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Critically Reading News Related to Health Care
When reading stories about new methods for curing a disease or
a new medication, one has to carefully
and critically read to find out whether what is stated is really
true. The questions below will help you to
do so – these are the questions you should ask yourself before
you believe the “hype” about the new
wonder drug.
Each question has a little graphic that is a warning, together
with the issue that may arise. This is
followed by more details to help you assess whether there is an
issue.
1. Does the story adequately discuss the costs of the
intervention?
Health care isn’t free. News stories don’t help
patients and consumers if they don’t tackle costs.
When rating a story on this criterion, check whether the story
discusses the costs of the intervention,
whether it’s a new device, medication, surgery, exercise fad,
therapy or any of the myriad treatments
being studied. It’s not good enough to say, “The cost is much
lower than the invasive procedures.”
What is that cost? How much lower? Also, do insurance policies
typically cover the intervention?
Might there be other expenses (psychologists, dietitians,
required follow-up visits or tests, etc.) that
increase the burden on patients? If they cannot be quantified,
they should at least be mentioned.
For early trials or preliminary research, it may be difficult to
estimate costs of an experimental
approach early in its development. But a news story can at least
cite costs of existing alternatives. If
the new approach is comparable to other approaches then the
cost of the alternative methods could
be cited. Bottom line: If it’s not too early to talk about benefits
of a new intervention, it’s not too
early to talk about costs.
We also know that some interventions may cost more in the
short term, and yet are cost-effective in
the long term because they reduce the need for expensive care
down the road. While these longer-
term costs may be difficult or impossible to pin down, good
stories make a reasonable attempt to
discuss the implications.
2. Does the story adequately quantify the benefits of the
treatment/test/procedure?
New healthcare treatments should work well.
When reading a story, people want to know: How
effective is the intervention? Do the numbers back
it up?
News stories should explain what the researchers measured, in
numerical terms. And to use absolute
numbers whenever possible. Many news stories tell us how
wonderful a new treatment, test, product
or procedure may be. Few provide helpful numbers to back that
up.
Ideally, the story should also explain whether the findings make
an actual difference in people’s
lives. If a study says a new drug improved function by 30% in
MS patients, what does that mean?
How was that measured? What would an MS patient want to
know?
Also, research often isn’t about an actual improvement in health
or quality of life, it’s instead
centered around surrogate outcomes, such as changes in blood
test scores, or tumor shrinkage. These
endpoints can be useful for researchers (and biotech investors),
but surrogate outcomes
do not automatically equal living better or longer. Readers need
to know that.
If a story is about preclinical research like a mouse or monkey
study, it must point out that
researchers have no guarantee that the intervention will provide
the same benefit to people.
And, stories that rely too heavily on patient anecdotes may be
unrepresentative of the true benefit.
The same goes for unchallenged exaggerated quotes (“this is a
real game-
changer/breakthrough/cure” etc.), which can throw a story out
of balance and overshadow the
statistics. When a story is top heavy with personal stories, it
makes it hard for readers to sustain their
critical thinking when (if) they get to information that is
quantitative. If you hear glowing patient
anecdotes about how well something worked, always ask
yourself if that was a representative
example.
3. Does the story adequately explain/quantify the harms of the
intervention?
All healthcare interventions carry potential harms.
When reading a news story about a new treatment,
readers should find out what is known about the
harms.
When a story is about a treatment (new drug, surgery, therapy
lifestyle change, etc) or screening test,
is should include a discussion of harms and side effects, as well
as any measured “adverse events” in
a study.
There are tradeoffs involved in any health care decision. No
matter what you choose to do, you stand
to gain something and you stand to lose something. All
treatments have potential harms, side effects,
and complications. Also, there is no such thing as a simple
blood or screening test. They carry the
risk of a false-positive or false-negative result, which can result
in missed diagnosis or
overtreatment, and anxiety.
Ideally, stories discuss both frequency of side effects and
severity of side effects, and discuss both
major and minor side effects. What might be minor to one
person could be major to another.
Preliminary animal studies or otherwise early research: It’s also
important to remember that we
often have no idea what the true impact of a drug is until it’s
been used in a large number of people
(and not mice and not cells in a lab), so the story should point
out that some harms may be
unknown–especially when the research is far from ready for
prime time.
Many stories emphasize or exaggerate potential benefits while
minimizing or completely ignoring
potential harms. They may:
• Fail to mention or quantify potential harms.
• Fail to describe the severity of potential harms.
• Fail to account for “minor” side effects that could have a
significant impact on a patient’s life.
• Rely too heavily on a patient anecdote about safety or on a
researcher’s comment that an
approach “appears to be safe” – without supporting data.
4. Does the story seem to grasp the quality of the evidence?
Ideally, healthcare interventions are subjected to
rigorous testing to prove they work. When reading
about a new intervention, device or diagnostic tool,
people should come away with a sense of how rigorous
the evidence is for the intervention.
The story should include enough details about the study and
how it fits into the hierarchy of
evidence. As in: Was it an animal study? An observational
study? A small, safety trial? A large,
randomized controlled trial? A meta-analysis or systematic
review? A recommendation from a task
force that reviews evidence? And regardless the type of
evidence, what was the quality of the
evidence?
Not all studies are equal. Not all evidence is bullet-proof. There
is not a certainty or a finality to
everything that appears in the New England Journal of Medicine
or any other journal. And just
because it’s a study – or just because it’s published somewhere
– the story is not over. That’s not the
way science works.Yet many stories:
• Present anecdotes as evidence of a treatment’s benefits –
rather than as a single illustration of its
use.
• Leave out study limitations – even though all studies carry
limitations.
• Fail to caution readers about interpretation of uncontrolled
data.
