Fundamentals of Interactive Journalism

Before I took up reporting, I spent a lot of time thinking about what goes on in the unsourceable confines of our individual brains.

For a generation of psychologists, neuroscientists and philosophers of mind, one man had more influence on our understanding of the human mind than anyone else.  And most of us never knew his name.

H.M. died yesterday, and the initials with which the scientific community respectfully – and affectionately – maintained his privacy are no longer required.  they might stay in use for a while, though.  Patient H.M. was a research subject for over fifty years, and old nicknames can be hard to shake.

H.M.’s amnesia was the opposite of the amnesia in daytime soaps.  He knew the name the textbooks always concealed.  He could tell stories and ask after people from the life he lived before the experimental brain surgery he underwent as a young man.  After that surgery, for the rest of his 82 years, he never formed a memory of another event.  He could carry on a conversation until you left the room; if you came back in, he had no idea you’d ever met.  It’s like that folk trivia about goldfish, only in a person, not a fish.

What’s amazing, though, is that though he didn’t remember events or names, he did remember.  He recognized the patterns, voices and feelings of his post-surgery life, he just never knew where he recognized them from.   I’ve heard his experience compared to a permanent state of déjà vu.

He must have known the spaces around M.I.T. where he lived out his life like the back of his hand.  He must have learned, without knowing when he learned it, to accept acting on knowledge he couldn’t explain.

In one study he solved the same puzzle repeatedly over subsequent days. (The Tower of Hanoi – it’s similar to Heather’s frogs.)  He found the solution faster every day until he had the steps memorized.  But he still approached each attempt unsure if he’d be able to figure it out.

Studying H.M. was a career-long commitment.  He knew which researchers he liked and which he didn’t, and would confidently state made-up histories explaining how he knew the people he considered his friends. Those scientists must be experiencing a unique and complicated feeling of loss.

There have been other cases of amnesia like H.M.’s, but it’s usually brought about by alcoholism or an infection that visits indiscriminate damage around the brain.  H.M. was removed from the stream of time with a surgeon’s scalpel – personality and crossword puzzle fondness intact.

The Times’ obit is here. This is good if you like your history of science from primary sources. If you’re really intrigued you can put this book on your list.  The next few days will surely produce some thoughtful eulogies from the people who think hardest about thought.

Memory research – and, by definition, H.M. – haven’t been part of my life for years. Reminded of him now, there’s something comforting in his bittersweet story.   We all do the most amazing things without knowing what’s going on.

A recent survey published in Archives of General Psychiatry claims that 1 in 5 young people have personality disorders that interfere with their lives – including substance abuse, as well as obsessive, compulsive or anti-social behaviors – but only 25% actively seek treatment for them.

Though the study divided students and non-students, it found similar data between the two groups. Substance abuse was the most common disorder, though college students had higher alcohol abuse (20% vs. 17%), while drug abuse was higher among non-students (7% vs. 5%).

One noticeable different between the two groups found that obsessive-compulsive disorders and tendencies were at a higher rate for college students.

The study showed that while 8% of young people who participated in the study had OCD, the rate moved up to 12% among students. Researchers cited the recent mass murders at Virginia Tech and Northern Illinois University as evidence that mental health is a major issue on college campuses that should be properly addressed.

The study analyzed 5,000 young people between 19 and 25 through live interviews (it received praise for being extensive).

The New York State Medicaid Fraud Unit had a productive 2007. But, have the crackdowns effected legitimate service providers as well?

When dealing with Medicaid fraud, it seems that the rule is guilty until proven innocent.

A new campaign designed to root out and prevent Medicaid fraud now makes filing claims laborious for many law-abiding service providers, they complain.  One service provider believes the problem stems from the State’s lack of consideration for life’s great wild card.

“To be human is to be imperfect,” said Hannah Achtenberg Kinn, CEO of the League Treatment Center.  “The fact that they consider human error fraud is terribly unfair and intimidating.”

The problem dates back to 2006, when New York City hired 50 new special investigators and auditors.  This resulted in a windfall of convictions and restitution totaling $112.5 million gained through the State’s Medicaid Fraud Unit, the State Attorney General’s long arm of Medicaid law.

But, with good intentions also came strict regulations in filing procedures.  For example, if a Medicaid biller makes a minor mistake in procedure, the claim is voided in fear of fraud.  In order to regain funding for a particular claim, it requires a strict and thorough review.

“It’s horrific,” said Kinn.  “If they had this level of policing at Lehman Brothers, they wouldn’t have lost their billions.”

According to a 2007 official report, the Medicaid Fraud Unit completed a total of 383 investigations, of which 330 involved provider fraud. The Unit obtained a total of 104 convictions and has an overall conviction rating of 97%.

The League Treatment Center, under the protective umbrella of the state’s mental health agencies, provides “an alternative to institutionalization for children and adults with autism and severe developmental disabilities.”  The Center, servicing 500 adults and school age children, undergoes annual fiscal audits and operational reviews by numerous federal, state and city agencies.  The results of those audits filter back to those policing Medicaid fraud.

