Awful week for health news on NBC

| 10 Comments

First, we send our sincere best wishes to NBC reporter George Lewis, who this week reported on his diagnosis and treatment for prostate cancer. I have respected his work throughout his career. George Lewis.png

But the standards of sound journalism are not suspended when a reporter chooses to report on himself. Indeed, concern for balance should be heightened when a reporter chooses to report on himself. In this story he talked about his choice of proton beam therapy. But he never mentioned questions about the evidence for/against this therapy, the tremendous cost of the therapy (can be more than $50,000 per patient), or the fact that there are only a handful of centers in the U.S. where this is done.

The New York Times, on the other hand, recently had no problem exploring these issues. It found a Harvard radiation oncologist who said "that while protons were vital in treating certain rare tumors, they were little better than the latest X-ray technology in dealing with prostate cancer, the common disease that many proton centers are counting on for business.

“You can scarcely tell the difference between them except in price,? he said. Medicare pays about $50,000 to treat prostate cancer with protons, almost twice as much as with X-rays. …

“There are no solid clinical data that protons are better,? the chairman of radiation oncology at the University of Michigan told the Times. “If you are going to spend a lot more money, you want to make sure the patient can detect an improvement, not just a theoretical improvement.?

The Times also mentioned an economic analysis by researchers at Fox Chase Cancer Center in Philadelphia that found that proton treatment would be cost effective for only a small subset of prostate cancer patients.

Why didn't NBC include any of that information? Maybe because NBC was more interested in emotion than evidence.

But the flaws in the NBC story didn't end with the proton beam coverage. The network allowed its reporter to become an advocate and a crusader when Lewis said, "Every guy over 50, doctors say sometimes every guy over 45, should get tested annually for prostate cancer. There’s a simple blood test called a PSA and a digital rectal exam where the doctor feels for lumps in the prostate. Early detection is the key." That is not an evidence-based recommendation.

The U.S. Preventive Services Task Force states:

The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE). Although the Task Force found evidence that screening can find prostate cancer early and that some cancers benefit from treatment, the Task Force is uncertain whether the potential benefits of prostate cancer screening justify the potential harms.

The potential harms of prostate cancer screening include fairly frequent false-positive results from PSA screening, which may lead to unnecessary anxiety and biopsies. In addition, early detection and treatment may result in complications from treating some cancers that may never have affected a patient's health.

We have commented on such stories before. NBC Nightly News had already done something similar to this - when reporter Mike Taibbi advocated lung cancer screening after he was scanned in a story. Such stories violate the Society of Professional Journalists' code of ethics which states that journalists should "distinguish between advocacy and news reporting. Analysis and commentary should be labeled and not misrepresent fact or context."

But that was only one episode in NBC's week of medical news mis-steps.
no sweat anchor.png
Last night they aired a piece (as so many media did) on mouse research on a pill for exercise. What was stunning about the NBC piece was the following:

• It devoted more than 2 minutes out of its total of 22 minutes or so of news time to this story. We are at war. The economy is in the tank. No one can afford gas in the tank. But 2 minutes was given to this mouse research.

• About a quarter of that time was spent explaining why this wasn't a story for people yet - ample caveats, indeed. But why, then, did they devote so much time to the story? NBC schering.png

• They used some of the air time to explain that this was a Schering-Plough drug - even putting the company's name and logo onscreen. Why? With limited airtime, why was that an important nugget? Unless one's goal is to make drug company sponsors happy.

From these two stories, the big scorecard in the sky reads:

Medical industry interests 2, NBC viewers 0.

10 Comments

First, grey print is stylish but difficult to read.

Discouraging prostate cancer screening is less helpful than encouraging it. I dislike finding myself in the position of defending the MSM, but I don't think they can be faulted for leaving out the small print, unless in printed stories with lots of room.

The exercise pill story is fascinating to us fat, lazy citizens of the USA. The pharmas are years from profiting from these drugs, so any association made will be soon lost. Again, why am I here, letting pharmas off the hook?

There IS much to complain about in the coverage of health issues in the media, but those mentioned here are insignificant.

You seem to be not just anti-proton therapy, but also anti-DRE and PSA screening and anti-new pharmaceutical news. FYI, there are many diabetics and other metabolically compromised individuals who know they should exercise, but do not for various reasons. This pill that took up 9% of the nightly news on NBC, could evolve to be the answer to their problems, or part of them, once it moves from the mouse model that was reported on. Most new pharmaceuticals are first validated in mouse model tests. Maybe you are just anti-NBC News??

