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.

Tuesday, March 17, 2009

Religious Belief Influences End-of-Life Treatment Choices

I'm starting to notice that in some of these Health articles, the writers have a little bit of leeway with attribution. For example, the article asserts that "aggressive end-of-life care can lead to a more painful dying process, researchers have found, and greater shock and grief for the family members left behind." The reader is given no information about the researchers that found this or the statistics that prove this.

The article itself is not about the study that produced those results; the article is about a study that showed that patients of strong faith are three times as likely to try to prolong life even during the last weeks. The sources are the author of the study and a cancer specialist who has also studied end-of-life decision making. I think that it might have added a human element if the article had included a patient's voice, but instead the author of the study speculates how patients must feel. Interviewing a terminally ill patient could definitely cross the line when it comes to minimizing harm, but an interesting perspective could have been someone of strong faith who pursued aggressive treatment and lived.

The article is for the most part focused and clear, but at the end, I thought the quote from Silvestri was confusing. "Doctors don't always acknowledge, and I'm pretty sure patients are telling us, that God is really important in their lives." God is really important in whose lives? And he's "pretty sure" they're telling "us" this? I feel like this could have made much more sense as a paraphrase. The paragraph directly following this quote has the same problem. "While cancer patients listed their oncologist's recommendation as the most influential factor affecting their decisions about medical care, their faith in God was the second most influential factor." This makes it sound like patient's are looking for oncologists with faith in God. Those two distracting mistakes at the end of the article left a bad final impression.

Saturday, March 14, 2009

President Promises to Bolster Food Safety

The first thing I noticed about this article was that the headline changed. I began this blog and came back to it a few days later, and in that time it went from "Obama Plans Team to Overhaul Food Safety" to "President Promises to Bolster Food Safety." I feel like the new headline casts a more positive light on Obama--now he's not just putting a team together to change things, he's promising to "bolster" food safety himself. The original headline is closer to the truth.

The summary lead gave all the necessary information, including Obama's name because of his prominence and a startling statistic that grabs the reader. I wanted to continue reading to learn more about this "fractured food-safety system."

I feel like the additional announcement about the banning of "downer cattle" throws off the flow of the article. It is related, but maybe would have been better if it was included later in the article, since the article shifts right back into talking about Obama's food safety team. At this point, the article started to lose my attention, but caught it again with Obama's colorful quote about Hamburg bringing new life to a "demoralized agency" as health commissioner in New York City. The article could have gotten bogged down in statistics, but I feel like the writer chose only those which would make an impact--like the fact that only 7,000 of 150,000 domestic food facilities were inspected last year.

It was also a good choice to include the quote "Whenever a president uses such strong language, that's a big, meaningful occurrence," because it shows us that the news is not only that Obama is creating this team, it's that he is actually taking a strong and clear stance on this issue. Harris concludes the article with another powerful statistic to prove just how newsworthy of an issue food safety really is.

When Patients Feel Abandoned By Doctors

The concept of the article is a sensitive one, and I think that the fact that it was written by an M.D. changed the way I read it. It uses first person and includes personal stories and assessments as well as "objective" ones.

The article is based off of a study of terminally ill patients and their caregivers and doctors, but this study only followed 55 patients. Not many details are given about the study--what percent of patients felt abandoned? The whole article builds off of the premise that this is a rampant problem, but there's not much support either way. In the personal example of Chen's patient John, she fails to communicate with the patient's family after his death. However, despite Chen's statement that closure "mitigates any feelings of abandonment," the story does not prove that. Chen doesn't include the reaction of John's niece--did this person crave closure and feel abandoned? The reader has no idea, and the story is poignant but not very effective towards Chen's point.

Dr. Back's quote about the two types of doctors is a good one. So is the one about patient death feeling like failure and looking for meaning. Despite the fact that he led the study about feelings of abandonment, I felt like this article lacked authority. There is a lot of speculation about why these feelings occur and how things can change, but it feels just like people guessing at causes and solutions.

At the end of the article, Chen finally mentions that this is a column, which was a surprise to me because the beginning presents itself as a news article detailing the results of a scientific study. The fact that it is a column doesn't change the fact that Chen didn't really support her assertion well. All I know now is that some number of patients, out of a study of 55, were somehow measured as having feelings of abandonment towards doctors. The article ends well, though, incorporating the visual picture of the ducks used earlier in the article.

Tuesday, March 3, 2009

"Liked the Show? Maybe It Was the Commercials"

This article wasn't really newsworthy or timely, but it was still interesting. The article details evidence from several studies that "commercials make T.V. programs more enjoyable to watch." There are some good quotes from the expert sources, especially when talking about reactions that people have to this research. The article's topic is a simple idea to grasp because the writer avoids scientific jargon. He uses specific word pictures to drive home a point. By describing "a mind-bending trek through the Australian outback," "listening to vacuum cleaner noise" and "a morning in the hotel hot tub," he defines the experiences that the article is approaching scientifically, but makes them accessible to the reader's imagination.

The article is very focused and drives its point home again and again, but using different sources. At one point, I scrolled back up to the top of the article because I thought he was using the same source the entire time: that's how cohesive all of his quotes and the studies behind them are. At the very end, though, he does admit that not all pleasurable experiences are enhanced by interruption. Again, he uses an easily understood example: artist or musicians being lost in their work who are stopped by the lunchtime whistle.

Overall, this was just a fun read. It's more like trivia information than anything else; it has no broader application or extension into a person's life, other than understanding why the strategically placed commercial breaks in The Bachelor make it that much more intense.

Monday, February 23, 2009

"In Turnabout, Children Take Caregiver Role"

The first thing I noticed about this article was that the lead uses the full name of a person whose name we don't recognize. I think it works here because the whole article is very personal and includes a lot of quotes from different families. The article is about children who act as caregivers for family members and how this responsibility affects their lives. It is an interesting subject that hasn't received a lot of attention, I feel. The article quotes child caregivers, their family members, teachers, and experts on the topic. It also includes some relevant statistics, like how in 2005, 3 percent of households with children ages 8 to 18 included a child caregiver. The only criticism I would make of this article is that it obviously supports The Caregiving Youth Project. Three examples of success stories through the Caregiving Youth Project are given. I wondered who is paying for the program and if it really is the best option for these children--it seems like it gives them a break from their responsibilities but then sends them right back to those responsibilities. The article makes the program out to be a godsend, but it doesn't get to the root of the problem.