How numbers can be used to buttress falsehoods
On The New York Times‘ Well blog, Tara Parker-Pope interviewed NYU journalism professor Charles Seife, author of Proofiness: The Dark Arts of Mathematical Deception. While the book’s not exclusively focused on health care, the interview does touch upon numbers and health journalism.
Once you get past all the goofy catchphrases (proofiness! randumbness!), the basic point Siefe makes in the interview, that correlation is not causation, shouldn’t surprise anyone. Nevertheless, I enjoyed his elegant, health-related illustration of the phenomenon:
We are extraordinary pattern-matchers. Anytime there is something that is happening, we try to find a cause. But sometimes in medicine, sometimes things are absolutely random. Our minds don’t accept that. We must find a cause for every effect.
A really good example is the autism issue. Whenever a parent has a child who ends up being autistic, the parent more than likely says, “What caused it? How did it happen? Is there anything I could have done differently?” This is part of the reason why people have been so down on the M.M.R. vaccine, because that seems like a proximate cause. It’s something that usually happened shortly before the autism symptoms appeared. So our minds immediately leap to the fact that the vaccine causes autism, when in fact the evidence is strong that there is no link between the M.M.R. vaccine or any other vaccines and autism.
One caveat: Covering Health is not in the book review business, and I haven’t yet read Proofiness beyond what’s been excerpted.
Assessing acute care in America
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
The New York Times‘ Kevin Sack reports on a Health Affairs study that explores “acute medical care,” particularly initial visits for the fever and cough type of stuff that would traditionally go to a primary care physician. While 42 percent of such visits were still handled by a patient’s personal physician, a full 28 percent took place in emergency rooms. According to Sack, that number includes almost all visits made outside of typical office hours, as well as most visits made by patients without insurance.
More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.
Reform provisions such as medical homes, accountable care organizations and more money for primary care seek to rebalance acute care delivery in the United States, but Sack reports that the study’s authors fear it won’t be enough.
The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”
Remember, free access to Health Affairs is one of many perks enjoyed by AHCJ members.
NFL to post concussion warning in locker rooms
In The New York Times, football concussion reporter Alan Schwarz examines the content and ramifications of a new warning poster the NFL will be putting in every locker room. An image of the poster can be seen here.
Photo by Eagle102.net via Flickr
The poster lists symptoms that players should look out for, including headaches, confusion, memory problems and feeling more emotional, and warns them not to ignore symptoms.
In addition to strictly medical information — including the most starkly worded warnings yet from the league — the poster reminds players that concussions can also have long-term negative impacts on their families and on the health of those youngsters who idolize pro athletes.
Greg Aiello, a league spokesman, said in an e-mail message that the poster, spearheaded by the league’s new head, neck and spine medical committee and written in collaboration with the players union and the Centers for Disease Control and Prevention, “is intended to present the most current and objective medical information on concussions and will be distributed to the players and clubs in the near future.”
Calif. dental care crisis could get worse
Filed under: Health data, Health journalism, Hot Health Headline, oral health
Laurie Udesky, writing for The New York Times, has found that that pediatric dental care in the state has reached rock bottom, especially for children from low-income families. Unfortunately, in California, it’s starting to look like there may be a floor even lower than rock bottom. Udesky writes: “If Gov. Arnold Schwarzenegger’s recent proposed cuts remain — amounting to a $16.5 million reduction to Healthy Families and a $523 million reduction to Medi-Cal —more cases of untreated dental-related illnesses are likely.”
California children’s dental health was ranked third from the bottom in the National Survey of Children’s Health, above only Arizona and Texas. In the Bay Area, children and teenagers up to the age of 17 made nearly 1,980 visits to emergency rooms for preventable dental conditions in 2007. The cost of these visits averaged $172, but if a problem required hospitalization it cost an average of $5,000.
Today, experts interviewed said the dental care crisis had reached an even more alarming level. “We can only go up from here,” said Dr. Jared I. Fine, the dental health administrator at Alameda County Public Health Department. “We have an epidemic of dental disease in children that’s absurdly pervasive.”
For more on children’s dental health, check out The Cost of Delay (PDF), a report the Pew Center on the States released earlier this year. It seeks to answer the questions “What can states do to ensure better dental care?” and “How many states are doing those things right now?” and includes a strong body of statistics and analysis within its 74 pages.
