Where to put health stories in the paper and why it matters

The Boston Globe has taken to playing stories on medical research findings — like today’s digital mammography report —  on Page 2. For the writer, good play, but not great. To the reader, this suggest important, but not front page important.  This is commendable – often stories about complicated or incremental developments make  the front page,  giving readers the false impression that they need to stop eating eat this food or start taking that drug.

photo (3)A front page story on a research paper suggests a major development. (Good health writers try not to use the hyperbolic word “breakthrough.”)  So, the 1A Vertex story on a new CF drug rates as both a business and medical story. It could be life changing for people with cystic fibrosis and for the company’s bottom line, which is suffering from the arrival of new Hep C drugs. What we don’t like about the CF story – it could use a comment from someone not involved in the research. It’s a business story, so they seek out an analyst,  but he gushes. And his agenda is investing, not health.  It needs a CF scientist or clinician not involved in the study. Still, we get how hard it is to pull these stories together on deadline.

The Page 2 story on digital mammography offers such a comment. The JAMA article was accompanied by an editorial from Dr. Etta Pisano, a breast imaging radiologist at the Medical University of South Carolina who has done a lot of work in this area. Could have been a bit higher in the story but it works:

“There’s a debate about the harms of screening and overdiagnosis of breast cancers from mammograms and to me, this doesn’t resolve that,” she said.

Want to see how it shouldn’t be done? Check out the Health News Review. The list of stories that resorted to sensational language – breakthrough, game-changer, best way of detection, any woman should have this, lifesaver – was long.”

What’s the Boston play online? By late morning, neither story was high on the home page. At least you can click on the Business section from the home page. Health? Still no home on the home page. Click on “News” to find the link.

 

Berwick stays in the Massachusetts race for governor, supports single-payer

Former Medicare Chief and Democratic gubernatorial candidate Don Berwick apparently got a boost at a recent state convention, coming in third behind two front-runners.  Former political editor Peter Canellos writer notes Berwick’s support for single payer in the Globe’s new “Capital” section:

When his rivals claimed he wasn’t really offering anything new — just another health care commission — Berwick doubled down by calling it “Medicare for all,” a description that pretty much suggests he’d eliminate private inberwicksurance.

Now, with the Democratic race down to three candidates — Berwick, and two party regulars with histories of failing to excite voters — single-payer will finally get the attention it merits as essentially the only markedly different policy proposal to emerge from either party. A bold move to show the Obama administration what real reform looks like? A takeover that will roil the system? A vehicle for finally bringing about equality in health care? A threat to Massachusetts’ world-class doctors and hospitals? Single-payer could be all those and more. And if Massachusetts were to broadly restructure its health system, yet again, reverberations would be felt across the nation.

The Globe tagged along with him earlier this week, starting with a scene at the WBUR studios.

Can Berwick, who ran Medicare and Medicaid in the Obama administration for 1½ years, appeal to voters outside the left wing of the Democratic Party?

 He’d face the question twice more Monday, once from a Boston Herald reporter and again that evening at a Democratic gubernatorial forum in Jamaica Plain.

 For Berwick, the question is misplaced because, he says, it underestimates the liberal impulse of the entire state — a state that elected Governor Deval Patrick and Senator Elizabeth Warren.

 “This is a place where people really want to honor the idea that we are in this together, community by community,” he said in the WBUR interview. “And no, I don’t feel this is confined to some kind of fringe progressive wing.”

A bit here from Berwick on some of the Republican ideas for Medicare from out 2012 post.

 

 

 

 

 

 

Former NEJM editor Arnold Relman dies at 91

RelmanSee Storify for updates. 

Arnold Relman, the former New England Journal of Medicine editor, has died. From Bryan Marquard at the Globe: 

Eloquent and forceful on the page or the podium, Dr. Arnold Relman led the New England Journal of Medicine for more than 13 years, raising a sometimes lonely voice to warn about the dangers of for-profit medicine when many in politics and his profession raced to embrace a free market approach.

