This week the NBC Today Show offers a series the likes of which makes my skin crawl. With 45-million uninsured Americans, the Today Show reports on "Saving Your Life: Modern Medical Miracles." If a miracle were available but nobody could afford it or access it, would it still be a miracle?
Riding the appeal of reporter involvement, the Today Show had Matt Lauer get a 64-slice cardiac CT scan. The MSNBC website explains that the machine is made by GE. The website says: "GE Healthcare's LightSpeed VCT is the world's first machine that enables physicians to capture images of a human heart in just five heartbeats — something no other CT system can offer." The website does not remind viewers that GE owns NBC. But why bother with disclosure when we're talking about miracles? And why bother with a discussion of the arguments against using such scans in healthy people?
Then, in a segment entitled "Magic Pill Scans Your Insides," Katie Couric swallowed a camera-in-a-pill to show us more of her insides that you may have missed from her last colonoscopy on the air. There was only scant discussion of costs and insurance coverage and no meaningful discussion of why we needed such a camera-in-a-pill in our growing medical armamentarium.
Please bring back Dave Garroway and the chimp.
A journalist bemoans the lack of skepticism in news coverage of Tamiflu in last week's edition of the BMJ.
"From a bit of a dud to the world's most sought after drug in the space of six months" is the way the writer describes Tamiflu's recent fate. "Despite a silly name and a lack of convincing evidence that it will have any real impact on an influenza pandemic, sales and recognition of the drug frequently dubbed 'our best hope against bird flu' have leapt through the roof."
He describes a British researcher who "routinely provides the media with positive comments about Tamiflu and has even appeared in promotional videos for the drug." Yet the man's ties to Tamiflu's manufacturer are rarely mentioned in the news. Another British researcher observes, "Perhaps the media should speak to more than one person when it's looking for comments or information. Somehow the mainstream media needs to think more on what it's going to do about this."
Sometimes journalism affords us a stunning glimpse of differences in the way we view health care. Yesterday was once such day, as the Associated Press and the Wall Street Journal published stories about strikingly different perspectives on the value of current treatments for Alzheimer's disease.
The AP story said that "families battling Alzheimer's disease and similar dementias increasingly are calling for a shot at riskier therapies that might bring bigger benefits than today's pretty safe but largely disappointing drugs." And it reported on a survey of elderly people at risk which showed that most accepted even the greatest potential for side effects for any shot at benefit.
The Wall Street Journal, on the other hand, described a preliminary British government decision to ask doctors to stop prescribing Alzheimer's drugs because the cost-benefit ratio wasn't good. The WSJ quotes a British National Health Service spokesman saying, "We reached a point a while ago where there is far more medical intervention available than any health-care system can afford."
The paper explains: " (In the U.S.) even the most cost-conscious insurers say they'll pay if a drug works and there aren't other options. Britain openly and unapologetically adopts the second course. If a drug or type of surgery costs a lot and helps only a little, it says no."
Kudos to the WSJ for presenting the big picture. Unfortunately, AP, which reaches all newsrooms, only told half the story on this day.
With sales reaching more than $700 million a year, makers of supplements glucosamine and chrondroitin sulfate have not been hurting.
But do the supplements relieve arthritis pain?
Depends on how you view the data from a big NIH study, presented last week at the American College of Rheumatology meeting, and reported in the Washington Post.
The principal investigator said, "The first take-home message is that in the overall study population, none of the supplements were better than placebo."
The Post reports that supplement industry folks are taking solace in one aspect of the study. "When researchers looked at the 20 percent of participants with moderate to severe pain, they found that 79 percent of those taking a combination of the supplements experienced pain relief, compared with 69 percent of those who took Celebrex and 54 percent of those who took placebo. The combination was also better than either supplement alone."
The Post quoted one rheumatologist trying to put this in perspective: ""It is encouraging that glucosamine and chondroitin seem to help some people who have a significant knee disease -- it's something to consider -- but to think that it has replaced anything or works better across the board wouldn't be correct."
