Myths obscure lack of health care for some Asians
Filed under: Health journalism, Hot Health Headline
A focus on “ethnic disparities” can obscure the fact that racial designations are so broad that the disparities within them are just as great as those without.
The latest example? The paper “Barriers to healthcare among Asian Americans,” [press release] by two SUNY Buffalo sociologists. The paper takes on the myth that Asian-Americans are a well-adjusted, monolithic “model minority,” particularly when it comes to access to health care. Instead, language, health literacy, health insurance and immigrant status all conspire to push certain groups of Asian-Americans well below the national average.
Tapped’s Jamelle Bouie discusses the post, then adds a demographic summary to point out how Asian-American economic status can vary based on country of origin.
While Chinese, Japanese, and Korean Americans tend to do well when compared to their white counterparts, the same can’t be said of Vietnamese, Pacific Islanders, and Cambodians, as well as Hmong and Laotians. Among Vietnamese, for example, per capita income is $23,080 – compared with just over $30,000 for whites – with an overall poverty rate of 13.3 percent, compared to 10.5 percent for whites. Likewise, only 13.3 percent of Cambodians and a scant 9.3 percent of Laotians have a bachelor’s degree or higher, compared to nearly 30 percent of whites.
Is California’s prison health system really fixed?
Filed under: Health journalism, Hot Health Headline
After years of failing to prevent preventable inmate deaths, the California Department of Corrections health system was placed under a federal receivership in 2005. Soon after, state officials claimed that the system had reached an “acceptable standard,” and that they were ready to take control back from the feds.
Over the course of a year, Southern California Public Radio’s Julie Small has been digging deep into the system to determine if it’s really as acceptable as the Schwarzenegger administration claims. You can see the whole series here. There are five main installments, four of which come with sidebars. Everything comes in text and audio with a little video and photo mixed in.
- Part 1: California’s budget woes thwart improvements to prison medicine
- Part 2: Chino prison sees some improvements in medical care
- Part 3: California inmates still suffer from lapses in prison medical care
- Part 4: Vacaville’s California Medical Facility – The ‘gold standard’ for prison medical care in California
- Part 5: Fewer improvements planned for prison medical care
Chino Prison’s medical system from 89.3 KPCC on Vimeo.
ReportingOnHealth.org has a conversation with Small about the subject.
Related
Hear Small talk about her reporting process and the difficulties of covering prison health with our friends at Reporting on Health, and check out this related Q and A.
Conflicts of interest + off-label use = Blockbuster
Filed under: Conflicts of interest, Health journalism, Hot Health Headline
Medtronic is back at the FDA, asking for approval of another spine fusion product. Not coincidentally, the Journal Sentinel’s John Fauber is also hard at work, this time exposing the conflicts of interest and off-label applications which helped make Medtronic’s first spine fuser, Infuse, into a dubious blockbuster.
First approved for a relatively narrow application, Infuse now succeeds thanks to widespread off-label use. It’s key component is BMP-2, a protein which “essentially turned whatever it touched into bone,” Fauber writes.
One recent study found a fourfold increase in the use of all BMP products in five years, from 24,000 procedures in 2003 to 103,000 in 2007. About 85% of that was off-label use, according to the study, which was presented in March at an orthopedic surgery meeting.
If you’re wondering what problems could result from all of these applications, Fauber’s got a story for that too.
According to Fauber, the 2002 Infuse introduction was straight out of the classic drug industry playbook:
First, a buzz is created about a potential new therapy. Then, research - often by doctors with financial ties to the product - is presented to the FDA for a specific use in a narrow group of people. Once the product is on the market, other uses for it are promoted in articles and presentations, often by doctors with financial ties to the company.
And it’s those financial ties, of course, that Fauber is determined to ferret out. He starts with a man whose name (and photo) will already be familiar to Fauber fans: Thomas Zdeblick.
