Ruling puts stem cell research on hold
A federal judge’s ruling has, at least temporarily, blocked efforts to expand stem cell research, based on a decision that says “regulations designed to expand federal funding for embryonic stem cell research violated a law [the Dickey Wicker Amendment] prohibiting destruction of embryos for research purposes.”
When stem cells like these human embryonic stem cells divide, each new cell has the potential to remain a stem cell or become a cell with a more specialized function, such as a muscle cell or a red blood cell. Photo: National Institutes of Health
It’s yet to be determined what the implications of this ruling [PDF] will be if it stands, but it could affect millions of dollars of federally-funded research. AHCJ has some background and links to help reporters who might be looking at how this will affect local researchers.
- PBS’ Newshour has a roundup of some of the coverage.
- The Scientist Who Helped Stall Stem Cell Research
- Obama order expected to increase speed, efficiency of stem cell research (April 2009)
- Covering stem cells: Background on science, politics and global competition: Terri Somers, who was then biotechnology writer for the San Diego Union-Tribune, wrote a primer on stem cell research for AHCJ members. (Note: Somers is now director of communications for BIOCOM, an industry association based in Southern California.)
- Mark Johnson of the Milwaukee Journal Sentinel wrote a three-part series detailing the discovery of how to create embryonic stem cells out of normal cells. One of the key labs in the research is located at the University of Wisconsin-Madison. The online package includes a time-lapse video of an embryo’s first five days of development and links to a discussion about the ethics of stem cell research.
- Stem cell research in California: A presentation by Zach W. Hall, president of the California Institute for Regenerative Medicine, offered at a plenary on stem cell policy at Health Journalism 2007.
- National Center for Biotechnology Information
- NIH Stem Cell Information
- Embryonic Stem Cell Research: A Decade of Debate from Bush to Obama; Yale Journal of Biology and Medicine (2009)
PTSD or personality disorder? It matters to soldiers
Filed under: Government, Health journalism, Health policy, Studies
The AP’s Anne Flaherty has put together a story that illuminates the Army’s refusal to admit that it could have misdiagnosed (and discharged) hundreds of soldiers who may have had PTSD or traumatic brain injury instead of a personality disorder. Keep in mind that a discharge for “personality disorder” means no veterans’ benefits and a lifetime of stigma. A diagnosis of PTSD or injury, on the other hand, means treatment will be covered by the government.
Photo by isafmedia via FlickrThe Army, for its part, has decided there’s nothing unusual about the following chain of events (taken from Flaherty’s story):
- The Army “discharged about a 1,000 soldiers a year between 2005 and 2007 for having a personality disorder.”
- In 2007, The Nation’s Joshua Kors writes a cover story exposing the Army’s apparent habit of diagnosing soldiers with a personality disorder instead of considering the possibility of PTSD or traumatic brain injury.
- Soon after, “the Defense Department changed its policy and began requiring a top-level review of each case to ensure post-traumatic stress or a brain injury wasn’t the underlying cause.”
- Sure enough, “the annual number of personality disorder cases dropped by 75 percent.”
- At the same time, the number of post-traumatic stress disorder cases has soared. By 2008, more than 14,000 soldiers had been diagnosed with PTSD — twice as many as two years before.
- Army officials “reviewed the paperwork of all deployed soldiers dismissed with a personality disorder between 2001 and 2006″ and said they “did not find evidence that soldiers with PTSD had been inappropriately discharged with personality disorder.”
Study: Foreign training doesn’t affect care
Filed under: Europe, Health policy, Hot Health Headline
A Health Affairs study evaluating the relative quality of care provided by international medical graduates practicing in the United States has attracted attention from all quarters and reignited the discussion about medical licensing in this country.
First, a few background statistics pulled from Pauline Chen’s commentary in The New York Times.
- About 25 percent of all practicing physicians in the U.S. graduated from international schools (Canada is not considered international in this context)
- 20 percent of those are Americans who studied medicine abroad, usually in the Caribbean
- 30 percent of the nation’s primary care doctors graduate from international med schools
Chen, again:
… it turns out that contrary to certain individuals’ worst fears, accent or nationality did not affect patient outcomes. Rather, the main factor was being board-certified: completing a full residency at an accredited training program, passing written and, depending on the specialty, oral examinations, and having proof of experience with a defined set of clinical problems and technical procedures.
There was, however, one key difference, and it came in primary care. Patients of foreign-born primary care doctors fared better than patients of American primary care doctors. “The foreign international medical graduates are some of the smartest kids from around the world,” said John J. Norcini, lead author of the study . “When they come over, they tend to fill in where the U.S. medical school graduates don’t necessarily go.”
If you’re looking for further background on the international component of America’s physician workforce, I recommend the AMA’s 2010 profile of international medical graduates. As you can see below, 20 countries taught more than 70 percent of the international medical graduates in the United States.
