Military slow to treat mild traumatic brain injury
Filed under: Government, Health journalism, Hot Health Headline
ProPublica’s T. Christian Miller and NPR’s Daniel Zwerdling have found unpublished military documents which indicate that tens of thousands of soliders who suffer from mild traumatic brain injury have gone undiagnosed.
Photo by isafmedia via FlickrThese are in addition to the 115,000 soldiers known to suffer from such injuries, many of which are inflicted by shock waves caused by roadside bombs. They write that the lack of concern shown by top brass for mild traumatic brain injuries was “a reflection of ambivalence about these wounds at the highest levels.”
“It’s obvious that we are significantly underestimating and underreporting the true burden of traumatic brain injury,” said Maj. Remington Nevin, an Army epidemiologist who served in Afghanistan and has worked to improve documentation of TBIs and other brain injuries. “This is an issue which is causing real harm. And the senior levels of leadership that should be responsible for this issue either don’t care, can’t understand the problem due to lack of experience, or are so disengaged that they haven’t fixed it.”
After a thorough review, one not helped by a top medical official’s early attempts to prevent local medical commanders from responding to the reporters, the duo distilled their findings into three bullet points:
- From the battlefield to the home front, the military’s doctors and screening systems routinely miss brain trauma in soldiers. One of its tests fails to catch as many as 40 percent of concussions, a recent unpublished study concluded. A second exam, on which the Pentagon has spent millions, yields results that top medical officials call about as reliable as a coin flip.
- Even when military doctors diagnose head injuries, that information often doesn’t make it into soldiers’ permanent medical files. Handheld medical devices designed to transmit data have failed in the austere terrain of the war zones. Paper records from Iraq and Afghanistan have been lost, burned or abandoned in warehouses, officials say, when no one knew where to ship them.
- Without diagnosis and official documentation, soldiers with head wounds have had to battle for appropriate treatment. Some received psychotropic drugs instead of rehabilitative therapy that could help retrain their brains. Others say they have received no treatment at all, or have been branded as malingerers.
Read the full investigation at ProPublica or NPR. It’s some of the deepest work on the subject we’ve seen thus far, and includes incredible quotes such as “What’s the harm in missing the diagnosis of mTBI?” as well as graphics and an explanation of why the numbers are so fuzzy.
Medical groups voluntarily tighten ethics rules
Filed under: Health data, Health journalism, Hot Health Headline
Writing for NPR’s health blog, Maggie Mertens reports that while recently passed reform legislation includes the “Physician Payments Sunshine Act” (PDF) that will require companies to report any payments or gifts to physicians over $10 in value starting in 2012 (and reported and made available in a public database in 2013), some groups are getting a jump on the rules and voluntarily tightening their own conflict of interest policies.
Take, for instance, the recent decision by a bunch of medical specialty groups to stop taking industry money when coming up with guidelines for treatment. The Council of Medical Specialty Sciences, representing groups like the American College of Physicians, the American College of Cardiology and the American Society of Clinical Oncology, unveiled new rules on conflicts of interest last week. Thirteen of the member groups have adopted them so far, with the others saying they aren’t far behind. The rules also require that all funding from pharmaceutical and device-making companies to board members or groups will be publicly disclosed. Swag at medical conferences becomes a no-no, although big drugmakers had said a few years back they were going to stop the giveaways of medicine-branded pens, logoed tote bags and that sort of thing anyway.
For a discussion of the challenges reporters face when investigating conflicts of interest, read Elizabeth Bahm’s AHCJ article about a related panel at the recent Health Journalism 2010 conference, and this related article by John Fauber.
Hensley explores HIT-related privacy breaches
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Studies
NPR health blogger Scott Hensley writes that the HHS’ running list of “breaches of unsecured protected health information affecting 500 or more individuals” reads like a sort of police blotter for health wonks, and explores a few of the more interesting cases.
Related: FDA committee recommends anonymous HIT error database
As expected, the FDA’s Health IT Policy Committee endorsed a database to confidentially record reports of HIT-related errors. A few months, another committee and the Office of the National Coordinator still sit between the recommendations and action.
