Health Journalism 2012
Identifying disparities in diagnosis and treatment
• Vladimir N. Cadet, M.P.H., clinical writer/analyst, ECRI Institute
• Beatrice Gee, M.D., F.A.A.P., associate professor, clinical pediatrics, Morehouse School of Medicine; medical director, Sickle Cell and Hematology Program, Children’s Healthcare of Atlanta
• Theresa Gillespie, Ph.D., associate professor, Department of Surgery, Emory University School of Medicine and Winship Cancer Institute
• Moderator: Carrie Teegardin, reporter, The Atlanta Journal-Constitution
By Sandy Kleffman
People traditionally think of health disparities in terms of race.
But numerous other factors contribute to the sharp differences in life expectancy and disease rates in the United States and these are things we could do something about, said speakers at Health Journalism 2012 in Atlanta.
Income, education, access to medical care and the environment in which people live all play a role in determining whether some Americans live shorter and sicker lives than others.
Several emerging technologies, some of which are still undergoing safety and effectiveness trials, show promise in helping to reduce such health inequities, said Vladimir Cadet during the “Identifying Disparities in Diagnosis and Treatment” panel.
Cadet, a clinical writer and analyst for the ECRI Institute, cited several innovations as having “potential high impact,” including:
- A type of whole-breast external radiation therapy for women with early-stage breast cancer. This could reduce treatment time and make it easier for low-income women who often have transportation and other difficulties to complete their therapies, he said.
- A blood test for colorectal cancer screening. Many people refrain from getting a colonoscopy because of the inconvenience and discomfort. A simple blood test could improve screening rates and save lives, Cadet said.
- A “sleeve” designed to enable partially digested food to move through the gastrointestinal tract without allowing nutrients to be absorbed to achieve weight loss. This could help severely obese patients who are ineligible for surgery, he said.
- A “Text-4-baby” program that sends free text messages to the cell phones of pregnant women and young mothers with information about prenatal care and caring for a baby during the first year of life. The hope is that this would help reduce infant mortality.
While such innovations are encouraging, Cadet said there are several questions reporters should ask when evaluating any new technology:
- Will it increase or drive down costs?
- Will it be widely available or offered only at specialized centers far from low-income neighborhoods?
- Will insurance cover it?
- Is it sensitive to varying cultural traditions and beliefs?
- And will it increase or reduce health inequities?
Even genetic diseases such as sickle cell, a blood condition seen mainly in people of African and Middle Eastern descent, can be affected by health disparities, said Beatrice Gee, M.D., medical director of the Sickle Cell and Hematology Program at Children’s Healthcare of Atlanta.
Some bodies, for example, respond better to medication than others.
And the severity of the disease may worsen if people have other health problems or if they live in low-income neighborhoods where they are routinely exposed to toxins, she said.
Gee provided several story ideas for journalists, including examining whether specialized care for various health conditions is available in your region.
Noting a lack of public awareness about sickle cell disease, Gee said reporters could also investigate which diseases benefit from the greatest amount of fundraising and compare that to the numbers of affected people.
Journalists should be careful not to be misled by many of the common myths surrounding health disparities, said Theresa Gillespie, Ph.D., associate professor in the department of surgery at Emory University School of Medicine and Winship Cancer Institute.
When researchers seek to increase the participation of African-Americans in clinical trials, for example, Gillespie said it is a mistake to assume that numbers are low because of mistrust engendered by the infamous Tuskegee experiment.
During that experiment, begun in 1932, federal officials decided to study the progress of untreated syphilis in poor, rural African-American men who thought they were receiving free health care. Instead, the men were never told about or treated for their condition.
Gillespie said a study found no evidence that anger over that experiment is causing low participation in today’s clinical trials, so researchers should seek other reasons for the under-representation of African-Americans.
Sandy Kleffman is a health reporter at the Contra Costa Times in the San Francisco Bay Area. She was a 2012 AHCJ-Health Journalism Fellow.
