NYT reporters tease hip replacement numbers from difficult data
Filed under: Government, Health data, Health journalism, Hot Health Headline, Public records, Studies
Writing for The New York Times, Barry Meier and Janet Roberts analyzed a particularly tricky batch of federal reports detailing a variety of complaints with popular metal-on-metal hip replacements. They found that, since January, the FDA has received more complaints (5,000-plus) about the devices than it did, total, from 2007 to 2010.
Photo by Michael Simmons via FlickrWhile processing the data, the paper’s staff did their best to parse duplicate reports, international filings and other inconsistencies, but the reporters make it clear that the numbers are still best viewed in general terms. Even so, they demonstrate that the surge in complaints and lawsuits involving metal-on-metal hips — and the resulting mass defection of doctors who once implanted them — signals a broad shift in hip replacement surgery, one of the most common such procedures in the country. It also signals another blow for device manufacturers and patients, and a related windfall for the legal profession.
The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.
The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.
…
As problems and questions grow, most surgeons are abandoning the all-metal hips, saying they are unwilling to expose new patients to potential dangers when safer alternatives — mainly replacements that combine metal and plastic components — are available. Some researchers also fear that many all-metal hips suffer from a generic flaw. Current use of all metal devices has plummeted to about 5 percent of the market, though a few of the models are performing relatively well in select patients.
Initiatives not improving patient safety; poor implementation to blame
Filed under: Health data, Hot Health Headline, Studies
A large-scale study that followed mistakes in health care delivery at 10 North Carolina hospitals from 2002 to 2007 found that, despite state efforts, there was no improvement in patient safety over the time period. According to The New York Times‘ Denise Grady, the problem lay primarily not in design, but in execution. Even when safeguards were in place, they were not followed.
The study, published in the New England Journal of Medicine, reviewed thousands of patient records and looked for any of 54 red flags that something had gone wrong.
Dr. [Christopher] Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.
But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.
The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.
Problems cited in the study include a lack of electronic medical records, doctors and nurses regularly working long hours and poor compliance with even simple interventions such as hand washing. Proposed solutions include computerized drug ordering systems and a mandatory nationwide monitoring system.
Community-led effort sparks public health wave
Filed under: Health policy, Hot Health Headline, Public health
Writing in The New York Times, Jessica Reaves writes about how a 2000-06 Chicago community survey embodies the block-by-block, community-reliant approach to public health that it helped inspire.
In the heavily Puerto Rican Humboldt Park neighborhood, researchers worked with community leaders to write study questions, then relied on community members to conduct the actual survey. From these roots, the level of community participation snowballed, and locals demonstrated an interest and investment in public health that researchers hasn’t seen before. Today, initiatives born out of that study still provide residents with access to fresh produce, free diabetes screenings, fitness classes and more.
Now, researchers are further localizing and intensifying their effort with a block-by-block approach. The Humboldt Park model has become one that others are working to replicate across the country.
The specifics of the Sinai approach (In Humboldt Park) — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.
“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.
This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.
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.
Foreign trial data used in 4/5 of approved drugs
Filed under: Health data, Health policy, Hot Health Headline, Pharmaceuticals
FairWarning’s Lea Yu and The New York Times‘ Gardiner Harris drew our attention to a report from the HHS Office of Inspector General which reviewed 2008 data and found that “Eighty percent of approved marketing applications for drugs and biologics contained data from foreign clinical trials.” Furthermore, the OIG found, “Over half of clinical trial subjects and sites were located outside the United States.”
The OIG expects the trend to grow in the future, writing that “Western Europe accounted for most foreign clinical trial subjects and sites; however, Central and South America had the highest average number of subjects per site.”
The FDA only inspected a minuscule percentage of these foreign test sites, but says it has taken the OIG’s advice and is stepping up efforts to put together agreements with its foreign counterparts and to figure out other methods to standardize and evaluate these foreign trials.
Calif. dental care crisis could get worse
Filed under: Health data, Health journalism, Hot Health Headline
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.
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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
