Schwitzer health news blog

Reporters & McCain's health care campaign canard

Trudy Lieberman writes:

The Rocky Mountain News’s coverage of John McCain’s campaign stop in Denver last week raises an important issue for reporters, especially those covering the election: Do you let a candidate’s remarks stand unchallenged even if they are wrong or misleading?

McCain had come to town to talk mostly about health care, the paper reported, noting that the topic took up a large part of his hour-long speech. The News offered all too typical coverage of such talks, however—bits and pieces on a lot of topics, with quotes here and there. We do learn that on health care, McCain urged states to take a leadership role in reform, and that he pumped his tax credit aimed at helping Americans buy health insurance. In the next graph, the paper said that McCain’s rationale for the tax credits “is that making major reforms and using government to work through the problem will affect the quality of coverage for Americans—which he called the best in the world.”

The best health care in the world? McCain has asserted that before and so have other politicians. No doubt we will hear it again. But the evidence says otherwise.

Read the whole piece and see some of her reminders about Clinton's and Obama's less-than-true campaign comments.

Proud of my undergrad health journalism students

I'm proud to offer a link to a class project done by four undergraduate students in my Advanced Reporting Methods: Health & Medical Journalism class.

"The Uninsured: You're in your 20s. Why should you care?" is a website researched, designed and launched by four seniors.

Mind you, it's not perfect. But consider that this was an effort of 20-something undergrads. They proved that you can tackle a complex issue and make it come to life for your audience using various media formats.

There were three other noteworthy student projects in this class this semester but this is the only one I can make immediately publicly accessible.

There is hope for the future of health journalism.

Undisclosed conflicts of interest in media interviews

Jeanne Lenzer and Shannon Brownlee have a piece in Slate today that asks, "Are doctors shilling for drug companies on NPR?"

The piece begins:

"A few weeks ago, devoted listeners of National Public Radio were treated to an episode of the award-winning radio series The Infinite Mind called "Prozac Nation: Revisited." The segment featured four prestigious medical experts discussing the controversial link between antidepressants and suicide. In their considered opinions, all four said that worries about the drugs have been overblown.

The radio show, which was broadcast nationwide and paid for in part by the John D. and Catherine T. MacArthur Foundation, had the air of quiet, authoritative credibility. Host Dr. Fred Goodwin, a former director of the National Institute of Mental Health, interviewed three prominent guests, and any radio producer would be hard-pressed to find a more seemingly credible quartet. Credible, that is, except for a crucial detail that was never revealed to listeners: All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac.

We don't know just how much funding or when the show last received it, since neither Goodwin nor the show's producers responded to repeated requests for interviews. But the larger point is that undisclosed financial conflicts of interest among media sources seem to be popping up all over the place these days. Some experts who appear independent are, in fact, serving as stealth marketers for the drug and biotech industries, and reporters either don't know about their sources' conflicts of interests, or they fail to disclose them to the public."

Disclosure: I am interviewed in the story. But don't let that stop you. The piece is worth reading.

Texas hospital bans workers from reading critical newspaper series

The Fort Worth Star-Telegram reports that administrators of the county's public hospital system have banned workers from reading a newspaper series critical of the system - at least while they are at work. The paper reports that the hospital system blocked internet access to the Star-Telegram.com site.

The newspaper says that three of its reporters spent four months examining the JPS Health Network.

The series, which began last week, opened like this in part one:

"The waiting room reeked. Along a crowded hallway, patients lay in beds, with only a thin curtain for privacy. Nurses readying for a new case in surgery noticed blood, bone and globules of fat on the walls and floor and stuck to wheels of carts.

Chance brought to the hospital teenagers from car wrecks, fathers hurt on the job, police officers injured in the line of duty. Others -- the poor -- came because they believed they had nowhere else to go.

They were greeted last year at an overburdened emergency department where the staff could be robotic and hardened to patients. Sometimes, inexperienced nurses evaluated the sick and suffering.

Some patients were shuffled to a stifling back room to wait. Medical records, crucial lab results -- even patients -- got lost. Staff didn't notice when one Alzheimer's patient walked home in 100-degree heat. Another patient was dismissed because doctors didn't get lab results indicating a life-threatening disease.

The trauma center was described as a war zone. Operating rooms as chaotic. In too many places, instruments were broken, rooms dirty, linens threadbare.

Welcome to a hospital flush with cash and rife with problems. Welcome to John Peter Smith Hospital, hub of the Tarrant County Hospital District.

Boosted by tax funding other local hospitals don't get, JPS has been racking up fat surpluses -- nearly $97 million last year alone.

But the cash has not helped a dedicated core of doctors and nurses overcome the system's callousness, ineptitude and filth. JPS is a hospital that many of its own doctors wouldn't recommend."

Sex & Cereal

There are many very smart people scrutinizing health news coverage these days. Some of them populate the Chance News wiki based at Dartmouth College.

Look at how one observer analyzed recent news coverage of the stories behind some of these headlines:

The Independent: "Big breakfast is most important meal -- if you want a baby boy."

Reuters: "Skipping breakfast may mean your baby is a girl."

New Scientist: "Breakfast cereals boost chances of conceiving boys."

CNN.com: "Study shows bananas make baby boys."

New York Times: "Boy or Girl? The Answer May Depend on Mom's Eating Habits."

The Healthy Skeptic - written by one who is

Here's a book you should buy and read. University of California Press has published "The Healthy Skeptic: Çutting Through The Hype About Your Health," by Robert Davis, PhD.

