Poet’s piece on bias against elderly people serves as reminder to reporters

Anyone writing about older people with any seriousness will eventually confront the phenomenon known as “ageism.”

The great gerontologist Dr. Robert Butler, the first director of the National Institute on Aging, coined this term in 1968 to refer to prejudice against older people fueled by stereotypes about aging that often lead to discriminatory practices.

It’s a phenomenon that pervades medicine, as it does institutions across our society.

Think of a doctor who speaks to a middle-aged daughter who’s accompanied her elderly mother to a medical appointment, not to the older woman herself. It happens all the time.

Think of a hospital nurse who ignores an 80-something man’s increasing agitation and disorientation because of the assumption that it’s natural for older people to be irritable and confused. Talk to families and you’ll hear such stories.

Think of all the people 65 and above – the numbers are untold – who have been told over the years that their medical problems are to be expected because, after all, they’re old and there’s not much to be done about that.

I’ve found myself thinking about all this because of a four-page article by the great American poet Donald Hall in the Jan. 23 issue of The New Yorker.

It’s a lyrical piece about reaching the age of 83, coming to know the rhythms of this stage of life, and feeling connected with others who have traveled the journey of age before him.

Intermingled with Hall’s memories of his mother in her final years are his unsparing observations about himself:

“Each season, my balance gets worse, and sometimes I fall. I no longer cook for myself but microwave widower food, mostly Stouffer’s. My fingers are clumsy and slow with buttons. … For years, I drove slowly and cautiously, but when I was eighty I had two accidents. I stopped driving before I kill somebody … New poems no longer come to me, with their prodigies of metaphor and assonance. Prose endures. I feel the circles grow smaller, and old age is a ceremony of losses.”

Becoming advanced in years, Hall writes, involves a process of becoming an “alien” – another type of life form, different from everybody else. He doesn’t use the word “ageism” but describes its effect.

“When we turn eighty, we understand that we are extraterrestrial. If we forget for a moment that we are old, we are reminded when we try to stand up, or when we encounter someone young, who appears to observe green skin, extra heads, and protuberances.

“People’s response to our separateness can be callous, can be good-hearted, and is always condescending.”

Describing his reaction to a woman who has written to the local newspaper calling Hall a “nice old gentleman,” Hall says, “Old is true enough, and she lets us know that I am not a grumpy old fart, but ‘nice’ and ‘gentleman’ put me in a box where she can rub my head and hear me purr. Or maybe she would prefer me to wag my tail, lick her hand, and make ingratiating dog noises.”

Yes, there is a note of bitterness, as in several other incidents of being unconsciously ignored or put down that Hall relates. It’s the sharpness of his voice here – a contrast to the poetic sensibility that pervades the rest of his piece – that reached out and grabbed me and made me realize, yes, this slicing, grating, isolating sense of otherness is what ageism feels like.

As reporters, be aware of this potential for treading on feelings when you speak to older people. Don’t patronize, don’t be condescending. Try to understand their experiences from their point of view, not your own. Learn about what their lives are like by listening with respect and attentiveness. And watch out for ageism in the institutions and professionals you cover and in the words that you write.

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.

Experts offer story ideas for covering health reform

More than 30 attendees heard local experts sketch the particular challenges and issues presented by the Affordable Care Act in California in the latest “Implementing health reform in the states” panel, hosted by AHCJ’s San Francisco Bay Area chapter on Wednesday night at the San Francisco Chronicle.

The panel, one of a series sponsored by AHCJ, the Alliance for Health Reform and the Robert Wood Johnson Foundation, began with an explanation of exchanges and what’s happening with their implementation (or lack thereof) around the country by Larry Levitt of the Kaiser Family Foundation.

He posed some story ideas, such as: How vigorously will the states promote enrollment through the exchanges? What sort of variations to the ACA might emerge once states have the ability to ask for waivers in 2017?

