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.

A Madison, WI television station has offered to showcase doctors who pay for advertising as the top experts in their fields, according to the AP. Excerpt:

WKOW 27, an ABC affiliate, sent letters to doctors and clinic managers last month soliciting help to create "a local source for credible, consumer information on health specialties." The letter describing the "unique marketing initiative" didn't specify when the programming would run, which left some readers believing it would be on news shows.

Great piece of local health policy journalism by the Dallas Morning News. Excerpts:

"There's a lot of money to be made in owning imaging machines," said Dr. Richard Strax, president of the Texas Radiological Society. "You can buy a relatively inexpensive second- or third-hand MRI machine for a few hundred thousand dollars and make millions on it."

"Today we can't even tell you how many MRI machines are in Texas, who owns them, what condition they're in and what quality of scans they're turning out," Ron Luke, health policy chairman of the Texas Association of Business, told state lawmakers this year. "That doesn't sound like we're very bright, does it?"

For three sessions, radiologists and doctors have fought in the Texas Legislature over the issue of self-referral. This year's legislation, backed by radiologists and business lobbyists, would have required licensing and accreditation of imaging machines, along with a year-long state study of the extent of self-referral by physicians. But it failed.

Proponents of the legislation say opponents are driven by financial motives. Imaging has become a "lifeline" for many doctors, said Dr. Cynthia Sherry, past president of the Texas Radiological Society.

"It's all about the money, OK? Those very doctors opposed to this are the ones participating in it," Sherry said.

An 1,800-word story on a vital health policy topic. Wow, do we need more like this. Ten gallon hats off to the Dallas Morning News.

In another fine example of its dedication to important health care journalism, the Milwaukee Journal-Sentinel published a piece, "Debate on MRI payments just one hurdle for reform."

Gems in this piece include:

• Information on the Access to Medical Imaging Coalition, a group backed by the major manufacturers of imaging equipment, including GE Healthcare. The paper reports: "That industry backing goes unmentioned by the innocuously named group. The Access to Medical Imaging Coalition, which includes cardiologists and radiologists, is just one of the myriad special interest groups that often oppose cuts in what Medicare pays for medical services."

• "The reality is the status quo puts a lot of money in a lot of people's pockets," said Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change, a policy research organization in Washington, D.C.

  Another reality is groups such as the Access to Medical Imaging Coalition often succeed in persuading Congress to protect their interests.

Read the entire piece. It includes local angles on local industry affected and about Wisconsin legislators' activities in this area. A fine example of local journalism on a national issue.

Marketplace on NPR has begun an occasional series called "The Cure." The lead-in to the first segment said:

"Up first, the inner workings of a typical medical practice. Did you ever wonder, for instance, what all those people on the other side of the counter are actually doing? And why there are so many of them? We sent Marketplace's Tamara Keith to find out."

Keith spent the day at a doctor's practice, seeing firsthand why there were more administrative staff than health care professionals in this particular practice. They're dealing with health insurance - and different flavors of insurance from different health insurance companies. It's the American way. It's the marketplace at work that anti-health care reform forces want to preserve.

Listen to it. It's good radio journalism.

But you should also read the comments section following the text story on the Marketplace website. One guy wrote:

"I worked for Ingenix, a subsidiary of UnitedHealth group, for three years as a software developer. I worked on a crack team of Java developers who used cutting edge technology to build two huge software systems: ContractManager and iCES.

ContractManager cost $150,000 a seat. It sat in the offices of large physician practices and analyzed the doctor's rejected claims and figure out ways to bleed more money from insurance companies.

iCES sat in the office of insurance companies and analyzed claims using high technology with the intent of finding ways of paying doctors less.

Our shorthand internal way of describing what we did: "Selling guns to the Hatfields and the McCoys."

Having worked for several insurance companies, I must point out that the single payer, public option is the way to go. Right now, providers and payers are having an arms race and you and I are paying for both sides."

A physician friend of mine in Los Angeles told me her office deals with 94 different insurance plans. 94 DIFFERENT INSURANCE PLANS! And none of the people who push that paper do anything directly to benefit your health. Amazing.

The Oklahoman is another newspaper that must love new, expensive, unproven medical technologies.

The story, "Tulsa company hopes device can ease cancer screenings," may just as well have been headlined, "Tulsa company can't write a better promotional news release than this."

It's a local business story, cheerleading for local business, and to hell with the evidence. And for that matter, the story thumbs its nose at women who need better information than this about breast cancer screening.

Former Washington Post health section editor Craig Stoltz wrote this summary on HealthNewsReview.org:

"This story on a new ultrasound imaging device stands out from other zero-star stories we've reviewed. This piece doesn't merely fail to be accurate, balanced and complete. It fails to even try.

* It draws on only one source, a company executive whose job it is to sell machines
* It doesn't present any data to justify the source's claims of efficacy and superiority
* It doesn't provide any context about similar devices and other diagnostic techniques
* By implying the device can detect cancers mammograms cannot, it could provoke unjustified fear
* It fails to distinguish between screening and diagnosis

Looking over the story, it's not clear the reporter even asked a question. It is not mean or hyperbolic to say that most press releases are more informative."

Consider the impact on consumers of this kind of daily drumbeat of such stories by news organizations all across the country while you listen to all of the mounting opposition to health care reform proposals in Washington. (Today I've blogged about just two - albeit egregious - examples in South Dakota and Oklahoma.)

Until we educate health care consumers better than this, health care reform is going to be a really tough sell.

This story has barely been touched by local Twin Cities news organizations. But a student journalist, Emma Carew, reported on it as her last story at the Minnesota Daily before graduating and before going to work for the Washington Post this summer.

As you'll see, the story touches on issues of duplication of services, increased costs, competition and the medical arms race.

A 1,200-word story by a student journalist on an important topic for local discussion.

In the inquisitiveness and determination of young journalists, there is hope for health care journalism. This is one shining example.

Intro to Hospital Public Relations: How to learn from bad examples.

Minnesotans, wake up from your winter doldrums and get your heads around health care reform issues.

Tomorrow (Friday April 24) - free documentary screening of Alex Gibney's film on Maggie Mahar's book , "Money-Driven Medicine."

Link to map of Murphy Hall location. Parking in Washington Avenue ramp two blocks east of this location.

See Maggie Mahar's entry on the HealthBeat blog.

And for a little wisdom of the crowd, here is one online reader reaction to Maggie's post:

"Our local CBS station has a regular feature called "Breakthroughs Everyday" featuring one healthcare network. I've written to the news director at this station requesting, in the interests of fair and impartial journalism, that they also have a regular feature entitled "Failures Everyday" and start reporting on the stories of patients from the same hospital. No reply. ... The hospital PR has disgusted me for years."