Language and Culture in Global Healthcare

Rodolfo Speaks Spanish, right??

2011-11-14T08:28:00.001-08:00

If you needed to have your appendix removed, would you ask the EMT that lives next door to take it out? Since she is your neighbor and already knows how to save lives, certainly she could handle the job. You could lay down on the kitchen table and let her take it out with a steak knife. It would certainly be cheaper than seeing a doctor and going to a hospital.

Would it be worth the money you save? No.

As a company in need of translating company communications into another language, why would you consider letting Rodolfo from the IT department translate your new Spanish brochure simply because he was born in Costa Rica?

Will in-house translation save you money? Sure.

Will it be worth it? No!

Someone who is multilingual and a professional translator are two entirely different animals. Translating is more than simply trading one word for another word in a different language. Translation involves the communication of equivalent meanings, contexts and intents from one language or culture to another.

Translating also involves communicating these meanings in a clear and concise manner. Rodolfo may be a native Spanish speaker but can he write well whether its in Spanish or English? A fifth grader may speak English well but would you hire one to write your next marketing brochure? Writing well is a learned and practiced skill.

Good professional translators have years of education in linguistics followed by years of experience translating. Translating source text about a subject with which you are unfamiliar is difficult at best and typically translators have advanced degrees in the field with which they work (healthcare, law, technology, etc.)

Even within a particular field, verbiage can vary widely and be highly unique. Building a relationship with a translation agency means they understand your business. Using up to date software they build glossaries around your business terminology so current and future materials for your business are consistent and correct. Over time these glossaries save you money on future translations.

Can Rodolfo guarantee you the same efficiency and quality? How about confidentiality?

Professional translators are worth the money. They save you time, frustration and communication blunders in the long run. Professional translators are highly qualified and trained to provide you with ethical, accurate and confidential translated materials your business requires.

(Sherry Dineen)

Bad News a Good Way?

2011-10-25T13:23:00.000-07:00

A recent study reported in Archives of Surgery looked at 44 general surgery residents who had received "communications training." Yup, this training was designed to help them improve the way they deliver bad news to their patients.

In the study, the doctors were assessed on how they delivered bad news, and on their communication skills in general. Then, they took the class and were subsequently reassessed. Turns out certain aspects of their delivery improved, but their general communication skills did not.

We suppose that doctors are supposed to know how to communicate. Apparently, this is not something that everyone can do. Now imagine if they are charged with communicating across culture and language? How low would they score?

(MARN)

The Times They Are A-Changin’

2011-08-25T06:12:00.000-07:00

by Bob Dylan

Come gather 'round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You'll be drenched to the bone
If your time to you
Is worth savin'
Then you better start swimmin'
Or you'll sink like a stone
For the times they are a-changin'.

As a nation we are in the middle of a cultural revolution. Can you feel it? The latest census figures are out and times really are changing.

According to the most recent census reports, women are becoming more educated (they now outnumber men in the number of doctoral degrees conferred), populations are shifting from rural and urban areas to the suburbs, and household size is increasing (mostly due to immigrant populations who are more likely to live in multi-generational homes.)

America is also aging and diversifying at a faster rate than anyone predicted.

According to the reports, the number of people age 85 and older (5.5 million) has doubled since 1990. While the older population increases, the younger population is dramatically diversifying.

According to a recent article on the front cover of USA Today, “One of the most significant demographic trends of the past 20 years is the explosive growth of Hispanics.” Half of the population growth in the United States over the past 20 years is from the 30 million person increase in the Hispanic population. One in six Americans is Hispanic.

“An entire Venezuela’s worth of Hispanics was added in just those two decades.” said Robert Lang, urban sociologist, University of Nevada, Las Vegas in the article.

This growth is not just found in traditionally considered high Hispanic population states like California and Florida. In 1990, North Carolina’s population contained only 1% Hispanics, in 2010, the census showed almost 7%. The Hispanic population in Illinois has doubled in the past 20 years going from 7.9% to 15.8%.

While black and white racial relations saturate our nation’s history, 2003 marked the first year Hispanics surpassed African American in population numbers.

After the census figures release in 2000 it was predicted 2050 would be the year our population shifted to less than half non-Hispanic White. That timeline has now shifted to 2042.

Part of this dramatic diversification rate is due to a higher than average birthrate for Hispanic women (2.9 versus the national average of 2.1). Another significant reason is the increased number of people claiming more than one race.

The 2000 census marked the first year people were allowed to select two or more races on their form. Nine million people reported more than one race. Of marriages today, one in seven contains a spouse of a different race or ethnicity. Their bi-racial children will check more than one box on their next census form.

These latest census numbers represent changing times in our nation’s cultural, racial and ethnic history. In the USA Today article, William Frey, demographer at the Brookings Institution, a non-profit public policy organization in Washington, DC, was quoted as saying, “The future is people of all races and ethnicities.”

Change is a beautiful thing.

(Sherry Dineen)

Health Disparities CAN Be Reduced

2011-05-26T07:50:00.001-07:00

Prominent physicians suggest that health disparities of Latino children with ADHD could be correlated to cultural factors as reported at the annual conference of the National Hispanic Medical Association. According to Dr. Andres J. Pumariega, chairman of the psychiatry department at Cooper University Hospital in Camden, N.J., and an expert in cultural diversity and mental health, ADHD is typically diagnosed through parental reporting. Cultural misconceptions might prevent parents from recognizing or acknowledging the illness in their children. Parents often believe ADHD is misdiagnosed in Latino children, but they often think that it is being over-diagnosed, and data from more objective studies actually point to it being under-diagnosed. The reported rate of ADHD among Latino youth being low is misleading.

During the same conference, Dr. Eugenio M. Rothe, professor of psychiatry and public health at Florida International University, Miami, suggests that disparities in treatment between Latino youth and their white counterparts might be tied to several factors, including language barriers and a lack of parental understanding. Dr. Rothe also cited a national survey conducted by Harris Interactive that found that Latinos were less likely to be familiar with ADHD and nearly 10% less likely to know where to obtain treatment. He also suggested that ADHD can contribute to some of the psychosocial problems of Latino youth, including school dropout rates, teen pregnancy rates and substance abuse.

How can health disparities be reduced? Leading physicians recommend bridging the gap by offering patient education materials in Spanish and increasing the number of Spanish-speaking health care professionals. The materials would also have to be culturally relevant to make an impact. It could be years before Spanish-speaking health care professionals accommodate the sheer number of Latino patients. In the meantime, it would behoove the health care industry to be culturally competent. If health care providers can comprehend the importance of values in the Latino culture, this can be significant. Recognizing strong family ties and acknowledging respect and trust as inherent to a high quality relationship will make a difference. It can certainly be a step toward reducing health disparities.

MUR

Dear Technology - Part 2

2011-05-24T08:26:00.001-07:00

Dear Technology,

Well, you’ve done it again.

Now you’ve gone and messed with our language. Will your madness never end?

The current generation of learners uses you to learn to speak, read and write.

You’ve infiltrated our diction as well. Your fancy lingo has permeated our daily verbiage. “Texting”, “sexting” and “facebooking” are not terms someone having survived the Great Depression would necessarily understand nor want to know.

Of course, you giveth and you taketh away.

Adding to our vocabulary is one thing but making us grammatically dumb is another altogether. Your texting and smartphone technology has modified how we express ourselves in written form. When you limit us to 140 words: punctuation & grammar r 1st 2go.

No one uses commas anymore. I must admit, sometimes that’s a good thing.

Small children exist in this world that have never actually held a book in their hands. They hold a Kindle or an iPad and touch a screen to turn pages in their Cat In The Hat.

Knowing nothing but high tech, they will expect high tech in return. Next they will expect their devices to talk back to them. Knowing you, you’ll do it too.

Or will you?

To talk back to us, first you have to understand us.

Sure, you can use your analytical skills to analyze our frequency of word use and derive patterns that intimate what we are trying to say. But do you truly understand?

You are akin to a good machine translation. You recognize a pattern and repeat it, but do you really get the nuances behinds the words?

Culture is not something you know because in your clinical mainframe world, it doesn’t exist. Your point of reference is purely analytical and language is so much more than that.

Language is backed by hundreds of thousands of years of history. It’s an organic, ever-changing entity that cannot be replicated.

Good luck with that.

Sincerely,
aiaTranslations

Fear Is Not An Option

2011-05-17T06:32:00.001-07:00

If half the time you asked for directions, they were wrong and you got lost, you would be upset, right? What if half the time, it resulted in you bleeding in a ditch on the wrong side of town? Upset would no longer describe what you are feeling. Fear might.

Most people take prescription medication hoping to feel better, yet for non-English speakers, mistakenly translated prescription labels can make taking their meds a fearful experience.

According to a 2010 study of Bronx pharmacies conducted by Iman Sharif while at Montefiore Medical Center, the computer programs used to translate prescription labels had an overall error rate of 50%.

If “once a day” gets translated to “eleven times a day”, that’s close enough, right? What can it hurt if its not right? I’m sure eleven doses of an anti-seizure medication would be fine.

The software helps them comply with legal requirements to provide translation services but is it true compliance if half the time it’s incorrect and potentially lethal?

If you end up in a hospital or clinic, most states require non-English speakers receive translation services. Pharmacies, however, do not fall under this domain. Only one state, California, legislates translation services be provided in pharmacies.

In New York City, the Language Access in Pharmacies Act requires pharmacies with four or more locations provide non-English speakers with free and accurately translated labels, warnings, ingredients and brochures. They also must post signs in English, Spanish, Chinese, Korean, Russian, Polish, Italian and French stating they provide such services.