Disclosure: Robert is my friend and trusted colleague. I hired him at CNN longer ago than either of us wants to remember.

Just to give you a taste of his book, here are some of the chapter titles:

1. Says Who? How We Know What (We Think) We Know
2. The News Media: Eat This!
3. Diet Books: Don't Eat That!
4. Advertisements: Take a Supplement!
5. Government Campaigns: Watch Your Cholesterol!
6. Celebrities: Get Tested!
7. Health Groups: Wear Sunscreen!
8. Consumer Activists: Beware of Chemicals!
9. Anti-Aging Doctors: Don't Get Sick, Don't Get Old, Don't Die!
10. Guaranteed! Overpromising on Prevention

We need more journalists like him, and more informational/educational efforts like his book.

Congratulations, Robert. Hope you sell a bunch of them.

Re-design & new features on HealthNewsReview.org

Visit HealthNewsReview.org to see its entirely new design and new "Join the Discussion" forum, allowing for better dialogue among journalists, health care consumers, news consumers and others.

The site is now two years old and has reviewed more than 540 stories.

Alcohol & breast cancer stories worthy of lining the bird cage

I should have mentioned Sandy Szwarc's blog, Junkfood Science, long ago. I am impressed by the depth and thoroughness of her analysis.

This week she jumped all over news coverage of a study linking alcohol intake to breast cancer.

You should read the entire post, but it begins:

Does a single drink a day really raise a woman’s risk for breast cancers? That’s what 403 media stories (and counting) have been reporting, based on a new study said to be “the largest of its kind.” But not all studies reported in the news are worth taking seriously or let worry us. Here’s why this one shouldn’t have even registered on our radar.

Since there’s actually no study to review (!), we’ll walk through the news. When would you have changed the television station or tossed the newspaper aside?

According to the news, the researchers reviewed data on 184,418 post menopausal women and found that women who drank even just one to two drinks a day were 32% more likely to develop breast cancers of a certain type (estrogen-receptor and progesterone-receptor positive, or ER+/PR+). This study was said to provide evidence that alcohol is positively associated with breast cancer.

When hundreds of news outlets around the world report on a single study, out of the hundreds released each day, on exactly the same day and all saying exactly the same thing, you can be sure someone issued a press release. Sure enough, this paper came with a press release.

Please go to the link above to read the rest of her comments on this study and news coverage about it.

Blogs like hers give citizen journalism a good name.

60 Minutes piece on Kanzius cancer cure not worth 60 seconds

One of the worst stories by a major news organization on a health care topic was turned in by CBS' 60 Minutes last Sunday with a piece it entitled on its website, "The Kanzius Machine: A Cancer Cure?"

The story was reviewed on HealthNewsReview.org and given one of the lowest ratings possible. The review summary stated, in part:

If the report were to be done and broadcast on 60 Minutes, it would have benefited considerably from additional context provided by other credible researchers. Did CBS look for and fail to find anyone skeptical of this technique? None was interviewed.

The story has elements that make it appealing as an act of infotainment: a lone-wolf outsider who can cure cancer with pie pans and hot dogs, a man motivated by his desire to help "hollow-eyed kids" with cancer, and hopeful researchers with impressive institutional affiliations, including a Nobel laureate said to have turned from skeptic to believer by the time he died from cancer.

But good stories don't always make good journalism. This is such a case.

The segment is likely to raise hopes, clearly prematurely if not falsely, of millions of people affected by cancer, or even cancer risk. This is the opposite of public service.

The most disturbing aspect of the segment was its one-sidedness, its lack of context and independent perspective. And given that these segments run about 15 minutes, CBS can't hide behind the excuse that this is TV and we don't have enough airtime to go into great depth.

Disease mongering by Women's Health magazine

Add Women's Health magazine to my list of publications guilty of disease-mongering by advocating tests that are not supported by evidence - recommendations that run counter to those of the U.S. Preventive Services Task Force.

The article, "THE MEDICAL TESTS YOU SHOULD TAKE: Head-to-Toe Tune-Up" is not unlike those I've criticized on CNN, in the Minneapolis Star Tribune, and in a number of other news outlets.

No source is given for the recommendations.

Journalists: when you promote testing and screening in healthy populations in the absence of evidence of benefit and in the presence of known harms you may be causing harm yourselves. And you're certainly stirring up the "worried well" to seek medical attention when they may not need it. We're already devoting 16% of the gross domestic product to health care.

We should expect better from a medical journal

I've reported many times on news organizations hyping medical technologies. But this past week, a medical journal - BMJ - did the same thing in its "news" section, presenting only the fantastic potential of robotic surgery without any evidence - any quantification - of potential benefits and harms and without any discussion of costs.

The BMJ "news" story was entitled, "Robotic prostatectomy transmitted live to engineers to promote collaboration."

Read my letter and that of a British oncologist in response to that article. I wrote:

"...the story was completely devoid of any data.

We learn that robotic radical prostatectomies are much more common in the US than in the UK but we learn nothing about outcomes.

We learn that there are ethical issues but none is specified.

We learn that a urologist believes robotic surgery has several advantages. But those are not quantified. What does "better results" mean?

We learn that "patients recover more quickly" but we're not told how many patients. We learn of "better cancer control" without any definition of that term.

Ditto for reported claims of more precision, "less collateral damage, resulting in less blood loss, faster recovery, and fewer complications." No numbers.

I'm trying to teach my health journalism students, "No numbers? No story." I hope they weren't reading this week's BMJ "news" section."

Stop running scared

Shannon Brownlee on disease-mongering.

