Carlat reviews Dollars for Docs, and the bleak picture it paints
Filed under: Conflicts of interest, Health data, Health journalism, Public records, Tools
Writing on KevinMD.com, psychiatrist and blogger Daniel Carlat reviews ProPublica’s Dollars for Docs database from the perspective of a medical professional, one who has taken a firm stand against drug company money and the conflicts of interest it brings. Carlat’s real focus is not the Dollars for Docs project, but rather the data available from drug companies. He does point out some limitations inherent in the data ProPublica is working with. And he writes about a slightly inverted use of the data, one which caused him to ask “How have we allowed this to happen to our once proud profession?”
There’s another way to use the Dollars for Docs database, although this is not spelled out on the website. If you want to browse for all the doctors in your city or state who are “on the take,” simply leave the “name” field blank, choose a state from the drop down menu, and click search. You’ll get a huge spreadsheet which is arranged alphabetically by last names of the doctors. By clicking on the various columns, you can sort the data by city, drug company, amount of money, or time period of the payments. This is a nice feature that is absent from most of the drug company databases.
Carlat’s data trick is a simple one, and one which local reporters should take a minute to replicate if they haven’t already. After reviewing the mountain of local data revealed by his sorting and the vast armies of conflicted doctors it implies, Carlat reminds us of the power of pharma money then drives home the sheer magnitude of the issue.
The true malfeasance here is in the aggregated effect. The companies are using these legions of doctors to artificially manipulate medical discourse. Any doctor who participates in the enterprise knows exactly how they are being used. You decide whether this is “immoral” or not.
How South Africa rations dialysis
ProPublica’s Sheri Fink, M.D., went to South Africa, where panels in hospitals still decide which patients deserve the scarce dialysis treatments and which must be left with failing, untreated kidneys. Fink was in the room as the assembled physicians gave the final approval or denial, and when they expressed their bitterness that hospital executives required folks on the medical side to make what were, essentially, cost-control decisions. The costs, after all, are not negligible.
In South Africa, only the roughly one out of five patients who have a form of health insurance or the small proportion of patients who can afford pay are able to get dialysis at private clinics or hospitals based on medical need alone. The cost of paying out of pocket—about $20,000 per year— is nearly double the gross domestic product per capita.
…
Probably in the middle of the last decade we were turning away 50 percent of the patients,” said Dr. Rafique Moosa, a kidney specialist at Tygerberg Hospital and head of the Department of Medicine at the University of Stellenbosch. According to him, as of August they were turning away 80 percent, and in November, only two out of 20 patients were accepted. “We just don’t have the resources to deal with the patients,” Moosa said..
Until relatively recently, there weren’t any formal guidelines for rationing dialysis care, an omission which opened the door for broad racial disparities.
The new general guidelines were drawn up by medical ethicists and emphasize medical criteria, which Fink reports on. It’s a carefully chosen set of criteria, but the enormity of the medical shortage gets in the way of neat formulae like those, Fink writes.
The problem is, few actually are able to get transplants. There are far more good medical candidates than there are dialysis slots. Therefore, the committee falls back on subjective criteria—does the patient seem motivated? Does he or she have a good social support network?
ProPublica releases ratings of 5,000 dialysis providers
On the heels of a successful FOIA request related to Robin Fields’ dialysis investigation, ProPublica has published a database evaluating dialysis clinics on 15 different measures. The information has been available to state health agencies for years, but this is the first time it’s been released for general public consumption, Fields writes.
Patients have long chosen dialysis clinics based only on location or physician recommendation, even though the data shows a wide variation in quality among the 5,000-plus such facilities nationwide.
In more than 200 counties nationwide, the data show, the gap between facilities with the best and worst patient survival, adjusted for case-mix differences, is greater than 50 percent. In areas such as Allegheny County, Pa., or Franklin County, Ohio, each with upwards of two dozen clinics, the differences are even more substantial, exceeding 200 percent.
