Schwitzer health news blog

Blogger Breather Break

I'm giving my fingers a couple of weeks off.

For those of you interested in unbiased critical reviews, evaluations, and grading of health news stories, please go to HealthNewsReview.org.

And I'll be blogging again sometime in June.

Ambien Zombies

No one should miss a recent Washington Post story on Ambien, "the pill that drove us to sleep."

I'll only give you the lead, "Zolpidem tartrate, the sedative-hypnotic better known to wide-awake, stressed-out sheet kickers as Ambien, is an efficacious little helper if you ever thought you might go crazy from not sleeping. It's 'Goodnight Moon' for grown-ups. You should take it only with some Charlie Rose. Now it's also become the new explanation for that which goes bump in the night: I took an Ambien, Americans are saying, and then I don't know exactly what happened."

If you're not on Ambien right now, you should go read the rest yourself.

If you are on Ambien right now, you're probably falling asleep or raiding the fridge, so read it in the morning. And don't blame anyone but yourself.

Horse sense

Kentucky Derby winner Barbaro’s injury in the Preakness Stakes and subsequent treatment garnered the kind of news coverage usually reserved for heads of state.

The horse “was a good patient,” according to ABC. Did he take on Mr. Ed-like qualities and tell ABC something that led to that assessment? The horse’s treatment was the subject of news cut-ins throughout the afternoon on Sunday TV.

After the slew (thankfully Triple Crown winner Seattle Slew was spared) of broken legs leading to premature mercy-killing of countless horses, you might think you’d hear some news coverage questioning “the sport of kings.”

I guess there’s too much money and too many mint juleps tied up in that vested interest to question it.

But let me put the news coverage in this perspective: one horse’s injury gets this much news coverage, but what’s the last time the nation’s 45-million uninsured people got this much news coverage?

P.S. The Minnesota state legislature approved stadium bills for both the baseball Twins and the University of Minnesota Gophers football team this weekend. What a relief (we're not talking tax relief) for the citizens of Minnesota. (Anybody know any health policy-related legislation acted on by the legislature this year?)

UnitedHealth shareholders sue

Bloomberg News reports that CEO William McGuire and other officers and directors of UnitedHealth Group Inc. have been sued by shareholders for allegedly backdating stock-option grants.

The suit was filed last week, one day after the nation's second-largest health insurer said it had been subpoenaed by the U.S. attorney in New York and the IRS over its stock-option grants.

Bloomberg reports: “Executives including McGuire and Chief Operating Officer Stephen Hemsley were issued options that were backdated to days when the company's shares were unusually low to increase the recipients' profits once the options were exercised, the suit claims.

‘William W. McGuire would have us believe he is the luckiest man in America,’ the 35-page complaint says. ‘McGuire and/or Hemsley somehow managed to receive stock option grants on the single lowest trading day of the year four years in a row.’

Incidentally, the suit was filed last Thursday. This is a big Minnesota story, since UnitedHealth is based here. But the Star Tribune published the Bloomberg story – not its own story – in Saturday's paper on page D3. That’s the fourth section of the paper, on the 2nd last page of the section.

Nurse criticizes Strib for promoting cancer magic bullet

First, this is not "beat up on the Star Tribune week." There's no agenda here. Sometimes events and patterns unfold before one's eyes.

On Monday, in my "Proportionality in Journalism" entry, I wrote about Mother's Day weekend stories in several media - "endless weapy stories about breast cancer. But few hard issue-oriented stories about breast cancer. About the dilemmas in diagnosis and treatment, in funding, in consumer decision-making."

Today, a woman who describes herself as a veteran oncology nurse has a letter to the editor in the Star Tribune.

She writes: "As a longtime oncology nurse, I was pleased to see the May 15 front-page story about the Susan Komen Race for the Cure. As the name of the event implies, there is not yet a cure for metastatic breast cancer. This important fact was then obscured by the reporter's choice to focus on a young woman who is seeking treatment unsupported by the type of rigorous scientific study that the Komen Foundation funds. The story pulls at the heartstrings, but fails to inform us about proven treatments and the progress that has been made in prolonging and improving the lives of women with breast cancer. A physician who offers his treatment as the 'only hope' is, sadly, too good to be true."

Her letter is a call for evidence-based medical reporting. And proportionality. That's the backbone of my week-long tirade about what I've seen - and not seen - in Twin Cities health news this week.

It may be time to listen to the readers and viewers. They're not happy. That may be why readership and viewership are declining.

Local news media fall prey to medical marketing

I've seen the trend play out all over the country: local journalists give lots of free publicity to local medical marketing maneuvers, seemingly throwing aside sound, basic journalistic skepticism and critical inquiry.

