Photo: Len BruzzeseCDC Director Tom Frieden briefs the 2013-14 AHCJ Regional Health Journalism fellows on Monday morning.
A nasty virus just landed on America’s doorstep.
Tom Frieden, M.D., M.P.H., director of the Centers for Disease Control and Prevention, confirmed the arrival of “chikungunya” fever in the Caribbean. Frieden made the announcement Monday while talking to a group of West-based AHCJ Regional Health Journalism Fellows at the CDC in Atlanta.
News of two confirmed cases in the island of St. Martin in the West Indies was reported Friday by The Daily Herald following a press conference by health officials in the region.
Named from the phrase “that which bends up” in Mozambique’s Kimakondan language because of its symptoms, chikungunya was first isolated from a Tanzanian patient in 1953, according to the CDC. Chikungunya exhibits symptoms similar to the dengue virus, including fever, rashes, headache, nausea and muscle pain. The virus is also transmitted through mosquitoes.
Until recently, cases of chikungunya were primarily seen in Africa and Asia. No cases have been reported in the United States, making the Caribbean cases the closest confirmation yet in terms of proximity. Continue reading
If you attended Health Journalism 2013, you heard from plenty of Boston-based medical professionals, some of whom are in the news now talking about the Boston Marathon bombings. You might remember hearing from:
Ron Medzon, M.D., led AHCJ members through the SIM lab part of one of the field trips and talked with attendees about doctors and nurses communicating with patients and families about medical errors. Medzon, emergency room physician at Boston Medical Center, was on duty when victims of the bombing began arriving. He talked about the experience with Robin Young of WBUR-Boston.
Paul Summergrad, M.D., chair of psychiatry at Tufts Medical Center, spoke about mental disorders at the conference, offers advice on how to care for the emotional wounds of the bombing in several articles:
- Coping with the marathon bombing: expect fear, anxiety, and anger, psychologists say, Deborah Kotz, The Boston Globe
- Boston doctors ‘finish the job’ of traumatic amputations, G. Jeffrey Macdonald, Karen Weintraub, Stephanie Haven and Gary Strauss, USA Today
- Boston hospitals well prepared for blast casualties, Noam N. Levey, Los Angeles Times
And John Halamka, M.D., the chief information officer at, Beth Israel Deaconess Medical Center, talked about communication and technology in the wake of the bombings in “Social media key in enabling quick provider response to Boston bombings,” by Dan Bowman for FieceHealthIT. At the conference, he spoke about electronic health records.
Have you seen other panel speakers quoted in the news? If so, please let us know by posting links to the stories in the comments section.
Update: AHCJ member Naseem S. Miller, of Internal Medicine News Digital Network, interviewed Medzon and a doctor who was in the medical tent at the finish line about their experiences.
Update: AHCJ member Leana Wen writes on NPR’s Shots blog about treating patients in the aftermath of the bombing while wondering if the next patient she saw was going to be her husband.
Nevada has been shipping mental health patients out of state as it has cut funding for mental health services, according to a Sacramento Bee investigation.
In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012. During that same period, the hospital has dispersed those patients to an ever-increasing number of states.
Cynthia Hubert, Phillip Reese and Jim Sanders report that Rawson-Neal Psychiatric Hospital in Las Vegas, the primary state psychiatric hospital, put more than 1,500 patients on Greyhound buses bound for other cities.
The reporters reviewed bus receipts kept by Nevada’s mental health division. Southern Nevada Adult Mental Health Services has had a contract with Greyhound since July 2009, a bus company spokesman said. He also revealed that “Greyhound has contracts with ‘a number’ of hospitals around the country, but declined to identify them.”
Mental health professionals in other places are quoted as saying putting someone with a mental illness on a bus is risky and several said their counties don’t do it.
The Center for Medicare and Medicaid Services is investigating Rawson-Neal and the situation has prompted statements from California’s Senate president and a member of the U.S. Commission on Civil Rights.
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.
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
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.
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.
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.
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.
The Tennesean‘s Nate Rau becomes the leader in the clubhouse for 2012′s “most viscerally disquieting use of a verb” award after opening his youth sports concussions story with “The hit that sloshed 17-year-old Joseph Lascara’s brain.” The entire anecdote, much like the hit it describes, is well-timed and jarring, and Rau then follows through with a thorough investigation of Tennessee’s legislative approach to youth head injuries, or lack thereof.
The state’s athletic association has adopted limited concussion prevention and treatment regulations, but they do not apply to nonmember schools or independent youth sports organizations. Furthermore, Rau writes that efforts to pass statewide legislation “fizzled” this year, meaning that “Tennessee is now one of only 11 states, mostly in the Southeast, without a law,” even though “doctors who specialize in youth concussion care say the issue is urgent.”
The number of youth concussions treated at hospitals in Tennessee has increased 74 percent from 480 in 2007 to 834 in 2010, according to the state’s Traumatic Brain Injury Program, which functions as a resource for Tennesseans recovering from brain injuries. Those numbers do not include young athletes who were treated by their pediatricians instead of going to the emergency room.
Journalists looking to replicate Rau’s work would do well to note how he used public records requests to access the so-called “Return to Play” forms (required by many state and local concussion-prevention laws) which doctors must file before young athletes may return to the field. While some local counties couldn’t locate the forms, the 140 he did find indicated a somewhat inconsistent implementation.
The review showed that doctors are frequently clearing athletes to return to practice or competition without following the recommended guidelines that gradually ease players back into physical activity. Of the 156 athletes who visited a doctor with concussion-like symptoms, 57 were immediately cleared to return to play.