Author Archives: Andrew Van Dam

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Causes, consequences of Nashville’s diabetes hot zone

In The Tennessean (and USA Today), Tom Wilemon has assembled a series of reports on what he calls “the diabetes hot zone,” “a cluster of predominantly African-American, inner-city neighborhoods where diabetes rates soar to more than double the Davidson County average.”

After establishing the outlines and perils of the hot zone in his first piece, Wilemon follows up by looking into the scarcity of transplants and pervasiveness of dialysis in the area.

Although organ transplants can occur between races, matches are more difficult to achieve for blacks. Transplant recipients must have similar genes in their immune systems to those of the donor. Otherwise, the body will reject the organ.

Whites account for 68 percent of all organ donors, while African-Americans account for only 14 percent, according to the U.S. Organ Procurement and Transplantation Network. Although the number of blacks and whites waiting for a kidney in 2011 was about the same, whites received just over half of kidney transplants that year, while blacks received less than a third.

Finally, he examines the causes of the diabetes epidemic and, in the process, wading deep into the “soul food” versus “fast food” debate.

Wilemon is a 2012-13 AHCJ Regional Health Journalism Fellow and wrote this story with support from USC’s Annenberg School of Journalism.

N.C. hospital garnishes patient tax refunds to collect debts

Joseph Neff, reporting for North Carolina’s News & Observer, explains how UNC Health Care is taking advantage of “a little-known law, the Set Off Debt Collection Act, that allows state and local agencies to collect debts by seizing state tax returns and lottery winnings.

UNC is the only hospital in the state that qualifies to use the service and is, in fact, legally compelled to do so.

Last year, UNC Hospitals collected $5.7 million, while UNC Physicians and Associates collected $2 million. Together, that accounted for 11 percent of the $72 million of set off debt collected for all state and local agencies that year

Even in treatment guidelines, pharma conflicts abound

As part of the ongoing Milwaukee Journal Sentinel and MedPage Today series “Side Effects” John Fauber and Ellen Gabler “examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the United States” and unearthed yet another tactic by which “pharmaceutical companies, with billions in sales at stake, exert a powerful but often unrecognized influence over the practice of American medicine.”

Issued by leading medical associations and government institutions, treatment guidelines are supposed to be based on rigorous science. But the committees that write them have been dominated by doctors who have worked as paid speakers, consultants or advisers for companies selling the recommended drugs.

In their investigation, the duo found:

  • Nine guidelines were written by panels where more than 80 percent of doctors had financial ties to drug companies.
  • Four panels did not require members to disclose any conflicts of interest. Of the 16 that did, 66 percent of doctors on the panels had ties to drug companies.
  • Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing. Medical experts have raised such questions about guidelines for anemia, chronic pain and asthma.

For extensive anecdotes and examples, dig into the full piece.

KC Star: Centralization of Big Beef also aggregates risk

Mike McGraw’s recent investigation into “big beef” at The Kansas City Star begins with an interesting assumption: Regardless of their safety record, massive slaughterhouses and meatpacking plants introduce unacceptable systemic risk based on their size alone. Or, as he summarizes the argument, “When processing speed and volumes rise, so do the chances for contamination to be introduced and spread widely from its source to other meat inside the plant and at other plants that process it further.”

In particular McGraw focuses on mechanical tenderizing, a relatively new process in which tougher pieces of beef are penetrated with sharp metal blades to break up their fibers. The blades can also pick up E. coli from the meat’s exterior and ram it deep inside, where it’s less likely to be killed when the future steak is seared and served. Statistics are hard to come by, but because the practice is so widespread in the nation’s meat supply, the risk it introduces enjoys similar reach.

USDA data analyzed by The Star show that large plants until recently had higher rates of positive E. coli tests than smaller plants. Federal meat safety officials said the latest data show big plants are improving.

But the volume of meat a plant produces is a key issue. A USDA study published in March showed that from 2007 through 2011, E. coli positives at very small plants resulted, The Star found, in only 465,000 pounds of contaminated beef. A slightly lower rate of positive tests at large plants, however, produced more than 51 million pounds of contaminated beef.

Regardless, experts agree that most E. coli generally originates at larger slaughter plants, where pathogen-laden manure is a bigger problem because that’s where cattle are coming in from the feedlots.

LA Times: While board investigates, doctors’ ‘reckless prescribing’ kills

By zeroing in on one particular type of dangerous physician behavior, known as “reckless prescribing,” Los Angeles Times reporters Lisa Girion and Scott Glover were able to draw a powerful link between the state medical board’s inaction and patient death in an investigation titled “Dying for Relief.”

For the piece, reporters reviewed state medical board records and coroner’s files, assembling evidence that “At least 30 patients in Southern California have died of drug overdoses or related causes while their doctors were under investigation for reckless prescribing. The board ultimately sanctioned all but one of those 12 doctors, and some were criminally charged – too late to prevent the deaths.”

For its part, the board has been hit hard by state budget cuts and, the reporters write, is hamstrung because “Unlike medical regulators in other states, it cannot suspend a doctor’s license or prescribing privileges on its own, even to prevent imminent harm.” The resulting lack of oversight has led to pervasive overprescribing and uneven enforcement. For more details and a powerful narrative hook, I strongly recommend reviewing the paper’s brilliantly produced online package.