The National Survey of Children’s Health, last fully updated in 2007, is still a comprehensive source for national data on pediatric dental health. There are data fields for overall dental health, as well as for specific oral health issues in children. For an overview of the data, I just pulled the overall health numbers and mapped a subset of them.
Residents not warned of nursing home foreclosures
Writing for The New York Times, Laurie Udesky reports that despite significant rates of foreclosures, California nursing homes are not required to notify residents – many of whom require constant care – that they’re being shuttered. She even found at least one home in which residents were caught by surprise when deputies showed up to force an eviction. Udesky also added a companion piece on the NYT’s Bay Area blog. Foreclosures, she found, are not uncommon among smaller nursing homes.
But a New York Times analysis of licensing and foreclosure data indicated that about 16 percent of the 1,600 Bay Area properties licensed as small residential-care homes has been in some stage of foreclosure since June 2006. According to RealtyTrac, a company that compiles foreclosure records, that includes more than 100 homes under foreclosure in the last six months.
It is impossible to tell from the data how many of these were operating as residential-care homes during the foreclosure proceedings or thereafter. But those properties housed as many as 700 elderly residents.
Fortunately, some in the state are working to close what Udesky referred to as a “loophole,” with a California senator introducing a bill that would “require people licensed to run such facilities to notify the licensing division of the Department of Social Services and the residents or their legal representative within 24 hours of notification of foreclosure, bankruptcy, missing a mortgage payment or the prospect of a utility cutoff.”
Deconstructing a NYT op-ed in three acts
On April 17, New York Times‘ op-ed columnist Thomas Friedman wrote a column about globalization, international competition and entrepreneurship. Here, as anyone who has even held a newspaper with his column in it will know, he’s on all too familiar territory. It’s not until he steps over into uncritical praise of a medical device maker that Friedman starts stepping on land mines.
He profiles EndoStim, a company working on an implant to treat acid reflux. Friedman admits that he has “no idea if the product will succeed in the marketplace,” then the cheerleading begins.
EndoStim was inspired by Cuban and Indian immigrants to America and funded by St. Louis venture capitalists. Its prototype is being manufactured in Uruguay, with the help of Israeli engineers and constant feedback from doctors in India and Chile. Oh, and the C.E.O. is a South African, who was educated at the Sorbonne, but lives in Missouri and California, and his head office is basically a BlackBerry. While rescuing General Motors will save some old jobs, only by spawning thousands of EndoStims — thousands — will we generate the kind of good new jobs to keep raising our standard of living.
Journalist Merrill Goozner, of GoozNews fame, picked up on the story the next day and asked the world “Why Is Tom Friedman Championing Higher Health Care Costs?” Goozner effortlessly chronicles the marketing-driven history of acid reflux treatments, from Pepto-Bismol to Zantac to Prilosec to Nexium, each conveniently emerging as the patent to their predecessor expired, then puts EndoStim in its place at the end of the chain.
… instead of finally being out from beneath the wasted billions now being spent on brand name acid indigestion pills like Nexium, the health care system will be lined up to move onto the next chapter in the lengthening medical text for treating what for most people is a relatively minor and passing phenomenon.
In his final paragraph, Goozner gets to the heart of what Friedman’s vision of “thousands of EndoStims” really means for the U.S. economy.
Friedman is right. Endostim’s success will create “the best jobs - top management, marketing, design” at company headquarters. But let’s not forget that to create those jobs, the entire society through its collective health care system will have to pay an unnecessary tax, which burdens every other industry and shifts scarce societal resources away from potentially more useful activities.
Finally, Trudy Lieberman, AHCJ immediate past president, catches Goozner’s post and wades into the fray in her own column on cjr.org, writing that Friedman’s column was “essentially a puff piece for EndoStim.” Lieberman ties Goozner’s observations on EndoStim into his previous writings as well as her own, writing “there’s nothing in the new law that limits the use of the device only to patients with chronic disease who don’t respond to other, less costly treatments.”
I can see hospitals advertising: “Hey acid reflux sufferers come to us. Our surgeons know how to get that thing down your gut. They are the best in the world, and by the way, insurance will pay.”
