Controversy over breast implants spreads across Europe

In the wake of the discovery that a leading international manufacturer was found to be using industrial-grade silicone in its breast implants, questions have emerged about the regulatory process that allowed the implants and who is responsible for removing the substandard implants from women who spent thousands to get them.

John Lister, the web coordinator of AHCJ’s focus on Europe, explores the controversy surrounding the implants, including the lack of data on how many women in the United Kingdom received them, how the United Kingdom’s National Health Service has been drawn into the business of removing the implants and the regulatory system that allowed the implants in the first place. Lister reports:

But when it came to ascertaining the numbers of women who may have had PIP implants in British private clinics, it became clear there was no comprehensive or reliable data. A working estimate of 40,000 women potentially at risk eventually emerged, while the private clinics said they were not required to remove the suspect implants or replace them with safe ones. Yet the figures that were available showed that for one clinic as many as 7 percent of PIP implants had leaked, well above initial claims of a failure rate of about one percent.

The Reuters enterprise team has a special report on the breast implant scandal and a piece that shows how the regulatory system may be another scandal waiting to happen. It also looks at how, in the United States, the FDA handled an application from that company in 2000.

The history of breast implants is littered with flawed devices, a colorful cast of intertwined players and billion-dollar lawsuits. Reuters reviewed hundreds of pages of police investigation transcripts and financial documents, and interviewed former PIP employees, the company’s suppliers, customers and health experts, to piece together this latest chapter in that history.

Investigation delves into Wash.’s prescription drug problem

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.

Journalists discuss reporting from the heart of a pandemic

Recently, New York Times health and science reporter Donald McNeil joined the National Journal’s Maggie Fox, the Nieman Foundation’s Stefanie Friedhoff and the Canadian Press’ Helen Branswell on a Global Journalist radio panel to discuss reporting on international pandemics and global diseases. The full episode is available to download, listen or watch online.

McNeil provided his take on everything from what he packed to keep himself safe from SARS to his take on the accuracy of the movie “Contagion,” but his most relevant thoughts for AHCJ readers were in response to questions about sourcing and a journalist’s obligations in an outbreak situation.

GJ: What are some of the ways you, as a journalist, verify the information you receive, and where do you get that information?

McNeil: … it all depends on the disease. But generally, you get fairly accurate, careful information out of the Centers for Disease Control and Prevention in Atlanta and the World Health Organization (WHO) in Geneva. There are times when you aren’t happy with the information you are getting or the decisions they make, but most of the time, I think they are both extremely careful science-driven organizations.

GJ: In reporting on the potential danger of flu and warning people to stay vigilant, are you ever concerned that some reports from the media might cause panic among people?

McNeil: I don’t see my job as being a public health official; I see my job as a journalist. So my job is to tell the truth, and the truth is basically the one goddess I serve. Obviously, people care about this stuff, so in the same way another journalist who covers the White House wants to tell people accurately what the president did or didn’t do yesterday and what it means, I am trying to tell my audience how dangerous the virus is if it’s a virus, and how many people are killed, and what can be done about it. My job is telling the truth and getting the news out.

Ohio’s hospital transparency law under fire

Thanks are due to blogger and one-time hospital executive Paul Levy for drawing our attention to the Ohio hospital industry’s recent push to overturn much of the state’s recently passed transparency legislation.

The law required hospitals to post performance data, such as infection rates and patient satisfaction, on the Ohio Hospital Compare site.

According to Brandon Glenn’s report in the MedCity News, the hospital industry opposes the site, online since Jan. 1, 2010, because it serves the same purpose as the federal Hospital Compare site.

The OHA supports the new legislation… because it wants to remove “duplicative” reporting requirements on the state’s hospitals. Ohio hospitals already report the same data to a federal Hospital Compare website maintained for the public by the Centers for Medicare & Medicaid Services, said OHA spokeswoman Tiffany Himmelreich.

The new legislation “doesn’t reduce reporting. It just eliminates reporting the same information to two different places,” she said. “We don’t want the public to feel that this is taking a step backwards in terms of data availability.”

