Schwitzer health news blog

The good and the ugly in TV health news

Last weekend I watched examples of the good and the ugly in TV health news.

The good was a segment on Bill Moyers Journal on PBS, in which journalist Melody Petersen discussed her new book, "Our Daily Meds," and how drug companies sell their products.

The ugly was on CNN's House Call during which CNN again gave unsupported, non-evidence-based health test advice to women of various age groups. And they featured an interview with Dr. Christiane Northrup, author of "Women's Bodies, Women's Wisdom," in which they let the author get away with saying - unchallenged:

"I had a big old fibroid, big as a soccer ball, right side, OK? Right side, typically the masculine side, or the men in your life. And I believe that fibroids, which 40 percent of women have, are creativity that hasn't been burst yet, or they are creative energy that we have pushed into a dead end job or a relationship."

There was no counter to that statement, no challenge, not even a look of incredulity. What did that mean?
What kind of journalism is that to let someone say that on the air without explanation? Believe me, it burst my bubble when I heard it!

American & German health care

I attended a terrific local forum today, "American & German Health Care: Health Technology Assessment and Health Care For All." It was hosted by the University of Minnesota's Center for German & European Studies.

It was an opportunity to meet and hear directly from leaders in the German health system - which many hail as far more efficient than that in the US, and at much lower spending levels. The US devotes 16% of its GDP to health care spending; Germany spends 10%. Their system is universal, comprehensive, and includes a mix of public and private efforts.

We also heard from representatives of the Massachussetts health reform plan, from major insurers, from drug companies and from health care providers.

How many local journalists attended to learn, to conduct interviews with leading health policy makers, and to file stories? I saw none.

Maybe they'll show up for day two.

The hosting Center is actually paying Twin Cities Public Television to put a video together for air.

CheneyCare irks California Nurses

A recent Bill Moyers Journal program brought my attention to a California Nurses Association ad campaign called "CheneyCare."

The CNA says:

"All Americans have the right to the quality of care that our Vice-President, President and Congress already have," said Rose Ann DeMoro, Executive Director of CNA/NNOC and a vice-president of the AFL-CIO. “All the leading Democratic proposals fall well short of “CheneyCare”, keeping insurance companies at the apex of power and allowing them to deny care that can save lives. The Republican proposals are even worse.”

The ad uses recent headlines about Vice-President Dick Cheney’s latest heart procedure to point out the difference between the government-funded health care that the nation’s leading politicians enjoy and the precarious health care situation in which most Americans find themselves.

Why isn't it called plagiarism in TV health news?

"It's not their story and they're sticking to it," is the headline of Florida media critic's piece on a phenomenon in local TV news that we've written about before.

Across the country, on many local TV stations' health reports, you are being deceived if you think that the "reporter" was actually a "reporter." He/she may only be putting his/her name on a story produced by an outside company. The St. Pete media critic found at least 9 TV stations that used the exact same story with the exact same wording - with the only difference being that each station stuck their logo on the screen as if they did the piece.

Excerpt of the story:

"In the print world, presenting another outlet's work as your own without attribution would be called plagiarism. But TV stations often present stories written by other news services or affiliate stations without notifying viewers. ...

Many TV professionals say this is a routine practice. TV reporting, after all, is a team sport where producers, camera operators and on-air reporters collaborate to create a single story.

I've always felt reports branded with the name of a specific personality are different. There's an expectation that health reports bearing (a reporter's) name were actually reported by her — and the fact that stations don't really identify when their personalities are reading reports developed by a news service, indicates they know this, too.

Critics of this practice say it helps make local TV reporting more generic across the board, with station Web sites and broadcasts across the country featuring the same story within days of each other.

It's also a further blurring of ethical lines prompted by economics, allowing a single reporter to present more stories in a week than he could possibly research on his own."

More on school lunch panel conflict of interest

Sandy Szwarc, who does a terrific job on her JunkFood Science blog, adds to the discussion about conflicts of interest on the school lunch panel - something I blogged about two days ago.

But in her perspective:

"...industry funding is often the least of concerns when it comes to possible conflicts of interest. If your entire career has been based on the belief that obesity is due to bad foods and inactivity; if your professional reputation and status among your peers, your speaking engagements and book deals, and the grant funding you’ve brought to your university* or program have all been based on an obesity crisis and dietary behavioral interventions; if you’ve been hand-selected for a prestigious committee, sponsored by a major funder who has made obesity and diet and lifestyle interventions its key agenda; and if you are surrounded by like-minded important people — how likely do you think you would be to risk all of that by seriously questioning and objectively examining the evidence that might tumble the entire house of cards and put you on the outs in your field?

