Schwitzer health news blog

The $6 Million Dollar Researcher

The story of Stanford psychiatry chief Alan Schatzberg, his ownership of $6 million in stock in a drug he's investigating, Senator Charles Grassley's letter to the university, and the university's response is too good to miss.

Journalist Ed Silverman has blogged about it.

So has psychiatrist Daniel Carlat. Excerpt:

"I do find it incredible that Stanford finds it acceptable for him to serve as the chairman of an academic department. As chairman of psychiatry, Dr. Schatzberg is involved with many decisions having to with hiring staff and funding research. While I have no doubt that he is an ethical person, the fact that he owns $6 million in stocks can never be far from his mind. If it were me, I'd be thinking about it when I woke up in the morning, during my coffee breaks, my meals, and while I was brushing my teeth at night. We're talking $6 million here, people.

He doesn't have the cash yet. He will only be able get it if his company issues a successful IPO, and that will happen only if his drug, mifespristone, looks successful. Here are some problematic possible scenarios. A young professor in his department is up for promotion. But he is researching a medication in direct competition with mifepristone. Dr. Schatzberg has to make a decision, knowing that this could have an eventual impact on his ability to retire with $6 million.

Another scenario. A psychiatry resident has written a wonderful review paper on antidepressants which has been submitted for a departmental award. In it, the resident has concluded that mifepristone is not a promising agent. Schatzberg has to decide who will get the award.

Equally amazing to me is the American Psychiatric Association has no policy forbidding this level of conflict of interest in candidates for APA president. Shatzberg won the most recent election, and will be installed as APA president next May. What will happen if and when Dr. Schatzberg is asked to make decisions regarding the appropriate relationships between the pharmaceutical industry and the organization?

Let Dr. Schatzberg have his pharmaceutical company. But his financial entanglements are far too significant to have him entrusted to positions of leadership at major institutions.

Making tough decisions is part of life, and Dr. Schatzberg needs to decide between being a tycoon and an educator. He can't have it both ways."

To hell with evidence

Read this terrific piece of journalism in the New York Times - "Weighing the Costs of a CT Scan's Look Inside the Heart."

It analyzes important questions about the lack of evidence for these tests, the costs, the radiation risks, and the conflicts of interest of many who promote them.

The story includes a quote from a physician who is a heart CT scan promoter - "It's incumbent on the community to dispense with the need for evidence-based medicine."

To hell with evidence. To hell with science.

This attitude always reminds of me of the saying, "It ain't what a man don't know that gets him into trouble. It's what he knows for sure that just ain't so."

Would back surgery be approved if it were a drug?

An Australian pain specialist writes an intriguing letter to the BMJ this week, entitled, "What if back surgery was a drug?" He wrote:

"I find it fascinating that surgical treatments and medical treatments are evaluated very differently in the literature and by ethics committees. Let’s say you told a human research ethics committee (HREC) that you expected only a short to medium term reduction in radicular pain (editor's note: that means pain that radiates from the back to the legs - or sciatica) with no real improvement in disability or axial back pain for a drug treatment. You go on to say that treatment had a 70% chance of entrenching the axial back pain as permanent, a 5% chance of worsening the pain, 1% risk of permanent neurological damage, with lesser chances of major vessel damage or paraplegia, I wonder how many HRECs would approve it ? If you then presented a literature search that relied mainly on a 30 year old study with major design flaws and a couple of meta-analyses of poor data you could reasonably expect to be sent packing. By way of comparison, in Australia last year lumiracoxib was banned by the Therapeutic Goods Administration for causing fulminant hepatitis at a rate of one in 15,000, with two deaths out of an estimated 60,000 patients who received it.

Without a standard battery of outcome measures which can be used in both surgical and non-surgical trials, and without sham surgical studies, which must measure pain related disability and psychological outcomes (since there is clear evidence that these influence overall disability in a major way) it is difficult to interpret the vast but mostly useless back pain literature."

That is why evidence-based and shared decision-making - which presents a balanced presentation of tradeoffs, of harms & benefits, and of uncertainties - is so important.