Former WFLA-TV Tampa news director Forrest Carr wrote me a long e-mail criticizing my BMJ article of last week, in which I reported my analysis of 3 top TV stations' performance in covering (or not covering) health care reform or health policy issues in the 2004 election year.
It was an exhaustive analysis, in which I studied 326 hours of newscasts -- the stations' showcase late newscasts. But Carr wrote:
"Your conclusion that the local TV news media "don't want to cover" health policy stories based on a study of this one time period is not sound. WFLA-TV, for instance, does 5 hours of news each weekday. To make a broad conclusion about the station's overall journalistic efforts on any topic based on a study of that one unique 11 p.m. half-hour program is like studying the metro section of your morning newspaper to the exclusion of all else, then concluding on that basis that the newspaper doesn't cover national news. It just doesn't hold up. To claim that WFLA-TV covered "only three stories in ten months on Medicare, totaling less than 2.5 minutes" is flat wrong."
No one in TV news would dispute that their late newscasts are their showcases -- their money-makers. They want to put their best product on the air in those newscasts. Yet very little news about health policy or health care reform appeared in 10 months of these newscasts during an election year. The data don't lie, mislead or distort.
Carr also wrote: "...as long as we fund TV news the way we fund it now -- through advertising dollars awarded in proportion to the size of the audience attracted -- you're going to get what we've got, specifically, newscasts that balance public service against the business needs to grow ratings, with business needs usually taking priority. Even if you do manage to somehow force changes in the program to present more of the kind of content you and a thousand and one other special interest constituencies want and demand, unless you somehow manage to find a way to tie people to their chairs, you still can't make the public sit through it -- at least not in large numbers."
TV viewership has declined in most analyses. Maybe it would rise again if news departments -- and the corporations to whom they answer -- addressed vital citizen issues instead of some of the pablum they now put on the table.
I respect Forrest Carr as one of the good guys in TV news. He is smart and he cares. But it is the job of journalists to mirror and address the needs of the population. And health care reform is one of the biggest such needs. I don't represent any special interest constituency. But there are 40-million Americans without health insurance and millions others lost in a tsunami of confusion over Medicare and prescription drug testing/marketing/pricing issues. They deserve more serious journalism in the newscasts which TV stations hold up as their best.
TV stations don't own the airwaves. They've been granted a license to serve the audience. On this issue -- one of the most important facing the nation -- my analysis showed a failure to earn the license.
In his weekly radio address last weekend, President Bush called the new Medicare drug benefit "the greatest advance in health care for seniors and Americans with disabilities since the creation of Medicare 40 years ago."
OK, that's his view. Here are what some of the nation's newspapers think:
* Arizona Republic: In enacting the Medicare drug benefit, "Congress created a deeply flawed program of fiendish complexity with a price tag that is headed through the roof," a Republic editorial states. The editorial continues that lawmakers should "make some drastic changes, starting with allowing the government to negotiate better drug prices."
* Baltimore Sun: "It should soon be abundantly clear to lawmakers hoping for re-election next year that the drug benefit program desperately needs to be retooled," particularly to allow "Medicare to use the bargaining leverage of its 40 million beneficiaries to negotiate drug prices with pharmaceutical companies." According to the editorial, "The program as constructed is paying way too much for way too little in direct benefits to seniors." It continues, "Much more also needs to be done to make the benefit program comprehensible to its users."
* Chicago Tribune: The new drug benefit "is a runaway government entitlement of mind-numbing complexity, rammed through Congress with cooked numbers, launched at a time when the country can least afford it," according to a Tribune editorial. The editorial says that the "benefit is so confusing and so ineptly constructed that many seniors are likely to take a pass."
* Denver Post: The program could become "the mother of all federal boondoggles".
* Detroit Free Press: The new drug benefit is "hardly all-encompassing," and "[w]orse, the signup process is so complicated it's discouraging."
* Los Angeles Times: Medicare beneficiaries who enroll in the prescription drug benefit will "need an actuarial adviser, a personal pharmacist, a high-speed computer connection and maybe a sharp 12-year-old to help them navigate the Medicare Web site."
