Tag Archives: Wisconsin

Network drives increase in painkiller prescriptions

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.

In the latest installment of his ongoing investigation for the Milwaukee Journal Sentinel and MedPage Today, John Fauber looks for the source of America’s prescription painkiller boom (graphic), outlining what he describes as “a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.”pills-and-money

Beginning 15 years ago, the network helped create a body of dubious information that can be found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.

Apparently, that network has been effective. Federal data shows that prescription painkiller sales have quadrupled in the past decade or so, Fauber found, and some of those sales may not have been warranted.

A band of doctors who get little or no money from opioid makers has begun to challenge the hype behind the drugs. They say pharmaceutical industry clout has caused doctors to go overboard in prescribing the drugs, leading to addiction, thousands of overdose deaths each year and other serious complications.

Several of the pain industry’s core beliefs about chronic pain and opioids are not supported by sound research, the Journal Sentinel/MedPage Today investigation found. Among them:

  • The risk of addiction is low in patients with prescriptions.
  • There is no unsafe maximum dose of the drugs.
  • The concept of “pseudoaddiction.”

That concept holds those who display addictive behavior, such as seeking more drugs or higher doses, may not be actual addicts – they are people who need even more opioids to treat their pain.

His investigation dips deep into each of those beliefs and how they helped push painkillers. For a case study, see this companion infographic.

New Wisc. rules lead to interesting disclosures

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.

Thanks to new disclosure requirements from the University of Wisconsin’s doctor group, the Wisconsin State Journal‘s David Wahlberg was able to report that 10 UW-Madison doctors received $48,000 or more from drug and device companies.

Thomas Zdeblick, M.D., pulled in almost $1.7 million. In fact, most of them were orthopedic surgeons, a fact which shouldn’t surprise anyone who’s been following the State Journal‘s conflict-of-interest work, as well as that of the Journal Sentinel‘s John Fauber.

Before 2010, doctors only had to report that they’d received more than $20,000 from such industry associations. Now, they have to disclose specific amounts. The disclosure requirements are currently the most prominent component of the schools’ crackdown of conflicts of interest, but activists say conflict disclosure is only half the battle.

A policy adopted in 2009 by the UW Medical Foundation, the university’s doctor group, bans doctors from doing promotional speeches for companies and accepting gifts such as free meals. Surgeons, however, can use materials created by device companies to conduct government-required training sessions, Golden said.
The foundation’s policy prohibits doctors from receiving royalties for using products at UW Health, which removes any incentive to use the doctors’ products instead of others, Golden said.

An interesting side note: UW clinics post signs detailing how patients can obtain their doctor’s disclosure form, but such requests have been few and far between, Wahlberg found “14 in 2009, 18 in 2010 and seven” in 2011.

Reporter’s narrative illuminates little-researched birth defect

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.

When Wisconsin State Journal reporter David Wahlberg investigated what appeared to be rural Wisconsin’s increase in gastroschisis, a rare birth defect in which the intestines grow outside of an infant’s body and must be replaced after delivery, the lack of institutional research, statistics or easy answers seemed to raise far more questions than it answered, particularly in relation to rural incidence and pesticide use.

Wahlberg’s solution to this roadblock is to dive headlong into the human component of the story. In a two-part narrative (Part 1, Part 2), he puts these larger questions on the back burner and instead follows a family, in real time, as they deliver an infant boy who had been diagnosed with the condition during an ultrasound. No amount of summary would do Wahlberg’s piece justice, so I encourage you to simply invest a few minutes and bury yourself in the details. You’ll exit with an understanding of the condition and the toll it takes that no amount of statistical analysis could match.

MJS finds attempts to improve infant mortality rates are fragmented

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.

This year, a team at the Milwaukee Journal Sentinel launched “Empty Cradles,” a yearlong reporting effort to find out why infant mortality is so high in the region and whether it must be that way. As we near the halfway point, their effort has already produced some powerful journalism and given new impetus to an issue that had been simmering, almost ignored, on the front burner all long.

Lakisha Stinson holds her newborn daughter, Rashyia, in their Milwaukee home. Stinson’s first daughter, Kelviana, died of sudden infant death syndrome in 2004. Infant mortality is a problem that plagues the Milwaukee area. Photo: Rick Wood/Milwaukee Journal Sentinel
Lakisha Stinson holds her daughter, Rashyia, in their Milwaukee home. Stinson’s first daughter, Kelviana, died of sudden infant death syndrome in 2004. Photo: Rick Wood/Milwaukee Journal Sentinel

In their latest major installment, in which they explore potential solutions to the crisis (and the recent lack thereof), reporters Crocker Stephenson and Ben Poston sum up the reason for their investigation in two damning paragraphs.