• Fail to explain if a primary outcome is a surrogate marker1 or
fail to caution readers/viewers
about extrapolating this to health outcomes.
• Fail to point out the limited peer review that may have taken
place with findings presented at a
scientific meeting.
• Conflate causation and association – failing to explain
limitations of observational studies.
• Get caught up in reporting on the latest study without
reporting on larger, better-designed studies
that have been done already.
1 An indirect indicator of a disease state or of its response to
therapy. Such markers often include laboratory tests thought to
represent clinical progress accurately. For example, in diabetes
mellitus, the glycosylated hemoglobin level is used as a
marker of glycemic control; in AIDS the level of HIV RNA is
used as a marker of disease progression.
Questions to ask:
• What are the limitations of the evidence?
• Was the study done in only a few people?
• Was the study done for only a short time? What might happen
long-term? Will there be follow-
up?
• Did the study report on an outcome that you really care about
– like illness or death? Or did it
only report on test results, markers, or scores?
• Did this information come from a talk presented at a scientific
meeting? If so, you should know
this kind of research is often considered preliminary because
other experts haven’t had a chance
to thoroughly review it.
• Were the findings from an animal or lab experiment that might
not be applicable to human
health?
• Did the information simply present anecdotes as evidence of a
treatment’s harms or benefits –
rather than real numbers from the entire study group?
5. Does the story commit disease-mongering?
Sometimes new conditions or diseases actually may
just be opportunities to medicalize (and monetize)
normal states of health. Readers aren’t well-served
by stories that exaggerate or oversell conditions.
There are different forms of “mongering,” including:
• turning risk factors into diseases, with the implication that,
then, these must be treated (e.g., low
bone mineral density becomes osteoporosis);
• misrepresentation of the natural history and/or severity of a
disease (e.g., early-stage low-grade
prostate cancer);
• medicalization of minor or transient variations in function
(e.g. temporary erectile dysfunction);
• medicalization of normal states (aging, baldness, wrinkles,
shyness, menopause);
• exaggeration of how common a disorder is (e.g., using rating
scales to ‘diagnose’ chronic dry
eye; see “not satisfactory” story examples below).
Identifying disease mongering is a matter of judgment.
Sometimes it is obvious. Sometimes there’s a
fine line about whether an article on irritable bowel disorder,
erectile dysfunction, restless leg
syndrome or osteoporosis (all of which can be serious for some
sufferers) is misrepresenting the
condition to the public.
Note: Most of the conditions we list are not life-threatening.
The grand-daddy of disease-mongering
is fixating on LDL cholesterol numbers instead of evaluating
whether studies showed a change in
how well or how long people live–and whether treatment results
in fewer cases of heart disease or
fewer deaths.
Beware of statistics that may inflate the seriousness of a
condition. Beware of articles that
exaggerate the human consequences of a condition – “millions
of us are suffering in silence with
toenail fungus.” Suffering? Beware of interviews with “worst-
case” patients – holding such patients
up as examples as if their experiences were representative of all
with this condition.
The story should discuss the prevalence of the condition under
discussion–and if that prevalence
could possibly be inflated.
6. Does the story use independent sources and identify conflicts
of interest?
Health care is rife with conflicts of interest. Readers
deserve to know if the sources in the story have any
conflicts of interest. They also deserve to hear the opinion
of objective, independent third-party experts, who are vital
to backstopping exaggerated claims.
Conflicts of interest are common among people making claims
about new treatments, tests, products
or procedures. Examples include:
• A trial paid for by the drug manufacturer.
• Researchers employed by or getting fees from a drug
company.
• A spokesman for a device manufacturer.
• Doctors who are early adopters and true believers in a new
device.
• An inventor or researcher who is seeking patents.
All of these people want their product or their idea to look as
good as it can.
News stories should identify the source of the story (news
release, journal article, editorial, scientific
meeting presentation, etc.) and explain how likely that source is
to be conflicted (e.g., a PR
consultant working for the company said; or Dr. Smith, who
received a company grant to perform
the study, said…)
They also must include the input of a trusted independent
source with expertise on the subject to
comment on the claims made. (Ideally, more than one such
independent source would be used). But
often stories only have one source, and it’s someone with “a
dog in the hunt.”
7. Does the story compare the new approach with existing
alternatives?
Just because something is “new” in health care
doesn’t mean it’s better. When reading about a
new drug, test, surgery, etc., readers should come
away informed that there are other options on the
table.
Journalists want to cover what’s new. But without a discussion
of alternatives, readers can come
away with the impression that the new option is the only good
option. Therefore, the new
intervention or finding must be put in context with existing
alternatives that have a longer, more
proven track record.
Alternatives to an intervention can mean lifestyle changes,
another drug, surgery, no treatment, or
“active surveillance” – declining immediate aggressive therapy
while remaining under close medical
care. A good article contains a brief discussion of the other
treatments on the table, and how they
compare in effectiveness and cost.
Stories may get rated ‘Not Satisfactory’ if they:
• Discuss a surgical approach without mentioning non-surgical
alternative approaches.
• Discuss a new test without mentioning other tests that are
available; including the option of not
being screened in the case of a screening test.
• Fail to discuss the advantages/disadvantages of the new idea
compared with existing approaches.
• Fail to discuss how the new treatment, test, product or
procedure fits into the realm of existing
alternatives.
8. Does the story establish the availability of the
treatment/test/product/procedure?
New medical treatments often get lots of attention before
they’re ever made available to the public. After reading a
story about a new intervention, a person should be able
to answer: Is it actually available to me?
Sometimes news stories report on things as if they were
available at the corner drug store (or
doctor’s office), when, in fact, they may be years away from
even coming on the market. There may
be a lot of marketing hype that suggests that something is well-
studied and ready for use–this hype is
good for stock prices, but not patients.
