10 Things I Learned at AHCJ 2010

The annual Association of Health Care Journalists conference has become indispensable in a way conferences never are.

Far from just an excuse to see old friends and drink too much, the AHCJ conference is always so packed with great speakers and workshops that writers find themselves wishing for a baby monitor they could set up in one session while they attend a different session down the hall.

I went to sessions Thursday, Friday, Saturday and Sunday this year and wished I could have fit more in. Here are a few key ideas I picked up, many of which I will expand on in later posts.

1. There is much more work to be done in getting to the roots of the flourishing forest of conflict of interest violations in medical research. According to Dr. Catherine Deangelis, editor-in-chief of the Journal of the American Medical Association, "Up until 1988 there were no articles in the medical literature written on conflict of interest. Then it picked up in 1988 and reached peak in 2007. Now 600 articles are written in the medical literature annually on conflicts of interest." Have you read any of them? You should.

2. Statins aren't the only drugs that deserve a reassessment. Antidote interviewed John Carey about his outstanding work knocking statins down from "miracle drug" status. Using concepts such as "number needed to treat," or NNT, Carey was able to show that statins do work for a subset of the population but not for everyone with heart disease and certainly not for everyone with elevated cholesterol. He also showed that side effects have been downplayed while benefits have been overhyped. In two different talks, Carey's reporting was invoked to show that reporters need to use NNT more often and rely less on the drug companies' marketing messages.

3. Health progress doesn't necessarily mean greater health equity. Dr. Ernest Moy, a medical officer in the Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality explained that when an entire population improves in one area, such as diabetes, the racial disparities between the groups may stay the same. If blacks are more likely to have diabetes than other groups and there is a push to lower the rates of diabetes in a state or county, the push may have the effect of lowering the rate for everyone but continuing to lock that disparity in. At the end of the day, blacks will still be more likely to have diabetes.

4. Never be afraid to ask tough questions. Often at conferences, the panelists and moderators are so nice to each other that no one feels comfortable asking the questions that are on everyone's minds. This is especially true if some big wig has been lured to the event with the promise of a friendly audience and a big platform for them to spread their ideas. Superbug author Maryn McKenna had a crowd of nearly 500 journalists surrounding a stage set with top officials from the CDC and the American Medical Association, and she pulled no punches. She started the lunchtime talk about H1N1 by listing a series of failures in the planning and execution of the federal government's response to the epidemic, and, with help from Jeffrey Levi, executive director for Trust for America's Health, the tough questions kept coming.

5.  Remember what they say about hindsight. During that same lunch talk, the CDC's Dr. Anne Schuchat was surprisingly frank and contrite about what her agency and others did right and wrong. Everyone else on stage had something negative to say about what the government has done, and Schuchat carefully dissected the criticism, taking blame where it needed to be taken but killing many red herrings. "People have been distrusting the government since we founded the country," Schuchat said in addressing the idea that people refused to be vaccinated or have their children vaccinated because of big brother phobias. She said the CDC looked that and other reasons why people did not seek out the vaccine. "The most commonly cited reason among people who were not vaccinated was that they didn't think they needed it," she said.

6. Passionate parents aren't medical experts. Trine Tsouderos and Patricia Callahan at the Chicago Tribune wrote an incredible series of stories, Dubious Medicine, about experimental autism treatments that enraged a good number of parents whose kids were receiving the treatments. The parents presented their children as evidence. The reporters carefully listened to what they had to say and then weighed their experiences against mountains of scientific literature and dozens of interviews with experts in a wide range of disciplines.

7. Patients don't always know what ails them. Self magazine features director Sara Austin explained why her magazine always requires documentation of a person's health problems. "Everyone we've ever featured in the magazine who had a health issue got it slightly wrong."

8. Ask your medical school for the faculty's "outside activity" reports or whatever the equivalent may be. This is what John Fauber at the Milwaukee Journal-Sentinel did to great effect. He has exposed multiple problems at the University of Wisconsin. He was able to access records from the state university's medical school, but he didn't stop there. He also asked the state's other medical school, a private one, for records. That school declined, but Fauber noted that there could be a legal case to be made for an organization that has the tenacity (and the budget). Even private schools receive tons of federal money and should be subject to open access requirements.

9. Read the study. Ivan Oransky, executive editor of Reuters Health, said his team covers 110 studies a week. "I have never assigned a story about a study without myself and the editor for that story having that study and actually reading it," Oransky said. If Oransky can read 110 studies a week, you can read one or two.

10. Follow up. Tracy Weber and Charles Ornstein at the Los Angeles Times exposed huge problems at Martin Luther King Jr./Drew Medical Center near Watts. They won a Pulitzer for the Troubles at King/Drew, and then they checked back to see if the hospital or any regulators had done anything about the nurses who had repeatedly shown incompetence, negligence and dishonesty that hurt and killed patients. They kept checking back, even after they left the Times to work for ProPublica. People sue doctors. They don't sue nurses. And reporters rarely write about them. Weber and Ornstein found out that regulators rarely do anything about them, either, and it turned into another series, Caregivers Who Harm, which was named a finalist for a Pulitzer this year. You can start checking out your own nurses by looking at ProPublica's map showing where to go for state-level information online.