WSJ Health Blog's March Madness drug company CEO brackets

At a conference yesterday, Scott Hensley of the Wall Street Journal Health blog showed off a story I had missed. Since it's the last day of March and basketball's Final Four is now set, the time is just right to look at it. See the Journal's “Our March Madness: The Drug Company CEO Bracket”.

They explain:

Restless shareholders, listless labs and a tidal wave of generic competition confront the top executives at drug makers around the globe. Big Biotech has plenty of problems of its own. Did we mention pushback on prices?

So we wonder who among the leaders of the current executive pack will win the test of endurance to remain the last CEO standing? Take a look at our second annual bracket by clicking on the image at the right. Feel free to start your own office pool.

The posting is fun. It's interactive. You can vote on the poll. And the user comments are worth reading. One wrote: "A more relevant question is - which CEO has the most integrity?"

Happy 10th Birthday to Assoc. of Health Care Journalists

The Association of Health Care Journalists is celebrating its 10th birthday. AHCJ has become a leader in quality improvement in health journalism - and a leader in the entire journalism industry.

That effort - and many others - like our University of Minnesota health journalism MA program - are striving to improve the flow of meaningful health and medical news information to the public.

Lord knows we need it.

March madness in medical news on network TV

Reviews of network TV health news stories on HealthNewsReview.org so far in March would suggest it’s more like Halloween season than Easter. The stories have been so bad, it’s scary. Examples & excerpts:

Medical breakthrough? New procedure fights tumors
ABC's Good Morning America
March 18, 2008
Rating: 1 star

Excerpt of our summary: “This short story presents little in the way of useful information to the consumer. It does not adequately describe the availability of the treatment, the strength of the available evidence to support its use, or any harms of the procedure. The story does not quantify the benefits of the treatment nor does it adequately describe the advantages and disadvantages of the alternatives.

Furthermore, by using such terms as "breakthrough", "great success" and "promising", the story exaggerates what is and isn't known about the procedure and glosses over the fact that the studies have yet to be published in a peer-reviewed journal.”

Special candy fights cavities
ABC's Good Morning America
March 14, 2008
Rating: 1 star

Excerpt of our summary: “This was a 3-minute ad - not a piece of journalism. So much good can be done with 3 minutes of network TV time.

But this story failed to:

* discuss costs
* discuss evidence - of harms or benefits
* present any independent expert's opinion

It even featured the two co-anchors sucking lollipops at the very end. Wow.”

Decoding your DNA
NBC Today show
March 14, 2008
Rating: 1 star

Excerpt of our summary: “This is one example where even a low "one- star" ratings score is deceptively high. This story was lacking in many significant ways… News? Or advertising? If the former, it failed badly. If the latter, it was a steal - free, long, and unchallenged on network TV. We don't like using harsh terms in our reviews. We try to be constructive. At times like this it feels impossible.”

Breast Cancer Drug Good Later Than Thought
CBS The Early Show
March 11, 2008
Rating: 2 stars

Excerpt of our summary: “(The reporter did not) talk with oncologists who could put the study results in context. We are not told how results could alter clinical practice guidelines for women with early-stage breast cancer who have taken tamoxifen for 5 years. The cost of the drug is also not mentioned. Cost is an important consideration for women considering an additional multi-year therapy.”

A man's eye-opening surgery
March 4, 2008
NBC Today Show
Rating: 0 stars

Excerpt of our summary: “Its use of a dramatic stunt--a surgery done in real time with interviews before and after the procedure--implies the surgery is fast, uncomplicated and complete in a single session. This is not an accurate portrayal of the full treatment.

It uses a single surgery--done on an employee of the same TV network by a surgeon with a commercial interest in selling the device and procedure--to explain the procedure.

Whether the employee paid for this service or whether he received it free or at a discount is not known. If the patient has not paid full price as an independent consumer, his comments should not be considered objective. If he did pay full price, the network should have avoided even the perception of a conflict of interest by finding someone else to profile.

By creating a dramatic demonstration of a medical procedure and implying its success--without context, independent comment or reporting of potential harms and research findings--this segment violates almost every important principle behind responsible medical reporting.”

You can do a good job in covering health news on TV. These were not examples of that possibility.

Newspaper lets hospital buy news coverage

I've blogged in the past about TV news operations accepting sponsored news deals with local medical centers. In these deals, oftentimes the news only includes perspectives from that sponsoring hospital.

Now, in the first instance I'm aware of, the trend has come to newspapers. The HometownAnnapolis.com website of The Capital newspaper yesterday announced:

Partnership should improve health coverage

Published March 16, 2008
By TOM MARQUARDT

In today's editions we are experimenting with a new concept that could alarm some readers: Anne Arundel Medical Center, or AAMC, has paid us to provide content for our Health & Fitness page once a month.

Newspapers don't normally sell access to news pages, and certainly we would not give away content privileges on any other news page. I'm sure County Executive John Leopold would love to have his staff write the stories for the front page, but that's not going to happen for any price.

But partnering with the hospital on the Health page seemed to make sense. We don't have a health reporter to write about medical issues and often use stories from syndicated services that quote doctors from other cities.

The local hospital is giving us stories about local physicians and programs it has to offer - in their words, without an effort to balance the copy with comments from other hospitals or from doctors who don't practice at AAMC.

The stories are written in newspaper style and the hospital staff is responsible for the page's design. To be open and transparent about the partnership, a disclaimer is clearly displayed at the top of the page.

I'm not entirely comfortable with the arrangement, purely for journalistic reasons. But in the end I think the reader benefits - and that's my goal.

