In the wake of the recent US measles outbreak, Public Health Seattle King County has published searchable data on student immunization levels covering all K-12 schools in the county. Data fields include vaccination completion rates at each specific school ( color-coded to show rate levels); MMR immunization among kindergarteners; and immunization coverage rates in general among kindergarten and 6th grade students. The sociodemographic correlations to vaccination rates reflect the national trends that have made headlines, are not a surprise to locals. Kudos to the PHSKC team for innovative use of technology in the public interest!
Archive for the ‘Ethics’ Category
Posted in Advocacy, Discrimination, Ethics, Health Disparities, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Paitent safety, Patient Safety, Translation on 30 November 2014 | Leave a Comment »
In recent weeks I’ve received email alerts announcing “Hospitals Making Progress on Health Care Disparities“, a new study from the American Hospital Association’s Hospitals in Pursuit of Excellence program and associated organizations. I took a look first at the infographic accompanying the notices, and then at the published study itself, the 2013 Diversity and Disparities: A Benchmark Study of U.S. Hospitals. It was no surprise to read that the demographic profile of hospital executives and boards is still so far from representative of the general population, since the last HPoE study in 2011. However, the 2013 study reports data on language services in hospitals that raised my eyebrows ( 2011 comparison data points shown in parentheses):
- 95% (90%) are collecting data on primary language of patients
- 87% (80%) are translating forms and documents for patients
- 66% (61%) collected information on patient language needs
Leaving aside the matter of ascertaining the difference between collecting “primary language of patient” and “patient language needs,” these highly encouraging results led me to seek details in the source report. Having recently done extensive research for my own presentation on the status of language services in healthcare for the 2014 WASCLA Summit, the HPoE findings seemed even more amazing. What I found in the report itself , which did conclude that more needs to be done to achieve equity of care in the broader sense, was that some basic background and research points seemed not to have been included or were too limited in scope to be meaningful. For example, the report did not include the list of hospitals which had participated in the survey, nor how the recent cohort compares to the 2011 and 2009 participant groups. There was no discussion of the statistical validity of the response rate of 1109 hospitals (~19% of all 5922 AHA member hospitals invited to participate), nor how representative the response sample is for hospitals nationwide. For example, while the study noted that all data was self-reported, there was no mention of the possibility that only hospitals which have disparities reduction initiatives chose to participate. I am pursuing the actual data used for the study, and hope to have information to share soon.
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 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.