Right. It’s not going to happen. It's human nature.

The public has been invited by the IOM to comment on its provisional committee selection for the next 7 days week here, but it goes to the IOM committee members with even more prestigious and influential positions in line with the war on obesity. The bigger issue is that we have private vested interests funding and influencing the health policies of federal agencies and health programs that affect you and your children. Until the National Academy of Sciences cleans its own house, the public and the integrity of science-based policies will continue to lose."

She adds a very important addendum to the discussion. I don't know how she manages that prolific blog, but keep it up, Sandy.

Concerns about clinical trial recruitment

A Wall Street Journal column offers some information and some caution about recruitment for clinical trials. Excerpt:

"Medical ethics experts warn there are still concerns when it comes to protecting participants, with alarming reports in recent years about deaths in clinical trials and persistent questions about conflicts of interest among researchers who have financial stakes in drugs or treatments. Karen Maschke, an associate for ethics and policy at the Hastings Center, a Garrison, N.Y., nonprofit bioethics research institute, warns that patients have to be sure that researchers aren't "overselling the benefits and playing down the risks." Recruiting should be carried out "so that it is clear there is no moral obligation to participate and people's decisions will be respected if they say no," she says."

Conflicts of interest on school cafeteria standards panel

The Integrity in Science Watch project of the Center for Science in the Public Interest reports:

At least 8 of 14 prospective members of the National Academies of Science committee reviewing the nation’s school cafeteria standards have received recent research support from the food industry or currently receive honoraria for sitting on the board of an industry-funded non-profit, an investigation by Integrity in Science Watch showed. Just one of those affiliations was disclosed in the NAS announcement that invites the public to comment on the proposed nominations.

Recent research support for five of the proposed panelists came from a variety of industry-affiliated organizations, including the National Dairy Council, International Life Sciences Institute, National Pork Foundation, and the USA Rice Federation. Members have also worked with specific companies such as General Mills and Gerber. The committee’s proposed chairman, Virginia Stallings of the Children’s Hospital in Philadelphia, serves as president of the Dannon Institute, a non-profit housed within the Dannon Co.’s White Plains, N.Y. headquarters and fully funded by the company. Stallings received $15,000 from the Dannon Institute in 2006, according to its latest publicly available Internal Revenue Service filing. The Institute’s charitable activities include support for a Johns Hopkins University-based program to combat obesity in early childhood.

The NAS committee is funded by the Agriculture Department’s Food and Nutrition Service. It will set standards for the national school lunch and breakfast programs. NAS policy requires current conflicts of interest be disclosed to the public. The public has nine days to comment.

Why didn't FDA act on Procrit ads?

The Cancer Letter reports:

Internal FDA documents show that the agency made a series of unsuccessful attempts to stop a direct-to-consumer advertising campaign that claimed that Johnson & Johnson’s erythropoiesis-stimulating agent Procrit (epoetin alfa) improved “fatigue” associated with chemotherapy-induced anemia.

The advertising campaign, which is widely credited with making ESAs into the biggest-selling class of oncology drugs, was allowed to proceed with relatively minor changes after the FDA Office of Chief Counsel became involved in the controversy.

Getting "informed consent" for drug trials in poor countries

Merrill Goozner reports that the FDA decided that it will no longer require that clinical trials submitted to the agency to get regulatory approval for a new drug adhere to the Helsinki Declaration.

Why should you care? Gooz says this "increases the likelihood that more trials will go abroad and that more of them will not even be registered with the FDA, which makes them all but impossible to monitor."

Huge issue. And, as Gooz points out, one not reported by many news organizations.

Is ultrasound the stethoscope of the 21st century?

Journalist Jacqui Wise writes from London in the BMJ about the explosion in ultrasound use, some turf war issues over the technology, and concerns about training and proper use. Excerpts:

"Ultrasound machines were once the size of washing machines and used solely by radiologists and sonographers working in radiology departments. But in the past 10 years they have become cheaper, smaller, and more portable—the latest models are even pocket sized.

As a result ultrasound machines are increasingly used by non-radiologists as part of the clinical examination or to assist in practical procedures such as insertion of a central line. The number of general practitioners buying their own ultrasound machines has also gradually increased. So is this good or bad news for patients?

Gill Markham, vice president of the Royal College of Radiologists, says: "The price of an ultrasound machine has come down enormously to £5000-£10 000 [{euro}6000-{euro}12 000; $10 000-$20 000] and as a result they are used much more widely. Ultrasound has a reputation as a simple, easy test. It is easy to do but interpreting the results is not so easy and there are things that could be missed."