Instead of generic stories originating from another city, the reader will have local news featuring people they recognize, doctors they use and services that are available to them. The hospital staff is getting to the stories we are not able to write because of other priorities.

Is the page more readable now? You tell me.

Wow. "Partnering" - or being paid by a hospital to provide their news? Actually, he calls it content, not news. Whew. Because we used to call that advertising.

Also a relief - "the stories are written in newspaper style and the hospital staff is responsible for the page's design." So they'll look professional! Just like, or maybe even better than, real news.

And who cares if we give readers only one side of a story? Maybe a side that is so incomplete it can hurt them? And so what if we don't disclose the financial conflicts of interest of the doctors who might appear in the stories written and designed by the hospital itself? And so what if there are other opinions or other approaches from other doctors on the other side of town that don't get covered?

The main thing is: "Is the page more readable now?"

The nasty bloodsucking bedbug epidemic

If you survived the last TV ratings period and DIDN’T see a story about the horrible epidemic of bedbugs right in your town - maybe right in your own bed - then just stay tuned until the next sweeps period.

David Segal of the Washington Post was on NPR’s “On the Media” program talking about the hyperbolic news coverage of the bedbug panic.

More on news organizations promoting unnecessary testing

A physician who teaches evidence-based medicine, and who is also a freelance health journalist, has been reading my thoughts about journalists advocating screening tests in the absence of evidence.

She wrote me: "Here's one of the more annoying recent examples, one that I actually used in class to illustrate the issue of patients coming in and requesting specific tests based on what they read in the newspaper."

So I'm adding Parade Magazine to my list of offenders.

Here we go again - another industry-funded Sleep Awareness Week

Don't let the special interest campaign catch you napping!

Dozens upon dozens of stories about Americans lacking sleep are popping up from news organizations all over the country this week, driven by another of the National Sleep Awareness Week campaigns of the National Sleep Foundation.

Few - if any - of these stories will tell you that it is industry special interests - sleeping pill makers, sleep labs, mattress makers - who are paying for this campaign. They do it every year. And news organizations fall into line like sheep and report the "new" findings every year.

Examples:

USA Today reports:

U.S. workers are silently suffering from a dramatic lack of sleep, costing companies billions of dollars in lost productivity, says a study out Monday.

Nearly three in 10 workers have become very sleepy, or even fallen asleep, at work in the past month, according to a first-ever study on sleep and the workplace by the non-profit National Sleep Foundation. The late-2007 survey was based on a random sample of 1,000 workers.

AP reports:

Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.

CNN, WebMD, UPI, the St. Louis Post-Dispatch and many, many more news organizations are reporting the same stuff - handed to them by the industry-funded campaign.

Yawn.

Wake me when the next disease-mongering campaign comes around.

Is This Test Really Necessary?

The Star Tribune newspaper finally - 10 days after I submitted it - published my op-ed piece countering a feature story entitled, How To Be A Screen Queen. I give the paper credit for publishing my response, although they edited my submission and did not share with me in advance what the final published version would be. This is more than a little troubling to me - since what was published was not what I submitted.

One thing they left out was the broader context of such media advocacy pieces crusading for screening tests in the absence of the best evidence, something I reported on in a piece entitled, "Unhealthy Advocacy: Journalists & Health Screening Tests."

I'm going to continue to track news coverage of health screening tests and will continue to report on the results on this blog and in whatever venue I can find.

Drug Trials Should Not Be Done for Marketing Purposes Only

I've blogged earlier about something being smelly about the ENHANCE trial, comparing the cholesterol drug Zetia plus Zocor versus Zocor alone.

This week, a commentary in the Journal of the American Medical Association addresses some of the stink. Excerpts:

The unusual release on January 14, 2008, in the news media and on a drug company Web site, of a portion of the Effect of Ezetimibe Plus Simvastatin Versus Simvastatin Alone on Atherosclerosis in the Carotid Artery (ENHANCE) trial data resulted in numerous articles and commentaries in the lay media. The availability of only fragmentary information created massive confusion and raised many more questions than answers for patients, physicians, pharmaceutical companies, and regulators. A full report of the ENHANCE trial in a peer-reviewed medical journal is not expected for months, and the first public presentation of the study's findings in a medical setting will not occur before late March 2008.

Lesson 1: Drug Trials Should Not Be Done for Marketing Purposes Only

Lesson 2: The News Media Must Be Sure to Get the Facts Straight. Errors in Reporting Can Cause Serious Damage, and Patients May Be Harmed or Become Distressed From the Resulting Confusion

Lesson 3: Leading Scientific, Patient-Oriented, and Disease-Oriented Organizations Must Scrupulously Avoid Conflict of Interest

Another case of paid-for "fake" TV health news

Dallas TV critic Ed Bark writes the latest chapter of an ever-thicker and ever-sicker story about TV stations selling "news" time to hospitals that want to look good on the air.

As I've asked before, when is the Radio-Television News Directors Association going to step up and address this situation, which is addressed in its own code of ethics but apparently almost universally ignored? Excerpts of that code:

Professional electronic journalists should:

* Gather and report news without fear or favor, and vigorously resist undue influence from any outside forces, including advertisers, sources, story subjects, powerful individuals, and special interest groups.
* Resist those who would seek to buy or politically influence news content or who would seek to intimidate those who gather and disseminate the news.
* Determine news content solely through editorial judgment and not as the result of outside influence.
* Resist any self-interest or peer pressure that might erode journalistic duty and service to the public.
* Recognize that sponsorship of the news will not be used in any way to determine, restrict, or manipulate content.
* Refuse to allow the interests of ownership or management to influence news judgment and content inappropriately.

