Journalist recounts the pressure of GSK clinical trial
Filed under: Health journalism, Hot Health Headline
In the wake of questions about GlaxoSmithKline’s Avandia clinic trials, the Austin American-Statesman’s Ana Cantú talks about her own experience in a different GSK clinical trial five years ago. Her column isn’t long, but she manages to capture the pharmaceutical giant’s desperation and the pressure put on participants. It helps that Cantú was, in some ways, a fulcrum for the study’s success.
I don’t want to spoil the story, but it all revolves around the requirement that seven of the 20 participants complete the study to garner sufficient data for submission to the FDA. After 13 participants dropped by the wayside, a sick and unhappy Cantú found herself on the bubble. She needed a medical authorization to drop out and still receive the $4,800 she was due for her participation, but the physicians in charge of the study were under immense pressure to keep her around and maintain that all-important quorum.
In the end, there’s a reason she refers to it as the “most miserable month of my life,” but at the time Cantú had only scratched the surface of the significance of her participation. Now, her reflections are revealing.
Rural Texas hospitals seek lifeline from state
The Texas Tribune’s Elizabeth Titus reports that rural hospitals in the scores of Texas counties without tax bases strong enough to support a full, modern facility are struggling to find a sustainable model. The latest effort is a push to allocate $50 million on the state level to renovate or replace as many as 42 rural hospitals.
The ultimate goal is to keep the hospitals in line with state and federal safety codes, which must be met in order to receive Medicare and Medicaid reimbursements. Urban lawmakers are skeptical, and there are questions as to whether the one-time fee would really help in the long term, as codes and technology are continually evolving. “For example, a state or federal mandate that all hospitals have sprinkler systems could bust their budgets,” Titus wrote.
For a stupendous primer on covering rural health issues, AHCJ members can check out presentations from Rural Health Journalism 2010. Washington University Professor Timothy D. McBride’s guide to understanding rural health disparities in context should be particularly useful to reporters looking for stories like Titus’.
Texas data shows origin of foreign-trained doctors
Filed under: Health data, Hot Health Headline, Public records
Emily Ramshaw and Matt Stiles of The Texas Tribune looked into where that state’s doctors were trained and who received fast-tracked medical licenses in exchange for treating government-subsidized patients.
They found that “Of the roughly 1,500 doctors who have received fast-tracked licenses in the last three years for agreeing to treat Medicaid and Medicare patients, about 40 percent were trained at international medical schools, while just a quarter were trained at Texas medical schools.”
The site then used the data, obtained from the Texas Medical Board, and Google Gadgets to create an interactive map showing where Texas doctors were educated.
Related
- Tip sheet: Foreign-born doctors exploited by U.S. physicians
- Indentured doctors, Las Vegas Sun
Express-News investigates Texas nursing homes
Filed under: Hospitals, Hot Health Headline, Public records
San Antonio Express-News reporters Karisa King, John Tedesco and Melissa Fletcher Stoeltje took advantage of a number of tools to assemble a broad investigation into the city’s nursing homes.
Slow action on nursing home problems
In the package’s centerpiece, the reporters plowed through 2,200 claims filed against the town’s 55 licensed nursing homes from 2006 to 2009 and found that investigators arrived long after the incidents in question and marked so many claims “unsubstantiated” that the state attorney general posted a notice advising residents that they should take even unsubstantiated claims into account when evaluating nursing homes. They also consulted ratings and visited 10 local nursing homes.
With the ratings as a guide, the newspaper examined more than 3,000 pages of abuse and neglect investigations and annual inspections of 10 nursing homes with the lowest scores. It also reviewed dozens of wrongful-death lawsuits filed against local nursing homes to examine how Texas watches over its elderly.
In addition to a few dangerous homes and some disquieting anecdotes, the reporters found an unenforced reporting law:
(Department of Aging and Disability Services) also is failing to enforce a state law that requires nursing homes to report details about every resident who dies. State officials are supposed to analyze the fatality reports to publicize problems and trends, but that research isn’t being done.
