Tsouderos looks at federal funding of alternative medicine
Filed under: Government, Health care reform, Health policy, Hot Health Headline, Pharmaceuticals, Public health
In her latest series, Chicago Tribune reporter Trine Tsouderos, whose award-winning reporting has brought her hard-nosed approach to investigating less-proven areas of medicine, which will be familiar to many members, to bear upon the federal government.
This time, her target is the National Center for Complementary and Alternative Medicine, which she calls “a small, little-known branch of the National Institutes of Health … launched a dozen years ago to study alternative treatments used by the public but not accepted by mainstream medicine.” According to Tsouderos, the center has spent $1.4 since its inception, some of it on curious projects.
A Tribune examination of hundreds of NCCAM grants, dozens of scientific papers, 12 years of NCCAM documents and advisory council meeting minutes found that the center has spent millions of taxpayer dollars on studies with questionable grounding in science.
You’ll want to read it for yourself, but highlights include sentences such as “The cancer treatment involving coffee enemas was based on an idea from the early 1900s, and patients who chose to undergo the risky regimen lived an average of just four months” and “Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn’t do a lot for our ability to heal a wound.”
It’s not all just cherry-picking wacky studies, of course. Tsouderos also looks deep into the powerful alternative medicine industry as well as the scientific rigor, or lack thereof, that sits at its core.
Americans unprepared to pay for long-term care
Filed under: Aging, Government, Health care reform
In the Chicago Tribune, Deborah Shelton examines how unprepared Americans are to pay for their own long-term care needs as they age. Long-term care tends to slip under the radar because, as one of Shelton’s sources told her, “People buy insurance for their life because they know they are going to die, for their car because they know that can get in an accident and for their health because they know they can get sick, but people don’t tend to buy insurance because they think they are going to need someone to help them take a bath.”
Long-term care encompasses everything from nursing home fees to in-home assistance with everyday routines. It all comes with a price tag; Medicare only covers a limited amount and Medicaid programs apply only to those below certain economic thresholds. That leaves the middle class, who can’t afford the services but don’t really qualify for Medicaid, in the lurch, Shelton writes.
Most people assume Medicare will pay the bills, but the program covers long-term care only under certain conditions and for a limited time. While Medicaid covers long-term care, beneficiaries have to be poor or willing to “spend down” their assets to be eligible. Private insurance can be expensive and excludes applicants with serious medical problems.
As a result, many families pay out of pocket until they exhaust their resources and then turn to Medicaid.
The Affordable Care Act attempted to fill in the blanks, but long-term care provisions of that reform plan withered under intense cost pressure.
An initiative that would have incorporated long-term care into the Obama administration’s health reform plan was scrapped in October after actuaries determined that it would not be financially self-sustainable over the long haul. The Community Living Assistance Services and Supports Act would have created a voluntary, self-funded, employer-based insurance option to help people save for long-term care.
Related
Baby’s death illustrates how health IT can introduce complexity, error to system
Filed under: Health care reform, Hospitals, Hot Health Headline, Pharmaceuticals
Chicago Tribune reporters Judith Graham and Cynthia Dizikes explore the pitfalls of health information technology through the story of an infant boy who survived despite being born months early and weighing just 1.5 pounds, only to be killed by a sodium chloride overdose when a pharmacy tech entered information into the wrong field of his electronic medical record.
Photo by Christiana Care via Flickr
The tech’s fatal clerical error was compounded by disabled alarms on a compounding machine, incorrect labeling on an IV bag and an ignored lab test. The heart of the errors, the reporters write, seems to be that all the different systems involved don’t communicate.
Almost all medication requests at Advocate are transmitted by a doctor’s keystroke to the hospital pharmacy’s drug-dispensing system. But in this case, there was no electronic connection with the automated compounding system that prepared the IV bag for baby Burkett, a specialized device that handles low-volume, highly individualized orders.
So a technician transcribed the order by hand, and an error was introduced.
Electronic communication gaps are common at large hospitals, which typically use upward of 50 to 100 different information systems at their facilities, with different technologies used in emergency rooms, labs, pharmacies and other medical departments, said Ross Koppel, a sociologist at the University of Pennsylvania who studies health information technologies.
“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Koppel said. With each jury-rigged software solution comes the potential for new software bugs, transcription errors and other problems.
Winning work: Swine flu, costs and mental health
In the SPJ’s 2010 Sunshine State Awards, AHCJ members made their presence felt in the “Medical/Health Care/Science Reporting” category, where they snagged two of the three spots.
The Miami Herald; John Dorschner; Healthcare costs
“Thanks to Dorschner’s detail-oriented reporting, readers of The Miami Herald learned just how much a 45-hour hospital stay for thyroid treatment might cost. Dorschner did not stop there either, confronting the hospital with the charges and asking them to justify the expenses – which they declined to do.”
The Palm Beach Post; Stacey Singer; Swine flu
“So many stories were written about swine flu in 2009 but few of them provided the human details and intimate touches of Stacey Singer’s reports. She introduces us to the people who were deeply affected by the flu, especially the expectant mothers and their children who were most vulnerable to it. She tells their stories with vivid, insightful details.”
In Mental Health America’s Awards for Excellence in Coverage, Portrayals of Mental Health Issues David Jackson pulled in the investigative reporting award for the Compromised Care series he did with Gary Marx. Read The Chicago Tribune’s full package here. AHCJ members can read an article about how they reported the story.
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.
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
