Hoaxes, Hospitals and High Schools: My Favorite Health Stories of 2011

It was difficult to narrow Antidote's list of favorite health stories from 2011 down to just 10. But here they are, in no particular order. I'll share five stories today and five on Friday.

1. "State pushes prescription painkiller methadone, saving millions but costing lives," Ken Armstrong and Michael Berens, The Seattle Times, December

The reporters treated methadone like a charming serial killer. They explained why it is attractive to patients and policymakers. They showed how it works differently from other drugs. And they carefully mapped its trail of destruction: more than 2,000 deaths in Washington in just the past eight years:

Methadone belongs to a class of narcotic painkillers, called opioids, that includes OxyContin, fentanyl and morphine. Within that group, methadone accounts for less than 10 percent of the drugs prescribed - but more than half of the deaths, The Times found. Methadone works wonders for some patients, relieving chronic pain from throbbing backs to inflamed joints. But the drug's unique properties make it unforgiving and sometimes lethal.

Antidote has written a lot about painkillers, but even people who think they know much about this area of medicine could learn from reading this piece and the others in the series, "Methadone and the politics of pain."

2. "Doctors and dentists tell patients, ‘all your review are belong to us'," Timothy B. Lee, Ars Technica, March

The headline may have stopped you if you aren't a video game fiend or frequent email forwarder. That would be a shame. While so many of us just sign whatever paperwork our doctors and dentists hand us as part of what we perceive as the privilege of having our ailments addressed, Lee balked:

The agreement that Dr. Cirka's staff asked me to sign on that February morning began by claiming to offer stronger privacy protections than those guaranteed by HIPAA, the 1996 law that governs patient privacy in the United States. In exchange for this extra dollop of privacy, it asked me to "exclusively assign all Intellectual Property rights, including copyrights" to "any written, pictorial, and/or electronic commentary" I might make about Dr. Cirka's services, including on "web pages, blogs, and/or mass correspondence," to Dr. Cirka. It also stipulated that if Dr. Cirka were to sue me due to a breach of the agreement, the loser in the litigation will pay the prevailing party's legal fees.

This seemed fishy to me, so I asked for more information. I had a long conversation with Dr. Cirka's office manager, who insisted that the agreement was not intended to censor the truthful reviews of Dr. Cirka's patients. Rather, she said, it gave Dr. Cirka a tool to remove fraudulent reviews. She said they were especially concerned about non-patients (such as competitors, ex-spouses, or former employees) writing fake reviews to damage Dr. Cirka's business.

As Antidote has noted, Lee's work has prompted the company that creates agreements like Dr. Cirka's, Medical Justice, to rethink its policies. And it has prompted one of the biggest consumer review sites, Yelp, to hunt down fake positive reviews.

3. "Without Autopsies, Hospitals Bury Their Mistakes," Marshall Allen, ProPublica, December

Whenever ProPublica launches a new investigation, you can be certain there will be mountains of data and other evidence to back up the findings. As part of ProPublica's series on death investigations, "Post Mortem," Allen explored a topic where the lack of data was the story:

Hospitals are not required to offer or perform autopsies. Insurers don't pay for them. Some facilities and doctors shy away from them, fearing they may reveal malpractice. The downward trend is well-known - it's been studied for years. What has not been appreciated, pathologists and public health officials say, are the far-reaching consequences for U.S. health care of minuscule autopsy rates.

Diagnostic errors, which studies show are common, go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost to learn about the effectiveness of medical treatments and the progression of diseases. Inaccurate information winds up on death certificates, undermining the reliability of crucial health statistics.

The story captures some of the personal drama around death diagnosis, the economics at play and the erosion of one of public health's pillars. It's a quick and fascinating read. I only hope more people in a position to actually pay for autopsies take the time to read it.

4. "How the vaccine crisis was meant to make money," Brian Deer, BMJ, January

Deer already had provided a great service by doggedly reporting on the bad science behind Andrew Wakefield's claims that vaccines caused autism. In this story, part of his series "Secrets of the MMR scare," Deer took his reporting to a level most reporters don't – or can't. He showed how this phony public health scare was driven by avarice. To prove his case, he fully annotated all of his findings:

The revised business plan was ambitious and detailed, aiming to raise £2.1m from investors. It spanned the detection of Crohn's disease, the treatment of autism, and "a replacement for attenuated viral vaccines." The methods for the molecular test for Crohn's disease were newish. But those for the treatment and vaccines were dated. They relied on transfer factor, a largely abandoned fringe technology to move immune cells from person to person.

Nevertheless, the school remained interested, and a two year courtship ensued. Even as the vaccine scare escalated, triggering a deluge of referrals to Walker-Smith, staff at Freemedic, the commercial arm of what was now the merged Royal Free and University College Medical School, poured over contracts and plans.

Anyone who has written more than a few sentences about the purported link between vaccines and autism knows that the topic raises intense emotions on both sides of the discussion. This piece and the rest of the series contributed a truckload of evidence to the argument that we should stop wasting time on dead ends like the MMR vaccine and focus more of our efforts on finding true causes and real treatments.

5. "Castlemont High School students cope with stress and violence," Beatrice Motamedi, The Oakland Tribune, May 31

Interviewing kids can be painfully hard. Some answer in three words or less. Some embellish the truth without blinking. Some have their parents call you after the interview to tell you that you can't print anything they said. Motamedi, a California Endowment Health Journalism Fellow, built an entire series on the great interviews she had with kids. They told her about the daily stresses they faced. Then she talked to experts and dug up research about how that might affect their health:

Asked to describe what stress feels like, Perla Quinones, a 17-year-old Castlemont business technology school senior, has no trouble.

"I can tell when I'm stressed because my stomach starts to hurt, my hands get sweaty and my body feels funny," she writes.

"I can tell when I'm stressed because I don't really have an appetite and (I) want to sleep a lot," writes Shay-Nesha George, also a senior.

"Mentally, it makes me feel drained ... physically, my body gets tired."

The students' descriptions couldn't be more medically accurate. A teen body responds to stress in a way perfected by millions of years of practice. Confronted by danger, the brain's sympathetic adrenal medullary (SAM) axis kicks into gear, and the adrenal gland starts to flood the body with epinephrine and norepinephrine.

The links between stress and specific health effects are not as clear as, say, tobacco and cancer, but Motamedi shows that there are important health challenges worth exploring if you can just get kids to open up.

What are your picks? Share them in the comments below, send me an email at askantidote@gmail.com or ping me on Twitter @wheisel.

Coming Friday: The rest of the best from 2011

Photo credit: bayasaa via Flickr