To top off this tale of dysfunction, they also unearthed at least five cases in which would-be nursing home whistle blowers were fired.
Stoeltje added a sidebar on nursing home rating systems, their utility and their shortcomings. She addresses both the local Texas system and the federal Nursing Home Compare database. She talks to both nursing home operators and patient advocates; the operators tend to dwell on ratings’ weaknesses while advocates spoke on their strengths.
LIST: Examples of problems found at nursing homes
Six more examples culled from complaints and often backed with interviews.
MAP: Quality of nursing homesA Yahoo! map linking nursing home location, size and rating.
Texas Public Radio
Terry Gildea, host of a news discussion program called “The Source,” interviewed all three Express-News reporters about their investigation.
Slim guide:
Covering the Health of Local Nursing Homes
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.
• More investigations of nursing homes
• 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
Public records shed light on Texas blood samples
Filed under: Health data, Health policy, Hot Health Headline
The Texas Tribune’s Emily Ramshaw got her hands on almost a decade of public e-mails that help show the thoughts and intentions behind the state’s decision to store infant blood samples without parental consent. She also uncovered a previously undisclosed “transfer of hundreds of infant blood spots to an Armed Forces lab to build a national and, someday, international mitochondrial DNA (mtDNA) registry.”
Photo by valleyboy74 via Flickr
Ramshaw published PDFs of the e-mails alongside her story (E-mails, part 1 | E-mails, part 2).
Ramshaw’s report follows officials’ intricate dance around the issue of parental disclosure, as well as their reluctance to publicize the warehousing of the blood samples. Here’s her summary:
For decades, the state has screened newborns for a variety of birth defects, pricking their heels and collecting five drops of blood on a paper card. Until 2002, the cards were thrown out after a short storage period. But starting that year, the state health department began storing blood spots indefinitely, for “research into causes of selected diseases.” Four years later, DSHS began contracting with Texas A&M University’s School of Rural Public Health to warehouse the cards, which were accumulating at a rate of 800,000 a year. State health officials never notified parents of the changes; they didn’t need consent for the birth-defect screening, so they didn’t ask for it for research purposes. The agency’s rationale was that it let parents who asked opt out of the newborn blood screening and de-identified all of the samples before shipping them off.
According to Ramshaw’s sources, baby blood spots are “incredibly valuable” to researchers, and can be useful even when stripped of all identifying information. Yet public perception doesn’t line up with this scientific value in part, Ramshaw says, because scientists are unwilling to even try to explain the use of blood spots because it’s such a controversial topic.
Fortunately, Ramshaw writes, the first steps toward educating the public are now being taken. Parents are being asked for their informed consent when the blood samples are taken, and the state health agency has made a clean break with the past by destroying the earlier blood spots collected without full consent.
Doctors turn to ‘speed dating’ to find patients
American Medical News‘ Victoria Stagg Elliott outlines a Texas program called “Doc Swap,” which is a sort of speed dating for medical professionals and patients. A doctor and potential patient have five minutes to find out if they’re a good fit for each other before the rotation bell rings and they start the five-minute discussion over again with another partner. 
For Texas Health, it’s a “low-cost way to drive patients to affiliated physicians.” For physicians, even representatives say it’s “good marketing,” as they can net three or four new patients for just an hour’s worth of unpaid effort.
Elliot writes that it appears to be the first such event in the country, though less formal doctor-patient meet-and-greets are common. Physicians say it’s a good way to filter out patients who wouldn’t be a good fit for their practice and expertise, and to help direct patients to the right specialist from the start.
Firing patients
“Doc Swap” and its take on the doctor-patient relationship fit with a recent column on doctors “firing” their patients. Beck says it’s a common topic of discussion among doctors, and lays out the basic criteria for showing a patient the door.
The list of reasons is relatively short, according to medical associations: Patients who are chronically abusive, disruptive or drug-seeking may be asked to leave a practice. So might those who habitually miss appointments or refuse to pay reasonable bills. Failing to heed medical advice isn’t necessarily grounds for a split, but some doctors suggest that patients who won’t quit smoking, use illicit drugs or have potentially harmful habits (daily enemas, say) might be more comfortable in another practice.