A question about the value of online discussion free-for-alls

Ten days ago, the New York Times posted Tara Parker-Pope's column, "No Answers for Men With Prostate Cancer." It discussed the federal agency report that concluded that nobody can tell men with prostate cancer what type of treatment is most likely to save their lives - or that any treatment is better than doing nothing.

Many news organizations, when they post such columns online, now offer readers the chance to comment online. As of this morning, 141 people have sent in comments in 10 days. They are all visible following the story posted online. Ms. Parker-Pope has responded to a few of the comments online, but other user comments raise assertions, make claims, ask questions - all unanswered or unchallenged.

That's disturbing for a number of reasons, the biggest one that it lends the credence of the New York Times' website to some spurious information posted on their site in an unchallenged manner.

I would suggest that if the Times is going to moderate some of the discussion, then it should moderate all of the discussion. And I realize what a tough task that would be, with 141 messages in 10 days.

But this should not just be a marketing move - that offering a sense of "online community" is good for business. Journalism principles should enter into this as well. But right now it looks like the New York Times has invited a conversation, got one, and now doesn't know what to do with it.

And this trend is only going to deepen. Witness CNN's I-Report feature that invites citizen journalism: "What's happening where you are? Is news happening in front of your eyes? Pull out your camera and I-Report it for CNN."

Democratization of news? Or abdication of journalistic oversight responsibility? Read the 141 messages (probably more by the time you get there) on the Times article above and make a judgment about whether the "community" discussion was worthwhile or not.

Glass half empty or full? What's the news?

It's interesting to see the different interpretations, emphases, and headlines of different news organizations on the same story.

The New York Times uses a headline, "Most Breast Cancer Sites Get It Right" over a story that begins:

The Internet is filled with unreliable health information and bogus claims. But sites dedicated to breast cancer information appear to have a high level of accuracy, a new study shows.

Texas researchers recently analyzed 343 Web pages, retrieved using search engines that consumers are likely to use when seeking information about breast cancer. The study, published online today in the medical journal Cancer, turned up 41 inaccurate statements on 18 of the Web sites, or an error rate of just 5.2 percent.

But that "just 5.2 percent" is the focus of the headline and the lead in a Reuters wire service story on the same study, but headlined, "Some breast cancer websites inaccurate." The story begins:

Five percent of breast cancer Web sites have mistakes, with those involving alternative or complementary medicine the most likely to be misleading, U.S. researchers reported on Monday.

So is an error rate of "only" 5% good - and worthy of headlines? Or is an error rate of 5% "bad" and worthy of the headline?

Probably the best judges are women with breast cancer.

Kudos to local TV reporter for tackling health policy

A tip of the hat to KARE-11 TV (Minneapolis) reporter Rick Kupchella for the start of his ratings period series, "A Cure For Health Care?".

TV news across the country is a wasteland if you 're looking for serious health policy discussions. But in the past couple of years Kupchella has tackled some of the most complex health care reform issues and proved that local TV news can tackle these topics. He's once again proved that TV doesn't have to hide behind the excuses of "It's gotta be short" or "It's gotta be gee-whiz visually."

And he doesn't even cover health news fulltime.

Kudos to Kupchella for his personal commitment and for striving for excellence in serving local viewers.

Nothing but miracles, breakthroughs, rainbows & unicorns for TODAY Show

Last week the NBC Today Show presented a series it called “Mini Medical Miracles.”

Were you waiting for news on cancer? Heart disease? Diabetes? Infectious diseases?

Sorry. What you got was baldness, insomnia, dandruff and wrinkles.

But NBC called the approaches “miracles” and “breakthroughs.” Man, that’s what we need is a good miracle for dandruff and wrinkles.

Anchor Matt Lauer led into the wrinkles story by asking “Could having a new laser treatment in your forties or fifties prevent you from ever needing a facelift?”

Who says that anyone needs a facelift? Facelifts are a matter of want, not need.

47-million uninsured is a matter of need.

Lauer and NBC medical editor Dr. Nancy Snyderman could barely contain their enthusiasm for the laser “treatment.”

(Snyderman:) “This is going to be in your doctor’s office soon.”

(Lauer:) “It’s interesting. And anything that keeps people away from the knife. I mean, that’s major surgery.”

(Snyderman:) “I think you can say to people, this is a preemptive strike and it’s taking care of your skin and you can avoid a real operation. There will be a lot of people, men and women, who will be interested.”

There was no discussion of evidence, no quantification of benefits or harms, no discussion of how long the approach has been tested nor in how many people.

On HealthNewsReview.org the story is one of only 10 of the first 500 stories reviewed that got a score of 0.

Oh, for the good ol’ Today Show days of Dave Garroway and J. Fred Muggs, the chimp.

Cheers & jeers for health care journalists

The Integrity in Science Watch project of the Center for Science in the Public Interest has a weekly e-newsletter that includes cheers and jeers for certain aspects of health care journalism. This week's:

* Jeer to Alicia Chang of the Washington Post for failing to mention that the authors of a study supporting the off-label use of drug-eluting stents received funding from Cordis, Boston Scientific and Abbott Vascular, all manufacturers of drug-eluting stents.

* Cheer to Stephanie Saul of the New York Times for noting that the American Heart Association, which has defended the cholesterol drug Vytorin in recent weeks, receives $2 million a year from Merck/Schering-Plough Pharmaceuticals, the joint venture that markets Vytorin.

