PR specialist: Health journalists have critical role
Health journalists may be surprised to find support from Paul Oestreicher, a marketing communications consultant and adjunct professor at New York University with experience in the pharmaceutical industry.
Oestreicher makes the case that the health care industry has a vested interest in increasing the public’s health and science literacy - something he says will be supported by “news outlets being repopulated with professional journalists to help carry information forward.”
Though the pharmaceutical industry has suffered from behavioral, communication and performance missteps that have lowered reputation, it is low health literacy among consumers and the decline of science journalism that are fundamental to this problem.
Oestreicher cites numbers that show the pharmaceutical industry is suffering from a poor reputation that will only be helped by the public’s ability to evaluate medical facts and evidence. He also cites articles and a survey done by AHCJ and the Kaiser Family Foundation about the critical need for journalists who understand scientific studies and statistics.
Professional health and science journalists must help to communicate the progress and the failures, and to differentiate the facts and evidence from the frauds and junk science. Unfortunately, we’ve seen surveys confirm what we already know about the state of health and science journalism over the past few months. It’s a shrinking, wounded profession. We know the symptoms – they’ve been well documented. Like the global economy, journalism needs a recovery plan.
Feds take aim at off-label marketing
Filed under: Conflicts of interest, Pharmaceuticals
The Wall Street Journal’s Jeanne Whalen writes that a recent string of charges against drug companies, including heavyweights like Pfizer, Eli Lilly, AstraZeneca, Johnson & Johnson and Novartis, shows that a decade of aggressive prosecution hasn’t deterred them from some shady marketing practices. [Article require subscriber access]
Whalen says the promotion of off-label prescriptions is still at the core of the most common offenses, and that, according to says Patrick Burns, director of communications at Taxpayers Against Fraud, problems are most likely to crop up “when drug companies are promoting therapies that are similar to others on the market.”
Whalen reports that the Justice Department, which often relies on corporate whistleblowers to spark investigations in this arena, has made such cases a priority.
“Combating health care fraud is a top priority of the Department of Justice,” said Tony West, Assistant Attorney General of the Justice Department’s Civil Division
Drug companies have apparently taken notice. GlaxoSmithKline recently started “capping its annual payments to U.S. doctors at $150,000 and publishing the figures” while AstraZeneca’s CEO said the crackdown had made pharmaceutical companies “more sensitive than we’ve ever been” when it comes to preventing illegal drug promotion. Whalen writes that these steps may not be enough.
But Shelley Slade, a former Justice Department lawyer who now represents corporate whistleblowers through the firm Vogel, Slade & Goldstein LLP, in Washington, D.C., said large criminal monetary penalties and civil settlements don’t appear to deter companies sufficiently. “It’s not going to stop until the government puts some of these executives in jail,” she said. “Many of these companies view the fines as a small fraction of what they have gained through illegal schemes, and just a cost of doing business.”
Drug data could inform stories about elder care
The 2007 National Home and Hospice Care Survey (NHHCS ) Medication Public-Use File and Documentation are now available for downloading.
One group of researchers used earlier NHHCS data to “examine changes in hospice services over time, as they were collected during the period from 1992 to 2000, paralleling the period of substantial growth in hospice use and spending.”
With recent studies and news about the increase in use of antipsychotics in the elderly, this data might be useful in reporting such stories and documenting the increase, as well as stories about how treatments have changed.
The 2007 NHHCS Medication Public-Use Data File is supported by SAS, SPSS, and STATA input statements. The documentation includes three PDF files: technical notes, a data dictionary, and a PDF file that provides drug name codes, drug estimates and rates, and drug characteristics.
Joint Commission finds improved hospital quality
Filed under: Conflicts of interest, Health data, Hospitals, Pharmaceuticals, Studies
The latest report from The Joint Commission, a hospital accrediting organization, finds that “overall, hospitals are following evidence-based standards for treatment of myocardial infarction, heart failure, and pneumonia,” as MedPage Today reports.
The report, which looks at 31 evidence-based measures, did find decreases in two areas: measuring oxygen in blood for pneumonia patients and administering antibiotics to pneumonia patients in the intensive care unit within 24 hours.
