Legacy of Agent Orange continues in U.S., Vietnam
The Chicago Tribune is in the middle of an ambitious five-part series in which reporters Jason Grotto and Tim Jones seek to shed light on one of the great gray areas of veterans’ medicine: the effects of Agent Orange. The first installment gave background on the use and consequences of Agent Orange.
Subsequent pieces chronicle the veterans’ battle for compensation, the suspected link between the defoliant and birth defects in Vietnam and continued pollution in that country from defoliants. The last, not-yet-published piece will reveal “documents showing that decisions by the U.S. military and chemical companies that manufactured the defoliants used in Vietnam made the spraying more dangerous than it had to be.”
The authors explain how they did it:
With assistance from the Fund for Investigative Journalism, the Tribune spent a month traveling to eight provinces throughout Vietnam, conducting nearly two dozen interviews with civilians and former soldiers who say they were exposed to the defoliants.
The newspaper used a database of every spraying mission, mapping software and a GPS device to help corroborate their stories. And in the U.S., the paper researched thousands of pages of government documents and traveled to the homes of veterans to gauge the impact and measure the cost in both dollars and human misery.
According to the reporters, 65 percent of Agent Orange and its defoliant relatives were contaminated with the super-toxin dioxin, and some even contained arsenic. The full impact of this chemical onslaught is unknown, but the Tribune reporters have tracked down a number of alarming anecdotes and numbers.
“We do not know the answer to the question: What happened to Vietnam veterans?” said Jeanne Stellman, an epidemiologist who has spent decades studying Agent Orange for the American Legion and the National Academy of Sciences. “The government doesn’t want to study this because of international liability and issues surrounding chemical warfare. And they’re going to win because they’re bigger and everybody’s getting old and there are new wars to worry about.”
Tribune investigates nursing home psychiatrist
In the latest installment of the Chicago Tribune’s investigation into Illinois nursing homes, Sam Roe and ProPublica’s Christina Jewett investigate Dr. Michael Reinstein, an impressively prolific prescriber who, in 2007, wrote more prescriptions for clozapine (”a potent psychotropic medication that carries five ‘black box’ warnings”) than all physicians in Texas put together.
In that same year, he prescribed medications to 4,141 Medicaid patients. Furthermore, while the average American doctor sees about 35 patients each with, Reinstein sees an incredible 60 patients each day. Reinstein’s workload may have something to do with the fact that he’s the psychiatric director at 13 different nursing homes, but Roe and Jewett write that the ultimate blame lies on systemic problems in Illinois.
Earlier
New 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.
Recent workshop
AHCJ’s Aging in the 21st Century workshop, held Oct. 16 and 17 in Miami, addressed many topics raised by the Tribune’s reports, as well as 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
Trib looks into dangerous nursing home residents
The Chicago Tribune’s Gary Marx and David Jackson examined the effectiveness of Illinois regulations implemented in 2006 to protect nursing home residents from potentially dangerous peers. They’ve pulled together some alarming anecdotes and data that show the law is not as effective as hoped.
For example, the reporters focus on the man with a criminal record who attacked by another resident with an ice pick. Just a year after the attack, he ended up in the same facility as his victim again. This time, he slashed him with a box cutter. Obviously, there was a hole somewhere in the new system. Marx and Jackson lay out the facts:
With growing numbers of mentally ill felons entering Illinois nursing homes, the state in 2006 became the first to require criminal background checks as part of an overall risk assessment of new residents. The screenings by state contractors are used to identify high-risk individuals who should live in private rooms and be closely monitored.
But a review of confidential reports in 45 recent cases shows that in many instances the assessments were incomplete, leaving out some criminal convictions and other crucial details.
The project includes a searchable database of safety reports on nursing homes in Illinois, including information not searchable on government sites. Readers can use the database to find out the number of residents at a facility who are convicted felons and sex offenders, crimes reported at Chicago nursing homes and fines levied because of deficiencies in care. Head over to the investigation’s homepage to follow the story and its results.
Evaluation of nonprofits’ charity care continues
If you’re keeping a list of issues that have been rejuvenated through inclusion in the Baucus bill, you can safely add Iowa Sen. Chuck Grassley’s crusade to keep nonprofit hospitals accountable for the provision of adequate amounts of charity care. According to the Chicago Tribune’s Bruce Japsen, the proposed bill includes Grassley’s provision to “improve the community service, transparency and billing practices of nonprofit hospitals.”
From Japsen’s story:
“For now, there’s no minimum percentage requirement for charity care and community benefit,” Grassley said in a statement on Baucus’ proposal. But Grassley is not ruling out a required level in the future, saying it needs “more study.”
“I agree with groups that take their charitable mission seriously … that a percentage payout requirement would become a ceiling, not a floor, like the private foundation payout of generally five percent,” Grassley said in a memo Thursday. “Instead, we need a formula that would maximize expenditures for charitable purposes.”
The Washington Post’s Kathleen Day, meanwhile, reported on the results of a Grassley-backed Senate investigation into the charity care provided by nonprofit hospitals:
The investigators found that while federal law requires charity care in exchange for tax-exempt status, a 37-year-old IRS rule implementing the law is so vague that nonprofit hospitals have been able to exploit it by offering some free services but often little aid to the poorest people in their communities.
Nonprofits frequently charged higher prices to poorer people with no health insurance than they did to better-off patients who had coverage, researchers found. At the same time, many of the hospitals’ top executives enjoyed generous perks such as paid country club memberships and stays at expensive hotels.