Whenever you hear a prediction about something “expected to
be approved by the FDA” in a certain
time period, take it with a grain of salt. It doesn’t get approved
until it gets approved, and there may
be many steps left in the approval process. Ignore crystal ball
predictions; they usually come from
someone who stands to benefit. It’s also important to know that
“approved” medical devices in the
U.S. may not be safe or effective.
Another issue to be aware of is that something might be
approved in Europe, but not in the U.S. That
should raise questions about why it hasn’t been submitted for
approval in the U.S. yet, or why it
hasn’t gained approval yet. If it’s already approved in the U.S.,
or doesn’t need to be approved (such
as a new surgical method or a new type of exercise equipment),
it’s usually not enough to just say
the intervention is “available.” For example, if it’s a type of
heart surgery, do patients have to travel
to specific hospitals that offer that surgery? If it’s a new fitness
fad, is it only available in trendy
gyms in Manhattan? If it’s a new drug, will it immediately be
stocked on pharmacy shelves?
9. Does the story establish the true novelty of the approach?
Often something that’s lauded as new or novel really
isn’t. Or it may be new, but it’s not better. So, when
reading about a “new” medical intervention, people
deserve to know: What is truly new and different
about this idea?
Drug companies (and device-makers) are very good at
promoting their new drugs or products as
“novel” to increase initial sales. Yet many “new” treatments,
tests, products or procedures are not
really novel. A “new” drug may be another member of a well-
established therapeutic class of drugs.
And even if a drug is the first in a new class of drugs it may
offer no more benefit than the drugs that
are widely available.
By focusing on one new idea, it may appear that it’s the only
thing being researched in the field.
Putting this in context of past research helps keep hype in
check. That backstory can be hard to find
unless the reporter finds a truly independent expert.
We repeat: Newer isn’t always better in health care. And it may
not really even be newer. Stories
should establish just how novel the new thing is.
Resources for establishing novelty:
• Clinicaltrials.gov can provide information about other studies
that are underway about a specific
treatment or for a particular condition. It can be useful for
providing context about something
seemingly innovative.
• With PubMed, you can put in a key word or two and pretty
quickly establish whether something
is absolutely unique and if not – how long it’s been around and
studied.
10. Does the story appear to rely solely or largely on a news
release?
Sometimes news stories rely solely or largely on a
PR news release–and never disclose that the
information came from a news release. Readers
deserve to know if a story includes no original
reporting.
With many news organizations facing tough economic times,
financial pressures may lead some
newsrooms to become more open to using news releases as a
way to publish content while cutting
costs. News releases can be valid sources of some information.
But journalism is charged with the
task of independently vetting claims. Therefore, it is
unacceptable to rely on a news release as the
sole source of information–and to not disclose that.
The Great Shutdown : How COVID-19 changed
the world economy
Having good [email protected] financial [email protected]
with foreign countries and the IMF is crucial
for any
country. The IMF has always helped countries facing
financial problems, especially during world
financial crisis such as the 2008 housing crisis,
Greek bankruptcy and the most recent market
crash because of the COVID-19 pandemic that
the world was faced with.
With this research paper, I am to study and
report on the various challenges that many
countries faced such as a health crisis,
financial crisis and a collapse in commodity
prices. The
IMF and policymakers were faced with the challenge of
providing the world with unprecedented
support to not only households and small
business but even large [email protected] and
financial
markets in order to shape and mold the markets
to be prepared when the world opened up
aOer the global lockdown. The global lockdown
restricted travel, businesses world
wideworldwide, the healthcare system was overworked
and overloaded with
[email protected][email protected]
and a disease the world had never seen before.
Many believed that the great lockdown caused
an economic recession worse than the Great
Depression and much more worse than the
global
financial crisis.
In March when the COVID19 disease was
declared as a global pandemic, the projected
global
growth fell downfell to – 3%. [email protected]
showed the combined loss to global GDP would
be
somewhere around the 9 trillion dollar mark.
Countries that were heavily dependent on tourism
and travel expected massive [email protected]
Developing economies and emerging markets
were
[email protected][email protected] growth rates for -1%
for the year 2020. Countries like India and China
were
faced with more problems due to the high
[email protected] in their countries.
As the world went into lockdown, policymakers started
to take [email protected] on large, @mely
and
targeted fiscal, financial and monetary policies. These
policies included credit guarantees,
liquidity [email protected], laon forbearance ,forbearance,
expanded unemployment insurance, tax
reliefs and [email protected] payments. These policies
enabled small business and households to
[email protected] to pass the lockdown. These
measures ensured that there were less job losses
due to
the pandemic.
The above listed measures and policies are a
small part of the reopening phase of the
lockdown,
however it played a vital role in ensuring
economic stability post lockdown. In my research
paper I want to focus on what these policies
were, how each one impacted what industry,
country and lastly how it helped the world
recover from the financial crisis.
The COVID-19 pandemic was different from all the
other past economic downturns and trigger.
The pandemic triggered [email protected], shortage of
labor, [email protected], lockdowns and social
distancing across the world. All business and
movement was halted apart from [email protected]
[email protected]@es. These measures were put in
place in order to minimize the spread of
the virus
amongst the public. With workplaces being closed,
supply chain and [email protected] was
disrupted.
Layoffs, incomes declines and heightened uncertainty
made people more [email protected] than
ever. On the other hand, medical expenses were at an
all @[email protected] high with healthcare
equipment manufacturers running factories over @me.
Rising unemployment triggered
widespread default on credit card payments and
loans. Lenders were faced with the difficult
decision to hold back credit for firms and
individuals.
