A few weeks back I caught up with a Health 2.0 veteran Dean Stephens, CEO of Healthline. For those of you who’ve not been paying attention Healthline.com has become a very fast growing consumer site–now with over 30m visits a month. Meanwhile, Dean’s been incubating a provider-focused natural language search product called Coding InSight to extract information from EMRs, which will compete with the likes of Apixio, Clinithink and others. Many more details in the interview below!
Infectious disease is the most hyperbolic of all medical fields, at least when the media gets ahold of such.
Right now we are to fear a new avian influenza virus. Previously there was another avian influenza strain whose outbreak threatened the world and of course SARS and, more distantly, the ebola virus and the threat of bioterrorism. And on the periphery, as these acute threats come and go, is the persistent threat of super bugs; bacteria resistant to multiple antibiotics. Sometimes all antibiotics.
I remember my pharmacology professor in medical school claiming that within our practice lives we would reach the useful end of antibiotics. A claim, literally, that physicians would no longer have any use for antibiotics by the time I reached the end of my career.
Scary stuff but evidence that such outrageousness sells pharmacology in a classroom as much as it does magazines on a news stand. Time magazine a post called “The End of Antibiotics?” referencing a Guardian article along the same lines. This followed a similar 2009 scare article in Time.
On March 20, 2013, the media picked up a story about CVS Caremark’s latest wellness program. In summary, CVS will be requiring all of its employees to complete a health screening in order to qualify for a reduction in their health insurance premium. For those employees who participate, the employee’s screening data goes to a third party, and CVS never sees it.
Such wellness financial incentives are commonplace and have been around a long time. And if that is how the media had described the CVS program, it’s doubtful anyone would have even paid any attention to it. Unfortunately, that’s not how the media ran with the story. Let’s look at how the media sent the wrong message – using ABC News as an example – and why it matters to get the message right.
Sending the Wrong Message
ABC’s Good Morning America segment was emblazoned with the headline, “Who’s Watching Your Weight – CVS Employees Required to Disclose Weight.” Their website ran a similar headline, “CVS Pharmacy Wants Workers’ Health Information, or They’ll Pay a Fine.”
The coverage of the Japanese reactor situation reminds me of the coverage of many other technical issues when they overlap with serious breaking news stories. I wrote a little on this subject a few years ago, talking about the Merck/Vioxx business, but I wanted to expand on it.
I’m not going to rant on about the popular press not understanding this or that scientific or technical issue. There are more systemic problems with the way that news is reported, and in the way that we take it in. I’m not sure of what to do about them other than to be aware of them, but that’s an important step right there.
The first of these is narrative bias. Reporters like to relay stories (and the rest of us like to hear stories) that have a progression. They have a beginning, a middle, and an end, the way our most popular novels and movies do. Something starts, something happens, something ends. Real life sometimes conforms to this template, but sometimes it doesn’t. For example, some situations don’t start, so much as they suddenly get noticed after they’ve been there all along. And some don’t end, so much as they just stop having attention paid to them.
Another narrative-bias problem is the tendency to assign participants in any event to recognizable categories: good guys and bad guys, for starters. Moving to finer distinctions, there’s Plucky Young X, Suffering Y, Salt-of-the-Earth Z, along with Untrustworthy Spokesman A, Obfuscating B, Crusading C, and the whole crowd. Mentally, we tend to assign people to such categories, especially if we don’t know them personally, and it makes it easier for reporters, too. It’s a team effort. The problem is, of course, that not everyone fits into a recognizable category, and many others overlap in ways that a simple narrative structure won’t accommodate. Most real people are capable (more or less simultaneously) of great and venal actions, of heroism and cowardice, of altuism and selfishness.
“Despite their great explanatory powers these laws [such as gravity] do not describe reality. Instead, fundamental laws describe highly idealized objects in models.”
— Nancy Cartwright, “Do the Laws of Physics State the Facts?”
In Part I the limitations of science in helping us make wise choices and decisions about our health were examined.
Because of an inherent difficulty in establishing causation, absolute certainty is unattainable even in science. Medical knowledge follows Karl Popper’s theory of science because the right answer, whether about what causes ulcers or if you should take hormone replacement therapy, keeps changing with the publication of new studies. And most depressingly of all, a respected expert on evidence-based medicine concludes, “The majority of published studies are likely to be wrong.”