Conflicts of interest involving Thomas Zdeblick, a prominent surgeon at the University of Wisconsin-Madison, are at the heart of the BMP-2 story. He and a small group of doctors from around the country with financial ties to Medtronic have paved the way toward the product’s approval and widespread use.
Zdeblick holds patent rights to a key component of the product and has received more than $22 million dollars in royalties and other payments from Medtronic since 2002. He also is co-author of research reports about the pivotal FDA clinical trial that led to the approval of Infuse.
When Infuse was first approved, it was noted that physicians with financial ties to Medtronic produced results twice as good as those of their independent counterparts. At the time, the panel dismissed it with a joke about how every physician should have a stake in Medtronic, as it sure seemed to improve outcomes. When Fauber tried to find out more about these early concerns and disclosures, however, he ran up against a wall of FDA obfuscation, intentional or otherwise.
The FDA redacted sections of its 2001 file listing the financial disclosures of the Infuse investigators, and it repeatedly told the Journal Sentinel that information no longer was available.
An FDA spokesman first e-mailed this reply: “The information you are asking for was part of the sponsor’s presentation and FDA did not require submission nor did the agency maintain copies.”
Then Friday, a different FDA official said the agency erred and the records were available, but they would be difficult to find.
With a similar BMP-2 based Medtronic product, Amplify, now under consideration, the story of Infuse is more relevant than ever.
Related
- Article looks at evidence behind back surgery
- Uncovering conflicts of interest in medicine, research
- Journalists encounter obstacles in identifying conflicts of interest in medical research
Hospitalist: What health journalists should know
R. W. Donnell, an Arkansas hospitalist with a long-running blog and a few burrs in his saddle, has outlined what amounts to an exam for health care journalists. It’s based on the assumption that journalists should have some prerequisite knowledge before tackling difficult scientific issues. But, instead of just grumbling about the “lay press,” the man who calls himself “Dr. RW” takes the next step and actually writes the first draft of such an exam. As you might expect, it’s an eclectic document.
Photo by thegirlsmoma via FlickrMost of the questions address specific pieces of scientific knowledge and vocabulary, presumably the bits that Donnell has found to be most difficult for journalists, including:
- Scientific method
- DNA vs. RNA
- Define and distinguish: humoral immunity, cell mediated immunity, innate immunity, acquired immunity
- Describe Medicare’s prospective payment system and the financial conflict of interest it causes
Mixed in with the pop-quiz style questions are a few broader queries that seem to be staples of just about any AHCJ gathering, as they point to the fundamental dilemmas of the profession:
- Explain the hazards of examining scientific questions in the arena of public debate.
- Explain why scientific progress does not lend itself to sound bite reporting or “news of the day” journalism.
Likewise, there are others that should be familiar to any member who’s heard one of AHCJ’s leading voices deliver an introduction to health journalism:
- Define: relative risk reduction, absolute risk reduction, number needed to treat.
- Explain the difference between clinical significance and statistical significance in clinical trial results.
- Explain why consideration of biologic plausibility is important in the evaluation of health claims and why evidence based medicine often fails when biologic plausibility is not taken into account.
In the end, he admits that the list “is by no means comprehensive or even realistic,” and invites others to contribute. It’s a goofy mix of questions, but I’d be surprised if I was the only one who was mentally grading himself throughout the entire exercise.
Gays excluded from clinical trials
Thanks to an awards announcement from the National Lesbian & Gay Journalists Association, we just noticed Jen Colletta’s story in the Philadelphia Gay News about the exclusion of gays from clinical trials. Colletta won an Excellence in News Writing Award. The exclusion of gays in clinical trials is an issue that hasn’t received much mainstream attention, apart from a letter from Colletta’s sources in NEJM, a write-up by Ed Silverman and a story in The Philadelphia Inquirer.
According to Colletta, the data behind the story grew out of a chance discovery by researchers at the Fox Chase Cancer Center in Philadelphia.