For their part, consumer advocates say website maintenance is not an onerous burden, and that the hospital association’s push is part of a larger, statewide antitransparency trend.

As an interesting side note, Glenn found the Ohio Hospital Compare site to be rendered inoperable by apparent bugs on an initial visit but discovered that, after his inquiries to the state health department, the site was put into working order.

Media must understand, explain changes in European health services

One of the points that stood out for Spanish journalist Esther Paniagua at the first European conference on health journalism was from conference organizer John Lister. “Few journalists understand what [the] health care system’s reforms means,” Lister said during the Health in the Headlines conference at Coventry University in June.

That assertion spells trouble not only for journalists who have to report on this but for all of society. These days, public health systems in Europe are up for debate; only few weeks ago Italy imposed a copayment requiring patients to pay 10 euros (almost $15) each time they visit a doctor and 25 euros (almost $36) if someone goes an emergency room. This may sound normal - even ridiculously low - for an American. However, Europeans are used to “free” and universal care at the point of service and they pay for their systems through diverse taxes. So in effect, copayments make patients pay twice for the same service.

Journalists need to understand the function of copayments and explain all the arguments, for and against. Read more …

Inspired by NHS, Lieberman calls for reporters to spotlight patient safety improvements

Fresh off a trip to powwow with health journalists, academics and officials in England as a Fulbright Senior Specialist, AHCJ Immediate Past President Trudy Lieberman writes on CJR.org about what American health systems can learn from the British National Health Service when it comes to patient safety.

In particular, Lieberman looks at the NHS Institute for Innovation and Improvement, which has pushed a few simple changes that have lead to measurable and marked improvements in several key safety measures and are, she writes, embraced by “almost all U.K. hospitals.”

Since 2007 the Institute has fostered nurse-led innovations to improve care in such areas as patient hygiene, nursing procedures, meals, medicines, and ward rounds that frees up more time to be with patients. Now almost all UK hospitals embrace some of these practices. Positive stats from this “Releasing Time to Care” project show a thirteen percentage point increase in the median time spent on direct care; a seven percentage point increase in median patient satisfaction scores, and a twenty-three percentage point increase in median patient observations.

The innovations include little tricks like nurses donning red pinafores to signal “don’t interrupt me, I’m dispensing medication” and charting patient falls with red dots on a hospital floor plan, so that problem areas can be easily spotted.

According to Lieberman, simple changes like these don’t get the attention or widespread adoption they deserve. Thus, she ends her piece with a call to arms for health journalists, asking them to tell the stories of the sort of simple, easy-to-relate-to steps that are saving lives on both sides of the pond (Oregon, in particular, has been quick to follow the NHS lead in these areas).

So where does the press fit into all this? Media outlets in the UK and the US have something in common—they aren’t much interested in reporting good news and what works. It’s in our journalistic DNA to ferret out the evil, bad, and ugly with the hope that press exposure will change practice. But my visit to the NHS showed that positive change does happen and should be reported. Taylor told me she tried to interest British journos in some of the Institute’s achievements but got “not a sniff.”

“Journalists don’t celebrate success,” she said, “but innovation is to be shared.” Nor has there been any interest from U.S. reporters. CareOregon hasn’t sent out any press releases partly because the results are just coming in and because officials fear that the U.S. stereotype of the NHS is so powerful the program might die a-borning. If I were still a local consumer reporter, I would forget about all that ambiguous, hard-to-interpret data about hospital quality and look for concrete improvements patients and families can relate to, like red pinafores and scorecards for reducing falls. Then I would make a how-to comparison chart showing which hospitals were embracing some of the simple technologies that appear to work.

Journalist compares U.K. science writers, American health reporters

When the Association of British Science Writers announced the nominees for their 2011 Science Writers’ Awards, Guardian science blogger Martin Robbins noted a familiar pattern.