Our Friday "feel good" about the health care system segment

From the Wall Street Journal, a report on more Americans, many of them with health insurance, delaying or skipping medical care because of costs.

And, from the Associated Press, a story on some parts of the country (the Southwest) having uninsured rates of up to 30% - up to 18% of children. One health policy researcher reacted, "There are substantial inequities in coverage depending on where you live, and they seem to be getting worse."

God bless America and its greatest health care system in the world (as some would have us believe).

Problems in bioethics

Two different news stories about problems in bioethics caught my eye this week. The Wall Street Journal reports:

"...as the number of hospitals with ethics consulting services has grown in recent years, so have questions about how qualified some of these professionals are to render life-and-death advice. The complex ethical issues arising from new life-prolonging medical technologies are throwing up new challenges. And hospitals face potential legal liability if patients and families feel they haven't been properly counseled or provided with all the information they need to make decisions."

On a quite different theme, Scientific American profiles the problems of one bioethicist at one center. Excerpt:

"When Glenn McGee founded the Alden March Bioethics Institute (AMBI) at Albany Medical College in New York State in 2005, magazine articles and newspaper stories hailed the arrival of the man once described as "Socrates with a beeper." Now, a month after his abrupt departure, former colleagues are painting a complex portrait that suggests the ethicist's own personal and professional relationships may have led to the institute's undoing.

McGee remains a tenured professor at AMBI, and neither he nor college officials will discuss the circumstances surrounding his change in status. Former colleagues, however, say the institute began to unravel shortly after his arrival when Union College in Schenectady, N.Y., severed its longtime educational partnership with AMBI's parent medical school and as disillusioned faculty—accusing the ethicist of everything from forgery to spreading insulting rumors—left."

House Republicans Use Antidepressant Slogan

Catching up on some old, but quirky news.....

Last month, House Republicans made news by announcing a new slogan, "The Change You Deserve, " to promote their agenda.

But within hours, the New York Times posted a followup report:

Democrats heard something familiar today in that new theme emerging from House Republicans: “The Change You Deserve."

Turns out that slogan is also used to market an antidepressant, which Democrats quickly lampooned as reflecting the Republican mood at the moment.

We're #5! We're #5!

OK, we're not #1.

But we're a busy little blog, as shown by the fact that this blog has just become the 5th most active blog out of 6,336 blogs with 15,465 authors hosted on the University of Minnesota Libraries.

What we rank 5th in is in the number of entries. Since September 2004, I've posted 866 entries on this site. And counting.......

"If a surgeon recommends this, run away as fast as you can."

Judy Foreman reports on an alternative to hip surgery that, "propelled by aggressive marketing featuring pictures of vigorous, youngish athletes, is sweeping the United States: hip resurfacing."

She reports on one man who had it done, and whose surgeon is among those who "are worried about the rate at which doctors, most of whom are still on a steep learning curve for this technically demanding procedure, are jumping to do it."

She quotes another surgeon who advises that if a surgeon recommends hip resurfacing, "Run away as fast as you can. Or limp out of that office. There is no advantage and many disadvantages. It won't give you anything more than a total hip replacement, and with some significant downsides."

Good article. Good snapshot of medical technology assessment (or lack thereof) - especially when it comes to surgical procedures.

Key opinion leaders not in the public interest?

Journalist Ray Moynihan reports on the role of the influential experts paid by industry to help "educate" the profession and the public. Excerpt:

In the world of medicine, "key opinion leader" is the somewhat Orwellian term used to describe the senior doctors who help drug companies sell drugs. These influential doctors are engaged by industry to advise on marketing and help boost sales of new medicines. Across all specialties, in hospitals and universities everywhere, many leading specialists are being paid generous fees to peddle influence on behalf of the world’s biggest drug companies.

Read the article and listen to the video clips with former drug rep Kimberly Elliott.

