And why are so many stories so unquestioning about these runaway surgical Twitter practices? Just look at this frame grab from a Google search showing all the stories (so far) on one hospital team's surgical Twitter exploits. One story stated:

"Senior hand fellows...when not actively involved in the surgery, sat at a laptop just outside the operating suite and tweeted real-time updates during the procedure, according to a hospital press release. According to the Twitter feed, expert teams of hand surgeons rotated in and out of the operating room throughout the surgery."

Oh, phew, their hands were tweeting when their hands were not operating! I might rather that my surgeons - even when not actively involved in the operation and when rotating out of the OR - would just rest their digits and not flex them digitally. But what an old-fashioned guy I am.

On the Croakey blog, Melissa Sweet writes about some burning conflict of interest questions in her corner of the world. Excerpt:

"...it would be useful to have a central online registry where journalists and others could easily search to see the commercial ties and COI policies of health and medical experts. This might also be useful for patients, especially when making major health care decisions. I was heartened to hear one psychiatrist in the audience is considering how best to declare such information to patients.

Meanwhile, I also showed this image of a flier distributed at the Dietitians Association of Australia conference in Darwin last year."

While we're on the Mac attack, a PR company (which I've asked to stop sending me stuff), compared its clients' claims in a head-to-head with McD.

I'm not taking sides. I really don't care. Let 'em fight it out in the gutter.

And to the PR company, I ask again that you stop sending me your fluffy news releases.

There may be just a few more important things to spend one's time on in the field of breast cancer.

But the Wall Street Journal reports on an ugly dispute, "Charity Brawl: Nonprofits Aren't So Generous When a Name's at Stake." Excerpts:

As the leading breast-cancer charity, Susan G. Komen For the Cure helped make "for the cure" a staple of the fund-raising vernacular. The slogan is so popular that dozens of groups have sought to trademark names incorporating the phrase. Among them are "Juggling for a Cure," "Bark for the Cure," and "Blondes for the Cure."

Komen sees this as imitation, and it's not flattered. Instead, it's launching a not-so-friendly legal battle against kite fliers, kayakers and dozens of other themed fund-raisers that it contends are poaching its name. And it's sternly warning charities against dabbling with pink, its signature hue.

"It is startling to us that Komen thinks they own pink," says Mary Ann Tighe, who tangled with the breast-cancer charity over the color for her "Kites for a Cure" lung-cancer fund-raiser. "We cannot allow ourselves to be bullied to no purpose."

Read some of the online comments following the WSJ story to see rising skepticism - even cynicism - among posters about non-profits and their missions.

Breast cancer advocacy doesn't need this.

Breast cancer advocates should be trying to explain the tradeoffs involved in mammography screening, the tradeoffs involved in treatment decisions, the ramifications of health care reform legislation and involving themselves in many other pressing matters.

Otherwise all parties run the risk of hearing the public tell them all to go fly a kite.

Journalist Larry Husten, on his CardioBrief blog, describes a "new one on me" in linking to what he calls "an extraordinary document" describing cozy - indeed, invited and paid-for meeting opportunities between medical industry leaders and physicians at a heart valve conference.

Of a long laundry list, one item got special notice from Husten:

"And for $6000 sponsors get to participate in "Meeting of the Minds":

Choose four faculty members for a private one-on-one meeting. Secure your faculty choice early as faculty will be removed from selection list once chosen.

I think the organizers may have missed a big opportunity here. Why only $6000 for 4 faculty? I'm surprised they didn't think of an auction. I'll bet there are some faculty members who could fetch way more than $1500..."

(Photo credit: from Tracy O on flickr)

Here's the headline: "Buffalo birthing center has the latest amenities."

And here's an excerpt:

"Starting in August, new mothers will have a chance to multi-task in style in Buffalo, Minn.

The local hospital is unveiling its new birth center, where every patient room will be equipped with an iPod docking station, a flat-screen TV and DVD player, a soaking tub, rocking chair and refrigerator -- oh, and a place for the baby to sleep, too.

Buffalo Hospital has spent $7.1 million to turn its old labor and delivery unit into a state-of-the-art facility to appeal to a new generation of patients.

At maternity wards around the country, that increasingly means catering to patients and families as if they're at "a luxury hotel," as the Buffalo Hospital website puts it."