Part I ended with some suggestions that seemed to imply that savvy patients should enroll in a graduate level statistics class and understand the subtleties of observational studies, meta analysis, and randomized controlled clinical trials. Being an informed health care consumer is evidently difficult indeed.
Part II explores how we all have to change if we are to live wisely in a time of rapid transformation of the American healthcare system that everyone agrees needs to decrease per-capita cost and increase quality.
When I talk to physicians about pay for performance programs, I am always asked why should doctors be responsible for patient behavior that they cannot control. Even if we were able to have health care access for all and eliminate every error in medicine, we would only account for 10% of whether an individual stays healthy. Environment and genetics account for about 35%, but the remaining 55% of whether one stays well depends on behavior (exercise, smoking, diet) and social support systems (families, communities, places of worship).
“The mind leans over backward to transform a mad world into a sensible one, and the process is so natural and easy we hardly notice that it is taking place.” Jeremy Campbell
On the same day in November, headlines from the Wall Street Journal and the New York Times reported on the same story about a federal panel’s recommendations on consumer intake of vitamin D.
“Triple That Vitamin D Intake, Panel Prescribes” read the WSJ story;
“Extra Vitamin D and Calcium Aren’t Necessary, Report Says” stated the New York Times. (http://ow.ly/3tJMe) Since I had recently started taking vitamin D daily, I was interested in what the experts in Washington, DC were recommending.
How should you decide what advice to follow about the relationship between your diet, lifestyle, medications, health, and wellness?
Is this just another example of how the media does a terrible job? Many of us resonate with the view of media watchdog Steven Brill who said, “When it comes to arrogance, power, and lack of accountability, journalists are probably the only people on the planet who make lawyers look good.” (http://ow.ly/3tKdM)
The media does play a role here and needs to improve, but it turns out that it is really complicated to figure out what the “truth” is about diet, exercise, medicines, and your individual well being. Everybody (journalists, government panel members, scientists, patients, physicians, and nurse practitioners) needs to change.
Dear Speaker Pelosi:
As your respective chambers work to reconcile the differences between the House and Senate health care bills, C-SPAN requests that you open all important negotiations, including any conference committee meetings, to electronic media coverage.
The C-SPAN networks will commit the necessary resources to covering all of these sessions LIVE and in their entirety. We will also, as we willingly do each day, provide C-SPAN’s multi-camera coverage to any interested member of the Capitol Hill broadcast pool.Continue reading…
Ariana Huffington recently anointed diet-and-exercise guru Dean Ornish as her chief medical correspondent. With all the guff her site had taken from the science-based medicine crowd for giving free rein to anti-vaccinists, faith healers and the no-evidence-needed alternative medicine freaks, I thought it was a smart move — a tack toward the responsible center, if you will.But in a post this week, Ornish recounted his 14-year-battle to get Medicare to pay for a pilot project to test lifestyle intervention as a cure for heart disease (which wouldn’t save Medicare money, but would save more lives for the same money expended as, say, giving those people cholesterol-lowering medication). What he drew from his saga was that the government can’t be trusted to run health care, and that health care reformers needed to rise above the right-left divide and unite around reimbursing physicians for keeping people well.It was a classic case of crunchy granola versus the class warriors. The comments section was overwhelmed with hostile attacks on Ornish’s above-the-fray moralizing. The commentators defended single-payer, pointed out the indiscriminate nature of many diseases, articulated the special needs of the poor whose stress and multiple jobs make them especially prone to disease, etc. etc. What was striking was how thoughtful and well-reasoned many of the comments were, a far cry from conspiracy-minded rants of that usually dominate the comments space.
Emory University psychologist and political consultant Drew Westen in the weekend Washington Post offers a troubling view of the public’s role in health care reform. While reform’s reality involves complicated technical issues like insurance exchanges, public plan governance, physician and hospital payments and who will pay higher taxes, the public’s understanding of these issues is virtually non-existent, Westen assumes.
Stephen Colbert’s Republican Health Care Infomercial. Quite wonderful. Can’t get it to embed but here’s the link