Increasing H7N9 bird flu toll demands constant vigilance.

Explanation: A wave of H7N9 bird flu cases and deaths in China since the start of 2014 shows emerging flu strains need constant surveillance if the world is not to be caught off guard by a deadly pandemic.

At least 24 H7N9 flu infections and three deaths have been confirmed in the past week by the World Health Organisation (WHO), a big increase on the two cases and one death reported for the four-month period of June to September. China’s National Health and Family Planning Commission said on Friday it had seen 28 confirmed human cases of H7N9 in five provinces across the country since the start of the year. “There’s now a clear second wave of this virus,” said Jake Dunning, a researcher at Imperial College London who has been monitoring the outbreak. While the winter flu season means an increase in infections is not unexpected, it raises the risk of the virus mutating and perhaps getting a chance to acquire genetic changes that may allow it to spread easily from one person to another. The H7N9 bird flu virus emerged in March last year and has so far infected at least 170 people in China, Taiwan and Hong Kong, killing around 50 of them. Many, but not all, of those infected had contact with poultry or other birds, so for now this virus has apparently not adapted to easy human-to-human transmission - one of the main features keeping a pandemic emergency response on hold. China’s health commission said experts had concluded that H7N9 transmission “is still from poultry to humans”. Yet the strain does have some worrying features, including a limited capability to spread from one person to another. Several clusters of cases in people who had close contact with an infected person have been reported in China. An analysis of probable H7N9 transmission from person to person, published last August, gave the best proof yet that it can sporadically jump between people. A separate team of researchers in the United States said in December while it is not impossible that H7N9 could become easily transmissible from person to person, it would need to undergo multiple mutations. Another alarm was sounded last month when scientists said they had found that a mutation in the virus can render it resistant to a first-line treatment drug without limiting its ability to spread in mammals. WHO chief spokesman Gregory Hartl said the United Nations health agency had noted the rapid increase in infections in the past few weeks and was keeping a watchful eye. “So far we haven’t seen anything that causes us to change our risk assessment,” he said from WHO’s Geneva headquarters  The WHO’s stance, based on its December 20 assessment, is that five small family clusters have been reported but “evidence does not currently support sustained human-to-human transmission of this virus. The current likelihood of community-level spread ... is considered to be low.”  That was echoed by the Chinese health commission, which said: “Up to now, inspections have found no mutations of the virus that are of significance to public health”. Flu viruses, however, often put on their biggest show of strength in the northern hemisphere’s cold winter months of January and February. And with more of the virus circulating in wild birds, poultry and in the larger numbers of people infected, the new strain has more opportunity to adapt and mix with other strains that may give it pandemic potential. Peter Openshaw, director of the Centre for Respiratory Infection at Imperial College London, said the rising toll of infections and deaths is “a signal for concern” because “historically what has happened in major outbreaks is there are occasional, sporadic cases and then it starts to build”. “But whether it means that there is any change in the virus’ behavior is another important question. If it were changing the way it is behaving, that would be more alarming,” he said. Early gene analysis work on the emerging H7N9 virus in April last year found it had been circulating widely but went undetected and had acquired significant genetic diversity. Scientists warned then that its genetic diversity showed the H7N9 virus has an ability to mutate repeatedly and was likely to continue doing so. Hartl said: “Mutations happen all the time. While yes, the more virus there is, the more mutations could happen, it is also true that almost all of these mutations are benign.”


Good news, bad news for former estrogen users

Explanation: In its brevity, this piece lacks that all-important context that more expert comment might have provided. In addition, it fails to answer key questions that any reader will ask:  DOES THIS APPLY TO ME? The story does not emphasize clearly enough the fact that this study concerned estrogen ALONE, vs estrogen plus progestin in combination. So women who took estrogen with progestin may think the results apply to them. Not until the last line is this crucial difference addressed. Also, if there were risks or benefits, how big are they? There is no quantitative, and little qualitative information about the size of benefits and risks. In addition, some of the statements are misleading – see details below. Millions of women have already taken hormone replacement, and more are poised in the delicate transition where such therapy may be considered. The medical confusion is tricky for them, and this story will be widely read. Giving a true picture of this confusion is vital to helping women maneuver among unknowns.

The story didn’t quantify the benefits. The competing NY Times did a somewhat better job, although it got an unsatisfactory score as well. The Post tries but fails to do justice to the mixed picture of longer-term outcomes for women who took estrogen-only therapy. There is no quantitative statement about the risks, or the benefits. Some of the findings are misstated: “Risk for heart disease during the follow-up period was similar to that seen while women were taking the hormone.” The point of the study is that there was no increased risk in heart disease in estrogen-alone users (as opposed to findings with estrogen/progestin arm); and longer followup confirmed no increase. As stated, the story seems to imply there was an increased risk for heart disease that did not diminish during followup. This story didn’t do as good a job as the competing NY Times did on this criterion. While the Post mentioned an accompanying editorial, it didn’t emphasize some expert skepticism. The expert comments in the Times piece were more clear and concise in their questioning of the relative relevance and importance of the evidence. For example, the Times reported:   This short story avoids mongering, although our medical editor on this review thought the tone hypes the dangers of estrogen when the data show that the risks, though real, are small in absolute terms. We’ll give the story the benefit of the doubt here, as it at least cited an accompanying editorial – although, as noted in the “evidence” criterion above, the NY Times did a better job in eliciting clear quotes about context from its sources. Although not as thorough as the NY Times on this point, the story at least stated:


Baltimore mayor says her $500K book deal was a ‘mistake’.

Explanation: Baltimore’s mayor on Thursday described a lucrative arrangement to sell her self-published children’s books to a university-based health care system as a “regrettable mistake” and offered apologies for “any lack of confidence or disappointment” citizens and colleagues may be feeling.

Health, Childrens books, University of Maryland, Catherine Pugh, Maryland, U.S. News, Baltimore

At a City Hall news conference, Mayor Catherine Pugh provided five pages of paperwork, asserting they detail production and various deliveries of her “Healthy Holly” books to Baltimore’s school system. She also provided a copy of a January 2011 letter to the district’s chief academic officer describing a donation of 20,000 copies of “Health Holly: Exercising is Fun!” Since 2011, Pugh received $500,000 selling her illustrated paperback series to the University of Maryland Medical System, a $4 billion hospital network. Pugh sat on the medical system’s board of directors for about 18 years. “I am deeply sorry for any lack of confidence or disappointment which this initiative may have caused any Baltimore City residents and colleagues. In hindsight, this arrangement with the University of Maryland Medical System was a regrettable mistake,” she said, speaking in a weakened voice as she recovers from what spokespeople called a bout of pneumonia. One of Maryland’s largest private employers, the UMMS paid Pugh half-a-million dollars for 100,000 copies of her roughly 20-page books, arguably making her among the world’s most successful self-published authors. There was no contract behind the deal and the hospital network described some of the purchases as “grants” in federal filings. Pugh — who once sat on a state Senate committee that funded the major health network before becoming mayor in 2016 — served on the system’s board since 2001. Pugh’s slim “Healthy Holly” books, sharing tips on nutrition and exercise, were meant to be distributed to schools and daycares. But the school district has described her hard-to-find books as “unsolicited” donations after The Baltimore Sun recently exposed Pugh’s arrangements with UMMS. Fewer than 9,000 copies were found collecting dust in a district warehouse. It’s unclear where tens of thousands of other copies are. Pugh suggested Thursday that it was up to the city’s school district to clear up the confusion. “I do hope that we find out from the school system where the rest of those books are,” she said. During the evening press conference, Pugh also held up cloth bibs, onesies and other baby items with words like “jump” and “play” emblazoned on them that she says were intended to be part of her campaign to teach youngsters and families about health. She said her “Healthy Holly” initiative was “never about books” but was “about a lifestyle.” She said her lawyer advised her not to take any questions since the arrangement with UMMS is now being investigated. A retired state corruption investigator has filed a complaint against Pugh with the state prosecutor’s office. Pugh choked up at the end of her presentation and departed the conference room, appearing drained as reporters yelled out questions. A Democrat, Pugh faces a 2020 Democratic primary for re-election in a city dominated by her party’s political machine. Criticism of UMMS and of Pugh has lately been intense. The Washington Post’s editorial board recently asserted the UMMS had a “get-rich-quick program” for many of its board members, with Pugh’s involvement painted as an egregious case of “political sleaze.” In recent days, Pugh resigned from the volunteer UMMS board and returned her most recent payment of $100,000. She also amended years of financial disclosure forms from her state Senate days. Pugh is not the only board member who received significant financial compensation from UMMS. About one-third of the UMMS board members received compensation through the medical system’s arrangements with their businesses, a revelation that Gov. Larry Hogan has called “appalling.” Two other members of the board have also resigned, and four others went on voluntary leave while the system reviews governance practices. The president and CEO of the University of Maryland Medical System has recently been sent on a temporary leave of absence. Maryland Comptroller Peter Franchot says an independent audit is urgent to understand how many “self-dealing” arrangements there have been over the years. ___ Follow McFadden on Twitter: https://twitter.com/dmcfadd


Chain message Says "special military helicopters will spray pesticide against the Corona virus in the skies all over the country.

Explanation: There is no evidence the United States military is using helicopters to spray pesticide in an effort to kill the coronavirus.

