Calif. program of bundled dental care for children gets a checkup
Filed under: Children, Hot Health Headline, Public health, oral health
About 18 years ago, California implemented a program of “geographic managed care” for children’s dental coverage in Sacramento. Now, in partnership with The Sacramento Bee, Jocelyn Wiener of CHCF’s Center for Health Reporting provides an exhaustive report card on the program and its outcomes.
In her centerpiece, Weiner writes that “the state pays private dental plans in Sacramento County a monthly fee – currently about $12 – for each Medi-Cal child assigned to them. The amount paid is the same whether or not the child sees a dentist.”
Last year, Wiener writes, the state paid almost $20 million to the five plans it works with in the capital city. In exchange, “The plans are obligated to provide 24-hour emergency care for children with severe dental problems, to schedule all other appointments within a month, to see at least 38 percent of enrolled patients each year and to report that data to the state.”
State data may be skewed, some of Weiner’s sources said, because Sacramento dentists are less likely to overtreat, and less likely to report when they do treat, since they get paid their lump sum regardless. Nonetheless, the numbers that are out there paint a discouraging picture.
In fiscal year 2010-11, only 30.6 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office. That year, the county ranked third worst in terms of the percentage of kids who got care in the state – above only rural Alpine and Trinity counties. During the three previous years, it was the state’s lowest performing children’s dental system, state numbers show.
The state is working on ways to improve the program, but for now long times and access issues persist. For more context, see Richard Kipling’s piece on how San Diego county is succeeding in providing dental care to children despite similar geographic challenges.
National crisis in oral health
A hearing and a report released this week by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging, put a spotlight on dental health and the lack of access and care many Americans experience. According to “Dental Crisis in America (PDF):”
- More than 47 million people live in places where it is difficult to access dental care.
- About 17 million low-income children received no dental care in 2009.
- One-fourth of adults in the United States ages 65 and older have lost all of their teeth.
- Low-income adults are almost twice as likely as higher-income adults to have gone without a dental checkup in the previous year.
- Bad dental health impacts overall health and increases the risk for diabetes, heart disease, and poor birth outcomes.
- There were more than 830,000 visits to emergency rooms across the country for preventable dental conditions in 2009 – a 16 percent increase since 2006.
- Almost 60 percent of children ages 5 to 17 have cavities – making tooth decay five times more common than asthma among that age group.
In a statement prepared for the hearing, Sen. Jay Rockefeller (D-W.Va.) said he is “working on legislation to make affordable dental care for our seniors a reality once and for all.”
Cover this topic for AHCJ
This is just the kind of story and report that AHCJ will be tracking and writing about as part of its new “core topic” on oral health. We’re currently looking for a journalist to lead the oral health core topic, a job that will include writing and assigning tip sheets and stories about the subject as well was writing regular blog posts to help journalists cover this important topic.
Case could set precedent for regulating stem cells
On Forbes.com, Gergana Koleva digs deep into the ongoing court battle between Regenerative Sciences and the FDA over the question of whether stem cells “should be federally regulated as drugs.” While the treatment at issue isn’t generally a matter of life or death, the courts’ decisions in this case will have implications for other headline-grabbing stem cell treatments.
(Photo: National Institutes of Health)
At the heart of the debate is a therapy that uses stem cells derived from bone marrow to repair damaged joints. It was developed in 2005 by the Colorado-based company, which began offering it to patients around 2007, and has since gathered a raft of clinical evidence and testimony about its safety and efficacy. The FDA is questioning its legality, alleging that the stem cells it uses are more than minimally manipulated drugs and should be regulated and subject to approval as drugs. In 2008, the agency accused Regenerative of practicing medicine without a license required for the introduction of a new drug, and in 2010 sued to stop it from performing the procedure.
Regenerative and its allies argue that, because the therapy re-injects a patient’s own cells, it creates, as Koleva writes, “fewer and less severe complications than the more invasive and costlier surgical procedures it helps many patients avoid.” For its part, the FDA calls the therapy unproven and not guaranteed to be safe. In the end, the FDA indicates, it boils down to semantics.
Regulators have argued that the Regenexx procedure is equivalent to the administration of a drug because the stem cells that are re-injected into patients constitute an “‘article’ that is intended to treat, cure, and mitigate diseases and to affect the structure and function of the patient’s body,” therefore fitting within the definition of “drug.”
Network drives increase in painkiller prescriptions
Filed under: Conflicts of interest, Government, Health policy, Hot Health Headline, Pharmaceuticals, Public records
In the latest installment of his ongoing investigation for the Milwaukee Journal Sentinel and MedPage Today, John Fauber looks for the source of America’s prescription painkiller boom (graphic), outlining what he describes as “a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.”