Policymakers and governments were kicked into
overdrive in order to draw up a plan that
would
provide a roadmap for countries, industries and small
businesses to ride the pandemic and
sustain through it to be able to resume
businesses once the pandemic had passed. To
come up
with strategies, policymakers looked at previous
economic downturns to get [email protected] on
how
to overcome this downfall. In response to the
pandemic, advanced economies [email protected]
[email protected] fiscal and monetary policy support
measures. These measures were believed to be
far greater as compared to the ones taken in
response to the global financial crisis in
2008.
While these measures were being planned and put
into [email protected], there was [email protected] a
great amount of
uncertainty revolving around the pandemic, which
added [email protected] pressure on
policymakers
to be prepared to implement even larger
measures in the months to come. (Gopinath,
n.d.)
(Gopinath, n.d.)
As [email protected] above, there was a high level of
uncertainty revolving around the pandemic,
there were significant upside as well as downside
risks to the outlook of the pandemic. The
upside being vaccine trialsshowing progress,
treatments ge_ng be`er and more policy support
that would lead to quicker [email protected] of
economic [email protected]@es. However, there were
newer
variants of the virus showing up around the world
that would trigger more waves of
[email protected]
and @ghten financial [email protected] with people
spending more on healthcare.
With a crisis like no other, it was expected
that there will be a recovery like no other. As
countries would reopen, it was expected that the
pick uppickup in [email protected]@es would be
staggered
and uneven. Demand for retail products would be
high with demand with backed up orders
whereas travel and hospitality business would
remain at all @[email protected] lows.
Countries that
were heavily dependent on tourism would face serious
financial problems and would lead to
increasing poverty. [email protected] policy support
proved to be crucial in advanced economies
and
to a lesser extent for emerging and developing
economies that were more constrained by fiscal
space. During the course of the pandemic the
global fiscal support reached $10 trillion
and
monetary policy had eased [email protected] with
interest rate cuts, liquidity [email protected] and
asset
purchases. These measures ensured that small
livelihoods and small businesses sustained
and
at the same @me larger [email protected] avoided
bankruptcies, this helped reduce long
[email protected]
damages to the economy.
In countries that were being severely contained by
the pandemic and went into lockdown such
as India, people that were directly impacted should
receive income support through
unemployment insurance, wage subsidies and cash transfers.
Firms that are impacted by the
pandemic should be supported with tax deferrals, loans
and grants. Right before the pandemic
hit, countries like India had given tremendous
importance to [email protected]@on and digital
banking.
This proved to be crucial to reach the
unemployed.
Policy support was expected to shiO formfrom being
targeted to being more broad based,
wherein the fiscal space would permit
countries to taken green public investments
and
accelerate the recovery process while [email protected]
climate goals. During the pandemic,
[email protected]
levels were at all @[email protected] lows with
factories and transport being halted. Along
with the
long termlong-term challenges that policymakers faced,
a medium term challenge that needed
to be addressed was public debt.
(Gopinath, n.d.)
Public debt was projected to reach all
@[email protected] highs in [email protected] to
GDP in advanced as well
as emerging and developing economies. Countries
would need strong fiscal frameworks for
medium term [email protected], cut down on
wasteful spending, widening tax bases and
minimizing
tax avoidance.
In response to the 2008 crisis, policy rates were
reduced by an average of 3 percent by
the
central banks in advanced economies.
Governments on a average deployed
expansionary fiscal
[email protected] with primary balances to the GDP
declining by an average of 4 percentage.
Alongside
these [email protected], the central banks deployed
[email protected] monetary policy tools, large
scale financial asset purchases and [email protected] interest
rates. It is believed that these policies
helped the economy avoid an even deeper slump.
The IMF projected a deeper recession in 2020 and an
even slower recovery in 2021. It was
expected that the global output will experience a
decline of 4.9% in 2020 and would be below
by 1.9 percentage points as compared to the
[email protected] made by the IMF for April.
One of the key moves taken by policy makers
was to deliver [email protected] to liO
aggregate demand in
the market. Fiscal [email protected] such as a
[email protected] point to powerful effects of
fiscal [email protected] when
normal interest rates are at an [email protected]
lower bound or monetary policy is
[email protected] The
size of fiscal [email protected] varies on how it
is delivered. A meta-analysis of the vast
literature on
fiscal [email protected] points to average
[email protected] for public spending on goods
and services.
[email protected] are expected to be higher when
leakages from the economy are low and contained
or when the monetary policy is [email protected]
Bibliography
(Gopinath, n.d.)
CBS News: Same-day hip replacements
summary
This article summarizes information about hip replacement
surgery where patients go home on the same day.
Mentions more than 300,000 hip replacement procedures done
annually.
NYU Langone Medical Center claims to be the first academic
medical center in New York City to implement a same-day hip
replacement program in 2015.
The article gives a brief description of some of the options for
hip replacement surgery as well as some of the risks of the
surgery.
Mentions research done by the American Academy of
Orthopaedic surgeons showing “no significant differences”
between surgical approaches relative to recovery outcomes six-
months after surgery.
Be sure to include any statistics or data given in the report.
2
Criticisms
No discussion of costs of the treatment.
No discussion of benefits of the treatment.
Minimal discussion of evidence.
Only one study cited, red flag. Are there other studies?
Does not compare with existing alternatives.
Only refers to a single procedure and the length of stay in the
hospital.
No discussion of costs, information which is easily available.
Although going home the “same day” seems to be important in
the article, the overall benefits of the procedure itself are not
discussed.
Only mentions one study, does not refer to other studies that
may show alternative outcomes.
Report fails to say other treatments available for hip issues,
only discusses the length of stay option.
3
ITEMS DONE WELL
Story does NOT rely solely or largely on a news release.
Includes original interviews and other reporting
Story does NOT commit disease-mongering
Hip problems are not exaggerated
The story DOES adequately explain/quantify harms of the
intervention.
