Tag Archives: NYT

Calif. dental care crisis could get worse

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.

Laurie Udesky, writing for The New York Times, has found that that pediatric dental care in the state has reached rock bottom, especially for children from low-income families. Unfortunately, in California, it’s starting to look like there may be a floor even lower than rock bottom. Udesky writes: “If Gov. Arnold Schwarzenegger’s recent proposed cuts remain — amounting to a $16.5 million reduction to Healthy Families and a $523 million reduction to Medi-Cal —more cases of untreated dental-related illnesses are likely.”

California children’s dental health was ranked third from the bottom in the National Survey of Children’s Health, above only Arizona and Texas. In the Bay Area, children and teenagers up to the age of 17 made nearly 1,980 visits to emergency rooms for preventable dental conditions in 2007. The cost of these visits averaged $172, but if a problem required hospitalization it cost an average of $5,000.

Today, experts interviewed said the dental care crisis had reached an even more alarming level. “We can only go up from here,” said Dr. Jared I. Fine, the dental health administrator at Alameda County Public Health Department. “We have an epidemic of dental disease in children that’s absurdly pervasive.”

For more on children’s dental health, check out The Cost of Delay (PDF), a report the Pew Center on the States released earlier this year. It seeks to answer the questions “What can states do to ensure better dental care?” and “How many states are doing those things right now?” and includes a strong body of statistics and analysis within its 74 pages.

The National Survey of Children’s Health, last fully updated in 2007, is still a comprehensive source for national data on pediatric dental health. There are data fields for overall dental health, as well as for specific oral health issues in children. For an overview of the data, I just pulled the overall health numbers and mapped a subset of them.

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Residents not warned of nursing home foreclosures

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.

Writing for The New York Times, Laurie Udesky reports that despite significant rates of foreclosures, California nursing homes are not required to notify residents – many of whom require constant care – that they’re being shuttered. She even found at least one home in which residents were caught by surprise when deputies showed up to force an eviction. Udesky also added a companion piece on the NYT’s Bay Area blog. Foreclosures, she found, are not uncommon among smaller nursing homes.

But a New York Times analysis of licensing and foreclosure data indicated that about 16 percent of the 1,600 Bay Area properties licensed as small residential-care homes has been in some stage of foreclosure since June 2006. According to RealtyTrac, a company that compiles foreclosure records, that includes more than 100 homes under foreclosure in the last six months.

It is impossible to tell from the data how many of these were operating as residential-care homes during the foreclosure proceedings or thereafter. But those properties housed as many as 700 elderly residents.

Fortunately, some in the state are working to close what Udesky referred to as a “loophole,” with a California senator introducing a bill that would “require people licensed to run such facilities to notify the licensing division of the Department of Social Services and the residents or their legal representative within 24 hours of notification of foreclosure, bankruptcy, missing a mortgage payment or the prospect of a utility cutoff.”

Deconstructing a NYT op-ed in three acts

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.

On April 17, New York Times‘ op-ed columnist Thomas Friedman wrote a column about globalization, international competition and entrepreneurship. Here, as anyone who has even held a newspaper with his column in it will know, he’s on all too familiar territory. It’s not until he steps over into uncritical praise of a medical device maker that Friedman starts stepping on land mines.

He profiles EndoStim, a company working on an implant to treat acid reflux. Friedman admits that he has “no idea if the product will succeed in the marketplace,” then the cheerleading begins.

EndoStim was inspired by Cuban and Indian immigrants to America and funded by St. Louis venture capitalists. Its prototype is being manufactured in Uruguay, with the help of Israeli engineers and constant feedback from doctors in India and Chile. Oh, and the C.E.O. is a South African, who was educated at the Sorbonne, but lives in Missouri and California, and his head office is basically a BlackBerry. While rescuing General Motors will save some old jobs, only by spawning thousands of EndoStims — thousands — will we generate the kind of good new jobs to keep raising our standard of living.

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Photo by Roadsidepictures via Flickr

Journalist Merrill Goozner, of GoozNews fame, picked up on the story the next day and asked the world “Why Is Tom Friedman Championing Higher Health Care Costs?” Goozner effortlessly chronicles the marketing-driven history of acid reflux treatments, from Pepto-Bismol to Zantac to Prilosec to Nexium, each conveniently emerging as the patent to their predecessor expired, then puts EndoStim in its place at the end of the chain.

… instead of finally being out from beneath the wasted billions now being spent on brand name acid indigestion pills like Nexium, the health care system will be lined up to move onto the next chapter in the lengthening medical text for treating what for most people is a relatively minor and passing phenomenon.

In his final paragraph, Goozner gets to the heart of what Friedman’s vision of “thousands of EndoStims” really means for the U.S. economy.

Friedman is right. Endostim’s success will create “the best jobs – top management, marketing, design” at company headquarters. But let’s not forget that to create those jobs, the entire society through its collective health care system will have to pay an unnecessary tax, which burdens every other industry and shifts scarce societal resources away from potentially more useful activities.

