Author Archives: Andrew Van Dam

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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.

Causes, consequences of Nashville’s diabetes hot zone

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.

N.C. hospital garnishes patient tax refunds to collect debts

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

Even in treatment guidelines, pharma conflicts abound

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.

KC Star: Centralization of Big Beef also aggregates risk

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.

LA Times: While board investigates, doctors’ ‘reckless prescribing’ kills

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.