The Boston Globe series that Steward Health took to court — before the stories ran

The Globe’s narrative story about one man’s struggles with his mental health care is running this week. And the company that runs one of the hospitals where he was treated was not allowed to read it first.ssLast week:  

A Suffolk Superior Court judge ruled Thursday that Steward Health Care System has no right to review the reporting or records collected by The Boston Globe for a yet-to-be-published article about a man’s journey through the mental health care system.

Judge Jeffrey Locke said the for-profit health care company may comment broadly to the newspaper and answer limited questions on the patient’s care without violating medical privacy laws.

Steward, in a suit filed against the Globe Wednesday, asked the court to permit release of the patient’s private medical records, which the company said it needed to rebut a Globe story that is scheduled to be published this weekend.

The hospital chain also served papers to the man profiled in the story. Read the full story above a full run-down of the legal contortions hospital lawyers performed to argue that they were not going after the patient or trying to repress the story.

This is more about more than a thin-skinned story subject.  Health care reporters seeking comment or information for stories can come up against overly broad interpretations of patient privacy laws.  Worth watching.

Finally, a question: What would The Cheescake Factory do? 

 

#NEJM #Relman obit: “A master in the use of the bully pulpit” #HCR

A not entirely objective perspective on the  career of the journal’s storied editor. Here’s the last paragraph:

In the increasingly complex world of health care, Bud Relman was a prophetic figure, larger than life. He acted nejmas our conscience. In his writing and speaking, he always reminded us that the medical profession is far more than a business and that as physicians, we have the responsibility to do what is right for patients and for the community as a whole. As distinguished as he was as a researcher, clinician, editor, teacher, and administrator, Bud Relman will be most remembered for the way he fought for a fundamental reshaping of our nation’s health care system. His passionate commitment to that cause will forever secure his position in the pantheon of leaders in medicine.

 

 

Boston Globe reports: Biolab & ebola

Two recent Boston Globe items of note:

Local hospitals prep for ebola

emergencyIn response to the West African outbreak of the deadly Ebola virus, some Boston hospitals are instructing clinical staff to ask patients as soon as they arrive about their travel histories, and reminding doctors and nurses of the symptoms.

But hospital officials say they would be ready to quickly identify the illness and prevent its spread if an infected patient showed up, using protocols and equipment already in place.

Column : Local biolab sits mostly empty as the CDC copes with its own lab safety crisis.

Over a decade of community protests, Boston University has beaten back lawsuits aimed at closing the lab and won City Council backing. Final approvals are still pending from the Boston Public Health Commission and the federal Centers for Disease Control and Prevention.

Its critics, though, have been given fresh ammunition: The CDC confessed earlier this month to sloppy handling of anthrax and avian flu at its laboratories elsewhere, exposing dozens of employees to the deadly bacteria. The mistake was the kind that proponents of the Albany Street lab had called nearly impossible.

“The CDC example is a wake-up call, if you needed a wake-up call,” said David Ozonoff, a Boston University professor and the longtime dean of its department of environmental health who opposes the lab.

Does advertising from Partners taint Boston health reporting and advocacy?

Speaking of bias: Disclosure: BHN has dogs in all of these battles.

Speaking of bias: BHN has dogs in all of these fights.

Former BIDMC hospital chief Paul Levy thinks “so many people in town receive financial support from Partners that the public commentary on such issues (Partners’ acquisition of two suburban hospitals)  is biased by that financial power. ” 

“Take WBUR and its Commonhealth blog.  Yes, they do cover the Partners issues and do so as fairly and comprehensively as anyone in town.  But again, prominent among WBUR’s supporters is, you guessed it, Partners Healthcare.  Here, the issue is not that PHS influences the editorial policy of WBUR:  That clearly does not happen.

In this case, the power is more subtle but no less effective: Whatever points might be made in the Commonhealth blog on this topic–read by a few thousand readers–are dramatically reduced in impact by the quid pro quo given to Partners, i.e., repeated self-serving messages on air, heard by tens of thousands of listeners during drive time. In addition, as you see above, PHS gets to place an ad on the Commonhealth site, persisting with its message day after day.”

This is an old saw. For years, critics have charged legacy media outlets with pandering to or being influenced by advertisers. The charges rarely hold up.