Finally, Trudy Lieberman, AHCJ immediate past president, catches Goozner’s post and wades into the fray in her own column on cjr.org, writing that Friedman’s column was “essentially a puff piece for EndoStim.” Lieberman ties Goozner’s observations on EndoStim into his previous writings as well as her own, writing “there’s nothing in the new law that limits the use of the device only to patients with chronic disease who don’t respond to other, less costly treatments.”

I can see hospitals advertising: “Hey acid reflux sufferers come to us. Our surgeons know how to get that thing down your gut. They are the best in the world, and by the way, insurance will pay.”

Reinhardt called out for conflicts of interest

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.

Bloggers and online journalists (Health Care Renewal, the nytpicker, Business Insider) have noticed that Princeton health economist Uwe Reinhardt, who writes for The New York TimesEconomix blog and was the keynote speaker at Health Journalism 2009, earns $500,000 a year working for a number of health care companies, owns about $5 million in related stock, and thus appears to be in violation of The New York Timesconflict-of-interest policy. The conflicts are not yet listed on his Times bio, though the newspaper and Reinhardt both promise they will be soon.

Uwe Reinhardt at Health Journalism 2009
Uwe Reinhardt at Health Journalism 2009

Business Insider’s Lauren Hatch got Reinhardt’s response. The economist said he has never “shilled” for a company, and that his connections enhance, rather than skew, his blogging. He does, however, acknowledge the apparent conflict of interest.

“I guess I have to take the rap for this, but I don’t see it as an ethical lapse,” (Reinhardt) told (Business Insider) in a phone interview. “It never occurred to me. My board memberships are public knowledge.”

“When all is said and done, they pointed it out and that’s good. I had no intent to be unethical or deceitful. I have talked to the New York Times and soon my board memberships will be added to the bio so everyone can see it.”

As of 3 p.m. Eastern on April 8, those conflicts have not yet been disclosed on his bio. The Business Insider story was posted on April 6.

The New York Times, for its part, provided Business Insider with the following statement:

“Professor Reinhardt is a leading expert on the economics of health care, and has provided valuable and independent insights in his blog posts. He has mentioned his service on corporate boards in the blog, but we are reviewing how to more fully describe his activities for readers of Economix.”

According to nytpicker, which seems to have come to the story first, Reinhardt is involved with at least five private health-related enterprises, for which he is being compensated with both cash and stock options. Those include Amerigroup Corporation, Boston Scientific, H&Q Healthcare Investors and H&Q Life Sciences Investors, and Legacy Hospital partners.

Comments invited on latest draft of DSM

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.

A new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has come out every decade or so (it varies widely) since 1952. dsm-5It hasn’t substantially changed since 1994, but the next revision is slated to come out in 2013. It’s a pretty big event, as the book’s diagnostic criteria are used around the world to determine who is diagnosed with mental disorders.

With the release of the new version, lines may shift and folks who were diagnosed with mental disorders may find themselves “undiagnosed.” Others will have labels changed and gain labels they didn’t have before.

The latest draft proposal of the May 2013 revisions, upon which public comment will be accepted until April 20, 2010, was posted on Feb. 9. APA workgroups will review the comments and begin trials soon after. Benedict Carey rounded up and evaluated some of the biggest proposed changes for The New York Times. In addition to bipolar disorders in children and autism spectrum disorders, Carey discusses the sheer significance of the changes.

“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.

“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”

FDA warns against promoting unapproved drugs

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.

The New York Times‘ Natasha Singer looked into the FDA’s recent warning of prominent cosmetic doctor Leslie Baumann (bio) for the promotion of an unapproved drug, based on comments she made about Botox-like Dysport (she was an investigator in a trial of the treatment) in outlets such as Allure, Elle and the Today Show. Singer also considered the chilling effect this warning might have on other clinical investigators upon which the media has traditionally relied.

baumann
Dr. Leslie Baumann, from skintypesolutions.com

Now, some industry experts say the F.D.A. warning may curb the media enthusiasm of certain cosmetic doctors who until now have provided scoops about coming medical products — or have talked up the latest unapproved cosmetic uses for drugs and devices that the agency had approved only for other purposes.

“It’s a wake-up call,” said Nancy Behrman, owner of Behrman Communications, a public relations firm in Manhattan. Her firm has represented cosmetic medical companies as well as doctors. “The whole business has spiraled out of control, and we need to step back and slow it down.”

FDA representatives say that there’s a line between scientific discussion and drug promotion, and that investigators are welcome to talk to the media as long as they don’t cross it.

Thomas W. Abrams, director of the agency’s Division of Drug Marketing, Advertising and Communications, said that investigators were free to have scientific conversations about investigational drugs with their peers and with journalists. But an investigator should not promote any unapproved prescription drug — or an unapproved use of an already approved drug — as being safe or effective if the agency has not yet deemed it to be so, he said.

Singer also talks to another of the media’s favorite doctors, dermatologist Fredric S. Brandt, who said that, in future discussions with media he would take care to offer only scientific facts on unapproved drugs, and leave his opinions and recommendations out of the discussion.