The report, “Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2009,” (PDF) and those from three previous years are available on the commission’s Web site. Among the key findings:
- Hospitals accredited by The Joint Commission have significantly improved the quality of care provided to heart attack, heart failure and pneumonia patients over a seven-year period.
- Hospitals have steadily improved on individual surgical care performance measures – as well as on additional individual heart attack and pneumonia care measures - over a two-, three- or four-year period.
- Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma is excellent after only one year of measurement.
- Improvement is still needed.
- Where a patient receives care makes a difference.
As ProPublica’s Charles Ornstein explains in his tip sheet, The Joint Commission does routine inspections of participating hospitals to ensure they meet the standards required for accreditation. It compiles public reports on each hospital, which are available on the qualitycheck.org Web site. These reports include the hospital’s accreditation status, as well as some data on hospital outcomes and practices.
It does not release its detailed inspection reports to the public, and many states’ open records laws specifically exempt the reports from public disclosure. In the past, these inspections have not been surprises, and the group has been faulted for being slow to act against hospitals with problems Also, The Joint Commission rarely takes punitive steps against hospitals, preferring to work with them to improve.
Tip Sheets
A road map for covering your local hospital’s quality
Study: Hospital quality comparisons are inconsistent
News: Congress requires Joint Commission to re-apply for accreditation privileges (Sept. 17, 2008)
GAO looks at ‘extraordinary’ drug price hikes
Filed under: Government, Pharmaceuticals, Studies
In a new report (pdf), the Government Accountability Office looks into what caused hundreds of extraordinary increases in prescription drug prices during the past decade. The GAO defines an “extraordinary” price increase as a single hike that more than doubled a drug’s price, an event that occurred regularly throughout the past decade. In their summary of the report (pdf), the GAO summarizes the relevant numbers thus:
From 2000 to 2008, 416 brand-name drug products—different drug strengths and dosage forms of the same drug brands—had extraordinary price increases. These 416 brand-name drug products represented 321 different drug brands. The number of brand-name drug products that had these extraordinary price increases represents half of 1 percent of all brand-name drug products. The number of extraordinary price increases each year more than doubled from 2000 to 2008 and most of the extraordinary price increases ranged between 100 percent and 499 percent. Almost 90 percent of all brand-name drug products that had an extraordinary price increase sustained the new higher price—by either having another increase in price or remaining at the increased price.
More than half of the these extraordinary increases came in drugs in the central nervous system, anti-infective, and cardiovascular classes. According to the report, limited competition and a lack of equivalent drugs (either from generics or brand-name competitors) may be to blame for the price increases. Industry consolidation is also an issue, analysts said, as several drugs jumped in price after their parent company’s acquisition had been finalized.
Related: FDA approval causes drug price to skyrocket
Report looks at disclosure of adverse events
Filed under: Government, Health data, Pharmaceuticals, Public records
Adverse events that harm patients are publicly reported unevenly, according to a report from the inspector general for the Department of Health and Human Services.
The report reviewed the public disclosure of the information by state adverse reporting systems, patient safety organizations and the Centers for Medicare & Medicaid Services. As the report points out, reporting such events can help educate health care providers about why such events happen and how to prevent them.
The report (Adverse Events in Hospitals: Public Disclosure of Information about Events OEI-06-09-00360) does highlight seven state systems that are disclosing more information than others: Maryland, Massachusetts (both the Board of Registration in Medicine and the Department of Public Health), Minnesota, New Jersey, Oregon and Pennsylvania.
The inspector general points to those systems as models:
The disclosure practices of the seven State systems with more extensive disclosure can serve as models for other entities. These systems disclose analysis of the causes of events, evidence-based guidance for reducing occurrences, and information about demonstrated improvements by hospitals. This type of information, if disseminated by other State systems and entities that receive adverse event information, could help to improve patient safety.
The report provides some useful information for journalists about what information is publicly reported and AHCJ is, of course, gratified to see a government report that advocates public disclosure of patient safety information.
Cheryl Clark of HealthLeaders Media wrote about the report.
FDA documents for most-popular drugs not online
Filed under: Government, Pharmaceuticals, Public records
Nancy Watzman, writing for the Sunlight Foundation Reporting Group, has found that, because the Food and Drug Administration only makes approval background documents available for drugs approved after 1997, safety and efficacy information for nine of the 25 most-prescribed drugs is not available online.