Yesterday I wrote about the Minneapolis Star Tribune and its commercial-like coverage of the local HealthEast Care System's webcasts of surgical procedures.

Recently, that same hospital system got fawning "gee-whiz" coverage on a kidney stone procedure from local WCCO-TV. That story is reviewed - not favorably - on the HealthNewsReview.org website. The review says, in part, "The story says 'After Dr. Portis presents results of his study, he thinks doctors everywhere will want to adopt it. ' But we have no idea how many are using it now, nor is there any independent evidence that anyone else will adopt this approach. ... The story lets the physician-researcher say that 'his approach has a 95 percent success rate with a single treatment and quicker recovery time. ' But there is no evidence given to substantiate that."

Evidence seems to be lacking in these stories, doesn't it?

You'll find both the Star Tribune and the WCCO stories on HealthEast's website where it touts recent news coverage. In fact, there seems to be a special pipeline between the HealthEast marketing department and WCCO, which has seven stories listed on the HealthEast "In the News" website.

In a recent financial report, HealthEast bragged that hospital admissions were up over the previous year "which management attributes to increases in market share resulting from higher visibility in the local media regarding high tech services such as the CyberKnife and the Da Vinci Surgical System."

The Da Vinci system has been hyped in the Star Tribune, even in a sports story. Ill-explained CyberKnife billboards have littered area freeways. It is not the job of journalism to give donations to marketing campaigns for high-tech webcasts, CyberKnifes or robotic surgical systems. Rather, journalism may want to spend more time on the costs of such technologies, the evidence to support (or refute) the use of such technologies, and questions of access for the 45-million Americans without health insurance.

Hospital webcasts make me ill

I know that hospital webcasts have become important marketing tools.

But does a major metropolitan newspaper have to contribute free space to the marketing effort? That's what it looks like the Minneapolis Star Tribune has done, publishing a front-page story on one local hospital system's expensive webcasts. The piece reads like an ad itself. Then the newspaper's website offers a link to one of the hospital webcasts!!! Is this journalism or an "I'll scratch your back, maybe you'll advertise in our paper" approach?

The story says, "Each webcast costs between $35,000 to $50,000 -- typically paid by whoever commissions it -- to produce and promote." That's incomplete. Who pays for the kidney stone webcasts that are highlighted in the story? Whose budget does that come out of?

Here's something else troubling about such webcasts. Hospital marketing people can say they educate patients, but what is the quality of that education? Is there a discussion of harms and benefits? Is there a discussion of costs? Is there a discussion of alternative options?

That's just some of what can be problematic about this marketing trend. And it's a lot of what was wrong with the Star Tribune story. It failed to ask tough questions and felt more like an ad than a news story.

Proportionality in journalism

In The Elements of Journalism, Kovach and Rosensteil plea for proportionality in news coverage. It’s a call for coverage in proportion to the significance of events in peoples’ lives.

This has been a rough month for proportional news coverage. I couldn’t even submit an entry yesterday.

It’s a May rating-sweeps period for TV, so we know what we’re going to get and we’re getting it. But even in print, I question the proportionality of current coverage.

Locally, we continue to get breathless, joyful news coverage every night about the separation of conjoined twins. One giddy anchorwoman even said – just hours after the girls had been separated – that they would play sports someday. Proportionality.

Meantime, there’s also lots of coverage of three different proposals to fund and build new stadiums in Minneapolis-St. Paul. But there’s almost no coverage of any health care proposals before the legislature. Proportionality.

Meantime, coverage of a political party’s decision for which candidate would be endorsed to run to fill a key vacant Congressional seat got only brief mention. And there were no good in-depth profiles of the candidates nor the issues. Proportionality.

For Mother's Day weekend, there were endless weapy stories about breast cancer. But few hard issue-oriented stories about breast cancer. About the dilemmas in diagnosis and treatment, in funding, in consumer decision-making. Proportionality.

CNN had a Mother's Day segment on advice for women at different ages about tests they should have. Almost all of their recommendations flew in the face of evidence-based guidelines. (I'll be writing about this in a future entry.) Months ago, CNN was an equal opportunity disease-mongerer, ignoring the evidence when making testing recommendations for men. See my Publisher's Note on HealthNewsReview.org.

I have better things to do today than to be depressed about current news trends. Proportionality.

You can tell it’s TV sweeps-ratings time

As my research has shown, whenever ratings-sweeps periods roll around, television news departments miraculously find time to cure the problem of not having enough time to devote to health news.

In my market, Minneapolis-Saint Paul, the May sweeps period has been filled with tears, joy and new hope surrounding dramatic breakthroughs and promising developments for victims of illness. (There, I just polished off my “seven words you shouldn’t use in medical news” in almost the same time as the normal TV anchor lead-in.)