Trib’s Triage blog ends, Graham goes investigative
Filed under: Health journalism, Hot Health Headline
The Chicago Tribune’s Triage blog has closed its doors and Judy Graham – the face of the blog for the past year – has moved on to the paper’s investigative and watchdog team.
Graham will still find time twice a month to write the sort of stories Triage writers have come to know; fans will be able to find them in the pages of the Chicago Tribune’s Sunday section and in other Tribune papers.
Homeless man teaches MD about inequalities
The Chicago Tribune’s Judith Graham tells the story of a doctor who befriended a homeless man who sold StreetWise magazine at a local pharmacy, then offered him a place to live. As the doctor has worked to help his friend achieve financial independence, he has learned to view health care inequalities from a different perspective.
Now (Dr. Allen) Goldberg uses insights from (Everett) Atkinson — for example, how African-Americans in poor communities can distrust white doctors — in his volunteer work in tough city neighborhoods. “He helps me understand a lot because who knows better about being disadvantaged?” Goldberg said.
Goldberg said he’d never been exposed to true poverty before, and that the exposure has changed his thinking and informed his approach to medical outreach.
The doctor said he’s learned the need to listen to other people deeply, carefully and without judgment — a lesson he’s using in volunteer work with the Chicago Asthma Consortium. The group plans “listening sessions” with residents of poor neighborhoods this year about ways to reduce asthma’s burden.
FDA dropped ball on sketchy syringes
Filed under: Conflicts of interest, Government, Hot Health Headline
According to a report by Christina Jewett of ProPublica and Deborah L. Shelton of the Chicago Tribune, the U.S. Food and Drug Administration — understaffed, overworked and increasingly reliant upon the cooperation and assistance of the industries it’s expected to oversee — allowed a North Carolina plant to ship tainted syringes which have “been linked to at least 4 deaths and 162 illnesses nationwide.”
The reporters chronicle the, the series of FDA internal safeguards that failed to catch the syringes before they were shipped.
- In October 2007, an inspector visited the plant after reports of specks of debris in fluid-filled syringes. She reported that management had a plan to deal with the problem, not noting that their sterilization method was unreliable.
- The company, AM2PAT, announced a recall a week later. This should have triggered an automatic FDA review but the overloaded agency ignores that particular fail-safe unless it judges lives to be on the line.
- In late 2007, as folks started getting sick, the FDA finally gave the plant a detailed inspection, finding a gummy brown substance on the syringe filler and brown water coming from the taps. It was closed in January 2008, but the damage had already been done.
The reporters found the regulatory failures were the cumulative effect of overwork and an increasingly heavy reliance on industry to police itself.
For this article, Gordon Harnack, a consultant who helps medical device companies prepare for inspections, reviewed more than 120 pages of FDA reports on the AM2PAT plant dating to 2005. He said inspectors didn’t look deep enough, and FDA managers were too tolerant.
“Time after time, the evidence was there that [AM2PAT] management had little intent of complying with adequate FDA regulations,” Harnack said. “In 2005, [the FDA] might have caught it. In 2007, they should have caught it. And finally when reports of deaths came in, it all became evident.”
The Propublica/Tribune report exhaustively chronicles AM2PAT’s fraud and manipulation of the system, a history of deception which the FDA failed to act on until it was too late.
Tribune: Lupron to treat autism is ‘junk science’
Filed under: Hot Health Headline, Pharmaceuticals
The Chicago Tribune’s Trine Tsouderos reports on the growing use of Lupron, a drug sometimes used to chemically castrate sex offenders, to treat autism in children. The practice’s proponents, a father and son duo with clinics across the country, call it a “miracle drug.” Mainstream scientists are not convinced. Tsouderos chronicles their ire:
Four of the world’s top pediatric endocrinologists told the Tribune that the Lupron protocol is baseless, supported only by junk science. More than two dozen prominent endocrinologists dismissed the treatment earlier this year in a paper published online by the journal Pediatrics.
The story includes warnings that the drug can “disrupt normal development, interfering with natural puberty and potentially putting children’s heart and bones at risk,” according to experts in childhood hormones. The treatment involves regular, painful shots.
Tsouderos pulls no punches — in the story the Lupron treatment is referred to as “junk medicine” that spreads “false hope” — and takes on several alternative treatments and theories surrounding autism, including links with mercury or vaccination. In addition to interviewing disapproving scientists, she also details the marketing practices of the doctors behind the Lupron treatment and questions their success stories.
Resurgent bedbugs spread through Chicago
Almost eradicated by DDT in the ’50s, bedbugs - annoying, biting pests not shown to carry disease - seem to be making a comeback in major American cities. Colleen Mastony of the Chicago Tribune reports that bedbug complaints in that city jumped last summer and have been climbing ever since.
The problem, experts say, has been exacerbated by the economy. Landlords are slow to send exterminators. And cash-strapped neighbors seem more likely to pluck infected furniture from Dumpsters. What’s more, some suspect the bugs are spreading through used-furniture outlets and online networks such as Craigslist.
“Five years ago, it wasn’t an issue,” said Arturo DelAngel, who works the complaint hot line at the Metropolitan Tenants Organization. “Now it’s bedbugs all the time, every day.”
Mastony cites reports from New York, Boston and Cincinnati and finds that the bedbug infestations may be taking on the dimensions of a national trend.
Michael Potter, an urban entomologist at the University of Kentucky, believes that bedbugs are poised to become the country’s most pressing pest problem. “We’re going to see serious increases of this pest, and it’s going to affect a lot of people,” he said.
Scientific American gets the facts about bed bugs in its Ask the Experts feature.
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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