Of the 12 places on the shortlists for science writing, 6 went to New Scientist, 1 each to Nature and the BMJ, and 1 each to the Guardian and the Independent The final two places went to a freelancer and the website SciDev.Net. That means that newspapers combined took just two spots, while specialist science publications took eight. Meanwhile, the TV shortlist was occupied by BBC 3, BBC 4, and BBC 2, while the radio shortlist featured BBC Radio 4, BBC Radio 4 again, and, yes, BBC Radio 4.

A lists of nominees from earlier in the decade reveals a similar pattern of “Near-dominance of broadcast science by the BBC, while specialist publications competing with a dwindling group of broadsheet newspapers for the literary prizes,” Robbins writes. To better understand this apparent one-sidedness, Robbins talked to ABSW chair Connie St. Louis, who suggested that U.K. newspapers have succumbed to a form of churnalism and “communication,” because they simply don’t have the resources for in-depth work like that which occurs at the BBC or the specialty outlets. Here’s St. Louis:

I have this thesis which is… science journalists have forgotten how to be journalists. They’re actually science communicators, and they go into the job and… the job was to tell you what science was doing and help you understand science, and I think that’s an incredibly important function, but don’t call yourself a science journalist if that’s what you’re doing, call yourself a science blogger, call yourself a science communicator, but if you’re going to call yourself a journalist then behave like a journalist, dig for stories, ask questions of science, ask questions of scientists, look at numbers, look at figures, and do what journalism does.

St. Louis then goes on to compare U.K. science journalism (somewhat unfavorably) to the relatively higher level of scrutiny faced by American health journalists, scrutiny brought about thanks in part to a few key thought leaders.

We’re always explaining new cures, explaining new science, but where are the guys who are really digging down, where are our Ivan Oranskys, where are our Gary Schweitzers [sic], we don’t have them. It’s all very much “here’s a new cancer drug”, and I’m not knocking that, it’s really important, but actually we’re in a very deficit model of journalism at the moment.

Related

• Health news “infoxication” - info fatigue syndrome - not just a US phenomenon: reflections on European health journalism conference
• Storify: European Health Care Journalists - Coventry 2011

Stark reflects on health journalism in U.S., Europe

The standards of health reporting in the United States are higher than ever before, according to AHCJ Vice President Karl Stark.

Stark, the health and science editor at The Philadelphia Inquirer, is in England for “Health in the Headlines,” a European conference on health journalism co-sponsored by AHCJ and Coventry University.

While there, he was a guest on “FT Science with Clive Cookson,” a Financial Times podcast.

Stark said this is a time of great opportunity and great foment in U.S. health journalism. When asked about covering pharmaceutical companies, Stark acknowledged that is a challenge and requires training to penetrate and learn the language.

Stark used an analogy about sports preferences in the United States (high scoring) and Europe (low scoring) to explain the differences in how people in the two places view health care.

It’s worth listening to Stark’s segment; it’s about six and half minutes long at the beginning of the podcast.

Audit: UK’s health IT program falls short of expectations

After a damning report from the U.K.’s national audit office indicating that the National Health Service’s massive health IT program has essentially been a black hole which vacuums up far more money than its lack of progress would justify, politicians are now calling for what amounts to the program’s termination.

Physicians support a national system of health records, but there seems to be a consensus that, in the current climate of British austerity, it may be time to amputate the program to stop the bleeding. After all, the audit indicated that despite a seven-year extension, it looks like the program has no chance of meeting its 2014-15 deadlines, or even of producing meaningful results. Here’s Polly Curtis in The Guardian.

The original aim of the £11.4bn NHS IT programme – to install a patient record database accessible from any point in the NHS in England by 2015 – will fail, the National Audit Office (NAO) warned.

The £2.7bn spent so far on the system has not been value for money, the watchdog said, adding it had no confidence that the remaining £4.3bn would be any better spent.

The nine-year-old project – the biggest civilian IT scheme attempted – has been in disarray since it missed its first deadlines in 2007. While its ambitions have been downgraded in recent years, the bill from the suppliers has remained largely unchanged, the report said.

Gates’ funding of journalism raises ethical questions

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.”

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