Paul Allan, clinical director of radiology for Edinburgh, agrees: "There are people with very little training using ultrasound badly." He says he is aware of surgeons doing ultrasound investigations for acute abdominal pain and mistaking invasive cancers for ruptured spleen.

The key issue is adequate training. As Dr Allan says, "I have no problem with who does ultrasound investigations, but they must be trained. Ultrasound does require experience and expertise. There is no physical risk to the patient but there is a risk of false negatives or false positives."

Reporters & McCain's health care campaign canard

Trudy Lieberman writes:

The Rocky Mountain News’s coverage of John McCain’s campaign stop in Denver last week raises an important issue for reporters, especially those covering the election: Do you let a candidate’s remarks stand unchallenged even if they are wrong or misleading?

McCain had come to town to talk mostly about health care, the paper reported, noting that the topic took up a large part of his hour-long speech. The News offered all too typical coverage of such talks, however—bits and pieces on a lot of topics, with quotes here and there. We do learn that on health care, McCain urged states to take a leadership role in reform, and that he pumped his tax credit aimed at helping Americans buy health insurance. In the next graph, the paper said that McCain’s rationale for the tax credits “is that making major reforms and using government to work through the problem will affect the quality of coverage for Americans—which he called the best in the world.”

The best health care in the world? McCain has asserted that before and so have other politicians. No doubt we will hear it again. But the evidence says otherwise.

Read the whole piece and see some of her reminders about Clinton's and Obama's less-than-true campaign comments.

Proud of my undergrad health journalism students

I'm proud to offer a link to a class project done by four undergraduate students in my Advanced Reporting Methods: Health & Medical Journalism class.

"The Uninsured: You're in your 20s. Why should you care?" is a website researched, designed and launched by four seniors.

Mind you, it's not perfect. But consider that this was an effort of 20-something undergrads. They proved that you can tackle a complex issue and make it come to life for your audience using various media formats.

There were three other noteworthy student projects in this class this semester but this is the only one I can make immediately publicly accessible.

There is hope for the future of health journalism.

Did you want butter on your cigarette butt?

The Wall Street Journal reports on a World Health Organization announcement about problems with the new generation of sleeping pills - a market that grew by 10% last year.

Among the oddities reported by the Journal:

• people eat, walk, make phone calls or get behind the wheel while still asleep after taking the drugs;
• some people have cut themselves with knives, consumed inedibles like buttered cigarettes and woken up gasping for air with their mouths full of peanut butter, a particular sleep-eating favorite.

Undisclosed conflicts of interest in media interviews

Jeanne Lenzer and Shannon Brownlee have a piece in Slate today that asks, "Are doctors shilling for drug companies on NPR?"

The piece begins:

"A few weeks ago, devoted listeners of National Public Radio were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.

We don't know just how much funding or when the show last received it, since neither Goodwin nor the show's producers responded to repeated requests for interviews. But the larger point is that undisclosed financial conflicts of interest among media sources seem to be popping up all over the place these days. Some experts who appear independent are, in fact, serving as stealth marketers for the drug and biotech industries, and reporters either don't know about their sources' conflicts of interests, or they fail to disclose them to the public."

Disclosure: I am interviewed in the story. But don't let that stop you. The piece is worth reading.

Conflicts of interest in psychiatry's bible group

The Integrity in Science Watch Project of the Center for Science in the Public Interests reports:

"More than half the 28 new members of writers of the next edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) have ties to the drug industry. The conflicts of interests were posted online by the APA last week. They ranged from small to extensive. Leading the pack was William Carpenter, Jr., director of Maryland Psychiatric Research Center at the University of Maryland, who over the past last five years worked as a consultant for 13 drug companies, including Pfizer, Eli Lilly, Wyeth, Merck, Astra Zeneca, and Bristol-Myers Squibb. APA President Carolyn B. Robinowitz claimed that "we have made every effort to ensure that DSM-V will be based on the best and latest scientific research, and to eliminate conflicts of interest in its development." The fifth DSM, produced in conjunction with the National Institute of Mental Health, will be published in 2012. It is used by mental health professionals to classify mental illnesses."

Texas hospital bans workers from reading critical newspaper series

The Fort Worth Star-Telegram reports that administrators of the county's public hospital system have banned workers from reading a newspaper series critical of the system - at least while they are at work. The paper reports that the hospital system blocked internet access to the Star-Telegram.com site.

The newspaper says that three of its reporters spent four months examining the JPS Health Network.

