If the meeting of the British Medical Association (BMA) is representative of British physicians, writes BMJ editor Fiona Godlee, "there's an astonishing consensus among UK doctors about the health service (they) want." The BMA met in Belfast this week, and Godlee says "There was no mistaking the passion among BMA representatives for a publicly funded, freely available national health service....Equally overwhelming was rejection of US-style health care." She writes that those at the meeting agreed that the values of the current British National Health Service (NHS) could not be delivered through private corporations.
Godlee writes: "There's enough bad news about America's health system to justify this wholesale rejection. On top of the familiar spectacle of inefficient and fragmented care, spiralling costs, and growing inequities of access, there's now evidence that quality of care is patchy and worse overall than in other developed nations. There's an irony in the UK government being in thrall to US-style health care, while US commentators now hold as their exemplar the Veterans Health Administration—America's nearest thing to the NHS."
Nonethless, the BMA meeting showed the concerns over future directions of the British health care system. According to the BMJ, some doctors "blamed the government for the financial crisis in the NHS, saying that it has taken a record amount of money away from the care of patients and 'squandered' it on unproved reforms."
Don Berwick and the Institute for Healthcare Improvement have done important work in addressing health care quality issues. But they may have overstepped the boundaries of evidence with a recent study that drew a lot of news coverage, claiming that hospitals they worked with saved over 122,000 lives by cutting down on errors and improving care.
"The Numbers Guy" column by Carl Bialik in the Wall Street Journal says the studies warrant a second opinion. Bialik quotes Dr. Bob Wachter of UCSF, author and lecturer on medical errors: ""I don't think it saved 122,300." He added that, like in a political campaign, the health-care campaign used "statistics selectively to try to mobilize your base to do good. It's understandable. It's not good science."
Dr. Gil Welch of Dartmouth and the VA said, "I think there's been a tendency in the errors business to first overstate the size of the problem, and now, I'm afraid, to overstate the effect of interventions on the other side."
Read Bialik's full article. It does a good job of questioning claims and pointing out how well-intentioned advocates may be driven by passion more than by evidence, and how journalists can easily get sucked into the vortex. (Bialik points out how the Wall Street Journal reported the Berwick claims, along with the Associated Press, U.S. News & World Report and many other media.)
Congressman Henry Waxman has published a new report on the FDA - the result of a 15-month investigation. It finds that there has been a "precipitous drop in FDA enforcement actions over the last five years." The main findings:
* FDA enforcement actions have declined under the Bush Administration. The number of warning letters issued by the agency for violations of federal requirements has fallen by over 50%, from 1,154 in 2000 to 535 in 2005, a 15-year low. During the same period, the number of seizures of mislabeled, defective, and dangerous products has declined by 44%.
* FDA headquarters officials have routinely rejected the enforcement recommendations of career field staff. Internal agency documents show that in at least 138 cases over the last five years involving drugs and biological products, FDA failed to take enforcement actions despite receiving recommendations from agency field inspectors describing violations of FDA requirements.
* FDA’s recordkeeping and case tracking practices are inadequate.
Harvard's Dr. Jerry Avorn, in a letter accompanying the report, writes, "one is left with the image of an organization unable or unwilling to do its job effectively."
The New York Daily News boasts on its website about the community service it is providing with its seventh annual week-long free prostate cancer screenings.
They profile a 45-year old African-American man who came in for screening because his father was diagnosed with prostate cancer a few years ago. His race and his family history do put him at higher risk.
But then the News says that man “is one of thousands of men who have sat down for a simple blood test.” What they don’t tell you is that most of those thousands are not at high risk of a cancer that could kill them. But the News goes on to quote a local urologist who says, "You save one person, you're doing a good job."
Yes, you are. But at what cost? The doctor and the newspaper should have explained how many men need to be screened in order to save one life. How many will have false-positive tests, telling them they have a problem when they really don’t? How many will endure the anxiety, discomfort and expense of a biopsy needlessly? And how many men who do have true elevated PSA levels actually have a cancer that will hurt them in their lifetimes?
