Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
Even if you only cover health care occasionally, you run across myriad medical studies and health claims. The results and claims often seem conflicting and confusing. But understanding evidence-based medicine will help journalists explore for their audiences the science and the policy decisions that impact lives.
The program is set and the speakers are confirmed for next month’s Journalism Workshop on Evidence-Based Medicine.
Sessions will include:
The connections and disconnections of science and policy
Getting up to speed on clinical studies
Research tools for evidence-based stories
How to report on scientific fraud
Understanding and reporting on screening evidence
Digging into statistics
How to use anecdotes and narratives while sticking to evidence
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 Timesop-ed was published. Continue reading →
If they still opt for surgery, they can have it. But the thinking is (based on what other health systems have learned) that many will opt for physical therapy and rehabilitation once they learn more about the pros and cons, risks and benefits, of all their options.
“Patients can still see a surgeon if they wish. But after this visit, they’ll be better informed about all of their options, and can make decisions more aligned with their own values,” the story quoted Dr. Thomas Marr, HealthPartners’ medical director of clinical relations as saying.
“In general, it’s a bad thing when the doctor and patient can’t determine the treatment without interference from the insurance company or the government,” spine surgeon Jeffrey Dick was quoted as saying. But this is an exception, he said. Surgery is appropriate for only about one out of eight low back pain patients he sees. Getting them into appropriate care from the start can save money – not to mention years of lingering back pain.
“These aren’t HealthPartners criteria,” he added. “These are treatment algorithms for low-back pain that we all should be following – but maybe haven’t been by all practitioners.”
The story also noted how HealthPartners is working with stakeholders and monitoring patient reaction and satisfaction to minimize criticism and misunderstandings.
So what are those health reform themes?
Value-based purchasing – loosely translated – is paying for what works.
Evidence-based medicine is what it sounds like – and the evidence is that a lot of back surgery is unnecessary. Sounds simple but it’s not always practiced – even in those cases where the evidence is strong. Sometimes it’s even derided as “cookbook medicine.” Financial incentives are certainly one big impediment: surgeons, hospitals, etc., make money from procedures that may not always be the best choice for the patient. Practice patterns – how physicians are taught and what’s done in the medical culture of a given hospital or community – play a role. And patients often want treatments they don’t need because they don’t understand that it’s not necessary, or they think surgery is a reliable quick fix.
Some researchers exploring medical decision-making have found that physicians are a lot more likely to talk about why to have a certain procedure, including back surgery, than why not. Clinicians and researchers are beginning to develop models for “shared decision-making” and there’s even a bit of language in the health reform law to promote it.
So are there programs like this rolling out in your local hospitals or health plans? We’d like to hear more. It will be interesting, too, to watch how people react to the HealthPartners and similar ventures. Will patient/beneficiary attitudes begin to change? Will they come to understand that more isn’t always better? Will they be glad to find out they really don’t need surgery? Or will there be a backlash about choice and control. The answer may depend on whether patients feel the decision is shared, or imposed.
Earlier this month I saw on Twitter one of those collisions between journalism and wonkdom. Maybe “collision” isn’t the right word; maybe it was some kind of interspecies mating dance. Anyhow, the gist of it was that we, journalists, don’t know how to evaluate evidence and someone should step in and teach us.
So I stuck in my two cents (or, rather, my two tweets) pointing out that, yes, there is a need for training and, yes, there are places to get the training, including through AHCJ. (See more after the Twitter discussion.)
So, before I remind you about those resources, just a word on why we need them:
On the surface, it may seem that AHCJ houses two kinds of health journalists – those of us who report on the science side of things, and those of us who are more in a policy world. But some of us do both – and research/evidence/evaluating science are also becoming an increasing part of the underpinnings of policy beats. Value-based purchasing, comparative effectiveness, benefits of screening/prevention, quality measures, outcome research … these are all part of the health care reform story.
That doesn’t mean all of us must become economists/biologists/epidemiologists/statisticians. Old fashioned reporting – including calling experts who can help us make sense of numbers – is certainly part of the job. But it’s also good to have some sense of what the experts are talking about, what these numbers mean. Why a study on N=16 patients doesn’t really tell us that much. What do we mean by “endpoints,” “outcomes,” “progression?” What’s relative versus absolute risk? Etc.
In addition, there’s a course called Medicine in the Media, sponsored by National Institute of Health’s Office of Medical Applications of Research. It’s free, but you have to apply, and there’s not room for everyone. I know of at least one recent summer (the only one I, personally, could have managed the timing!) it wasn’t given, and as of now, there’s nothing on the website about this year. But you can sign up for email notifications, so if you are interested, do that now because the deadline in past years has been early.
The Poynter Institute has some online modules, too. Lots of the focus is on new media and writing and story telling, but there is a math basics refresher for those of you who haven’t taken it since the SATs, some online Excel training, and a unit on reporting on nonprofits.
An aside – another kind of data to watch out for: Polls. At the AHCJ conference in Philadelphia last year, we had a session on understanding political polls. Here are materials from that presentation, from Claudia Deane, associate director of public opinion and survey research, Kaiser Family Foundation, and representing the American Association for Public Opinion Research.
The basics are useful not just for political polls but for all those other polls that end up in health reporters’ inboxes. An awful lot of them are meaningless, either because of the sampling methodology (or lack thereof) or because the questions were written in such an apple pie, no-trade-offs way. Americans love pain control! Americans want to cure cancer! Americans like healthy children! An online survey of doctors who may or may not be in a relevant specialty but who felt like clicking on the poll this week agree with X, Y and Z.
We’ll take a look at other resources out there in future posts.
And one word of wisdom. Get familiar with these concepts and materials, but don’t necessarily try to cram your head overly full of information or skills that you aren’t going to put to use right away. When I was a Kaiser Media Fellow a few years ago, the program included three days of pretty intense Excel training. But my reporting project wasn’t data driven. Having that basic familiarity with Excel is useful and it gives me a basis to build on if and when I need to. But, for me, a three-day crash course – without immediate application – was probably overkill. (Although we had a lot of good meals in St. Pete!)