Archive for the ‘Global Health’ Category
Posted in Advocacy, Assistance, Discrimination, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, Promotions, State of Washington, Translation on 20 December 2013 | Leave a Comment »
Posted in Advocacy, Discrimination, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, State of Washington, Translation, tagged language translations, quality translations, translations, Washington Healthplanfinder, Washington State on 10 December 2013 | Leave a Comment »
The irony was not lost for me that while writing on the positive results of the FDA’s use of translation services, that here in my state, once known as a national leader in language services, we are still struggling to get quality translations for our Health Benefits Exchange (HBE). The efforts to achieve this goal have been a major focus for the Washington State Coalition for Language Access, and its been a year now since we co-authored with Northwest Health Law Advocates the report Language Access in Washington under the Patient Protection & Affordable Care Act expressly for the HBE efforts. Now with 175,000 enrollees, Washington State deserves the praise it’s getting for the record-breaking enrollment figures in the new health insurance marketplace Washington Healthplanfinder, especially compared to the situation in neighboring Oregon and to the federal Healthcare.gov platform. But the picture is much less rosy regarding providing equal access for Washingtonians with limited English proficiency (LEP), who now number some 8% of state population or half-million residents, representing an increase of 210 % in the past decade . Demographic data on enrollees is said not to be available.
We are now less than 2 weeks away from the enrollment deadline for coverage to start Jan. 1, 2014, and the consumer fact sheets that were intended to inform the public of the options under the ACA have not yet been made available to Washington’s LEP population. Even though work began in July to replace the problematic original translations – errors brought to HBE’s attention by advocates- there are still no consumer fact sheets available in Washington’s threshold languages ( in written form these are: Chinese, Lao, Khmer, Korean, Russian, Spanish, Somali, and Vietnamese).
In addition, the Spanish versions of the paper application for Healthplanfinder, while continuing to be publicly available, have contained horrific translation errors. In the section which inquires about the applicant’s citizenship status, the phrase ” Non-citizen legally present in the US” was translated into Spanish to mean just the opposite, i.e., the translation says “ non-citizen not legally present….” , complete with the I-word in Spanish in version #1. After the mistake was identified on Oct. 15 , again by advocates, staff said they took immediate action to have the vendor correct it. The screenshots included here show the sections containing the mistranslations.
Spanish version #1
This one particular error may now have been recently corrected for a 3rd iteration, through volunteer efforts of local language access advocates trying to beat the clock to help consumers. However, we hear anecdotally that more translation concerns persist and can’t be confident that there are not similar errors in the translations in the other languages.
What remains a mystery is how this sorry state of affairs has come about, and if there were ever robust quality assurance measures in the procurement chain for the translations. It is beyond comprehension how such blatant errors could be made given that the work was done by vendors holding official State contracts who must affirm that they use qualified translators and proper translation procedures. And if this is happening in Spanish, the 2nd most used language in both our State and nationally, and thus one for which there is an ample number of nationally-certified translators available to do the work, there is a real reason to fear that similar egregious errors may exist in other language translations.
Shortly before Thanksgiving, HBE staffers announced at a meeting of its Health Equity Technical Advisory Committee, that work halted back in June to create a Language Access Plan (LAP) for the HBE requested by the TAC , will resume in the new year. LAPs are meant to serve as blueprints to guide the work of agencies and programs to comply with the laws requiring they provide language services, and to help prevent the kind of problems that we’ve being seeing here in the other Washington. I’ll continue to report on the work in progress.
Posted in Consumer Protection, Environmental Health, Ethics, FDA, Global Health, Health Care Marketing, Hispanic/Latino, Language Services, Paitent safety, Patient Safety, Promotions, Translation on 9 December 2013 | 3 Comments »
Two recent news stories about honey, illustrate yet again the vital importance of communications to health. In these completely unrelated cases, it was all about translations, the rendering of messages from one written language to another. The fraudsters seemed to have assumed they could get away with selling their products to unsuspecting consumers due to a lack of language skills on the part of regulatory authorities.
In September, Bloomberg Businessweek broke the story on a honey scandal at the global level with an article entitled The Honey Launderers: Uncovering the Largest Food Fraud in U.S. History , describing a convoluted plot by German company ALW to sell millions of pounds of Chinese honey in the US, by disguising its origins. Over the course of several years, ALW arranged with the Chinese brokers to channel their product through other countries, where it was filtered, doused with additives to disguise its unpleasant flavor, and re-labeled to make it seem to have come from nations authorized to export honey to the US. Some of the adulterated honey was also found to contain residues of the antibiotic chloramphenicol, long banned in the US. The impetus for the fraud was purely financial , as honey fetches top dollar in this country, the major world consumer. Over a decade ago when domestic beekeepers complained that honey imports from China were seriously undercutting their business, the US imposed such stiff tariffs on Chinese honey imports that little enters the country legally any more. But the super-cheap price of honey in China has remained a lure for international exporters. Some Chinese producers seize this opportunity to increase their own profits by artificially increasing the quantity of honey available to be sold. According to the FDA investigation of this case, a number of techniques like harvesting the honey early and not letting the bees complete the process naturally were routinely used in China, along with machine-drying the honey to speed things along. ALW abetted the process and instructed its 2nd-country middlemen to add sweeteners to disguise the sour taste caused by the premature harvesting.