Remember, free access to Health Affairs is one of many perks enjoyed by AHCJ members.
EPA changes would improve public access to data
Filed under: Government, Health data, Health policy, Hot Health Headline
A recent OMB Watch story covers the EPA’s latest attempt to leverage the Toxic Substances Control Act to make it easier for the public to access chemical data and harder for manufacturers to hide health and safety related information behind the “trade secrets” label.
Fire and emergency response personnel practice techniques for hazardous materials containment and removal. (CDC photo)
The key is the expansion of the Inventory Update Reporting rule, which requires companies to report toxic substances over a certain weight threshold. According to OMB Watch, the Bush administration bumped this threshold from 10,000 to 25,000 pounds, and decreased reporting frequency from every four years to every five years.
The proposed rule lowers or eliminates thresholds for reporting and increases reporting frequency, moves that should provide the public with more information on more chemicals. The amount of a chemical manufactured at a facility in any given year fluctuates widely. … EPA’s proposed rule would require a manufacturer to submit information on a chemical if the volume exceeds the 25,000-pound threshold for any year since the previous submission. The agency is also proposing to return the reporting frequency to every four years rather than every five. Additionally, EPA is proposing requiring all reporters to submit data on the processing and use of the chemicals. The current program requires such reporting only for chemicals manufactured or imported over 300,000 pounds.
The manufacturers would use EPA-provided software to report their chemical inventory – currently, most manufacturers submit paper reports. The paper reports take years to process and the data-entry process introduces extra error into the system.
Another proposed change would require reporting of a number of valuable pieces of information, such as yearly production volumes, more specific chemical names and numbers to ensure the correct chemical substances are identified, and the approximate number of workers exposed to the chemicals.
Furthermore, manufacturers currently can label just about anything as “confidential business information,” the new rules would place annual limits on the practice and require manufacturers to justify any such designations.
The Society of Environmental Journalists wrote about the issue back in March and included a link to a report [PDF] from the EPA’s Inspector General, as well as other coverage.
Health IT moves forward, regulation doesn’t
Filed under: Government, Health policy, Hot Health Headline
Fred Schulte and Emma Schwartz report that while the Obama administration plans to create a digital medical file for every American by 2014, “the administration has established no national mandatory monitoring procedure for the new devices and software. That no process exists to report and track errors, pinpoint their causes and prevent them from recurring is largely the result of two decades of resistance by the technology industry, a review of government records and interviews by the Huffington Post Investigative Fund shows.”
Major HIT malfunctions continue – they focus on one of 10 hospitals in the Trinity Health System in the upper Midwest – and nobody has a grip on their location or frequency. Meanwhile, the administration has issued regulations for HIT implementation that make no mention of safety and quality standards, standards the FDA has been considering for some time.
CDC: Obesity rises unabated, no state meets goals
Filed under: Government, Health policy, Hot Health Headline
According to Vital Signs, a new part of the CDC journal Morbidity and Mortality Weekly Report (more on that in a minute), the number of adults whose self-reported numbers indicated obesity rose 1.1 percent between 2007 and 2009. Nationally, 26.7 percent of adults were obese in 2009, a number that’s even higher for non-Hispanic blacks (36.8 percent), Hispanics (30.7 percent) and folks who didn’t graduate from high school (32.9 percent.) [PDF transcript of today's briefing.]
States ranged from Mississippi (34.4 percent) to Colorado (18.6 percent) and none met the federal Healthy People 2010 obesity target of 15 percent.
Healthy People 2010 was started by the HHS in 2000 as an effort to improve public health and eliminate disparities across the country. Obesity percentages were a key benchmarks, as were tobacco use, access to health care, mental health, environmental quality and immunization.
The objectives for Healthy People 2020 are being considered now. They would keep the obesity-related goals from the 2010 effort and augment them with nutrition-based standards.
The CDC says Vital Signs, which will be published on the first Tuesday of each month, “is designed to provide the latest data and information on key health indicators – cancer prevention, obesity, tobacco use, alcohol use, access to health care, HIV/AIDS, motor vehicle passenger safety, health care-association infections, cardiovascular health, teen pregnancy, infant mortality, asthma and food safety.”
Report examines health reform implementation
Filed under: Health care reform, Health policy, Hot Health Headline
A special report just released by The American Prospect looks at the implementation of health care reform. For the wide-angle view, read Paul Starr’s road map of where the battle lines will be drawn in the implementation effort.
AHCJ members Joanne Kenen, Jonathan Cohn and Rebecca Ruiz contributed to the 12-part report. Cohn discussed the construction and implementation of insurance rules, Kenen looked at Connecticut’s push for a local public option and piecemeal reform implementation in individual states.
