Shannon Brownlee: All Publications, Events and Press

Critics at Dartmouth Assess Health Bills | New York Times

Cecille Isidro — Fri, 13 Nov 2009 12:20:00 -0500

In a recent blog post on the Web site of the policy journal Health Affairs, Dr. Wennberg, two other Darmouth researchers and the author Shannon Brownlee ...

Does the Vaccine Matter?

Erin Drankoski — Fri, 16 Oct 2009 08:05:00 -0400

Drive too fast along Red Lion Road, beside Philadelphia's Northeast Airport, and you will miss the low-rise cement building where the biotech company MedImmune has been quietly pumping out swine flu vaccine at about a million doses a week. Through the summer and fall, workers wearing protective gear that covered them from head to toe brewed up batches of live, genetically modified flu virus. Robots then injected tiny doses of virus-laden fluid into glass vials, which were mounted into nasal spritzers, labeled, and readied for shipment at the direction of the

Facts About Swine Flu | The Atlantic

Erin Drankoski — Wed, 14 Oct 2009 14:24:00 -0400

Shannon Brownlee and Jeanne Lenzer, the authors of the November 2009 story "Does the Vaccine Matter?", answer questions about H1N1 diagnosis and immunity. ... Original Article

Government Orders Columbia to Tell Patients 'True Nature' of Drug Study

Erin Drankoski — Wed, 07 Oct 2009 06:56:00 -0400

The man who would be known as Patient No. 1 emerged from routine open-heart surgery at Columbia University Medical Center in stable condition. Then he began to bleed uncontrollably. Surgeons rushed him back to the operating room to reopen his chest, but by the time they could stop the hemorrhaging, Patient No. 1 was barely breathing and in a coma.

On Aug. 15, 2000, shortly before he was discharged on his way to a nursing home, a physician wrote a terse final diagnosis in his chart: "Medical disaster."

Your Health Plan's "Dr. No" | Smartmoney.com

Cecille Isidro — Tue, 22 Sep 2009 05:16:00 -0400

“We're all headed for a health care train wreck if things don't change,” says Shannon Brownlee, senior fellow at the New America Foundation and author of ...

Health Debate Short on Evidence-Based Science

Erin Drankoski — Wed, 09 Sep 2009 11:56:00 -0400

The public's faith in President Barack Obama's plan for health care reform is fading. Proposals ranging from the public insurance option to reimbursing physicians for end-of-life counseling are mired in a debate that's as overheated as August temperatures. Even the seemingly self-evident idea that the nation has a moral duty to make sure all citizens have basic access to health care is up for grabs. But there's one aspect of health care reform that California voters support almost universally: better medical evidence.

America, Heal Thyself

Erin Drankoski — Mon, 24 Aug 2009 10:21:00 -0400

It's no secret that the United States has the most expensive health care system in the world. We spend nearly twice as much per person as do other developed countries for health outcomes that are no better and in some cases much worse. Moreover, the citizens of most other countries, including Canada and the U.K., who are routinely reviled by opponents of "socialized" medicine, express greater satisfaction with their health care systems than we do with ours.

What If The Problem Is Too Much Care? | Baltimore Sun

Cecille Isidro — Wed, 19 Aug 2009 02:24:00 -0400

... months after the needle biopsy incident, I read Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, by Annapolis author Shannon Brownlee. ...

Why Dollars Alone Won't Fix US Healthcare | New Scientist

Cecille Isidro — Wed, 29 Jul 2009 12:11:00 -0400

"When people understand, they're less likely to choose expensive, invasive procedures," says Shannon Brownlee of the New America Foundation a think tank ...

When Doctors Lose Patience | Washington Monthly

Cecille Isidro — Sat, 11 Jul 2009 14:57:00 -0400

As journalist Shannon Brownlee explains in her book Overtreated, this led to a change in the way insurance companies did business. ...

Reforming the US Healthcare System Must Start with Reducing Demand | Fort Worth Star Telegram

Cecille Isidro — Sat, 09 May 2009 19:29:00 -0400

Journalist Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, gives partial credit of overtreatment to Americans' blind faith in technology and science. About 34 percent agreed with the statement in a Harvard ...

File Under ‘Hodgepodge' | Newsweek

Cecille Isidro — Sat, 02 May 2009 15:02:00 -0400

"Whatever is done has to be accompanied by a whole series of other changes," says Shannon Brownlee, Schwartz senior fellow for the New America Foundation, which is in the forefront of studying this issue. "There are a whole series of good little ideas...

..."All doctors think they're practicing good medicine," says Len Nichols, director of the health-policy program at New America...

Cancer Screening: Doing More Harm than Good?

Erin Drankoski — Wed, 01 Apr 2009 16:35:00 -0400

Suzanne Bull always half expected that she'd get cancer. After all, she lived in Marin County, California, where breast cancer rates are among the highest in the country. Still, she was determined to do whatever she could to protect herself. She ate right and exercised, and every year, she went into San Francisco to get a mammogram.

Suicide-Linked Cymbalta Promoted for Minor Conditions | The Epoch Times

Cecille Isidro — Tue, 17 Mar 2009 18:32:00 -0400

But some, like Shannon Brownlee, author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” question the revenue-driven prescribathon. Should drugs “that may have a really serious side effect called suicide,” be used for simple knee ...

The Issues: Healthcare | The Atlantic Monthly

Cecille Isidro — Wed, 21 Jan 2009 10:58:00 -0500

SHANNON BROWNLEE: As somebody who was born and raised in Honolulu, and who went to the same school as our new president, I would imagine a lot of people in ...

CBO Says Health Care Overhaul Will Be Significant Challenge | CQPolitics.com

Communications — Thu, 18 Dec 2008 17:40:00 -0500

... impact on the trend in health care costs, provided that capacity is not increased,” said the study’s authors, John E. Wennberg and Shannon Brownlee. ...

Best Nonfiction Books of 2008 | Christian Science Monitor

Communications — Mon, 01 Dec 2008 10:00:00 -0500

Overtreated by Shannon Brownlee included in Christian Science Monintor's list of best nonfiction books this year.

Quote Christian Science Monitor: "Award-winning science journalist Shannon Brownlee analyzes another phase of the US healthcare crisis: patients who are overtreated."

Toxic Town

Cecille Isidro — Sun, 30 Nov 2008 18:01:00 -0500

Nancy Nichols made a deathbed promise to her sister that she would investigate the toxic history of their hometown, Waukegan, Ill., on the shore of Lake Michigan. A small town once known as the "Coho Capital of the World," Waukegan was a bucolic place for the girls to grow up, with happy summer days spent splashing in the lake. That was before the Environmental Protection Agency designated the town as the location of three separate Superfund sites. Beginning in the 1950s, the Outboard Marine Corporation, maker of Evinrude and Johnson boat motors, poured

5 Myths on Our Sick Health Care System

Cecille Isidro — Sun, 23 Nov 2008 12:19:00 -0500

With Congress ready to spend $700 billion to prop up the U.S. economy, enacting health-care reform may seem about as likely as the Dow hitting 10,000 again before the end of the year. But it may be more doable than you think, provided we dispel a few myths about how health care works and how much reform Americans are willing to stomach.

1. America has the best health care in the world.

Let's bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name. Life expectancy at birth? We rank near the bottom of countries in the Organization for Economic Cooperation and Development, just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments (gasp!) pay for the lion's share of health care. Infant mortality in the United States is 6.8 per 1,000 births, more than twice as high as in Japan, Norway and Sweden and worse than in Poland and Hungary. We're doing a better job than most on reducing smoking rates, but our obesity epidemic is out of control, our death rate from prostate cancer is only slightly lower than the United Kingdom's, and in at least one study, American heart attack patients did no better than Swedish patients, even though the Americans got twice as many high-tech treatments.

Moreover, the quality of health care is different in different parts of the country. The Centers for Medicare and Medicaid Services have issued a list of 26 measures of quality, such as making sure that heart-attack patients being discharged from the hospital get a prescription for a beta blocker or aspirin to help reduce the risk of a second attack. It turns out that quality is all over the map, and it isn't necessarily better in the places we might expect, such as academic medical centers. Worse still, according to the Congressional Budget Office (CBO), there appears to be no connection between how much Medicare and other payers spend on patients in different parts of the country and the quality of the care the patients receive. You are no more likely to get that beta blocker or aspirin in Los Angeles than in Portland, even though Medicare spends twice as much per beneficiary in Los Angeles.

2. Somebody else is paying for your health insurance.

Nope. Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.

Rising health-care costs are partly to blame for stagnant wages. Over the past five years, health insurance premiums have on average risen 5.5 times faster than inflation, 2.3 times faster than business income and four times faster than workers' earnings. Four times. That's why wages have been nearly flat since the 1980s, even as U.S. productivity has been going up. In effect, about half the money you should be earning for being more productive is being sucked up by ever more expensive health insurance premiums.

If you pay taxes, you're also paying for the health care provided through state and federal programs such as Medicare, Medicaid, the Veterans Administration and the military. All told, the average family of four is coughing up $29,000 a year for health care through taxes, lower wages and out-of-pocket medical expenses.

