aren’t out of line with comparable pay in the public sector.
If you’re looking to re-create Ryan’s work in your neck of the woods, he’s written a nifty little “How I did it” that should get you started, although he tells Covering Health that Washington’s law requiring nonprofit 
executive pay to be comparable to public-sector pay might be unique. But for looking into all kinds of executive compensation stories, AHCJ members should refer to tip sheets such as:
- Digging Into Hospital Finances: Recent trends and five key documents
- Reporting on the business of health care
- Changes to 990 forms make hospital finance investigations necessary.
Alarm fatigue hurts patient care, overwhelms nurses
Filed under: Health data, Hospitals, Hot Health Headline, Nursing
In the wake of several high-profile incidents, The Boston Globe’s Liz Kowalczyk has assembled a thorough investigation of alarm fatigue in hospitals. Alarm fatigue, for the record, is the idea that the huge arsenal of patient monitors in any given hospital floor are going off so often that nurses become slower in their responses to the alarms. For example, in one 15-bed unit at Johns Hopkins, staff found that, on average, one critical alarm went off every 90 seconds throughout the day.
With the help of ECRI, Kowalczyk has managed to attach some numbers to the issue.
The Globe enlisted the ECRI Institute, a nonprofit health care research and consulting organization based in Pennsylvania, to help it analyze the Food and Drug Administration’s database of adverse events involving medical devices. The institute listed monitor alarms as the number-one health technology hazard for 2009. Its review found 216 deaths nationwide from 2005 to the middle of 2010 in which problems with monitor alarms occurred.
But ECRI, based on its work with hospitals, believes that the health care industry underreports these cases and that the number of deaths is far higher. It found 13 more cases in its own database, which it compiles from incident investigations on behalf of hospital clients and from its own voluntary reporting system.
Kowalczyk also looks at potential solutions to the problem and how some institutions are trying to make changes to eliminate alarm fatigue, including cutting back on unnecessary monitors and having monitor warnings appear on nurses’ pagers or cell phones.
To back up the numbers, Kowalcyzk got some telling quotes from frustrated nurses.
“Yes, this is real, and, yes, it’s getting worse,’’ said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.’’
“Everyone who walks in the door gets a monitor,’’ said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 [types of] alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes . . . background.’’
Kowalcyzk’s investigation points out that, while alarms do tend to go off when there’s a real problem, it appears that they do so at the expense of also going off when there isn’t.
Monitors can be so sensitive that alarms go off when patients sit up, turn over, or cough. Some studies have found more than 85 percent of alarms are false, meaning that the patient is not in any danger. Over time this can make nurses less and less likely to respond urgently to the sound.
For more specifics on device design issues, see the final subheading, titled “Looking for solutions.”
For a one year, the Joint Commission made routine alarm testing and training part of their accreditation requirements, but dropped the stipulation in 2004 when it felt the problem had been solved.
Other parts of the series:
- Graphic: Hospital Alarms
- Ask a nurse how they deal with all the noise in hospitals
- Video: Watch an FDA Patient Safety News video on alarms
- ECRI Institute’s 2011 Top 10 Health Technology Hazards
Four AHCJ members power JAMA’s new blog
We’re proud to note that AHCJ members Bridget M. Kuehn, Mike Mitka, Joan Stephenson and Rebecca Voelker are writing for JAMA’s new health news blog.
In the first month, the bloggers have used their relationship with the Journal of the American Medical Association as a tool, taking advantage of access to JAMA sources while still covering a wide range of news found in other journals and sources.
To keep up with the new blog, just point your favorite RSS reader to http://newsatjama.jama.com/feed/.
Global health journalism, a beat in flux
Filed under: Europe, Health journalism, Hot Health Headline, Studies
If it’s 32 pages on the present and future of journalism and major global health issues you seek, look no further than the Kaiser Family Foundation’s Taking the Temperature: The Future of Global Health Journalism (PDF). The paper’s authors, Nellie Bristol and John Donnelly, interviewed 51 reporters, editors, freelancers and producers from across the media landscape and assembled their findings into a sort of “state of the industry” report.
Their report opens with a bit of a paradox. At the very moment that the news industry in general and global health coverage in particular is on the decline worldwide, overall funding for global health has surged, thanks in large part to the American federal government and high-profile private organizations like the Gates Foundation. That isn’t to say, of course, that those organizations have been absent from the media arena either.
In fact, throughout the course of the report, you can’t help but notice just how many global health reporting efforts are funded by public media or Gates and company. Thanks to these funds and the evolution of media in the United States, the global health reporting landscape seems to be shifting as more journalists exit the discipline and more purpose-driven organizations slide in to take their places. Furthermore, these new pressures, both positive and negative, have arrived alongside a shift in the focus of the beat itself.
Many interviewees noted that increasingly, stories they covered tended towards infectious disease outbreaks, like influenza, and disaster related health issues. This was not only a resource issue, but what some saw as story fatigue or lack of fresh angles on health stories in developing countries, especially related to HIV/AIDS. Many, though not all, found policy angles, such as U.S. government efforts to improve global health, difficult to incorporate into their stories, much less serve as a focal point.
Major news organizations like The Associated Press and New York Times have shuttered foreign bureaus and tightened their travel budgets, and the funds allocated for freelancers are falling across the board.
The current financial reality for many global health freelancers, whose work is viewed as filling the gap created by media staff reductions, is pretty grim. Samuel Loewenberg who has written on global health issues for publications ranging from The New York Times to The Lancet, said freelance rates for many publications have fallen. Arthur Allen, a former AP staff writer and now an author and freelancer, said a prominent online publication recently dropped its rate from $1,000 to $500 a story. Another pays $300 a story. “I asked why they are decreasing payment and they say, ‘Some people are writing for nothing,’” Allen said. “It’s a hobby for people who have other gigs. …Certainly doctors and lawyers have a lot to say about things, but it’s difficult for people like me who are journalists.”
As an interesting aside, The Boston Globe has replaced those traditional coverage extenders, travel and freelance, with something more direct: Skype and the cell phones that are now commonplace in even the more remote bits of the planet.
Amid the tales of industry-wide retreat that fill the report, there’s one clear bright spot: academic and professional journals. The authors found journal staffers to be particularly optimistic about their profession and optimistic about the future.
Medical, science and health policy journals have expanded their global health reach, supported both by grants and a larger global health professional audience. While the journals’ primary purpose is to publish research, several also now offer news columns or field-based reporting that focus on global health.
Giffords’ neurosurgeon to deliver keynote speech at Health Journalism 2011
G. Michael Lemole Jr., M.D., the neurosurgeon who treated U.S. Rep. Gabrielle Giffords after she was shot in Tucson on Jan. 8., will be the keynote speaker at Health Journalism 2011.
Lemole
Read more about Lemole.
Other confirmed speakers include Francis S. Collins, M.D., Ph.D., director of the National Institutes of Health, and Donald M. Berwick, M.D., M.P.P., administrator for the Centers for Medicare and Medicaid Services, who will take part in separate Newsmaker Briefings.
Take a look at the topics to be covered at the best annual training event in health journalism, then register and make your hotel reservations. AHCJ’s annual conference will be April 14-17 in Philadelphia. Along with Newsmaker Briefings, it includes panels, workshops, field trips and networking opportunities for reporters interested in health and health care. The Awards for Excellence in Health Care Journalism will be presented.
Unprecedented number of fellowships available
Journalists covering rural health, working beats other than health, those working for the ethnic media and journalists in California, Missouri, New York and Oregon can apply for fellowships to attend the conference. Deadline: Feb. 23
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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