There is also wide variability in how often patients at different clinics are hospitalized for septicemia. Although septicemia cases can be unrelated to dialysis, it is a significant risk for patients, who typically have their blood cleaned of toxins three times a week. Nationally, the rate was about 12 percent a year for 2006 to 2008. But in dozens of counties, the spread between facilities with the highest and lowest rates was more than 25 percentage points.
Like Dollars for Docs, this new database should provide plenty of ready localizations of of the story.
ProPublica finds academic physicians violating schools’ conflict rules
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Pharmaceuticals, Public records, Tools
While journalists have been finding innovative ways to use ProPublica’s Dollars for Docs database, the database’s founders, Tracy Weber and AHCJ President Charles Ornstein remain ahead of the curve when it comes to using the freely available data for fresh stories.
This time around, the duo looked for medical schools with strict conflict-of-interest policies and ran their faculty lists through the database. They found dozens of matches, even at elite research institutions. It’s an idea so effective that it’s a wonder nobody thought of it sooner – and apparently the institutions involved feel the same way.
“For God’s sake, if the media can look at these websites, why can’t we?” said David Rothman, president of the Institute on Medicine as a Profession at Columbia University. “Why trust if you can verify?”
Stanford, the University of Pennsylvania, the University of Colorado Denver and the University of Pittsburgh drew particularly heavy attention. (On the other side of the coin, UMass Memorial Health Care was singled out as an example of a robust conflict policy.)
Pizzo, Stanford’s dean, said physicians who appear to have violated the policy will be investigated and referred for discipline if necessary. He compared some of their explanations to what a cop might hear after catching a motorist running a late-night stop sign.
“You can give 1,000 reasons: There was nobody around. It’s safe. I looked and didn’t harm anyone,” he said. “The reality is, it’s still a stop sign.”
Watch the full episode. See more Nightly Business Report.
And this isn’t just a database story. Weber and Ornstein also found time for a review of various academic conflict of interest policies and point out how policies are weakened through inaction, loopholes and a reliance on self-policing.
N.Y. reporter finds local doctors in ProPublica database
Filed under: Conflicts of interest, Government, Health data, Pharmaceuticals, Public records
Writing for Gannett’s Binghamton, N.Y., Press & Sun-Bulletin, Julia Hunter localized ProPublica’s investigation of pharmaceutical companies and disciplined doctors by starting with the nonprofit’s database, then adding some investigation of her own. She names names, talks with local physicians and uncovers anecdotes.
There are plenty of tales of medical malfeasance, including that of Dr. Robert Douenias, who lied about a previous criminal conviction when applying for a New York medical license. Until recently, Douenias had spoken on behalf of Avodart to prevent prostate cancer. “He said he stopped because he didn’t want to be associated with the controversial practice of speaking on behalf of pharmaceutical companies.” The FDA has since “voted against the approval of Avodart as a cancer risk-reduction method.”
Hospital management says it wasn’t aware of the physician’s previous conviction, and that it wouldn’t be looking into it further. After all, Hunter writes, “99 percent of patient surveys indicated a ‘good’ or ‘excellent’ experience with Douenias.”
Prolific antipsychotic prescribers have industry ties
Filed under: Conflicts of interest, Health data, Hot Health Headline
California Watch’s Christina Jewett compares a list of that state’s top antipsychotic prescribers reimbursed by state Medicaid (obtained through Sen. Charles Grassley, R-Iowa) to ProPublica’s database of educational and speaking fees pharmaceutical companies have paid to doctors.
Not surprisingly, she finds matches. Of the top 10 prescribers, Jewett writes, “Three of them accepted $20,000 or more in educational or speaking fees from the company that makes the drug they prescribe to Medi-Cal patients.” Of those, the most remarkable are a duo who share an office near San Diego:
Samuel Etchie prescribed Seroquel more than 1,000 times in 2009 at a cost of $449,000 to the state, according to Medi-Cal records collected by the ProPublica news organization and provided to California Watch. The drug’s maker paid him $25,350 this year to speak to health professionals.