Moynihan's concluding quote:

David Blumenthal, a Harvard University researcher who has studied the relationships between industry and the profession, says company payments to key opinion leaders, rather than being corrupt, are simply not in the public interest. "I think these are legal relationships between consenting adults who have overlapping interests that are not consistent with the interests of the larger society or necessarily with the patients served by these physicians." Blumenthal is part of a small but growing global chorus, which includes advocacy groups No Free Lunch and Healthy Skepticism, that is calling for a major winding back of industry influence over the medical profession and in particular its education.

Disease-mongering by Russert pundits

There has been a lot of speculation about what happened to and what could have saved Tim Russert.

Some, like a Wall Street Journal piece, "A Visceral Fear: Unexpected Heart Attacks," bordered on disease-mongering. That story discussed:

"...experts who think wider use of coronary calcium CT scans could help spot more people at risk of soft-plaque blockages. The noninvasive procedure takes about 15 minutes and costs a few hundred dollars. But few insurers cover it because there is scant evidence that treating people on that basis saves lives.

At a minimum, seeing a picture of the calcium lining their arteries can be a wake-up call for patients to take their coronary-artery disease seriously and to be diligent in taking medication, exercising and making other healthy lifestyle changes."

I'm sure there are such experts. But there are many other experts who do not support wider use of such scans. It's not just insurers who are reluctant. The story makes the procedure sound quick and inexpensive. But that is on the individual level. Who should be screened? Everyone over 40? The entire population?

Pictures - even those of the insides of our coronary arteries - don't tell the whole story. And neither did this piece.

Tracking conflict of interest news coverage

From time to time, I've highlighted how the Integrity in Science Watch project of the Center for Science in the Public Interest tracks news coverage (or lack thereof) of conflicts of interest in medicine and science.

This week's offering:

• Cheer to Andrew Pollack of the New York Times for disclosing that Eric L. Matteson, chairman of rheumatology at the Mayo Clinic, has consulted for many companies developing arthritis medication. Matteson is author of a recent study examining the link between various arthritis medications and cancer.

• Jeer to Audrey Grayson of ABC News’ Medical Unit for failing to note that Michael J. Manos, head of the Pediatric Behavioral Health Center at the Cleveland Clinic’s Children’s Hospital, consulted and served on the speakers’ bureaus of Eli Lilly, McNeil Consumer and Specialty Pharmaceuticals, and Shire US. Manos was quoted supporting use of pharmaceuticals to treat Attention Deficit and Hyperactivity Disorder rather than St. Johns Wort.

• Cheer to Marilynn Marchione of the Associated Press for disclosing that Michael Gnat, a professor at the Medical University of Vienna, consults for Novartis, AstraZeneca, and other breast cancer drug makers. Earlier this month, Gnat announced results of his recent study showing Novartis’ bone drug, Zometa, can slow the spread of breast cancer.

And while we fiddle with Botox, Rome burns

Employer health care costs are expected to increase by 9.9% in 2008 -- more than double annual inflation rates -- and 9.6% in 2009, according to a study released Tuesday by PricewaterhouseCoopers.

I'm on the lookout for any of those Botox users in my insurance pool. I'm going to give them a new reason to frown.

Billion dollar Botox bill

Newhouse News Service reports:

Americans last year spent an estimated $13.2 billion — more than the gross domestic product of Bolivia — on cosmetic surgery.

What did they get?

An array of bodily rearrangements from face-lifts to buttock augmentation, from chemical skin peels to laser hair removal.

And Botox. Lots of Botox. In all, 2.8 million treatments with Botox injections, costing more than $1 billion.

In the past decade, surgical cosmetic procedures have more than doubled, and nonsurgical procedures — such as Botox injections — grew nearly eightfold. …

The latest statistics come from the American Society for Aesthetic Plastic Surgery Inc. Its report is based on 12,000 surveys sent to board-certified surgeons and physicians in plastic surgery, dermatology and otolaryngology.

Checking local health care costs before you move

Dartmouth's Jack Wennberg has often said, "Geography is destiny in health care."

The Wall Street Journal reports on a new twist to that idea. Excerpts:

Charges for medical insurance and for health care differ tremendously in different locales, says Steve Zaleznick, president of Longevity Alliance, a Washington, D.C., company that provides quotes for retirement-related financial services.