Mention of complications in first night after surgery
The article includes original interviews and other reporting.
The story does not exaggerate the extent of hip problems.
The story includes warnings from a surgeon about complications
in the first night of surgery.
4
GOING BEyoND THE REPORT (OPTIONAL)
Does not use independent sources.
One outside doctor noted, no other outside sources.
Outside research discovered marketing campaign (no
information in the article)
Additional studies?
Thorough literature review recommended when possible. Story
does not provide links to sources.
To truly critique a news reports, independent investigation
through online searches, overall review of original source
material (subject websites, press releases) is advised, although
not required for this project.
5

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Critically Reading News Related to Health Care When readi

  • 1. Critically Reading News Related to Health Care When reading stories about new methods for curing a disease or a new medication, one has to carefully and critically read to find out whether what is stated is really true. The questions below will help you to do so – these are the questions you should ask yourself before you believe the “hype” about the new wonder drug. Each question has a little graphic that is a warning, together with the issue that may arise. This is followed by more details to help you assess whether there is an issue. 1. Does the story adequately discuss the costs of the intervention? Health care isn’t free. News stories don’t help patients and consumers if they don’t tackle costs. When rating a story on this criterion, check whether the story discusses the costs of the intervention, whether it’s a new device, medication, surgery, exercise fad, therapy or any of the myriad treatments being studied. It’s not good enough to say, “The cost is much lower than the invasive procedures.” What is that cost? How much lower? Also, do insurance policies typically cover the intervention? Might there be other expenses (psychologists, dietitians,
  • 2. required follow-up visits or tests, etc.) that increase the burden on patients? If they cannot be quantified, they should at least be mentioned. For early trials or preliminary research, it may be difficult to estimate costs of an experimental approach early in its development. But a news story can at least cite costs of existing alternatives. If the new approach is comparable to other approaches then the cost of the alternative methods could be cited. Bottom line: If it’s not too early to talk about benefits of a new intervention, it’s not too early to talk about costs. We also know that some interventions may cost more in the short term, and yet are cost-effective in the long term because they reduce the need for expensive care down the road. While these longer- term costs may be difficult or impossible to pin down, good stories make a reasonable attempt to discuss the implications. 2. Does the story adequately quantify the benefits of the treatment/test/procedure? New healthcare treatments should work well. When reading a story, people want to know: How effective is the intervention? Do the numbers back it up? News stories should explain what the researchers measured, in numerical terms. And to use absolute numbers whenever possible. Many news stories tell us how wonderful a new treatment, test, product
  • 3. or procedure may be. Few provide helpful numbers to back that up. Ideally, the story should also explain whether the findings make an actual difference in people’s lives. If a study says a new drug improved function by 30% in MS patients, what does that mean? How was that measured? What would an MS patient want to know? Also, research often isn’t about an actual improvement in health or quality of life, it’s instead centered around surrogate outcomes, such as changes in blood test scores, or tumor shrinkage. These endpoints can be useful for researchers (and biotech investors), but surrogate outcomes do not automatically equal living better or longer. Readers need to know that. If a story is about preclinical research like a mouse or monkey study, it must point out that researchers have no guarantee that the intervention will provide the same benefit to people. And, stories that rely too heavily on patient anecdotes may be unrepresentative of the true benefit. The same goes for unchallenged exaggerated quotes (“this is a real game- changer/breakthrough/cure” etc.), which can throw a story out of balance and overshadow the statistics. When a story is top heavy with personal stories, it makes it hard for readers to sustain their critical thinking when (if) they get to information that is quantitative. If you hear glowing patient
  • 4. anecdotes about how well something worked, always ask yourself if that was a representative example. 3. Does the story adequately explain/quantify the harms of the intervention? All healthcare interventions carry potential harms. When reading a news story about a new treatment, readers should find out what is known about the harms. When a story is about a treatment (new drug, surgery, therapy lifestyle change, etc) or screening test, is should include a discussion of harms and side effects, as well as any measured “adverse events” in a study. There are tradeoffs involved in any health care decision. No matter what you choose to do, you stand to gain something and you stand to lose something. All treatments have potential harms, side effects, and complications. Also, there is no such thing as a simple blood or screening test. They carry the risk of a false-positive or false-negative result, which can result in missed diagnosis or overtreatment, and anxiety. Ideally, stories discuss both frequency of side effects and severity of side effects, and discuss both major and minor side effects. What might be minor to one person could be major to another. Preliminary animal studies or otherwise early research: It’s also important to remember that we
  • 5. often have no idea what the true impact of a drug is until it’s been used in a large number of people (and not mice and not cells in a lab), so the story should point out that some harms may be unknown–especially when the research is far from ready for prime time. Many stories emphasize or exaggerate potential benefits while minimizing or completely ignoring potential harms. They may: • Fail to mention or quantify potential harms. • Fail to describe the severity of potential harms. • Fail to account for “minor” side effects that could have a significant impact on a patient’s life. • Rely too heavily on a patient anecdote about safety or on a researcher’s comment that an approach “appears to be safe” – without supporting data. 4. Does the story seem to grasp the quality of the evidence? Ideally, healthcare interventions are subjected to rigorous testing to prove they work. When reading about a new intervention, device or diagnostic tool, people should come away with a sense of how rigorous the evidence is for the intervention. The story should include enough details about the study and how it fits into the hierarchy of evidence. As in: Was it an animal study? An observational study? A small, safety trial? A large,
  • 6. randomized controlled trial? A meta-analysis or systematic review? A recommendation from a task force that reviews evidence? And regardless the type of evidence, what was the quality of the evidence? Not all studies are equal. Not all evidence is bullet-proof. There is not a certainty or a finality to everything that appears in the New England Journal of Medicine or any other journal. And just because it’s a study – or just because it’s published somewhere – the story is not over. That’s not the way science works.Yet many stories: • Present anecdotes as evidence of a treatment’s benefits – rather than as a single illustration of its use. • Leave out study limitations – even though all studies carry limitations. • Fail to caution readers about interpretation of uncontrolled data. • Fail to explain if a primary outcome is a surrogate marker1 or fail to caution readers/viewers about extrapolating this to health outcomes. • Fail to point out the limited peer review that may have taken place with findings presented at a scientific meeting. • Conflate causation and association – failing to explain limitations of observational studies. • Get caught up in reporting on the latest study without reporting on larger, better-designed studies that have been done already.