But with the rise of digital media, the terrain is shifting. Traditional advertising — prints ads, radio spots, billboards and TV commercials — is on the wane. Now we have content marketing, native advertising, and pre-roll.  (Disclosure: As a journalism prof and freelancer, TR has dogs, friends and family in all these fights.)

Parnters is a powerful force in the community, for better and worse. We do bristle when we hear these ad-like messages on public radio. They somehow feel more like endorsements than display ads. But, they aren’t, and they don’t dramatically reduce” the impact of WBUR health reporting for us. These potential conflicts and muddled messages are worth pointing out, but these gripes about advertising and bias in Partners coverage feel overstated.

There are real muddled media issues out there to be concerned about. What were once called and clearly marked as advertorials are now ambiguously called sponsored-content.”  Corporations, universities and hospitals now produce websites with articles that  use the tools of journalism – reporting, research and objective voice –and look like news, but are designed for marketing and advocacy.  The difference between two identical features on BU Today and Boston.com? For one, the customer is the institution; for the other, the customer is the reader. While that may not make a difference for many stories, it makes a big difference on others.

Not a problem, if you are aware of the differences. But, many of our students can’t distinguish between sites like these, sponsored content, random blogs and straight news. The answer? More media literacy. 

NYTimes Magazine: Recalling the debate over repressed memories

ssThis weekend’s profile of Boston Dr. Bessel van der Kolk brought up some bad memories of the debate over what is clinically known as “dissociative amnesia.” The story profiles van der Kolk’s approach to treating Post Traumatic Stress Disorder, known as psychomotor therapy.  

“Trauma has nothing whatsoever to do with cognition,” he says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures, regions that, he says, no cognitive therapy can access. “It’s not something you can talk yourself out of.” That view places him on the fringes of the psychiatric mainstream.

Not the first time, the story notes, as it recalls the doctor’s past support of repressed memories – a much debated concept that came into play when charges of sexual assault were levied against day care workers and priests in the ‘80s and ‘90s. Dr. van der Kolk’s Harvard colleague, psychologist Richard McNally, called the concept “the worst catastrophe to befall the mental-health field since the lobotomy era.”

From the Times:

For a time, judges and juries were persuaded by the testimony of van der Kolk and others. It made intuitive sense to them that the mind would find a way to shield itself from such deeply traumatic experiences. But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned. Most research psychologists argued that it was much more likely for so-called repressed memories to have been implanted by suggestive questioning from overzealous doctors and therapists than to have been spontaneously recalled. In time, it became clear that innocent people had been wrongfully persecuted. Families, careers and, in some cases, entire lives were destroyed.

After the dust settled in what was dubbed “the memory wars,” van der Kolk found himself among the casualties. By the end of the decade, his lab at Massachusetts General Hospital was shuttered, and he lost his affiliation with Harvard Medical School. The official reason was a lack of funding, but van der Kolk and his allies believed that the true motives were political.

Not clear what the story means by “political,” but the implication is that he was banished for promoting an unpopular concept.

It didn’t help critics of repressed memory that the concept was being used in cases against alleged pedophiles. Most notoriously, lawyers defending defrocked priest Paul Shanley,  who was convicted of raping a young boy, used doubts about the concept to discredit the grown-up victim who testified that he had repressed memories of abuse. Shanley — who was the subject of numerous complaints to the church —  was found guilty in 2005. His lawyers filed an appeal, again based on the shakiness of the repressed memory concept.

From a Times story on the appeal

You have prominent scientists, psychologists and psychiatrists saying this is not generally accepted. So why allow it in a court of law in a criminal proceeding?” Mr. Stanley’s lawyer, Robert F. Shaw Jr., asked the state’s highest court Thursday.

The debate over repressed memory — the idea that some memories, particularly traumatic ones, can be inaccessible for years — has simmered since the 1980s, when some patients in therapy described long-past scenes of sexual abuse. Some of those experiences turned into high-profile legal cases. The scientific controversy boiled over in the 1990s — as experts raised questions about many claims — and then died down.

Recently, scientists have begun to spar again over the theory. New studies suggest, and many scientists argue, that what people call repression may just be ordinary forgetting; memory is not “blocked.” Others say the process is more complex and may involve a desire to forget.

“My impression is there continues to be a few scientists who honestly believe that it is actually possible for someone to be involved in a traumatic event and not be able to remember it at all,” said Dr. Harrison G. Pope Jr., a professor of psychiatry at Harvard. “But you cannot possibly argue that it’s generally accepted, which is the criteria for it to be admissible from a legal standpoint.”

