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.
Indiana numbers show preventable errors down
The Indianapolis Star’s Daniel Lee reports that, according to the state’s newly released 2009 numbers, preventable medical errors are down in Indiana. There were 94 reported errors last year, down from 105 each in 2007 and 2008.
Part of the decline can be attributed to the health department’s Indiana Pressure Ulcer Initiative, which appears to have helped bring bed sore occurrences down 33 percent from 2008.
The initiative, which began in June 2008 and runs through September, focuses on improving hospitals’ systems for assessing risk factors for patients developing bed sores. Efforts have included in-person and online prevention training for hospital personnel.
The real story is the Indiana error numbers, which are wonderfully extensive. They’re broken down by condition (28 different serious errors), location and specific facility.
Related
- More on medical errors
- Record crowd hears from Dennis Quaid, Elizabeth Edwards
- Tip sheet: A road map for covering your local hospital’s quality
Conference presentations
- Arrogance without accountability? Where is the media? [Peter Pronovost | Watch an excerpt of his keynote address]
- The National Healthcare Reports, Ernest Moy
- How a Hospital Failed a Boy Who Didn’t Have to Die, Helen Haskell
- Citizens for Patient Safety, Patty Skolnik
- MRSA Survivors Network, Jeanine Thomas
- Improving patient safety through health information technology
AHCJ articles
- Medical misconnections: Patient-safety problems [About the project | Contest questionnaire]
- Experts discuss benefits, dangers of telemedicine
- Hospital patient safety initiatives borrow from transportation industry
- Specialty hospitals, surgery centers call 911 in emergencies
- Reporter documents surgical errors through public records
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
Society ‘snookered’ by research that isn’t new
Peggy Peck of MedPage Today found that research presented as new at the European Society of Cardiology’s annual meeting this weekend was actually published in July, despite the society’s requirement that information submitted for presentation must be new, unpublished data.
When asked by MedPage Today to point out the “news” in the Hot Line presentation, STAR lead investigator Bodo-Eckehard Strauer, MD, of the Heinrich Heine University of Düsseldorf, Germany, said the news was that bone marrow cell therapy significantly improved survival in patients with chronic cardiomyopathy, which he illustrated with a slide showing a Kaplan-Meier curve – the same graph that was published in the July issue of the European Journal of Heart Failure. Moreover, every data slide in Strauer’s presentation matched the tables in the published paper.
Following questions from MedPage Today, the organization acknowledged its error and has announced the researcher will not be allowed to present at its meetings for two years. Roberto Ferrari, M.D., president of the society, said the research had been accepted for presentation because they thought it had new data but that “We were snookered.”
Identical tubing demonstrates FDA’s inaction
In The New York Times, Gardiner Harris outlines the problem of medical tubing that looks very similar – leading to medical errors – then deftly works his way up the chain in an attempt to find the source of device regulator’s failure to solve a problem that seems entirely solvable.
Many medical device tubing looks the same, which leads to horrific mix-ups like the delivery of food straight into the bloodstream. In 2007, The Wisconsin State Journal’s David Wahlberg earned first place in the medium newspapers category of AHCJ’s Awards for Excellence in Health Care Journalism for his Medical Misconnections series, which detailed the same problems. He even wrote an AHCJ article teaching journalists how to investigate patient safety problems.
Photo by bennylin0724 via FlickrSince then, not much has changed. Which is not all that surprising, when you consider that not much had changed in the decades before Wahlberg’s story either. Harris’ mission is to dig past the finger-pointing and figure out why. In the end, it all seems to point to some remarkable systemic flaws in the FDA’s device approval system, as well as an unwillingness on the industry to change without the threat of brute regulatory force. In addition to compelling analysis, Harris punctuates each argument with a few spicy quotes.
You’ll have to read Harris’ story to truly understand the perversity of the FDA system and how its lent such inertia to the status quo, but here’s a sample:
Dr. Robert Smith, an F.D.A. device reviewer who left the agency on July 31 and was among nine agency employees who in 2009 decried the agency’s device approval process as illegal and dangerous, said that the tubing problem, which has gone on for decades, was another example of how the agency failed to protect the public. “F.D.A. could fix this tubing problem tomorrow, but because the agency is so worried about making industry happy, people continue to die,” Dr. Smith said.
And, from Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who believes that “Nurses should not have to work in an environment where it is even possible to make that kind of [tubing] mistake.”
“The regulators have been waiting for the manufacturers to come up with a solution,” Ms. Pratt said, “and the manufacturers won’t spend the money to design and produce something different until the regulators force them to. And now the international standards organization is taking forever to get the whole world onto the same page.”
Mass. won’t post hospitals’ death rates
Filed under: Health data, Hot Health Headline, Public records
The Boston Globe’s Liz Kowalczyk reports that, two years after it was first proposed by a consumer group, the Massachusetts Health Care Quality and Cost Council has decided it won’t publish hospital-wide mortality rates. The problem, it seems, is the lack of an accurate, universal method of computing such numbers.