For example, the average annual premium for one type of Medicare supplement policy last year ranged from $3,700 in New York to as little as $1,200 in Phoenix, according to an Alliance survey. ...

The Longevity Alliance provides a downloadable booklet about health-care costs in moving at LongevityAlliance.com.

Apologies for the server issues

Many of you may have had problems accessing this blog in the past few days. The server on which it resides has been under attack.

Bear with us.

The dark forces will be defeated.

Did Dad get his navel pierced for Father's Day?

Results of a British survey show that one in ten adults in England have had a piercing somewhere other than their ear lobe, with a quarter experiencing complications, and one in 100 piercings resulting in a hospital admission. Other piercing factoids from the BMJ report:

• Piercing is more common among women than men, with nearly half the women (46.2%) surveyed aged 16-24 years having a body piercing. Of all the piercings in the survey a navel piercing was the most popular (33%), followed by nose (19%), ear (13%), tongue (9%), nipple (9%), eyebrow (8%), lip (4%) and genital (2%).

• The type of piercing also varied by gender with nipple piercing being the most popular among men but one of the least popular among women, while navel piercing was by far the most popular in women but was rare in men. Genital piercing, while uncommon, was found to be twice as popular among men as women.

• Four out of five (80%) piercings were performed in specialist piercing shops, with the researchers saying a "worrying" one in ten (9%) tongue piercings were performed by non-specialists. In every anatomical site, including the tongue and genital areas, they found a number of people who said they had performed the piercing themselves or they'd had it done by a friend or relative.

• The most common problems with piercings were swelling, infection and bleeding, with tongue piercings being the most likely to cause problems - almost half resulted in complications. Serious complications were significantly more likely to occur if the piercing had been performed by a non-specialist.

• The researchers say the clear trend in piercing could "place a significant burden on health services for many years."

Were the data on Paxil suicide risk cooked?

The Wall Street Journal reports:

GlaxoSmithKline PLC faces new questions about whether it deliberately misrepresented data on suicide risk for its antidepressant Paxil when it applied for the drug's approval to the U.S. Food and Drug Administration at an advisory committee meeting in 1991, a charge the company has denied.

A study by a Harvard psychiatry instructor, underwritten by plaintiffs' lawyers and previously kept under seal by a court order, says that Glaxo "improperly" counted patients taking placebos during clinical studies. From 1989 through 1991, Glaxo then submitted information to the FDA that indicated no major difference in risk of suicidal behavior, or suicidality, as doctors call it, between patients who took Paxil and those who took a placebo.

However, Glaxo's counting minimized the differences between suicidality rates in the Paxil and placebo groups, according to the report. For instance, the company counted placebo patients who had attempted or committed suicide before the study formally started, which enhanced the results for Paxil.

The real risk for suicidality from Paxil, says the report's author, Joseph Glenmullen, was eight times its risk for patients on placebo. "Glaxo was aware of this risk, and hid it," Dr. Glenmullen's report states. The drug was approved for sale in the U.S. in 1992. Dr. Glenmullen said, in an interview Thursday, that if Glaxo had given the agency the "correct" data in 1991, the FDA would likely have added warnings about the risk for suicidality when it approved Paxil.

Russert was a role model for TV journalists

As one who has tried to teach TV news to young journalists, and who has tried to point to role models for the right way to use that medium, I must post a note of sorrow for the passing of Tim Russert.

He may be one of a dying breed in TV news. He wasn't thin, young and handsome. He was tough, fair, and thorough. If he were starting in TV news today, some consultant would probably say he didn't appeal to the right target demographic audience.

In the dumbing down of so much news on TV, Russert, as many observers have pointed out in the past hours, was always a teacher, elevating the standards.

Wow, what a loss.

NY Daily News unhealthy Father's Day prostate promo

Add the New York Daily News to my list of news organizations taking an unhealthy advocacy stance for screening tests.

A promotion in the paper screams out, "Get your free prostate cancer screening, courtesy of the Daily News":

Beginning on Father's Day, New York's hometown newspaper offers these free tests every year, because we believe we should help New Yorkers take care of themselves.

