PR Advice To Medical Panels: Fight Stories With Stories

The Russian legend of The Princess Frog

Hear, hear. A paper in the prestigious Journal of the American Medical Association today calls on scientists to fight stories with stories.

That is, in the service of more powerfully conveying what research actually shows, they should no longer shy away from “anecdote” just because it lacks statistical power. They should use stories of real people that illustrate evidence-based points in order to convey information better to the public.

The paper begins with a federal panel’s recent controversial recommendations against routine prostate screening for healthy men. Celebrities from Rudy Giuliani to Joe Torre fought the recommendations using that most powerful of weapons, their own personal stories, in which they attributed their survival to screening.

Panel members, in contrast, tended to explain their decision with numbers, not stories. They did not offer heartbreaking tales from men left incontinent, impotent or otherwise harmed — though goodness knows, they would not be hard to find. And that data-driven high road, the JAMA paper argues, tends to lead to defeat.

“Each time, those who espouse only evidence — without narratives about real people — struggle to control the debate,” the authors write. “Typically, they lose.”

They offer a vivid example of how to fight a story with a story, a “counter-narrative” that uses an anecdote  to parry an unscientific argument:

Take the largely negated theories of a causal link between childhood vaccines and autism. As recounted by Offit in his book on this topic, a celebrity actor claimed that she does not need real science to know that the measles-mumps-rubella (MMR) vaccine triggered her son’s autism: “[My son] is my science,” she stated on television to thunderous audience applause. Such narratives, challenging scientists who come to the table (or television studio) armed only with data, often succeed in the court of public opinion and weaken efforts to promote evidence-based health decisions.

The public needs to hear the stories of patients, and their families, who encountered a drug that offered hope but was ultimately ineffective and even dangerous.

When scientists encounter stories that promote unscientific approaches to health and health care, they should deploy an evidence-based counternarrative. The story of a mother in San Diego whose infant, too young for the MMR vaccine, became sick after exposure to an unvaccinated child with measles would add persuasive weight in a debate with the actor mentioned above. Continue reading

Study: Costs Keep Med Students From Much-Needed Mental Health Care

By Fran Cronin

CommonHealth intern

Medical students are a challenged lot — sleep-deprived, stressed and driven. With the constant cramming of facts into their overloaded heads, and the constant need to steel themselves against the daily rounds of disease and injury, many medical students are left mentally and emotionally drained. Like their patients, they need a doctor. But many don’t reach out for help.

In a research letter just published in the Journal of the American Medical Association, Drs. Rachel Nardin and J. Wesley Boyd — both from the Harvard-affiliated Cambridge Health Alliance (CHA) — help illuminate the vulnerability of U.S. medical students to untreated and debilitating depression and substance abuse. These at-risk students tend not to seek the mental health services they need, the researchers found, due to the overwhelming cost of appropriate mental health services.

Schools and parents may be mandated to provide health insurance, but the study found that many of the plans offered did not provide affordable or adequate coverage for mental health and substance abuse treatment.

Data culled for this first-time survey of health insurance offered to U.S. medical students was collected from June through December 2010. The findings from 115 of the total 129 public and private medical schools in the U.S. revealed wide variability in annual dollar and visit limitations across the non-uniform plans.

‘Mounting debt from long stints at expensive schools weighs very heavily upon the students.’

For example, mental health dollar limits ran from $1000 – $200,000 for outpatient services; $800 – $200,000 for outpatient substance abuse treatment; and $1000 – $200,000 for inpatient mental health and substance abuse treatment. Continue reading

Docs Suggest Fixes For In-Flight Medical Emergencies

Doctors suggest that airlines adopt a more standardized approach to deal with in-flight medical emergencies

Every time I get on a plane, I’ve got a set plan figured out in case I have a panic attack or start throwing up. I’ve got my pills at the ready, my barf bag tucked discreetly in the seat pocket and I silently identify the flight attendant who might be most responsive to a really nervous, high maintenance flyer.

Apparently, though, not every airline has a comprehensive, uniform plan in place to deal with in-flight medical emergencies.

Two doctors from Beth Israel Deaconess Medical Center write that “the kinds of approaches that have improved flight safety have not been extended to providing optimal care for passengers who become acutely ill while on board airplanes.”

In an online commentary published this week in the Journal of the American Medical Association, physicians Melissa Mattison and Mark Zeidel say that “despite 10,000 in-flight medical emergencies identified by European airlines over a 5-year period, each airline has its own reporting system and protocol. And while emergency medical kits are mandated to contain medications and equipment, actual kits vary by airline.”