This week on local TV, I saw:

• The “countdown to separation” for conjoined twins. And I saw it over and over and over on all local stations. All conjoined twins all the time. Like it's never been done before. You'd never know there were 45-million uninsured in this country but you sure know a lot about these two kids.

• A single-source story, “Doctor Has New Method To Break Up Kidney Stones,” with no input from any independent source

• “Minnesota Twins’ wives step up to fight cancer”

• “States prepare for bird flu fears, pandemic” – how health officials from California to New York were taking steps to allay any fears that might arise from the TV movie "Fatal Contact: Bird Flu in America" – a local ABC affiliate story about the ABC network movie that was panned by critics. Nice cross-promotion, huh? Or, the local affiliate could have just refused to air the sappy production.

• Another station posted on its website, “Bird Flu Preps,” asking the tough questions for which we all want answers, such as: “But what happens if there's no one to anchor the news? No one to operate the cameras? And no reporters in the field to tell us what's going on?”

To be fair, I saw only a portion of one story that reported: “An organ donation group that gives priority to members over others in need is causing medical ethicists to question its appropriateness.” This is the kind of issue-oriented health news story that is lacking in many TV newscasts. So credit should be given to KSTP-TV for digging beneath the surface of news releases on breakthroughs and cures.

"A significant deficiency" at UnitedHealth

The Star Tribune reports:

"Embattled UnitedHealth Group said Thursday it discovered "a significant deficiency" in its controversial executive stock option program and may have to restate earnings by $286 million for the previous three years.

The issue of preferential treatment of top executives in the award of stock options has dogged the nation's second largest health insurer for the last several months and prompted its board of directors last week to terminate the program for its most senior management."

Wake up! More sleeping pill drug dirt!

Tufts med school prof Daniel Carlat, in an op-ed piece in the New York Times, says "makers of sleeping pills are now paying doctors to publish bad things about competing drugs."

Carlat claims that industry has colluded to slam the use of trazodone, an antidepressant that psychiatrists prescribe off label to treat insomnia because it works so well. He says trazodone has a long safety record and is cheap, costing as little as 10 cents a pill. He says new highly-advertised sleep drugs Ambien and Lunesta can cost $3 a pill or more.

Carlat continues: "Each time a psychiatrist prescribes trazodone, a potential sale of Lunesta or Ambien is lost. No doubt that is why, in the past few years, several articles have been published in professional journals that can only be described as trazodone-bashing. With titles like 'The Use of Trazodone as a Hypnotic: A Critical Review' (published in The Journal of Clinical Psychiatry), these articles purport to present balanced reviews of the scientific literature on sleeping pills. But the authors, psychiatrists with university affiliations, have been paid by Sepracor, Sanofi-Aventis or Takeda, the companies that stand to gain from trazodone's downfall."

In these articles, Carlat claims, "Trazodone is criticized as lacking high-quality research data on its ability to help people sleep. What is left unmentioned is that because trazodone is no longer patented, no pharmaceutical company stands to profit from doing such research."

Carlat calls for a mandate of "fuller disclosure of links between drug companies and authors. Several states now insist that drug makers report the gifts they give doctors. These same companies should be required to disclose the exact nature of a doctor's involvement in preparing a sponsored article, as well as the dollar amount of his or her fee. I suspect it would be the rare doctor who would want such information to come to light."

Losers and winners in Medicare drug benefit

The Associated Press reports that the feds have "added 6,000 operators, quadrupled computer capacity for enrollment and will assist with more than 1,000 events in the week ahead as part of a final push for signing people up for the Medicare drug benefit" prior to the May 15 deadline.

Meantime, the Wall Street Journal has pointed out that "the massive effort has produced clear winners and losers among businesses and seniors. The early winners include some of the nation's largest health plans, which are peddling the drug coverage. After a rocky start in January, the plans have snagged roughly 15 million new customers and healthy government subsidies. Also buoyed: drug makers, which are reporting increased demand for some products used by seniors, such as drugs for chronic conditions. Many seniors are also giving the benefit good reviews, despite initial confusion about which plan to choose."

The WSJ also reports: "But not everyone is faring well. Many seniors have yet to sign up, which is leading to debate in Washington about extending the enrollment period. Medicare already has extended the deadline for people with low incomes. They stand to gain the most because of extra government subsidies, but their enrollment continues to lag. Dozens of smaller health insurers, meanwhile, are seeing only minimal enrollment gains, and independent pharmacists are criticizing the lower payments and suffering cash-flow problems. ... By far, the biggest winner in the race to sign up seniors is UnitedHealth Group Inc., which has used an alliance with AARP to help it grab more than 3.9 million new customers."