That’s why whenever someone calls this a “simple” test, I shudder. There’s nothing simple about it, nor about the decision to have it or decline it.
The U.S. Preventive Services Task Force doesn't recommend annual PSA screening. These are the facts that should have been provided.
But advocacy journalism is sometimes blind to the facts that people need to make good health care decisions. Rather than sponsoring week-long free screenings, the paper would provide a bigger public service by sponsoring open, balanced, evidence-based discussions of the harms and benefits of various screening tests. That would make consumers smarter. And it would hurt no one.
The Gannett Company has sold a 32-page issue of an insert entitled "USA Weekend HealthSmart" to drug company advertisers and to newspapers across the country. The New York Times reports that the insert appeared in 76 newspapers with an estimated circulation of 7.5 million.
I was one. I am no smarter for having scanned the section. I have, however, become familiar with many more drug ads thanks to this piece of fish-wrap. You can't call it news. There's lots of "advice." And then there are all the ads.
There is one four-page spread from Astra-Zeneca that could lead just about any reader to self-diagnose with bipolar disorder. The ads ask if there's ever been a period when you flew off the handle at little things...needed less sleep...felt irritable...were much more interested in sex than usual, etc. If so, the ad goes, you may need treatment for bipolar disorder. Gee, that's about 100% of us. What a nice market!
Sadly, this won't be the last of such bombardments. The Times reports: "Executives at USA Weekend initially considered the issue to be a test. But after seeing the results — more than 16 advertising pages, from marketers like AstraZeneca, Johnson & Johnson and Pfizer, bringing in more than $3 million in revenue... they are already looking at publishing HealthSmart again, perhaps as soon as the fourth quarter."
And the Times story suggests this is a sign of the health of U.S. newspapers. If this is healthy, I don't want to see sickness.
At least CNN doesn't discriminate based on gender when it gives screening test advice that clashes with evidence-based guidelines.
Back in February, CNN's Sanjay Gupta gave screening test recommendations to men at various ages. The advice flew in the face of unbiased, authoritative guidelines of the U.S. Preventive Services Task Force (USPSTF).
Then on Mother's Day weekend in May, CNN's Elizabeth Cohen gave women screening test advice that also conflicted with USPSTF recommendations.
See my full commentary on this topic.
To promote screening in groups for whom the evidence of benefit is not clear and for whom the evidence of some harm is significant is not good journalism. It is a form of advocacy journalism that is advocating the wrong things.
Dartmouth's Steve Woloshin and Lisa Schwartz have studied the pitfalls of news coverage based on scientific meetings. Their new work, in the Medical Journal of Australia, looked at print and broadcast news stories based on research reports at five major scientific meetings on heart disease, AIDS, cancer, neuroscience and radiology.
Results: "34% of the 187 stories did not mention study size, 18% did not mention study design (another 35% were so ambiguous that expert readers had to guess the design), and 40% did not quantify the main result. Only 6% of news stories about animal studies mentioned their limited relevance to human health; 21% of stories about small studies noted problems with the precision of the finding; 10% of stories about uncontrolled studies noted it was not possible to know if the outcome really related to the exposure; and 19% of stories about controlled but not randomised studies raised the possibility of confounding. Only 29% of the 142 news stories on intervention studies noted the possibility of any potential downside. Twelve stories mentioned a corresponding 'in press' medical journal article; two of the remaining 175 noted that findings were unpublished, might not have undergone peer review, or might change."
This is important work, pointing out that "the public may be misled about the validity and relevance of the science presented."
What ethical standards still exist at Time magazine? Or do they exist and they're just being ignored?
The Center for Science in the Public Interest points out that this week's Time magazine includes a column by Dr. Andrew Weil touting the benefits of fish oil supplements. CSPI says, "The column was sparked by a recent report in the Journal of the American Medical Association showing that fish oil supplements did not reduce the risk of serious abnormal heart rhythms. The article failed to disclose that Dr. Weil sells his own brand of fish oil supplements on his website.
I've pointed out other questionable advertising-related editorial practices at TIME in the past.
Let the reader - and the buyer - beware.