Nope. I’m none of those.

What I am is a firm believer in balanced, evidence-based journalism. I’m not against any of the tests or treatments you mention. And I am not anti-NBC.

I am against imbalanced and incomplete reporting that does not discuss harms and benefits and costs in detail. I am against TV news that gives a disproportionate amount of time to an animal study, and then goes out of its way to name the drug company – an odd use of its precious air time.

I happened to meet George as a co-patient at Loma Linda. So there in lies my bias.
As a patient in any of the five centers but in particular at Loma Linda you have a very strong community of like cancer patients to compare reaction to treatments. Admittedly these observations are more anecdotal in nature. Some of us had strictly protons and some had combination treatments. Those who had the misfortune of having to deal with x-ray treatment because of the severity of their cancer wished they had never had to deal with the results of the x-ray machine. They had dietary issues as a result of collateral x-ray damage on other organs which most proton patients never experienced. They could not eat salads or roughage as it created diarrhea (the embarrassing kind). Their skin pallor changed to a chalky white. Tiredness was a common complaint and activity decreased.
Yes you can compare cost of x-ray versus protons but you have to ask what the secondary costs are. Since my insurance paid for my proton treatment (without even haggling) I can only assume actuarially they see the benefits of paying more upfront and paying less over the coming months and years for secondary treatments.
When you have a doctor say “There are no solid clinical data that protons are better,? the chairman of radiation oncology at the University of Michigan…? You have to wonder why Philadelphia is opening a center; Chicago and Oklahoma City are planning two proton systems; why Colorado is exploring adding proton treatments. You might also wonder if the fact Michigan is suffering with the loss of manufacturing jobs and investments might have something to do with his comment.
Now three months out of treatment and no side effects the quote of “You can scarcely tell the difference between them except in price,? is not quite accurate. Hopefully you will never have to confront the comment from a doctor “You have Cancer?. Once you do you or your loved one start exploring all of the treatment avenues available to you. You start of f with the typical statistics to guide your decision. Once you come to a conclusion for a treatment the next thing that happens is the exploration of side effects and problems created by the treatment. If you are lucky, as with most prostate patients, you have time to think through your decision, you realize the statistics are only part of the story. The real part of the story is between 10% to 20% will be on the BAD side of the statistics for any prostate cancer treatment.
With that in mind the decision must include the decision of which treatment will provide the best outcome with a minimum of side effects, and if you succumb to a side effect is there a simple treatment for that side effect. The most obvious example is during a prostate surgery the prostate is removed. In the process one of the two sphincters is removed. Hence, the result is 60% experience incontinence and must wear a urinary pad of some sorts. Can you deal with it?
The case of x-rays in not so clear, but is more subtle and the effects of the treatment more difficult to access. For me understanding the difference of the science behind the treatments helped to make my decision. X-ray radiation is very much like a flash light. The brightest or strongest light is at the source and the further away the less potent the beam. X-rays leave a lot of energy on the surface of the skin and diminishes until it exits the body. The docs rotate the source of the x-ray around the body so the intersection of the beams is at the prostate and less total energy is distributed in any one spot around the body. However there is considerable x-ray dose deposited on the rectum and other sensitive body structures. Unlike x-rays protons highest energy release is at the prostate having much lower entry energy than x-rays and zero energy exits the body. Both deliver similar amounts of destructive energy at the prostate. The bottom line, for me and can attest from personal experience, is proton patient react to treatment with fewer complications.
The comments you make are unfortunate and ill informed. I hope you do not dissuade those who could benefit from the least invasive of treatments.

Peter,

I'm not sure you read my entry very carefully. It was not I who said “You can scarcely tell the difference between them except in price.? That was a Harvard radiation oncologist.

You also wrote: "The bottom line, for me and can attest from personal experience, is proton patient react to treatment with fewer complications."

Unfortunately, the plural of anecdote is not data.

And unfortunately the NBC story discussed no data. That is my beef with the proton part of the story. Period.

Actually, NBC may have gone overboard in warning viewers not to go overboard in imagining when this drug will be available to humans. Drug stimulates precise location on murine genome as on human one and shares same pathway of expression to humans. Drug is already in Phase I and Phase III clinical trials for other human medical conditions. Measurements of muscular reserve and endurance should follow easily when drug's efficacy at targeting primary condition yields results. (WSJ and PBS).