* Nashua Telegraph: The benefit is "off to a rocky start" because "the Bush administration and GOP leaders in Congress wanted to use 'competitive market forces' to deliver" the program, a Telegraph editorial states. The editorial adds, "Congress should be taken to task for developing a prescription drug plan that is so unclear and complex."
* Seattle Times: "The array of options and maze of forms" for the Medicare prescription drug benefit are "daunting."
The Lancet is challenging an editorial published last month in the New England Journal of Medicine that called the results of several studies of Genentech's Herceptin cancer treatment "revolutionary." The October 20 issue of the NEJM published three studies that found patients with early stage metastatic HER2-positive breast cancers who received Herceptin along with standard chemotherapy were half as likely to experience recurrence of tumors as patients with similar cancers who received chemotherapy alone. In an editorial accompanying the studies, Gabriel Hortobagyi of the M.D. Anderson Cancer Center called the results "simply stunning" and "revolutionary" and even said that Herceptin was "maybe even a cure" for breast cancer. The Lancet says "The excitement is premature. ... It is profoundly misleading to suggest, even rhetorically, that the published data may be indicative of a cure for breast cancer."
Consumer ads for a class of antidepressants called SSRIs often claim that depression is due to a chemical imbalance in the brain, and that SSRIs correct this imbalance, but these claims are not supported by scientific evidence, according to a new article in PLoS Medicine.
The researchers studied U.S. consumer ads for SSRIs from print, television, and the Internet. They found widespread claims that SSRIs restore the serotonin balance of the brain. “Yet there is no such thing as a scientifically established correct ‘balance’ of serotonin,” the authors say. They say that in the scientific literature it is openly admitted that the serotonin hypothesis remains unconfirmed and that there is “a growing body of medical literature casting doubt on the serotonin hypothesis,” which is not reflected in the consumer ads.
The authors point out that the widely televised animated Zoloft (setraline) commercials have dramatized a serotonin imbalance and stated, “Prescription Zoloft works to correct this imbalance.” Advertisements for other SSRIs, such as Prozac (fluoxetine), Paxil (paroxetine), and Lexapro (escitalopram), have made similar claims.
The authors say that while the Irish equivalent of the FDA, the Irish Medicines Board, recently banned GlaxoSmithKline from claiming in their patient information leaflets that paroxetine (Paxil) corrects a chemical imbalance, the FDA has never taken any similar action on this issue.
Commenting on the work, Australian researcher David Healy said: “The serotonin theory of depression is comparable to the masturbatory theory of insanity. Both have been depletion theories, both have survived in spite of the evidence, both contain an implicit message as to what people ought to do. In the case of these myths, the key question is whose interests are being served by a widespread promulgation of such views rather than how do we test this theory.”
Editorials:
The Charlotte Observer: "[I]t's one thing to have a plan and quite another to have the capacity to carry it out." The plan "depends on citizens seeking and getting medical help when flu symptoms crop up," but "millions of Americans lack health care coverage."
The Greensboro News & Record: "Stockpiling drugs doesn't amount to preparedness."
Opinion Pieces
Daniel Hollander, UCLA professor of medicine, in the Los Angeles Times: "Once again, President Bush is misinforming the public," because there is "no effective vaccine against bird flu, ... no proven therapy" and "no proof that the present bird flu virus can be transmitted from person to person." He concludes, "It is time to stop misinforming the public and time to stop fanning mass hysteria."
Marsha Mercer, in the Richmond Times-Dispatch: "If we can't get shots to Americans for the ordinary flu that comes every fall, what will happen if, and more likely when, the dreaded bird flu arrives?" She continues, "The government's plan relies on several assumptions -- that people will cooperate, that they'll accept rationing of drugs, that they'll stay at home and stay calm. That requires people to trust their government."
There's been too much hype about the antiviral drug Tamiflu as an answer to stopping an avian flu pandemic. U.S. Health & Human Services Secretary Michael Leavitt reminded Congress last week that Tamiflu has not yet been proven as a treatment for avian flu, adding, "Any sense that Tamiflu is synonymous with preparedness is wrong."