Etchie did not return two calls to his office.
John Allen, who shares an office with Etchie, was among the state’s top prescribers of Zyprexa, also an antipsychotic drug. Allen dispensed 418 prescriptions at a cost to the state of $346,569. This year and last, the drug’s maker, Eli Lilly and Co., paid him about $27,000 to educate other medical professionals.
The icing on the cake? A quote from Allen:
“I think it’s unfortunate that there’s an implication in articles that we’re robots for drug companies,” Allen said. “We have to have our own experience with medications and find out what works best. We’re not 5-year-olds in front of TV watching cereal and toy commercials.”
Dialysis program: Experiment in socialized medicine comes with high costs, risks
Filed under: Europe, Government, Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Pharmaceuticals, Public health, Public records, Tools
ProPublica’s Robin Fields has put together an artful examination of the nation’s Medicare-funded dialysis system. Part history and part investigation, it explains how this massive anomaly of government-run medicine came to be, and how it demonstrates the promise and peril of so-called socialized medicine.
The reporting has had an immediate impact, both upon the dialysis industry (read leaked plans for their response here) and upon the federal government. For health journalists, the federal response is particularly interesting, as it involves the disclosure of previously hidden data, and a classic government excuse.
ProPublica first asked CMS for the clinic-specific outcome data it collects — at taxpayer expense — two years ago under the Freedom of Information Act. The agency declined to say whether it would release the material until last week, as this story neared publication. It subsequently has provided reports for all clinics for 2002 to 2010. ProPublica is reviewing the data and plans to make it available for patients, researchers and the general public.
The reasons CMS has given for withholding the information until now is that some measures are disputed or lack refinement. Regulators and providers can put the data in perspective, officials had said, but patients might misinterpret the information or see it as more than they really want to know.
As befits something destined for publication in The Atlantic, Field’s piece might take more than one sitting to fully digest. And, if you haven’t yet had that second sitting, you’ll have missed some particularly nifty bits of comparative journalism, particularly where Fields compares the U.S. system to that in Italy, where the costs are significantly less and patients “got half the average dose of Epogen given to U.S. patients, perhaps because there’s no profit incentive to give them more.”
In Italy, about one in nine dialysis patients die each year. In the United States, that number is one in five. In dialysis treatment, there’s a trade-off between speed, cost and outcomes. And even high-rated Italy has had to make a few sacrifices, as evidence by comments from an Italian doctor:
“The decision to make dialysis faster wasn’t a scientific decision, it was a managerial decision,” he says. “It’s to allow you to do four shifts a day and make money.” He schedules just two shifts a day to accommodate longer treatment times.
Fields ends the piece on a high note. There’s hope for future efficiency in the dialysis system, thanks to a new program of bundled payments that will supplant the current system in which clinics see the actual dialysis as a “loss leader” and profit instead from heavy use of well-reimbursed drugs.
ProPublica promises more stories about this throughout the week, so be sure to check back its site for developments. Fields discussed dialysis on NPR today, as did Dr. Barry Straube, the chief medical officer at CMS.
ProPublica investigates pharma payments to doctors
Filed under: Conflicts of interest, Health care reform, Health data, Health journalism, Hot Health Headline, Pharmaceuticals, Public records, Tools
ProPublica’s massive investigation into the hefty fees pharmaceutical companies have paid doctors with dubious track records stamps an exclamation point on what has been a banner year for high-profile assaults on pharma-paid physician/marketers.
Books like Daniel Carlat’s Unhinged and Carl Elliot’s White Coat, Black Hat, and the promotional tours that came with them, led the charge and raised awareness of an issue that reporters Charles Ornstein (you may know him as AHCJ’s president), Tracy Weber and Dan Nguyen have driven home with tens of thousands of carefully researched data points and one flagship story.
