Controversy over breast implants spreads across Europe

In the wake of the discovery that a leading international manufacturer was found to be using industrial-grade silicone in its breast implants, questions have emerged about the regulatory process that allowed the implants and who is responsible for removing the substandard implants from women who spent thousands to get them.

John Lister, the web coordinator of AHCJ’s focus on Europe, explores the controversy surrounding the implants, including the lack of data on how many women in the United Kingdom received them, how the United Kingdom’s National Health Service has been drawn into the business of removing the implants and the regulatory system that allowed the implants in the first place. Lister reports:

But when it came to ascertaining the numbers of women who may have had PIP implants in British private clinics, it became clear there was no comprehensive or reliable data. A working estimate of 40,000 women potentially at risk eventually emerged, while the private clinics said they were not required to remove the suspect implants or replace them with safe ones. Yet the figures that were available showed that for one clinic as many as 7 percent of PIP implants had leaked, well above initial claims of a failure rate of about one percent.

The Reuters enterprise team has a special report on the breast implant scandal and a piece that shows how the regulatory system may be another scandal waiting to happen. It also looks at how, in the United States, the FDA handled an application from that company in 2000.

The history of breast implants is littered with flawed devices, a colorful cast of intertwined players and billion-dollar lawsuits. Reuters reviewed hundreds of pages of police investigation transcripts and financial documents, and interviewed former PIP employees, the company’s suppliers, customers and health experts, to piece together this latest chapter in that history.

Leaded aviation fuel a threat to public health, children

KUOW’s John Ryan used federal data and a few key sources to delve deep into issues surrounding one of the few remaining sources of airborne lead in the United States, a leaded aviation fuel known as “avgas.” In the process, he reveals damage that even low levels of lead exposure could be doing to children.

Avgas accounts for less than 1 percent of the nation’s liquid fuel use. Yet enough piston–engine planes fly enough miles on avgas to belch out half of all the lead going into the nation’s air.

Lead paint in old buildings remains a bigger threat, but even low levels of childhood exposure, one source tells Ryan, can manifest itself in “Decreases in IQ, changes in test scores, changes in attention, hearing threshold, all sorts of things like that.”

Earlier this month (January), an expert panel advising the Centers for Disease Control and Prevention cut in half the levels of lead in children that should alarm parents or doctors. Researchers have yet to find any level of lead exposure that doesn’t cause harm.

Michael Kosnett, a medical toxicologist at the University of Colorado, told Ryan, “In any one child, it’s not something that’s going to necessarily cause them to display any kind of signs and symptoms. But if you can lower the lead exposure of a population of children, you’re going to give that population more of an opportunity to have gifted children and to have children who have higher IQs, and that’s certainly a desirable public health goal.”

Marie Lynn Miranda, an environmental health scientist and a dean at the University of Michigan, points out that “Living close to an airport can increase your blood lead level anywhere from 2 to 4 percent,” acknowledging that is a small amount but that evidence indicates even small amounts of lead are bad. She also notes that “lead is especially a problem for the low–income families that are most likely to live near airports.”

Pilots who still use avgas say their businesses would be dead in the water if they couldn’t get the leaded fuel, an argument Ryan contrasts with quotes from a Europe-based lead-free avgas producer, who sells it for 40 cents less a gallon, but hasn’t been able to break into the U.S. market “Because no one thinks that there will be demand for an unleaded–grade aviation gasoline.”

The federal database Ryan used, The National Emissions Inventory, is posted online by the EPA.

Investigation delves into Wash.’s prescription drug problem

Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.

Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.

The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”

Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.

Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”

She drills down into many of those causes, with my personal favorites being two key origin stories:

• How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
• How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”

See the upper right-hand sidebar for more stories from the six-month investigation.

With state funds gone, Okla. dental programs still serve needy

Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”

Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.

“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”

For more on NPR’s StateImpact project and a list of current participants, check out their lab.

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.

Why are rural Westerners killing themselves?