And here's how some smart readers reacted:

Bioethicist Steve Miles submitted this comment to the Strib online:

"It is so sweet that moms can start multitasking before they have a chance to leave the TV on during what used to be "family time" during dinner. --1 out of 13 persons in Wright County do not have health insurance. I hope that Buffalo hospital will step up and offer them means catering to patients and families as if they're at catering at the level of "a luxury hotel" including iPod docking stations, a flat-screen TV and DVD player, a soaking tub, rocking chair and refrigerator -- oh, and a place for the baby to sleep, too. --Oh silly me, the hospital website advises "Prior to receiving services at an Allina facility, we recommend that you verify coverage with your health insurance plan." "

Gary Thaden, government affairs director for the Minnesota Mechanical Contractors Association - and a guy who knows a bit about health care since he's trustee for a $50 million/year health plan - wrote:

"What if the Buffalo Hospital had spent $7.1 million on lowering their hospital inspections rate? How many fewer people would have been sick if the hospital had passed on the DVD player and original artwork? Why isn't the StarTribune investigating the economic disincentive hospitals have to lower their infection rate?"

Bioethicist Carl Elliott wrote to me - short, not so sweet, but to the point:

"Oh man, that turns my stomach."

Addendum on July 26: Sometimes MedPageToday.com republishes some of my blog posts, as they did with this one. There were some interesting online comments on the MPT site. Examples:

• As a former hospital nurse, this remodeling job doesn't surprise me a bit. I've seen it happening over and over again for thirty years. It was at least 15 years ago that one of my floor managers gave us a lecture during a staff meeting about how our patients are our customers, and it's our job to provide good customer service. Her most memorable words: Patients don't care if you're saving their life -- just be sure the coffee you're bringing them is hot. As a society, we have developed a disgusting level of attitude about personal entitlement. The basics just aren't good enough for us anymore. We deserve at least the appearance of the very latest, the very best, etc., no matter the fallout around us. Whether or not what we're lusting after is necessarily good for us, for society, or for the earth is secondary.

• Turns my stomach too. Are your bioethicist friends going to point out why the hospital advertises these amenities? (Hint: it's about money).

They do it because birthing is a bellwhether event (if you give birth at a place, you are likely to choose it for other types of care), and more importantly, because birthing stays are, in the main, short, cheap, and high reimbursement. In short, hospitals recoup the money they spend on birthing centers, whereas no one is paying for lower infection rates, or shorter ED stays, or decreased readmissions (the last of which actually directly reduces reimbursement, regardless of being right for the patient).

Perverse incentives of this kind are why the market (at least as currently structured) can never make health care *better*, only pricier. So get out your wallet, because you just paid for a bunch of DVD players, iPod docks, soaking tubs and rocking chairs which most of you will never use.

• WHY?....Marketing! We are becoming only for what is looking right not what is right . the relatively few with a paying source or big pocketbook and champagne taste are driving the resources allotment based on marketing and focus groups. The will to do right, lead responsibly is being trumped and, well handwashing is a low tech solution with measurable outcomes it's just not glitzy enough. We need some real hard looks in the mirror!

Nice job by the Chicago Tribune in its story, "Looking at the food pyramid," a story on last week's Washington, DC meeting to accept public comment on the proposed guidelines for 2010, which will be released at the end of the year. The story touches on issues raised by the salt, fat, seafood and dietary supplements industries.

Excerpt:

"The proposed 2010 guidelines are the first to acknowledge America's dire obesity epidemic and the roles environment and communication play in actually getting the public to follow the suggestions.

They cite "powerful influences that currently promote unhealthy consumer choices, behaviors and lifestyles" in our environment."

See Natasha Singer's New York Times piece and/or just listen to the following audio clips of phone calls from a federal investigation, with testing company representatives telling "consumers" some egregious and unsubstantiated things about what the company tests can show and what the results mean. This is some pretty troubling stuff. Read Singer's piece for more details on the feds' investigation.

See the LA Times' Booster Shots piece that lets readers know about who's behind a survey touting the benefits of chocolate in a healthy diet. And the piece also addresses some concerns about chocolate industry corporate sponsorship of the American Dietetic Association. Excerpt:

"The Hershey Center stepped up its commitment to your health this week by becoming a corporate sponsor of the American Dietetic Assn., the professional group for nutritionists and dieticians. (The organization can be found online at EatRight.org. In doing so, Hershey joined an esteemed list of health food purveyors, including the Coca-Cola Co., PepsiCo and Mars Inc. (Yes, the soda companies also sell juice and water, and Mars makes Uncle Ben's rice, but that doesn't make them health food companies.)

The folks at Fooducate are understandably appalled (if not surprised) that the ADA would let itself be influenced by big bucks from candy and soda makers. "Instead of a very simple message - 'less candy' - we'll hear 'moderation,' 'balance,' 'chocolate is healthy' and other messages that help nudge consumers to buy more snacks instead of less," according to a post on the Fooducate blog.