According to Kinn, state agencies audit her organization frequently and they often extract the same sets of fiscal and operational data.  Kinn said many of these audits overlap in their scope and are examples of the “duplication of duplication of auditing.”

She also said that these policing agencies should work in tandem, not separately, in order to increase their effectiveness.  In turn, she feels this will weed out fraud without hurting honest service providers.

Matt Glazer, a representative of the Office of New York State’s Attorney General, would not comment on his office’s policy on Medicaid policing.   Instead, he referred to the Office’s website, where it states, “The Medicaid Fraud Unit investigates and/or prosecutes Medicaid recipient fraud only in conjunction with provider fraud investigations and prosecutions.”  He was unavailable for further comment.

The Office of the State Attorney General encourges people with information on Medicaid violations to report it to their office. They do not employ the use of this image on their website, though.

Jill Daniels of the Office of Mental Health, one of the agencies involved in the statewide policing process, said her office’s investigations act as a way to check if a program is operated correctly. She could not comment on the difficulties of the Medicaid claim process itself, but noted the “necessity of operational reviews” in monitoring agencies.  Daniels’ records showed that the Center “never failed an audit or operational review yet.”

While Kinn and her employees welcome the scrutiny, she wants the focus to remain on the non-profit organization’s main objective.

“Leave us to help the children,” said Kinn.  “This is a circular game.  They should give out the money they use to duplicate auditing so we can serve the children.”

Georgie Kovacs tries to live healthy. The thirty-four-year-old works out five to six times a week in midtown. She also recently started paying more attention to what she eats.

“I am trying to be much more aware of what the calories are in foods,” Georgie said. “Sometimes it is hard to tell what the calories are in foods and we might make assumptions.”

But since July, Georgie and other consumers don’t always have to guess. The New York City Health Department began enforcing a regulation requiring chain restaurants with more than fifteen locations to post calorie information on their menu boards. The regulation is part of an effort by the city to curb the nationwide obesity epidemic.

“We like to think of New Yorkers needing 1,800 calories a day,” said Arlene Sparks, a nutrition professor at Hunter College.

Health Department surveys found people consume one hundred fewer calories per meal when they have access to calorie information. The department estimates this could reduce the number of obese people by one hundred and fifty thousand in the next five years, and prevent thirty thousand cases of diabetes.

“What we do know is there’s a lot of obesity in New York and certainly other places as well,” Sparks said. “Health-wise probably the first problem is diabetes.”

If you’re headed south of the border during the holidays this year, and you’re a poor, uninsured student, you may want to pair your pleasure with some pain, or at least some novocaine. Did you know that you can go on a Mexican Dental Vacation?

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Last Saturday (Nov. 15), 12-year-old Motl Brody Brooklyn, N.Y, died of brain cancer. That was the second time he was pronounced dead, the first being on Nov. 2, when doctors at his Washington D.C. hospital ran a series of brain tests and found no brain activity. However, Brody’s parents – in consultation with their rabbi – argued that according to their religious doctrine, the cessation of heart and lung activity determines death, not just that of the brain. The controversy erupted when the hospital filed a court order to discontinue life support and the family filed one to keep their son on life support. Click here to read more about the case.

Dr. Michael J. Green, physician and bioethicist, said the issue is not a new one. He explained that brain death, where the brain registers no activity, differs from cardiovascular and circulatory death, where the heart and lungs stop beating. In general, brain death is “widely accepted, but not universally accepted” as total death in the US, Green said. However, some states have statutes requiring healthcare facilities to respect the religious beliefs of patients’ families.

Confusion arises, Green said, in cases like Brody’s, because the situation is one where brain death is death “unless someone disagrees with it based on religion.” Specifically, people might not understand if patients like  are “only really dead the second time or are they dead the first time? And does it depend where they live?” (referring to states where the hospital cedes to the family’s wishes).

For the most part, healthcare centers tend to wait to avoid problems because full death usually occurs within a week of brain death. But there are instances when individuals live longer, and healthcare providers in such cases feel that the “person is dead and you’re forcing us to treat a corpse, to put it bluntly,” Green said.

And especially because the cost of life support is extremely high, and healthcare costs are very much on the nation’s radar, the controversy is likely to become more widespread.

Taken by Henry Cool Pics on Flickr

On Tuesday’s morning edition of “The Today Show”, host Matt Lauer interviewed former Victoria Secrets model and current TV show mogul,Tyra Banks on a survey her show conducted during this summer to over 10,000 teenage girls and young women.

“Tyra Banks good morning and Wow” were the first words Lauer said. “I’m a parent of three little kids and my jaw dropped….What surprised you the most?”

Tyra explained that finding out how honest the girls were in their answers because the survey was anonymous, surprised her the most.

The survey itself was composed of questions centering on “sexuality, sexually transmitted diseases and teen pregnancy, as well as drinking, drugs and violence among females.” (excerpt taken from Today Show contributor Laura T. Coffey report on the story.)

Here are some of the statistics from the study:

• On average, girls are losing their virginity at 15 years of age.
• 14 percent of teens who are having sex say they’re doing it at school.
• 52 percent of survey respondents say they do not use protection when having sex.
• One in three says she fears having a sexually transmitted disease.

Just viewing some of the clips that was provided to Today’s viewers showed one 16-year-old girl wearing a green jacket who smirked when she told Tyra she had nine lovers since losing her virginity at age 13.

Click here to view the Today Show video in its entirety

In addition to the video, an article was accompanied to provide more description of the survey and statistics. (http://today.msnbc.msn.com/id/27706917/?GT1=43001)

And an interactive map: http://today.msnbc.msn.com/id/27285583/

NYC STATS

“About 1 in 3 youth are currently sexually active”

Last year in August, the New York City Department of Health and Mental Hygiene issued its sixth volume of “NYC Vital Signs”, focusing on”Teen Sexual Activity and Birth Control Use in New York City”.

Statistics was provided by the New York City Youth Risk Behavior Survey.

Knowledge of emergency contraception varies by gender and borough

*Youth in Manhattan (55%) and Staten Island

(54%) are more likely to report knowledge of

EC than youth in Queens (41%) and the Bronx (43%).

*Youth in East and Central Harlem more

commonly report having heard of EC than youth

in North and Central Brooklyn (59% vs. 37%).

The show will be airing this Friday…check for local listings.

I just read about an interesting development by Google.  Based on people’s Google searches for terms like “flu” and “flu symptoms,” google.org/flutrends has interactive maps and charts that detect where flu outbreaks are occurring, practically in real time.

In a New York Times article published today:

Tests of the new Web tool from Google.org, the company’s philanthropic unit, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention.

Last February, Google recorded a spike in flu cases days before the CDC had information.  According to today’s Google Flu Trends, New York state is currently experiencing low flu activity.

I’m curious about the accuracy of the Google statistics.  How can computer software detect whether a person searching “flu symptoms” is in fact ill, or just a curious school kid writing a report about the flu.  Or, if the person is indeed ill, how can a computer system know that the person actually has the flu, not a common cold?

CDC maps of flu trends take more time to report because they rely on data from health care providers and hospitals who have seen and diagnosed patients with the flu.

Even though I’m skeptical, Google seems to have been accurate so far.

The premise behind Google Flu Trends — what appears to be a fruitful marriage of mob behavior and medicine — has been validated by an unrelated study indicating that the data collected by Yahoo, Google’s main rival in Internet search, can also help with early detection of the flu.

“In theory, we could use this stream of information to learn about other disease trends as well,” said Dr. Philip M. Polgreen, assistant professor of medicine and epidemiology at theUniversity of Iowa and an author of the study based on Yahoo’s data.

I’d be interested to see if Google’s accuracy can handle the increased cases that will come with the height of flu season.

Google explains its methodology on its website, but it seems rather quaint and unscientific to me.  Still, their information could reach more people and prove more beneficial.  The CDC’s weekly flu reports are packed with numbers, charts and medical terms that are difficult to parse.  Google presents its information in plain language and in an easy-to-navigate format.

Perhaps this is just where popular medicine is headed.  After all, I know I can’t be the only one who self-diagnoses based on WebMD.

Jerry Adler, senior editor at Newsweek wrote an article this week, suggesting that Americans are smarter now than they were fifty years ago. He bases this on a look at ads from the early to mid twentieth century, that have doctors, athletes, and celebrities endorsing cigarettes and ensuring consumers that smoking doesn’t affect their health.  Sure that sort of advertising wouldn’t fly today, since I think it’s safe to say the “smoking is harmless” myth has been busted. But if we’re going to use advertisements as a measurement of the nation’s intelligence, let’s consider a few things before we start throwing the smart word around:

Google the words “celebrity diet,” and over half a million links will appear. And I’m willing to bet that a decade from now, many of these “super-safe” perhaps even FDA approved diets will be linked with some medical problem or another. And everyone will be shocked, and endorsers will say, “I had no idea!”

Or watch tv for an hour. Any hour. Any station, and check out the ads. McDonald’s sounds healthy. Medications sound safe and effective. Vacations sound affordable. Advertisers are still doing their jobs–pushing their products until facts emerge and consumers call their bluff and get “7 on their side” for being duped. It’s the same ol’ story…

The New York Times recently published an analysis of the health care proposals of both candidates.  It points out that Senator McCain’s proposal would cost more in the short run and potentially cost more in the long run, and would likely reduce the number of insured Americans, rather than increase it.

I, for one, find most economic debates deadly dull and opaque without analogies that illustrate the concept being discussed.  So I sat with myself and tried to find an aspect of my life that might be analogous to health care, and eventually I decided on wine. (more…)