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.

Hospital closures: “Survival of the fattest”

No. Grove St. Today. Note street sign.

MGH

Some say the health care system could stand to shrink a bit. Here, Alan Sager of BU uses the sudden closure of North Adams Regional Hospital to argue that the wrong hospitals are closing.  Hidden on the Globe letters page:

Over half of the Massachusetts hospitals open when John F. Kennedy was elected president have now closed. Not one that closed was a major teaching hospital. Heavy reliance on teaching hospitals helps explain our state’s extraordinarily high hospital costs. The pattern of closings may be partly responsible for that reliance.

Some might suppose that a functioning free market protects needed and well-run hospitals while closing unneeded and inefficient ones. Sadly, that pattern seldom prevails. Low-cost, efficient hospitals are not likelier to survive. But hospitals in wealthier places, with more patients insured by higher-paying insurers, rarely close. Some call this survival of the fattest.

More good work from the Globe health desk here:

 Are cardiologists refusing to follow new cholesterol recommendations?

#Google #Glasses in the hospital: A “mixture of intrigue and skepticism. #HIT #EMR

google glasses

Giuseppe Costantino photo

When it comes to health information technology — a term that encompasses everything from medical records to monitors — John Halamka — the chief information officer at  of Beth Israel Deaconess Medical Center — is the man. Here he reports on wearable computing in the hospital.

Here’s what we’ve learned thus far:
 
halamkaPatients have been intrigued by Google Glass, but no one has expressed a concern about them. Boston is home to many techies and a few patients asked detailed questions about the technology. The bright orange pair of Glass we have been testing is as subtle as a neon hunter’s vest, so it was hard to miss.
 
Staff members have definitely noticed them and responded with a mixture of intrigue and skepticism. Those who tried them on briefly did seem impressed. More from Halamka on his own blog Life as a Healthcare CIO.
Photo permissions:
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Globe: BU sports #concussion doc plays for both teams

Today’s Globe has a terrific story on conflicts of interest for BU’s Dr. Robert C. Cantu, the go-to expert on  football concussions.

The story is behind the pay wall, but click here for a great interactive graphicglobe ss

He is America’s concussion doctor, a pioneer in the fight against sports-related brain damage. …

Yet for all his contributions, Cantu’s roots in the field have grown so tangled that his connections with parties on many sides of the concussion crisis have become emblematic of the conflicting interests in the football, helmet, medical, and scientific communities.

Cantu has worked for and against the NFL. He has been paid to help set helmet safety standards for the National Collegiate Athletic Association while accepting tens of thousands of dollars to submit testimony for players suing the NCAA over head injuries. And corporations that Cantu has served or promoted have contributed more than $1.3 million to entities he helped to create, including a research center, concussion foundation, and charitable endowment.

(Disclosure: TR teaches at BU.)

NEJM: 80% of arthroscopic partial meniscectomy procedures do little for the knees

Note: Consider BMC for your next knee surgery. You may not need it.

From The New York Times:

A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

“Those who do research have been gradually showing that this popular operation is not of very much value,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University. This study “provides information beautifully about whether the surgery that the orthopedist thinks he or she is doing is accomplishing anything. I think often the answer is no.”

Globe: BWH surgeon sues BWH over wife’s post-#hysterectomy #cancer diagnosis

The Globe’s play on this story should say something — Metro front rather than 1A.  Malpractice stories are tricky– serious charges and a response penned by a lawyer, not a doctor.  (At 8 a.m., a complete version of the story was lingering on White Coat Notes, outside the paywall.)

Note the Brigham’s carefully worded statement on the link between cancer and  morcellation, the procedure used during a minimally invasive hysterectomy.

The Brigham said in a statement that “while it’s not possible to know what impact the procedure will ultimately have on Dr. Reed’s health, we do know that literature suggests morcellation of malignant tumors increases the chances of mortality. 

Here’s the lead

A Boston surgeon and his wife, an anesthesiologist, are pushing to stop a widespread surgical technique used on thousands of women during hysterectomies, which they say caused her undetected cancer to dangerously spread.

The she said/she said suggest that

Dr. Barbara Goff  president of the Society of Gynecologic Oncology and director of the Division of Gynecologic Oncology at the University of Washington in Seattle says “Morcellation allows many women to have safer hysterectomies with better outcomes than full abdominal surgery, including less blood loss, smaller wounds, and a quicker overall recovery.”

“You try to balance cost and outcomes and doing the best you can for an entire population of women,” Goff said.

But Dr. Bobbie Gostout, chairwoman of obstetrics and gynecology at the Mayo Clinic, said more women should be given the option of a vaginal hysterectomy, where the uterus can often be taken out intact through the vagina, especially because morcellation “is a questionable practice.”

She said morcellating devices are not yet good at capturing tissue or protecting other sensitive organs from rotating blades.

“I don’t want to see [morcellation] go away, but I would like to see it kept in perspective and occupy its necessary place,” she said. “Morcellation is still so far off what it ought to be.”

HIV, gone after marrow transplant, returns to Boston’s “Berlin” patients

Update: Health News Review used this story as an example of overuse of the term “cure.” HNR also pointed out how the “cure” got a lot of coverage and the news that it wasn’t a cure did not.

The Globe’s story is behind the paywall. Here is the nut.

Or here

Boston researchers are reporting the return of the HIV virus in two patients who had become virus-free after undergoing bone marrow transplants, dashing hopes of a possible cure that had generated widespread excitement

The story reports that doctors detected the return of the virus in one patient in August. The second patient chose to continue in the study, but in November, doctors found traces of HIV and he went back on his medication

Some background here from Nature Boston. 

More on the meeting where this was reported here.

As pointed out above in HNR, the overuse of the term “cure” often leads to disappointment? Here’s what the Google search looks like:

ssniOr here.

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