The ProPublica database is built upon the voluntary disclosures of seven drug manufacturers (Eli Lilly, Cephalon, AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co. and Pfizer) which represent about 36 percent of the market. Reform law requires the other manufacturers to make similar disclosures by 2013. The package uncovered a bucket of horror stories — that mug shot of high-earner Dr. Donald Ray Taylor next to the paragraph describing why he was disciplined is the very definition of “disturbing” — yet also distinguished itself by giving doctors who rep pharma the opportunity to explain both their work and their motivation.
In its examination of pharma payments, the investigation goes beyond a simple database match with disciplinary records. Some physician/marketers had clearly earned their stripes and displayed impressive resumes and relevant research records, the reporters found, but others had disciplinary records, lacked any board certification or publications or appeared to have been manufactured by the drug-makers themselves.
“It’s sort of like American Idol,” said sociologist Susan Chimonas, who studies doctor-pharma relationships at the Institute on Medicine as a Profession in New York City.
“Nobody will have necessarily heard of you before — but after you’ve been around the country speaking 100 times a year, people will begin to know your name and think, ‘This guy is important.’ It creates an opinion leader who wasn’t necessarily an expert before.”
If you can’t get enough of the investigation, see the work by ProPublica’s partners at The Boston Globe, Consumer Reports, the Chicago Tribune, Nightly Business Report and NPR.
Finally, don’t miss the comments on the article, headlined by a lengthy response from the leading pharmaceutical industry group.
CMS failed to report disciplined providers
Filed under: Government, Health data, Hot Health Headline
ProPublica’s Marian Wang reports that the Centers for Medicare & Medicaid Services “essentially undermined” HHS efforts to create a national database of disciplined health care providers by failing to report disciplinary actions. The news comes from a report by the HHS Office of Inspector General (23-page PDF).
According to Wang, the investigation “found that CMS, which oversees health care programs serving about 45 million Medicare beneficiaries and 59 million Medicaid beneficiaries, took disciplinary action against numerous bad medical providers but did not report those actions to the Healthcare Integrity and Protection Data Bank.” As anyone who’s been following ProPublica’s award-winning “When Caregivers Harm” series knows, the database is chronically deficient, and – despite federal requirements – CMS isn’t helping.
CMS is required by law to report the following types of disciplinary action to the database: revocations and suspensions of laboratory certifications; terminations of providers from participation in Medicare; civil monetary penalties against all types of providers, managed care plans, and prescription drug plans.
Some of the data that should’ve been reported includes 148 sanctions imposed against laboratories in 2007 and 30 sanctions taken against managed care and prescription drug plans between January 2006 and July 31, 2009. From 2004 to 2008, the agency banned 45 nursing homes from participating in Medicare, and those actions were not reported until fall 2009, long after the required reporting timeframe, the inspector general’s office said.
According to officials, it was all just a big misunderstanding.
Sapien wins award for natural gas impact coverage
An investigation into the environmental impact of natural gas drilling, conducted by AHCJ member Joaquin Sapien and his ProPublica colleagues Abrahm Lustgarten and Sabrina Shankman, earned a second place, print, Kevin Carmody Award for Outstanding Investigative Reporting in the Society of Environmental Journalists’ Awards for Reporting on the Environment.
Photo by arimoore via Flickr
In its announcement of the award, SEJ cited four particular entries in the extensive series (64 parts!), including Sapien’s “With Natural Gas Drilling Boom, Pennsylvania Faces an Onslaught of Wastewater.”
This exhaustive ProPublica series into the environmental impact of natural gas drilling on water resources raised public awareness of an important, but largely overlooked, environmental issue and helped to spur politicians to action. The methodical and well-written stories were easily understandable, neatly melding the human experience with the investigative paper chase. Importantly, the series exposed not just problems, but also pointed to solutions.
-
Join us in Omaha to find untold rural health stories
New at HealthJournalism.org
- AHCJ offers financial data about nonprofit hospitals
- Diversity in aging: Putting gray in the rainbow
- Southeast journalists eligible for regional fellowship program
- AHCJ-NLM Health Journalism Fellowship offers hands-on medical research training
- AHCJ announces 2011 winners of top health journalism awards