Celebrex tries to bounce back with new ads

As the New York Times observed last week, ads for painkiller Celebrex are back. You've undoubtedly seen the one of the man walking up the steep stadium stairs while holding a little boy's hand. "52 steps won't keep you from taking him out to the ballgame," touts the ad copy.

"But a heart attack would," reminds the Times. And each new ad now includes the new warning: "Celebrex may increase the chance of a heart attack or stroke that can lead to death."

The Times says Pfizer, maker of Celebrex, "is offering consumers a decidedly mixed message. But 16 months after the company stopped advertising Celebrex over concerns about its heart risks, Pfizer has returned to the consumer ad market in hopes of reviving sales of the drug, which plunged last year during the ad moratorium."

Dr. Sidney Wolfe of the advocacy group Public Citizen told the Times, "There's no objective evidence of any unique benefit with this drug, and there is objective evidence of a unique risk."

More consumer reaction to UnitedHealth pay and stock options

Letters to the editor of the Star Tribune continue to come in addressing the pay and stock options granted UnitedHealth CEO Dr. Bill McGuire.

Today, James A. Berquist of LaPorte, Minnesota, writes:

"How sorry is McGuire?

Bitter Pill Awards

A group called Prescription Access Litigation has announced this year's Bitter Pill Awards in four categories to drug companies engaging in over-zealous and questionable marketing practices. The drug industry’s national lobbying group, PhRMA, received two awards, and the remaining three awards were shared among makers of five of the nation’s most well-known drugs: Lunesta, Ambien/AmbienCR, Lipitor, Crestor and Strattera.

Disclosure: This effort is led by a bunch of class action law firms that say they're trying "to make prescription drugs more affordable for consumers by using class action litigation and public education to bring an end to illegal pharmaceutical price inflation."

UnitedHealth CEO sorry for fuss over pay

The Star Tribune reports that "amid tight security and a full house, the chairman and chief executive officer of UnitedHealth Group Inc., apologized to shareholders Tuesday, saying he is sorry about the unflattering spotlight placed upon the company over executive compensation in general and his stock options in particular."

Columnist Nick Coleman wrote that Dr. Bill McGuire gave himself a clean bill of health, talking "about the brilliant things that have happened at UnitedHealth since, well, since he got there."

Coleman also wrote about a high school math teacher, Larry Larson, "the only one to break through the love bubble at Doc's meeting. After taking questions from worshipful shareholders, McGuire was about to end the meeting when Larson, 68, came up to the microphone.

Loud applause followed Larson's candid outburst. "

Coleman concluded his column describing the setting for the shareholders meeting:

"In the hall ... there was a rusty iron sculpture that looked like a nonfunctioning gyroscope or a broken navigating device.

Maybe it was a moral compass."

Overblown news about "breakthrough" breast cancer drug?

The April 17 release of some clinical trial data from the STAR trial, comparing raloxifene and tamoxifen to prevent breast cancer in high-risk postmenopausal women continues to be scrutinized - both for how and why the National Cancer Institute made its announcement and for how journalists covered the story.

The San Jose Mercury News profiles the response of San Francisco breast cancer specialist Laura Esserman, who says she doesn't think this comes anywhere close to being a "breakthrough." Others in this column describe the announcement as "overselling...overblown...misleading."

It's good to see the San Jose columnist scrutinize the facts and the evidence. It should have happened sooner and more often across the country on this story.

Breast cancer advocates scrutinize news better than some journalists

I spoke to the National Breast Cancer Coalition Fund (NBCCF) this weekend as part of a panel trying to answer the question, "Do media get the breast cancer story right?"

I came away convinced that some breast cancer advocates scrutinize claims made about progress in breast cancer better than many journalists.

For example, NBCCF president Fran Visco reminded the crowd that her group pointed out the flaws in the design of the STAR trial (comparing raloxifene with tamoxifen to prevent breast cancer in high-risk postmenopausal women). She asked why the government (and journalists) rushed to release the early trial results before they were published and peer-reviewed. She asked, "Is this great news for women?" And then she answered herself by saying that no one can know because all the data haven't been reviewed.

Breast cancer survivor and author Musa Mayer also addressed the conference, recalling how, in the past, she "swallowed the hype" of many news stories "only to end up disillusioned." She recalls feeling "lied to, jerked around." She reminded listeners that "hoping is not the same as knowing...we assume success is more likely than not...we can't afford to keep adding expensive new drugs with only modest benefits."

There are many lessons that journalists and the general public could learn from these breast cancer survivors about how to demand evidence and validation.