Other elements include:
- Keith Wailoo’s evaluation of the pain management reform components of the bill, which amount to the promise that “we’ll look into it and maybe throw a little grant money in that direction.”
- Maria Abascal examines how reform will impact immigrants, legal and illegal alike. Legal immigrants, which make up a substantial portion of the nation’s uninsured, stand to benefit — as long as they can prove citizenship. Illegal immigrants don’t.
- Harold Pollack looks at health reform’s massive blind spot, the period between now and January 2014. Stopgap measures won’t be adequate for the majority of the uninsured, and Pollack pushes for an accelerated timetable.
Related
A briefing from the Alliance for Health Reform, cosponsored by the Robert Wood Johnson Foundation, looks at “50 Ways to Implement Health Reform: State Challenges and Federal Assistance.”
Frugal Minnesota splurges on lower backs
Filed under: Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Public health, Studies, Tools
For physicians and patients, treating lower back pain is an exercise in restraint and patience. According to federal guidelines, such pain usually resolves itself within six weeks with minimum intervention, so it’s often a matter of resisting the temptation to order a $500 MRI within that time window. And in Minnesota, a state known for its health-care-related moderation, that temptation seems to be too much.
As the Christopher Snowbeck of the St. Paul Pioneer Press reports, Minnesota doctors are worse than the national average when it comes to giving lower back pain patients MRIs without exploring cheaper alternatives. And in the land of Lake Wobegon, being below average is a big deal. The conclusions come from Hospital Compare’s newly released 2008 outcomes data. To learn more about this data, check out AHCJ’s recent conference call on the subject.
For some help reading between the lines of Snowbeck’s story (and the Hospital Compare data), see Gary Schwizter’s recent blog post on the subject; he doesn’t mince words.
The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.
For more about treatment of back pain, particularly how much money is spent on it, see the just-released “Back Problems: Use and Expenditures for the U.S. Adult Population, 2007” (PDF) from the Agency for Healthcare Research and Quality.
How reform will affect America, group by group
Filed under: Health care reform, Health policy, Hot Health Headline, Studies
In Health Affairs (AHCJ members get free access), economist Joseph Newhouse considers how health care reform will affect four major groups. They’re summarized below.
- Uninsured or on Medicaid or CHIP (30 percent)
- Insured individually or through a small business (10 percent)
- Insured through a mid-size or large business (45 percent)
- Recipient of Medicare (15 percent)
Medicaid expansion and broader subsidies are “major gains.”
This group will undergo the most change, with the individual mandate expanding their ranks to as much as 50 million people (16 percent of Americans). Health reform should “repair” this now-broken sector of the market.
A wash, as an insurance tax is balanced out by a reduced need to cover uncompensated care for the uninsured.
Complicated. The doughnut hole will close, but future financing sources are murky. Newhouse goes pretty deep into just how murky.
His conclusion is relatively upbeat. Newhouse writes that while reform “addressed many issues in health care financing, it left many others unresolved.” The system will need to be revised and updated throughout the foreseeable future, Newhouse writes, and effective implementation will “require persistence for many years to come.”
New rules affect patients’ insurance appeals
Filed under: Health care reform, Health policy, Hot Health Headline
Kaiser Health News’ Phil Galewitz and Michelle Andrews have an update on health care reform implementation, pointing out that new rules will give consumers the right to appeal insurance denials, first directly to the insurer and then to review boards. The rule doesn’t break new ground in most states – only five lack such regulations, and existing plans are “grandfathered in” under the old rules – but it may bring order to a chaotic national patchwork on insurance appeals. The White House estimates that, by next year, the rules will benefit about 41 million Americans insured either through employers or through individual plans. The administration is pushing states to implement the new standards by next July.
The new regulations take effect for plan years starting Sept. 23. But they won’t automatically apply to residents in states that have existing external review laws until next July. That’s to give states time to adjust to the new standards.
If states fail to change their rules by next July, their residents will then be able to rely on the federal standards. But federal officials are still working out the details of how that would be done.
Read the HHS press release here.
AHCJ resources
- Reporting on health reform between now and 2014: Some top Washington, D.C.-based journalists discussed implementation deadlines, how to tie local issues to reform, Medicare reimbursement rates, what reporters should look for in their states and more. A recording and transcript of this briefing and a resource list are available.
- Covering high-risk insurance pools: The federal government and states are scrambling to create temporary high-risk pools for the medically uninsurable, as one of the first provisions of the Patient Protection and Affordable Care Act to go into effect. Apart from being a policy story, it’s of great interest to all your readers, viewers or listeners who have pre-existing conditions and are struggling to find coverage. Four reporters covering the topic have shared their story tips, suggestions and resources for AHCJ members.
- Health care reform has passed: What’s next? Four journalists on the front lines offer their advice and suggestions on what needs to be covered next, how it might affect local communities and how to approach this complex topic.
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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