Beginning 15 years ago, the network helped create a body of dubious information that can be found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.
Apparently, that network has been effective. Federal data shows that prescription painkiller sales have quadrupled in the past decade or so, Fauber found, and some of those sales may not have been warranted.
A band of doctors who get little or no money from opioid makers has begun to challenge the hype behind the drugs. They say pharmaceutical industry clout has caused doctors to go overboard in prescribing the drugs, leading to addiction, thousands of overdose deaths each year and other serious complications.
Several of the pain industry’s core beliefs about chronic pain and opioids are not supported by sound research, the Journal Sentinel/MedPage Today investigation found. Among them:
- The risk of addiction is low in patients with prescriptions.
- There is no unsafe maximum dose of the drugs.
- The concept of “pseudoaddiction.”
That concept holds those who display addictive behavior, such as seeking more drugs or higher doses, may not be actual addicts – they are people who need even more opioids to treat their pain.
His investigation dips deep into each of those beliefs and how they helped push painkillers. For a case study, see this companion infographic.
AHCJ’s ranks continue to grow; welcome these new members
Please welcome AHCJ’s newest members. All new members are welcome to stop by this post’s comment section to introduce themselves.
- Lacey Avery, student, University of Georgia, Watkinsville, Ga. (@lacey_avery)
- Jeff Cohen, reporter, WNPR, Middletown, Conn. (@ctcapitalregion)
- David Corcoran, deputy science editor, The New York Times, New York (@dacorc)
- June Cross, associate professor, Columbia University, New York, (@junecross)
- Ann Curley, assignment manager, CNN Medical News, Atlanta, Ga. (@annjcurley)
- Sue Darcey, reporter, The Gray Sheet, Rockville, Md.
- Carolyn Dickey, student, University of Georgia, Athens, Ga. (@CarolynAmandaD)
- Carmella Gutierrez, president, Californians For Patient Care, Sacramento, Calif. (@carmellag)
- Mary Harp Shankles, independent journalist, Sherman, Texas
- Monica Hogan, senior writer, The Gray Sheet/Elsevier Business Intelligence, Rockville, Md.
- Jennifer Jenkins, lead home page producer, The New York Times, Brooklyn, N.Y.
- Jessica Luton, graduate student and independent journalist, University of Georgia, Athens, Ga. (@jluton)
- Ryan McNeill, computer-assisted reporting editor, The Dallas Morning News, Dallas (@skins96)
- Lisa Mullenneaux, New York City correspondent, Agence-France Presse, New York,
- Marianne O’Hare, producer, Conversations on Health Care, Middletown, Conn. (@MAOHare)
- Anissa Routon, director of communications, Californians For Patient Care, Sacramento, Calif.
- Christine Vestal, senior writer, Stateline, Washington, D.C.
- Eric Weber, chief executive officer/executive editor, Healthcare BizDev - Health Insurance Plan News Daily, Washington, D.C. (@HCBD)
- Louise Whiteley, assistant professor, Medical Museion, University of Copenhagen, Copenhagen, Denmark (@lewhiteley)
If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.
See who has joined AHCJ recently
Please welcome AHCJ’s newest members. All new members are welcome to stop by this post’s comment section to introduce themselves.
- Julia Belluz, associate editor/blogger, Medical Post, Toronto (@juliaoftoronto)
- Dian Cai, student, University of Georgia, Athens, Ga. (@DianCaiUGA)
- Valerie Canady, reporter, Mental Health Weekly, Johnston, R.I. (@mhwnewsletter)
- Esther Chapman, independent journalist, Sacramento, Calif.
- Michele Cohen Marill, independent journalist, Decatur, Ga.
- Melanie Evans, reporter, Modern Healthcare, New York (@MHmevans)
- Melissa Franckowiak, independent journalist, Grand Island, N.Y.
- Sarah Gantz, staff writer, San Francisco Examiner, San Francisco
- Donald Hackett, editor, Daily Rx, Austin, Texas (@don_dailyRx)
- Gina Hagler, independent journalist, Rockville, Md. (@GinaHagler)
- Elizabeth Hanes, independent journalist, Albuquerque, N.M. (@ehanesrn)
- Gail Holtz, independent journalist, Hauppauge, N.Y.
- Tod Jones, managing editor, The Costco Connection Magazine, Issaquah, Wash.
- Katherine Kam, independent journalist, Alameda, Calif.
- Rebecca Kern, reporter, The Gray Sheet, Rockville, Md.