Best piece of health care journalism I've seen in a long time

I'm drooling, but I shouldn't be. John Carey of BusinessWeek has the cover story this week, entitled, "Do Cholesterol Drugs Do Any Good?" I'm not going to post an excerpt because I want everyone to read the entire article. It's that good - and that rare. I'm drooling over it but I shouldn't be, because the themes he explores should be part of all news stories making claims about new ideas in health care.

Carey explores absolute vs. relative risk statistics - showing how the latter are abused and are misleading to the general public to trump up drug benefits. But he also is one of the only journalists I've ever seen explore and explain another statistical tool - the Number Needed to Treat or NNT.

See his insert on this important statistic. It will raise questions about the way drugs are promoted and sold to hundreds of thousands of people who won't benefit from their use.

When I wrote the Statement of Principles of the Association of Health Care Journalists, I urged health care journalists to "consider explaining the 'number needed to treat' - the number of people you would have to treat with the experimental intervention (compared with the control) to prevent one event." And I included tips on how to do that. But it rarely, VERY rarely ever happens.

Carey and BusinessWeek hit a home run with this cover story. Kudos to them. Keep up the good work. Let's hope other journalists - and certainly consumers of news and health care - learn from this excellent piece of work.

Ethical news director quits over hospital deal for fake TV health news

Although I said I was on a blog break until January 22 because I'm on vacation and should be out on the beach, when I read about this, I had to share it with those who may not have seen it.

An Eau Claire, Wisconsin newspaper reports the following:

"One year after being hired as WEAU TV-13 news director, Glen Mabie has resigned because of a disagreement with station management regarding coverage of medical topics.

According to Mabie and other sources close to the situation, station management attempted in recent weeks to negotiate a deal with Sacred Heart Hospital in which TV-13 would run medical stories featuring personnel from that hospital and its affiliates but not employees of other Chippewa Valley hospitals or clinics.

That didn't sit well with Mabie, who said an exclusive deal with Sacred Heart posed an obvious conflict of interest that called the newsroom's objectivity into question. Mabie said he was unsure whether the hospital would pay TV-13 as part of the agreement.

"My problem with this is it was going to dictate newsroom content," said Mabie, whose last day at TV-13 was Friday. "I told myself that I could not with a clear conscience go into that newsroom and tell the staff that this was a good thing."

If this went down as the newspaper reports, my hat goes off to Glen Mabie, the only news executive I've heard of in this country who spoke up and stood up against this very common practice. Health news is being sold to the highest bidder in many communities.

In the past, I've blogged about this practice and how widespread it is. How and why the Radio-Television News Directors Association - whose code of ethics clearly addresses such practices - fails to address this directly and openly should be a source of embarrassment to that organization.

And to all other station managers and news executives who - unlike Glen Mabie in little Eau Claire, Wisconsin - have looked the other way and allowed this practice to continue, shame on you. Viewers of these stations should turn away from your "product" and never come back.

More journalistic screening bias: "a matter of faith not science"

Last year I published an article documenting several instances of U.S. journalists' apparent bias in favor of certain screening tests - in the absence of evidence supporting such tests in they way they were being promoted.

Now it's just come to my attention that an Australian team published an article in November describing an analysis of Australian news coverge of prostate cancer screening. Their conclusion:

"Australian men are exposed to unbalanced and often non-evidence-based appeals to seek PSA testing. There is a disturbing lack of effort to redress this imbalance."

Of special note is how the authors documented the "widespread, overwhelmingly negative" reaction to a statement by the head of an Australian cancer agency who told a newspaper that, at age 59, he chose not to have a PSA test.

And journalists seemed to join in the ad hominem attacks. All because the man spoke from a perspective of evidence and science, not faith and emotion.

We will continue to follow journalism's role in promoting non-evidence-based approaches and will address it whenever we see it.

2007's "Stinkiest Media Performances"

Jeff Cohen and Norman Solomon have posted their 2007 P.U.-litzer Prizes for "the year's stinkiest media performances."

Two health-news-related pieces made the list. Here's what the judges said:

"AMERICANS DON'T WANT UNIVERSAL HEALTHCARE" AWARD -- Jeff Greenfield of CBS, et al.

Reflecting what became mainstream media's conventional wisdom in the wake of Michael Moore's "SiCKO" documentary, CBS correspondent Greenfield explained that the U.S. lacks a universal healthcare system not because of the powerful insurance lobby -- but because "Americans are just different." He quoted an academic who said Americans, unlike Canadians and Europeans, don't want government involvement in healthcare: "It's a cultural difference."

Actually, CBS's own poll of Americans had found 64 percent supporting the view that the federal government should "guarantee health insurance for all" -- with 60 percent approving of higher taxes to pay for it. A CNN poll found 64 percent American support for the idea that "government should provide a national health insurance program for all Americans, even if this would require higher taxes."

"IT'S TRUE BECAUSE WE SAID IT" AWARD -- CNN's Lou Dobbs

To prove his claim that illegal immigrants were bringing "once eradicated diseases" into our country, Dobbs featured a CNN reporter in 2005 who claimed that the United States had seen only 900 cases of leprosy for 40 years -- but that "there have been 7,000 in the past three years." This year, in May, Dobbs was challenged on the shocking statistic by Lesley Stahl on 60 Minutes, who cited a federal report saying there were 7,000 leprosy cases over the last 30 years. Dobbs' response: "If we reported it, it's a fact."

Stahl: "How can you guarantee that to me?"