So far more than 120,000 men have taken our free tests, and almost 10,000 have found that they need further action.

The screening is quick and easily performed.

Let's stop and break that down. More than 120,000 men have taken the free tests and almost 10,000 found they need further action? How many were false positives? How many faced further testing, treatment and anxiety that lead to nothing?

The screening is quick and easily performed? Does that mean that the decision about whether to have it should be quick and easy? Or should a man slow down and consider some of the cascading consequences of this "quick and easy blood test?"

Back to the newspaper promo:

The American Cancer Society recommends that men take the screenings from the age of 50, but high-risk males who include African American men and those with a family history of prostate cancer.

The Cancer Society may recommend that, but the group viewed as the "gold standard" in making preventive health recommendations, the U.S. Preventive Services Task Force, does not. USPSTF states:

The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes. Screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient's health. The USPSTF concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population.

Why, oh why, don't news organizations tell the other side of this story? Why don't they tell the evidence-based side of the story, instead of playing on peoples' fears to help sell newspapers?

What's happening with cancer costs?

An analysis published in the Journal of the National Cancer Institute finds that:

"The cost of cancer care incurred during the period two months prior to cancer diagnosis and 12 months following diagnosis increased substantially between 1991 and 2002 for elderly patients in the United States. The increases in costs for breast, lung, and colorectal cancer were due in large part to increases in the percentage of patients receiving radiation therapy and chemotherapy and the rising costs for those therapies."

HealthDay reported:

"Over the course of the study, the average cost for treating a lung cancer patient went up $7,139, to an average of $39,891. With prostate cancer, the average price tag for treatment went up $5,345, to an average of $41,134. The cost of treating breast cancer went up $4,189, to an average cost of $20,964. ...

One expert says that increasing costs for cancer treatment are having a significant effect on Medicare's ability to provide them and a patient's ability to pay for them.

"There were changes to Medicare payment policy over the period of this study. And they had significant impact on how physicians were reimbursed," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. "The net result is that it may have influenced practice patterns that we are seeing, such as the transition from surgery and radiation therapy for prostate cancer."

Lichtenfeld noted that many new drugs have driven the costs up even further. "The impact to Medicare is going to be substantial," he said.

Moreover, increasing costs may actually be preventing some Medicare patients from getting cancer treatment they need, Lichtenfeld said.

"In February, Avastin was approved for the treatment of recurrent breast cancer. It costs about $55,000 a year for a Medicare patient to receive the drug," Lichtenfeld said. "But there is a 20 percent co-pay. If a Medicare patient has insurance, it may be covered, but if they don't have insurance, there is an $11,000 co-pay to cover -- and $11,000 is a lot of money."

There is anecdotal evidence that doctors and patients are being forced to consider costs when they make choices for treatment regimens, Lichtenfeld said.

"Some people are not able to afford those treatments," he said. "The increased use of expensive chemotherapy is having an impact on how we treat cancer patients." "

Disease-mongering: Let's all be worried about our plaque buildup

Reuters was among those reporting on the latest recommendation to put more Americans on statins to lower cholesterol. The story states: "The number of U.S. adults on cholesterol-lowering medication could rise by one-quarter to one-half if doctors were to routinely scan adults' arteries for plaque buildup, a study suggests." The study was by a task force called SHAPE.

But Reuters importantly concludes the story by pointing out that authors of an editorial accompanying the study in the Archives of Internal Medicine "question where the task force's funding came from, and whether "conflicts of interest might bias the authors' judgment."

The recommendations provide "food for thought," the editorialists write. "But as a guideline for clinical use, SHAPE does not shape up."

That won't stop drug companies from disease-mongering. This ad would have us worried every second about the plaque that might be building in our arteries - silent, stealthy, sinister. Just like drug ads - trying to increase market share and instill fear into the worried well.

