5-star Friday: Hiding in plain sight

Part of the mission of good health care journalism is to see the problems hiding in plain sight and make them visible to readers and the public.

Whether it’s the perverse impact of pharmacy middlemen on drug prices, or the downstream consequences of shuttered local newspapers on public health, this week’s 5-star stories call attention to these issues and force us to acknowledge their presence.

If you agree that these stories are worth sharing, please pass them along.

Joy Victory

Joy Victory | Deputy Managing Editor

When towns lose their newspapers, disease detectives are left flying blind • by Helen Branswell • STAT

One of my first jobs out of college was working as the medical reporter at the Corpus Christi Caller-Times in deep South Texas. Corpus happens to be my hometown, but I saw it through new eyes as a journalist.

Growing up, I had no idea diseases like murine typhus and Saint Louis encephalitis were fairly common. And many others in my community didn’t either, so I made sure to write about them. (Murine typhus, you may ask? That’s a bacterial infection from fleas, often from those who infest possums or rats that live near human dwellings. And Saint Louis encephalitis is a garden-variety mosquito-transmitted virus).

Little did I know that my reporting was helping not just my community, but also epidemiologists who utilize local news stories to detect and track disease outbreaks. For example, as Helen Branswell’s story highlights, local reporting helped scientists solve a mumps outbreak in Arkansas, and track the emergence of the swine flu in California and Mexico.

Yet as more and more local newspapers fold, this could mean less accurate disease tracking, especially for emerging outbreaks. “It is well-known that event-based surveillance depends on healthy, local journalism,” Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Disease, told STAT. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”

Mary Chris Jaklevic | Reporter-Editor

Mary Chris Jaklevic

Reporter’s Notebook: The Tale Of Theranos And The Mysterious Fire Alarm • by Jenny Gold • Kaiser Health News

In this galling account, a seasoned journalist describes how a PR team pulled nasty tricks — apparently even pulling a fire alarm at a Walgreens — to discourage her from probing into why Theranos wasn’t using its finger-prick blood test on patients.

Gold set out to do a radio feature about the supposedly cutting-edge test in 2014, a year before it was exposed as a fraud.

Theranos pressured her to do a single-source story based on an interview with CEO Elizabeth Holmes.

Then real trouble started when she interviewed people in line at a Theranos clinic at a Palo Alto, Calif., Walgreens. She asked why they were all getting standard venous blood draws, rather than the prick.

Company reps appeared worried, she writes, and suggested her interview with Holmes could be canceled.

“It was clearly a threat to try to steer me away from where the story was taking me: Theranos seemed to be doing very few, if any, of its revolutionary tests on actual patients,” Gold writes.

Then the fire alarm went off, when there was no fire.

Gold eventually ditched the story.

Readers might wonder why Gold didn’t push harder to get at the truth, but the better question illuminated by the piece is why other news organizations such as Wired and The New Yorker succumbed to these tactics.

Kevin Lomangino | Managing Editor

Inside a drug pricing contract • by Bob Herman • Axios

Kevin Lomangino

Shrouded in secrecy, contracts between pharmacy benefit managers (or PBMs) and pharmaceutical companies are the X Factor in drug pricing. PBMs administer prescription drug plans on behalf of insurance companies and employers, and one of their key roles is to negotiate discounts on the list price of pharmaceuticals from drug manufacturers. In theory, most of those rebates are supposed to be passed along to health plans and their members. But it’s become increasingly clear that PBMs are pocketing a significant portion of those savings. Just how much they are pocketing is unclear because PBM contracts are kept confidential; despite widespread calls for more transparency, PBMs tightly guard the details of how they make their money.

Enter Bob Herman at Axios, who obtained a contract template used by ExpressScripts, the largest PBM in the US, from a source inside the health care industry. He taps industry analysts to explain the key provisions and how they serve the interests of PBMs but not their clients. Notable elements highlighted by Herman include rebate-like fees collected by ExpressScripts that don’t have to be passed along to employers. Said one industry source: “There are so many carve-outs of what they consider a rebate that it’s very murky of what’s being kept and what’s being passed through (to clients).”

ExpressScripts is not pleased to have its dealings — and their role in maintaining high prescription drug prices — open to public scrutiny. They’ve lodged a complaint resulting in the full text of the contract being temporarily taken offline. Axios says it’s searching for an alternate way to post the document.

Jill U. Adams | Associate Editor

Record Numbers of College Students Are Seeking Treatment for Depression and Anxiety — But Schools Can’t Keep Up • by Katie Reilly • Time

Jill U. Adams

This story hits all the marks on this important topic. College students struggling with anxiety and/or depression are seeking treatment. (Yay!) Colleges are recognizing the need and trying to step up. (Yay!) But the fixes aren’t easy and money is tight. 

In addition to citing facts and figures documenting the increase in numbers over the last several years. Reilly profiles a couple of struggling students, as well as some campus counseling offices which have increased staff and still can’t keep up with demand. She introduces readers to some colleges’ more creative approaches, embedding counselors in the dorms and placing satellite clinics in various places on campus.

A key quote:

“A lot of schools charge $68,000 a year,” says Dori Hutchinson, director of services at Boston University’s Center for Psychiatric Rehabilitation, referring to the cost of tuition and room and board at some of the most expensive private schools in the country. “We should be able to figure out how to attend to their whole personhood for that kind of money.”

Please Note: The above stories have not been subject to our rigorous, 10-criteria systematic review for accuracy, balance, and completeness. Rather, they represent pieces of health care journalism and opinion writing that members of our staff found compelling and wanted to share with others.

The recent stories below have been systemically evaluated by our team of expert reviewers and each earned a 5-star score. These are also examples of great health care journalism that are worth reading and sharing with others.

• Philadelphia Inquirer: Is kratom a safe herbal remedy or a dangerous opioid? • by Mari A. Schaefer
• CNN: How barbershops could help lower blood pressure • by Jacqueline Howard
• VOX: Alcoholics Anonymous works for some people. A new study suggests the alternatives do too • by German Lopez

5-Star Friday is a regular feature on HealthNewsReview.org. You can find a list of previous installments HERE.