The Sustainable Food blog got to the heart of the issue: "If the world's largest group of nutrition professionals is in bed with junk food giants like Pepsi and Mars, how can consumers believe any of the organization's dietary advice?" Instead, the blog suggested that "folks can get better dietary direction from a fortune cookie." "

Andrew Pollack's story, "Hope Against Hepatitis C," has many elements of solid health journalism - and from the business perspective as well.

Sure, it leads with "hope."

"The new drugs, which could start reaching the market as early as next year, could help subdue a virus that infects roughly four million Americans, most of them baby boomers, and 170 million people worldwide.

"I almost think this will be revolutionary, to be honest," said Dr. Fred Poordad, chief of hepatology at Cedars-Sinai Medical Center in Los Angeles. "We are chomping at the bit to try to treat as many patients as we can." "

But there is also frank discussion of reality - with some skepticism.

"But even if the drugs do work, some experts and doctors warn that this virus may be particularly tough to vanquish. Three-quarters of the people who are infected do not know it because they are not tested for the virus and because the infection can be asymptomatic for years while it stealthily attacks the liver.

And because this disease is transmitted by blood, those infected largely are former or current IV-drug users -- a population that characteristically has little or no health insurance -- who may not be the most able to stick to a lengthy treatment regimen that can cause brutal side effects.

Pharmaceutical companies "completely ignore the real face of hepatitis C," said Dr. Diana L. Sylvestre, who runs a clinic in Oakland, Calif., that treats drug addicts and former addicts with hepatitis C. "A minority of patients who have hepatitis C will benefit from these drugs."

When she gave a recent talk at Vertex, Dr. Sylvestre's first slide showed a man in a suit, meant to be a Vertex executive, with his head in the sand."

There was an inside look at pharma's promotional efforts.

"Nevertheless, pharmaceutical companies realize that difficulties getting patients screened and treated could limit the use of their drugs. So they are contributing to a groundswell of activism to raise awareness of what has long been known as a silent epidemic.
...
Drug makers contribute to the National Viral Hepatitis Roundtable, which helped pay for the Institute of Medicine report, and several companies have banded together into the Corporate Hepatitis Alliance to lobby for more government funding. In January, several companies started the Viral Hepatitis Action Coalition, to help finance research at the Centers for Disease Control and Prevention.

Vertex has commissioned studies projecting a rising toll from hepatitis C. One such study, done by Milliman, a health insurance consulting firm, projected that the number of people with advanced liver disease from hepatitis C would quadruple in 20 years if treatment did not improve.
...
"I think the companies have done a superb job of marketing this disease," said Dr. Ronald L. Koretz, emeritus professor of clinical medicine at the University of California, Los Angeles. Dr. Koretz said there was no good evidence that treatment made a difference since many patients cured by the drugs might never have developed serious problems anyway."

Enough excerpts and highlights. Read the entire story at the link above - or the old fashioned way - with newsprint in hand! My point is: more health business news should be as complete, balanced, indepth and analytical as this was.

Kudos to Pollack and the Times.

Here we go again. And believe me, as one who covered the artificial heart experiments of the 1980s, I feel like I've been through this countless times before. But so have news readers.

Another entrepeneurial team announces its hopes for its artificial heart device and some news coverage trumpets the company's announcement.

But this was in the New York Times! Now, granted, it's in a "Global Business" section. But we don't see why that removes the need for more scrutiny, for independent perspective, for a better discussion of evidence. The story begins:

"It is a long-held dream: an artificial heart to replace one that is damaged or diseased. Now, a French company says that it has the technology to make the implantation of it a standard surgical procedure."

But the story never scrutinizes what the company says - except to say "While the sales pitch may make for a compelling story, as with any start-up, there is no guarantee that the enterprise will succeed." But that's about business prospects. It's not about the science and the evidence.

"The company hopes to start human testing in France by the end of next year and to bring the technology to the market in Europe in 2013."

On the one hand, we got somewhere with that sentence - human testing hasn't even begun. On the other hand, we let the company get away with projecting widespread marketing within 3 years! What is that based on? Besides a company's hope and a prayer?

It was good that the story reminded readers of other devices either already approved or in development.

It concluded with the company's chief executive estimating the:

"... the potential market at "a minimum" of 100,000 patients a year in the United States and Europe. However, he said cost constraints meant it was unlikely that more than one-tenth of those patients would actually receive an artificial heart."

And that cost was estimated elsewhere in the story:

"When all expenses are considered, including hospital and surgical expenses, it says it will cost just over $315,000, about the same as a transplant."

Let's remember to "Be still, my beating heart" and to scrutinize the enthusiasm of a company - maybe until it has experience with, say, at least one human experiment. I remember some of the breathlessly enthusiastic news coverage of experiments with Barney Clark, Bill Schroeder, Murray Hayden and others with the Jarvik-7 artificial heart in the '80s.

Has journalism learned anything about coverage of artificial hearts in 30 years?

Freelance journalist and author Suzanne Schlosberg wrote because she was so upset over a New York Times story, "The Chip That Stacks Adds a Multigrain Twist," that she wanted us to review it. I thought anyone who feels so strongly about something should review it herself. So she did. And here is Suzanne's guest post:

I was flabbergasted when I read this New York Times piece on Procter & Gamble's new entry into the potato-chip market: multigrain Pringles. The story accepts at face value P&G's misleading marketing pitch -- that "multigrain" is equivalent to "healthy." When I sent a link to my nutritionist friend Cynthia Sass., M.S., R.D., she replied: "Did you notice it says 'advertising' in the top left corner? It must be a paid ad that resembles an article."

Actually, it's not. It's a business story that ran in the Media & Advertising section. Though the story didn't appear on the health pages, it should have made clear that multigrain simply means that more than one grain is included in the product -- not that the product is necessarily nutritious.

What's more, the story confuses "multigrain" with "whole grain," here:

Mr. Bergsma (Pringles marketing director) said that the multigrain Pringles campaign was devised to appeal to people 35 and older, a group that tends to be more aware of calories and sodium content and that also looks to keep the pounds off with whole grains.

Even more egregious: It's not until the 11th paragraph, and only in parentheses, that the story mentions that -- oh, by the way -- the new Pringles actually aren't any more nutritious than original Pringles. (Even so, multigrain Pringles, which are made from rice, corn, wheat and black beans in addition to dehydrated potatoes, have about the same amount of sodium and calories as regular Pringles.)

The story might also have mentioned that multigrain Pringles, like original Pringles, have 1 measly gram of fiber.

Cynthia Sass told me that misleading articles like this one have a real impact on her clients' perceptions about what's healthy and what's not. She said: "Whether it's sugar-free, low-fat or multigrain, when processed foods are being presented as 'healthy' they become perceived as healthy, even if they're not. Foods that earn a health halo, deserved or not, are often consumed more frequently or without regard to calories, let alone overall nutritional value. I think it can lead to people truly thinking they're eating healthfully then wondering why they aren't losing weight or don't have energy."

Thank you, Suzanne, for your contribution and for joining us in the quest to help consumers scrutinize claims made for new treatments, tests, products, procedures --- and potato chips.

Former US Senator David Durenberger (R-MN), in his monthly commentary from the National Institute of Health Policy at the University of St. Thomas, writes about an example of a patient and a provider balking at evidence and outcomes data.

The commentary is built on the back of a story in the St. Paul Pioneer Press by Jeremy Olson (who is leaving soon to join the Star Tribune across the metro). Durenberger writes:

For many years MN health insurance companies like BCBSMN have been trying to convince members that they can provide more value for the premium prices they charge, because they can give members access to higher value health care services. This is what the HMO has been about for three decades and "data on docs" and the creation and sponsorship of the Institute for Clinical Systems Improvement (ICSI). For example, Health Partners Medical Group reports key clinical outcomes of more than 400,000 patients classified, since 2004, by socio-economic status, race and ethnic group because more than 90% of their patients will trust them with that kind of information.

Jeremy Olson, St Paul Pioneer Press, writes about an interesting new chapter in this effort. A 38-year-old leukemia patient is concerned that BCBSMN requires her to go to the Mayo Clinic for a bone marrow transplant rather than to the University of Minnesota where she has received all her care. "It breaks my heart," the patient says. But BCBSMN has the local and national data to show that Mayo's transplant outcomes for cases like hers are better than the UMN. The response from UMN is: "We treat the toughest cases that others won't." This is the kind of response we've become used to hearing when outcomes research is used to inform and to direct pre-paid patient decisions.

It doesn't hold water. When lives are at stake, and reputations are on the line, research data must be as precise as possible. There are those in the medical industry who love bashing insurers and managed care even more than President Obama does. Traditional insurance plans will tell you that hospitals with less than the best outcomes may be motivated by their finances in taking on cases for which success is less likely. I will always recall the two neurosurgeons involved in the development of the cyber-knife telling me about a Miami colleague who bought two and was making a mint off "hopeless" tumor cases.

When the UMN says their cancer transplant cases are "tougher" than Mayo's and therefore their success rate is lower, they need to be asked first to prove it, and then whether admission decisions can be affected by reimbursement which is unrelated to outcomes. What I would love to know, were I this patient, is which cancer centers, or which oncological surgeons, in this country have even better results for people like me than Mayo. Maybe one is right here in Minneapolis?

This gap - between what evidence shows on outcomes - and individual or institutional resistance to the evidence - is a huge barrier standing in the way of any meaningful health care reform.

Kudos to Jeremy Olson and David Durenberger for writing about it.

Nice piece on how "Foods masquerading as drugs have become a $160 billion business" and how even products that flop in clinical trials continue to be marketed as if their evidence was golden. Excerpts:

Foods masquerading as drugs are the hot spot in the packaged-food business. The world's biggest food companies are stuffing ostensibly beneficial bacteria, omega-3 fatty acids and other additives into packaged foods. They are funding clinical research in order to justify health claims--often deliberately vague--that blur the line between nutrition and medicine. The foods promise to boost immunity, protect your heart and digestive system or help you sleep. In some cases, like the ProBugs kefir, manufacturers aren't adding new ingredients but merely repackaging old foods with bold new health claims.
...
But most of the claims "are completely unsubstantiated," says Steven Nissen, head of cardiology at the Cleveland Clinic. "Medical attention does not come from a Cheerios box." Designer foods can be a way for clever marketers to lure people away from real health foods--fresh fruits and vegetables. "It plays on our psychology," says Michael Pollan, author of The Omnivore's Dilemma. "We want to consume sugar; we want to consume fat; we want to consume salt. These products give us an excuse to binge."

Read the entire column to run the gamut from probiotics to pomegranates.

This week, NPR aired an interview with James Unland, Editor of the Journal of Health Care Finance, regarding questions about hospitals' spending on advertising - especially in a time of economic troubles. An especially interesting question in the Twin Cities right now, on the eve of a nurses' strike. The transcript is online.

Or you can listen to the clip here:

Go on a tour of a "midsized academic health center" with Dan Shapiro, chair of the Department of Humanities at Penn State College of Medicine, by reading his essay in the current issue of Health Affairs. Excerpt:

"It doesn't make sense to me that we live and die by our procedure-based departments. Lifestyle is implicated in many if not most diseases, from diabetes to heart disease and some cancers, but the experts in helping patients change their behavior--our primary care and behavioral scientists--are poorly compensated. It is, in short, depressing.

We do stomach stapling, but won't invest in teaching young, mildly overweight patients how to eat inexpensive, healthier food that can still taste good or how to distinguish anxiety from hunger. We'll reimburse cardiac surgeons for numerous invasive interventions, but, aside from a few demonstration projects, we won't reward doctors who successfully get their patients to lose weight. We pay physicians to do complex procedures, but then we don't follow up to make sure our patients have even picked up their medications.

Are we reimbursing procedures better because they take more skill? Is it truly harder to install a titanium hip joint than to help patients drop pounds or consistently do weight-bearing exercise? Is it harder to blow open an artery than to help a person quit smoking? I respect the skills of my surgical and procedural colleagues, as well as all of the specialists who walk our halls. But I also know it's incredibly hard to help kids identify and avoid what triggers their asthma, and I know that it takes special skill even if it looks like "just talking."

Perhaps it's because we think procedures are riskier, and physicians who do procedures should be rewarded for their courage. But is overcoming risk in the quiet of the operating theaters truly more courageous than working in an asthma clinic, helping a flood of patients with limited resources navigate the challenging waters of a life-threatening breathing disorder?"

Julie Appleby of Kaiser Health News has an intriguing story about five insurers in Oregon offering "value-based insurance design."

She explains:

"...a new type of insurance that offers free care for some illnesses, such as diabetes or depression, but requires hefty extra fees for treatments deemed overused, including knee replacements, hysterectomies and heart bypass surgery.
...

The policies are among the first to apply financial incentives on both sides of one important factor driving up the nation's health care tab: The underuse of proven treatments and overuse of certain surgeries and diagnostic tests that may be less valuable."

Ahhh, spring! When a young man's thoughts turn to:

• urinating at baseball Spring training

• getting a vasectomy during basketball March Madness.

Am I right?

I am if I do marketing for urologists.

American Medical News reports that some urologists are trying to get men's attention by marketing March Madness as a great time to get a vasectomy. Excerpt :

"After all, men, if you're going to do something that requires you to sit around in a bathrobe, doing nothing for two days, why not do it when there's wall-to-wall basketball on TV?

For a growing number of urology practices, tournament time has become key to marketing a procedure that many men put off or avoid out of -- shall we say -- sensitivity. And because many men meet a urologist for the first time through a vasectomy, the practices find it a great way to get their names out to new patients."

They market under the labels "Rip City" or "Snip City" or with "I Got Chopped at the Urology Team" T-shirts. You can see the gory details at the link above.

But as basketball season winds to a dramatic close, baseball season fires up again.

Indefatigable Yankees fan Ivan Oransky followed his Bombers to Florida for Spring training last week, presumably imbibed, presumably relieved, and found this urinal screen in the process:

My wife made me block out the urologist's name and phone number. She said, "You're not going to give that guy any more free publicity."

I can't imagine anyone at a urinal writing down the urologist's name and number. I can only imagine Ivan taking out his cell phone and taking a picture. I know he feared ending up on a post office wall for this. He may still.

Imagine the urologist deciding on the need for a marketing campaign and going to the
PeePeeFace.com site and choosing his personalized urinal screen.

Now that's a fan. Or a urologist desperate for customers.

(Correction: Ivan Oransky advises that he saw the Cards play the Marlins. Not a Bronx Bomber in sight.)

We've written before about some of the headlines praising robotic surgery:

• Robot doctor - surgery of tomorrow

• Da Vinci puts magical touch on the prostate

• Cancer survivors meet lifesaving surgical robot

• Robotic surgeon's hands never tremble

• Da Vinci is code for faster recovery

• Surgical Maestro

• DA VINCI ROBOT IS SURGERY WORK OF ART

Now even the news that a company is testing a couple of robotic-surgery-training-simulators "and expects the units to go on sale for about $100,000 by early 2011" makes news.

The AP reported it (this is their photo at left of the news conference) and the story was picked up by ABC News.com, CNBC, the Los Angeles Times and elsewhere.

Granted, a simulator that might help train docs in what seems to be the inevitable spread of this technology might be an important quality/safety improvement.

But the AP story that spread across the country didn't mention any concerns about the medical arms race involving robotic devices, nor any questions about evidence.

• Hold news conference.

• Demonstrate gizmo.

• Get nationwide news.

How easy it can be to get free publicity, without ever having people focus on some of the important policy questions at stake. But after this week, who cares about health care policy, anyway?

The Center for Public Integrity has posted a searchable database of what they say are the 1,750 companies and organizations that have hired 4,525 lobbyists to influence health care reform legislation. The Center states:

"Despite the recession, 2009 was a boom year for influence peddling overall with business and advocacy groups shelling out $3.47 billion for lobbyists to represent them on all kinds of issues, according to the nonprofit group Center for Responsive Politics.

Much of that money went to fight the health reform battle, according to Center for Public Integrity data. Businesses and organizations that lobbied on health reform spent more than $1.2 billion on their overall lobby efforts. The exact amount they spent on health reform is difficult to quantify because most health care lobbyists also worked on other issues, and lobby disclosure rules do not require businesses to report how much they paid on each issue.

From an industry perspective, it was money well spent. A close look at the health reform bills that passed the House and Senate show lobbyists were apparently effective at blocking provisions like a robust government-run insurance program, and blunting the effect of cost-cutting measures on health care companies."

This is the second business section health news story we've questioned today. But we're not the only ones.

A Star Tribune headline screamed, "Blockage Breakthrough" on behalf of a local company's hopes for its coronary artery intervention product.

Problem: We never learn what the product really is or how it works.

We only hear the praise from one - just one happy patient - and the pronouncement from the lead investigator (perhaps a bit conflicted?) that this is the closest they can come to the Holy Grail for treating blocked coronary arteries.

Readers are not dumb. Online, some commented as follows:

• "I don't get it...exactly what is the breakthrough? It sounds like a normal angioplasty,"

• "Please define what (these devices) actually do."

• "There is no description of what it is, what it does."

• "Seems like the main point is not in the article? So how does the thing work? I kept reading it over thinking I missed it in there."

No matter where you live - think twice about health stories on the business page that make things sound too good to be true. And if the story doesn't deliver what you need to understand, take a moment to write in as these folks did. Maybe someone will listen.

Gina Kolata's NYT piece, "Results Unproven, Robotic Surgery Wins Converts," looks at how "robot-assisted prostate surgery has grown at a nearly unprecedented rate."

Excerpts from the story:

• "..robot-assisted prostate surgery costs more -- about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same."

• "Meanwhile, marketing has moved into the breach, with hospitals and surgeons advertising their services with claims that make critics raise their eyebrows."

• "Medical researchers say the robot situation is emblematic of a more general issue. New technology has sometimes led to big advances, which can justify extra costs. But often, technology spreads long before investigators know whether it is worthwhile."

• "...a situation like robot-assisted surgery illustrates how patients may end up making what can be life-changing decisions based on little more than assertive marketing or the personal prejudices of their surgeon.

"There is no question there is a lot of marketing hype," said Dr. Gerald L. Andriole Jr., chief of urologic surgery at Washington University. Dr. Andriole does laparoscopic prostate surgery, and although he tried the robot, he went back to the old ways.