Kim Belshe, a board member of the California exchange, and Marian Mulkey of the California HealthCare Foundation discussed the California scene, with lots of detail, touching on the state’s large undocumented immigrant population, the challenge of getting people enrolled (since the law of the land is now “performance” –  which means maximum participation), new opportunities for medical professions, such as nurses, to fill gaps in care delivery, and how to ensure coordinated care during the transition period to exchanges so no patient is harmed. This is the accountability part of the ACA, and needs thought and new procedures, Belshe stressed.

Belshe noted that Medicaid (Medi-Cal) is the foundation of reform, a subject which reporters sometimes overlook. Both she and Mulkey noted that California is a national pacesetter when it comes to reform implementation - a story idea in itself.

The session was moderated by Ed Howard, executive vice president of the Alliance for Health Reform.

On Tuesday night, a similar briefing was held at the University of Southern California, featuring Walter Zelman, Ph.D., a professor and director of health science at California State University-Los Angeles; Daniel Zingale, senior vice president of the Healthy California program at The California Endowment; Anthony Wright, executive director for Health Access, a California health care consumer advocacy coalition; and Deborah Crowe, the health care and biotechnology industry reporter for the Los Angeles Business Journal. Howard, of the Alliance for Health Reform, moderated the session.

Zelman posed a number of questions about reform, mostly about exchanges. To a reporter from Orange County, he suggested a story about the origin of the individual mandate – an idea championed by Republicans early on, he noted, and opposed by Obama and many Democrats. To a question about accountable care organizations and bundling, he suggested stories about how fee-for-service medicine is anything but dead.

Wright offered a look at what’s happening in Sacramento, including a hearing held just a few hours before the briefing.

Zingale mentioned the importance of prevention, and how the ACA encourages prevention. He too pointed out how nonprofits in the state can team up with reporters to educate people about the ACA. He said that the more people know about the law, the better they like it.

From a reporter’s perspective, Crowe offered several practical story ideas that reporters can start writing about today.

John Gonzales  of the California HealthCare Foundation Center for Health Reporting wrote about the panel and Michelle Levander of the California Endowment Health Journalism Fellowships program offers some of the story ideas mentioned by the panelists.

Special thanks to Colleen Paretty, chair of the Bay Area chapter, and Bill Erwin, of the Alliance for Health Reform, for contributing details about the panel discussions for this post.

Recognizing best health journalism can be inspiring

One of the best things about working at AHCJ is the chance to see the broad range of really strong coverage our members produce.

Whether I’m reading stories about the ways money influences how medicine is practiced, uncovering the mistreatment of vulnerable people, looking at how pollution is affecting public health or investigating flawed health care systems, I am consistently awed by the work health journalists are doing.

I have the opportunity to see this work day in and day out, which is what helps keep me optimistic about the future of journalism. No doubt, we face many challenges, but take a look at the winners of last year’s Awards for Excellence in Health Care Journalism and I promise you will feel better about our business.

That’s why I want to encourage everyone to submit entries for this year’s contest. We re-vamped the categories this year to reflect changes in how news content is being delivered. We recognize that great reporting is being done across platforms and through new partnerships and collaborations.

We want to honor that reporting and make sure the rest of the world sees the value in independent, quality coverage of health and health care issues. Please consider entering your best work of 2011 and encourage your colleagues to do so as well so we can share it and we can learn from it.

Entries must be submitted by 5 p.m. ET this Friday, Feb. 3. Our online entry system makes it easier than ever and our contest committee is standing by to answer last-minute questions.

Survivor goes undercover in Tijuana cancer clinics

Reporting for Al Jazeera English’s People & Power, Sarah Macdonald tells how her own battle with breast cancer led her to shave her head, hide a camera and go undercover to investigate south-of-the-border clinics touting alternative cancer therapies.

The thriving sub-industry of alternative Tijuana cancer clinics relies primarily on palliative care licenses to operate, a end-of-life-care-focused designation that seems somewhat sinister when it’s hidden behind promises of miracle cures. In looking beyond those promises, MacDonald’s investigation finds an interesting mix of chicanery and genuine good intentions, but ends on a familiar, cautionary note.