  • 7. 1 An indirect indicator of a disease state or of its response to therapy. Such markers often include laboratory tests thought to represent clinical progress accurately. For example, in diabetes mellitus, the glycosylated hemoglobin level is used as a marker of glycemic control; in AIDS the level of HIV RNA is used as a marker of disease progression. Questions to ask: • What are the limitations of the evidence? • Was the study done in only a few people? • Was the study done for only a short time? What might happen long-term? Will there be follow- up? • Did the study report on an outcome that you really care about – like illness or death? Or did it only report on test results, markers, or scores? • Did this information come from a talk presented at a scientific meeting? If so, you should know this kind of research is often considered preliminary because other experts haven’t had a chance to thoroughly review it. • Were the findings from an animal or lab experiment that might not be applicable to human health? • Did the information simply present anecdotes as evidence of a
  • 8. treatment’s harms or benefits – rather than real numbers from the entire study group? 5. Does the story commit disease-mongering? Sometimes new conditions or diseases actually may just be opportunities to medicalize (and monetize) normal states of health. Readers aren’t well-served by stories that exaggerate or oversell conditions. There are different forms of “mongering,” including: • turning risk factors into diseases, with the implication that, then, these must be treated (e.g., low bone mineral density becomes osteoporosis); • misrepresentation of the natural history and/or severity of a disease (e.g., early-stage low-grade prostate cancer); • medicalization of minor or transient variations in function (e.g. temporary erectile dysfunction); • medicalization of normal states (aging, baldness, wrinkles, shyness, menopause); • exaggeration of how common a disorder is (e.g., using rating scales to ‘diagnose’ chronic dry eye; see “not satisfactory” story examples below). Identifying disease mongering is a matter of judgment. Sometimes it is obvious. Sometimes there’s a fine line about whether an article on irritable bowel disorder, erectile dysfunction, restless leg syndrome or osteoporosis (all of which can be serious for some
  • 9. sufferers) is misrepresenting the condition to the public. Note: Most of the conditions we list are not life-threatening. The grand-daddy of disease-mongering is fixating on LDL cholesterol numbers instead of evaluating whether studies showed a change in how well or how long people live–and whether treatment results in fewer cases of heart disease or fewer deaths. Beware of statistics that may inflate the seriousness of a condition. Beware of articles that exaggerate the human consequences of a condition – “millions of us are suffering in silence with toenail fungus.” Suffering? Beware of interviews with “worst- case” patients – holding such patients up as examples as if their experiences were representative of all with this condition. The story should discuss the prevalence of the condition under discussion–and if that prevalence could possibly be inflated. 6. Does the story use independent sources and identify conflicts of interest? Health care is rife with conflicts of interest. Readers deserve to know if the sources in the story have any conflicts of interest. They also deserve to hear the opinion of objective, independent third-party experts, who are vital to backstopping exaggerated claims.
  • 10. Conflicts of interest are common among people making claims about new treatments, tests, products or procedures. Examples include: • A trial paid for by the drug manufacturer. • Researchers employed by or getting fees from a drug company. • A spokesman for a device manufacturer. • Doctors who are early adopters and true believers in a new device. • An inventor or researcher who is seeking patents. All of these people want their product or their idea to look as good as it can. News stories should identify the source of the story (news release, journal article, editorial, scientific meeting presentation, etc.) and explain how likely that source is to be conflicted (e.g., a PR consultant working for the company said; or Dr. Smith, who received a company grant to perform the study, said…) They also must include the input of a trusted independent source with expertise on the subject to comment on the claims made. (Ideally, more than one such independent source would be used). But often stories only have one source, and it’s someone with “a dog in the hunt.” 7. Does the story compare the new approach with existing alternatives? Just because something is “new” in health care
  • 11. doesn’t mean it’s better. When reading about a new drug, test, surgery, etc., readers should come away informed that there are other options on the table. Journalists want to cover what’s new. But without a discussion of alternatives, readers can come away with the impression that the new option is the only good option. Therefore, the new intervention or finding must be put in context with existing alternatives that have a longer, more proven track record. Alternatives to an intervention can mean lifestyle changes, another drug, surgery, no treatment, or “active surveillance” – declining immediate aggressive therapy while remaining under close medical care. A good article contains a brief discussion of the other treatments on the table, and how they compare in effectiveness and cost. Stories may get rated ‘Not Satisfactory’ if they: • Discuss a surgical approach without mentioning non-surgical alternative approaches. • Discuss a new test without mentioning other tests that are available; including the option of not being screened in the case of a screening test. • Fail to discuss the advantages/disadvantages of the new idea compared with existing approaches. • Fail to discuss how the new treatment, test, product or procedure fits into the realm of existing
  • 12. alternatives. 8. Does the story establish the availability of the treatment/test/product/procedure? New medical treatments often get lots of attention before they’re ever made available to the public. After reading a story about a new intervention, a person should be able to answer: Is it actually available to me? Sometimes news stories report on things as if they were available at the corner drug store (or doctor’s office), when, in fact, they may be years away from even coming on the market. There may be a lot of marketing hype that suggests that something is well- studied and ready for use–this hype is good for stock prices, but not patients. Whenever you hear a prediction about something “expected to be approved by the FDA” in a certain time period, take it with a grain of salt. It doesn’t get approved until it gets approved, and there may be many steps left in the approval process. Ignore crystal ball predictions; they usually come from someone who stands to benefit. It’s also important to know that “approved” medical devices in the U.S. may not be safe or effective. Another issue to be aware of is that something might be approved in Europe, but not in the U.S. That should raise questions about why it hasn’t been submitted for approval in the U.S. yet, or why it hasn’t gained approval yet. If it’s already approved in the U.S.,