Facebook Fact-checks, Coronavirus, Chain message,

Not even neighborhood social networking apps are safe from misinformation about the COVID-19 pandemic. A recent post on Neighbors, an app created by Ring — the company that makes video doorbells — claims that the United States military is using helicopters to "spray pesticide against the Corona virus in the skies all over the country." A map on the post indicates that the user shared it in San Diego. "So you must stay indoors after twelve o’clock at night and remove all clothes which are outside," the post reads. "When you hear the sounds of airplanes at night, it is for you to know that it is related to this matter (COVID-19)." A reader sent us a screenshot of the post, which was subsequently shared on Snapchat, on March 23. The text of the post has also been shared on Facebook. (Screenshot from Snapchat) We’ve seen several other chain messages that make  claims about the military’s actions against the coronavirus, so we decided to check this one out, too. There is no evidence that the U.S. military is using helicopters to spray coronavirus-killing pesticide on American communities. A similar hoax has been passed around in Pakistan, India, Malaysia, Egypt, the Philippines and the United Arab Emirates. On March 22, President Donald Trump said during a press briefing that the federal government is deploying additional National Guard assistance to New York, California and Washington to help slow the spread of the coronavirus. During the same briefing, Vice President Mike Pence said the government is also working with the military to charter flights for Americans abroad. Meanwhile, Navy ships have been sent to New York and California to provide additional health care support. The Army Corps of Engineers is building more medical facilities. And, according to the Military Times, more than 8,000 National Guard troops have been mobilized in all 50 states. That’s a significant activation of the military within U.S. borders, but it’s a far cry from using helicopters to spray pesticides on cities across the country. In September, Rhode Island officials approved aerial spraying to kill mosquitoes, which had caused an outbreak of the eastern equine encephalitis (EEE) virus. Other states have taken similar actions, and the U.S. Air Force Reserve has an aerial spray program. But those efforts are aimed at limiting the populations of insects that carry diseases, not the diseases themselves. And while Chinese officials have used drones to disinfect surfaces potentially tainted by the coronavirus, experts told us there is no evidence that spraying pesticide from a helicopter would kill the virus on the ground in the U.S. "That idea is pretty far-fetched," said Murray Isman, dean emeritus of the Faculty of Land and Food Systems at the University of British Columbia, in an email. "There are no pesticides that specifically target viruses, and general antimicrobials that might have any effect (bleach, alcohol) would have to be applied in ridiculously high volumes." According to the Environmental Protection Agency, disinfectants qualify as "antimicrobial pesticides" since they are used to kill bacteria and viruses. The agency has listed dozens of products on its website that meet the criteria for use against the coronavirus. The chain message is inaccurate. We rate it . If you receive a chain message that you want us to fact-check, send a screenshot to [email protected].


Legionnaires' disease can be contracted from a face mask used repeatedly.

Explanation: In May, the Centers for Disease Control and Prevention (CDC) issued guidance for reopening buildings after widespread and abrupt COVID-19 shutdowns of businesses, schools, and other facilities. Those closures resulted in decreased water usage, which could contribute to pooling in water systems that are prime locations for the growth of Legionella bacterium. Combined with shutdown-related declines in water chlorination and regular cleaning, the agency noted that the bacteria may accumulate in standing water over the course of weeks or months before being aerosolized through devices like showers, hot tubs, fountains, and air conditioning cooling towers used once localities reopen.

A series of social media posts widely circulated in August 2020 claimed that Legionnaires’ disease, a respiratory infection that can cause a rare and sometimes fatal form of pneumonia, could be contracted from reused face masks worn to protect against COVID-19. Snopes readers asked us to verify this rumor that essentially argues respiratory droplets containing Legionella pneumophila, the pathogen that causes Legionnaires’ disease, may persist in those contaminated respiratory droplets held within a used mask. Specifically, the social media posts stated that the “moisture and bacteria” found in an anonymous woman’s mask, which she wore daily, resulted in a misdiagnosis of COVID-19. Mask wearers beware … A caller to a radio talk show recently shared that his wife was hospitalized and told she had COVID and only a couple of days left to live. A doctor friend suggested she be tested for legionnaires disease because she wore the same mask every day all day long. Turns out it WAS legionnaires disease from the moisture and bacteria in her mask. She was given antibiotics and within two days was better. WHAT IF these “spikes” in COVID are really something else due to improper mask wearing?? Copied and pasted The claim in the social media post is false. According to Legionella, a nonprofit organization that shares educational material and scientific research about the disease, Legionnaires’ is not contagious and cannot be transmitted by infected persons or their masks. “You cannot contract Legionnaires’ disease from wearing face masks. Legionella bacterium is transmitted by aspirating drinking water or breathing in water droplets. Legionella is not spread from person-to-person in respiratory droplets nor does the bacteria survive on dry surfaces. Your mask would not be a source of transmission for the Legionella bacteria,” wrote the organization on its website. Legionnaires’ disease is a severe form of lung infection caused by breathing in mist or water that is contaminated with the bacterium. The condition is characterized by a cough, fever, headache, and shortness of breath — all symptoms that are also associated with COVID-19 and could potentially result in the misdiagnosis. Though Legionnaires’ is treatable with antibiotics, about 1-in-10 infected people will die. However, as noted by Legionella, if a person were diagnosed with Legionnaires’ disease, it would not be a consequence of wearing a mask. Water contaminated with the bacteria must be directly inhaled or drank by an individual in order to become infected. As such, a mask would theoretically need to come into direct contact with contaminated water in order for it to be inhaled. Even so, Legionella only grows in standing water under warm temperatures and cannot survive on dry surfaces.


Justin Bieber and Katy Perry made public statements warning that the music industry is run by pedophiles.

Explanation: We reached out to representatives of Justin Bieber and Kate Perry for comment, but did not hear back before publication time.

Entertainment, conspiracy theories, fake news, justin bieber

In early August 2017, articles appeared on unreliable web sites reporting that two of the most popular entertainers in pop music, Justin Bieber and Katy Perry, had made public statements asserting that the music industry is run by pedophiles. (Note: We recognize that pedophilia, which is defined as a sexual attraction to children, is not the same as child sexual abuse, although the web sites under discussion do not observe that distinction.) A YourNewsWire story written by Dmitry Baxter (one of the promulgators of the thoroughly discredited “Pizzagate” conspiracy theory claiming in 2016 that Hillary Clinton and other “Washington elites” ran a pedophile ring out of a pizza restaurant in the nation’s capitol) intimated that the reason Bieber canceled the last leg of his 2017 world tour in July was his realization that pedophilia is rampant in the entertainment business:  Justin Bieber told hundreds of people at a Bible study class in Los Angeles that he has “woken up” to the “evils of the music industry” and he needs to take a break from the industry because it is “controlled by the absolute worst kind of people — pedophiles.” Bieber has become a regular at the Bible study class held at the Montage in Beverly Hills and on Saturday 22nd July he shared what he described as a “horrific story” with the congregation and explained why he felt he had to quit his world tour. Describing a party on tour — attended by the upper echelon of the music business, including executive VPs of development, producers, power agents and international financiers — Bieber said he was encouraged to sexually abuse a young child who had been bought to the party for the sexual gratification of the industry elite. One day later, a similar article about Katy Perry was posted on the web site Neon Nettle (another hardcore purveyor of “Pizzagate” rumors, not to mention articles falsely attributing statements about show business pedophilia to actor Brad Pitt and implying connections between the deaths of alt-rockers Chris Cornell and Chester Bennington and music industry child abusers): In a shocking exposé from one of the biggest pop stars in the world, Katy Perry has dealt a devastating blow to the entertainment world elite by revealing that the entire industry is “controlled” by “sick pedophiles”. The “I Kissed a Girl” singer had left many concerned about her mental state following a series of public breakdowns earlier this year. She made headlines when she disclosed her suicidal tendencies and exhibited signs of a split personality disorder, saying “I don’t want to be Katy Perry anymore”. The article goes on to paint a picture virtually identical to that in the YourNewsWire article of industry pedophiles making up an “exclusive club”:  Clearly troubled by the details, she told a group of close friends: “I can’t live this life any longer. They’re all pedophiles. What they do to these children is sick.” She continues to elaborate, visibly traumatized by the things she’s witnessed: “And they’re every where you go. It’s like they’re not even trying to hide it. They flaunt it like it’s a badge of honor” “The producers, the executives, the big names… They’re all in on it” “It’s like an exclusive club that you can only join if you do these evil things to innocent children… And it’s not just dirty old men, it’s all of them. Even the women.” “They say to me, ‘Katy, you need to take the next step in your career’, but there’s no way I would do those things to kids.” Despite the fact that both stories include elements of truth to shore up their credibility — Justin Bieber did cancel part of his 2017 tour, for example, and Katy Perry did say in a live-streamed therapy session that she doesn’t want to be “Katy Perry” anymore (i.e., in the sense of having to live up to fans’ expectations) — in neither case are the statements attributed to them about pedophilia sufficiently sourced or corroborated to earn readers’ credence. No such statements by Bieber and Perry have been quoted (or even mentioned) by any mainstream news outlets. On the contrary, these statements are lurid fabrications designed either to garner social media likes and shares (and advertising dollars), or spread disinformation intended to harm the reputations of so-called “Hollywood elites” (a favorite political target of both YourNewsWire and Neon Nettle), or both. Unfortunately, by disseminating these false stories, the web sites dilute and lend confusion to the impact of actual claims of industry pedophilia made by the likes of former child actors Corey Feldman and Elijah Wood, who have separately gone on record saying the extent to which the sexual abuse of minors occurs in Hollywood is underreported. Worse, child abuse is one of those emotion-laden topics that can lead to violence, so there’s no room for false reporting. One would hope that lessons were learned from the Pizzagate debacle, which resulted in a credulous fake news reader firing an AR-15 rifle inside Washington DC’s Comet Ping Pong, a family restaurant; the shooter said he expected to rescue “child sex slaves” from a pedophile ring that does not exist, which was purportedly run out of the restaurant’s basement, which also does not exist.


The Michigan secretary of state's office sent absentee ballots to 7.7 million people

Explanation: Did Michigan Send Absentee Ballots to 7.7 Million People?

