Health Care Links

It's not a stretch to call Gary Schwitzer the Walter Cronkite of health care journalism. His Health News Review was fact-checking since before fact-checking was cool.  I followed it for a long time with Google Reader but dropped it when I got overwhelmed by the volume. It's like the Guinness Book of Records or an unabridged dictionary -- more than most laymen can handle. But this week I re-subscribed and will give it another run. Anybody serious about health care news and reform should have this guy on their radar.  Here are some recent links for starters.

►  7 Words (and more) You Shouldn't Use in Medical News
This is a thirteen-year-old classic.

Over a 25-year career in medical journalism and health care communications, I have developed my own list of taboo terms – all of which appear in print and on the public airwaves too frequently. I offer my own list of the seven words you shouldn’t use in medical news and health care communications. I urge colleagues – both health care providers and professional communicators – to abandon their use for the sake of health consumers everywhere. I urge consumers of all health care information to be wary of these words because they mean different things to different audiences.

• Cure

• Miracle

• Breakthrough

• Promising

• Dramatic

• Hope

• Victim

How many times do we see these words in headlines, TV reports and most notably in commercial messages?  I once had a teacher who had a firm rule: Never use the word "thing." Ever. There is always a better word. If you can't think of it, then you shouldn't be writing about it. 
Over the years I have slipped a few times, but not often. Go to the link for a fuller explanation of each, for example...

Dramatic discoveries seem to occur in the medical media more often than even in our television soap operas. The ancient Greeks would remind us that drama could be both comic and tragic, as can the use of the word “dramatic” to inject hype into an otherwise important piece of research news.
Veteran science writer Victor Cohn once chided medicine and the media by saying, “It seems like there’s only two types of medical news stories: new hope and no hope.” A woman struggling with cancer once told me she wished medical reporters would leave the word hope out of their reports and allow consumers to decide how much “hope” to assign to each story.

►  Prozac and SSRIs: Twenty-fifth Anniversary by David Healy 
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that affect serotonin levels in the brain. Serotonin is a chemical neurotransmitter. For many people, SSRIs are the first choice of depression treatment selected by health care providers. And by now, everyone has heard of Prozac.
Schwitzer links this reflection which reminded me of the a sad retrospective of trans-orbital lobotomies, a treatment of choice for extreme cases of mental problems prior to the introduction of Thorazine in 1954.
The NPR story of Howard Dully is a haunting story of how much worse mental problems were managed in the past.  It's only 23 minutes long.  Highly recommended.
But Dr. Healy reminds us that the journey still has a long way to go.

Prozac was approved in 1987 in the US, and launched in early 1988, followed by a clutch of other SSRIs. Twenty-five years later, we now have one prescription for an antidepressant for every single person in the West per year.
Twenty-five years before Prozac, 1 in 10,000 of us per year was admitted for severe depressive disorder – melancholia. Today at any one point in time 1 in 10 of us are supposedly depressed and between 1 in 2 and 1 in 5 of us will be depressed over a lifetime. Around 1 in 10 pregnant women are on an antidepressant.
No one knows how many new cases of depression there are per year partly because modern depression is a creation of the marketing of Prozac. Until recently what is now called depression was called anxiety, nerves or a nervous breakdown. SSRIs can help some cases of nerves but they are of no use for depression proper – melancholia. But the money for companies lies in treating nerves not melancholia – and as a result any of us with severe depression is likely to get worse treatment now than we once did. We’ve gone backwards.
[...]
Many see or saw psychiatry as a medical backwater with grim, overcrowded hospitals, and a dim understanding of the disorders it treats. In fact it was the first branch of medicine to have specialist hospitals and journals, the first to discover the bases for and eliminate several serious disorders, the first to adopt rating scales and controlled trials. And with Freud’s son-in-law, Edward Bernays, it was the first to step into public relations.
Twenty-five years ago, no one could have imagined that the bulk of the treatment literature would be ghostwritten, that negative trials could be portrayed as glowingly positive studies of a drug, that controlled trials could have been transformed into a gold-standard method to hide adverse events, or that dead bodies could have been hidden from medical academics so easily. Twenty-five years ago no one would have believed that a drug less effective for nerves or melancholia than heroin, alcohol or older and cheaper antidepressants could have been brought on the market and that almost as a matter of national policy people would be encouraged to take it for life.

►   An update on how we die in the U.S.

Okay, this is another pitch for all readers to take action on advance directives for medical care, for themselves and anyone in their life who needs encouragement.  

Schwitzer points to yet another article about end-of-life care, this time in the LA Times. 

But the latest research suggests that patients' wishes may not be getting through to the family members and physicians who help guide patients' end-of-life journeys. As a result, their final days are far from what most would consider ideal.
There's almost always, in every medical circumstance, one more thing we can try," said Dr. Julie Bynum, a gerontologist at Dartmouth's Geisel School of Medicine and coauthor of the study. "It's hard for a doctor to say, 'I have one more thing I can do, but it's not a good thing.'"
The time to begin the conversation with family members and doctors about end-of-life care is well before the final crisis begins, she said. If a patient's wish to avoid aggressive treatment is clear, "you need to prevent him from getting into that cycle of acute care," she added, "because once they get into the hospital, it's really hard to get them out."

Grim humor here....
Q.  Why do coffins have nails.
A.   To keep out the oncologists.