Sunday, April 5, 2009

Getting a Health Policy When You're Already Sick

This article is ultimately a series of tips on dealing with health insurance, but it has the great news tie-in that Congress may make it impossible for the health insurance industry to charge higher premiums or deny coverage to people with health problems. The article leads with that, but then explains that it may be months before this is settled. A great quote from Karen Pollitz helps shift the article from the news aspect to guidance about insurance.

Insurance is not the most interesting thing in the world to read about, so it was a good choice to format the article the way it is, with bold headings for each section. Konrad chose to address "you" in the article, but I think it works to keep readers engaged and make it feel like an advice column more than a list of policies. Konrad uses very simple terms ("In reality, most insurers deny individual coverage to sick people.") and keeps our attention with quotes that sound like people actually said them. We get even more of the personal aspect when we hear the story of a woman who went through a struggle with obtaining health insurance. More advice is given about what to do if you're in her situation.

The article ends with one last warning about temporary insurance policies, a popular remedy that could lead to big problems. This article could have been painful to read, but by making it newsworthy, breaking it up visually, and keeping the human element in the story at all times, it held my attention.

Do You Know What Your Doctor Is Talking About?

I read another of Pauline Chen's doctor-patient columns in March, but I enjoyed this one much more. The column addresses the serious issue of "health literacy" for patients, and talks about the shared understanding that is sometimes missing between doctors and patients. Although it is a column, it provides supporting statistics and quotes that drive Chen's point home.

The article begins with a powerful--although slightly long--illustration of the danger of limited health literacy. She uses the story of a patient who ended up dying because he didn't follow his instructions for at-home care. Chen now realizes that she may not have been connecting with him on a level at which he could understand and act on what he was hearing.

Chen connects Jack's story to a larger trend of limited health literacy. Chen defines the term and then points to the trend. Tens of billions of dollars in health care costs go to people who are hospitalized repeatedly because of this problem, Chen says, and then cites an even more powerful study statistic: elderly patients with limited health literacy are twice as likely to die.

Next, Chen quotes Dr. Rebecca Sudore, associate professor of medicine, at length. However, all of the Sudore quotes have a point, are clear, and support Chen's opinion that health literacy and doctor-patient understanding is important. The article ends with Sudore's advice on how to achieve this understanding. This makes the article important for both patients and doctors. All in all, this column was very clear and well-written and makes a great case for the importance of health literacy.

Your Old Man

One problem, I think, with reading the Times online is that there's none of the context of reading the actual newspaper. I went into this article as though it were a news article, but by the end I realized it was probably in the Opinion pages. The sidebar said that Belkin has something called the "Motherlode Blog," and by the end I felt like I was reading someone's blog as opposed to an actual newspaper article.

The beginning of the article does a great job of tying together the larger implications of an Australian study. The study showed that children born to older fathers have lower IQs than those born to younger fathers. Belkin cites several other studies in which the age of the father made a difference to the health difficulties of the child and in which the mother's age did not matter. A useful graphic on the side of the screen also illustrated that the risk increases as age increases. Then comes the helpful summarizing quote from the expert, where Dr. Dolores Malaspina tells the reader, "It turns out the optimal age for being a mother is the same as the optimal age for being a father."

It's at this point that the article undergoes a complete shift. Belkin starts using "we" to talk about women, discusses the differences in social attitudes about age towards men and women, and predicts that older men may "gasp!" start to date women their own age. I wish she would've written a newsy article with this new information, used the sources that she used and perhaps gotten a psychiatrist to weigh in on the social attitudes part, and saved her own opinions for her blog.

Regimens: Creepy, Maybe, but It Seems to Work

The headline of this article completely drew me in. And it definitely paid off. This short article was about the use of live maggots in the healing of leg ulcers. It was basically all oddity because I doubt this is really going to catch on. The maggots work just as well as chemical dressing but are more expensive and more painful. "On the whole, the researchers concluded, there is little difference between the two treatments, and the choice should be left up to the patient." This cracked me up--"Okay, so it's your call. Do you want maggots to be eating your leg? They work the same as our chemical but they're more expensive and more painful." Tough decision. But that's where the article gets even more surprising--people actually do want this because they're in such pain they're eager to try any new method. Over all, it was not the biggest health news of the decade, but fun to read about.

Sunday, March 29, 2009

It's Time to Make a Coffee Run

I really enjoyed this article. It covered many sources but remained clear and focused. It made strong claims about research that I think few people know about.

The lead was very effective, I think. The quotes are powerful and descriptive, and we get the punch when we find out this doesn't just work for one person, it's proven scientifically to work for all athletes. I thought it was surprising that caffeine is one of the "best-studied performance enhancers." Kolata supports the claim well by describing all of the testing that's gone on in several sports, but keeps it snappy. ("The answers are yes and yes and yes and yes.") Kolata brings in an expert opinion to support the claim with especially definitive quotes.

There is a nice explanatory paragraph that could have been difficult to read, but instead uses simple language to say how caffeine provides endurance. I thought Kolata should have defined the word glycogen, though. The next explanatory paragraph is also simple and provides even more ways that caffeine helps the body during exercise.

Kolata brings in another expert source to tell us that the amount of caffeine needed to improve performance doesn't necessarily have to be huge. Another expert tells us that too much hurts performance. Then the article quotes "Mike Perry, a friend." Since his quote came directly after Johnson, I assumed he was Johnson's friend. Perry at first provides a contrasting opinion, which gives the article a little more depth as opposed to it just being an ode to the wonders of caffeine.