The advocacy groups that implemented this Act, Make the Road New York and New York Lawyers for the Public Interest are currently pushing to expand this legislation to the rest of the state. To check their efficacy, the groups surveyed seven national chain pharmacies with 250 branches in New York State and found in locations outside NYC, about 50% of the pharmacies did not supply translated drug labels and 30% did not provide interpretation services.

Taking prescription medicines should not involve fear. "It's easy to be seriously injured or killed by your medication," said Assemblyman Richard Gottfried (D-Manhatten) who recently reintroduced the bill to expand the legislation.

“Folks are not getting the language services that they need,” said Theo Oshiro of Director of Health Advocacy and Support Services for Make the Road New York. “They are not able to take their medicines or are hurting themselves because they don’t understand the language that is used. If you are not providing language services to these folks, you are not counseling them appropriately."

Caring for the Health of Latino Patients

2011-05-02T13:12:00.001-07:00

According the U.S. Census Bureau, Latinos are the fastest growing minority population in the U. S. Already approaching 17%, it is projected that by the year 2050, the figure will be 24% with Latinos comprising the largest minority group in 20 of the 50 states. Another interesting statistic is that this population is young in comparison to the general U.S. population, which means more child-bearing age groups. The rising population numbers are indicative of increasing health issues across the board. This means that the health care industry should be prepared to address a population with unique cultural factors and various degrees of biculturalism.

Some illnesses are more prevalent in the Latino population. For example, there are higher rates of diabetes, tuberculosis, hypertension, HIV/AIDS, alcoholism and cirrhosis. For a variety of reasons, many Hispanic patients may delay medical care until their condition worsens and necessitates immediate attention. Some factors that delay or prevent health care include poverty, lack of health insurance and limited access to health care. Along with serious illness, crisis and emotional stress, the complexity of navigating the medical system becomes even more complicated.

The language barrier is another cultural factor that prevents Latino patients from experiencing effective communication with their health care provider. Medical terminology is not always easily understood by mainstream and even less so for Spanish-speakers. Health care professionals who speak Spanish are few in number even though a total of 35 million speak Spanish at home. Cultural factors may also be correlated to delay or lack of doctor visits such as a belief system that some health issues are natural and therefore, do not necessitate medical attention. For example, folk medicine and traditional healers are common practices in some Latino sub-cultures. The culture is broad and unique posing many challenges. Health care providers need to be careful not to allow any characterizations of values, customs or beliefs dominate the way they deliver health care services to such a diverse group. It is noteworthy for health care professionals to keep in mind that each person is unique.

Maria Ugarte-Ramos

Dear Technology: A Letter

2011-04-25T10:40:00.001-07:00

Dear Technology… you precocious little Minsk.

What are we going to do with you?

You replicate, expand and improve faster than we can keep up. In a few days time, 4G will be so yesterday. We use you for our own advancement and entertainment with the always underlying thought that someday you very well may trump us all a la some crazy real world version of Terminator.

In the world of medicine you have become quite useful and adept. You provide physicians and patients with valuable information about diseases and the means to treat them. Pharmaceutical companies can now globally reach millions of consumers in the language of their choice.

In parts of the world where the number of patients far exceeds the number of doctors available to treat them, a physician’s time is precious and limited. Again, technology, you come to our rescue, allowing for CME and new product information exchanges to happen quickly and electronically. No appointment necessary.

Patients benefit as well with the ability to access disease awareness and education sites across the globe. Armed with more information than many may actually need, they march into their doctor’s office with many, many questions. Oh so many questions!

Ah, but again you are wily and not easily bound to regulations and conventions of protocol. DTC is illegal in most countries. You know it and we know it, yet you refuse to adhere.

When a patient demands to see your internet content on Lipitor, you are uncontrollable. You always give up the goods. You provide branded programs and information without discrimination. Not once do you ask, where do you live and who regulates your access to this information?

Someone in India can Google a pharma brand name and pull up sites not controlled in India. These online brand discussions can in fact be undercover DTC. You are a naughty little devil.

Ah, technology, you are slippery as an eel. Your benefits in the field of medicine abound, yet you are uncontrollable.

What are we going to do with you?

Sincerely,
aiaTranslations

(Sherry Dineen)

Pharma Misses the Mark with Hispanics

2011-03-23T11:45:00.001-07:00

The Hispanic/Latino population in the U. S. is one of the quickest growing and Spanish is the second most-common language in the U.S after English. According to the 2009 American Community Survey conducted by the U.S. Census Bureau, Spanish is the primary language spoken at home by over 35.5 million people aged 5 or older. There are 45 million Hispanics who speak Spanish as a first or second language and there are 6 million Spanish students making it the world's second-largest Spanish-speaking community. The implications are that all major aspects of life are conducted in Spanish. The impact of language is significant in the health care arena where communication is the key to successful outcomes.

A recent national survey of physicians conducted by KCI Partners and the Jeffrey Group revealed that U.S. pharmaceutical companies communicate poorly with Hispanic/Latino audiences. The ratings showed the lowest possible scores with 33% of the physicians stating that only 7% communicate “very well” with Latino/Hispanic patients. On a scale of one to seven – with seven being the highest positive rating – 24% of doctors gave pharma a three for communication ability, and another 24% gave pharma a four. There are clearly some issues that could include lack of cultural knowledge combined with language barriers. By this scale, pharma appears to miss the mark.

The sheer numbers of Hispanic/Latino growth is indicative of health care needs increasing along with rising trends in diabetes and some cancers. Although the health care crisis continues to expand for this group due to lack of access and limited insurance, it remains questionable whether health care reform will impact this population. In the meantime, there are specific actions that can be employed to reduce disparity. First, pharma could invest in how to communicate better with Hispanic/Latino patients as this market will continue to grow. There are ways to communicate better. Culturally relevance and language are crucial. Second, communication between pharma and the Hispanic/Latino patient could make a difference in millions of lives. Pharma can still make the grade.

New Generations More Adept With Technology

2011-02-24T13:57:00.001-08:00

Everyone knows that each generation has specific characteristics that involve all aspects of life including how they obtain health information. Generation X grew up with the development of computers and remains constant users of technology. The Internet Generation (also known as the Millennial Generation or Generation Y finds great ease and comfort in communicating via technology. Instant communication is a way of life and they are online 24/7 either emailing, text-messaging or enjoying online technology. Now here comes Generation Z who has only known technology their entire lives and has even become dependent on it since it is available in their own pocket. They are indeed the ‘immediate need’ generation. What does this say about the future of utilizing mobile apps for global health care needs?

A recent study by Euro RSCG tonic demonstrates percentages of common virtual users in the U.S. It seems that the most receptive individuals to online health care are those with chronic illnesses, more affluent and younger generations. About 50% of the respondents use mobile apps to run do it yourself (DIY) tests at home and monitor their own symptoms. These patients have much to gain by way of convenience and low cost. This high number of users will inevitably increase worldwide as more users realize these benefits. This is a win-win for physicians who can be more efficient due to time constraints and patients who will receive personalized care. Although the study focused on 1,000 U. S. online users, it is noteworthy to recall that Eastern cultures often follow Western culture patterns.

This change in health care usage is correlated to generational shifting. Already half of the new generations (X, Y & Z) are comfortable with virtual health visits compared to Baby Boomers at almost 40%. These newer generations from around the globe will drive remote health care even further. Their different mindset will make it more likely that they will increasingly use technology to serve their health care needs. This will transform global health care delivery. After all, this is the Internet Generation.

(MUR)

High Standards Remain Necessary in Language Translation

2011-02-02T06:21:00.000-08:00

There is a lot to be said about technology and language. For example, the Chinese language is quickly gaining speed by the number of users in the world (second most spoken language in the world next to English as first and Spanish as third). Technology has come a long way and one can now look up words online in just about any language and you can even communicate albeit in a loose way. You can get the gist of the topic at hand, but not implicit information that makes a difference in one’s life. However, there is one exception in digital communication when it comes to technology translation. Health care communication needs to be precise. It is this accuracy that makes it valuable. It is just too important to have personal information be translated by technology in a verbatim way.

First, technology translation about health is private, individual and unique to the patient. It could be a difference of life vs. death, healthy living vs. poor habits or knowledge vs. ignorance. No one can negate the intimacy of communication between a health care provider and a patient where health care is concerned. Technology translation cannot possibly fulfill patient needs in a personalized way. Preciseness is necessary in this case.

There is no question that technology translation has much to offer all industries around the world. We are not quite there for communication about health care matters. Computers may be experts in word translation, but not effective human communication. It is projected that technology translation will not be perfect, merely adequate. Now these applications are often considered “passable”. This is fine for general information or basic business, but not delicate matters with the potential to impact health. Therefore, we still need to rely on medical translation firms who specialize in high quality language standards. Just ask yourself. If you were in China, would you trust your personal health needs to a technology translation application? How about if the words were passable?

(MUR)

Pharma Can Fill This Order

2011-01-25T13:17:00.000-08:00

It is no secret that physicians worldwide have demanding schedules round the clock. They often have limited time since they have to first see their patients who come to their offices, make rounds in hospitals and stay abreast of medical information that makes them competent. Of course, there are many other tasks to accomplish for this complicated role in medicine.

This leaves little room for digital communication with their patients who need to know more about their illness or medication. Not only is this a patient need, it has become a craving for patients throughout the world. A recent study conducted by MedTera revealed that 95% of patients require more comprehensive information to manage their disease, learn about their illness or manage their medication. New studies are underway to determine useful tools to help patients. In the meantime, this is an opportunity for pharma to fill the void by providing valuable information particularly for the global patient who has additional needs related to language and culture.