The article points out that doctors base their treatment decisions on information in peer-reviewed articles, where drug companies have little incentive to publish negative information. The studies the FDA uses to make approval decisions, however, may have more complete and balanced information that would be useful to doctors and consumers.
Watzman reports that the FDA apparently receives such documents electronically, then prints them out, redacts them by hand (using white out!) and then scans them and saves them as PDF documents that are not searchable.
The report includes a list of the 25 most-prescribed drugs and highlights those for which FDA review documents are available online.
FDA approval causes drug price to skyrocket
In a collaboration between The Philadelphia Inquirer and Kaiser Health News, Harris Meyer looks at the case of colchicine, a drug used to treat gout that has been on the market so long that it predates the FDA approval process, and thus had never been approved. 
Like thousands of drugs it existed in a sort of grandfathered generic state. That ended in 2009 when URL Pharma earned FDA approval for a branded version of the drug, which it sells for 50 times more per pill than the generic.
The drug company convinced the FDA that its version was safer than the generic, a claim disputed by many physicians. Now, Meyer reports, it’s likely that the generic colchicine will be forced from the market over the coming months, driving customers of the centuries-old drug (a natural version was first mentioned by the ancient Greeks) into the arms of URL Pharma. According to Meyer, the case is just one of several that have resulted from post-2006 FDA efforts to gain control and approval over all those grandfathered-in unregulated drugs.
In the cold, elderly more likely to break hip
USA Today’s Kim Painter reminds folks, especially the elderly, to practice “defensive walking” during winter months, citing a “decade-long study of 66,346 hip fractures in New York City found that, at least in that city, fracture rates were highest in winter, especially on the coldest and windiest days.”
At the same time, Painter reports, overall fall rates don’t seem to budge to much in the winter, perhaps because folks are more likely to stay inside rather than risk icy steps and walkways. Painter says the increased fracture rates could be because of icy streets, weaker muscles as a result of winter inactivity and even lower vitamin D levels, which have been linked to weak muscles and brittle bones.
Poynter’s Al Tompkins, who first alerted us to this story, also points to CDC resources on the “silent epidemic” of hip fractures in America.
AHCJ on Aging
AHCJ’s Aging in the 21st Century workshop, held Oct. 16 and 17 in Miami, addressed the changing picture of aging Americans and key research and issues related to this growing population. Tip sheets and presentations from that workshop are available to AHCJ members, as are these related tip sheets:
- Aging Nation: Troublesome Health Care Issues
- Headlines an advocate for seniors would like to see
- The impact of aging upon health care
- Covering nursing homes and other issues of aging
- How will retiring boomers affect the national health agenda?
- You Can Run, but You Can’t Hide: Policy and Problems in Long-Term Care
- Biology of Aging: Sources and Resources
Slim guide: Covering the Health of Local Nursing Homes
Check out AHCJ’s latest volume in its ongoing Slim Guide series. This reporting guide gives a head start to journalists who want to pursue stories about one of the most vulnerable populations – nursing home residents. It offers advice about Web sites, datasets, research and other resources. After reading this book, journalists can have more confidence in deciphering nursing home inspection reports, interviewing advocacy groups on all sides of an issue, locating key data, and more. The book includes story examples and ideas.
AHCJ publishes these reporting guides, with the support of the Robert Wood Johnson Foundation, to help journalists understand and accurately report on specific subjects.
NPR to air explanatory Fosamax piece tonight
Filed under: Hot Health Headline, Pharmaceuticals
NPR correspondent Alix Spiegel’s latest piece, an examination of how Merck manufactured a disease (and an epidemic) en route to turning Fosamax into a blockbuster drug, is set to air on All Things Considered tonight. 
We all know how the story ends, but the real focus is the journey. As Spiegel says, “it’s the story of how the definition of what constitutes a disease evolves, and the role that drug companies can play in that evolution.”
In the case of Fosamax, it’s a real humdinger, going all the way from a sweltering meeting room in Rome to the shady backrooms of corporate America and, just in case that isn’t Da Vinci Code enough, it even involves dubious decisions at the highest levels of government.
Update
In a sidebar added to the story after this entry was posted, journalist Gisele Grayson writes about learning that she has osteopenia.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- 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
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