On May 20 2020, United States President Donald Trump attempted to smear the Michigan secretary of state’s office in a tweet regurgitating one of his most thoroughly debunked claims.“Michigan sends absentee ballots to 7.7 million people ahead of Primaries and the General Election. This was done illegally and without authorization by a rogue Secretary of State,” Trump wrote on May 20, 2020. “I will ask to hold up funding to Michigan if they want to go down this Voter Fraud path!”The allegation was quickly refuted by Michigan secretary of state Jocelyn Benson.“We sent applications, not ballots,” she replied. “Just like my GOP colleagues in Iowa, Georgia, Nebraska and West Virginia.”Hi! 👋🏼 I also have a name, it’s Jocelyn Benson. And we sent applications, not ballots. Just like my GOP colleagues in Iowa, Georgia, Nebraska and West Virginia. https://t.co/kBsu4nHvOy— Jocelyn Benson (@JocelynBenson) May 20, 2020Not only was Trump lying about Benson’s office sending “absentee ballots,” in reality the “7.7 million people” he referenced represents the total number of registered voters in the state. As the Detroit Free Press reported, receiving an application for an absentee ballot does not automatically mean one will be issued; the application would still need to be filled out and returned to the recipient’s local clerk’s office either physically or via regular or e-mail. If the recipient’s signature on the application matches the one in their existing voter records, they are then issued a ballot.According to Benson, the move to expand opportunities for casting an absentee ballot followed an uptick in voter turnout via mail on May 5 2020, when fifty local elections were held throughout the state amid the COVID-19 pandemic, which has killed 4,915 residents since March 2020.“By mailing applications we have ensured that no Michigander has to choose between their health and their right to vote,” Benson said. She also correctly stated that Iowa, Georgia, Nebraska, and West Virginia — all states with Republicans holding her position — sent absentee ballot request forms available to their respective electorates.Trump’s threat to “hold up funding” against the state is his latest swipe at Democratic officials in Michigan, such as Benson and Gov. Gretchen Whitmer. Earlier in the month the president used his Twitter account to support armed far-right demonstrators demanding that Whitmer ease stay-at-home health measures to limit the spread of the disease. In reality, a much greater majority of Americans has consistently expressed concern that “reopening businesses” would only cause an increase in COVID-19 infections.The Twitter smear was also another instance of Trump attempting to push the completely false claim of “voter fraud.”Comments


Indiana veteran who wanted final flight dies after reunion.

Explanation: A Vietnam War veteran from western Indiana had his last wish fulfilled by his reunited Army comrades, who flew in the Terre Haute Air Show.

Health, Lou Gehrigs disease, Terre Haute, Air shows, Indiana, Veterans

Ken Dierdorf died this week, just days after his debilitating illness prevented him from flying in a military helicopter with the men who fought alongside him, the Tribune-Star reported . He was 68. Dierdorf’s health had been in steady decline since 2010 when he was diagnosed with Lou Gehrig’s disease, which attacks nerve cells that control muscles throughout the body. The illness, also known as amyotrophic lateral sclerosis, or ALS, led Dierdorf to eventually require a full-time respirator to aid his breathing. The Dierdorfs reached out to the Visiting Nurse Association and Hospice of the Wabash Valley earlier this year to see if they could get a Bell UH-1 Iroquois “Huey” ride for the Dirty Half Dozen, a group of Vietnam War veterans comprised of Dierdorf and his friends. VNA Hospice Care arranged a flight with the Army Aviation Heritage Foundation’s Huey at the air show. Even though Dierdorf couldn’t ride in the Huey last weekend, reuniting with his fellow military friends and watching them experience the flight fulfilled his last wish, said Kim Dierdorf, Ken’s wife. “He talked about it nonstop since Saturday,” she said. “And even though I know it took a lot out of him, I think because it was his last hurrah that he really, really wanted to do, I think that once that was able to happen for him he knew he didn’t have to fight any longer.” Ken Dierdorf getting his last wish fulfilled is fitting for someone so kind and full of life, said Gil Edgington, one of the Dirty Half Dozen friends. “It was all in God’s plan,” said Edgington, 69. “It meant so much to us, in his passing, that while it’s a shock we know that he’s not suffering anymore.” ___ Information from: Tribune-Star, http://www.tribstar.com


Pakistan battles dengue epidemic, with 20 deaths so far.

Explanation: Pakistani health officials were battling an outbreak of dengue fever in the South Asian nation on Tuesday, a day after health officials confirmed over 10,000 cases and 20 deaths in recent months.

Pakistan, Dengue fever, Health, Islamabad, General News, Asia, Epidemics, South Asia, Asia Pacific

More patients with symptoms of dengue fever were arriving at hospitals in all major cities, including the capital Islamabad, putting a strain on the country’s poor health system. Health officials hope that the anti-mosquito spraying in urban areas targeting stagnant water will help contain the disease. According to Zafar Mirza, a government adviser on health, as many as 10,013 dengue cases had so far been reported. Free medical treatment will be provided to patients suffering from the illness, he said. He said the number of dengue patients was still low as compared to previous years. Health officials are keeping dengue patients in isolated wards in hospitals across the country. Pakistan’s opposition criticized the government for not taking adequate measures to prevent the alarming outbreak of the disease. “The cases of dengue fever are increasing because of government’s incompetence,” said Maryam Aurangzeb, spokeswoman for the opposition Pakistan Muslim League party. Rafique Ahmed, a medical doctor at a government hospital in the city of Rawalpindi, said more than 150 patients suffering from dengue fever were being treated at their hospital, but “hopefully we will overcome this epidemic.” He said people with symptoms of a simple fever also rush to hospitals in a panic, fearing they had dengue fever. The mosquito-borne viral infection kills dozens of people every year in Pakistan. Dengue is a mosquito-borne viral infection found in tropical countries worldwide. It can cause joint pain, nausea, vomiting and a rash, and can cause breathing problems, hemorrhaging and organ failure in severe cases. So far 2,363 cases were reported in the eastern Punjab province, 2,258 in the southern Sindh province, 1,814 in the country’s northwest and 1,772 in southwestern Baluchistan province, Mirza said.


UK trials new breathing aid developed by Mercedes Formula One.

Explanation: A new version of a breathing aid that can help coronavirus patients has been developed in less a week by a team involving Mercedes Formula One, and is being trialed at London hospitals.

Continuous Positive Airway Pressure (CPAP) devices have been used in China and Italy to deliver air and oxygen under pressure to patients’ lungs to help them breathe without the need for them to go on a ventilator, a more invasive process. The new CPAP has already been approved by the relevant regulator and now 100 of the machines will be delivered to University College London Hospital for trials, before being rolled out to other hospitals. Reports from Italy indicate that approximately 50% of patients given CPAP have avoided the need for invasive mechanical ventilation, which involves patients being sedated, freeing up ventilators for those more in need. “These devices will help to save lives by ensuring that ventilators, a limited resource, are used only for the most severely ill,” UCLH critical care consultant Professor Mervyn Singer said in a statement on Monday. “We hope they will make a real difference to hospitals across the UK by reducing demand on intensive care staff and beds, as well as helping patients recover without the need for more invasive ventilation.”  The new breathing aid was developed by engineers and clinicians at UCLH teaming up with Mercedes-AMG High Performance Powertrains who worked at UCL’s MechSpace hub to reverse engineer a device that can be produced quickly. Asked about the risk to healthcare workers of using CPAPs as contaminated droplets can escape from the device, Professor Rebecca Shipley, Director of UCL Institute of Healthcare Engineering, told the BBC, that the risks were very low if those workers wore appropriate personal protective equipment. She also said that the new device could be scaled up very quickly. “Mercedes can make 1,000 a day within a week, and if the tests go well they can be in the NHS by the end of this week,” Shipley told BBC radio. Development of the new device took fewer than 100 hours from initial meeting to production of the first one. The team working on it also includes Oxford Optronix, a small company that will manufacture the oxygen monitors for the CPAP devices. Britain announced separately on Monday that it has placed an order for 10,000 ventilators to be made by a consortium of companies including Ford (F.N), Airbus (AIR.PA) and Rolls-Royce (RR.L) as part of efforts to fight the coronavirus, an industry source told Reuters.


Explanation: The idea that screening may be harmful is not often discussed in news stories. The story nicely presents this seemingly counter-intuitive point that finding more cancer may not save lives; however, the story could have discussed the role patients can play in deciding whether or not to get screened and how they could discuss this decision with physicians, who may be strong advocates for screening. The story does not mention that women could discuss an individualized screening schedule with their physician. Some women at higher-risk of breast cancer may be better candidates for annual screening between age 40-50 (or earlier, depending on family history or genetic markers), while others may not wish to screen until they are in their 50s or 60s. The story does not mention how physicians could counsel anxious patients on the true value of screening for breast cancer. The story does note that mass screening results in overtreatment and possibly unnecessary treatment for some women; however, the cost implications for such treatments are not discussed, an important omission at this time in the development of U.S. healthcare policy and physician reimbursements for screening. The story superbly cites expert epidemiologists and clinicians who discuss the problems with overselling mammograms and how this flies in the face of public health campaigns and U.S. clinical guidelines that women over 40 get annual mammograms. The story also cites a breast cancer survivor and advocate who questions the value of screening for some women. An advocate from a pro-screening group is also cited and her message is balanced by a clinician (who consults with the organization) who gives a tempered response to the latest data that screening may not benefit, and may even harm, women who are not at high-risk of developing aggressive breast cancer.