See my article in the BMJ this week about the shameful performance of three leading local television stations as they failed to cover health policy issues in any meaningful way in the 2004 election year –- on the local, state, or federal level.
I analyzed 10 months or 326 hours of late newscasts on award-winning stations in Seattle, Chicago and Tampa.
KIRO/Seattle had only three stories in ten months, totaling 79 seconds, on any aspect of the George W. Bush or John Kerry health proposals in the 2004 presidential campaign.
WMAQ/Chicago had nine stories, totaling less than four minutes, on presidential candidates’ health plans. WMAQ had almost twice that many stories (16) on low-carb diet stories, including commercial-like promotions for new low-carb products offered by Wendy’s, Kentucky Fried Chicken, Starbucks, and Jack Daniels.
WFLA/Tampa devoted only 84 seconds to Bush-Kerry health platforms in six stories. Serving the senior-heavy Florida Gulf Coast, WFLA managed only three stories in ten months on Medicare, totaling less than 2.5 minutes.
With 40-million-plus Americans uninsured, in 10 months these three award-winning stations reported only one story on the uninsured. It was about an uninsured man with melanoma who won a state lottery.
There are many in this country who now accuse the President of shifting the focus from bad news to better news. I submit that public officials are able to do that only to the extent that journalists let them. And these TV journalists let important health policy issues fall off the radar screen.
The Wall Street Journal reports that state and local officials said they support the national strategy to prepare for an avian flu pandemic and have begun making their own plans, but some expressed concern that the funding earmarked for their efforts in the president's plan is insufficient. States will be responsible for 75% of the cost of buying antiviral drugs. The Journal reports that Rex Archer, president of the National Association of County and City Health Officials, said the cost-sharing plan is a "beautiful strategy to pass the buck." He added, "Plans don't mean much if there aren't the people to do it at the local level." Archer also said the funding for states under the plan contradicts a separate plan by the Bush administration to reduce by $130 million this year federal funding for state and local health department's general preparedness efforts. In the New York Times, Mary Selecky, secretary of health for Washington state, said the Bush administration's funding priorities are "a little out of whack," adding that the plan should do more to improve state health departments and less to purchase drugs to fill national stockpiles. And in the Los Angeles Times, Linda Rosenstock, dean of the University of California-Los Angeles School of Public Health, said the additional costs will burden health systems already strained by existing problems. She said, "We have had evidence for decades of erosion of the public health infrastructure."
Is it just coincidence that brand-name prescription drugs have been rising in price so much so soon before the start of the new Medicare drug benefit?
The Star Tribune reports that brand-name drug wholesale prices rose six percent in the past year, twice the rate of inflation and far higher than generic drug increases. John Rother of AARP is quoted: "Why are prices of brand-name drugs going up so much faster than generic drugs or inflation? Because the generics face competition, and the brands really don't."
The Philadelphia Inquirer reports on a bizarre drug industry fiasco.
Excerpt: "A pharmaceutical consultant secretly commissions a novel about terrorists poisoning Americans with medicine from Canada, then backs out and inadvertently spawns a thriller pillorying his own industry.
This is no pulp-fiction farce. Call it bookgate, an impossible-to-make-up public-relations disaster now dogging the pharmaceutical industry.
Its real-life cast includes a deputy vice president of the country's drug lobby, a celebrity divorce lawyer, a tell-all book publisher, and even former New York Times fabricator Jayson Blair in a cameo.
"It's a nightmare beyond nightmares," admitted Mark A. Barondess, the consultant who initiated the book deal and now calls it a mistake.
Ken Johnson, senior vice president of the Pharmaceutical Researchers and Manufacturers of America, or PhRMA, said the "idiotic" scheme had been concocted by an outsider with unauthorized help by one person in the trade group.
"We didn't know anything," Johnson said. "We have credible, safety-based arguments supporting our position against importation. We're not in the business of publishing pulp fiction and Looney Tunes." "