5-Star Friday: Simplicity

Health care is complex, but so much of its excellence and effectiveness comes from simplicity.

Our 5-star selections this week are good examples of this.

Our first story features a world leader in cancer who believes in simple and straightforward communication of risk, but challenges the prevailing notion that cancer screening is a “simple” and obvious choice.

The second story shows how very simple and easily avoided breakdowns in emergency services can have very complex and dire consequences.

And the final story take us behind the scenes of medical publishing to reveal longstanding problems that should have simple solutions, but somehow remain unaddressed.

It’s 5-Star Friday – enjoy!

Gary Schwitzer, Publisher

Gary Schwitzer | Founder & Publisher

Cancer Society Executive Resigns Amid Upset Over Corporate Partnerships • by Sheila Kaplan • The New York Times

By drawing attention to this article, I am not focusing on the journalism, but on the man who is the topic of the story.

Otis Brawley, MD, recently resigned as Chief Medical Officer of the American Cancer Society (ACS). The Times reported:

His departure was largely attributed to his dismay over some commercial partnerships, including with Herbalife International, the controversial supplements company, people close to him said.

While he would not comment publicly, others said that he had become uncomfortable with the society’s growing reliance on donations from businesses with questionable health credentials that he and others suspect are seeking to burnish their images.

Conflicts of interest in health care, including conflicted commercial partnerships that some health care nonprofit organizations enter into, have been a recurrent theme on our website. So Brawley’s decision – and what’s behind it – is worthy of attention.

He will be missed. Behind his leadership, the ACS was no longer the old ACS with the slogan, “Fight cancer with a checkup and a check.” He questioned some of the checkups and some of the checks being written.

He promoted a balanced discussion of the tradeoffs involved in cancer screening decisions, educating people that “simple” screening tests can, indeed, cause harm. This is evident in the podcast discussion I had with him.

In this video he stated his concerns about some prostate cancer screening promotions:

“There’s a lot of publicity out there – some of it by people who want to make money by recruiting patients – that oversimplifies this – that says that ‘prostate cancer screening clearly saves lives.’ That is a lie. We don’t know that for sure…

…We’re very concerned about a number of clinics that are offering mass screening where informed decision making – where a man gets told the truth about screening and is allowed without pressure to make a decision – that’s not happening. Many of these free screening things, by the way, are designed more to get patients for hospitals and clinics and doctors than they are to benefit the patients. That’s a huge ethical issue that needs to be addressed.

We’re not against prostate cancer screening. We’re against a man being duped and deceived into getting prostate cancer screening.”

He probably did not endear himself to some special interests when he spoke his mind telling journalists, “People in America may not live longer but we sure do a better job taking pictures (scans) of them dying.”

It’s unclear where he’s headed next. And it’s unclear what his departure means for the future of the American Cancer Society. The first will be interesting to follow. The second may be very disappointing.

His voice is vital in the health care and health policy discussions of our country – and beyond. After the announcement, people on Twitter referred to him as “ethical….principled…always willing to speak truth to power….we need more people with this level of integrity.”

Jill U. Adams | Associate Editor

Losing Laura • by Peter DeMarco • The Boston Globe

Jill U. Adams

This is a heart-wrenching piece about a woman who died of an asthma attack while just outside an ER department. Written by her husband, this long-form narrative delivers minute-by-minute detail to reveal multiple breakdowns in the emergency response systems – poor signage at the hospital, inaccurate phone GPS tracking, consolidation of 911 call centers, and good old human inertia.

If any one of these obstacles had been cleared, in a way that we all hope would happen should it be our own family members in crisis, Laura Levis might have recovered from her perfectly treatable asthma attack. Which leaves the writer in yet another pickle:

And it is the story of how there will be no justice through our legal system for what happened to Laura, as public hospitals in Massachusetts, and throughout most of America, are largely protected by state laws against malpractice and negligence claims, leaving thousands who rely on such institutions little recourse when harmed or lied to.

Michael Joyce | Writer-Producer

Peer Review: The Worst Way to Judge Research, Except for All the Others • by Aaron E. Carroll • for The New York Times

Michael Joyce

It seems “The Upshot” at the New York Times has caught on that Aaron E. Carroll, a pediatrician and health care blogger from Indiana, has a knack for pulling back the curtain on important goings on backstage in medicine.

In this case, the fallibilities of peer review, which is the process by which medical experts decide what does and doesn’t get published in medical journals.

What’s behind the curtain? Intransigent bias, trendy topics, a lack of women, and reviewers who are rarely trained or paid for what they do — in the case of the latter, an estimated bargain savings of over $3 billion in 2008.

Perhaps the most interesting part of the article comes toward the end when Carroll — himself an editor at a major pediatric journal — offers up his suggested remedies. It’s sobering how self-evident they are, and disturbing how they’ve managed to go mostly unaddressed for decades.

Please Note: These stories above 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.

However, our reviewers did give 5 stars to two Associated Press stories over the past month:

• AP offers strong reporting about the evidence for a drug treatment for moderate bone loss
• Thoughtful and thorough, AP story looks at growing trend of using ketamine for depression