The story does note that mass screening results in overtreatment and possibly unnecessary treatment for some women; however, the story does not address the cost implications for such treatments–around $10 billion annually for screening and another $10 billion annually on treatment– an important point at this time in the development of U.S. healthcare policy and physician reimbursements for screening. The story does a nice job presenting the number needed to test or NNT (how many women screened regularly would save one life) and NNH (how many women screened who would receive unnecessary treatments). These are important numbers that are typically missing in health news stories. The story also notes other evidence that 22% of cancers might regress on their own. This is another important point that women may wish to consider as they plan a personal mammography screening schedule, or if they choose not to screen for breast cancer. The story describes the discomfort of mammography and the potential harms of screening, i.e. finding benign lesions and overtreatment for a less agressive cancer. The story does not mention the anxiety many women face both before and post-screening, especially if a mammogram is positive. The false positive rate of mammography is about 50% over 10 years (~with 10 mammograms likely to get one false positive). The story does an excellent job explaining the BMJ study design and evidence from a recent Cochrane review of breast cancer screening. This new information is presented in the context of similar analyses that also found screening was overvalued for saving lives. The story does not engage in disease mongering. Instead, the story discusses lower-risk forms of cancer and pre-cancerous lesions that may not need to be treated. The story does a superb job here. There are expert epidemiologists and clinicians who discuss the problems with overselling mammograms and how this flies in the face of public health campaigns and U.S. clinical guidelines that women over 40 get annual mammograms. The story also cites a breast cancer survivor and advocate who questions the value of screening for some women. An advocate from a pro-screening group is also cited and her message is balanced by a clinician (who consults with the organization) who gives a tempered response to the latest data that screening may not benefit, and may even harm,  women who are not at high-risk of developing aggressive breast cancer. The story raises the clear option that some women may choose not to have regular mammograms – an option not often discussed in news stories. The long-time availability of mammograms is evident in the story. With the exception of certain lower socio-economic communities and geographic areas, mammograms are increasingly available to women as a result of well-funded public health campaigns and messages that more screening will save lives. The story focuses not on availability, but on a recently published article which adds evidence to previous meta-analyses that mammograms may be oversold for saving lives. The idea that screening may be harmful is new in the popular press. The story does a nice job presenting this seemingly counter-intuitive point that finding more cancer may not save lives; however, the story could have discussed the role patients can play in deciding whether or not to get screened and the role of shared decision-making between patients and caregivers. The story does not appear to rely on a press release for information. There is a good deal of interpretation of medical studies and independent reporting from a range of clinical experts and breast cancer advocacy groups.


Bike sharing offers big fitness benefits for the little commute.

Explanation: With bike sharing plans rolling on asphalt from New York City to Budapest, experts say city streets are becoming as fitness-friendly as country trails.

Even short cycling jaunts can make a difference in the health of city dwellers. “If you were driving a car and switched to biking, that 10 minutes going and coming a day would be a big deal,” said Dr. Robert Oppliger, an exercise physiologist with the American College of Sports Medicine. Oppliger, an avid cyclist, said even a two-to-three-mile (3.2-to-4.8-km) spin can yield significant health benefits. “There’s a lot of information coming out on something called active transport that compares traveling by bike or public transit to traveling by car,” he said. “The benefits are significant the more mobile you are.”  Government guidelines recommend adults accumulate 150 minutes of moderately intense physical activity per week. Cycling, he said, can be part of that. “Bicycling has positive effects on weight and cardio- vascular health,” he said. “Even a couple of times a week is beneficial in terms of all the problems with obesity.”  Last week the American Medical Association designated obesity, which affects one third of U.S. adults, a disease. Not all cities can accommodate bike share programs, which are not designed for avid cyclists, said Oppliger. He said his hometown of Iowa City, a relatively small community with short commuting distances, is unsuited for such a program. In New York City, which kicked off a massive bike sharing program this spring, 56 percent of auto trips are under three miles, according to the New York City Department of Transportation website. “For two to three miles it’s a pretty good way to get around,” said Oppliger, who also praised the city for adding 200 bike lane miles in the past three years alone. “New York City has done a pretty good job of preparing the area and now it’s starting to pay off,” he added. Bicycling magazine’s Editor-in-Chief Peter Flax predicts that 10 years from now the decision to introduce bike sharing to New York City will have seemed obvious. “Maybe more than any other American city, New York is perfectly suited to bike share,” said Flax. “It’s relatively flat and efficient to get around.”  Flax has sampled similar programs in Washington, D.C., Paris and Barcelona. He readily admits, after watching a parade of New York’s big blue bikes riding against the traffic on a one-way street, that the biggest, most ambitious bike share program in North America is in for a period of adjustment. “We’re 25 to 30 years behind Europe,” he said. “Our cycling community needs to embrace the rules of the road.”  He foresees attitudes changing as the bikes blend into street life. “In five years it won’t be a problem,” he predicts. “Taxi drivers are already changing their behavior. The last thing they want is to have an accident with someone on a city bike.”  Dani Simons of NYC Bike Share, which controls day-to-day operations, said the goal was simply to make it easier for New Yorkers to get around their city. So far more 44,780 people have signed up for annual membership in the New York program, which is similar in concept to bike shares in Paris, London and Boston, the website Citibikenyc.com. “We are really, really pleased,” said Simons, adding email requests are flooding in from New Yorkers who live in parts of the city not served by the program. New York-based fitness expert Liz Neporent, author of “Fitness for Dummies,” applauds the program. “The bikes are getting used a lot. I’m all for anything that gets people moving,” she said, adding that cycling gets hearts and lungs into shape and exercises muscles without stressing the joints. “Every little bit adds up,” she said. “Riding a bike beats grabbing a cab or sitting your butt down in the subway.”


Pop culture, wealthy Chinese spur medical tourism in Asia.

Explanation: It is one of Asia’s fastest growing industries and shows no signs of losing steam even as the global economy wobbles.

A plastic surgeon (L) speaks to his patient who travelled from Australia to Seoul to get liposuction at the BK DongYang Plastic Surgery Clinic in Seoul October 4, 2011. REUTERS/Lee Jae-Won Traveling abroad for medical treatment is now a multi-billion dollar business. From a nip-and-tuck to a heart bypass, hospitals from India to Singapore and South Korea treat more than 1 million foreign patients a year — lured by cut-price surgery, no waiting lists, cutting-edge technology, and highly trained doctors. Industry experts predict medical tourism in Asia will grow at a rate of 15 to 20 percent a year, mainly due to the emergence of nouveaux riches in the region. “Asian medical tourism ... seems to be increasing as affluence and mobility increase in Asia,” said David Vequist, head of the Center for Medical Tourism Research at the University of the Incarnate Word in Texas. “Consumer choice is a powerful force now in healthcare and is impacted by aging and increasingly heavier, sicker, and more needy populations in Asia.”   Medscape News web site has forecast medical tourism in Asia could generate $4.4 billion by 2012. The United States provides the most patients, as Americans travel abroad to avert the astronomical costs of having private treatment at home. Typically, Americans can save 40-50 percent. But there is a new patient on the operating table, and he or she is Chinese. Many of these patients are willing to spend what it takes to fix their problem. “No matter how expensive it is, I will go for it,” says Liu Xiao-yang, 34, of Shanghai, after having double-eyelid surgery, a facelift and corrective jaw surgery in Seoul. The rise of an affluent class in China, and an infatuation with so-called Hallyu, or Korean Wave, culture from pop music to drama have spurred a sharp growth in South Korean medical tourism, mainly in the field of cosmetic surgery. “Every time I watch South Korean drama and TV shows, I feel that they are pretty and I want to look like them,” says Liu. Kim Byung-gun, a plastic surgeon at the BK DongYang Plastic Surgery Clinic in Seoul, says his patients have ranged in age from 6, for double-eyelid procedure, to a 70-year-old seeking a skin lift. On average, they spend $5,000-$10,000 per procedure. “Medical tourism is going to be one of the growth engines of the South Korean economy,” Kim says, identifying the Korean Wave as a key contributor to the rapid growth of the sector in Asia’s fourth largest economy. South Korean authorities have every reason to be optimistic about the growth of the industry, particularly in the field of elective cosmetic surgery. CLSA Asia-Pacific Markets in a study released last month estimated that China would account for 60 percent of the rise in high net-worth individuals’ wealth in Asia over the next five years. Chinese patients arrive in South Korea with photographs of Korean celebrities they want to look like, says Lee Soo-jung of the Lamar Plastic Surgery Clinic in Seoul. Han Dong-woo of the Korea Health Industry Development Institute says the number of tourists coming to South Korea ballooned last year to nearly 82,000, generating about $700 million in revenues. Three years earlier, fewer than 8,000 medical tourists travelled to South Korea. Han projects some 200,000 will come next year. By 2020, the South Korean government envisages a million medical tourists a year. “I see an infinite growth potential in the plastic surgery market for foreigners,” says Han, who estimates operation costs in South Korea are about half that of the United States. South Korea may be one of the fastest growing medical tourism destinations, but for now it lags far behind trailblazers Thailand, Singapore, India, Malaysia and even the Philippines. They all have their own distinctive marketing strategies in an attempt to woo clients, as well as areas of specialization. Thailand and India, Asia’s leading destinations, specialize in orthopedic and cardiac surgery. India’s government says its medical services are cheaper than those in southeast Asia, and identifies its English-speaking doctors as providing a “major comfort factor.”   It has even introduced a special visa category to cater for the growing number of medical tourists. Thailand sells itself as dual purpose destination where medical treatment can be combined with a cheap recuperative holiday. Bangkok was this year identified by TripIndex as the best value global city for U.S. travelers. The Singapore healthcare industry positions itself as a “premium” center. Among its patrons have been many of Malaysia’s sultans, as well as other high profile political figures and celebrities from Asia and the Middle East. By next year, Singapore aims to treat a million foreign patients a year, generating about $3 billion for the economy, the Singapore Straits Times has reported. Its area of expertise includes cancer treatments, cardiology and other specialized care. Like South Korea, it sees China, as well as India, as being the catalysts for growth,   Neighboring Malaysia, attracted nearly 400,000 medical tourists last year, and aims to increase that number to 1.9 million by 2020, mainly by way of undercutting Singapore. A health official said costs in Malaysia are 30 percent cheaper than the city-state to the south. The Philippines also sees itself as a cut-price destination, and is projecting the number of medical tourists to hit one million by 2015, generating at least $1 billion in revenue. It targets patients from the United States, Canada, Taiwan and Japan. “We can compete with the rest of Asia because we have an edge in providing high quality medical and dental services but at a much lower cost,” said Marie Recarro, an official at the Department of Tourism in Manila. Some experts, however, lament the rise of the medical tourism industry, saying it exacerbates a brain drain of talent from the state to the private system, from rural to urban areas. A paper published in the International Journal for Equity in Health last year said specialists were being swayed by the higher wages and better technology of the private sector. If the industry achieved even a fraction of its projected growth “this could ultimately lead to locals being priced out of their own health care system, as demand from foreign patients can drive up the costs of providing care for everyone,” it said. Experts cite other concerns such as medical errors, lax follow-up care, and insurance, regulatory and ethical issues. The World Health Organization said in a report late last year that rapid development of medical tourism had presented “considerable implications for public health.”   It said that with the influx of foreign patients, the demand for and price of healthcare might rise. “In addition, an increasing number of health services might cater for the needs of foreign patients and neglect local needs,” it said.