"Bypass brain" or "pump-head"

It was about 13 years ago when I first I heard heart surgeons talk about what they called "pump head." They were talking about the cognitive deficits that they had seen among people who had heart bypass surgery. People who were once very sharp suddenly couldn't remember where they left their keys, or couldn't balance a checkbook. But I also learned that many people were never told about this possible complication before they had the surgery.

Today, a Wall Street Journal column addresses the phenomenon, building on the speculation that Bill Clinton became a pump-head after his heart surgery - something his aides deny.

The WSJ reports:

"Symptoms include short-term memory loss, slowed responses, trouble concentrating and emotional instability. In a landmark study published in the New England Journal of Medicine in 2001, researchers at Duke University Medical Center tested 261 patients before and after bypass surgery and found that 53% of them had significant cognitive decline when they were discharged -- and 42% still suffered from it five years later.

One explanation is that when a patient's blood is pumped through a heart-lung machine during bypass, tiny air bubbles, fat globules and other particles may enter the bloodstream. The pump can also damage platelets, which form clumps, and clamping the aorta loosens bits of plaque. That debris can travel to the brain and clog tiny capillaries, forming microscopic strokes."

Bottom line: in a true shared decision-making encounter, a physician should talk about the possibility of pump head or bypass brain with anyone considering bypass surgery.

Don't forget the underinsured

A Commonwealth Fund analysis appearing in Health Affairs "finds a sharp increase in the number of underinsured people. Based on indicators of cost exposure relative to income, as of 2007 an estimated twenty-five million insured people ages 19-64 were underinsured--a 60 percent increase since 2003. The rate of increase was steepest among those with incomes above 200 percent of poverty, where underinsurance rates nearly tripled. In total, 42 percent of U.S. adults were underinsured or uninsured. The underinsured report high levels of access problems and financial stress. The findings underscore the need for policy attention to benefit design, to assure care and affordability."

UK & Canadian questions: who's guarding the henhouse?

Two news items of special interest in last week's BMJ.

One discussed product placement in doctors' waiting rooms in the UK.

The other reported on funding threats to the Canadian drug watchdog project, Therapeutics Initiative.

Bottom line: this brief international glimpse shows increasing drug company marketing successes at a time when watchdog groups are being challenged.

Happy Monday.

FDA sending far fewer warning letters to pharma

This came out on a Friday afternoon, but should not be lost in the black hole of weekend news.

The Wall Street Journal reports:

The drug industry has been grumbling over how tough on safety the FDA is these days, but by one measure the agency has fallen off significantly a few years ago. The number of warning letters the FDA sends out has been cut in half in recent years. ...

David Kessler, who ran the FDA during the Clinton years, said the decline is something of a flag. “The number of warning letters has always been one of the surrogate measures of FDA’s enforcement performance,” he said. “It’s not the only measure, but any significant drop raises significant questions of what’s going on.”

The inexact science of projecting survival time

I am always amazed when friends and relatives use literal interpretations of a doctor's statement that "Joe has 6 months to live." If it turns out that Joe lives 5 months and 29 days, they feel robbed. If he lives 6 months and two days, he is an amazing fighter - maybe even a miracle.

Carl Bialik, "The Numbers Guy" of the Wall Street Journal has a column today on this "very inexact science" of projecting survival times.

Please read it.

It's a very important discussion that should help patients and their families form more realistic expectations when they ask or are told "how long has he got to live."

Even a physician knows right from wrong

A physician writes this "letter of the day" in the Star Tribune:

"Pardon me, but I can't stop laughing about Dr. William McGuire's defense of his backdating stock options from UnitedHealth Group. He was simply following the advice from his legal and financial advisers.

His advisers state that he has no formal training in finance, accounting or law. They state that his only professional training is as a medical doctor.

Well, excuse me. My only professional training is also as a medical doctor.

However, even I would know it's not a good idea to accumulate millions of dollars by robbing banks or by backdating stock options. Let the trial begin."