Reinhardt called out for conflicts of interest
Filed under: Conflicts of interest, Health journalism, Hospitals, Hot Health Headline, Public records
Bloggers and online journalists (Health Care Renewal, the nytpicker, Business Insider) have noticed that Princeton health economist Uwe Reinhardt, who writes for The New York Times‘ Economix blog and was the keynote speaker at Health Journalism 2009, earns $500,000 a year working for a number of health care companies, owns about $5 million in related stock, and thus appears to be in violation of The New York Times‘ conflict-of-interest policy. The conflicts are not yet listed on his Times bio, though the newspaper and Reinhardt both promise they will be soon.
Uwe Reinhardt at Health Journalism 2009
Business Insider’s Lauren Hatch got Reinhardt’s response. The economist said he has never “shilled” for a company, and that his connections enhance, rather than skew, his blogging. He does, however, acknowledge the apparent conflict of interest.
“I guess I have to take the rap for this, but I don’t see it as an ethical lapse,” (Reinhardt) told (Business Insider) in a phone interview. “It never occurred to me. My board memberships are public knowledge.”
…
“When all is said and done, they pointed it out and that’s good. I had no intent to be unethical or deceitful. I have talked to the New York Times and soon my board memberships will be added to the bio so everyone can see it.”
As of 3 p.m. Eastern on April 8, those conflicts have not yet been disclosed on his bio. The Business Insider story was posted on April 6.
The New York Times, for its part, provided Business Insider with the following statement:
“Professor Reinhardt is a leading expert on the economics of health care, and has provided valuable and independent insights in his blog posts. He has mentioned his service on corporate boards in the blog, but we are reviewing how to more fully describe his activities for readers of Economix.”
According to nytpicker, which seems to have come to the story first, Reinhardt is involved with at least five private health-related enterprises, for which he is being compensated with both cash and stock options. Those include Amerigroup Corporation, Boston Scientific, H&Q Healthcare Investors and H&Q Life Sciences Investors, and Legacy Hospital partners.
Health care reporting among SABEW winners
Health care reporting fared well in this year’s Society of American Business Editors and Writers Best in Business Writing competition as the business of health care took center stage in many publications and earned awards for both breaking news and in-depth packages. The health-related winners:
Breaking news
Real-time News Organizations
- Dow Jones Newswires: “Deep Coverage On Drug Deal”
- Reuters: “H1N1 Flu: The Global Story”
Enterprise
Small Publications
- Sarasota Herald-Tribune: “Contaminated Chinese drywall”
Weekly Publications
- Pittsburgh Business Times: “Eli Lilly details payments to docs”
Projects
Giant Publications
- The New York Times: “Toxic Waters”
Large Publications
- Dallas Morning News: “The Cost of Care”
Magazine Enterprise
Small
- Bloomberg Markets: “Big Pharma’s Crime Spree”
Comments invited on latest draft of DSM
A new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has come out every decade or so (it varies widely) since 1952. 
It hasn’t substantially changed since 1994, but the next revision is slated to come out in 2013. It’s a pretty big event, as the book’s diagnostic criteria are used around the world to determine who is diagnosed with mental disorders.
With the release of the new version, lines may shift and folks who were diagnosed with mental disorders may find themselves “undiagnosed.” Others will have labels changed and gain labels they didn’t have before.
The latest draft proposal of the May 2013 revisions, upon which public comment will be accepted until April 20, 2010, was posted on Feb. 9. APA workgroups will review the comments and begin trials soon after. Benedict Carey rounded up and evaluated some of the biggest proposed changes for The New York Times. In addition to bipolar disorders in children and autism spectrum disorders, Carey discusses the sheer significance of the changes.
“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.
“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”
Radiation oncologists request more regulation
The New York Times’ Walt Bogdanich reviewed the American Society for Radiation Oncology’s new six-point plan, most of which seem to be a response to Bogdanich’s series (Part 1 | Part 2) on serious radiation errors. As a whole, Bogdanich writes, the plan seems to signal a push for more standardized, consistent and universal regulation of radiation treatment in the United States.
The group’s six-part plan includes creating a database of errors, enhancing accreditation programs, improving training, working with patient support organizations to help patients and caregivers better communicate with their radiation oncologist, further development of a compliance program for technologies from different manufacturers and providing expertise and support to policymakers to pass an act requiring national standards.
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