Dobbs: "Because I'm the managing editor, and that's the way we do business. We don't make up numbers, Lesley. Do we?"

You do, Lou. The Centers for Disease Control report that new leprosy cases in the United States have been on the decline for close to 20 years (with 166 cases in 2005).

Bothered by "breakthroughs"

I have published the following commentary on the HealthNewsReview.org website.

TIME magazine, like many publications, loves year-end lists. Its “Top Ten Medical Breakthroughs of 2007”
list offers brief capsules on developments that someone at TIME decided were “in the top ten” and also that someone decided qualified as “breakthroughs.” The list:

• Circumcision can prevent HIV

•Test for metastatic breast cancer

•First human vaccine against bird flu

•Help for dieters: Alli

•New diabetes genes

•No more periods (Lybrel)

•Relief from fibromyalgia: Lyrica

•Early-stage test for lung cancer

•New source of stem cells

•Benefits of vitamin D

We believe that with any claim of “breakthrough’” the claimant should include some discussion of the quality of the evidence behind this claim. And for stories that discuss treatments, tests, products or procedures, we should be talking at least a little bit about how much these “breakthroughs” will cost.

TIME didn’t mention cost with any of the ten breakthroughs it highlighted. The magazine didn’t discuss the quality of the evidence behind the ideas covered in any of the eight product-related stories. The discussion of benefits was lacking in several.

Yes, we know that editors think these lists are cute, promotable features. But the cumulative effect of discussing breakthrough after breakthrough without any mention of cost or evidence leaves the reader waiting for Santa to arrive with the next one.

The “Help for dieters: Alli” segment stated that the drug “blocks the body's ability to absorb fat by 30%.” But what does that mean to the user? And given the “common and unpleasant side effects — cramps, gas, diarrhea and oily discharge” that the article acknowledges about the drug, we can only ask: Is this a breakthrough?

We ask the same question about the “No more periods” segment about the drug Lybrel. This is a breakthrough? The story acknowledges that the new pill “is similar to the conventional Pill” but doesn’t mention other competing products on the market that may limit the frequency of a woman’s periods. How do they compare?

The “Relief from fibromyalgia: Lyrica” segment states: “In studies, Lyrica not only soothed the aches of fibromyalgia but also significantly improved patients' quality of life.” How was that measured? How would a reader objectively quantify the chance for benefit? For harms?

For 2008, it is our hope that more news organizations abandon the breakthrough mentality. There aren’t breakthroughs every month as the magazine implies. There are things one stands to gain and things one stands to lose with any treatment, test, product or procedure. Readers need help weighing the evidence. And they certainly need help thinking about health care costs.

We need more informed health care consumers, not more magic bullet believers.

Does the language of a story match the evidence?

Mark Zweig and Emily DeVoto authored a thoughtful piece on how journalists may imply cause-and-effect in reporting on research, when the study design didn't really establish cause-and-effect. Examples:

Eating fish may help preserve eyesight in older people.

The authors calculated that participants who did 75 minutes a day of activities… lowered their risk of dying by 30%...

Overall, those who drank [coffee] were 22 percent less likely to have diabetes, with decaf drinkers reaping somewhat greater benefit…

Women who ate fish 5 times a week cut their risk of dying later from a heart attack by half...

Higher aspirin dose seems to stave off some cancers… The strongest effect was for colon cancer.

Drugs that suppress acids may make fractures more likely…Taking proton pump inhibitors for more than a year increased the likelihood of a hip fracture by 44 percent.

They urge health care journalists to be mindful of when cause-and-effect language is warranted by the study design and when it is not.

Goodbye, Columbus TV health news credibility

Nothing new here at all - just the latest episode of a local community discovering that its glorified local health news is often just paid-for advertising.

The Other Paper of Columbus, Ohio unveils how Ohio State University Medical Center pays one station almost $100,000 a year to air "Breakthroughs in Medicine" segments in the newscast, and pays another station almost $150,000 for a "MedBreaks" segment.

The VP and general manager of one of these stations rejected criticism saying, “They’re not ads, they’re vignettes. ...The reality is, a television station that maintains editorial control I don’t believe is doing anything ethically wrong.”

OK, then why doesn't the station tell viewers what they're getting by scrolling across the screen:

THIS VIGNETTE WAS PAID FOR BY OHIO STATE UNIVERSITY MEDICAL CENTER.

The Radio-Television News Directors Association’s (RTNDA) Code of Ethics states:

Professional electronic journalists should:

* Gather and report news without fear or favor, and vigorously resist undue influence from any outside forces, including advertisers, sources, story subjects, powerful individuals, and special interest groups.
* Resist those who would seek to buy or politically influence news content or who would seek to intimidate those who gather and disseminate the news.
* Determine news content solely through editorial judgment and not as the result of outside influence.
* Resist any self-interest or peer pressure that might erode journalistic duty and service to the public.
* Recognize that sponsorship of the news will not be used in any way to determine, restrict, or manipulate content.
* Refuse to allow the interests of ownership or management to influence news judgment and content inappropriately.

As we said at the top, this is nothing new. Columbus residents join the long list of television audiences all over the country who have been spoonfed one-sided PR and advertising messages from medical centers paying their way into newscasts. The fact that a supposed "news" organization would accept these deals is an embarrassment to the TV news industry.

When will RTNDA do something about it?