One of the reasons that "Michigan is suffering with the loss of manufacturing jobs and investments" is because it cost more money for GM to provide health care for its employees then to buy the metal for the cars they makes When journalists report on the latest technologies without balancing their reports with potential drawbacks, evidence, costs, etc. consumers will continue to demand the latest new pill, procedure or test and the cost of health care will continue to skyrocket.

Gary,

I'm glad to see the discussion on my story. Indeed, there is a lively debate in the radiation medicine field about the merit of proton treatment vs. enhanced conventional radiation techniques and whether the increased cost of proton treatment is justified.

I discussed this in the web version of my piece and pointed out that my decision to seek treatment at Loma Linda was based on several factors, including the hospital's nurturing attitude toward patients, something that went beyond questions of medical technology.

The problem for patients here is that everyone has a dog in the fight. Surgeons say that surgery is the gold standard. Hospitals with huge investments in proton facilities are pushing their form of treatment. Other hospitals with advanced IMRT radiation say their technology is just as good as proton therapy. There's insufficient science on all sides to back up many of the claims. We decided that the TV piece would be more about my journey through cancer treatment and not about the debate over treatment options.

Second, I realize that you, Gary, have a history of questioning stories in the mainstream media that advocate more screening and testing, arguing that often, this leads to unnecessary medical procedures.

But in my case, it was a routine PSA test that caught my cancer, later verified by a biopsy. While PSA tests can produce false positives, it was that test that correctly detected my prostate cancer in an early and highly treatable stage. Hence, my bias in favor of testing.

And while we're on the subject of bias, I notice that you have an affiliation with the Foundation for Informed Medical Decision Making, which seems to be partnered up with CIGNA and other companies in the health care field.


These companies are concerned with minimizing health care costs but have often been accused of doing so at the expense of patients.

In the interest of full disclosure, can you spell out your relationship with the HMO and health care business?

Yours very truly,

George Lewis
NBC News--Burbank, CA

George,

Thanks for your note, which I’m happy to post. I’m also pleased to post this response.

It is appropriate that you acknowledge your bias in favor of testing, which is understandable in your case. However, I believe that’s a bias that should not have been played out on the NBC network news. In my original post, I pointed out how that violates the tenets of the code of ethics of the Society of Professional Journalists.

The potential benefits and potential harms of routine PSA testing are spelled out in the U.S. Preventive Services Task Force document that I referenced in my original post.

My work on the HealthNewsReview.org project is funded by the the Foundation for Informed Medical Decision Making, a 501c3 not-for-profit whose mission is the improvement of patient decision-making. There is nothing in their mission about minimizing health care costs at the expense of patients. They develop shared decision-making programs that have been heralded around the world for their even-handed, unbiased, evidence-based approach to improving patient decision-making. The Foundation was founded by outcomes research pioneer Jack Wennberg of Dartmouth and colleagues who are now spread around the globe.

My mission, which is clear from my work, is the improvement of health journalism and the improvement of accuracy, balance and completeness in news stories about health care topics. Period. I’ve devoted my entire career to these ends.

I have no relationship with any HMO or with any health care business. No one tells me what to write or how to write it.

I hope that answers any doubts you may have about my purpose or my passion. If not, you may contact me directly.

Gary Schwitzer

Please note today's new announcement by the U.S. Preventive Services Task Force.

http://www.ahrq.gov/clinic/uspstf08/prostate/prostaters.htm

In men younger than age 75 years, the USPSTF found inadequate evidence to determine whether treatment for prostate cancer detected by screening improves health outcomes compared with treatment after clinical detection.

In men age 75 years or older, the USPSTF found adequate evidence that the incremental benefits of treatment for prostate cancer detected by screening are small to none.

The USPSTF found convincing evidence that treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime.

There is also adequate evidence that the screening process produces at least small harms, including pain and discomfort associated with prostate biopsy and psychological effects of false-positive test results.

The USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined.

For men 75 years or older, there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits.

Gary Schwitzer


About this Entry

This page contains a single entry by Gary Schwitzer published on August 1, 2008 9:10 AM.

Big Pharma & Big Politics was the previous entry in this blog.

Cell phone cancer scare on Larry King Live is the next entry in this blog.

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