More Favorite Health Journalism of 2011: Autism, Statins and a $25 Billion Pothole

Here's the second batch of my favorite health journalism of 2011. You can check out the first batch here. What are your picks? Share them in the comments below.

1. Navigating Love and Autism, Amy Harmon, New York Times, December

This squeaked in just before the Dec. 31 deadline, but Amy Harmon's can't-stop-reading account of how two "mindblind" young adults with Asperger's Syndrome navigate their romantic relationship just blew me away (and other writers, too). Harmon avoided condescension and prurience as she detailed how the couple handled everything from sex to managing a shared apartment to getting a cat. Harmon also educated readers about the social context as a generation of children diagnosed with autism spectrum disorders, including Asperger's, grows up. 

Only since the mid-1990s have a group of socially impaired young people with otherwise normal intelligence and language development been recognized as the neurological cousins of nonverbal autistic children. Because they have a hard time grasping what another is feeling - a trait sometimes described as "mindblindness" - many assumed that those with such autism spectrum disorders were incapable of, or indifferent to, intimate relationships. Parents and teachers have focused instead on helping them with school, friendship and, more recently, the workplace.

Yet as they reach adulthood, the overarching quest of many in this first generation to be identified with Asperger syndrome is the same as many of their nonautistic peers: to find someone to love who will love them back.

Harmon's story, which includes videos, is part of a larger occasional series on how teens and young adults diagnosed as children with autism and Asperger's are coping with the demands of adulthood.

2. "The War Over Lipitor," Fortune, Katherine Eban, Fortune, May

Katherine Eban, an investigative journalist who's written extensively on the pharmaceutical industry, raises troubling questions on the safety and availability of new generic versions of the statin Lipitor, which recently lost its patent protection.

You'd think that in this era of generic-drug dominance, making the transition to a nonbranded version of Pfizer's vaunted cholesterol-fighting statin would be smooth, or at least controlled. And indeed, that's precisely how it seemed -- until just a few months ago. Now the process appears to have unraveled, leaving serious questions about who will make the cheaper form of Lipitor, whether the price will really drop, and most disturbing of all, whether patients will be able to trust that the medication is safe.

She takes aim at Ranbaxy, the Indian manufacturer, which the FDA has accused of cutting corners on safety and quality in manufacturing generic Lipitor intended for American consumers. Great investigative reporting on a medication taken by millions of Americans. 

3. California hits $25B pothole on way to health-care reform, Sarah Kliff, Politico, May

Sarah Kliff, who now writes for Ezra Klein's blog in the Washington Post, did some stellar reporting on health reform and state-level politics in 2011. In this hard-hitting story, she contrasts California's rhetoric of being the "lead car" in implementing health reform with the tougher reality of its $25 billion (at the time) budget deficit and examines the implications of California's slow progress for other states.

Progress slowed significantly, many observers in California said, after (Gov. Jerry) Brown took office and shifted the focus from the federal reform law to the state's massive budget woes. That gives California a new distinction, albeit not the one the state was gunning for: being the only state in which reform implementation has slowed under the direction of a new, Democratic governor.

"You had the Republicans moving forward and the Democrats not totally picking up the ball," Drew Altman, president of the Kaiser Family Foundation, said of California's role reversal. "I've not seen that anywhere else."

4. Can Cancer Ever Be Ignored? Shannon Brownlee and Jeanne Lenzer, New York Times Magazine, October

If 2011 turns out to be the year that people finally realized that not all health screenings are created equal, Shannon Brownlee and Jeanne Lenzer's story surely will have been a tipping point. They examined the passionate debate over prostate cancer screening and "watchful waiting" and the demonization of health experts who argue that the harms of routine P.S.A testing for men outweigh its benefits.

Despite the seeming logic of the P.S.A. test, the evidence that it saves lives is far from conclusive A growing cadre of doctors, epidemiologists, patients and cancer biologists are rethinking its value. And the most recent studies, while not ending the debate, indicate that routine P.S.A. testing appears not to reduce the number of deaths, and if it does, the benefit is exceedingly modest.

5. The Hot Spotters, Atul Gawande, the New Yorker, January

It's not easy to make a story about health care costs exciting, but doctor-writer Atul Gawande frames his account of physician Jeffrey Brenner's work with one city's most expensive patients almost as a police procedural.

Besides looking at assault patterns, he began studying patterns in the way patients flowed into and out of Camden's hospitals. "I'd just sit there and play with the data for hours," he says, and the more he played the more he found. For instance, he ran the data on the locations where ambulances picked up patients with fall injuries, and discovered that a single building in central Camden sent more people to the hospital with serious falls-fifty-seven elderly in two years-than any other in the city, resulting in almost three million dollars in health-care bills. "It was just this amazing window into the health-care delivery system," he says.

So he took what he learned from police reform and tried a Compstat approach to the city's health-care performance-a Healthstat, so to speak. He made block-by-block maps of the city, color-coded by the hospital costs of its residents, and looked for the hot spots. The two most expensive city blocks were in north Camden, one that had a large nursing home called Abigail House and one that had a low-income housing tower called Northgate II. He found that between January of 2002 and June of 2008 some nine hundred people in the two buildings accounted for more than four thousand hospital visits and about two hundred million dollars in health-care bills.

I like this story because it's so local: there are similar cost-cutting efforts to reduce expensive "frequent flyers" at hospitals across the country, although few probably involve Brenner's level of data analysis.

Related Posts:

Favorite Health Journalism of 2011, Part 1

Sarah Kliff's Story Ideas for Covering Health Reform in Your State

Photo credit: Shannon Kringen via Flickr