A young boy named Dakota was air lifted to the hospital after having a seizure.

Explanation: What's true: A boy was airlifted to University of Mississippi Medical Center after suffering seizures. What's false: The child's name is Waylon, not Dakota, and the incident occurred back on 3 December 2016.

In December 2016, a message requesting that people pray for a young boy named Dakota who was allegedly airlifted to a hospital after having a seizure was widely circulated on Facebook: Although the verbiage of the message varied from post to post, all versions contained three basic elements — The boy’s name (Dakota), a short account of an emergency situation (he was airlifted to a hospital), and a call to action (please forward this message): Hey can you help get a prayer circle going for Dakota. They had to life flight him. He is having seizures. Forward this everywhere please. we need prayers for this little Boy please forward to all of your friends that prayers thank you This is a friend’s grandson Many of the messages, such as the one reproduced above, also included some note regarding a familial relation: Other messages were more specific and linked the prayer requests directly to another Facebook user. Those leads, however, also resulted in dead ends. Nearly every message about Dakota lacked credible information about where or when this incident occurred, but we did find a message posted to the prayer board of the Woodland Hills Baptist Church in Longview, Texas, which may have provided some additional details (i.e., the child’s full name and location) about the situation: Please pray for Dakota Wells. He is a child from Big Sandy  area … he is having continuous seizures and has been air lifted  to Dallas. Please pray for his healing … pray for his family and the Medical staff taking care of him. Thanks However, this information was inaccurate. Dakota Wells was not the name of the young boy who was airlifted to the hospital, but rather the name of the Facebook user who originally posted about the sick child. According to Wells, the young boy’s name is Waylon, her cousin, and he was airlifted to the University of Mississippi Medical Center on 3 December 2016:  A GoFundMe Page set up for Waylon Wells provided a little more information about the situation: Waylon was born Dec 3, 2016 son of Evan and Brandy Wells. He was airlifted to UMMC NICU within 3 hours of being born due to heart and lung complications. Prayers are being felt and greatly appreciated but the medical bills, gas and food expenses will be costly while Waylon is in the hospital. Any donation will be greatly appreciated!Help spread the word! Dakota Wells published pictures of Waylon being held by family members on 6 December 2016, three days after he was airlifted to the hospital. In early 2017, an update on his condition was published to the GoFundMe campaign’s page along with clarifications pertaining to social media rumors. Waylon was released from the hospital at the time the update was published, and”doing [great]”: I just wanted to update everyone on Waylon and clear up any misconceptions about his condition. Waylon does not nor did he ever have any seizures. He has Hypertrophic Cardiomyopathy, which is a thickening in his right heart muscle. Which he will always have to take medicine for. He will be able to live and function just like a normal child, no one will ever know anything is wrong with him just like a person that has diabetes if they don’t tell you, you wouldn’t know they had it. Waylon is doing GREAT! He has been home for almost 3 weeks now and is growing and developing as he should be. He sleeps and eats and is just a very content sweet baby boy. He will have routine monthly visits to his cardiologist for at least a year just to keep a check on his heart, all precautionary, he is otherwise a healthy boy! We are more Thankful for your prayers than we could ever express! I am not sure how Evan or myself would have gotten through those two weeks without all of you praying us through everything we were going through! Please continue to remember him in your daily prayers that he continues to grow strong and healthy! Thank y’all from the bottom of our hearts Although this prayer request most likely refers to Waylon Wells, the cousin of a “Dakota” Wells, it’s also possibly that this viral message refers to an incident in 2014, when a baby named Dakota when airlifted to a hospital in Bismarck. This request has also been conflated with one seeking prayers for a child shot with a nail gun.


Turning 40? Sen. Rand Paul says you can look forward to back pain in your near future, and maybe some anxiety. But don’t try to turn your ailments into a government check. At a breakfast event Wednesday, Jan. 14 in New Hampshire, the Kentucky Republican and potential presidential candidate spoke out against a public safety net that catches too many people who don’t need help. "The thing is, all of these programs, there’s always somebody who’s deserving. (But) everybody in this room knows somebody who is gaming the system," Paul said. The proof? Look no further than the diagnoses landing people on disability, he added. "Over half the people on disability are either anxious or their back hurts. Join the club," he said to laughter. "Who doesn’t get up a little anxious for work every day and their back hurts? Everybody over 40 has a little back pain." Paul may be having a little fun about the aches and pains of growing older, but his comment raises serious questions about a program relied on by millions of people. Is the majority of the disability population suffering from back pain and anxiety? We decided to check the numbers. Identifying the problem The Social Security Administration has provided benefits to people with disabilities since President Dwight Eisenhower signed legislation in 1956. The program is intended to provide cash assistance to people who are disabled for a year or longer and cannot work or can only work menial jobs for little pay (about $1,000 a month). The number of individuals receiving disability has been on an upward trajectory for decades. In 1970, there were less than 2 million beneficiaries; now, the program has surpassed 10 million, far outpacing U.S. population growth. Nearly two-thirds of people on disability are 50 or older. The large growth in the program has sparked claims of waste, fraud and abuse. And indeed, several reports from the Government Accountability Office have found problems with the program, as Paul’s office pointed out. After an audit of disability insurance in 2013, the Government Accountability Office estimated that  in fiscal year 2011, the Social Security Administration made $1.29 billion in potential cash benefit overpayments to about 36,000 individuals who were working and making more than $1,100 a month (the limit to receive disability benefits). The 36,000 people receiving improper payments, while a lot on paper, represent about 0.4 percent of all beneficiaries, the report said. There are other ways Social Security gives out benefits to those not deserving, but paying people already working is about 72 percent of the problem, according to the Social Security Administration. Factoring that in, the GAO estimates overpayments equaled $1.62 billion, or 1.27 percent of all disability benefits, in 2011. It’s a lot of money, but the disability program is a $128 billion program. The Government Accountability Office goes on to say the exact number of improper payments is unknown. It could be higher. Additionally, another GAO report warned the Social Security Administration’s efforts to thwart potential physician-assisted fraud are "hampered by a lack of planning, data, and coordination." Back and anxiety Let’s narrow in on Paul’s specific claim: "Over half the people on disability are either anxious or their back hurts." This is not rooted in the official numbers. Social Security does not group people by back pain or anxiety in any of their published reports. Instead, they track a much broader list of physical and mental ailments. What would back pain or anxiety fall under? Most back problems would fall under the category "diseases of the musculoskeletal system and connective tissue," the most common ailment. In 2013, 27.7 percent of all people received benefits for these types of ailments. If you look at just workers, it was 30.5 percent. There's also another category, "injuries," that might include some back problems. Those affect another 4 percent of workers. But not all musculoskeletal system and connective tissue diseases are back problems. Far from it. They include ailments ranging from a broken bone and bad burns to amputated limbs and deformities. Anxiety would be included in "mental disorders." That category is broken down further as follows: As you can see, it's a pretty confusing list, and it's not immediately clear which category certain mental ailments would fall into. If by "anxious," Paul meant a catchall term for all mental disorders, then, sure, about one-third of all disabled workers have some sort of mental issue. Paul's spokesman singled out the subcategory "mood disorders" when explaining how Paul reached his conclusion. Other media outlets have similarly placed anxiety under this heading. However, the Social Security Administration told us that category typically includes affective disorders like depression, not anxiety disorders. Instead, people suffering from "anxiety disorders" -- which include things like post-traumatic stress disorder and obsessive-compulsive disorder -- are included in the "other" category. That category also includes diseases like Tourette syndrome and affects far fewer people than mood disorders, about 3.9 percent. For the sake of argument, let's follow Paul's faulty logic. Even assuming generously that every single person with a musculoskeletal system problem came in with "back pain," and every person with a "mood disorder" had anxiety, it still only equals 45.4 percent, less than half. Throw in "other" mental disorders, you're still just below 50 percent. If you categorize anxiety correctly as "other" and add it to all musculoskeletal system problems, you would end up far lower, at 34 percent. And again, not every person with a musculoskeletal problem has a back problem, and not every person with a mental disorder has anxiety. For Paul to imply as much is either stretching reality or downplaying serious ailments. There has been an increase in the number of people receiving disability for musculoskeletal system and mental problems. In 1961, the most common ailment for new beneficiaries was heart disease or stroke. Meanwhile, 8 percent of those going on disability received assistance for musculoskeletal system issues. That’s an interesting and notable statistic, and one worth exploring. NPR published a very extensive report suggesting some older, unskilled workers are going on disability (many with back issues) because the only jobs available to them are physically strenuous. But that doesn’t wash away Paul’s mischaracterization of the ailments nor his inflation of the numbers. Our ruling Paul said, "Over half the people on disability are either anxious or their back hurts." The numbers don’t add up. The two broader disability categories that include back pain ("diseases of the musculoskeletal system") and anxiety disorders ("mental disorders - other") don’t even equal close to 50 percent, let alone those two ailments by themselves. Paul’s quip might make for a good soundbite, but it’s not rooted in reality. We rate the statement .