In Central Harlem, babies once died at a rate twice that of Milwaukee. But through a unified effort, the community has slashed its infant mortality rate by 78% since 1990. The rate there is now about 6 deaths per 1,000 births, lower than the state of Wisconsin as a whole.

In Milwaukee – where tens of millions of tax dollars have been spent in the past decade – 11 out of every 1,000 infants die before their first birthday. The city continues to have one of the worst infant mortality rates in the nation, especially for African-Americans, whose babies die at a rate about 2.5 times that of whites.

The problem, it seems, is that while the state supports 110  infant mortality reduction initiatives, they have so far failed to coalesce into a united public health effort.

Milwaukee and a few other urban areas are looking to change that, starting with the Lifecourse Initiative for Healthy Families which began in 2009. Modeled on successful programs in places like Harlem, the effort seeks to address the full spectrum of social factors that lurk behind high mortality rates.

In an earlier installment, reporters Mark Johnson and Tia Ghose looked at a medical mystery: African Americans in the United States are at a much higher risk than white Americans to have premature births, babies with low birth weights and infant mortality.

A married, college-educated African-American woman faces worse odds than a white, unmarried woman who dropped out of high school.

For more on how the series came together, see the background article editor Greg Borowski wrote for AHCJ this spring. It’s a great explanation of how to take a problem that everyone regards and common knowledge and report it into a deep, engaging, yearlong series. For more on previous installments in the series, see our coverage from January.

Drug-funded research group failed to disclose ties to makers of painkillers

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.

In his latest conflict of interest investigation, Milwaukee Journal Sentinel reporter John Fauber takes on a challenge that, even by his standards, is an ambitious one.

pills
Photo by somegeekintn via Flickr.

He attempts to show the effect pharmaceutical money and the local researchers who received it had on national opinions toward powerful prescription painkillers and how it all influenced the American epidemic of opiate abuse.

He focuses on the University of Wisconsin Pain and Policy Studies Group, which has received millions from painkiller manufacturers while publishing drug-friendly research and warning against increased regulation of OxyContin and its ilk. Many of these millions, Fauber found, appear not to have been disclosed in relevant publications even as the group was paving the way for the rapid rise of painkiller prescriptions in America.

The drugs had initially been approved for a very narrow range of uses, but became extremely popular as off-label use for the management of chronic pain spread like wildfire. It’s not easy to draw clean lines between the Wisconsin group and off-label use, but Fauber’s deft investigative work and careful sourcing make a strong case.

Related

Read more of Fauber’s work

Faltering Wis. transparency law has national lessons

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.

Journal Sentinel reporter Guy Boulton’s investigation of Wisconsin’s ongoing failure to properly implement a statewide health care transparency law that went into effect on Jan. 1 covers the local details well, but is really set apart by Bolton’s careful explanation of why hospital pricing transparency is so tricky. You’ll have to read straight through to the last paragraph to get the full effect, so be patient.

The law in question is an “incremental” measure that was all legislators could push through in the face of industry lobbying. It requires hospitals to “provide price information on request,” but Boulton writes that there’s a problem with that, namely, “That information just doesn’t have any relation to what you and your health insurance plan will actually have to pay. Rather, it requires disclosing the equivalent of a sticker price or manufacturer’s suggested retail price – a price that almost no one pays.”

The law does require physician practices with four or more doctors to disclose prices that are closer to what commercial health plans actually pay, on average, for 25 conditions. But compiling that information proved impractical in the time allotted.

The Department of Health Services didn’t even try implementing the law’s provisions for other health care providers this year, concluding that it wasn’t practical.

As Boulton points out, “price information also has become more important as more people have health plans with high deductibles,” but setting prices in health care is tricky and varies widely. To compound the problem, “prices negotiated by health plans and health systems are confidential.”

Wisconsin may provide a cautionary tale about what could happen in other states or nationally.

Reporter looks at black infant mortality in Wis.

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.

The Milwaukee Journal Sentinel‘s Crocker Stephenson took a look at disparities in infant mortality in that area and explored both their cases and ramifications. In Wisconsin, black babies die at twice the rate of white babies, a finding which may just be the tip of the iceberg. For national and international comparisons, see the companion infographic. According to Stephenson, infant mortality rates are an early indicator of a community’s degeneration. When mortality rises, so do other dire indicators.