I have been fortunate in that I have successfully emerged from my own treatment for breast cancer, so I completely understand the desperation that people will feel when they are told their condition is terminal. It is a death sentence. I understand why many patients or their families will begin to scour the internet in search of a cure and will seize on anything that offers hope. However, as our investigation has shown, at least some of the Tijuana clinics are offering nothing but false hope. There is little or no evidence to support their claims that their strange therapies actually work and there is plenty of evidence that vulnerable people have parted with large sums of money for no reason.

Web outlet pumps out dozens of stories on prescription drug abuse

In partnership with USC’s Annenberg School for Communication & Journalism and a number of other organizations, Santa Barbara online news outfit Noozhawk (about), put together “Prescription for Abuse,” an exploration of the misuse and abuse of prescription drugs in the Santa Barbara area. In the extensive, online-only series, the reporters take a look at the problem and its underlying causes, then go a step further by exploring possible solutions as well.

In a uniquely meta twist, the series even looks at how journalism such is advancing public health goals and explains how the project came together. The series features at least 36 individual articles, by my count, and every health journalist who takes the time to browse the full catalog will come across at least a few easily localizable ideas, but in this space I’ll just highlight those stories that deal directly with the series itself:

• USC, California Endowment Unite to Support Health Journalism at the Source
• Bill Macfadyen: Prescription for Abuse Project Is a Series of Opportunities
• Santa Barbara Teen News Network Adds Another Dimension to Prescription Drug Abuse Series
• Annenberg Fellowships Take a Diverse Approach to Community Health Journalism
• Bill Macfadyen: Noozhawk Earns a USC Annenberg Health Journalism Fellowship
• Noozhawk Journalists Recount Lessons Learned from Prescription Drug Abuse Series

NYT series digs into overprescription and developmentally disabled adults

In the series Abused and Used, New York Times reporter Danny Hakim and a host of his colleagues have been investigating how public resources are used to treat developmentally disabled New Yorkers. The series is ongoing, but hit an inflection point with the publication of Hakim’s piece on the few-strings-attached use of very powerful drugs to treat some of the state’s most vulnerable adult residents.

Developmental disabilities, Hakim writes, often manifest themselves in ways that are easily mistaken for mental illness, and these misdiagnoses can lead to unnecessary or improper medication. “In fact,” Hakim writes, “developmentally disabled residents of group homes in New York are more likely to be given Ativan, an anti-anxiety drug that has a tranquilizing effect, than multivitamins, the records show.”

Hakim’s reporting is rich with both anecdotes and data. These paragraphs from the series will give you an idea of how he approached the issue.

Tens of thousands of powerful pills created to treat serious mental illnesses like schizophrenia are given to developmentally disabled people in the care of New York State every day.

…a review by The Times of previously unreleased records, as well as interviews with state employees, clinicians, family members and outside experts, reveals that the psychotropic medications, which alter the brain’s chemistry, are often dispensed sloppily, without rigorous or regular review, by general practitioners with little expertise in the area.

And low-level workers at state group homes are frequently given discretion to increase the medication “as needed,” despite their lack of significant training.

Psychologists who have worked inside the system describe a culture in which the drugs are used to control the disruptive behavior of the developmentally disabled — people with conditions like autism, Down syndrome and cerebral palsy — an approach increasingly discredited in the field.

Reuters shows how shell companies hide Medicare fraud in plain sight

Reporting for Reuters, Brian Grow and Matthew Bigg used an analysis of public data to investigate the practice of using shell companies to defraud Medicare of millions while staying a step or two ahead of federal investigators.

While the specific damage inflicted by shell companies has not been tracked, “Last year, ‘improper payments’ resulted in $48 billion in losses to the Medicare program, nearly 10 percent of the $526 billion in payments the program made, according to a Government Accountability Office report last March.”

“Simply by reviewing the incorporation records of Medicare providers in two buildings” in Miami, they write, “reporters uncovered information that one government official said could prompt “a serious criminal investigation” of some of the companies.”

The fraud rings merge stolen doctor and patient data under the auspices of a shell company and then bill Medicare as rapidly as possible. Other shell companies are often layered on top to camouflage the fraud, law enforcement officials say.