All patients have unique concerns about their individual health. If they are not managing their disease or learning about an illness, they are working on prevention efforts such as altering their lifestyle and learning how to live a more healthy life. The global patient profile is a patient that speaks another language and requires information in a culturally sensitive manner so that it makes sense, is useful and makes an impact right away. Yes, one has to take time to figure out effective means of communication with the global patient. Pharma already has a strong knowledge base about comprehensive health information to meet the global patients’ needs. Furthermore, they have the resources at their fingertips to translate materials in a culturally appropriate way. If patients are hungry for more, who says that pharma cannot fill this order?

(MUR)

Social Networks for Medicine Require Extra Caution

2011-01-10T10:37:00.000-08:00

How do patients determine reliable social networks to help them make good life choices about their health? The answer is complex because there seems to be no warning when it comes to medicine and social networks. Therefore, patients who access social networks for medicine would be well-advised to proceed with extra caution. The endless worldwide web of medical information could be misleading especially for patients who place trust in social networking. More importantly, patients who speak other languages are at greater risk for trusting online information that may be false or misleading. There is more reason to be cautious.

A study underwritten by CVS Caremark and published online in the Journal of General Internal Medicine determined that the fifteen (15) largest Facebook communities for diabetes patients and caregivers promoted clinical studies of unapproved products. The reported rate of 25% shows that not all sources are trustworthy. Patients who speak other languages suffering from pain or an illness may fall prey to such sites. In addition, these sites had unconfirmed identities, which raises serious red flags. This may be only somewhat evident for English speakers who navigate social networks frequently. However, non-English speaking patients searching for online social support are even more vulnerable. They are hopeful they will find relief via support systems who share similarities even across language barriers. Online stumbles upon less than reliable sources may expose these patients to potential harm.

It is already a challenge for patients to decipher endless volumes of online information. It is crucial to caution patients who speak other languages to ensure social network medicine sites have validity and can be trusted. We need to spread the word in other languages to raise awareness that all sites may not hold the patients’ best interest in mind nor do they all necessarily provide the best medicinal support. How does a patient know what is safe? Who sets the standards? Where is the warning label?

MUR

Inclusion = WIN/WIN

2010-12-20T08:45:00.000-08:00

Patient advocacy groups provide valuable insight and are necessary to help patients overcome barriers. The information they provide pharma focuses on the needs and rights of patients worldwide and this helps attain appropriate linguistic and cultural responses. Patient advocacy groups are not only knowledgeable about all facets of drug development including discovery, research, clinical studies and education, but they are dedicated experts on the standards of care, patient needs and the rights of all patients from every possible angle. Drug development impacts the global patient population and patient advocacy groups are mindful of cultural diversity and language as an effective means to educate. The desired result is to treat, cure or fight disease and help patients obtain quality of life instead of suffering or from dying prematurely.

All patient populations could benefit from the collaboration between patient advocacy groups and pharma. Increasingly, patient advocacy groups play a crucial role in educating the marketplace on new medicines and treatments and most purport that drugs should have universal access. Globally, millions of patients represent a myriad of countries with hundreds of languages and thousands of cultures. Such advocacy groups guide us in the fundamental need for addressing patients in their native language and indicate that culture does matter in order to have a positive affect on patient communication. The right kind of communication can only optimize the patient population as a whole.

Pharma has much to gain from the insightfulness of patient advocacy groups. The FDA promotes the value of patient advocates while some pharmaceutical manufacturers rely on their perspective. Pharma would be wise to delve into what these groups imply about inclusion of culturally diverse patient populations when it comes to drug development. Let us not lose sight of the critical role of patient advocacy groups. They offer unparalleled insight and true collaboration means that the pharma companies would act upon their message and implement what is right. This is a valuable partnership. More importantly, it is a huge benefit for the global patient. This is a win-win situation!

MUR

When will the medicine kick in?

2010-12-07T07:38:00.000-08:00

A recent study in a series by the non-profit Commonwealth Fund showed that while Americans pay far more per capita for healthcare, they are unhappier with the results and less healthy than people in other rich countries. Unhappy because the costs are out of reach; Less healthy because we cannot afford the price of good health. Surely, this resonates with everyone. Our great country can offer so much by way of the most advanced technology, miraculous breakthroughs in medicine and the brightest scholars. But when it comes to health care, no one can deny that conditions are harmful for many, deplorable for the poor and dreadful for minority groups who suffer from more widespread diseases and dismal economic conditions.

An estimated 157 million adults have health insurance through their employer. Another 45 million over 65 and older including the disabled have Medicare coverage. Recently, the U.S. Centers for Disease Control and Prevention estimated that 59 million Americans had no insurance for at least some of the beginning of 2010. This is an increase from 58.7 million in 2009 and 56.4 million in 2008. Of those without health insurance, 15 million had high blood pressure, diabetes or asthma. Some of these illnesses are more prevalent in minority groups, which also tend to have higher uninsured rates in the United States.

The problems related to health care costs are insurmountable for many. If we cannot pay for health care, we forego medicine, treatment not to mention prevention. Diseases that go undetected end up costing more and the rate of disease continues to rise. Hospitalizations that could have been avoidable could become the norm, which leads to outrageous costs. The outcomes are disastrous. In addition to unnecessary pain and suffering, the results can be loss of homes or bankruptcy because of unreasonable costs and lack of options. We have grave problems when there are simply fewer funds to maintain one’s health, something necessary for survival. Why does the U.S. lag behind other countries in something so vital? When will we start to feel better?

MUR

Impact for Some, But Not All

2010-12-03T10:03:00.000-08:00

According to the Pew Research Center’s Internet & American Life Project, 61% of today’s adults search online for health information compared to the 2000 findings of only 25%, which indicates the increase of online users. Beyond online health queries, social media is a medium that can be advantageous for patients from all backgrounds, but it can be much more useful for minority populations who find doctors to be trustworthy and consider their opinions important. The online impact on decisions or actions is a positive one, but it may prove to be more important for ethnic groups who view the doctor as the absolute authority figure when it comes to health care. The right kind of social networking can make an impact.

Numerous studies reveal disparities among ethnic minority groups with reported higher incidence and chronic health conditions compared to the White population. Therefore, reaching ethnic populations via social media could make a significant impact on their health. Culture is a crucial component of the effectiveness of health care delivery and the high regard for the doctor’s opinion will affect the medical intervention. A physician via a social network would help the patient understand and manage their illness, change risky behaviors and make informed treatment decisions. This could play a major role in medical decisions for some groups such as Hispanics or Asians.

Social media can be a powerful tool between a health care expert and a patient willing to act upon the information to improve his or her health. Patients linked to their doctors seems more effective than random online visits for health queries that need to be deciphered and may or not be the best source of information. The ethnic patient will likely adhere to their doctor’s advice. Social media may be the next best link for non-mainstream populations to impact the health of a minority group not always connected to health care access. Communication is key. The doctor connection is crucial. Social media can help. Let’s stay focused on the goal: to improve the patient’s health. Will social media make an impact?

One Language Barrier at a Time

2010-11-22T08:21:00.001-08:00

Why do Hispanics experience disproportionately higher rates of disease, fewer treatment options, and reduced access to care? Some of the factors include low-income status, being uninsured or under-insured and communication barriers with health care professionals. These are all major deterrents to health care access, which is vital to good health. Monolingual Spanish-speakers cannot understand the law, their options or the costs associated with insurance coverage. Recently, Health and Human Services (HHS) launched a new website called CuidadoDeSalud.gov that offers health care information in Spanish. The language, often complicated by various dialects, is easy enough to read and understandable.

According to HHS Secretary Kathleen Sebelius, "CuidadoDeSalud.gov will give Latinos across the nation better information about the choices they have, how much they cost, and what they can expect from their doctor – specific to their life situation and local community." The new website is a resource for Hispanics who may not be able to obtain regular annual physical exams or preventative tests that detect the early onset of cancer, diabetes, heart and kidney disease. These are prevalent diseases in the Latino community. According to a recent government report on health disparities, the evidence shows higher rates of disease in the Hispanic population. For example, 14% of Hispanics suffer from adult onset diabetes compared to 8% of the White population. Another fact is that Hispanic women contract cervical cancer at twice the rate of White women. Other statistics show similar findings to support these disproportionate rates.

The Spanish-speaking population has gained technological access to critical information that provides options about health care choices. Individuals challenged by communication barriers can finally begin to understand our complex health care system in their own language. All this is just a click away. We may be on the verge of a breakthrough. Now we wait for the relief of suffering and pain of this impoverished community. More importantly, it has everything to gain: access to health care.

(MUR)

When it Comes to Online Health Information, Culture Does Matter

2010-11-16T08:20:00.000-08:00

According to a 2010 MARS Online Behavior Study, it appears that the worldwide web impacts online user behavior and that behavior is determined by the degree of seriousness of the medical condition. Dedicated websites hold a certain comfort level when there is a recent diagnosis or the user has a chronic condition. In this case, access to health care professionals provides a greater degree of trust over search engine researching. This is indicative of an online user who is more focused, serious and looking for comfort and ease from a trusted source. On the other hand, users afflicted with diabetes or less serious conditions not necessarily life-threatening, may use websites’ useful tools such as meal planning to influence a lifestyle change or they may use online community support. These users were more likely to be repeat users. Therefore, the severity of a health condition determines online behavior and reveals unique patterns.