  • 13. or doesn’t need to be approved (such as a new surgical method or a new type of exercise equipment), it’s usually not enough to just say the intervention is “available.” For example, if it’s a type of heart surgery, do patients have to travel to specific hospitals that offer that surgery? If it’s a new fitness fad, is it only available in trendy gyms in Manhattan? If it’s a new drug, will it immediately be stocked on pharmacy shelves? 9. Does the story establish the true novelty of the approach? Often something that’s lauded as new or novel really isn’t. Or it may be new, but it’s not better. So, when reading about a “new” medical intervention, people deserve to know: What is truly new and different about this idea? Drug companies (and device-makers) are very good at promoting their new drugs or products as “novel” to increase initial sales. Yet many “new” treatments, tests, products or procedures are not really novel. A “new” drug may be another member of a well- established therapeutic class of drugs. And even if a drug is the first in a new class of drugs it may offer no more benefit than the drugs that are widely available. By focusing on one new idea, it may appear that it’s the only thing being researched in the field. Putting this in context of past research helps keep hype in check. That backstory can be hard to find
  • 14. unless the reporter finds a truly independent expert. We repeat: Newer isn’t always better in health care. And it may not really even be newer. Stories should establish just how novel the new thing is. Resources for establishing novelty: • Clinicaltrials.gov can provide information about other studies that are underway about a specific treatment or for a particular condition. It can be useful for providing context about something seemingly innovative. • With PubMed, you can put in a key word or two and pretty quickly establish whether something is absolutely unique and if not – how long it’s been around and studied. 10. Does the story appear to rely solely or largely on a news release? Sometimes news stories rely solely or largely on a PR news release–and never disclose that the information came from a news release. Readers deserve to know if a story includes no original reporting. With many news organizations facing tough economic times, financial pressures may lead some newsrooms to become more open to using news releases as a way to publish content while cutting costs. News releases can be valid sources of some information. But journalism is charged with the
  • 15. task of independently vetting claims. Therefore, it is unacceptable to rely on a news release as the sole source of information–and to not disclose that. The Great Shutdown : How COVID-19 changed the world economy Having good [email protected] financial [email protected] with foreign countries and the IMF is crucial for any country. The IMF has always helped countries facing financial problems, especially during world financial crisis such as the 2008 housing crisis, Greek bankruptcy and the most recent market crash because of the COVID-19 pandemic that the world was faced with. With this research paper, I am to study and report on the various challenges that many countries faced such as a health crisis, financial crisis and a collapse in commodity prices. The IMF and policymakers were faced with the challenge of providing the world with unprecedented
  • 16. support to not only households and small business but even large [email protected] and financial markets in order to shape and mold the markets to be prepared when the world opened up aOer the global lockdown. The global lockdown restricted travel, businesses world wideworldwide, the healthcare system was overworked and overloaded with [email protected][email protected] and a disease the world had never seen before. Many believed that the great lockdown caused an economic recession worse than the Great Depression and much more worse than the global financial crisis. In March when the COVID19 disease was declared as a global pandemic, the projected global growth fell downfell to – 3%. [email protected] showed the combined loss to global GDP would be somewhere around the 9 trillion dollar mark. Countries that were heavily dependent on tourism and travel expected massive [email protected]
  • 17. Developing economies and emerging markets were [email protected][email protected] growth rates for -1% for the year 2020. Countries like India and China were faced with more problems due to the high [email protected] in their countries. As the world went into lockdown, policymakers started to take [email protected] on large, @mely and targeted fiscal, financial and monetary policies. These policies included credit guarantees, liquidity [email protected], laon forbearance ,forbearance, expanded unemployment insurance, tax reliefs and [email protected] payments. These policies enabled small business and households to [email protected] to pass the lockdown. These measures ensured that there were less job losses due to the pandemic. The above listed measures and policies are a small part of the reopening phase of the lockdown, however it played a vital role in ensuring
  • 18. economic stability post lockdown. In my research paper I want to focus on what these policies were, how each one impacted what industry, country and lastly how it helped the world recover from the financial crisis. The COVID-19 pandemic was different from all the other past economic downturns and trigger. The pandemic triggered [email protected], shortage of labor, [email protected], lockdowns and social distancing across the world. All business and movement was halted apart from [email protected] [email protected]@es. These measures were put in place in order to minimize the spread of the virus amongst the public. With workplaces being closed, supply chain and [email protected] was disrupted. Layoffs, incomes declines and heightened uncertainty made people more [email protected] than ever. On the other hand, medical expenses were at an all @[email protected] high with healthcare equipment manufacturers running factories over @me. Rising unemployment triggered widespread default on credit card payments and loans. Lenders were faced with the difficult
  • 19. decision to hold back credit for firms and individuals. Policymakers and governments were kicked into overdrive in order to draw up a plan that would provide a roadmap for countries, industries and small businesses to ride the pandemic and sustain through it to be able to resume businesses once the pandemic had passed. To come up with strategies, policymakers looked at previous economic downturns to get [email protected] on how to overcome this downfall. In response to the pandemic, advanced economies [email protected] [email protected] fiscal and monetary policy support measures. These measures were believed to be far greater as compared to the ones taken in response to the global financial crisis in 2008. While these measures were being planned and put into [email protected], there was [email protected] a great amount of uncertainty revolving around the pandemic, which