People in Kansas have been jailed due to medical debt.

Explanation: Are Americans Getting Jailed for Unpaid Medical Debt?

On February 10 2020, a story about people in Kansas being jailed over medical debt spread on Facebook and Reddit:"You wouldn’t think you’d go to jail over medical bills": County in rural Kansas is jailing people over unpaid medical debt from newsA news story also gained traction on Reddit’s sister site Imgur in a related post contrasting two concurrent Reddit threads:The post shown here was the same r/news Reddit post linked above, itself pointing to a February 9 2020 CBS News article headlined, “‘You wouldn’t think you’d go to jail over medical bills’: County in rural Kansas is jailing people over unpaid medical debt.” CBS News and investigative nonprofit ProPublica reported on one family in Coffeyville, Kansas and their experience with mounting medical debt and, subsequently, jail time:Tres Biggs went to jail for failing to appear in court for unpaid medical bills. He described it as “scary.”“I was scared to death,” Tres Biggs said. “I’m a country kid — I had to strip down, get hosed and put a jumpsuit on.”Bail was $500. He said they had “maybe $50 to $100” at the time.In rural Coffeyville, Kansas, where the poverty rate is twice the national average, attorneys like Michael Hassenplug have built successful law practices representing medical providers to collect debt owed by their neighbors … That law was put in place at Hassenplug’s own recommendation to the local judge. The attorney uses that law by asking the court to direct people with unpaid medical bills to appear in court every three months and state they are too poor to pay in what is called a “debtors exam.”If two hearings are missed, the judge issues an arrest warrant for contempt of court. Bail is set at $500.Hassenplug said he gets “paid on what’s collected.” If the bail money is applied to the judgment, then he gets a portion of that, he said.Biggs was jailed after missing an appearance related to unpaid medical debt, thanks to a law put into place on the recommendation of attorney Michael Hassenplug. Hassenplug told CBS he is compensated in part through bail money collected in the course of hearings like the one Biggs reportedly missed.In the comments on Facebook, some users argued that the reported imprisonment was not directly due to medical debt, but for missed hearings:The headline is super mis-leading. NO ONE is going to jail for not paying their debt, medical or otherwise. They are going to jail when the Court enters an Order requiring them to show up in court and they don’t show up, in contempt of court.Biggs was originally the subject of a far larger, far more detailed investigation by ProPublica published in October 2019. That reporting provided extensive detail on medical debt court cases in Coffeyville, Kansas, the role of Hassenplug’s firm in it, and the unorthodox array of conditions enabling its existence in the first place. ProPublica reported that of the missed hearings, some “fell on days when [Biggs’ son] Lane had [leukemia] treatment, at a hospital in Tulsa, an hour south,” and that Biggs’ wife Heather refused to postpone their child’s cancer care:[A] warrant, [Biggs] learned at the jailhouse, was for failure to appear in court for an unpaid hospital bill. Coffeyville Regional Medical Center had sued him in 2006 for $2,146, after one of Heather’s emergency visits; neither of his jobs offered health insurance. In the shuffle of 70-hour workweeks and Lane’s chemotherapy, he had missed two consecutive court dates. He was fingerprinted, photographed, made to strip and told to brace himself for a tub of delousing liquid. His bail was set at $500 cash; he had about $50 to his name.His friend bailed him out the next morning, but at the bond hearing, the judge granted the $500, minus court fees, to the hospital. Biggs compensated his friend with a motorboat that a client had given him in exchange for a hunting dog. But it wasn’t long before the family received a new summons. In 2009, a radiologist represented by Hassenplug sued them for $380.The article included some background and ongoing information about the Biggs’ entire medical and financial picture, and that after his imprisonment, “Biggs was still on the hook for the bill that had landed him in jail; bail had covered only part of it, and the rest was growing with 12% annual interest.” Further, the hospital had garnished Biggs’ wages, and the radiologist had garnished his bank account, seizing contributions that his family had raised for Lane’s cancer treatment:By 2012, the Biggs family had accrued more than $70,000 in medical debt, which it owed to Coffeyville Regional Medical Center and other hospitals, pediatricians and neurologists. Some forgave it; others set up lenient payment plans. Coffeyville’s was the only hospital that sued. The doctors who took them to court were represented by Hassenplug.ProPublica’s fourth paragraph began with an introduction to the presiding judge — a man without any legal background:Judge David Casement entered the courtroom, a black robe swaying over his cowboy boots and silversmithed belt buckle. He is a cattle rancher who was appointed a magistrate judge, though he’d never taken a course in law. Judges don’t need a law degree in Kansas, or many other states, to preside over cases like these.In 2017, The Atlantic reported that Kansas was one of a handful of states where judges like Casement “don’t need a law degree” in order to put defendants behind bars:Montana and seven other states — Arizona, Colorado, Nevada, New York, Texas, South Carolina, and Wyoming — allow non-lawyer judges to hand down jail sentences for misdemeanors without the right to a new trial before a lawyer-judge. Some states, like Montana, only allow the practice in rural or sparsely populated counties, while others allow it statewide.The situation may have been acceptable in the 19th century, when lawyers and law schools were scarce, critics say. But in the modern era, they say it raises serious questions about due process and the Sixth Amendment right to a fair trial. “What’s the point of having a legally-trained lawyer if the judge can’t understand what they’re saying?” said Stuart Banner, a University of California Los Angeles law professor.Biggs was not the only medical debt sufferer featured in ProPublica’s story. In one excerpt, Hassenplug faced off against a young survivor of a suicide attempt, whose income of disability checks was exempt from the reach of the court and its orders:SEATED AT THE FRONT of the courtroom, Hassenplug zipped open his leather binder and uncapped his fountain pen. He is stout, with a pinkish nose and a helmet of salt and pepper hair. His opening case this Tuesday involved 28-year-old Kenneth Maggard, who owed more than $2,000, including interest and court fees, for a 40-mile ambulance ride [in 2018]. Maggard had downed most of a bottle of Purple Power Industrial Strength Cleaner, along with some 3M Super Duty Rubbing Compound, “to end it all.” His sister had called 911.Maggard took his seat. He had cropped red hair, pouchy cheeks and mud-caked sneakers. “The welfare patients are the most demanding, difficult patients on God’s earth,” Hassenplug told me, with Maggard listening, before launching into his interrogation: Are you working? No. Are you on disability? He was diagnosed with schizoaffective disorder, bipolar type, and anxiety. Do you have a car? No. Anyone owe you money you can collect? I wish.They had been here before, and they both knew Maggard’s disability checks were protected from collections. Hassenplug set down his pen. “Between you and me,” he asked, “you’re never going to pay this bill, are you?”“No, never,” Maggard said. “If I had the money, I’d pay it.”Hassenplug replied, “Well, this will end when one of us dies.”Another man jailed in the course of the court’s operations had no means to travel to the rural courthouse:Derek Dustman, who is 36 and works odd jobs, had been driving a four-wheeler when he was hit by a car and rushed to the hospital. Though he was sued for not paying his $818 ambulance bill, he didn’t have a license to drive to the courthouse. This spring [in 2019], he spent two nights in jail. “I never in a million years thought that this would end with jail time,” he told me.Much of the reporting concerned confusing or conflicting information provided by parties involved — such as Casement and Hassenplug — about the legal authority of debt collectors to influence decisions such as the issuance of a bench warrant or the imprisonment of any individual for inability to appear before the court or pay a medical debt. In one excerpt about a woman named Christa Strickland and her attempts to pay a 2008 bill for $2,514 (which had risen to $5,736 thanks in part to court fees by October 2019), ProPublica requested clarification from Account Recovery Specialists Inc. (ARSI) and from a lawyer named Amber Brehm.Lizzie Presser, who reported on the issue for the ProPublica, explained Strickland’s frantic attempts to avoid a bench warrant after missing a hearing by one day:When I asked ARSI about how attorneys decide to request warrants, Joshua Shea, who is general counsel, told me that they don’t. The judge can choose to issue one if court orders are not followed, he said. But Casement said the opposite, telling me that he gave the choice to the attorneys. “I’m not ordering a bench warrant. My decision is to give them that option,” Casement told me. “Whether they exercise it is up to them, but they have my blessing if that’s what they want to do.”Shea sent me an eight-page email to make clear, in large part, that ARSI, as a collection agency, has no involvement in the courts, and that Brehm is a lawyer whom the agency contractually employs and who represents the hospital directly. Her email address, though, has an ARSI domain, and her resume lists her as ARSI’s director of legal. Brehm said that court hearings aren’t the only option for debtors, who can call her instead and answer questions under oath. Shea said nobody — not the hospital, ARSI, Brehm or the court — uses the threat of jail to “extract payment.”Strickland reached Brehm after several days, and the attorney agreed to a new hearing. On Aug. 13 [2019], when they met in court, Brehm sat at the front of the room.“We’re giving you a second chance on that citation; just to try to take care of this without there having to be any sort of bench warrant,” [Brehm] said. “I want to make sure that we’re all on the same page about the consequences of not coming into court when the order has been issued.”Strickland nodded.“Again, if you set a payment plan and keep it,” Brehm said, “we won’t have to worry about that.”Slate.com’s What’s Next podcast covered the ProPublica report in October 2019, following with a transcript of the segment on February 10 2020.Other news outlets followed up on the way Coffeyville handles of medical debt in February 2020, independently confirming the ProPublica investigation, which (as we mentioned) was originally published in late 2019. CBS News reported that while their cameras were not permitted, only one of 60 medical debtors present on the day they visited had a lawyer with them:CBS News went to court on debt collection day. They wouldn’t allow our cameras in, but we watched more than 60 people swear they didn’t have enough money to pay, and only one of them had an attorney representing them.In related fact checks, the question of whether medical debt was the cause of bankruptcies emerged as a point of dispute in the same way that commenters argued people were jailed not over debt, but over missed court appearances. Semantic objections of that description seemed to be the only counterargument involved, since both instances involved otherwise accurate and verified claims.In February 2020, CBS News rehashed the findings of a late 2019 ProPublica investigation into people in Kansas jailed over medical debt, largely thanks to an unusual rural court system that was influenced by debt collection firms and lawyers. That investigation and subsequent interviews with lawyers and debt collectors involved confirmed the accuracy of the report — that people in Kansas were indeed jailed due to unpaid medical debt. A presiding judge said that lawyers had broad discretion, and that at least one victim reported missing hearings because they were taking their child to receive cancer treatments. None of the parties involved disputed that people were jailed over medical debt in various independent investigations.