The MARS study, however, does not address cultural differences surrounding online behavior. It is evident that what is true for the mainstream culture cannot hold true if you have a different view on health or behave differently as a result of a health threat due to a diagnosis. Different cultures view information differently and thus require different types of health information. And many cultures react differently to how medical information is presented. Other cultures take varying approaches in how they respond to an illness. Knowing how other cultures respond to online medical information could prove to be an enormous benefit to the entire health care community - allowing them to reach more people. Many questions come into play. Are other cultures using the Internet to help them alter their lifestyle, make a life decision or obtain support? If so, are there patterns of how health information sites help? What impact do these sites have? Considering cultural diverse societies, this does matter, does it not?

(MUR)

Convenient Access?… Not For Everybody

2010-11-12T06:34:00.000-08:00

Patients of the new millennium have a strong desire for quick information and the Internet has made this incredibly convenient. One no longer needs to be on a desktop computer with increasingly popular wireless access via cell phones or the more common iPhone available. According to the Pew Internet & American Life Project, 83 percent of Internet users have looked online for health information. Any patient is now empowered to search online anytime, from anywhere, for valuable and sometimes critical information to help them learn about a medical condition or symptom and to search for viable options. The health concern may or may not be life-changing, but patients quickly want to learn their choices to help them reduce anxiety or allow them to plan ahead. They no longer have to wait for a medical appointment to obtain complex answers from their doctor rather they can quickly gain the necessary knowledge online to help them make an informed decision. The fact is that the Internet provides instant answers with options to empower the patient so that the least to the most educated patient can readily weigh the information. The question may not always be convenient, but the Internet sure is. This is a powerful pill.

Although the Internet is certainly convenient for the most sought after medical information such as herpes, pregnancy, depression, heart disease and breast cancer, many useful websites offer information only in English. Globally, millions of Internet users who seek health information are non-English speaking and speak an array of other languages. English-only sites that are well-intended may be counter-productive for those who speak other languages and could result in frustration, anxiety and fear. Language barriers pose challenges, prevent effective communication and remove the possibility of learning. This is the opposite of empowerment. People who speak other languages should be able to access valuable health information in their native language and gain the capacity to explore options. Why not give everyone a shot at this pill? Why not make it convenient for all?

(MUR)

Is a signature enough?

2010-09-28T11:32:00.000-07:00

GlaxoSmithKline’s diabetes drug, Avandia has been under intense scrutiny recently. According to a study by cardiologist, Dr. Steven Nissen and Kathy Wolski, published in the New England Journal of Medicine, the drug increases the risk of heart attack by 43% and increases the risk of dying from cardiovascular causes by 64%.

In Europe, the European Medicines Agency has banned its use. In the US, however, the FDA has decided to keep Avandia available to patients. The FDA argues study data is not strong enough to remove it from the market. It currently requires restricted access under a risk evaluation and mitigation strategy (REMS). As such, patients currently taking Avandia who feel they are benefiting from the drug may continue taking it upon signing a consent form acknowledging the potential risks associated with the drug. The strategy only allows new patients to take the medication if it is truly the only option available to them to control their glucose levels, and again, upon signing a consent form.

"Patients will only be allowed to use [Avandia] if they acknowledge and document the risk of this drug," said Dr. Joshua Sharfstein, FDA principal deputy commissioner.

In essence, the FDA has pushed the responsibility of determining if risk outweighs reward to the patient and their doctor. We would argue the signing of the consent form shifts much of this responsibility to the patient, relinquishing the doctor and the manufacturer of liability. They were told the risks, they signed the form, what happens next is on the patient.

In a case where your risks include heart attack, stroke or even death, is simply signing a written consent enough? Shouldn’t there also be a check for actual understanding? A panelist on the FDA advisory committee, a researcher from Duke, Ruth Day, suggested patients should be required to take a quiz to check for understanding.

We would agree. Here is the reality: A patient sits in an exam room as a doctor rattles off a laundry list of “potential risks.” The eyes glaze over a little, there is a lot of nodding and affirmative responses. A doctor whom they trust implicitly says “sign here” and voila, consent is given. Is that true understanding? Especially in patients for whom English is not their first language, how do you know they really understand? Would it be wrong to make the patient run it back?

Taking this medication can cause which of the following side effects?
a) purple fingernails
b) bulging eyeballs
c) heart attack, stroke or possibly death
d) all of the above?

If doctors and the FDA are going to put the responsibility of the risk of death onto the patient, shouldn’t they be responsible for ensuring patients fully and clearly understand that responsibility?

Cuidado! Do you know?

2010-05-18T06:30:00.000-07:00

On or about the first of May a warning went out to medicating parents everywhere: put down the children’s liquid medications. Cries of “but how will I get my kids to sleep tonight!” were heard across the country as viewers saw the warning on the CBS Evening News Bloomberg News and CNN, online over MedPage Today, HealthDay and WebMD and read about it in publications like the NY Times, Wall Street Journal, Chicago Tribune and the Washington Post.

The recall of pediatric formulations of children’s Tylenol, Motrin, Zyrtec and Benadryl was voluntary and mandated because of manufacturing deficiencies in the plant where the medicines were made. Consumers were advised “to stop using the medicine as a precaution.” Any children taking the recalled medicines and exhibiting “unexpected symptoms” were urged to contact a healthcare professional.

People in the healthcare industry love a good study, both clinical and academic. Here’s a suggestion for a study we’d like to see. In the United States, packaging for over the counter medicines is mostly printed in English. That’s fine. English is official language of the United States and most non-English speaking parents can probably go to the drug store and piece together the English they know to pick out pain relief medicine for their children.

What about this recall? Was information about the recall presented in other languages and to what degree?

How many non-English speakers are purchasers of these liquid children’s medications and what was the customer service rate of inquiry for non-English speakers for the recall? Do non-English speakers even realize there was a recall? Is the Russian mother of three who buses tables at the restaurant around the corner reading the NY Times and watching CNN? How do non-English speakers know to stop taking these medicines?

More Than a Hangover

2010-04-21T08:25:00.000-07:00

January’s post, I Know Not What I Pour, noted how excessive alcohol consumption may not be a conscious decision and can affect your health. There is further evidence that heavy alcohol consumption yields more than a hangover the next morning. An NHS Confederation report from this year states hospital and ambulance costs associated with treating heavy drinkers in the UK have doubled over the past five years.

According to Professor Ian Gilmore, President of the Royal College of Physicians, “The nation’s growing addiction to alcohol is putting an immense strain on health services, especially in hospitals, costing the NHS over ₤2.7 billion each year. This burden is no longer sustainable.”

According to Steve Barnett, chief executive of the NHS Confederation, “This report shows that not only are we drinking too much but that the cost to our health services is increasing.” He notes that of 18 people, who are addicted to alcohol, only 1 receives treatment. He believes more needs to be done to effectively identify, assess, and treat patients and calls for a “reappraisal” of social and cultural attitudes towards drinking.

The International Center for Alcohol Policies (ICAP) would agree. In 2008, they sponsored a focus group centered study on alcohol consumption in Europe, Brazil, China, Nigeria, Russia, and South Africa. As reported in the September 23, 2008 issue of Science Daily, they found “cultural influences are a dominant factor in youth attitudes about drinking and drunkenness.”

Attitudes towards drinking varied by country and the lower rates of heavy drinking were found in Mediterranean countries versus heavy drinking rates in Northern Europe (including the UK.) For some countries, Spain, Italy and France for example, drinking moderately on a daily basis is a way of life.

It will take a little more than a Bloody Mary and a bottle of Advil to cure this hangover. Whether you drink or not, the increasing costs associated with caring for those who do will be passed on to everyone. The answer will lie in doing more than simply identifying and treating patients addicted to alcohol. To be effective, preventative measures able to change attitudes towards drinking need to be implemented. These preventative measures can only be effective if they are based on an awareness of the cultural factors contributing to the high levels of alcohol consumption in the first place.

Want to know more about the ICAP study? No sweat! They wrote a book about it: Swimming with Crocodiles: The Culture of Extreme Drinking.

Branded Generics?

2010-04-13T12:17:00.000-07:00

Our last blog discussed the rise in popularity of generic prescription drugs domestically without mentioning their status overseas. Since most consumers outside the US market pay for drugs out of pocket and cannot afford expensive name brands, generics are very popular internationally. With the drop in brand name drug market share domestically, pharmaceutical companies are more than willing to fill this desire for low cost drugs.

Emerging markets are set to overtake US markets in overall sales. Pharmaceutical revenue in China in particular, with its current strides towards universal health coverage and improving its healthcare infrastructure, is predicted to double by 2013. Much of the growth in emerging markets (i.e., China, Brazil, Russia and India) is driven by low-cost generic drugs.

As a result, many pharmaceutical companies are now hawking branded generic drugs in overseas markets. While the term “branded generic” may seem at odds, it is actually becoming quite a lucrative market.

Americans, because they have been “brand washed” so extensively, tend to view generic drugs as lower in quality than brand name products, despite containing the same active ingredients. Marketed to less extensively, overseas populations are less biased against lower cost, generic formulations.

Branded generics make sense. There is no additional cost for a company to attach their company name to a generic formula, instilling consumer confidence in a less expensive formulation without adding millions in cost to marketing and promoting a specific brand name.

Companies approach this tactic differently. Some associate their main brand with the generic, while others purchase local overseas generic companies to sell their products under a different name.

“We are able to create different tiers of products at prices they haven’t previously seen with our stamp of approval,” Andrew P. Witty, the chief executive of GlaxoSmithKline told the NY Times.

According to the same article, “It definitely represents a change in thinking,” said David Simmons, the president of Pfizer’s established products business unit, whose company has already added over 200 generic products to its portfolio.

Discounted or Abandoned... What's a brand name pharmaceutical to do?