  • 20. added [email protected] pressure on policymakers to be prepared to implement even larger measures in the months to come. (Gopinath, n.d.) (Gopinath, n.d.) As [email protected] above, there was a high level of uncertainty revolving around the pandemic, there were significant upside as well as downside risks to the outlook of the pandemic. The upside being vaccine trialsshowing progress, treatments ge_ng be`er and more policy support that would lead to quicker [email protected] of economic [email protected]@es. However, there were newer variants of the virus showing up around the world that would trigger more waves of [email protected] and @ghten financial [email protected] with people spending more on healthcare. With a crisis like no other, it was expected that there will be a recovery like no other. As countries would reopen, it was expected that the pick uppickup in [email protected]@es would be staggered
  • 21. and uneven. Demand for retail products would be high with demand with backed up orders whereas travel and hospitality business would remain at all @[email protected] lows. Countries that were heavily dependent on tourism would face serious financial problems and would lead to increasing poverty. [email protected] policy support proved to be crucial in advanced economies and to a lesser extent for emerging and developing economies that were more constrained by fiscal space. During the course of the pandemic the global fiscal support reached $10 trillion and monetary policy had eased [email protected] with interest rate cuts, liquidity [email protected] and asset purchases. These measures ensured that small livelihoods and small businesses sustained and at the same @me larger [email protected] avoided bankruptcies, this helped reduce long [email protected]
  • 22. damages to the economy. In countries that were being severely contained by the pandemic and went into lockdown such as India, people that were directly impacted should receive income support through unemployment insurance, wage subsidies and cash transfers. Firms that are impacted by the pandemic should be supported with tax deferrals, loans and grants. Right before the pandemic hit, countries like India had given tremendous importance to [email protected]@on and digital banking. This proved to be crucial to reach the unemployed. Policy support was expected to shiO formfrom being targeted to being more broad based, wherein the fiscal space would permit countries to taken green public investments and accelerate the recovery process while [email protected] climate goals. During the pandemic, [email protected] levels were at all @[email protected] lows with factories and transport being halted. Along with the long termlong-term challenges that policymakers faced,
  • 23. a medium term challenge that needed to be addressed was public debt. (Gopinath, n.d.) Public debt was projected to reach all @[email protected] highs in [email protected] to GDP in advanced as well as emerging and developing economies. Countries would need strong fiscal frameworks for medium term [email protected], cut down on wasteful spending, widening tax bases and minimizing tax avoidance. In response to the 2008 crisis, policy rates were reduced by an average of 3 percent by the central banks in advanced economies. Governments on a average deployed expansionary fiscal [email protected] with primary balances to the GDP declining by an average of 4 percentage. Alongside these [email protected], the central banks deployed [email protected] monetary policy tools, large
  • 24. scale financial asset purchases and [email protected] interest rates. It is believed that these policies helped the economy avoid an even deeper slump. The IMF projected a deeper recession in 2020 and an even slower recovery in 2021. It was expected that the global output will experience a decline of 4.9% in 2020 and would be below by 1.9 percentage points as compared to the [email protected] made by the IMF for April. One of the key moves taken by policy makers was to deliver [email protected] to liO aggregate demand in the market. Fiscal [email protected] such as a [email protected] point to powerful effects of fiscal [email protected] when normal interest rates are at an [email protected] lower bound or monetary policy is [email protected] The size of fiscal [email protected] varies on how it is delivered. A meta-analysis of the vast literature on fiscal [email protected] points to average [email protected] for public spending on goods and services.
  • 25. [email protected] are expected to be higher when leakages from the economy are low and contained or when the monetary policy is [email protected] Bibliography (Gopinath, n.d.) CBS News: Same-day hip replacements summary This article summarizes information about hip replacement surgery where patients go home on the same day. Mentions more than 300,000 hip replacement procedures done annually. NYU Langone Medical Center claims to be the first academic medical center in New York City to implement a same-day hip replacement program in 2015. The article gives a brief description of some of the options for hip replacement surgery as well as some of the risks of the surgery. Mentions research done by the American Academy of Orthopaedic surgeons showing “no significant differences” between surgical approaches relative to recovery outcomes six- months after surgery. Be sure to include any statistics or data given in the report. 2 Criticisms
  • 26. No discussion of costs of the treatment. No discussion of benefits of the treatment. Minimal discussion of evidence. Only one study cited, red flag. Are there other studies? Does not compare with existing alternatives. Only refers to a single procedure and the length of stay in the hospital. No discussion of costs, information which is easily available. Although going home the “same day” seems to be important in the article, the overall benefits of the procedure itself are not discussed. Only mentions one study, does not refer to other studies that may show alternative outcomes. Report fails to say other treatments available for hip issues, only discusses the length of stay option. 3 ITEMS DONE WELL Story does NOT rely solely or largely on a news release. Includes original interviews and other reporting Story does NOT commit disease-mongering Hip problems are not exaggerated The story DOES adequately explain/quantify harms of the intervention. Mention of complications in first night after surgery The article includes original interviews and other reporting. The story does not exaggerate the extent of hip problems.
  • 27. The story includes warnings from a surgeon about complications in the first night of surgery. 4 GOING BEyoND THE REPORT (OPTIONAL) Does not use independent sources. One outside doctor noted, no other outside sources. Outside research discovered marketing campaign (no information in the article) Additional studies? Thorough literature review recommended when possible. Story does not provide links to sources. To truly critique a news reports, independent investigation through online searches, overall review of original source material (subject websites, press releases) is advised, although not required for this project. 5