Michael Joyce is a writer and producer with HealthNewsReview.org. He tweets as @mlmjoyce.
In 1945–a year when good news was clearly needed–Byron Nelson wowed and delighted by winning 11 consecutive golf tournaments. It’s the longest winning streak in professional golf. No one has come close since.
This past month (a month, you could argue, that good health care news was sorely needed) I’ve been wowed and delighted by another streak worth mentioning: Three of the finer pieces of health care journalism I’ve read in a long time. These articles are so good I’ve bookmarked them in a new folder labeled “Must Reads.” I feel like sending the folder to every medical school, journalism program, and doctor’s waiting room in the country. Let’s dive in:
If you read one piece of writing on cancer this year, make it this gem of investigative journalism by a veteran correspondent who has taken on an incredibly complex and important issue: the Food and Drug Administration’s (FDA) track record with cancer drugs. In a fair, balanced, and deeply researched piece, Liz Szabo blends provocative insights from patients, oncologists, and FDA scientists to explore a widely held belief: We need better, more affordable cancer drugs to be released faster. Are we doing that now? If so, how? If not, why? And … is there important context here to consider that reporters often miss? Yes.
Deftly incorporating an engaging patient story with more than a dozen sources, Szabo paints a picture of a “flurry” of new cancer drugs with very few “clear home runs.” She cites multiple reputable studies that clearly demonstrate what many news stories fail to mention: Most new cancer drugs don’t substantially improve survival or quality of life, and many actually hinder both.
She also brings up costs–not just that they are skyrocketing, but that many of the more expensive cancer drugs don’t necessarily work any better than cheaper alternatives, nor are they any safer.
There is one topic, in particular, included in this article that is rarely challenged by journalists but should be. That is the concept of “progression-free survival,” which the author rightly translates as “medical jargon for the amount of time that patients live while their tumors are under control.” It’s both a scientific and hopeful sounding phrase which is often neither. Calculating it is an inexact science and actually offers little hope since studies show progression-free survival does not necessarily correlate with overall survival.
Most importantly, this article doesn’t lose sight of what matters most: Those affected by cancer–either personally or otherwise–who don’t sit around debating costs, benefits, harms, or risks. These are very real issues they live with daily.
Full disclosure: I have NOT listened to the podcast published with this article but if it’s even half as good as Mr. Epstein’s writing, I will make a point of doing so.
This article should get 6 stars for exposing a malignant tumor that has been growing in plain sight within our health care system for many years. It’s this: There are a surprising number of popular, mainstream treatments for very common diseases that research has repeatedly shown either don’t help much, are dangerous or–as we’ve pointed out many times in this blog–take people down a path that does more to make them patients then it does to make them healthy. Furthermore, many of these treatments are both high volume and high profit, so much so that they have become household words (including stents, knee arthroscopy, and beta-blockers) and are often demanded by patients. That financial incentives are clearly at play here is not ignored by the author.
The thread running through this story is a popular misconception: If a treatment is popular or commonplace it must be good. Or, it’s probably well-tested. But Epstein provides evidence that this is not always the case. He mentions that at many medical journals, business-as-usual is favoring the publication of new and dramatic results over negative results that challenge what he rightly calls “entrenched common knowledge.” And it’s timely to bring up the mounting pressure by the Trump administration and others to lower the evidentiary FDA standards for approving new drugs and devices. This will clearly exacerbate the problem.
If there is a reason for a sixth star it is that Epstein does not shy away from an often-ignored reality; that is, our collective responsibility. It could be argued ours is a culture that does not approach health care either collectively or responsibly. That we are addicted to the quick fix and the new-and-improved–most of which costs money–but ignore the long-term benefits of adopting a healthy lifestyle.
This is one of the best examples of health care writing I’ve read in decades. I suspect it will go down as a classic, not just because it touches on something vital, but because it’s a damn good story.
You will often hear that we Americans have the best health care in the world. We don’t. The best crisis-oriented “rescue” solutions, perhaps. But individual or collective health as a long-term process? No. Gawande admits it was the the heroic, transformative and quantitative that drew him to become a surgeon in the first place. This essay is a heartfelt acknowledgement that the majority of what dictates the quality of health care is a far less dramatic form of heroism, but perhaps even more transformative, and draws its power from the qualitative. We’re talking about frontline, underpaid, overworked, often unappreciated primary care providers who, by temperament or necessity, practice a form of medicine that is patient, preventive, and pragmatic.
That this is not rewarded irks Gawande. He points out that a cardiologist that does procedures, on average, makes twice as much as a cardiologist who ONLY practices preventive and longterm care.
“This hundred-per-cent difference in incomes actually understates the degree to which our policies and payment systems have given short shrift to incremental care. As an American surgeon, I have a battalion of people and millions of dollars of equipment on hand when I arrive in my operating room. Incrementalists (ie. primary care docs) are lucky if they can hire a nurse.”
The implication is clear: Our first contact for a health problem is usually a primary care provider of some kind. How well that person is trained, the time they have allotted to build rapport and be thorough, and the quality of their decision-making ALL trigger a ripple effect not just on our quality of life, but also the quality of the health care system in general. Because this is nuanced and difficult to measure–or not as obviously “heroic” as surgery or some rescue procedure–it is easy to neglect and undervalue. Or, as Dr. Gawande puts it:
“…the basic decision has the stark urgency of right and wrong. We can give up an antiquated set of priorities and shift our focus from rescue medicine to lifelong incremental care. Or we can leave millions of people to suffer and die from conditions that, increasingly, can be predicted and managed. This isn’t a bloodless policy choice; it’s a medical emergency.”
It’s revealing that I sent this article to an internist friend of mine who works in rural California. She routinely churns out 70-hour work weeks, had her financially strapped practice subsumed by a large health care network, makes two to three times less than the specialists who rely heavily on her expertise, and who gets produce from her patients’ gardens. She goes to their birthday parties and funerals.
I told her she should read this article. She might feel empowered or validated by it. But she hasn’t had the time.
Finally, we’d like to tip our hats to BuzzFeed for this story on an app called “Natural Cycles” which is the first to be classified as a medical device for use as contraception.
It would have been easy to do a quick hit-and-run on this but reporter Kelly Oakes tracked down multiple independent sources and pointed out that the most complete study of the app’s effectiveness in preventing pregnancy – done by the company that developed it – actually has some important limitations.
Our reviewers found the story to be balanced, very informative regarding the plusses and minuses of a variety of birth control methods, and appreciated that the writer included this important caveat: “if you’re considering ditching the Pill because remembering to take it each day is too much effort, you probably won’t like having to remember to take your temperature every morning” (an important number users need to record in the app).