Health and Human Services Secretary Dr. JudyAnn Bigby, who heads the group that made the decision, said current methodology for calculating hospital-wide mortality rates is so flawed that officials do not believe it would be useful to hospitals and patients and could harm public trust in government.
It appears, Kowalczyk writes, that general hospital mortality rates just aren’t “ready for prime time” quite yet.
The council convened an expert panel, which worked with researchers to evaluate software of four companies for measuring hospital mortality. The problem was that researchers came out with vastly different results when they used the various methodologies to calculate hospital mortality between 2004 and 2007 in Massachusetts, and they could not tell which company’s results — or if any — were accurate.
As school starts, so do youth sports injuries
The University of Michigan’s new Michigan NeuroSport Concussion Program seems to be cropping up everywhere, and as far as I can tell, it’s all part of a coordinated effort by the University. They already claim to have one of the only pediatric sport programs in the country, and now they’re expanding it with a clinical and research focus on “neurological sports injuries.”
In related news, the latest CDC Morbidity & Mortality Weekly Report includes an analysis of the numbers for “Heat Illness Among High School Athletes” from 2005 to 2009. The study examined 100 schools and nine sports, and found that heat-related illness was most common in football, and that August was the worst month for such afflictions.
AHCJ has a rich pool of resources for journalists looking to report beyond the press releases on stories like these, including:
Tip sheets
Concussions in young athletes
Reporting on sports injuries in school-age children
Health and education: Two intersecting beats
Health and education: Reporting resources
Blog posts
Tougher concussion rules from high school assn.
GAO evaluates youth concussion databases
Concussion more likely when hit is unexpected (Youth hockey study)
Attention focuses on football’s neurological effects
AP story: Hundreds of PTSD soldiers likely misdiagnosed
Endowment funds local health reporter
Filed under: Health journalism, Hot Health Headline
Let’s get the headline out of the way first: The Merced Sun-Star is hiring a health care reporter!
Now, the interesting part. The Sun-Star’s new 18-month spot is funded by The California Endowment, which you may remember as a key backer of California Watch. 
It’s part of the endowment’s 10-year plan to improve local health.
Merced County was chosen as one of the 14 places in the state to work with the endowment in a 10-year plan to help transform communities and neighborhoods into places where everybody can be healthy, safe and ready to learn, according to Building Healthy Communities.
Thanks to that larger mission, the Merced health care reporter will cover some interesting sub-beats in addition to the Sun-Star’s traditional health coverage.
The endowment started with 10 goals to accomplish over the next decade. After polling folks in those communities, it set three priorities over the next three years: create healthier youngsters to grow, learn, play and lead, which organizers call “Healthy Youth Development;” prevent and reduce violence; and link economic development to community health.
They’re areas that are certainly not foreign to health care journalists, and a reminder that reporting on the health of the community means thinking beyond hospitals and outbreaks.
AHCJ members will probably already remember that this isn’t the first time Merced has taken the lead in health care journalism innovation, and that the new reporter is really the next step in an ongoing process.
Update
The California Endowment’s Mary Lou Fulton posted some background on the project, a sort of “how-to” primer she wrote for foundations looking to support local news. In addition to explaining why the foundation chose to fund local projects, Fulton also spends a considerable amount of time addressing concerns about editorial independence and conflicts of interest.
Article looks at evidence behind back surgery
Filed under: Conflicts of interest, Health care reform, Hot Health Headline
In the Star Tribune, Janet Moore seeks to counter aggressive spinal surgery with equally aggressive journalism. It’s a comprehensive take on a subject which journalists have been hammering away at piecemeal for some time now. Her anecdotes are strong, and her numbers doubly so. For example:
Photo by planetc1 via Flickr
Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health. Spending on back care soared between 1997 and 2005, reaching $86 billion — just shy of what Americans spent battling cancer.
As those numbers have multiplied, so have questions about the more aggressive forms of back treatment. A 2008 study in the Journal of the American Medical Association, for example, noted that the increase in back-care spending occurred “without evidence of corresponding improvement” in patients’ health.
As Moore points out, this is a debate that will continue as health reform is implemented because the new legislation will “require doctors and hospitals to demonstrate that their services are cost-effective. In that vein, the New England HealthCare Institute estimates the United States could save roughly $1 billion a year by eliminating unnecessary back surgeries.”
Minnesota is home to Medtronic, a leading maker of devices used in spinal surgery. Medtronic has consultation arrangements with a number of doctors and some experts question whether that relationship has an effect on how many spinal surgeries are done. The head of the Association for Ethics in Spine Surgery, says these financial incentives create demand for certain brands of product.
It’s a lengthy piece, and the numbers are just one component. The whole package is definitely worth a read.
Related
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
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- Briefing: Reporting on health reform between now and 2014
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- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
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