“We review all the different trials that are proposed here, and they don’t necessarily open here, but a lot of them are multi-center trials so we do look at them. And I saw that we had been looking at a number of clinical trials that explicitly excluded gay people, and they didn’t necessarily open at Fox Chase, but I started to become more attuned to this and realized that this is a bigger, national issue,” (Brian Egleston, assistant research professor of biostatistics at the center) said.
The researchers analyzed trials listed in the ClinicalTrials.gov database, maintained by the National Institutes of Health and the Food and Drug Administration.
In particular, Colletta reported, homosexuals are excluded from studies about couples, especially those dealing with erectile dysfunction, which are often related to treatments for prostate cancer. It’s entirely normal for a drug trial to have exclusion criteria, but an oversight in NIH regulations mean that the exclusion of homosexuals, unlike exclusion along racial lines, can be implemented arbitrarily.
In the mid-1990s, Congress mandated that NIH establish a set of guidelines that would prevent it from excluding minorities, such as women and African Americans, from federally funded clinical trials unless there was a significant reason. There are currently no such rules regulating the inclusion of LGBT individuals.
The distribution of exclusionary studies is particularly interesting. To put it in perspective, here’s a quick visualization of the data put forth in the NEJM letter:
Dissecting Gawande’s narrative structure
In a recent post, Not Exactly Rocket Science’s Ed Yong tried to break down Atul Gawande’s work and figure out why it can be so darn compelling. Yong and many thousands of others (myself included) were riveted by Gawande’s latest New Yorker piece, a treatise on palliative care.
Atul Gawande in action. Photo by Center for American Progress via Flickr.
It was a great read, but nothing shocking – much of it reminded me of sections of Gawande’s 2008 book, Better – and it clocked in at a mammoth 12,000 words. Yet, even in the age of bullet points and boldface, that didn’t stop anyone. Why?
Putting aside the fact that Gawande’s a wonderful writer who’s built a powerful brand for himself, Yong instead considered the power of Gawande’s narrative structure. It’s something I’ve noticed throughout the man’s work, and something that he can get away with as a prominent surgeon who writes for magazines: He saves the climax of his key anecdote (the patient’s outcome) for the end, and usually weaves it into several minor peaks and valleys in the course of the story.
These four sections are all obviously united by a common theme. But to hang together in a single feature, they need more than that. Gawande achieves this by using the tale of a terminally ill cancer patient, Sara Monopoli, to frame the four topics. It is obvious enough to use real-life stories to illustrate the theme of death and Gawande’s experience gives him plenty to draw from. But his critical move was to use a single story to frame all of the others.
NAMC folds, qualified members invited to AHCJ
The National Association of Medical Communicators, an organization for medical broadcasters, writers, organizational spokespersons and health professionals who communicate with the public on a regular basis, has disbanded.
In a blog post about the decision, Barbara Ficarra, who was an NAMC board member and is a member of AHCJ, cites cutbacks from pharmaceutical sponsors and changes in the broadcast world. Ficarra, who says “I couldn’t walk away with trying to find a home for [NAMC's] members,” has suggested that people involved with NAMC consider joining AHCJ.
“We’re all sorry to hear about NAMC’s difficult decision to disband,” said Charles Ornstein, AHCJ’s president. “For those NAMC members who write or broadcast health news and still seek the camaraderie of a professional home, AHCJ is a terrific hub for networking, learning, sharing and friendship. We have broadcast members from throughout the country and are always looking to offer additional opportunities in this area.”
Ornstein encouraged journalists to check out AHCJ’s membership categories.
Under AHCJ’s new membership guidelines approved earlier this year, some, but not all, NAMC members could qualify for professional or associate membership. At the same time, the guidelines reinforce the prohibition on people who do public relations work or pitch stories to journalists.
Australia lagging in conflict-of-interest disclosures
Filed under: Conflicts of interest, Health journalism
When a country is holding up the United States as a model of progress on medical conflict of interest issues, you might suspect there are some serious systemic issues there. Such seems to be the case in Australia, based on Melissa Sweet’s recent post on the Croakey blog. At present, there’s little baseline research into industry funding and influence in Australia, though what little there is seems to indicate a situation similar to what we’ve found in the United States. The lack of research seems to stem from a lack of awareness and perhaps even indifference.