2010-03-25T09:15:00.000-07:00

According to a recent study by Pharma Insight, released by Wolters Kluwer Pharma Solutions, in 2009 there were 2.6 billion prescriptions filled for generic drugs and only 1.3 billion for brand-name medications. In a down economy, more people turn to generics as a way to save money. This can cost the pharmaceutical industry billions of dollars every year.

Increased request for generics over brand names is not the only trend seen in the drug market. Abandonment is the term for prescriptions left at the pharmacy that are never fulfilled. Last year the abandonment rate for new prescriptions of brand name drugs was 8.6%, a 23% increase over the rate in 2008 and a 68% increase since 2006.

According to Dea Belasi, consulting practice leader of managed markets for Wolters Kluwer Pharma Solutions, “What’s peculiar is that the rate of increase among patients walking away is almost unprecedented. The [abandonment] trend that we are seeing is just going up and up.”

Belasi suggests macroeconomic factors such as the housing crisis, current recession and lower household incomes are behind the rising rate of prescription noncompliance. Consumers are trying to save money by self-medicating or reducing overall drug consumption.

For more on how the economy is affecting patient compliance in healthcare, please read our current online issue of CONNECT. To subscribe to this free, online newsletter, click here.

What Would You Do? Cost and Ethic Concerns in National Children's Health Study

2010-02-26T07:04:00.000-08:00

If a stranger knocked on your door and politely asked if they could collect your toenail clippings, body fluids and dust from your sheets for the sake of science, what would you say?

The National Children’s Study is doing just that. Its goal is to enroll 100,000 pregnant women across the country, then monitor them and their babies from before they are born until they turn 21.

The study involves collecting copious amounts of extremely detailed information in hopes of connecting patterns between environment (natural and man-made); biological, chemical, and social factors, physical surroundings, behavioral development, genetics, cultural and familial influences and geographic locations to see how they interact to effect a child’s health.

As you can imagine, the magnitude of the study has been compared to that of a lunar landing but critics are crying foul on the escalating cost of the study as well as ethical issues surrounding its structure.

Part of the cost escalation comes from enrollment issues. Instead of receiving a “yes” from roughly one in fourteen potential participants as initially predicted, the reality is one in forty. Let’s be honest. Twenty-one years is a long time and the quantity of information gathered during visits is burdensome and prohibitive. Many do not want to be bothered.

Racial and cultural issues slow enrollment as well. Study locations are chosen based on having diverse populations with a high number of births. The melting pot that makes our country great also makes recruiting in urban areas more difficult. A wide variety of languages and cultures are encountered, requiring translation services to communicate with potential study participants. With good reason, non-English speakers are suspicious of random strangers knocking on their doors and are tentative at best opening them.

Economics also effect enrollment. It is easier to draft participants in cash rich areas. Movie theatre ads and obstetricians reach potential patients. For a study to be comprehensive and inclusive though, you cannot exclude women unable to afford life’s little luxuries or prenatal care. Reaching these populations takes more time and finesse, and thus, money.

Ethics in information access are another criticism in the structure of the study. Protocol restricts study employees from urging participants to change their health habits. Is it right to make the effort to reach specific populations and not take time to educate them?

How much information should the study provide to participants and their communities? If a genetic mutation is discovered that may or may not appear, and holds no cure, should the participant be notified? Is it worth the worry (perhaps unnecessary) it could cause? If an environmental trigger is suspected to cause a medical condition within a community, should it be reported? The study provides an opportunity to help people and communities but how do you do it without skewing study data?

This is a lot to consider over the course of twenty-one years. If not on target from the start, a lot of time, energy and money will be wasted. For the time being, those heading up the study are taking the criticism seriously. At the moment, most of the study is currently on hold while the scientific community considers these issues.

*****************************************************************

The National Children’s Study will examine the effects of environmental influences on the health and development of 100,000 children across the United States, following them from before birth until age 21. The goal of the Study is to improve the health and well-being of children.

For more information, visit their website: www.nationalchildrensstudy.gov

I Say Medicine, You Say Midewin

2010-02-01T10:33:00.000-08:00

Think about the word, “medicine.” What does it mean to you? Do you think of multicolored pills? Your doctor? The pharmacy down the street?

If you are an American Indian from the Ojibwe tribe, the word for medicine is “midewin” (pronounced ma-DAY-win) and it means ‘from the Earth.’ It’s subtle, but the difference is clearly there. For American Indians, wellness does not come from a pill. Healing comes from plants and herbs that treat disease. Not viewed as a physical response with a cause rooted in the laws of science, disease encompasses a patient’s spirit, family, community and environment.

Dr. Doreen Wiese, who is of the Ojibwe tribe, is trying to revive the Ojibwe language precisely because of this difference. In the United States especially, native languages have withered up and died for two main reasons: first, because parents felt their children needed to learn English to become successful in American culture and second because until the 1940's, Native American children taken from their homes were forced to only speak English.

A PhD from Northern Illinois University who studies oral history and the ways in which learning is passed through generations, Dr. Wiese believes, “…language is the thread that keeps culture together. Language is woven into our brains and psyches and memories.”

It’s true. Language reflects culture. While the words can be translated into English, the meaning behind the words may change. An Ojibwean story about “midewin” takes on a new meaning when the word becomes “medicine.”

Dr. Wiese’s goal is to write down the Ojibwe language so it can be taught to others. Not an easy task. Part of her impetus in doing so came when she attended a religious ceremony where a speaker claimed God gives everyone a native language. “He said that if you can’t pray in your native language, the Creator cannot hear you. I wanted to learn how to pray in Ojibwe. I wanted to learn how to tell our stories in Ojibwe. That’s the only way we can be whole again as a native people.”

I Know Not What I Pour

2010-01-11T10:32:00.000-08:00

As a translation agency that specializes in medical and life science translation, we work on a lot of patient targeted materials. Often these communications hope to elicit patient compliance in some form or another. Many aspects about a patient influence their compliance: culture and language, education level, style of commucation they receive.

A recent experimental study through the Know Your Limit campaign in the United Kingdom indicates that a patient’s noncompliance may not always be a conscious decision.

When asking men and women in the U.K. to pour what they thought was a single serving equivalent of alcohol (25ml, about an ounce in the US), the average pour was 38ml (in reality one and half servings).

The experiment found men to be the most generous in measuring their spirits: 43ml was the average manly pour versus an average of 32ml poured by women. Wine is a different story altogether, in this case women are more generous, averaging a 186ml pour, which is 2.4 times the standard wine serving of 76.25ml (2.5 ounces in the US).

Studies show drinking more than the recommended limit for daily alcohol consumption; (2-3 units for women and 3-4 units for men in the U.K.) dramatically increases their risk of heart and liver disease, cancer, and stroke.

Anyone tracking their alcohol consumption for the purpose of maintaining their health may not be doing as well as they thought. While this finding does not affect the outcome of a clinical trial or important health study, it is an insight into patient behavior. The truth is patient compliance is affected by many aspects, some conscious, some not.

What are you?

2009-12-23T07:08:00.000-08:00

If you are not Caucasian, what are you? Hispanic or Latino? Black or African American? Japanese or Asian? Are you a person of color? Does it matter?

As a company that deals with communication across countries and cultures, this question comes up often and using “correct” terminology can be quite a struggle.

Recently we translated a brochure for a company into several languages, one of which was Japanese. The photo on the front contained a handsome Asian man. Upon final review our Japanese translator rejected the brochure based on the cover photo and suggested we instead picture a Caucasian American male. She said people from Japan do not consider themselves to be Asian.

I find this interesting.

How do Americans view themselves? If you are American but born of Costa Rican descent, how do you identify yourself? Do you distinguish yourself as Costa Rican or American? Do you consider yourself to be Latino? Which self-identity is stronger: that of your heritage or of the country you live in?

Clearly this is a personal preference which will keep communications professionals on their toes for a very long time. In one breath, a person can be Black, African-American, a person of color and American. That is the beauty of living in a Global Age. You can be whatever you want to be.

Adonde vas tu? Or Adonde tu vas?

2009-12-11T08:22:00.000-08:00

Language is an organic, ever-changing phenomenon reflected by its speakers. Documenting the linguistic diversity found in 400 million Spanish speakers is no easy feat, but yesterday, the Spanish Royal Academy presented its 4,000 page best shot.

Titled, Nueva Gramática de la Lengua Española, it attempts to account for variances in Spanish throughout the world and is billed as a "map" of the Spanish language. The surprising revelation in the Academy's work is acknowledging the influence Latin America has had on the language. It looks at how vocabulary, pronunciation and grammar change between countries and within social classes. While the Academy makes recommendations for “proper” Spanish, it recognizes localization and the influence of new words, positioning its purpose as one to “observe and document.”

Thus continues the struggle communicators and marketers have in creating a single set of Spanish documents. Spanish is highly localized. The less technical a communication is, the more localized it becomes. In fact, the Academy acknowledges there are more than 20 acceptable ways to say "Ball Point Pen."

In market research, patient education and patient recruitment, the possibility of alienating the reader is not resolved by the issuance of the Academy's work. While the work is interesting and important, the daily work of the Spanish translator goes on. Who is my audience? Where do they live and what is their social class? How can I reach them best?

Should Crowdsourcing Be In Your Mix?

2009-11-18T11:58:00.000-08:00

Crowdsourcing: Jeff Howe coined the term and wrote the book; many companies are buying into the idea. Wikipedia defines it as "the act of taking a task traditionally performed by an employee or contractor, and outsourcing it to an undefined, generally large group of people, in the form of an open call.”

To use the collective intelligence of many to do the work of a specialized few is good in theory. When it saves companies money, all the better, right? If you have a large, diverse group of qualified people, the knowledge of the crowd is a useful resource.

Is crowdsourcing the answer to the growing need for translations?

Crowdsourcing translation work for free has gotten a lot of press lately. No longer are non-profit companies requesting help on the cheap, companies are using free labor for profit. Internet sites like Facebook, Google, and LinkedIn all crowdsource translations and the industry seems to embrace it.

According to Howe, “[i]f there is one industry where crowdsourcing can turn things upside down, it is the translation industry.” Based solely on supply and demand, Howe claims the few hundred thousand translators existing worldwide are not enough to meet the growing need.

What about quality? In general, good professional translators will not work for free. If they do, it is for passion or prestige. Translating is laborious and intensive work. A good translation is not something the majority of native speakers of any language can produce. It is kind of like saying all English speakers are great English writers.

Ultimately, there is a place for crowdsourcing in the mix of human and machine translation but it is not the solution for everyone. It is not a good option for companies concerned about their brand, or in the highly-technical medical or legal fields where precision is unyieldingly required and confidentiality would preclude dumping out content to the masses.

Companies need to consider which solution will yield the best and most cost effective results and plan accordingly. Where quality is less important than cost, and where deadlines are unimportant, crowdsourcing translation projects is effective, but the reality is, you get what you pay for.

DUR 2T YR RX?

2009-11-12T11:38:00.000-08:00

Reaching a global patient means more than just speaking their native language. You have to know HOW to reach them too.

What is the one thing you rarely see a teenager without?

That’s right: their cell phone.

It rings and bings constantly as text messages, Tweets and Facebook posts stream in.

If they happen to be one of the 186,300 people under the age of 20 who have diabetes, why not put that attachment to good use?

Historically, healthcare professionals have struggled to gain teen compliance, with little success; however, a recent study published in the Journal of Pediatrics suggests texting may be the way to make it happen.

Researchers used a program to send text messages to young liver transplant patients reminding them to take their medications. The results were “with text messaging, patients were more likely to take their medications than they had been before.”

Let’s apply this lesson. Whether you communicate in English, Spanish or Mandarin, the message is only effective if it reaches the intended target.

DUR 2T YR RX?
(Did you remember to take your medication?)

Help Recruit the Rarest Patient

2009-10-26T11:00:00.000-07:00

Half of all clinical trial delays are a result of patient recruitment problems. Imagine the struggle faced by researchers of rare diseases. In addition to the normal recruitment problems, as well as the standard 20-30% post enrollment dropout rate, they are working with very limited patient populations.

To get viable results for rare disease studies you need adequate participation. The problem is people receiving Supplemental Social Security income are not allowed by US law to accept compensation for research. Doing so makes them ineligible to receive government medical benefits and prevents them from participating in clinical studies. Take that limited pool of participants and make it smaller. Now find a cure. Good luck.

As of the end of September, over 100 patient, academic and industry organizations have joined to support legislation that enables individuals with rare diseases to participate in clinical trials without losing their eligibility for government assisted healthcare benefits. Some of these include the Cystic Fibrosis Foundation, Johns Hopkins Hospital, the National Health Council, PhRMA and the Yale University Medical College.

According to Robert Beall, PhD., President and CEO of the Cystic Fibrosis Foundation, “Clinical trials are critical for developing effective therapies for cystic fibrosis and dozens of other rare diseases. Quick passage of this bill by Congress will support life-saving research for many people in need.” (Medical News Today 9/29/09)

The bill was introduced into the Senate September 16th and is called “The Improving Access to Clinical Trials Act.”

“This bill allows patients with a rare disease to disregard up to $2,000 of compensation received for participation in a clinical trial in their SSI and Medicaid income calculations,” said Senator Inhofe. “Though it will have a negligible impact on the federal budget, it will make a dramatic difference in the lives of those who will gain access to potentially life-saving treatments by enrolling in clinical trials as well as all those in the future whose lives will be improved by the medical advances that arise from this research.”

Over 30 million Americans are afflicted with one of the roughly 700 existing rare diseases and it is estimated two new pathologies are described every week in medical publications.

To track the current status of this bill, please click here: http://www.govtrack.us/congress/bill.xpd?bill=h111-2866

Please feel free to let your elected House and Senate representatives know you support this bill. Their contact information can be found here: http://www.usa.gov/Contact/Elected.shtml
You can even Tweet your support!

Is the "Pink" Message Getting To You?

2009-10-15T11:59:00.000-07:00

Pink is hot right now. In case you have missed the signs: from pink gloves and sneakers worn by NFL players to the barrage of ads on the TV and radio, October is Breast Cancer Awareness Month.

According to the American Cancer Society, 194,280 Americans will be diagnosed with breast cancer this year and 40,610 will die from the disease. Studies show that women who undergo reconstructive surgery after a mastectomy experience better quality of life. Reconstruction boosts self-esteem, body image and sexuality. Not all women choose reconstruction but all women should at least be presented with the option.

This is not always the case. A recent study, published in the Journal of Clinical Oncology, compared breast reconstruction among white women, African American women, Latina women who were highly acculturated (integrated into American society) and Latina women who were less acculturated. Of the 806 women studied, 41% of white women, 41% of highly acculturated Latinas and 34% of African American women underwent reconstruction; whereas, only 14% of less acculturated Latinas did.

Study researchers, from the University of Michigan Comprehensive Cancer Center, found the lower rate was not due to lack of interest. More than half of the less acculturated Latinas responded they would have liked more information about reconstructive surgery. They also claim this group was less likely to report their surgeon explained reconstruction to them or referred them to a plastic surgeon.

The study recommends better efforts be made to present breast reconstruction options to all patients, including those who do not speak English. They plan to do further research to understand how language and cultural issues affect a women’s choice to undergo reconstructive surgery post-mastectomy.

In addition to understanding their reconstructive options, targeted breast cancer awareness messages need to be directed at minority ethnic groups explaining symptoms, availability of screenings and insurance coverage. Women diagnosed with breast cancer in its earliest stage have a 9 out of 10 survival rate beyond five years. For cancer in its latest stage that has metastasized to other areas of the body, this rate drops to 1 out of 10. As you can see, early detection is key to survival.

This month is all about breast cancer awareness. For early detection and better survival, let’s make sure the “pink” message gets to everyone!

For more information about breast cancer in English and Spanish, including screening, prevention and treatment options, please visit the National Cancer Institute website:
http://www.cancer.gov/cancertopics/types/breast

Ayudame...

2009-10-12T11:34:00.000-07:00

In your day to day conversations, when the subject of human trafficking arises, images of young girls on the streets of Japan or India probably cross your mind. What you may not realize is that human trafficking is alive and well right here in the United States. Cases of human trafficking have been reported in all 50 states, Washington D.C. and some US territories.

According to the US Department of State, an estimated 14,500 to 17,500 foreign nationals are trafficked into the US annually for the purposes of commercial sex and/or labor exploitation or domestic servitude. Traffickers use force, fraud and coercion to compel women, men and children to engage in these activities.

Most sources agree, the covert nature of the crime, relative invisibility of its victims and the extreme amount of under reporting of the crime, mean these numbers are probably low estimates. Our melting pot identity sets up the US to be a trafficking magnet with people commonly trafficked from East Asia, Central & South America and Eastern Europe.

The greatest challenge lies in reaching and identifying victims. More needs to be done to reach victims in their native language and increased cross cultural and linguistic training activities need to be provided for social workers, health care professionals and law enforcement workers. It’s great that there is a 24-hour hotline you can call for assistance, but if you are petrified and only speak Korean, will the English speaking person on the other end be able to help you?

Victims need to understand information about their rights and translation services need to be made available. In the time period between, October of 2000 and fiscal year 2007, the Department of Health and Human Services (HHS) certified 1,379 foreign national victims of human trafficking. Despite the fact that over 10,000 people are trafficked into the US every year, only hundreds are assisted. Clearly more effort needs to be made to reach the people that need our help the most.

If you suspect a trafficking crime or need help, please call the national 24 hour toll-free Human Trafficking Resource Center at: 1-888-373-7888.

I Am How I Feel

2009-10-02T14:42:00.000-07:00

Our previous blog recounted a study that showed educational cues incited better vaccination habits in women versus emotional consumer ads or government mandates. In this study, education served to motivate better than emotion. Does that mean we should discount the effect emotion has on our identity and thus decisions we make about our health?

It’s true. Culture has a big impact on our perception of the world. However, can feeling emotionally good or bad make you act outside your cultural norms? Scientists decided to put this theory to the test and discovered that indeed, emotion has an effect on your cultural identity.

A journal article entitled, “Who I Am Depends on How I Feel: The Role of Affect in the Expression of Culture” outlines these results in Psychological Science. Scientists recruited volunteers from opposing cultural identities: Westerners, noted to value individuality and independence and East Asians who culturally value harmony and community. Then the unconscious tinkering began. To lift their mood they played upbeat music (Mozart), had them hold pens in their teeth (it force a smile). To bring them down they played Rachmaninov and had them hold the pen in their lips (forcing a frown).

Volunteers would then take a test to check for individualistic or group values: for example, given a choice of five pens, one red, the rest blue, which one would they pick? According to their stereotypical cultural values, the Western recruits should go for the red pen and the East Asian recruits should choose from the blue.

Their results were consistent in all the tests. Feeling good results in volunteers acting more exploratory and out of character whereas feeling badly reinforced cultural stereotypes and thought patterns. East Asians acted more independently and Westerners became more communal.

The researchers suggest “these experiments demonstrate a robust moderation of the expression of culture by affective state.” While past studies have shown culture can predict responses based on affect, this study shows it also works in reverse: affect can determine one’s expression of culture.