3. We would save a lot if we could cut the administrative waste of private insurance.

The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn't really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Following heart-attack or cancer patients to see which interventions work best is an administrative cost, but it's also invaluable if you want to improve care. Tracking the rate of heart attacks from drugs such as Avandia is key to ensuring safe pharmaceuticals.

Let's just say that we could wave a magic wand and cut private insurers' overhead by half, to what the Canadian government spends on administering its health-care system -- 15 percent. How much would we save? Not as much as you may think. Private insurers pay a little more than a third of what we spend on health care, which means that we'd cut a little more than 5 percent from our total budget, or about $124 billion. That's not peanuts, but it's not even enough to cover everybody who's currently uninsured.

More to the point, we only get to save it once. That's because administrative waste isn't what's driving health-care costs up faster than inflation. Most of the relentless rise can be attributed to the expansion of hospitals and other health-care sectors and the rapid adoption of expensive new technologies -- new drugs, devices, tests and procedures. Unfortunately, only a fraction of all that new stuff offers dramatically better outcomes. If we're worried about costs, we have to ask whether a $55,000 drug that prolongs the lives of lung cancer patients for an average of a few weeks is really worth it. Unless we find a cure for our addiction to the new but not necessarily improved, our national medical bill will continue to skyrocket, regardless of how efficient insurance companies become.

4. Health-care reform is going to cost a bundle.

Only if you think that covering the uninsured is our only priority. Yes, making health care available to all citizens is the right and ethical thing to do. But it isn't the only thing to do. We also have to fix the spectacularly wasteful and expensive way doctors and hospitals deliver care.

Our physicians are working within a truly dysfunctional, often chaotic system that prevents them from caring for us properly. Between 50,000 and 100,000 patients die each year from a preventable medical error. According to the Centers for Disease Control, 1.7 million Americans acquire an infection while in the hospital and nearly 100,000 of them die from it. Laboratory imaging tests are routinely repeated because the originals can't be found. Patients with such chronic illnesses as heart failure and diabetes land in the hospital because their physicians fail to monitor their condition. When patients have multiple doctors, there's often nobody keeping track of the different medications, tests and treatments each one prescribes.

Our doctors and hospitals are failing to provide us with care we need while delivering a staggering amount that we don't need. Current estimates suggest that as much as 20 to 30 percent of what we spend, or about $500 billion, goes toward useless, potentially harmful care.

There are two bright spots. One: We can improve the quality of care and cut costs without rationing. There are models out there for how to do it right -- the Mayo Clinic, the Geisinger Clinic in Pennsylvania, the Cleveland Clinic and California's Kaiser Permanente are just a few of the organized group practices that are doing a better job for less. Their doctors are better than average at using the best medical evidence available. They're more likely to be using electronic medical records, which can help keep track of patients who have multiple physicians and need complex care. And they're less likely to provide unnecessary care.

Two: Even moderate reform of the delivery system would improve care and save money. The Lewin Group's analysis shows that a bill proposed by Sen. Ron Wyden, an Oregon Democrat, calling for a more comprehensive overhaul of the health-care system than either McCain's plan or Obama's could actually insure everyone and save $1.4 trillion over 10 years. More reform is cheaper.

5. Americans aren't ready for a major overhaul of the health-care system.

We may be readier than you think. A recent study published in the New England Journal of Medicine found that only 7 percent of Americans rate our health-care system excellent. Nearly 40 percent consider it poor. A whopping 70 percent believe it needs major changes, if not a complete overhaul.

Now is not the time to think small, to cover a few million Americans and leave the bigger job of controlling costs and improving quality for another day. We can't afford not to reform the delivery system as soon as possible. At 17 percent of gross domestic product, health care is the biggest single sector of the economy, and it's consuming a larger and larger proportion every year. According to CBO projections, health care will account for 25 percent of GDP by 2025 and 49 percent by 2082. That's simply unsustainable. Any plan that reforms health care has to do more than simply cover the uninsured. The nation's health and wealth depend on it.

Doctors' Fees

Cecille Isidro — Fri, 21 Nov 2008 16:33:00 -0500

A few weeks ago, devoted listeners of National Public Radio were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.

We don't know just how much funding or when the show last received it, since neither Goodwin nor the show's producers responded to repeated requests for interviews. But the larger point is that undisclosed financial conflicts of interest among media sources seem to be popping up all over the place these days. Some experts who appear independent are, in fact, serving as stealth marketers for the drug and biotech industries, and reporters either don't know about their sources' conflicts of interests, or they fail to disclose them to the public.