"I just think that in this particular instance, with this particular robot," he said, "there hasn't been a quantum leap in anything."

Nerves seem to have been rubbed a bit raw at a couple of medical device companies, according to an interesting story by Christopher Snowbeck of the St. Paul Pioneer Press.

I'll only tell you that the story touches on:

• cow pies
(Photo by Jeff Vanuga, USDA Natural Resources Conservation Service, found on Wikipedia. Ed. note: This photo is provided for the education of users who have never been on a farm. It is not necessarily the "mud" referred to in the headline's reference to "mudslinging." This may be the only time I'll ever have the chance to discuss cowpies on this blog, so this is a rare teaching moment.)

• divorce

• Senator Chuck Grassley

• disciplining sales reps for repeatedly breaching code of conduct for interactions with health care professionals.

You'll have to read Snowbeck's piece to get the details.

The Akron Beacon Journal reports:

Akron General Health System recently began advertising up-to-the-minute wait times for its emergency rooms on billboards throughout town. Six digital billboards in Akron are automatically updated every 20 minutes to show current average wait times to see a doctor at the main ER in downtown Akron and in satellite ERs in the Montrose area and Stow.

The same info is on the hospital system's website:

The newspaper provides some background on this trend:

"Local hospitals increasingly are competing to grow their share of ER business, particularly since Akron General opened its satellite emergency departments in Bath Township and Stow in recent years.

Akron-based Summa Health System is working on a plan to share updated ER wait times and other information via mobile devices, spokesman Mike Bernstein said.

''We expect to begin offering this service in the next several weeks, beginning with Summa Akron City Hospital, and then we will begin to roll it out to the other hospitals throughout the year,'' Bernstein said.

More hospitals nationwide are starting to advertise their ER wait times through billboards, Web sites, text messages or social media sites, such as Twitter.

Some emergency medicine doctors, however, see this as a dangerous trend.

By viewing wait times, patients with serious problems might mistakenly drive across town to see a doctor quicker when, in fact, ER personnel make sure those with the most critical problems are seen immediately, said Dr. David C. Seaberg, a member of the board of directors of the American College of Emergency Physicians.

''I just think there are some real problems with doing this,'' said Seaberg, dean and professor at the University of Tennessee College of Medicine in Chattanooga.

Although emergency departments routinely monitor their wait times to try to improve, sharing the data publicly ''is really just a marketing tool more than anything else,'' he said. ''I worry about the potential harm that may be done by doing this.''

Got an email from a PR company the other day - same PR company I'd asked to take me off their mailing list last year. This important note proclaimed that:

"2010 is the year of the Pomegranate. On January 5, Reuters posted an article stating that Pomegranate helps reduce the risk of breast cancers. It is increasingly important for women to do all they can to continue fighting this ugly disease. Incorporating pomegranate into your foods and recipes is an easy way to get the appropriate doses to fight off many diseases and illness - including breast cancer."

What the news release didn't tell you was what else was in the Reuters story:

• This quote: "It's not clear that these levels could be achieved in animals or in humans because the (compounds) are not well absorbed into blood when provided in the diet," said Gary Stoner of Ohio State University.

Wait. What's that? The research WASN'T in humans? Not even in animals? Only in a lab dish? Hmmm. The news release didn't say that either.

But it DID tell women that adding a teaspoon of the product it was promoting - handsomely captured in the photos provided - would "aid in the fight of breast cancer."

The PR person offered to send me samples of the product. I won't ask for those.

She also said she looked forward to my feedback. i've just delivered it.

As long as they keep me on their mailing list, I'll continue to point out the completely unfounded claims they make. The leap between what's seen in the lab and what may happen in mice or in women should not be minimized in the attempt to pitch products.

If you've had a TV on at all in the past week, you've probably seen the new Taco Bell commercial with the woman claiming to have lost 54 pounds on her Taco Bell "drive-thru diet."

An ABCNews.com story did a good job taking a critical look at campaigns like this one or its forerunner - the guy who claims to have lost a lot of weight on a Subway sandwich diet. Excerpts:

"But dieticians are on the fence about whether these campaigns ultimately hurt or help a nation where more than a third of meals are eaten in restaurants and more than a third of the population is obese. ...

Dr. David Katz, director of Medical Studies in Public Health at Yale University: "I also suspect that most people hoping to 'be' Christine will be very disappointed, just as most Jared wannabes are. These are likely people who made a dramatic commitment to lifestyle change, and simply relied on a particular source of convenience food as part of their strategy. That doesn't make that source of convenience food the solution!" ...