Some of the shells purport to be billing companies; they form a buffer between the sham clinics and Medicare. Others pay kickbacks to doctors and patients who sign off on bogus medical claims or sell their Medicare ID numbers to enable the shell company to bill the government. Still other shells act as fronts to launder the profits.

The key to this kind of fraud, known as a “bust-out” scheme, is for each of the fake companies to bill as much as possible before authorities catch on. Shell companies become a tool that helps keep the crooks ahead of the cops.

The Armenian crime ring whose fraud made headlines last year used 118 shell companies in 25 states and bilked the feds out of at least $100 million. Varying incorporation rules make state-hopping and obfuscation “easy,” they write, especially since states don’t check to see if records are legit before they allow a company to incorporate. The reportes found that even a few simple safeguards would go a long way to detecting the boldest frauds.

In Florida, FBI agents say almost every Medicare fraud scheme involves shell companies. There, Reuters scrutinized incorporation documents for firms located in two buildings near the Miami International Airport. In a building with dimly lit corridors, a rickety elevator and almost no one in sight, a host of companies purport to provide services to Medicare recipients. But telltale signs of fraud abound.

Many of the 26 companies in the buildings had replaced corporate officers at least once in the last four years. Some had changed ownership, or their corporate executives represented more than one medical-related company. Law enforcement officials consider such activities to be red flags for fraud.

For its part, CMS told the reporters it simply didn’t have the resources necessary to conduct the widespread audits needed to catch fraud, though the $350 million allocated to such efforts under the 2010 health reform law should help.

Health journalists who will certainly want to review the “methodology” subheading at the end of the story.

Journalists should learn about study design, evidence-based medicine

Earlier this month I saw on Twitter one of those collisions between journalism and wonkdom. Maybe “collision” isn’t the right word; maybe it was some kind of interspecies mating dance. Anyhow, the gist of it was that we, journalists, don’t know how to evaluate evidence and someone should step in and teach us.

So I stuck in my two cents (or, rather, my two tweets) pointing out that, yes, there is a need for training and, yes, there are places to get the training, including through AHCJ. (See more after the Twitter discussion.)

So, before I remind you about those resources, just a word on why we need them:

On the surface, it may seem that AHCJ houses two kinds of health journalists – those of us who report on the science side of things, and those of us who are more in a policy world. But some of us do both – and research/evidence/evaluating science are also becoming an increasing part of the underpinnings of policy beats. Value-based purchasing, comparative effectiveness, benefits of screening/prevention, quality measures, outcome research … these are all part of the health care reform story.

That doesn’t mean all of us must become  economists/biologists/epidemiologists/statisticians. Old fashioned reporting – including calling experts who can help us make sense of numbers  – is certainly part of the job. But it’s also good to have some sense of what the experts are talking about, what these numbers mean. Why a study on N=16 patients doesn’t really tell us that much. What do we mean by “endpoints,” “outcomes,” “progression?” What’s relative versus absolute risk? Etc.

So for those of you who haven’t  taken a cyber-stroll through the AHCJ website, take five minutes and check out tip sheets, resources and slim guides. Of particular relevance to this discussion is Gary Schwitzer’s slim guide, “Covering Medical Research.”  There’s also a tip sheet/PDF presentation by Schwitzer on “Understanding studies.” His Health News Watchdog blog is also useful.

Reporting on Health (at USC) also has a lot of useful resources, and this essay “Tricks of the Trade: Finding Nuggets in the River of Medical Studies” is a good entry point to understanding data. It’s by Lauran Neergard, a longtime Associated Press health and science writer.

In addition,  there’s a course called Medicine in the Media, sponsored by National Institute of Health’s Office of Medical Applications of Research.  It’s free, but you have to apply, and there’s not room for everyone.  I know of at least one recent summer (the only one I, personally, could have managed the timing!) it wasn’t given, and as of now, there’s nothing on the website about this year. But you can sign up for email notifications, so if you are interested, do that now because the deadline in past years has been early.

The Poynter Institute has some online modules, too. Lots of the focus is on new media and writing and story telling, but there is a math basics refresher for those of you who haven’t taken it since the SATs, some online Excel training, and a unit on reporting on nonprofits