It appears that University of Minnesota biologist and blogger PZ Myers has finally seen a few too many “x gene linked to y condition” stories. He snapped, writing that “I just get so annoyed at this tendency for the media to focus on simplistic discrete causes that are split into a black & white nature or nurture false dichotomy.” He also felt compelled to write a few rules for journalists, as scientist-bloggers so often do.
Two of the four rules cover subjects which should be old hat for most AHCJ members, namely “understand science and causality” and “put news and numbers in context,” and it’s not until he focuses specifically on genetics that the list really shines.
Do not describe genes by the disease they cause when broken. This is a gene that contributes to male fertility. There is no infertility gene. If a man has a missing, damaged, or mutant form of this fertility gene, he may have problems conceiving children.
And, for the final rule, he builds on the basic, well-trod ideas of causality and context to provide a framework for interpreting gene discovery stories.
Learn this simple principle: genes affect how your body responds to environmental factors. Finding an allele associated with a particular physiological state does not mean you have described a cause. We also need to know how that gene acts, what triggers a particular pattern of expression, and what the gene changes in the cell. There are forms of genes that only have deleterious (or advantageous) effects given certain conditions; that effect must be described as a consequence of both the gene and a certain background or environment.
Given his teaching field and institution, it’s not surprising that Elliot couldn’t stay away from the Markingson story.
…the more I examined the medical and court records, the more I became convinced that the problem was worse than the Pioneer Press had reported. The danger lies not just in the particular circumstances that led to Dan’s death, but in a system of clinical research that has been thoroughly co-opted by market forces, so that many studies have become little more than covert instruments for promoting drugs. The study in which Dan died starkly illustrates the hazards of market-driven research and the inadequacy of our current oversight system to detect them.
Elliot goes after the idea that the new wave of anti-psychotics was any safer than its predecessors, then explains the clinical trial manipulations he says were used to claim they were.
From there, Elliot takes on the use of clinical trials for marketing purposes. Clinical trials can be dangerous, which is theoretically acceptable if they have the potential to advance medical care. But what if patients are just being exposed to those dangers in an effort to sell more drugs?
For physicians and patients, treating lower back pain is an exercise in restraint and patience. According to federal guidelines, such pain usually resolves itself within six weeks with minimum intervention, so it’s often a matter of resisting the temptation to order a $500 MRI within that time window. And in Minnesota, a state known for its health-care-related moderation, that temptation seems to be too much.
The story includes other excuses from local providers along the lines of “the data are outdated…we’ve changed…we’re better now…that can’t be right…it’s not us!” When have you ever seen a story on health care data that didn’t have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don’t like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we’re starting to collect some such data, vested interests find that information is a menacing thing.
MinnPost.com‘s Dr. Kay Schwebke reported that uncompensated care — both charity care and bad debt taken on by hospitals to fulfill moral and legal obligations — has climbed at “unprecedented rates” in Minnesota as folks lose insurance through layoffs or employer cutbacks or otherwise can’t afford out-of-pocket expenses and high deductibles.
In Minnesota, uncompensated care made up about 2.1 percent ($247.4 million) of hospital operating expenses in 2007, up from 1.6 percent ($128.7 million) in 2003, and there are indications that those numbers are rising.
Driven in large part by uncompensated care, “net hospital income fell from a positive 4.8 percent in third quarter 2007 to a negative 2.5 percent in third quarter 2008,” Schwebke reported.
Schwebke also looked at what these decreases meant in terms of layoffs, cutbacks and the availability of charity care at the state’s largest hospitals.
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.