The bottom third – the group of ZIP codes with the most poverty and lowest college graduation rates – had the highest infant mortality rate.

It also had the highest premature death rate, chlamydia rate, HIV rate and teen birthrate.

It had the greatest percentage of low birth weights; preterm births; uninsured adults; people who hadn’t seen a dentist in a year; births to mothers who received no prenatal care during their first trimester; smokers; pregnant smokers; obesity; violent assaults within the past year; single-parent households; and children who tested positive for lead poisoning.

Milwaukee’s health commissioner called it a “crisis,” one that Stephenson found is as much a social matter as it is one of access to proper care. For more, see the “Problem Areas” section of the story.

N.M. midwives deliver a model for rural health

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.

We’ve been following Wisconsin State Journal reporter David Wahlberg’s series on the future of rural health in his state, particularly because Wahlberg’s willing to look pretty far afield for examples that put rural Wisconsin in perspective, and which point to possible solutions to local rural health issues. His latest story, on rural midwifery and child delivery, took him to the mountainous areas around Las Vegas, New Mexico. In a way, it seeks to answer the key dilemma raised in the Montana piece: How do you provide care in areas so remote that the population can’t support an obstetrician and delivery facilities?

ratonPhoto by adventurejournalist via Flickr

Midwives have the potential to at least answer part of that equation, especially when they are used as obstetrician extenders. New Mexico is the nation’s leader in births overseen by midwives. Midwives account for 31 percent of births in New Mexico, a number that dwarfs the 8 percent national average.

Jaymi McKay, New Mexico’s maternal health program manager, said Hispanic midwives have long been a tradition in the state and activists pushed for midwife-friendly laws decades ago.

New Mexico still faces rural maternity care challenges, as 16 of its 33 counties have no hospital that delivers babies, McKay said. But without so many midwives, “it would be a lot worse,” she said. “They fill an important niche. That happens more in New Mexico than in other places.”

In addition to its culture, the New Mexico system stands out for its midwife licensing procedures. Wahlberg goes into greater detail, but here’s the national perspective:

All states offer licenses for nurse midwives. Most private insurers and Medicaid, the state-federal health plan for the poor, pay for their care.
Just 27 states license other midwives – including Wisconsin, which started doing so in 2006. Ten states ban them. Medicaid covers their care in 10 states, not including Wisconsin, and some private insurers cover them.

Rural health on the frontier

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.

A defining feature of reporter David Wahlberg’s ongoing look at rural health care for the Wisconsin State Journal has been his willingness to look beyond the state’s borders, as with his recent piece on health care navigators in Kentucky.

In his latest installment, he looks to Montana, not just for a model, but for perspective. In Montana, he finds that all rural health challenges are created equally, and that the rural areas of the Mountain West and western Great Plains are so remote that the term “rural health” just doesn’t do their situation justice. Instead, they deal with “frontier health,” where the only hospital in driving distance can’t afford to deliver babies, and hospitals have to fly patients hundreds of miles just so they can have access to adequate blood supplies.

Only 4 percent of Wisconsin residents live in frontier counties. In Montana, that number is 54 percent. Wyoming is even higher. “Frontier” counties are generally considered to be those with a population density of fewer than seven people per square mile. For those interested, the State Journal included a map of such counties alongside the story.

J-S settles records suit; docs rebel against COI rules

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.

As a result of the Milwaukee Journal Sentinel‘s now-settled lawsuit against the University of Wisconsin, John Fauber was able to review newly public e-mails which show just how angry a segment of the faculty became when faced with the university’s new, stricter conflict of interest regulations. The regulations came, of course, in the wake of Fauber’s investigative reporting on the subject.

The newspaper’s lawsuit argued that the faculty comments were public records under Wisconsin law and sought a court order to obtain them. To settle the lawsuit, the newspaper agreed to accept the 41 e-mails with the names of the doctors blacked out. The foundation also provided a separate list with the names of the 28 doctors who wrote the e-mails.

The (UW Medical Foundation) also agreed to pay the newspaper’s attorneys’ fees of about $12,400.

The e-mails make for good reading, and Fauber wastes no time in deploying the liveliest phrases in his story.

For example, some physicians complained about the 18-month exemption for orthopedic surgeons and other implanters of medical devices, including one who said “Allowing our docs to shill for device companies is a complete perversion.” An orthopedic surgeon responded with a different take, saying it was “clearly ridiculous” to limit his hourly take from device makers to just $500.

For an explanation from Fauber on how he has been able to consistently produce groundbreaking stories on the conflict-of-interest beat, see the article he wrote for AHCJ.