Photo by acediscovery via FlickrThe catalyst for this post seems to be the Walkey Media Conference, a media industry confab sponsored by the national journalists’ union that generated a bit of controversy thanks to a sponsorship from Exxon Mobil.
Sweet found a University of Sydney seminar in July that was to look at conflicts of interest to be less than packed, and inferred that Aussie “academics seem to regard (COI) as irrelevant, tedious or confronting.” Furthermore, she wrote, “Australian universities are dragging the chain in dealing with their staff’s conflicts of interest, at least compared with institutions in the US.”
The post makes a strong, well-researched case for COI disclosure and serves as a sort of roundabout compliment to the dogged American journalists (we’re looking at you, John Fauber) who are creating mainstream awareness of conflicts of interest.
AHCJ pushes for access to publicly funded research
Filed under: Government, Health data, Health journalism, Public records, Studies
The strong public interest in “direct, free and full text access to research articles” prompted the Association of Health Care Journalists to send comments to the House Oversight and Government Reform committee.
The letter [PDF] was in support of full-text access to the fruits of publicly-funded research to members of Congress considering H.R.5037 – Federal Research Public Access Act of 2009. One section of that bill would require researchers who receive funding from federal agencies to provide free online public access to final peer-reviewed manuscripts or published versions as soon as practicable, but not later than six months after publication in peer-reviewed journals.
While AHCJ did not take a position on the specifics of the bill, the group highlighted the strong public interest in “direct, free and full text access to research articles,” noting that for journalists to be able to provide readers and audiences with accurate and comprehensive reporting, they need to be able to see the full details of research reports, not merely the highlights contained in abstracts or news releases.
“The fundamental principle at issue is the public’s right to examine both the evidence produced by research studies and the methods employed by researchers. When the researchers are supported by taxpayers, the public’s claim is even stronger,” AHCJ’s statement read in part.
The statement took note of the concerns of some publishers who fear the mandate could cut into their income, while also pointing out that other publishers already provide free online access to the full text of research articles within six months of publication.
Related:
Bill would require public access to research
Initiative to help reporters cover European health
AHCJ has launched an effort to help reporters understand and cover health issues in Europe.
This new resource includes a series of web pages devoted to European issues and resources, as well as a listserv to allow journalists to share information, ask questions, join a debate, open fresh debates or post requests and queries similar to what happens on AHCJ’s main discussion list.
There is substantial health news in Europe that is certainly relevant there, but understanding those issues may help reporters everywhere put their reporting on in a global context. European countries are seeing proposals for cross-border health care, issues around the movement of health professionals and the drain of qualified staff from the world’s poorest countries to Europe, the United States and Australia.
Trudy Lieberman, AHCJ’s immediate past president, is coordinating the effort.
“For many years we have wanted to enlarge the reach of AHCJ to help journalists in Europe tell the stories of their own health care systems,” Lieberman said. “We believe that American journalists can learn from their counterparts overseas and vice versa, especially when it comes to covering infectious diseases, new drugs and treatments, access to care and what it costs. This new resource now allows them to do that. We look forward to our new trans-Atlantic dialogue.”
AHCJ Executive Director Len Bruzzese says John Lister, a veteran health journalist in England and a senior lecturer at Coventry University, has agreed to serve as the European web coordinator. He will help identify issues and bring together resources from across Europe that will improve the quality of health and medical journalism and enhance its professional standing. On these pages, you will find some discussion points and background on some emerging issues in Europe, as well as a resource page, identifying useful sources of official and alternative information on topics in the news.
“John is excited about finding contributors from other European nations who can feed into the website and start some cross-border discussions – and perhaps collaborations,” Bruzzese said.
-
Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
.jpg){kind=link}