Dr. Relman also was one of the nation’s foremost writers about the rising cost of health care. Persistent to the end, he received the galleys of his final article just a few days before he died of cancer in his Cambridge home early Tuesday, on his 91st birthday.

 

When he suffered a catastrophic fall last year, he wrote about it in The New York Review of Books:

 

Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.

 

What he reported was not flattering to Spaulding Rehab, the hospitals that has won praise for working with so many marathon bombing survivors.

What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out. I always knew that the treatment of the critically ill in our best teaching hospitals was excellent. That was certainly confirmed by the life-saving treatment I received in the Massachusetts General emergency room. Physicians there simply refused to let me die (try as hard as I might). But what I hadn’t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGHand Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.

What personal care hospitalized patients now get is mostly from nurses. In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

More on that piece from The NYTimes. 

 

Relman often commented on the influence of money on medicine. In 20o9,  he crashed the inaugural meeting of the Association of Clinical Researchers and Educators (ACRE) “an organization of medical professionals dedicated to the advancement of patient care through productive collaboration with industry and its counterparts.”

So, we asked for his thoughts about the presentations. Here they are:

“I sat through the whole program, which was a sustained diatribe against conflict-of-interest regulations rather than a scholarly, balanced discussion of the issues. There was practically no time for audience questions or comments, but instead an almost unrelenting barrage of ideological and anecdotal criticism of what was said to be a misguided “belief system” that worries excessively over relations between industry and the medical profession. There was an occasional informative and reasonable contribution, but for the most part sarcasm and anger prevailed.
 
The heavily industry-related audience loved the performance, but the obviously biased, self-serving, and often grossly flawed presentations should have embarrassed the organizers. Although neither Harvard Medical School nor the Brigham & Women’s Hospital sponsored or formally endorsed the meeting, the HMS Dean did give the initial welcoming remarks, and the Hospital offered its facilities for the event. One can only hope that they are now having second thoughts.”
More here:

Science writers meet in Cambridge MA to discuss the shabby treatment of female sci scribes

On deadline today, but will be keeping an eye on this.  You can too.  

ss

The world of science writers has a dual problem that we have confronted recently, involving issues of sexual equality and of sexual harassment. As an initial step toward grappling with these problems, the National Association of Science Writers held a session at its 2013 meeting in Gainesville, the XX Science Question, featuring six panelists and a standing-room-only audience intent on airing these concerns. What was originally planned as a session on women and representation among science writers instead grew into a plenary in which the community brought forward a number of issues. But time was necessarily limited, precluding getting into any single concern in any depth.

Now, the members of that panel have expanded what began at the plenary in Gainesville and are coordinating a conference to address these issues, with generous funding from the National Association of Science Writers. The conference will take place at MIT on June 13-15, 2014, to bring together stakeholders in the community for training, discussion, and finding consensus on solutions. While the team listed below is serving to organize and coordinate, the important contributions at this conference will come from attendees, some invited and others registered through open registration, all with the goal of having as much representation as possible across community stakeholders.

New video on Partners in Health’s Hôpital Universitaire de Mirebalais in #Haiti #hospital

Mew video from Boston-based Partners in Health:

Four years after an earthquake struck Haiti’s capital—damaging its already-weak medical infrastructure—a new public teaching hospital in Mirebalais, Haiti, is transforming the lives of people in the Central Plateau and beyond.

Since opening in March 2013, University Hospital has treated thousands of people who previously had little—or no—access to health care. The facility, built by Partners In Health and Haiti’s Ministry of Health, also serves as a training ground for Haiti’s future clinicians, and is a catalyst for economic growth in the region….

Hôpital Universitaire de Mirebalais, in Mirebalais, Haiti, provides primary care services to about 185,000 people in Mirebalais and two nearby communities. But patients from a much wider area—all of central Haiti and areas in and around Port-au-Prince—can also receive secondary and tertiary care. We see as many as 700 patients every day in our ambulatory clinics.

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. 

 

Follow

Get every new post delivered to your Inbox.

Join 67 other followers

%d bloggers like this: