Photo: Abby via Flickr
Health journalists received a few lessons in economics during a discussion last week on some alarming drug trends – largely the result of a broken market – that are threatening patient care and undermining the U.S. health care system.
At a New York City chapter event, Phil Zweig, a longtime financial journalist who also runs a group called Physicians Against Drug Shortages, spoke about the scarcity of generic drugs in hospitals and clinics – a problem that has persisted for years. Hospital group purchasing organizations (GPOs), which are not regulated and essentially negotiate supply purchases for hospitals, have the ability to charge market share to the highest bidder. Zweig said they can do this because the safe harbor provision in the 1987 Medicare anti-kickback law excluded GPOs from criminal prosecution for taking kickbacks from suppliers.
“The more you can pay to a GPO, the more market share you get,” Zweig said.
Because of the exclusive contracts that GPOs award, the number of competitors in the market shrinks, which has led to a shortage of generic prescription drugs – everything from sterile injectables to chemotherapy agents. Continue reading
The ties between smokeless tobacco and baseball run deep. The immortal Babe Ruth claimed Pinch Hit was his chew of choice (as this short film from the U.S. Centers for Disease Control and Prevention reminds us). Now, World Series-winning pitcher Curt Schilling, who revealed in June that his cancer was in remission but didn’t say what kind of cancer it was, has announced that it is oral cancer. He blames the cancer on his 30 years of chewing tobacco.
The June death of Hall-of-Famer Tony Gwynn served as a reminder of the dangers posed by the habit. Gwynn said he believed the salivary gland cancer that killed him was caused by his longtime use of chewing tobacco.
National, state and local health organizations used the story of Gwynn’s passing to talk about the dangers of smokeless tobacco and likely will use Schilling’s news to raise awareness. Is there an angle in this that you could explore in your own state or community?
Mary Otto, AHCJ’s core topic leader on oral health, has written a tip sheet that includes links to studies on the connections between smokeless tobacco and cancer, where Major League Baseball and the players stand on eliminating chewing tobacco from the sport and more information you can use when reporting on the almost inevitable awareness campaigns. Read it now…
Matthew CavanaughKaren D. Brown
When first diagnosed with breast cancer, journalist Karen D. Brown didn’t plan to write about it. But, as she met with surgeons, anesthesiologists and oncologists who presented her with treatment options, she found it was a lot more confusing than she had realized when reporting on the statistics.
All of a sudden I realized that my medical odyssey and the health news cycle had crossed orbits. I could write about my personal experience and also shed light on a bigger issue that I felt had not yet been told to death – namely, how hard it is for an individual to make decisions based on population-wide statistics, and politically loaded ones at that.
In this article for AHCJ, Brown tells us how she came to write a piece that appeared in The Boston Globe about the conflicts between statistics and emotions and how they affected her decisions.
She writes about how she chose the statistics that she included in her story, what information she did not include to avoid the appearance of a conflict of interest in her future reporting and how she made sure her narrative was fair and accurate. Read about Brown’s experience.
The U.S. Preventive Services Task Force just released a recommendation that pregnant women be screened for gestational diabetes, even if they have not been previously diagnosed with type 1 or 2 diabetes.
The task force often finds itself in the news when determining what works and doesn’t work in screenings and preventive care.
Previously, it told healthy women not to bother with calcium and vitamin D pills, said many women could wait on mammograms until age 50 and recently clarified who might benefit from regular lung cancer screening tests. The task force’s work lies in translating medical evidence into clinical practice, which can be a difficult and contentious task. Its recommendations are often nuanced and misunderstood.
How does the group come to these determinations and how can you report on the science and not just the heat a recommendation generates? What is evidence-based medicine and how does the USPSTF use it to make recommendations on health care services?
In a Jan. 28 webcast, USPSTF chair Dr. Virginia Moyer and co-vice chair Dr. Michael LeFevre will explain how the task force works in an effort to deepen our reporting of upcoming task force recommendations. A Q&A with the doctors, moderated by AHCJ medical studies topic leader Brenda Goodman, will follow. Continue reading
With mammograms in the news lately, it’s worth noting that the U.S. Preventive Services Task Force has posted its plan for reviewing and updating its recommendations for screening for breast cancer. The draft research plan lays out the “strategy the Task Force will use to collect and examine research and is the first step in updating the 2009 recommendation,” according to Ana Fullmer at USPTF. Recommendations are updated every five to seven years, so she says a new recommendation probably won’t be finished for a few years.
The panel is seeking answers about the specific benefits and harms of screening mammography for women over 40, they’re asking if benefits and risks vary by imaging technique – digital mammograms, ultrasound or MRIs; and importantly, they’re trying to find out how common ductal carcinoma in situ (DCIS) is in the U.S. and what benefits and harms are involved in treating it.
Experts recently recommended renaming DCIS to exclude the word “carcinoma” so the finding wouldn’t be so frightening to patients. DCIS is an abnormal pattern of cell growth in the milk ducts of the breast. In many cases, it doesn’t progress to cancer. Yet a growing number of women have decided to remove both breasts rather than take their chances that it isn’t dangerous.
Interested parties who want to weigh in on the draft plan are encouraged to submit comments and questions to the Task Force by Dec. 11.
Image by themozhi’s pixel displays via flickr.
It’s a jaw-dropper of a story. A reluctant television reporter is persuaded by her producers to have a mammogram in front of the cameras. A few weeks later, she reveals the results on air: The test she initially didn’t want found cancer.
In an essay for ABC News, her employer, Amy Robach wrote:
The doctors told me bluntly: “That mammogram just saved your life.”
If you’re a woman, this is the kind of news that sends a cold stab of fear through you. Here’s a professional in the prime of her life with no family history and, by her own estimation, very little in the way of personal risk. And she’s young — just 40 years old.
The problem with Robach’s story is that it is too scary. It seems to be a play for ratings in November, a month when television stations rely on viewership numbers to set advertising rates. Continue reading
Eva Grayzel’s symptoms started with a sore on her tongue.
“It felt like a canker sore,” she recalled.
Her dentist referred her to an oral surgeon who did a biopsy. It came back negative.
A pathologist diagnosed it as moderate dysplasia. Two years passed before another oral surgeon saw the lesion for what it was: oral cancer.
When she finally got the bad news, her life was on the line.
Grayzel related her story at the recent fall meeting of the California Dental Association.
Donna Domino of DrBicuspid.com reported on her nightmarish journey back from the brink of death:
After having a third of her tongue removed and enduring six weeks of daily radiation to her head and neck to treat her stage IV oral squamous cell carcinoma, Eva Grayzel had had enough.
The vivacious 31-year-old mother of two young children could only eat a spoonful of food a day because it was too painful to swallow. She developed painful blisters in her mouth and throat that would open and bleed during severe coughing fits. She lost her voice and would wake in a panic gasping for breath when thick saliva pooled in her throat. Given only a 15 percent chance of survival, she wrote a farewell note to her husband and children.
“I felt myself begin to wither away in fear, devastation, and loneliness,” she told a large and rapt group of dentists and hygienists during a session at the recent California Dental Association’s (CDA) fall meeting in San Francisco.
The Institute of Medicine’s newly-released report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,updates its recommendations on the looming “crisis” in cancer care. Adults over age 65 comprise the majority of cancer patients and the majority of cancer deaths. Their care needs are complex, yet the nation is faced with a shrinking health care workforce, providing fragmented care, at the time when the population of older adults is set to double in less than two decades.
Additionally, care and treatment costs are rising faster than many other areas of medicine — from $72 billion in 2004 to $125 billion in 2010. It’s projected to climb another $50 billion by the start of the next decade. This places an extraordinary burden on Medicare, as the primary insurer, on patients, and on families. The IOM also points out growing disparities in care – in access to care, affordable treatment options and in finding knowledgeable providers, particularly among those caring for seniors. The report also describes the complexity of caring for older adults with cancer, who may have multiple chronic conditions, decrease in cognition, require assistance with ADLs or IADLs, depend on family or friends for caregiving help, and who may be more vulnerable to side effects. Continue reading
Image by Gage Skidmore via flickr.
“The ability to talk to a lot of people is freakish,” said Chris Rock in a conversation with Jerry Seinfeld for his new online show “Comedians in Cars Getting Coffee.”
“It’s more freakish than being able to run fast or dunk a basketball or any of those things.”
It’s freakish and powerful, maybe too powerful when it comes to celebrity endorsements of medical tests.
Dubbed “The Katie Couric Effect” for the 20 percent boost to colonoscopies after the popular anchor televised her own screening in March 2000, it’s also been demonstrated in cervical cancer and myriad other kinds of cancer screening tests.
No doubt it is happening again in the wake of Angelina Jolie’s May announcement of her BRCA testing for breast and ovarian cancer. The stock market has bet on it. And some doctors saw spikes in calls from patients after her New York Times op-ed was published. Continue reading
Image by Sweet One via flickr.
It can be tough to find a medical study that is both important and compelling. But that was the opportunity presented to health reporters this week in the shape of a big study on a humble condiment, vinegar.
What makes this study even more wonderful, in a way, is that it was presented at the American Society of Clinical Oncology, a medical meeting that’s awash in high-stakes, big money, endlessly pitched and spun drug research.
In the midst of that madding crowd was Dr. Surendra Shastri, a preventive oncologist at Tata Memorial Hospital in Mumbai who needed an inexpensive, low-tech way to screen for cervical cancer – the leading cancer killer of women in India.
He found it in the form of sterile vinegar which bleaches suspect cells white when it’s swabbed on the cervix. Continue reading