Writing for ABC News, Alan Farnham seeks to explain the jump in suicide rates in the rural American West, particularly in Intermountain states such as Idaho, Wyoming and New Mexico.

Historically the suicide rate in rural states has been higher than in urban ones. According to the most recent national data available, Alaska has the highest rate, at 24.6 suicides per 100,000 people. Next comes Wyoming (23.3), followed by New Mexico (21.1), Montana (21.0) and Nevada (20.2). Idaho ranks 6th, at 16.5. Suicide is the second-leading cause of death for Idahoans aged 15-34. Only accidents rank higher.

Farnham focuses on the Gem State, where suicide rates are rising alongside unemployment and related economic hardship. In addition to economic factors, including cuts to Medicaid funding, and a regional lack of resources for the initial diagnosis of mental illness, local experts point to demographic and cultural factors.

Kim Kane, executive director of Idaho’s Suicide Prevention Action Network in Idaho says other factors explain the high rate of suicide in western mountain states. One is the greater prevalence of guns: In 2010, 63 percent of Idaho suicides involved a firearm, compared with the national average of 50 percent.

She and Garrett also say the West’s pride in rugged individualism can prevent people from seeking help. Their feeling, says Kane, is that they ought to be able to pull themselves up by their mental bootstraps. Idaho is the only state not to have a suicide-prevention hotline.

Kidney disease kills thousands in sugar cane fields

In The Center for Public Integrity’s iWatch News, Sasha Chavkin and Ronnie Greene write that, “Little noticed by the rest of the world, chronic kidney disease (CKD) is cutting a swath through one of the world’s poorest populations, along a stretch of Central America’s Pacific Coast that spans six countries and nearly 700 miles. Its victims are manual laborers, mostly sugarcane workers.”

Each year from 2005 to 2009, kidney failure killed more than 2,800 men in Central America, according to the International Consortium of Investigative Journalists‘ analysis of the latest World Health Organization data. In El Salvador and Nicaragua alone over the last two decades, the number of men dying from kidney disease has risen fivefold. Now more men are dying from the ailment than from HIV/AIDS, diabetes and leukemia combined.

Unlike in more developed nations, neither diabetes nor hypertension can be blamed for the widespread kidney ailments. Instead, the duo found, scientists suspect possible environmental toxins and strenuous labor conditions, both linked to the cane fields, as well as alcohol abuse and anti-inflammatory drug use. At present, researchers seem to be focusing on heat stress as the most likely culprit, and plantation owners seem to concur

Internal studies by Nicaragua Sugar, owners of one of Central America’s largest sugar plantations, provided by the company to ICIJ, show that the company has long had evidence of an epidemic tied to heat stress and dehydration. In 2001, company doctor Felix Zelaya conducted an internal study on the causes of CKD among its workers. “Strenuous labor with exposure to high environmental temperatures without an adequate hydration program predisposes workers to heat stress syndrome [heat stroke], which is an important factor in the development of CKD,” Zelaya concluded.

Nicaragua Sugar and other companies say they have acted voluntarily to protect workers by improving hydration, reducing work hours, and strengthening oversight of labor contractors.

Chavkin and Greene dig deep into the economic and political factors underlying the global response to the epidemic, as well as the day-to-day impact it all has on workers’ lives. For more, read their full investigation.

In Northwest, wood stoves run afoul of EPA

When setting out to explain the difficulty in improving the region’s air quality, InvestigateWest’s Robert McClure and Katie Campbell of EarthFix and KCTS found that old wood stoves, with an assist from fireplaces and their ilk, produce half the soot fouling Puget air during still winter days – a contribution five times great than that of heavy industry. It’s a common problem in the Northwest, where wood is a cheap (free, for many rural residents) alternative to electric or oil-fueled heaters.

Those old wood stoves are to blame, in large part, for putting Tacoma, Wash., and other cities in violation of the Clean Air Act. With the potential for tighter federal regulations to be drafted in 2012, the pressure is on for local governments to take on local wood burners, an unpopular prospect in tough economic times, especially in regions with little appetite for government interference and federal regulation.