Take the November 2006 NBC Nightly News story that asked, "Can lung scans really prevent cancer death?" Reporter Mike Taibbi, a former smoker, underwent scanning by Dr. Claudia Henschke, a professor of radiology at Weill Cornell Medical College in New York. Henschke claimed on the show that early detection with lung scans could prevent 80 percent of deaths from lung cancer. Although Taibbi included another expert who said that Henschke's claim was "outrageous," viewers were left with little way to evaluate the two conflicting viewpoints. And Taibbi himself concluded that early detection was his "best chance." At no point did viewers learn that Henschke's research was funded by a tobacco company, which has an investment in making the risks of smoking appear to be manageable--or that many experts warn that more research is needed to determine whether the potential benefits of scanning outweigh its harms.

How frequently are journalists glossing over such conflicts? Gary Schwitzer, a professor of journalism at the University of Minnesota, is the publisher of HealthNewsReview.org, a Web site that reviews health care news for balance, accuracy, and completeness. Schwitzer and his team of reviewers have looked at 544 stories from top outlets over the two-year period from April 2006 to April 2008. Journalists had to meet several criteria in order to receive a satisfactory score, among them: They had to quote an independent expert--someone not involved in the relevant research--and they had to make some attempt to report potential conflicts of interest. Half the stories failed to meet these two requirements, Schwitzer says.

Conflicts of interest abound even in unexpected places. A recent survey of academic medical centers published in the Journal of the American Medical Association found that 60 percent of academic department chairs have personal ties to industry--serving as consultants, board members, or paid speakers, while two-thirds of the academic departments had institutional ties to industry. Such ties can be extremely lucrative. And according to these articles in the medical literature, researchers who receive funding from drug and medical-device manufacturers are up to 3.5 times as likely to conclude their study drug or medical device works than are researchers without such funding.

An equally clever way for companies to get out their marketing messages is to go through a consumer group. Drug companies often seed "pharm teams," consumer groups that start out as legitimate advocacy organizations and are subtly manipulated by funding from pharmaceutical companies to convey the desired talking points. Unless reporters ask where groups and individual researchers get their money, they have no idea that their sources may be biased--and neither do their readers, viewers, and listeners.

Which brings us back to The Infinite Mind and "Prozac Nation: Revisited," a show that may stand in a class by itself for concealing bias. In addition to the show's unrestricted grants from Lilly, the host, Goodwin, is on the board of directors of Center for Medicine in the Public Interest, an industry-funded front, or "Astroturf" group, which receives a majority of its funding from drug companies. CMPI President Peter Pitts was one of Goodwin's three guests for "Prozac Nation." We don't know which companies fund his group because when we asked him, Pitts said, "I don't want to go into that." But CMPI took in more than $1.4 million in 2006 and, according to its tax forms, spent $210,000 to influence the media through a large conference, a blog the group maintains, op-eds published in major newspapers, and multimedia programs and podcasts. Pitts has another title that might have been relevant to The Infinite Mind; he is the senior vice president for global health affairs at the PR firm Manning Selvage & Lee, which represents Eli Lilly Inc., GlaxoSmithKline, Pfizer, and more than a dozen other pharmaceutical companies. Yet on the show, Pitts was identified only by his title as "a former FDA official."

The second guest on "Prozac Nation," Andrew F. Leuchter, is a professor of psychiatry at UCLA who has received research money from drug companies including Eli Lilly Inc., Pfizer, and Novartis. The third guest, Nada Stotland, president-elect of the American Psychiatric Association, has served on the speakers' bureaus of GlaxoSmithKline and Pfizer. None of Leuchter and Stotland's ties to industry was revealed to listeners--instead, each was introduced as a prominent academic.

The Infinite Mind's Web site states, "Our independence is perhaps our greatest asset." Perhaps, indeed. Neither Goodwin nor the show's producers responded to our repeated requests for interviews and queries about their funding. Pitts, who to his credit did give us an interview, said he didn't know why his ties to industry weren't revealed on the show. Curious, we tried to learn more about the funding for The Infinite Mind--and could discover only that the show's award-winning production company, Lichtenstein Creative Media, was dissolved by the state of Massachusetts on March 28 for failing to file a single annual report since its establishment in 2004.

Some reporters and producers argue that they can't be expected to ask every source whether he or she gets money from the drug industry. But there are obvious first steps to take. A list of academic researchers who are known to have financial ties to the drug and medical-device industries is available through the Center for Science in the Public Interest. (Yes, the name is a lot like the Astroturf group we mentioned earlier--coincidence?) To be fair, the list is inevitably incomplete, and Astroturf groups and academics with undeclared financial ties can make it difficult to ferret out their financial conflicts.

In hopes of making reporters' jobs a little easier, we've created for journalists an international list of prestigious and independent medical experts who declare they have no financial ties to drug and device manufacturers for at least the past five years. We have nearly 100 experts from a wide array of disciplines.