Tag Archives: nejm

Study: Good press releases contribute to good health journalism

Thanks to Gary Schwitzer for drawing attention to a study, published in BMJ, which analyzes the impact medical journal press releases have on actual press coverage of studies.

The authors begin with a somewhat gratifying hypothesis, writing that “Although it is easy to blame journalists for poor quality reporting, problems with coverage could begin with the journalists’ sources,” and positing that difficult-to-decipher studies and misleading press releases could lead to low-caliber health reporting.

They looked at 100 studies from five major journals, as well as a sample of 348 news stories based on those studies. In general they found that higher-quality press releases led to higher-quality coverage. Unfortunately, they also found that the inverse was true. Here’s an excerpt from the “Discussion” subheading (also highlighted by Schwitzer).

…Higher quality press releases issued by medical journals were associated with higher quality reporting in subsequent newspaper stories. In fact, the influence of press releases on subsequent newspaper stories was generally stronger than that of journal abstracts. Fundamental information such as absolute risks, harms, and limitations was more likely to be reported in newspaper stories when this information appeared in a medical journal press release than when it was missing from the press release or if no press release was issued. Furthermore, our data suggest that poor quality press releases were worse than no press release being issued: fundamental information was less likely to be reported in newspaper stories when it was missing from the press release than where no press release was issued at all.

Reporters looking for a Health News Review-style “how do I ensure my story clears their quality bar?” checklist can just scroll down to the “Quality Assessment” subheading. For the record, the metrics found there apply equally well to the PR professionals who write the releases.

NEJM article: Media partially to blame for slow adoption of cost-effective health care

In a new “Perspectives” piece in the New England Journal of Medicine, Victor R. Fuchs, Ph.D., and Arnold Milstein, M.D., M.P.H., examine why cost-effective health care has been slow to catch on in the United States.

They point to a number of factors, including insurance companies’ desire to protect profits, large employers that don’t want to alienate employees, legislators who collect campaign contributions from the health industry, hospital administrators protecting their revenue, doctors who are generally resistant to change, manufacturers that fear losing market share and more.

The authors also point blame at the media, saying it doesn’t adequately explain who really pays for health care:

Great harm is done when employment-based insurance is discussed as if it were a gift from “generous” employers rather than an alternative to wage increases.

They also mention a topic that is surely familiar to Covering Health readers: relative risk vs. absolute benefit.

The media also mislead the public by emphasizing the relative benefit of clinical interventions (“reducing risk of death by one third”) when the absolute benefit (“reducing risk from 0.03 to 0.02”) is usually more relevant.

“Misleading headlines, designed to attract larger audiences,” also get a share of the blame.

What do you think? Does media coverage have an effect on how cost-effective care is accepted? If so, do you have suggestions on what reporters could do differently?

Patients “blood doping” to get into trials

Like professional sports, cancer trials can be competitive, for both patients and researchers. And, also like professional sports, the competitors are apparently doing anything they can to get an edge, as MedPage Today’s Crystal Phend writes in a story about patients using “blood doping” to get into clinical trials.

Phend points to a NEJM letter which references three different patients who relied on blood transfusions to become eligible for trials of new chemotherapy agents. Naturally, Phend writes, this is not advisable.

Clinicians should try to correct the underlying laboratory value through other treatments first, such as treating anemia, they urged. Explore all possible other options, including looking for other trials at other institutions for patients who don’t meet eligibility criteria, they added.

“Patient safety must trump all decisions for such patients,” the group concluded. “There should be few situations, if any, in which a patient receives a transfusion solely for the purpose of temporarily altering a laboratory value to gain admittance to a clinical trial.”

The authors also recommend that publications disclose the number of patients in each trial who required blood transfusions to meet eligibility requirements.

Pharmaceutical spending varies geographically

The New England Journal of Medicine has examined geographical variation in Medicare drug spending, an area the authors said previous analyses hadn’t addressed. They used data from Medicare Part D and adjusted for local cost variations and other factors. You can find their nifty maps here and here.

Eileen Beal, the AHCJ member who suggested this report, reminds us that “While the report is specifically focused on Medicare spending, since that’s a major indicator of/for drug spending in general the report is probably going to be good background and resource material for AHCJ members covering healthcare cost/delivery.”

Their main findings, as summarized from the report:

  • Pharmaceuticals account for more than 20 percent of total Medicare spending, and drug spending “varies substantially among hospital-referral regions, with the highest-spending region spending 60 percent more per beneficiary on pharmaceuticals than the lowest. This variation is driven by variation in both the drugs prescribed and the number of prescriptions filled each month, with physicians in higher-spending areas prescribing both more drugs and more expensive drugs.”
  • It does not, however, vary as much as other medical spending. This difference, though, isn’t enough to really lower the total spending variation, even when drugs are taken into account.
  • “Pharmaceutical spending and medical (nondrug) spending are only weakly correlated across hospital-referral regions.”

And, the conclusion:

Thus, areas with high medical spending do not have offsetting lower pharmaceutical spending; in fact, if the coding practices in different regions are not too dissimilar, the substantial variation in pharmaceutical spending does not seem to be strongly associated with variations in medical spending at all.

Beal says she learned about the report from the Public Policy & Aging e-newsletter.

Getting patients home safely after a hospital stay

New America Media‘s Paul Kleyman explores the effects of hospitals cutting corners when it comes to patient transitions from hospital to home, a problem his sources call one of the biggest gaps in the health care system. Citing a widely reported 2009 New England Journal of Medicine article on preventable rehospitalizations, Kleyman explains why the current transition system is both expensive and broken, then chronicles the efforts of advocates and legislators to change the system or, at the very least, fill in the gaps.

Kleyman on the latest legislative attempt to change the system:

These findings led members of Congress to introduce the Medicare Transitional Care Act of 2009. According to the bill, “Insufficient communication among older adults, family caregivers and health care providers contribute to poor continuity of care, inadequate management of complex health care needs and preventable hospital admissions.” The Act would set up demonstration projects to test ways for improving patients’ continuity of care.