They also suggest, “Who one is-one’s behaviors, cognitions and self-construals-at any given point in time depends on the fundamental interplay between affect and culture.

Good to know.

By Sherry Dineen

Use Education, Not Emotion: Get People to Buy What You Are Selling

2009-09-17T11:30:00.000-07:00

Our fall newsletter (something to look forward to!) will focus on marketing and research within global audiences. If you find pharmaceutical marketing tactics of interest, you should consider contacting Michelle Steward, assistant professor of marketing at Wake Forest University.

Her study, entitled, "The Influence of Different Types of Cues-to-Action on Vaccination Behavior: An Exploratory Study," will be featured in the Spring Edition of Journal of Marketing Theory and Practice.

The study considered the effects of educational surveys, consumer advertisements and governmental mandates on the HPV vaccination habits of women ages 18 through 30. It concluded they were more likely to consider being vaccinated after participating in the survey versus viewing consumer ads or receiving government mandates.

"The educational cues in the survey are the least coercive and appear to prompt more thinking about the risks of not being vaccinated than laws, which may produce a negative backlash or advertisements, of which consumers might be skeptical," said Steward.

Merck should take her survey to heart considering its sales of Gardasil for the second quarter of 2009 were $268 million, a decline of 28 percent from the same quarter last year. It is estimated 3 out of 4 women remain unvaccinated despite the millions of dollars Merck has spent on advertising and lobbying for mandated vaccinations.

Combine this theory with the current Health 2.0 trend where e-patients are educating themselves about their health online and targeted internet marketing campaigns should reap the reward of increased vaccination rates.

By Sherry Dineen

Source: “HPV Vaccine Study Show Why Few Women Getting Shots” by Medical News Today (www.medicalnewstoday.com)

Turning Social Responsibility into Commercial Opportunity

2009-09-01T13:30:00.000-07:00

For the first time in over fifty years, the U.S. pharmaceutical market is not forecasted to see better results than last year. As a result, disappointed drug manufacturers are making major changes in how they view their role in the world – from pharmaceutical companies to healthcare companies.

With this shift in perspective comes a broader sense of responsibility to patients in developing countries. In the past, most manufacturers’ involvement limited their involvement to simply making their products available to people in poorer nations. A change of heart, though, is moving companies toward partnerships and collaboration with governments, NGOs and other private sector organizations to develop long-term sustainable solutions for improved healthcare access and overall wellbeing in underserved patient populations.

In order to offset the loss of profit from the decline in the US market, however, pharmaceutical companies must realize increases in these challenging new foreign markets. But developing countries with poor populations have dynamics that can further complicate marketing and sales strategies beyond standard demographics and ROI. Following are some key issues that should be considered:

Literacy
Poorer countries tend to have lower literacy rates that can impede a patient's understanding of their condition and potential treatment options. It may also mask unethical behavior by providers or pharmacists. Low literacy patients require greater efforts of advocacy and additional support systems.

Language & Cultural Barriers
In many cultures, and more often in developing nations, physicians play a principle role in managing healthcare decisions and treatment choice. Questioning your doctor, or acting as a partner in your own care, is very often unheard of for patients in some cultures. Without culturally-appropriate translation of prescription and disease information, patients will be increasingly dependent on the information provided to them by their physician.

Cost
Drug makers have long been aware that in many countries, cost has a direct impact on a patient’s choice of treatment. Costs must be kept low to ensure compliance with physician treatment prescriptions. Due to the large number of new potential patients in developing countries, manufacturers may see the potential volume increase as an offset to the creation of special pricing structures that benefit the poor.

Can Immigration Give You Cancer?

2009-08-19T11:50:00.000-07:00

A recent study conducted at the University of Miami Miller School of Medicine found that first-generation Hispanic immigrants living in Florida are 40% more likely to develop cancer than people who did not emigrate from their native countries. While researchers admit that further research is needed to determine the cause of this group’s higher cancer rate, culture has an obvious impact.

The increase in cancers among first-generation immigrants living in Florida may be due to the development of unhealthy habits. In addition, more widespread diagnostic measures in the U.S. that lead to greater detection could play a part. - Dr. Paulo Pirheiro, Lead Researcher

Certainly, better access equals better health care; however, the influence of a new culture should not be discounted. Different eating habits, changes in leisure and fitness activities, and other lifestyle modifications are common immigrant experiences and can all have an impact on a person’s health and wellbeing.

But what about stress? Immigration to a new country and culture can be an extremely stressful event. How this stress impacts the health of the 30,000 study participants is a perspective that warrants further study. Established research confirms that long-term, chronic psychological stress has a negative impact on a person's overall health, yet there are conflicting results concerning it’s impact on cancer development.

Visit the National Cancer Institute for more information about the link between stress and cancer: http://www.cancer.gov/cancertopics/factsheet/Risk/stress.

Medical Insurance is Not Enough

2009-07-15T12:42:00.000-07:00

Our current quarterly newsletter, CONNECT, focuses on language barriers in healthcare. (Not on our mailing list? Send an email to audrey.miller@atkinsinternational.com and include your name and email or mailing address.)

Our blog this week will continue with this theme.

A study led by Z. Jennifer Huang at the Department of International Health at Georgetown University supports the conclusion that simply having and affording medical insurance does not guarantee healthcare usage in this country. Language in fact can be a barrier to being healthy.

Ms. Huang studied 76 families from 3 different socioeconomic groups in the metropolitan D.C. area (42% of this area’s immigrant families are Asian.) To qualify for the study, families had to have both parents born in China and speaking Mandarin as their primary language.

From suburban areas there were 20 families in the low-income bracket, 45 in the middle to high income bracket and 11 urban families in the low income bracket from D.C.’s Chinatown area. Most families had access to either private or public health insurance coverage.

Families were asked if in the past year there was a time their child was sick and they chose not to seek health care. Anyone responding with a “yes” received a more detailed inquiry as to why.

According to Ms. Huang, the researchers were “surprised to find out the delayed care is more common in this population, especially the middle income group.” Since many in this group were insured, the researchers looked for issues beyond insurance coverage that affected healthcare utilization.

Ms. Huang found most parents did not get care because they could not find a Chinese speaking doctor or were unable to find an interpreter.

“Not many recent immigrant families know they can request translation service at clinics with federal funding.” Huang said.

More detailed reporting of this study can be found in the May 2009 issue of the Journal of Healthcare for the Poor and Underserved.

http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/

by Sherry Dineen

Understanding is Key to Staying Out of the Hospital - Part II

2009-07-13T13:44:00.001-07:00

Monday’s Blog discussed how many Medicare patients end up being readmitted to the hospital in part due to lack of understanding of follow-up care.

Another recent study by the Northwestern University Feinberg School of Medicine, found 78% of patients do not fully understand their discharge instructions before leaving the emergency department. To make matters worse, they found that 80% of the time patients were not even aware they did not understand their discharge instructions.

Kirsten Engel, M.D., lead study author and instructor of emergency medicine at the Feinberg School of Medicine said, “Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department.”

The study assessed 138 patients from Anne Arbor, Michigan according to four categories of comprehension (diagnosis and cause, emergency department care, post-emergency department care and return instructions.) Fifty-one percent did not fully understand what they were told in 2 or more categories.

According to Engle, “The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care instructions in the emergency department… When you are in the emergency department, be honest and don’t be afraid to ask questions.”

It turns out understanding what you should do at home after leaving a doctor’s care is important for your recovery. Yet many patients do not fully understand their post-hospital care instructions and are not even aware of their misunderstanding.

As far as we know the study did not account for language difficulties so we assume the study participants were English speakers. Imagine what the study would find for Non-English speakers…

By Sherry Dineen

This study was published online in July of 2008 by the Annals of Emergency Medicine.
www.annemergmed.com/

Understanding is Key to Staying Out of the Hospital - Part I

2009-07-13T13:01:00.000-07:00

A recent study by the Northwestern University Feinberg School of Medicine examined the frequency of rehospitalization, the risk of readmission and the frequency of follow-up outpatient doctor visits before being discharged from the hospital. The study looked at fee-for-claims service data for roughly 12 million Medicare patients discharged from a hospital in the years 2003 and 2004.

What the study found was astounding.

One out of five Medicare patients is readmitted to the hospital. The healthcare tab for readmissions in 2004 was 17 billion dollars. More than half of the patients that are rehospitalized within 30 days did not see a physician as an outpatient after being released the first time.

The study found that the rate of readmission increases as time passes from the first hospitalization. Thirty-four percent of patients were readmitted within 90 days of release and that number increases to 56.1 percent after one year of release.

Of those readmitted, 70 percent suffered from complications that could easily have been prevented by follow-up doctor visits such as urinary tract infections or pneumonia.

The study co-author, Mark Williams, M.D., chief of hospital medicine for Northwestern’s Feinberg School of Medicine and Northwestern Memorial Hospital, commented that Medicare does not pay doctors or pharmacists to spend time with patients to make sure they understand their discharge and medication instructions when they leave the hospital. “They pay for quantity of service, not quality.” He further adds, “They [Medicare] do not target payments to improve patient understanding of their care and their need for follow-up.”

“When patients and their caregivers understand the goals of their care, they commonly get better relief from their symptoms and use less health care services at their request,” Williams said.

Creating understanding for all patients regardless of their age or language spoken is the key to reducing our country’s healthcare costs by keeping needless hospital readmissions to a minimum.