- Sarah Kliff, reporter, The Washington Post, Washington, D.C. (@sarahkliff)
- Trinna Leong, student, Columbia University, New York, (@trinnaleong)
- Meredith Levine, independent journalist, London, Ontario, Canada
- Mark Miller, columnist, Reuters, Evanston, Ill.
- Caroline Modarressy-Tehrani, student, Columbia University, New York (@CaroMt)
- Kristi Nelson, reporter, Knoxville News Sentinel, Knoxville, Tenn.
- Jesse Newman, independent journalist, Columbia University, Brooklyn, N.Y.
- Nancy O’Connor, independent journalist, Channahon, Ill.
- Linda Ong, student, Columbia University, New York, (@ong_linda)
- Keldy Ortiz, student, Columbia University, Queens Village, N.Y.
- Andrew Parsons, student, Columbia University, New York
- Genevra Pittman, medical journalist, Reuters Health, New York (@genevrapittman)
- Patricia Salber, host/anchor, The Doctor Weighs In, Larkspur, Calif.
- Bonnie Schultz, independent journalist, Princeton, N.J.
- Emily Senay, medical correspondent, PBS WNET Need to Know, New York
- Curtis Skinner, student, Columbia University, New York,
- Edward Small, student, Columbia University, New York,
- Amy Solomon, senior editor, Everyday Health, Brooklyn, N.Y.
- Charlotte Sutton, health & medicine editor, Tampa Bay Times, St. Petersburg, Fla.
- Sarah Tan, student, Columbia University, New York
- Stephanie Vatz, student, Columbia University, New York,
- Yael Waknine, independent journalist, Atlanta (@YaelWaknine)
- Lina Zeldovich, student, Columbia University, Woodside, N.Y. (@LinaZeldovich)
If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.
Project follows the race to make bagged salad safer
The latest investigation by California HealthCare Foundation Center for Health Reporting’s Deborah Schoch will make you think twice before ripping into a sack of spring mix, but her work about the myriad food safety challenges posed by bagged salads examines the industry’s struggle to develop technology powerful enough to overcome the existential threat posed by E. coli and friends.
The industry has made great strides since a 2006 outbreak linked to tainted spinach, she writes, but “It’s impossible to stop all pathogens from landing on lettuce and spinach leaves.” And once they’re on the leaves, it seems as if their spread is almost inevitable. They hide in gooey biofilms and resist powerful washes.
Thousands upon thousands of salad leaves are taken to a central plant, washed together, bagged and shipped. Even if only a few leaves are tainted, harmful pathogens can spread in the wash water — the modern salad version of the old adage that one bad apple spoils the whole barrel.
“I would think of it as swimming in a swimming pool in Las Vegas with a thousand people I didn’t know,” said William Marler, a prominent Seattle-based food safety attorney.
Plenty of public and industry money has been aimed at the problem, Schoch writes. “The Center for Produce Safety at UC Davis, founded in response to the spinach outbreak as an industry-public partnership, has pumped more than $9 million into 54 research projects at 18 universities.”
Even the best research can’t reduce the risk of contaminated greens by 100%, scientists said. At Earthbound, Daniels says the ultimate goal is to achieve what scientists call a “5 log reduction,” the equivalent of pasteurizing milk. In short, if an unwashed lettuce contained 100,000 pathogens, the perfect wash system would knock off five “0s” and reduce the pathogen count to 1.
An added bonus? Schoch’s column on whether she (and the experts she talked to) feel like it’s important, or even salutary, to wash their bagged greens.
Study: Good press releases contribute to good health journalism
Thanks to Gary Schwitzer for drawing attention to a study, published in BMJ, which analyzes the impact medical journal press releases have on actual press coverage of studies.
The authors begin with a somewhat gratifying hypothesis, writing that “Although it is easy to blame journalists for poor quality reporting, problems with coverage could begin with the journalists’ sources,” and positing that difficult-to-decipher studies and misleading press releases could lead to low-caliber health reporting.
They looked at 100 studies from five major journals, as well as a sample of 348 news stories based on those studies. In general they found that higher-quality press releases led to higher-quality coverage. Unfortunately, they also found that the inverse was true. Here’s an excerpt from the “Discussion” subheading (also highlighted by Schwitzer).
…Higher quality press releases issued by medical journals were associated with higher quality reporting in subsequent newspaper stories. In fact, the influence of press releases on subsequent newspaper stories was generally stronger than that of journal abstracts. Fundamental information such as absolute risks, harms, and limitations was more likely to be reported in newspaper stories when this information appeared in a medical journal press release than when it was missing from the press release or if no press release was issued. Furthermore, our data suggest that poor quality press releases were worse than no press release being issued: fundamental information was less likely to be reported in newspaper stories when it was missing from the press release than where no press release was issued at all.