Investigation exposes police inaction in face of abuse allegations at Calif. facilities

In recent weeks, California Watch’s long-running focus on abuse of the developmentally disabled at state-run institutions has coalesced into a broad indictment of the flawed oversight and enforcement programs at those facilities.

Ryan Gabrielson’s centerpiece is a classic deep investigation which relies on a mix of data and anecdotes to show that, even though the centers are equipped with a state-run police force, in 36 incidences of alleged abuse over the past four years, “documents obtained by California Watch reveal that patients suffered molestation, forced oral sex and vaginal lacerations. But for years, the state-run police force has moved so slowly and ineffectively that predators have stayed a step ahead of law enforcement or abused new victims, records show.”

Beyond that, California Watch has gone above and beyond to make their investigation as accessible and shareable as possible with a share-friendly chart, an 11.75-minute YouTube video, or even an “explainer” companion piece.

Investigation: Peace Corps health system failing to provide for volunteers

In recent years, there has been a steady drumbeat of troubling news about federal support for Peace Corps volunteers, including a GAO report, federal legislation, and even a statement from the Corps’ acting director. Over at FairWarning, Lilly Fowler has worked with former volunteers to organize this steady stream of negative press into a report that the Peace Corps is not providing adequate health coverage to its volunteers, both past and present.

Fowler’s report dives deep into the bureaucracy surrounding the Corps’ treatment of health care claims, but the heart of the matter is quite simple:

Interviews by FairWarning with more than a dozen former Peace Corps personnel – about half of them members of Health Justice for Peace Corps Volunteers, an advocacy group – highlighted the struggles of harmed volunteers. Many failed to gain government-paid medical care when they returned to the U.S. because they couldn’t find doctors registered with FECA. What’s more, they say, claims for medical insurance reimbursements often bog down or are rejected because of bureaucratic bottlenecks and the lack of information provided to volunteers.

There have been many attempts to reform the system in recent years, Fowler finds, but none have led to comprehensive or lasting change.

Standalone emergency rooms generate profit, controversy

When a local hospital opened up a free-standing emergency room in a part of the county traditionally served by its competitors, The Palm Beach Post‘s Bill DiPaolo took a look at the economic motivations behind this move and similar ones around the country.

Standalone emergency rooms, which offer more options than urgent care facilities but still must transfer patients to full-size hospitals for more serious treatment, started cropping up in rural areas about two decades ago, DiPaolo writes. They are attractive to hospitals because they allow them to expand their coverage area at a fraction of the cost of building a full new facility. There are six in Florida alone, partly because hospitals can build them without acquiring the state “certificate of need” required for the construction of a full hospital.

The hospital that opened the ER in Palm Beach County says it is filling a local need and increasing its competitiveness, but its rivals claim the new facility could bring higher costs — because patients may be taken there instead of to urgent-care facilities — and lower quality — because transit times may increase for patients who arrive at the ER but must then be moved to a full hospital for further treatment.

Hospitals to workers: Get flu shot or get fired

In a story that could be replicated in many areas, The Morning Call‘s Tim Darragh writes that hopitals, both locally and nationally, are pushing hard for workers – both medical and otherwise – to get flu vaccines, as the Joint Commission moves toward stiffer requirements and CMS threatens to cut reimbursement rates for non-compliant hospitals.

Photo by Lance McCord via Flickr

Some of the Lehigh Valley region’s hospitals…. are mandating employees get flu vaccines if they have contact with patients — even if the employees don’t want the shots. If they don’t comply or get a valid exemption, they will be fired.

The list of staff affected by the policy is broad. It includes not only doctors and nurses and others directly involved in patient care but also housekeeping and maintenance workers.

Across the country, the stricter regulations seem to be making a difference, Darragh reports. A health system in Ohio has already issued termination notices to non-vaccinated workers, and even civil rights advocates known for taking the workers’ side admit that it is difficult to argue that hospital workers shouldn’t be vaccinated.

The ever popular (and quotable) Dr. Arthur Kaplan agrees.

Without greater compliance, the work environment won’t attain a level of immunity that will provide sufficient protection to the sick, said Dr. Arthur Caplan, a bioethicist at New York University’s Langone Medical Center. “You don’t get the ‘herd immunity’ until you hit 90 percent,” said Caplan, a proponent of mandatory vaccinations.

Pediatric MS on the rise in the northwest, drawing research attention

As part of a collaboration between KOUW and Investigate West, Carol Smith examined the rise of pediatric multiple sclerosis in the Pacific Northwest, a region that already has one of the highest rates of MS in the world.

Hard numbers are difficult to come by because the diagnosis is so complicated, but Smith writes that “current estimates suggest that between 18,000 and 25,000 children nationally either have MS, or have experienced symptoms suggestive of MS – some as young as age 5.”

Doctors aren’t sure what’s driving the apparent increase. It’s likely partly from improved diagnostic techniques and increasing awareness among pediatricians that MS can occur early in life. But some also think that the growing onslaught of chemical exposures in the environment may be making immune systems more vulnerable to whatever triggers the illness.

And the pivotal role adolescence could have in the shaping of a lifetime’s susceptibility to MS makes studying young MS sufferers a particularly critical task — a task which Smith explores further in a follow-up piece.