Trojan horses sneaking ads into peer-reviewed journals

A recent letter to the BMJ identifies a troubling new practice. Geraint Lewis of NYU and Peter Hockey of Harvard Medical School write:

"Two research papers were published recently in the BMJ, neither of which stated its funding, competing interests, ethical approval, provenance or peer review status. Both papers extrapolated in- vitro data to clinical situations and made other potentially misleading claims. However readers of the journal were unable to post Rapid Responses to point out these shortcomings. The explanation becomes apparent on closer inspection: these "research papers" were in fact advertisements. We and several of our colleagues began reading them as legitimate BMJ scientific papers and only later noticed the light blue header stating "Advertisement Feature".

We all feel misled. The company paying for these adverts has effectively purchased "academic copy" in a high-impact journal, bypassing the peer-review process and using the reputation of the journal as a Trojan horse to catch our attention. In doing so it has made it impossible for us to follow Richard Smith's advice to "flip over the adverts in the journal." Of more concern is the fact that we, like many readers, sometimes skim-read articles without poring over the details. We do this because we trust the BMJ to scrutinize articles on our behalf. These adverts pose a danger because skim-readers may turn to the next page of the journal without realizing that they had just read an advert rather than peer-reviewed research.

... Surely every page of the journal should be subject to all of the same rigorous standards that editors rightly set for scientific research.

...The option, which to our mind is the only workable solution, is a complete ban on pharmaceutical adverts in peer-reviewed journals. The publication of these two adverts, despite being calculatedly inconspicuous, has once again reopened the debate about whether medical journals should carry drug advertising."

News coverage about my health news coverage journal article

Almost no mainstream news organizations reported on my paper, "How do US journalists cover treatments, tests, products and procedures? An evaluation of 500 stories," in last week's PLoS Medicine journal.

That's probably not surprising. Why would you publish a story about an analysis that showed that you and your industry did a sub-par job in covering health news?

However, some journalists and top bloggers gave the study a good look.

Scott Hensley at the Wall Street Journal Health blog had some fun with it.

Maggie Mahar took a long look on her HealthBeat blog.

Minnesota Public Radio covered it on the air and online.

And, although I have no idea what they wrote, bloggers in France and Germany wrote something about our work. I hope it was helpful to those French and German surfers.

And I hope the dissemination of our results does some good in improving health journalism.

The whining dinosaur questions children's hospital turf wars

I'm not a big fan of hospital rankings - the kind US News & World Report does each year, for example.
But they do give some food for thought - and they certainly fed the inquisitiveness of Professor Bill Gleason of the University of Minnesota. Professor Gleason - who calls himself Mr. Bonzo (or the Whining Dinosaur) - writes on his blog about the Twin Cities market's medical arms race involving children's hospitals. And he uses the USNWR rankings to question duplication of services, and to question advertising by the University of Minnesota/Fairview Children's Hospital.

There has been surprisingly little public discussion and local news attention about this children's hospital turf war. He may be a Whining Dinosaur, but Mr. Bonzo is filling a void by keeping this issue alive - at least for anyone who finds his blog.

Connecting the dots in health care reform news

As we flip the calendar over from a very busy May into a sunny June, I want to reflect on the common themes in the blog entries of the past four days:

1. My PLoS Medicine article, “How Do US Journalists Cover Treatments, Tests, Products and Procedures? An Evaluation of 500 Stories.”

2. The Commonwealth Fund analysis on variations in child health care across the US.

3. Another "more care isn't always better care" study - this time in JAMA.

4. Consumer Reports releasing an online tool using Dartmouth Atlas data to allow you to look at aggressive vs. conservative care - comparing hospitals on this scale.

Connect the dots. Jack Wennberg's work rings through these themes.

Inexplicably widespread variations exist in the way health care is practiced in this country and more data comes in every day. More evidence also comes in every day that "more and newer isn't always better" in health care. And journalists are spending too much time on the "more" and the "newer" rather than on questions of evidence, costs, quality and access to care.

As a result, many consumers aren't getting much smarter at a time when some policymakers, employers and insurance company marketing folks push "consumer-driven health care" plans. Americans don't know what they're buying with the health care dollar and giving them more "skin in the game" doesn't make them smarter - only makes them hurt more - if they're not educated in the dots.