Reporters looking for a Health News Review-style “how do I ensure my story clears their quality bar?” checklist can just scroll down to the “Quality Assessment” subheading. For the record, the metrics found there apply equally well to the PR professionals who write the releases.
Programming errors led to overdoses with pain-medicine pumps
Building off a state health department report showing that, as The Morning Call’s Tim Darragh wrote, “Nurses at St. Luke’s Hospital three times in 2010 and 2011 improperly programmed patient-controlled pumps to deliver pain medication, causing patients to overdose themselves,” Darragh dug deep into each incident, uncovering patient details and adding perspective to the errors, which were severe enough that the feds decided the hospital’s patients were in “immediate jeopardy” until steps were taken.
Photo by Felix42 via Flickr.In each of those cases and in three others, the nursing staff failed to document the errors properly, state investigators found.
Employees told the investigators that St. Luke’s did not require annual competency training on the pumps. Unnamed employees offered conflicting statements about when and whether all the staff had received retraining in 2010.
For their part, hospital officials say they have bought new patient-controlled pumps, developed a restricted dosage plan and retrained staff.
“When St. Luke’s nursing staff members identified the dosing pump programming issues, the events were promptly reported to all the appropriate individuals and regulatory agencies as outlined in our Network Patient Safety Plan,” said Carol Kuplen, chief nursing officer for St. Luke’s Hospital & Health Network.
“There was complete transparency in these events,” she said in an interview Thursday.
Related
Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, appeared at a newsmaker briefing at Health Journalism 2010 to announce an FDA initiative to reduce risks associated with infusion pumps. Log in to the AHCJ website to see his presentation and listen to his announcement.
- Press release: FDA Launches Initiative to Reduce Infusion Pump Risks
- FDA page on infusion pumps and FDA’s new safety initiative
- White Paper: Infusion Pump Improvement Initiative
- Guidance for Industry and FDA Staff - Total Product Life Cycle: Infusion Pump - Premarket Notification [510(k)] Submissions
- Letter to Infusion Pump Manufacturers
- Public Meeting: Infusion Pump Workshop, May 25-26, 2010
- Generic Infusion Pump Project
Leaded aviation fuel a threat to public health, children
Filed under: Children, Health data, Hot Health Headline, Public health, Public records
KUOW’s John Ryan used federal data and a few key sources to delve deep into issues surrounding one of the few remaining sources of airborne lead in the United States, a leaded aviation fuel known as “avgas.” In the process, he reveals damage that even low levels of lead exposure could be doing to children.
Avgas accounts for less than 1 percent of the nation’s liquid fuel use. Yet enough piston–engine planes fly enough miles on avgas to belch out half of all the lead going into the nation’s air.
Lead paint in old buildings remains a bigger threat, but even low levels of childhood exposure, one source tells Ryan, can manifest itself in “Decreases in IQ, changes in test scores, changes in attention, hearing threshold, all sorts of things like that.”
Earlier this month (January), an expert panel advising the Centers for Disease Control and Prevention cut in half the levels of lead in children that should alarm parents or doctors. Researchers have yet to find any level of lead exposure that doesn’t cause harm.
Michael Kosnett, a medical toxicologist at the University of Colorado, told Ryan, “In any one child, it’s not something that’s going to necessarily cause them to display any kind of signs and symptoms. But if you can lower the lead exposure of a population of children, you’re going to give that population more of an opportunity to have gifted children and to have children who have higher IQs, and that’s certainly a desirable public health goal.”
Marie Lynn Miranda, an environmental health scientist and a dean at the University of Michigan, points out that “Living close to an airport can increase your blood lead level anywhere from 2 to 4 percent,” acknowledging that is a small amount but that evidence indicates even small amounts of lead are bad. She also notes that “lead is especially a problem for the low–income families that are most likely to live near airports.”
Pilots who still use avgas say their businesses would be dead in the water if they couldn’t get the leaded fuel, an argument Ryan contrasts with quotes from a Europe-based lead-free avgas producer, who sells it for 40 cents less a gallon, but hasn’t been able to break into the U.S. market “Because no one thinks that there will be demand for an unleaded–grade aviation gasoline.”
The federal database Ryan used, The National Emissions Inventory, is posted online by the EPA.
Investigation delves into Wash.’s prescription drug problem
Filed under: Aging, Children, Europe, Government, Health care reform, Health data, Health policy, Hot Health Headline, Pharmaceuticals, Public health, Public records
Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.
Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.
The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”
Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.
Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”
She drills down into many of those causes, with my personal favorites being two key origin stories:
- How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
- How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”
See the upper right-hand sidebar for more stories from the six-month investigation.
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