Even though the Federal Aviation Administration mandates that flight attendant training includes CPR and the use of automated external defibrillators, the authors note that there is no standard curriculum or testing required. “As a result,” they write, “physicians responding to emergencies can face a broad array of challenges including cramped physical space, emergency kits whose contents are unfamiliar, inadequate, and poorly organized, and flight crews unaware of how best to assist the physicians.”

Unlike the intense root cause analyses that follows a plane crash, for instance, the authors note that medical emergencies in the air tend not to be discussed again after the fact. Here’s how the JAMA piece begins:

As the flight begins its descent, a call comes over the intercom: “Is there a physician on board?” Three internists traveling together to a meeting respond. A woman has lost consciousness. She is incontinent and unresponsive, with a strong pulse and intermittent breathing. The physicians ultimately determine the patient has hypoglycemia and a seizure. It takes multiple requests before the flight attendants provide the physicians with the emergency medical kit. When the kit arrives, the flight attendants disappear, and the physicians search in vain for glucagon or intravenous dextrose. The physicians massage oral glucose gel into the patient’s buccal mucosa, and the seizure eventually stops. After landing, the cabin crew records the names and contact information of the physicians, with no discussion of the incident.

Mattison and Zeidel suggest four steps to begin to fix the problem:

1. Adopt a standardized recording system for medical emergencies on flights, with mandatory incident reporting and debriefing of anyone involved.

2. Airlines should should solicit recommendations on the optimal content of first aid kids with the goal of creating a standardized kit on every flight.

3. Enhance and standardize training for flight attendants

4. Standardize flight crew communication with ground-to-air medical support, and make sure it’s available when there are no health care personnel available.

New JAMA Editor From BU Med School

Here’s the AMA press release:

Professor of Pediatrics and noted researcher to become 16th editor in journal’s 127-year history

CHICAGO – Howard C. Bauchner, M.D., from Boston University School of Medicine, will become the next JAMA Editor-in-Chief on July 1, 2011, according to an announcement made today by Michael D. Maves, M.D., the executive vice president and chief executive officer of the American Medical Association. Dr. Bauchner will be the 16th editor in the journal’s 127-year history.

Dr. Bauchner is currently the editor-in-chief of the Archives of Disease in Childhood, the official publication of the Royal College of Paediatrics and Child Health in the United Kingdom. He is the first U.S.-based editor of that journal and has held that position since 2003. He is a professor of pediatrics and community health sciences at Boston University Schools of Medicine (BUSM) and Public Health. He is also the vice chairman of the department of pediatrics and assistant dean, alumni affairs and continuing medical education at BUSM. He has served on many editorial boards, including currently for the British Medical Journal and Journal Watch. Dr. Bauchner is also an accomplished researcher. He has published more than 125 papers in peer-reviewed journals. His research interests include health promotion, clinical trials and quality improvement.

“We are pleased that Dr. Bauchner will be the new editor of JAMA, ” Dr. Maves said. “JAMA is a world-class medical journal and we’re confident the journal will continue to grow and prosper under his leadership. The future of JAMA – one of the AMA’s most treasured assets – is in great hands.”

As Editor-in-Chief, Dr. Bauchner will have editorial oversight of JAMA and the 9 Archives journals, the specialty medical journals published by the AMA. Dr. Bauchner was chosen after an international search conducted by a committee comprised of members of the Journal Oversight Committee, JAMA Editorial Board, the AMA’s Board of Trustees and senior management and with help from the executive search firm, Russell Reynolds Associates. Dr. Bauchner is following Catherine D. DeAngelis, M.D., M.P.H., who is leaving the post after 11 years to return to Johns Hopkins School of Medicine in Baltimore.

“I have tremendous respect for JAMA and the prestige and stature it has achieved under Dr. DeAngelis,” Dr. Bauchner said. “JAMA is among the elite medical journals in the world and I am excited and honored by the opportunity to be its new editor.” Continue reading

Wanted: Editor-In-Chief For Leading Medical Journal

JAMA editor says she'll leave next June

Breaking news: Come next June, Dr. Catherine D. DeAngelis will step down as editor-in-chief of The Journal of the American Medical Association, the journal has just announced. JAMA, (pronounced as in the second syllable of pajama) is one of the nation’s most prestigious medical journals, its studies cited widely and given much credence. According to JAMA:

Dr. DeAngelis has been a leader among journal editors to increase the integrity and ethics of medical journal publishing. Working with the International Committee of Medical Journal Editors (ICMJE), she encouraged other editors to agree to a requirement for all clinical trials to be registered as a condition of publication and to strengthen conflict of interest guidelines. In one of her most courageous stands as a journal editor, she instituted the requirement that industry-sponsored clinical trials must have an independent academic statistician to review all data before a manuscript can be accepted and published in JAMA. No other journal has this stringent requirement to ensure the integrity of data.