In his weekly “Stories I’d Like to See” column, journalist and entrepreneur Steven Brill spotlights topics that, in his opinion, have received insufficient media attention. This article was originally published on Reuters.com.
1. Who gives out hearts?
In exploring whether former vice-president Cheney might have received preferential treatment when he got a heart transplant recently, many of the reporters covering the story referred to what The New York Times called “a national system that tracks donors and recipients by medical criteria.” Two doctors were then quoted as saying, as one put it: “It is not possible to game the system.”
Fair enough, but who runs the system? Who sets the criteria, and who signs off on who has met the criteria? Who decides close calls? Is there a form that gets signed by a majority of some committee, or is there one king of hearts? And are actual names attached to the patients, so that whoever was making the decision could have seen that Vice-President Cheney was an applicant for the heart in question?
Because transplants are done urgently once a donor becomes available—often after his or her sudden death in an accident, when apparently there are only hours to spare before the heart is no longer viable—is there some kind of operations center, where these decisions are signed off on and coordinated? Can’t some reporter take us there and have us meet the people playing God?
A few days after the Cheney operation, The New York Times shed some light on how transplants of another type of organ—kidneys—are decided. The Times reported on a controversy brewing over whether to establish a single registry to oversee matching kidney donors with recipients. But I’d still like to see a story on who’s making these life-and-death decisions and how. Ditto liver transplants. And, again, not just the processes but the people in charge as well as those on the front lines.
As the science around these transplants continues to advance, and as more patients continue to live longer and seek new hearts, livers or kidneys because they have survived other maladies, the rules and the people involved in these decisions are only going to get that much more important.
2. CVS and privacy:
Often you can get a good story idea just by being in the right place at the right time.
Last Saturday morning, I picked up the phone at home only to hear the beginning of one of those annoying robocall pitches. But this one was a shocker. It wasn’t a pollster or a reminder of an auto maintenance appointment. It was the local CVS drugstore (at least I think it was the local outlet) asking me to press “1” if I was actually “John Smith” so that I could get information about a prescription that was scheduled for a refill. (The robo-voice used another name, which I’m not repeating here, but it was not my name or that of anyone in my family.) I assume that if I had then pressed “1”, the voice would have told me what drug I was scheduled to get more of. I am guessing Mr. Smith would rather that outsiders not know the medication he’s taking.
There are multiple paths for a reporter to pursue here, starting with the privacy issue. Something obviously went awry, since I am not John Smith but got his phone call and presumably could have then gotten the information related to his use of some drug just by pressing “1.” Is this true? What safeguards does CVS have in place, if any, to protect against that. Why did they apparently fail, and how often do they fail? How many complaints have they gotten? Have any regulatory authorities received any complaints? Does anything about CVS’s robo-calling violate the provisions of HIPAA, the federal law that is meant to ensure the privacy of healthcare records?
Then there’s the issue of drugstores pushing prescription refills on people who might not need them. Is this a good service because it reminds people to keep taking meds that a doctor has prescribed, or is it another case of healthcare giants unnecessarily adding to the nation’s soaring medical bill? Are there any laws or regulations about this?
Does CVS Caremark (the company’s formal name) now do this kind of robo-selling (or robo-reminding, depending on your point of view) across the country? And, since CVS Caremark is also paid by insurance companies to administer insurance claims for prescription drugs (that’s the Caremark half of the company), is this outbound sales effort a conflict, since the insurance companies would obviously rather that people not refill prescriptions that they then have to pay for? What do the insurance companies think about that? And what does CVS Caremark CEO Larry Merlo have to say about all this?