The series, which began last week, opened like this in part one:

"The waiting room reeked. Along a crowded hallway, patients lay in beds, with only a thin curtain for privacy. Nurses readying for a new case in surgery noticed blood, bone and globules of fat on the walls and floor and stuck to wheels of carts.

Chance brought to the hospital teenagers from car wrecks, fathers hurt on the job, police officers injured in the line of duty. Others -- the poor -- came because they believed they had nowhere else to go.

They were greeted last year at an overburdened emergency department where the staff could be robotic and hardened to patients. Sometimes, inexperienced nurses evaluated the sick and suffering.

Some patients were shuffled to a stifling back room to wait. Medical records, crucial lab results -- even patients -- got lost. Staff didn't notice when one Alzheimer's patient walked home in 100-degree heat. Another patient was dismissed because doctors didn't get lab results indicating a life-threatening disease.

The trauma center was described as a war zone. Operating rooms as chaotic. In too many places, instruments were broken, rooms dirty, linens threadbare.

Welcome to a hospital flush with cash and rife with problems. Welcome to John Peter Smith Hospital, hub of the Tarrant County Hospital District.

Boosted by tax funding other local hospitals don't get, JPS has been racking up fat surpluses -- nearly $97 million last year alone.

But the cash has not helped a dedicated core of doctors and nurses overcome the system's callousness, ineptitude and filth. JPS is a hospital that many of its own doctors wouldn't recommend."

Thurston Howell III Would Have Loved Health Savings Accounts

The Wall Street Journal health blog this week put that clever Gilligan's Island spin on a new report from the U.S. Government Accountability Office suggesting that health savings accounts are fine for the rich — but that’s about it.

The blog posting kicked off many interesting reader responses. One of my faves:

"I have been in the HSA and hi deduct insurance plans for 3 years. First 2 years were nice, saving on premiums and socking away some money. The third year, 2008, my wife spent the first 6 days in the hospital, so now I am on the losing side of the “savings”. Can I get on Stark and Waxman’s health plan?

As usual, the socialists (read Democrats) use analysis of “averages” to prove a point when there is not a point. Next year I will retire and take all of my money to another country. Hasta la vista, comrades, communism does not work and is not for me."

As Thurston Howell III once said on the show: "No one can pull the wool over my eyes. Cashmere maybe, but wool, never."

Numbing news on rising health care costs

Are we getting numb to news about rising health care costs? I saw very little pickup of either of the following stories this week:

In the Los Angeles Times, *Workers' Health Insurance Costs Soar*:

Workers with job-based coverage for their families saw earnings rise 3% from 2001 to 2005, while their health insurance premium contribution increased 30%, according to the study by researchers at the State Health Access Data Assistance Center at the University of Minnesota. The average cost nationally of family coverage during the period increased nearly $2,500, to $10,728 from $8,281.

On a Chicago Tribune blog, " Ouch! Health Costs Rise as the Economy Falters":

Slightly more than 1 in 4 Americans (28 percent) report that the recent economic downturn has caused "serious problems" paying for medical care and insurance, according to a new survey by the Kaiser Family Foundation, a California policy group. It’s the third most frequent type of problem people are encountering, behind problems paying for gas (44 percent) and getting a raise or a good paying job (29 percent).

In a separate study, also released by the Kaiser Foundation, researchers at the Urban Institute are estimating that a 1 percent rise in the national unemployment rate would throw 1.1 million Americans into the ranks of the uninsured.

Current estimates put the number of people without health care coverage at around 47 million.

That’s what happens during a recession: People lose jobs and job growth stalls. Also, more people end up turning to state programs such as Medicaid or SCHIP (the State Children’s Health Insurance Plan) for health care coverage.

In turn, that puts states in a bind because state revenues drop when unemployment rises (and businesses, by definition, aren’t doing as well). Combine expanded need for public programs with reduced revenues and you have a difficult situation.

Layer on top of that expanding budget deficits in the states and you have a very, very difficult situation.

Sex & Cereal

There are many very smart people scrutinizing health news coverage these days. Some of them populate the Chance News wiki based at Dartmouth College.

Look at how one observer analyzed recent news coverage of the stories behind some of these headlines:

The Independent: "Big breakfast is most important meal -- if you want a baby boy."

Reuters: "Skipping breakfast may mean your baby is a girl."

New Scientist: "Breakfast cereals boost chances of conceiving boys."

CNN.com: "Study shows bananas make baby boys."

New York Times: "Boy or Girl? The Answer May Depend on Mom's Eating Habits."