In order to keep the doings secret, ALW officials exhorted the young German employees sent to run the firm’s US operations to use the phone, not emails, to discuss business and to conduct all communications in their native language. While the staff did restrict their discussions to the German language, they continued to use emails for correspondence. Their missives were later translated into English during the course of the FDA investigation. The federal prosecutor who worked on the case commented:
Earlier in the year in a less notorious case, the honey firm Nature Nate’s in Texas garnered FDA censure because it violated the instructions issued by the FDA following a 2012 audit, when the company was ordered to stop advertising its honey in ways that characterized it as a drug, i.e. by making various health claims for its products. While Nate’s had promised to stop the spurious marketing by Fall of 2012, an FDA follow-up in mid-2013 found that the firm continued to make these claims on its Spanish-language website, under the banner ” Remedios Caseros con Miel or Honey Home Remedies “, describing such benefits (in English translation) as:
• “Food Poisoning. Blend 1 Tablespoon Apple Cider Vinegar and 1 Tablespoon of North Dallas Honey dissolved in a glass of chilled water.”
• “‘[O]rganic honey’. A client of mine that is a doctor told me to try yours for allergy relief. It has COMPLETELY eliminated allergies for the entire household … it is our daily dose … “
A cached copy of the Spanish information on how to use Nate’s honey as an arthritis remedy said:
Para la artritis – 100% Pure Raw & Unfiltered Honey naturenates.com/espanol/para-la-artritis
“Receta 1. Tome una taza de agua caliente con dos cucharadas de miel y una cucharadita de canela en polvo por la mañana y la noche. …
And the phenomenon of the FDA using translation as an investigative tool is hopefully now a regular practice, as a evidenced by yet another recent case, this time involving the Sundial herbal supplement company which got an FDA Warning Letter based on claims made solely in Spanish which characterized its products as drugs. As a commentator for Regulatory Affairs so aptly explained
…just because a product’s unapproved claims aren’t in English, that doesn’t mean FDA isn’t paying attention.
Posted in Access to Medicines, Advocacy, Conflicts of Interest, Consumer Protection, Economics of Health Care, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Insurance, Healthcare Inequalities, Prescription drugs, Promotions, Tobacco control on 9 January 2012 | Leave a Comment »
As the new year starts, some ome items of note from near and far:
Posted in Advocacy, Conflicts of Interest, Consumer Protection, Economics of Health Care, Ethics, Global Health, Health Care Marketing, Health Insurance, Military medicine, Promotions, State of Washington, Tobacco control on 17 August 2011 | 1 Comment »
[Washington] State Insurance Commissioner Mike Kreidler has fined Regence BlueShield $100,000 for denying contraceptive coverage to 984 women.
Regence had covered the women’s use of an IUD, or intrauterine contraceptive device, but not the removal of it. When the women wanted to remove the device because it was outdated, or because they wanted to get pregnant, the insurance giant did not consider those reasons as “medically necessary,” state officials said Monday.
“There’s an important lesson here,” Kreidler said in a statement.
“If you believe you’ve been unjustly denied coverage, don’t just accept it, call us. Of the 984 women who were denied contraceptive coverage by Regence, only three appealed the decision – and all the denials were upheld.”
He said one woman’s call to his office resulted in coverage for nearly a thousand other women who were denied coverage over the span of eight years.
Five tobacco companies have filed suit against the U.S. government claiming that government-ordered graphic warning labels on cigarette packs violate their First Amendment rights.
Starting on Sept. 22, 2012, cigarettes sold in the U.S. will have to carry graphic images warning of the dangers of smoking. These images include a tracheotomy hole, rotting teeth, diseased lungs, and a body on an autopsy table.
The images will be accompanied by dissuasive wording on cigarettes and smoking, including “cigarettes are addictive,” “cigarettes cause cancer,” and “smoking can kill you.” They must be displayed on at least half of the front and back of cigarette packs, and 20% of the top of the pack.
The lawsuit was filed by four of the nation’s largest tobacco companies — including R.J. Reynolds Tobacco and Lorillard, and one smaller company (Sante Fe Natural Tobacco Company) — against the FDA and the Department of Health and Human Services.
The companies are seeking to prevent enforcement of the images, arguing that the government cannot legally force them to espouse an anti-smoking advocacy message….
This is yet another area of health promotion in which the US has long fallen short. Graphic warning labels on cigarette packs have been used in Canada since 2001, and dozens of other countries have followed suit.
A bit of both, local news that is national :
Madigan Army Medical Center surgeon Michael Eisenhauer says his military career foundered as he exposed cozy dealings between an Army doctor and a medical-equipment manufacturer. His whistle-blowing helped lead to the criminal conviction of one doctor; but Eisenhauer is still fighting to clear his own name.
Eisenhauer detailed a cozy relationship between the medical-equipment manufacturer Boston Scientific and two Madigan cardiologists, who insisted on sole-source purchases of that company’s implant devices.
The long-standing practice of drug companies and medical-equipment manufacturers offering doctors free trips, speaking honorariums and other payments is controversial. Critics say the money may often represent kickbacks for favoring a company’s drugs or devices.
Still, in civilian practices such payments are generally considered legal. In the military, however, doctors are prohibited from taking such payments.
“Military doctors must owe their allegiance to the soldiers and families they treat — not to drug companies or makers of medical devices,” said U.S. Attorney Jenny Durkan in a statement announcing the plea deal reached with Davis.
“That is why we have a bright line rule: doctors employed by the government cannot accept payments or gratuities from an outside source — especially one that is seeking government business.”