Chicago teachers’ contract talks about more than money.

Explanation: Chicago’s public schools will be closed Thursday as the city’s 25,000 teachers are set to go on strike . A strike in the nation’s third-largest school district would mean no classes for more than 300,000 students. Like most workers threatening to walk off the job, the teachers want a raise. But money is only part of the story.

Chicago, Health, General News, Strikes, U.S. News, Chicago Schools

Here are some of the issues behind the school district’s second strike in seven years: WHAT KIND OF MONEY ARE THE TEACHERS LOOKING FOR AND WHAT KIND OF RAISE IS THE CITY OFFERING? The city has offered 16% raises for the teachers over a five-year contract and calls for the teachers’ health care costs not to increase for three years. The city says that’s a pretty good deal for teachers, whose starting annual salary of just under $53,000 is higher than the salary for teachers in any other school district in the state. But the union, which is asking for a 15% raise over three years, says its analysis shows teachers at the end of the contract will make about $15,000 less than the city says they will. The union also said the contract leaves unclear just how much health care costs will increase during the final two years. WHY DON’T TEACHERS JUST TAKE THE MONEY? At first blush, it seems like a pretty good deal: a 16% raise over five years. But the teachers’ union sees a potential trap. Teachers say if they take the raise, they lose negotiating leverage as they demand more school nurses, social workers, librarians and smaller classrooms because those are not the kinds of things they can legally strike over. The union knows about the city’s vow to add at least 200 social worker positions and at least 250 full-time nurse positions but has made it clear that the only way to make sure the city follows through on its promises is to put it in writing in the next contract. WHY NOT JUST INCLUDE STAFFING REQUIREMENTS IN THE CONTRACT? Until this week, the city wanted nothing to do with adding staffing requirements to the collective bargaining agreement, saying it would make it tougher for principals to run their individual schools because it would require them to use a chunk of their budgets to fill those positions at the expense of the “needs and desires of the local community or school.” But this week the CPS and city announced a willingness to write into the contract language that would address class sizes and staffing issues. That’s potentially good news to the union, which has made it clear that any deal must address staffing shortages and overcrowded classrooms. JUST HOW CROWDED ARE THE CLASSES? It depends on who you ask. The school district contends that 80% of the kindergarten to third-grade classes made the 28-student maximum and 90% of the fourth- to eighth-grade classes met the 31-student maximum. The union estimates that a quarter of the city’s elementary school students are in overcrowded classrooms. That disagreement is partly why the union wants a contract provision that calls for teachers to receive an extra $5 a day per student whenever their classes exceed the mandated size limit. The union also is pushing for smaller class sizes. The district says that would require the hiring of another 1,150 teachers and 1,000 teacher assistants at a cost of at least $225 million annually. WHY ARE NURSES, LIBRARIANS, SOCIAL WORKERS, AND COUNSELORS SUCH A STICKING POINT? There is no disputing the fact that the school district needs more people on those jobs. According to the union, about one-fifth of the district-run schools have librarians. And as scarce as they are citywide, the union says they are even harder to find in schools where most students are black. As for nurses, both the union and the school district agree many more are needed, though they can’t agree on how many are currently working in the district. The union wants contract language that spells out that people will only be asked to do the jobs for which they are hired. It also has expressed concern about the number of students currently assigned to counselors and about various roles counselors are expected to fill, including as substitute teachers and lunchroom help. WHAT IS THE DEBATE OVER AFFORDABLE HOUSING ABOUT? Chicago is an expensive place to live and the way the union sees it, too expensive for some teachers and way too expensive for teaching assistants, clerks and other support staff. Like other city employees, teachers are required to live in Chicago and the union said that if police officers and firefighters receive housing subsidies, they should also get them. They want language in the contract that would call for the school district to provide housing assistance for new teachers and others, and to help students’ families who are at risk of losing their housing. Mayor Lori Lightfoot agrees affordable housing is an important issue but a collective bargaining agreement between the teachers and the city isn’t the place to solve it.


Oramed says oral insulin succeeds in midstage type 2 diabetes trial

Explanation: This is a brief story on findings from a phase II trial of a new oral insulin medication conducted by Oramed, a pharmaceutical company. The story gives us the basics on the study design and findings. It’s made clear that the drug must undergo further testing before it’s approved for use. The only commentary, though, was from the CEO. Given the nature of the research–unpublished and coming directly from a pharmaceutical company–an outside source would have made this story stronger. (We also reviewed the news release this story seems to be based on.) The worldwide occurrence of diabetes is about 400 million people, 90 percent of whom have type II diabetes. Many of these people eventually have to supplement their oral medications with injected insulin. Previously, oral delivery of insulin was considered impossible because the drug degrades in the digestive system, but Oramed believes they have overcome this problem.

A comparison of cost to currently available long-acting insulin would have been informative, but the report is on a trial for safety and efficacy, so this is preliminary. The story reports a decrease in “mean night-time glucose of nearly 6.5 percent” compared with a placebo. However, there is no indication of what that means for control of type II diabetes–absolute numbers are needed to be useful. The difference appears to be small and similar to what already-available oral medications can do. It’s also not clear if these patients continued to take metformin or not. This story states that there were “no reported serious adverse side effects and no issues with hypoglycemia, or dangerously low blood sugar.” The story tells us this was a randomly chosen, blinded study of 180 people over 28 days, and considered a Phase II trial. The story also mentions that stage III trials still need to be done, which is when the drug might be considered for approval. These are important details. But, because it’s an unpublished study, no one outside of the company has taken a look at the evidence. This story should have had a stronger signal that this is potentially straying from the realm of science and into marketing. Type II diabetes is a known disease of the industrial world and the numbers of people are increasing while the ages at which they are diagnosed is decreasing. An oral insulin would aid people in controlling their blood sugar levels. The story includes comments from the CEO. Getting an independent voice is especially important when the data is preliminary and comes from the pharmaceutical company. The story does say that this drug is intended for those for whom metformin, a standard treatment for type II diabetes, is no longer sufficient. But because there are many alternatives for diabetes management, and none were mentioned, this is Not Satisfactory. The story makes it clear that the drug needs more research before it will be reviewed by the FDA for approval. The story makes it clear that if this drug delivers the necessary insulin by mouth, then this would be a novel advance in treatment–and a “multibillion-dollar product.” Because the story contains original quotes not found in the news release, this squeaks by as Satisfactory. It is clear, however, that this story is being published because of promotional outreach by the company, and the lack of outside perspective makes this feel more like a news release than a piece of journalism. (We also reviewed the news release.)


FDA approves Epclusa for treatment of chronic Hepatitis C virus infection

Explanation: This release announces the approval by the FDA of a new pill, Epclusa, for patients with chronic infections with Hepatitis C virus, also known as HCV. The tablet combines an existing drug, sofosbuvir, with a new drug, velpatasvir, and is the first single therapy for all six major forms of the virus. Patients can be infected with different forms and require different treatments. The release informs on the novelty, harms and benefits of the drug but doesn’t give reporters — or lay readers — much background on the clinical trials that led to the approval. An estimated 120 million people have HCV infections worldwide, with an upper estimate of 3.9 million in the US alone, according to the Centers for Disease Control and Prevention (CDC). This new treatment — Epclusa — has an estimated cost of about $74,800 per 12-week necessary therapy length — or about $900 per pill. But without treatment, many HCV patients may require years of treatment and suffer damage to their livers that require transplants and could ultimately be more expensive. The economics of new drugs is a vital part of any story about the drugs. We wish this release had included some context on the cost issues surrounding HCV infection for both patients and the society at large. A blogger with Bloomberg News focused a post about the drug pricing which has been controversial due to the millions of patients affected.