Where There’s Smoke, There’s Sickness from EarthFix on Vimeo.

Restricting use of wood stoves that heat so many homes across the Northwest is a difficult proposition, though, because many people can get wood for cheap or for free, and using a wood stove can greatly reduce electricity and natural-gas bills that run wild in the winter. Installing a new clean-burning stove typically costs $2,000 or more – and many argue that it’s lousy timing to launch an expensive campaign to clean the air, federal standards or no federal standards.

Yet that’s the recommendation of a task force representing local governments, industry, the military and others involved with soot pollution levels in and around Tacoma. Last week the group voted to recommend removal of all wood stoves that don’t meet current government standards by 2015 in the area violating the Clean Air Act.

Currently, the Clean Air Act requires that cities like Tacoma clean up their soot by 2014, but the Puget Sound Clean Air Agency is already, in the reporters’ words, “counting on” the EPA to extend the deadline “until as late as 2019.” That agency’s director says, given the costs involved, “This is a Western problem, and we need federal help.”

That’s because of the size of the task. The Puget Sound agency estimates it needs to persuade or force some 15,000 of the 24,000 owners of uncertified wood stoves to remove them in order to comply with the Clean Air Act.Just to remove and patch up the walls where those 15,000 stoves now stand would cost about $7.5 million – and at least some families would need to install a new wood stove at a cost of $2,000 or more each.

According to McClure and Campbell, the sooty particles of that winter tradition we used to call “The Inversion” in Boise can contribute to “heart attacks, strokes, high blood pressure, asthma attacks and premature death – in addition to cancer.”

In Washington, the state Ecology Department estimates that sooty pollution from sources including wood smoke and diesel exhaust contributes to 1,100 deaths and $190 million in health costs annually.

Ecology says a conservative estimate of the annual number of deaths attributable to soot pollution in Pierce County alone is 140.

Related

• On patrol with the smoke police, The Bakersfield Californian
• A Burning Issue, California HealthCare Foundation Center for Health Reporting & Chico Enterprise-Record

Project looks at problems in how deaths are investigated

The results of a yearlong joint investigation of the American autopsy system by ProPublica, Frontline and NPR show that problems in the death investigation system throughout the country have led to innocent people being sent to prison, “allowed the guilty to go free and left some cases so muddled that prosecutors could do nothing.” When autopsies aren’t done, diagnostic errors go undetected and opportunities to learn more about medicine are lost.

One story of patient rights and legal wrangling sports the remarkable headline “Why Can’t Linda Carswell Get Her Husband’s Heart Back?” It hinges, among other things, on the simple fact that “Even though the Institute of Medicine has reported that medication errors affect an estimated 1.5 million patients per year, it is not typical to conduct toxicology tests as part of clinical autopsies. They are routine in forensic autopsies.”

Another piece takes a broader view, exploring the reasons behind and consequences of the fact that autopsies are performed on only about one in 20 patients who die in hospitals when, 50 years ago, the rate was one in two.

Hospitals aren’t required to perform autopsies – the Joint Commission hasn’t included autopsy rates in its accreditation process since 1971 – and neither Medicare nor private insurers reimburse hospitals for the procedures, which Allen found cost about $1,275 each. The implications of these financial disincentives, combined with related factors such as some physicians’ confidence that new diagnostic tools such as MRIs and CT scans provide such accurate results that they obviate the need for postmortem work, are far-reaching.

Diagnostic errors, which studies show are common, go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost to learn about the effectiveness of medical treatments and the progression of diseases. Inaccurate information winds up on death certificates, undermining the reliability of crucial health statistics.

Furthermore…

A 2002 review of academic studies by the federal Agency for Healthcare Research and Quality found that when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of 10 cases, the error appeared severe enough to have led to the patient’s death.

Other stories in the project report that suspicious deaths of the elderly are rarely investigated and that the deaths of children “pose special technical challenges for forensic pathologists.”

Watch the full episode. See more FRONTLINE.

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