I found Perry's experiment on himself to be a very interesting part of the article, since he didn't just say that he felt like there was a difference when he used caffeine, he actually had a placeboed experiment to back that claim. Perry was an everyman-turned-expert source. His statistics are impressive--his average time using caffeine was faster than his fastest time without it.

Then the article takes a turn that I really disliked in which Kolata used first person and told a story about her son. This took away from the professional tone of the article, I felt. I also realized that "Mike Perry, a friend" meant Mike Perry her friend. Kolata continues with a story about her running partner and soon the article has the feel of an anecdote ("We love coffee and probably have caffeine in our blood all the time except for the middle of the night"). I didn't like this shift in tone--if you're going to quote experts and set yourself up as an objective third party, do that. If you're going to write about you and your friends' experiments with caffeine as a performance-enhancer, do that, but don't try to mesh the two.

We return to the expert source from earlier in the article, who surprised me by saying that caffeine doesn't actually dehydrate athletes. This was something I believed. The doctor again is very adament ("there's no question about it) with his praise of caffeine as a performance enhancer. I wish that the article had ended there. However, Kolata goes on to describe how the doctor is actually a huge fan of coffee, and always has some before a race. I feel like this actually weakens his testimony as an expert source. We already have our human--that was Johnson from the lead. I felt like the doctor's forceful quotes throughout the article were weakened by including the fact that he thinks coffee is "heaven." When an expert says a study has shown that something is "unequivocal" it's usually surprising and something to take note of, but if this person just really loves coffee, he might be stretching the truth in favor of it. That's not necessarily what's going on, but the last bit made me lose faith in the rest of what he said.

There isn't a lot of timeliness to this article, but it reminded me of the IHSA's banning the use of high levels of caffeine as a stimulant and including it in drug testing. An unacceptable level of caffeine in urine is 15 micrograms/ml according to the IHSA Web site, but that doesn't mean much to me. I'm unclear as to whether the amounts discussed in the NY Times article could get a student athlete punished. This could be another angle to pursue in an article--in the NY Times it is portrayed as a performance-enhancer without consequences, but then why does the IHSA ban it?

In the Home, a Four-Legged Tripwire

I love the headline of this article. It provides a mental picture from the start and then is supplemented with the actual picture on the site. The lead adds to that picture and helps the reader relate to the issue. I think most people who've had a pet have experienced what the article talks about.

The nut graph comes next with statistics that tell us this is a noticeable phenomenon and why it's newsworthy. The rest of the article details the results of the study, interweaving statistics and quotes from the epidemiologist who wrote the report. While the article is easy to read, I feel like there could have been much more of a human element to it. Where is the elderly person who suffered a hip fracture last year because she tripped over Fluffy but refuses to get rid of her closest companion? I was waiting for that real person source, but she never arrived. Also, I thought the ending quote was really weak. It barely relates to the main point of the article; it just explains why the study was done.

I noticed that the article "Religious Belief Linked to Desire for Aggressive Treatment in Terminal Patients" that I blogged about earlier was also written by Roni Caryn Rabin. She follows a similar formula in that article as this one. Both describe the results of a study and mostly quote the author of the study. That article also was missing the voice of the average Joe, but was clear and concise like this one.

Saturday, March 28, 2009

When the Stork Carries a Pink Slip

My reaction upon seeing the headline, since I've blogged about an article entitled "When Patients Feel Abandoned By Doctors," was to check if this was some sort of "When..." health series. The articles were written by two different people, but both "When..." headlines invite the reader to find out what's going on and why.

The lead is also inviting and surprising. I know as a reader I'm more engaged by a quiz than I am by a list of facts. But this topic would lend itself well to a variety of powerful leads. Many people might start with a description of a woman who has been laid off due to pregnancy--the article about child caregivers from one of my earlier posts starts with that sort of heart-wrenching lead.

I thought "national layoff tsunami" was an interesting choice of words. I guess it's been five years since the tsunami that killed hundreds of thousands of people, so that's not an off-limits metaphor anymore. It seems like a fitting illustration, though--layoffs sweeping in, affecting everyone in their path. But the article tries to point to a trend towards layoffs of pregnant women.

Alderman quotes a lawyer who says that employers are using the economy as a pretense for laying off just one person; the economy is the excuse for discrimination against older employees or pregnant employees, the lawyer says. The article never really nails down if that's true or not. Yes, charges of discrimination have gone up. Yes, we can find people who have been fired while pregnant. But Alderman practically refutes herself: Sarah Feider, example number one, was let go during company cutbacks. Example number two's position was eliminated companywide, the article says. Poonam Sharma, example number three, was one of seven people let go from a 70-person firm. So none of these cases illustrate this "using the economy as a pretense for laying off just one person."

It also would have been nice to have the employer's side of the story. There are several people making claims about discrimination but the employers don't get a chance to defend themselves. Or maybe there would be an employer willing to admit to Sharma's argument being true: women on maternity leave aren't working on projects that would be disrupted if they were let go.

Despite these problems that I have with the article, there are some great quotes. I especially like Feider's, "Instead of being given an office baby shower, I was given a pink slip." Each of the three women who were fired while pregnant/on maternity leave illustrate the sting of being laid off in a different way. Feider argues that it was morally wrong with the quote about her friends. Kevorkian focuses more on the vulnerability of the unemployed pregnant woman. Sharma is the logical and financial part. In this way, Alderman's sources are diverse, but they're only diverse on one side of the issue.