The release does not discuss cost. The FDA evaluates drugs without consideration of cost, so it’s understandable that they wouldn’t comment on it — and that’s why we’re rating this Not Applicable. We look forward to the day when any news release about a new drug — even one from the FDA — includes some mention of cost in its message. After all, the value of a new drug is a function not just of how well it works, but its cost-effectiveness. The release includes results from Phase III clinical trials in about 1,600 patients showing a benefit. “Results demonstrated that 95–99 percent of patients who received Epclusa had no virus detected in the blood 12 weeks after finishing treatment, suggesting the patients’ infections had been cured.” The release also notes that after 12 weeks, 94 percent of patients with more advanced disease who received Epclusa in combination with ribavirin showed no virus in their blood. The release notes that the most common side effects of Epclusa are headache and fatigue. It also explains that Epclusa carries a warning that “serious slowing of the heart rate (symptomatic bradycardia) and cases requiring pacemaker intervention have been reported when amiodarone is used with sofosbuvir in combination with another HCV direct-acting antiviral.” The FDA also warns that certain drugs may reduce the amount of Epclusa in the blood which would reduce its effectiveness. The release does not use the important words “randomized controlled” that would signal to the reader about the quality of the evidence. The release also does not give us the precise size of cohorts, or even tell us where to get further details with a journal citation, URL or a link. The FDA also missed an opportunity to inform readers about limitations of these studies and gaps in our knowledge related to these medications. For example, these were short-term studies, and so we don’t yet know whether these patients will have fewer cases of liver cancer, liver failure, or need for liver transplants down the line. That’s an educated inference based on the drug’s ability to eradicate the virus — but not proven. There is no disease mongering. The release did not identify funding sources or state whether there were any conflicts of interest.This release describes the approval of a new drug by a regulatory agency, but we’d still like to know who sponsored the study that’s the basis for the approval. It’s not enough to state who manufactures and markets the drug. The release explains in some detail that different HCV patients may follow different drug regimens, depending on their particular strain of virus and other characteristics of their infection. A bit more explanation about how patients and providers may choose whether to use Epclusa or other alternatives and how they will compare would have been helpful. The release is announcing the approval of the drug which usually means it will be available in the near future. The release states that this is a wholly new combination drug that has not been available until this approval by the FDA. It also states that it is the first drug that works for all six strains of the virus. There was no unjustifiable language.


Lorraine Fende Says that in Ohio "right now, you could be 8½ months pregnant and have an abortion for no reason.

Explanation: Rep. Lorraine Fende on point that abortion at 8 1/2 months is legal

A new bill to ban late-term abortions is gaining traction in the Ohio House of Representatives, reinvigorating debate over the state’s abortion laws. If passed, the bill would ban abortions when a woman is at least 20 weeks pregnant and tests show the fetus can live outside the womb – a condition known as being viable. The proposed ban contains exceptions for certain medical situations, a legal requirement for late-term abortion bans at the state level. The proposed ban is one of three bills related to abortion the Republican majority in the House introduced this week. The set of abortion bills comes on the heels of similar legislation Democratic Rep. Lorraine Fende of Willowick introduced earlier this year. Fende’s bill aimed to ban abortions when a woman is at least 22 weeks pregnant with a viable fetus. Fende’s bill is likely going nowhere now that Republicans have trumped her proposal with one of their own. But a case she made for her bill – involving the availability of late-term abortions in Ohio – also is central to Republicans’ plan to ban late-term abortions. "I had a conversation with someone quite some time ago that right now, you could be 8½ months’ pregnant and have an abortion for no reason," Fende told The Columbus Dispatch for a story published Jan. 17. Similarly, proponents of Republicans’ plan to ban abortions after 20 weeks of pregnancy decried the occurrence of abortions in Ohio up to the ninth month of pregnancy. While advocates and opponents of the proposed ban on late-term abortions prepare to debate this sensitive issue as it moves through the legislature, it is important to keep the facts straight. So we decided to check out Fende’s claim. Fende said she relied on statistics from the Ohio Department of Health. Doctors who perform an abortion in Ohio must submit to the department a Confidential Abortion Report, which does not include the woman’s name or other identifying information. According to the Ohio Department of Health, four abortions were performed in Ohio after 32 weeks (or eight months) of pregnancy in 2009, the most recent year in which statistics are available. Two abortions were performed when the mother was 32 weeks along; one abortion took place at 33 weeks; and one occurred at 35 weeks. Overall, 28,721 abortions were reported in Ohio in 2009. Of those, 613 involved pregnancies at least 20 weeks along and 116 of them were for women at least 24 weeks pregnant. The length of the pregnancy was unknown in 276 cases. The numbers confirm that at least one abortion occurred in Ohio when a mother was at least 8½ months’ pregnant. Fende said she was aware of this one abortion when she made her claim, and she said she did not know the reason behind it. Ohio law does not include an absolute ban on abortions when a woman is 8½, 8¾ or even 9 months’ pregnant. State lawmakers tried to pass a late-term abortion ban in 1995, but the U.S. Sixth Circuit Court of Appeals ruled the ban was unconstitutional because medical exceptions to the ban were not sufficiently specific. Courts, however, have upheld Ohio’s a ban on partial-birth abortions, which are performed after part of the fetus has been removed from the mother’s body. Partial-birth abortion is associated with late-term pregnancy but the two are not mutually exclusive. There are other abortion procedures, permitted under Ohio law, that can terminate a late-term pregnancy. Although certain late-term abortions are legal, pro-choice advocates say they are only done for medical reasons – not for "no reason," as Fende suggested. Kellie Copeland, executive director of NARAL Pro-Choice Ohio, said abortion clinics in the state will not perform an abortion if the woman has been pregnant for at least 24 weeks. She said any abortion performed afterward would take place in a hospital for medical reasons. Jessie Hill, a professor at the Case Western Reserve University School of Law, said abortions when a woman is 8½ months pregnant don’t happen in Ohio for no reason. "It’s just one of those things that’s unheard of," said Hill, who has researched reproductive rights. Hill said she is pro-choice. Michael Gonidakis, executive director for Ohio Right to Life, said that most abortion clinics advertise for abortions at 24 weeks or earlier. But, Gonidakis pointed out, statistics from the Ohio Department of Health show abortions are happening beyond 24 weeks. The statistics do not show whether the abortions are taking place in a hospital or an abortion clinic. But, upon request from the Democrats for Life of Ohio, the Department of Health provided data on the medical condition of women receiving an abortion after they had been pregnant for at least 23 weeks. The data was taken from the abortion reports doctors submitted to the department. The report includes a question about the patient’s medical condition, whether it was "good," "fair," or "other." Of the 116 abortions in 2009 performed when the woman was reported to be 24 weeks pregnant or more, all of them were listed in good medical condition, according to the Department of Health. So where does this leave us? The law does not explicitly outlaw such an abortion, but state health records show there was just one such case in 2009, and Fende said she did not have the background of that case. And a law professor who is an expert in reproductive rights told us that abortions at 8½ months aren't done for just "no reason." Fende’s claim was legally sound. But by itself it does not reflect what the state Department of Health is documenting. That there was just one case out of more than 28,700 abortions in 2009 that fits her statement is an additional piece of information needed to fully understand the claim. On the Truth-O-Meter that rates as .


To Inspect the Heart, Some Doctors Now Start at the Wrist

Explanation: This is an engaging and important enterprise story that explained a number of important issues to be factored in when considering medical interventions. It also nicely highlights the tension that exists in the development of new and presumably less invasive approaches to cardiac catheterization and angioplasty. It’s refreshing to still find 1,600-word stories that go into such detail. It is clear from the story that:  Cardiologists are not of one mind about the value or benefit of doing cardiac catheterizations thorugh the radial artery in the wrist as opposed to the femoral artery in the groin. Different physicians value patient comfort differently. Different physicians may be more comfortable with, and better with, certain procedures. However what was lacking from this story was an examination of the overall success rate of the intended procedure. While patient comfort surely has value, procedure outcome is vital. We never learned any data about whether the actual goal of opening an artery is any better one way or another. Interestingly, the cited meta analysis is only partially acknowledged. While a trend was noted toward an advantage to the radial artery approach (in terms of bleeding and procedural outcome), the authors concluded a large randomized trial is necessary to determine the true value of the approach. And that wasn’t mentioned in the story. Overall, though, the story delivers a clear picture of why patients need to have conversations with their caregivers about the risks and benefits of the various options available for their treatment. Being aware that there is often not a single answer to questions about the course of action is an important step towards making decisions that will get you the care that is best for you. The online version also included helpful graphics and a video.

The story mentions that using the wrist may better enable patients to avoid an "expensive overnight hospital stay" and that Medicare reimbursement was the same even though this route for catheterization may involve more physician time. But the story didn’t include any specific cost information about this new approach. Shouldn’t the physicians interviewed know whether their charge to patients depends on the vessel used? Nonetheless, we’ll give the story the benefit of the doubt on this criterion. The benefit of the treatment was presented in terms of patient comfort and time, and presented quantitative information indicating the radial approach results in a reduction in bleeding complications as compared with the femoral artery. But it did not provide any data about the outcomes of the procedure, namely, "How did it do in opening arteries?" It is interesting to note that the meta-analysis cited in the story concluded that additional studies are needed to better define the role of this approach, which was not mentioned in the story. The story mentioned that arterial spasms tops the list of complications with this procedure and indicated that it was particularly problematic in "little old ladies." Beyond this, the story did not give the reader any idea of how common this sort of problem was, making it difficult for readers to evaluate. The story did an incomplete job of including relevant evidence about the use of the radial artery for coronary catheterization. Since the  cardiac cath and angioplasty is intended to relieve symptoms by unblocking a coronary artery, it would have been helpful to have commented on the literature on outcome differences between the two approaches. The story implies an equal outcome with less risk of bleeding and shorter hospitalizations; both positive from the patient’s perspective. Without any comment on the outcome of the cath and angioplasty, patients cannot place a value on the radial approach. The story touched on the notion that there was a steep learning curve in order to develop proficiency using the radial insertion site. But there was both insufficient information for potential patients to use to assess whether the clinician they were consulting had adequate experience and what the ramifications of using this site without adequate experience might be. The story did not engage in disease mongering. The story included interview material from clinicians who utilize this technique only rarely as well as those who rely on it extensively. In addition, there were several patient quotes that presented the view from the other side of the table. While there was no discussion about the appropriate use of cardiac catheterization in general, the story included information about the two arterial routes that may be used for the procedure. The story indicated that radial catheterization is most likely not routinely available and that a low percentage (1%) of catheterizations are performed this way. The story did a good job placing the novelty of the approach into context. Reading the various physicians’ experiences with this technique, it is clear that it is not novel and yet is also not commonly utilized. Clearly, the story did not rely on a news release.