The comments on a related blog post provide a few more physician perspectives.
Corporate clinics scored scarce H1N1 shots
USA Today’s Alison Young reviewed state H1N1 vaccine distribution information from Florida, Texas and Georgia, finding that “When the swine flu vaccine was most scarce, health officials gave thousands of doses to corporate clinics at Walt Disney World, Toyota, defense contractors, oil companies and cruise lines.”
Young is working on getting the same data for New York and California. The officials Young talked to stressed that they were doing their best to distribute vaccines fairly, but Young quoted legislators and activists who questioned state health department’s ability to ensure that, once vaccines were given to corporations, they were delivered to the folks who needed them most.
Tracking H1N1 shots, in Texas and beyond
Filed under: Health data, Hot Health Headline, Public health
Jeffrey Weiss of The Dallas Morning News reports that he was able, via an open records request, to get a full list of organizations in Texas that have requested H1N1 vaccines, as well as list of all shipments ordered. The list doesn’t include any public health departments, and is led by large hospitals and mass vaccinators.
On a national scale, the HHS-maintained flu.gov has an updated list of the number of doses of H1N1 vaccine that have been shipped to states, territories and regions thus far. And for your readers or viewers who are trying to get the shots, Google has a flu shot finder map for both H1N1 and seasonal flu vaccines.
Texas Tribune’s launch has health data, stories
Filed under: Health journalism, Hot Health Headline
As you may have noticed, the much-anticipated nonprofit news site Texas Tribune launched today. From the start, the venture is including hard-hitting health news, leading with a data-driven story on the restraint of special education students in Texas schools and following through with a number of state-oriented health stories.
A quick examination of the lead story gives a few hints as to where Texas Tribune health coverage might be going:
Disabled students restrained, injured in public schools
Texas is one of four states that collects data on instances in which special education students are restrained, and Texas Tribune reporter Emily Ramshaw has taken advantage of that data to dig into the practice of restraining special education students in Texas and uncover illuminating statistics and a few distressing anecdotes. With the story, Ramshaw provides PDFs of a federal report and a simple pie chart of the data. The story’s arresting photos were contributed by a victim’s family.
Project looks at high price of health care in Dallas
Filed under: Conflicts of interest, Health data, Hot Health Headline
In their “The Cost of Care” package, Dallas Morning News reporters seek to explain why, as Jim Landers says in the lead of a key story, one of the nation’s largest cities is “broken market where doctors, hospitals and other providers shower patients with services of diminishing value but staggering cost.”
The problems are clear: The Dartmouth Atlas ranks Dallas as the 13th priciest health market in the nation, while new Census data gives Texans the dubious honor of living in the least-insured state in the nation. The whys and hows of these issues are trickier, but the Morning News wades into the health spending morass.
Dallas sees no relief in health care expenses as competition drives up costs
Jim Landers explores the paradox that health care in the city is expensive because there’s so much competition, and considers the contributions marketing and medical records make to health care costs. The piece includes an interesting profile of CIGNA regional president David Toomey’s attempts to rein in costs in the area.
Robert Garrett and Jason Roberson explain how everybody pays the price for the area’s super-low insurance coverage rates, and put an exact cost estimate, both financial and human, on the price of a high uninsured population.
Doctor-owned hospitals a lucrative practice, though opinions split on benefits
Gary Jacobson’s weighs the costs and benefits, both economic and medical, of doctor-owned hospitals, which are more common in Dallas than any other major metropolitan area.
Medical imaging a growth industry, but some say unneeded scans increase expenses
Ryan McNeill assesses just how useful the high-speed, unregulated growth of medical imaging has been for patients, doctors, investors and other stakeholders.
Critics see home health care boom as wasteful, but others tout benefits
When you’re looking to explain growing costs, it makes sense to focus your efforts on growing sectors, and Gregg Jones does just that, looking at the fast-growing home health sector. He leads with Medicare fraud, but then shows just how much deeper and more complicated the cost equation of home health care can get.
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