Little recent progress on foodborne illnesses
The CDC’s Morbidity and Mortality Weekly Report contains some early numbers on foodborne illness rates in 2009. The data, NPR health blogger Scott Hensley writes, aren’t promising, and it looks like most infection rates haven’t really improved since 2004. A transcript and audio of the April 15 media briefing is available.
The report comes with data for the 10 states monitored by the CDC’s Foodborne Diseases Active Surveillance Network; they’re also broken down by age. To demonstrate just how variable the infection rate is, we’ve pulled numbers for two of the most common foodborne illnesses, salmonella and campylobacter.
AHCJ resources
Tip Sheets
- Lifting the shroud: Using multiple-cause-of-death data (03/17/07)
- Melamine: A primer on the contamination of food (09/25/08)
Article
- Fatal Food: A study of illness outbreaks (02/19/07)
Web sites
AHCJ Award winners
- A Body’s Burden: Our Chemical Legacy (03/01/06)
- Border Health Series (03/01/06)
Health News
- Loophole allows E. coli-tainted meat to be sold (11/15/07)
- Meat, dairy products transported in unsafe temperatures, overlooked by inspectors (11/15/07)
- Airlines delay testing of onboard water (02/20/08)
- Salmonella outbreak: A selection of recent stories (06/24/08)
- N.Y. school districts not meeting federal guidelines on cafeteria inspections (09/26/08)
- Private companies, not the FDA, increasingly perform food safety inspections (09/26/08)
Fluportal.org: Postmortem of a temporary resource
Fluportal.org, a Corporation for Public Broadcasting-funded site built to help public media cover H1N1 and related issues, has completed its grant and will stop updating at the end of this month.
As a fitting capstone to a very well-executed and valuable resource, the staff has posted an exhaustive, honest review of what the site did, where things went right and where they went wrong. It’s a lengthy read, but one that gives insight into how best to organize and execute a health-related, issue-oriented Web resource.
Other resources on the site look into health reporting and how to communicate information about H1N1 to the public:
- Was H1N1 Info Communicated Well to the Public?
- How WBUR’s Sacha Pfeiffer Reports on H1N1
- Can Health Reporting Weather the Economic Storm
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.”
Transmitter tracks health-care workers’ washing
Despite constant reminders and a high-level of industrywide awareness, studies indicate that less than half of American health care workers wash their hands as frequently as they ought to. This contributes to the health-care-associated infections that kill tens of thousands annually. Now, NPR’s Gigi Douban reports, one Alabama hospital has resorted to high-tech monitoring devices to keep tabs on the handwashing practices of its employees.
Workers wear a special wireless transmitter, from which, Douban writes, “the hospital can tell when she entered a patient’s room, whether she washed her hands and whether she washed again on the way out. The information is sent to hospital officials, including the CEO.”
“If they’re habitually not complying, we can send them an e-mail or send them a text message, something that goes to them personally,” says Harvey Nix, CEO of Proventix, the company that developed the monitoring system at Baptist Princeton.
According to Douban, the CDC is currently investigating the effects of the technology upon the behavior of health workers.
More vets come home as result of psychiatric issues
On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.
The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.
American paratroopers in Afghanistan. Photo by U.S. Army Spc. William E. Henry via Flickr… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”
“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”
Related AHCJ articles
Interviewing ‘profoundly affected’ soldiers
Tips for interviewing service members returning from Iraq, the Middle East or Afghanistan
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.
Fluportal.org stays on top of H1N1
While H1N1 seems to have peaked in many states – at least for now – Fluportal.org’s resources to cover the pandemic are still growing. Recent highlights include tips for using American Public Media’s Public Insight Network (which we’ve mentioned before in conjunction with a ProPublica story on health care reform), a few interesting photos with creative commons licenses (like a collection of H1N1 street art).
One of the creative commons licensed shots of H1N1 street art spotlighted by fluportal.org. Photo by Brazilian artist guitavares via Flickr.
Fluportal also has tackled some media ethics issues related to the outbreak, notably in a post where staff from PRI’s The World had to consider how to frame the German medical establishment’s reluctance to recommend the H1N1 vaccine. After all, they did not want to confuse listeners or have a negative impact on public health, but they also weren’t going to “censor” the sincere opinions of German doctors, even if they conflicted with CDC advice.
Related
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- 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