"This is preposterous. This is the same Taco Bell that has the Volcano Nachos (almost 1,000 calories), that boasts about the 1/2 pound cheesy potato burrito, that has systematically encouraged people to eat between meals with their 4th meal campaign," said Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. ...

Bonnie Taub-Dix, spokeswoman for the American Dietetic Association, pointed out that the Fresco Crunchy Taco, for example, "barely has protein" and that "half of the calories in that meal are coming from fat. If someone had this for lunch alone, I'd say it's an inadequate lunch."

Interesting story on consumer behavior with high-deductible health insurance plans - and how one surgeon said, "You could not design a less intelligent system." Excerpt:

"People with insurance deductibles tend to put off medical care early in the year because they have to pay out of pocket. Some then burn through their deductibles anyway because of unexpected doctor visits or a trip to the emergency room. Anything else they get done this year is covered by insurance so they're trying to cram in procedures before Jan. 1. ...

Doctors report that deductibles do affect patient behavior. Many patients now ask about price. If in the past they demanded a costly MRI, now they'll question whether they need one. The plans' advocates say this sort of engagement is a first step to curbing the nation's runaway health costs.

But once the deductible is met, "they go right back to their old behavior," said Maureen Swan, a principal at health care consultancy MedTrend Inc. The incentive then is to use as many medical services as possible at little or no extra charge before the new year."

Natasha Singer's story looks at ads for cancer centers that tout high cure rates and low risk but no evidence to back that up. Testimonials rule the message. She writes:

"In medical science, such anecdotal data would not be considered statistically valid. But ads for nonprofit medical centers are not held to scientific standards of evidence.

....If a drug maker ran an ad for a cancer medicine, Food and Drug Administration regulations would require the company to be able to support any superiority claims with substantial evidence from rigorous clinical studies.

But federal agencies cannot limit the ad claims made by nonprofit medical centers about their ability to cure people of diseases like cancer, according to the government's main ad regulator, the Federal Trade Commission.

Cancer experts interviewed for this article say there are no comprehensive statistics showing that any one elite medical center has better overall cancer success rates than its competitors. "

It's an important story. Read the whole thing at the link above. And don't miss the great use of multimedia - with radio, TV and print ads included in the online story in the left margin.

A news story - it's not labeled as an editorial or as an advertisement - on a New Jersey news website bemoaned how "doctors will soon be forced to scale back or discontinue medical imaging services, due to the major reimbursement cuts recently released in the Centers for Medicare & Medicaid Services' (CMS) 2010 Physician Fee Schedule."

The story went on to quote four sources who promoted the need for imaging support - but it quoted no one who talked about questions of overuse of, and overspending on, medical imaging.

So a reader weighed in on the online comment section, writing:

"Is this a press release or a news story? Are you paid by the imaging lobby?

The part about "stifling innovation" and "delivering better outcomes with less radiation" is downright disturbing, particularly in light of a a recent National Cancer Institute report that said 29,000 cancers - and 14,500 deaths - related to radiation exposure from CT tests will occur in people who were scanned just in the year 2007.

You should know your reporting could be hurting people. How about an article detailing the risks of CT scans to provide some balance to your readers? Imaging can help but medical researchers are quickly discovering it's vastly overused, particularly for heart disease and musculoskeletal disorders. Not only can the radiation harm you, it can lead people to get unnecessary surgeries that carry the risk of harming them for life."

Thank goodness the "news website" posts comments. In this case, it made the page look smarter and more balanced.

Here's a glaring, classic example of how health care industry public relations is taking advantage of a weakened news media to get its story - and only its story - across.

For free.

As if it were independently vetted news.

Which it isn't.

In the circles I run in, there's been a buzz about an announcement first made last December about a "partnership" between the FDA and WebMD. Yesterday the two entities announced an expansion of that partnership "to provide increased access to FDA's consumer health information."

I can appreciate the FDA's interest in reaching the public more directly with its messages.

But WebMD has turned over its "channel" - some of it marked "news" - to a government agency. Should journalists "partner" with a government agency for news and information?

And they boast that "Since the launch, over 150,000 consumers have accessed the FDA destination on WebMD ... The FDA's consumer information is also available through WebMD the Magazine, distributed ten times a year and reaching an additional 11 million consumers with each issue."

And I would remind the FDA that, while there may not be any ads on the FDA pages of the WebMD site, users are just a link away from ads on WebMD material. I just visited and quickly found myself viewing ads for drugs for fibromyalgia, depression, coronary artery disease and others. Is that appropriate for the FDA?

Something doesn't feel right about this - for either party - or for the public.

Sandy Szwarc of the Junkfood Science blog looked at this in greater detail when the partnership was first announced in December.