Check back on Wednesday for Part II and read about another study linking understanding with improved healthcare.

by Sherry Dineen

The study was published in the New England Journal of Medicine on April 2, 2009 and can be found using the following link:
http://content.nejm.org/cgi/content/full/360/14/1418

Mr. Williams’ comments can be found at: http://www.northwestern.edu/newscenter/stories/2009/04/medicare.html

Culture Affects Fitness

2009-06-25T13:44:00.000-07:00

Exercise (no surprise) and culture (surprise!) were part of the focus at the Annual Meeting of the American College of Sports Medicine in Seattle at the end of May.

As part of the research presented, one study, conducted by Rafer Lutz, Ph.D., came to the conclusion that when under stress, college women who do not exercise regularly are less likely to exercise.

According to Lutz, “Someone who isn’t regularly active may view exercise as ‘one more burden’ when stressed.”

On the other hand, the study found college women with consistent exercise levels, “accumulate more physical activity” when similarly stressed. Lutz again expounds, “those who make it [exercise] a part of daily life may view it as a stress reliever and an escape from pressure.”

A second study presented at the Annual Meeting examined exercise differences between 400 American and Chinese college students. Researchers found that Americans exercise for weight control and physical appearance, whereas the Chinese students exercised for health and enjoyment reasons.

Lead study author, Zi Yah, M.S. concluded, “Although we didn’t study the origins of these exercise motivations, it may be a reflection of cultural values and what young people are taught to prioritize about themselves.”

Expanding this connection between exercise and culture further to include older women, another study is of note. In 2005, at the Second International Conference on Women, Heart Disease and Stroke, University of California San Francisco School of Nursing researchers proposed that exercise in tune with culture creates better program compliance.

They provided a Tai Chi program to older Chinese women with at least one major risk factor for coronary heart disease. Normally exercise programs for women with heart disease have high dropout rates but the retention rate for this one was 96% and there was a waiting list for the next session.

Part of the success of the study resulted from the researchers being culturally in tune with the group. One researcher, Ms. Taylor-Piliae had spent 15 years in Hong Kong, speaks Cantonese and is familiar with the culture. "Language was not a barrier to understanding in this study," she said. "This is important."

Researchers learned that Tai Chi appears to be a form of exercise that is safe and acceptable to Chinese women. "I think the key is to find out what already is a popular form of exercise within an ethnic group. If it is safe and is equivalent to brisk walking, then it not only may be effective, but more acceptable."

Risky Business

2009-06-18T10:04:00.000-07:00

The FDA’s latest draft Industry Guidance paper addresses how drug companies should present risk information in ads for prescription drugs and medical devices. It is meant to illustrate factors the FDA considers when evaluating ads and labeling for drugs and devices for compliance to relevant regulations. It delves into the mind of the consumer and provides examples on how companies should present risk information.

Risk information is critical to both health professionals and consumers and needs to be clearly communicated to its target audience. According to the FDA, omission or minimization of risk information is the most common violation of regulations for product advertising and promotion. They also claim research in Direct to Consumer (DTC) prescription drug advertising has shown that:

“60 percent of patients believe ads directed at them do not provide enough information about risks”
“60 percent of physicians believe that patients have little or no understanding from these ads about what the possible risks and negative effects of the products are” and
“72 percent of physicians believe that patients have little or no understanding from these ads about who should not use the product”

To comply with regulations ads cannot be false or misleading, they must reveal facts about the product and consequences from its use and they must present benefits and risks in a balanced manner. In other words, you can’t play up the drug’s benefits while downplaying its risks.

When evaluating a promotional piece, the FDA evaluates the net impression communicated by all the elements of the piece. It does so using “well-developed social science principles supported by decades of scientific research.” They use science to figure out how we understand best.

For example, the FDA explains how research indicates when people process a list of text they are better able to recall items at the beginning or end of the list. So ads should not insert important risk information in the middle of reams of text.

They also discuss how cognitive load, or the mental effort required to take in information, is affected by the amount of information presented and in what way. Word choice, loud colors and busy graphics can be distracting or put more emphasis on one piece of information versus another.

The bottom line from the guidance paper is that drug and device communications need to present risk and benefit information in a balanced manner and in language that is clear for its target audience.

A Wall Street Journal article reported that drug makers “remain committed to producing responsible, balanced promotional materials” and have adopted voluntary guidelines that say risks “should be presented in clear, understandable language without distraction.” via a PhRMA spokesperson.

Sales, Science and CME

2009-06-11T08:14:00.000-07:00

Pharmaceutical sales reps are taking advantage of the same Continuing Medical Education (CME) programs usually offered exclusively to healthcare providers. By obtaining a broader understanding of the science that supports and differentiates their company’s products, sales reps hope to differentiate themselves from their competitors.

The idea seems to have merit. So far, one pharmaceutical company has determined that their sales reps should be accredited and has teamed up with the American Society of Hypertension (ASH). Beginning this summer, Daiichi Sankyo will be sending sales teams to a Hypertension Accreditation Program designed to improve their understanding of hypertension and related cardiovascular diseases.

“Physicians prefer to interact with well-informed pharmaceutical sales representatives who not only understand the company’s products, but have a keen appreciation for the disease and underlying science.” - Henry R. Black, MD, President of ASH

The idea of CME training for pharmaceutical sales reps is not a new idea, although in the past, the content of such training was largely centered on the regulatory and compliance issues that directed the interaction between sales representatives and healthcare providers.

While our global economy is experiencing a downturn, pharmaceutical company leaders are optimistic about the future. Part of that confidence, it seems, comes from the idea of a smaller, but scientifically savvy, sales force. Beginning with the recruitment of medically competent candidates, and then providing continuing medical education, the name of the game to stay ahead is differentiation.

In an industry experiencing tremendous shifts - from the path of product development to new avenues in marketing - competition for market share is intense. CME accreditation could be another way for a company to set itself apart from the field. But, with more knowledgeable sales teams leading to stronger communication with healthcare providers, the patient’s health is ultimately better for it.

by Audrey Miller

How Do You Know Your Translation Provider is Good?

2009-06-03T09:44:00.001-07:00

¿Comprendes?

2009-06-02T10:18:00.000-07:00

Please read the following information carefully as it pertains to the medication prescribed to your child:

Para recibir la cantidad correcta de medicamento es indispensable cebar el inhalador. Cébelo antes de usarlo por primera vez o cuando no lo haya usado durante más de 14 días. Para cebarlo, quítele la tapa a la boquilla del disparador. Después, agite bien el inhalador y haga una pulverización al aire, lejos de su rostro. Para terminar de cebarlo, haga otras dos agitaciones y pulverizaciones de esta forma.

So, if you only speak English, do you now know how to give your child his or her medication? How does this make you feel right now? Confused? Angry? Concerned? Imagine being a non-English speaker and this is how the piece of paper stapled to your prescription medication reads:

You must prime the inhaler to get the right amount of medicine. Prime the inhaler before you use it for the first time or if you have not used it for more than 14 days. To prime the inhaler, take the cap off the mouthpiece of the actuator. Then shake the inhaler well and spray it into the air away from your face. Shake and spray the inhaler like this 2 more times to finish priming it.

Filling a prescription may not help you if you are unable to understand when or how to take it. The leading cause of medication errors is patient misunderstanding of prescription drug label instructions.

A new study from Northwestern University surveyed pharmacies in Texas, Colorado, Georgia and North Carolina where there are large Latino populations. Of the 764 pharmacies, only 43.3% could offer instructions in Spanish. 21.7% offered some translation services and 34.9% offered no services.

Most pharmacies offer none or limited translation services and not just in rural areas or those with small Latino populations. The conclusion of the study was that “Spanish-speaking patients encounter barriers to acquiring instructions that support the safe and effective use of medications.”

Should knowing how to take your medication properly be limited to persons who only speak English? That seems rather discriminatory. In a country where we have so much, is being able to read your prescription medication instructions too much to ask?

Outsourcing Clinical Trials: Up for Debate

2009-05-28T12:47:00.000-07:00

The ethics of pharmaceutical companies conducting late-stage human drug trials overseas is the hot topic of the day. An article published today by a few researchers from Duke University in the New England Journal of Medicine has sparked a debate among the big guns: the Wall Street Journal, the New York Times, CNN, Triangle Business Journal, HealthDay, even the FDA is chiming in.

A point of debate includes whether drug research in other countries where there may be genetic variations (such as in East Asia where the physical reaction to nitroglycerin varies) is relevant to American populations. It is questioned whether a trial for fibromyalgia for instance, is even needed in a country where tuberculosis is the norm. Lack of foreign oversight by institutional review boards, adequately discussed informed consents for subjects, and unfair financial inducements to subjects are some of the other points of discussion. The author’s research methods are also under fire.

Right or wrong, the best way to conduct ethical overseas drug trials is to ensure the rights of the trial subjects. This needs to happen through clear and concise communication with patients. Their rights are protected and the integrity of the pharmaceutical industry is preserved only when they are able to fully understand the process they are undertaking.

To ensure clear and concise communications overseas, a top-quality language vendor who specializes in medical and life science translation must be utilized. Not only do we provide translations performed by professional linguists with advanced degrees in medicine, biology, chemistry and pharmacology, aiaTranslations also has a new product, REEL CONSENTTM, an instructional video designed to provide improve enrollment and consent quality in non-English speaking and low literacy populations.

To see the original article by the New England Journal of Medicine, click the link below:
http://content.nejm.org/cgi/content/full/360/8/816

Reaction articles include:
CNN.com
http://www.cnn.com/2009/HEALTH/02/18/outsourced.trials/index.html
HealthDay
http://www.healthday.com/Article.asp?AID=624242
Triangle Business Journal
http://triangle.bizjournals.com/triangle/stories/2009/02/16/daily42.html

Go to www.wsj.com and www.nytimes.com to see responses from the Wall Street Journal and the New York Times.