In 2010, The Globe reported that the request for a new trial was thrown out

Jan 16, 2010: “In sum, the judge’s finding that the lack of scientific testing did not make unreliable the theory that an individual may experience dissociative amnesia was supported in the record, not only by expert testimony but by a wide collection of clinical observations and a survey of academic literature,” Justice Robert Cordy wrote for the SJC.

Shanley, now in his late 70s, was originally prosecuted by Martha Coakley, who is now attorney general and a Democratic candidate for US Senate. Her successor, Middlesex District Attorney Gerard T. Leone Jr., whose prosecutors defended the conviction before the SJC, applauded the ruling.

“As the SJC recognized, repressed memories of abuse is a legitimate phenomenon and provided a valid basis for the jury to find that the victim, a child at the time of the assaults, repressed memories of the years of abuse he suffered at the hands of Paul Shanley, someone who was in a significant position of authority and trust,” Leone said.

But Shanley’s appellate attorney, Robert F. Shaw Jr. of Cambridge, said the SJC had made a grievous mistake. Shaw, who argued in court papers that recovered memory was “junk science,” said Shanley deserved a new trial.

The SJC noted – literally in a footnote – that repressed memories alone may not be enough to convict a defendant. From the Globe:

The court also said that it may decide in the future to throw out a conviction where the only evidence is based on recovered memories.

“We do not consider whether there could be circumstances where testimony based on the repressed or recovered memory of a victim, standing alone, would not be sufficient as a matter of law to support a conviction,” Cordy wrote in a footnote.

But, the debate goes on. A review in the current issue of the American Psychological Association’s journal Psychiatric Bulletin, tries the put the issue to rest. Harvard’s McNally is one of the authors.  The article is in response to a 2012 paper in the same journal supporting the concept of repressed memories.

 (Although) a key assumption of the TM (Trauma model) is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma–dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorder. 

 

In today’s Globe: Stem cells, retractions, cystic fibrosis and lung transplants.

Capture

Two items of note, including one from obit writer Bryan Marquard on a patient who survived Mass General’s first living-donor double-lung transplant  which was “so new that no one could venture odds for long-term survival.Mr. Bean was 20 that July day as he lay on the operating table, helping advance science as much as he hoped to extend his life. He was 38 when he died in Mass. General on April 14, several months after his body began to reject the transplanted lungs and complications set in.”

 

And from Carolyn Y. Johnson’s always solid but hard-to- find science blog. Read it inside the Monday business section. Good luck finding it online.  Here’s some help:

Retracted stem cell papers get public, private scrutiny

Something would turn out to be wrong with both papers. Where these two tales diverge is how these problems have been handled.

In the weeks since the paper describing the acid bath technique was published in the journal Nature, it has been thoroughly — and publicly — picked apart. Several of its Japanese authors have held press conferences. The president of the RIKEN research institution in Tokyo, where many of the authors work, has apologized to the scientific community, prefacing his public remarks with a deep bow. RIKEN has released detailed reports and been specific about what portions of the paper it was investigating and what was found. It publicly accused a young scientist named Haruko Obokata of fraud, a finding she is appealing.

The incident has sparked a national discussion about the state of science in Japan and the need to ensure high standards in order not to lose the world’s trust.

In contrast, the 2012 paper was withdrawn in April without fanfare: a barebones retraction notice posted by the journal Circulation stated an institutional review had found that the paper contains unspecified “compromised” data. No details were provided about what was wrong with the data.

Health Leaders Media: What hospitals learned from the Boston Marathon Bombing

From Health Leaders Media

A year after the two bombs went off near the finish line of the Boston Marathon, killing three and injuring scores, the city is making final preparations for the 2014 marathon on Monday, April 21. 

First responders and healthcare workers in particular have learned a number of lessons from the events of April 15, 2013. For example, since the bombing, Boston hospitals have changed the way they receive unidentified trauma patients in the emergency department. Members of the city’s police force are now equipped with military-quality tourniquets.

More lessons, perhaps further-reaching, will come as researchers begin to analyze data on the injuries, surgeries, and outcomes for each of the more than 240 people injured.

Dr King’s Marathon from Tinker Ready on Vimeo.

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