"The Christmas miracle of antioxidants"

Ben Goldacre, a British physician and writer, makes a prediction in this week's BMJ (subscription required for full article access):

"I'd like to make a sage prediction, seeing as it's early December. One of the joys of watching bad science coverage in the media—as I have done for four years now—is that you start to spot patterns: and this year, just like every Christmas, as regular as mince pies, I can confidently predict a specific rash of stories: they will explain solicitously that chocolate is good for you—"actually"—and red wine is even better.

It's not much of a prediction, since in the world of public relations, Christmas has started already. "Choxi+" is milk chocolate with "extra antioxidants," and the newspapers are fawning over it already: "too good to be true," says the Daily Mirror; "chocolate that is good for you, as well as seductive," says the DailyTelegraph. The company is said to "recommend" two pieces of its chocolate a day. "Guilt free," says the Daily Mail: it's "the chocolate bar that's ‘healthier' than 5lb of apples." Meanwhile, Sainsbury's is promoting Red Heart wine—with extra antioxidants—as if drinking the stuff was a duty to your grandchildren.

These products represent triumphs of over-extrapolation from observational data, and laboratory hunches. ...

The antioxidant story took a bit of a blow, of course, when people started to do placebo controlled randomised trials with antioxidant vitamin supplements, to see what happened: because overall they seem to do nothing, or at worst, reduce life expectancy. And that's when you might start to think, well now, perhaps people who eat fresh fruit and vegetables are, just like the people who drink red wine in decorous moderation, living healthily in all kinds of ways. Much like the people who buy vitamin pills. Lusty walks around country mansions. Cycling to work. That kind of thing.

Of course there may yet be something valuable in the antioxidant story, although it's probably not going to be as simple as dishing them out by the spoonful. And of course observational studies aren't inherently evil or useless: they're frequently fascinating, as part of a puzzle. These are all interesting theoretical research findings, as we try to puzzle out the roots of cancer and heart disease.

But they make a pretty thin excuse for flogging chocolate and alcohol. And somewhere out there—right now—a researcher is rubbing their hands with glee, poring over a press release, picturing themselves in the Today programme studios, planning some choice quotes for the Daily Telegraph: something racy about mince pies cutting heart disease because of the raisins, perhaps, or red wine helping you run faster. Well, it's Christmas. Have another."

Trying to reach editors to improve health journalism

We may be preaching to the choir with many of our attempts to improve health journalism if we only reach reporters. The editors to whom they report may be the most important group to reach to effect change.

With that goal, I'm grateful that The American Editor, a publication of the American Society of Newspaper Editors, published my article, "Misplaced priorities in health news coverage."

TV sweeps period contrived controversy

We’re in the middle of the November TV ratings/sweeps period. TV stations at these times often suddenly like to show a great interest in health care stories because their consultants tell them that viewers want health care news. (Why they don’t give it this attention the rest of the year is unknown.) But health care is not a topic that you can suddenly dust off and act like you understand it. There must be a daily commitment to the issues and to understanding what’s important for consumers to understand.

Last week, WCCO, a top-rated station in a major market (Minneapolis) delivered a story with a tone that suggested that the station felt it had uncovered a major issue: that health plans were giving doctors a financial incentive to prescribe a certain percentage of generic drugs.

Here’s the full text of the story.

It never explained why generic drugs are important in the nation’s cost control effort (if there is one).

It never interviewed a physician about his/her practice of prescribing generic drugs.

It quickly threw out a line that said “This practice is known as ‘pay for performance' ” – never explaining anything about the much broader definition of “pay for performance” or why it is being implemented in settings across the country or why many health policy experts think it is a wise move.

It profiled a patient who didn’t match the contrived controversy the station was presenting. The patient said he tried generic drugs but he suffered side effects, so his doctor prescribed a brand name drug. So what’s the story? No one forced anyone to do anything. And the patient says he’s now happy. Controversy? More like viewer confusion!

For some reason, WCCO only mentioned two health plans that use the generic incentives but there are others who do this that weren’t named.

Anyone who knows me knows I'm no apologist for the health insurance industry, but I felt compelled to get health plans' reaction to this story.

Spokesman Greg Bury of Medica (which was named) wrote me:

The piece did little to educate consumers about generic drugs and their role in treatments, the practice of medicine and efforts to control health care costs.

As it was pointed out to WCCO, the drugs qualifying for the incentive have the exact same active ingredients as their brand-name counterparts. The FDA ensures that they are the same. Generic drugs started out as brand name drugs; therefore, one could argue that they are a safer starting point for treatment thana brand name drug because of their track record for safety and efficacy.

Generic drugs help control the rising cost of health care. They typically cost 80-90% less than their brand name counterparts. These savings are passed along to patients because their lowest copay level typically applies. The cost structure of generics also helps slow the rise of health care premiums that are paid by plan sponsors - employers for most people - and consumers themselves.

Overall, the story is a missed opportunity to point out the value of generic drugs in the health care system. One has to wonder if WCCO is interested in helping its viewers understand the system and how they can benefit from it or if they are more interested in stirring controversy to boost ratings. We are in a sweeps period, aren't we?

Medical director Dr. Pat Courneya of HealthPartners (also mentioned in the story) wrote me:

The story sets up a false dichotomy, suggesting that brand name drugs are inherently superior in some way to generics. Despite decades of effort by the pharmaceutical industry to sow doubt about the safety and effectiveness of generic drugs, the evidence shows they are both safe and effective. They now account for the great majority of the drugs prescribed to patients. Doctors write these prescriptions despite the billions of dollars spent to market brand name alternatives. They do not do so disregarding the best interests of their patients.

Primary care doctors (I am a practicing Family Physician) would be insulted by the implication that we could be expected to "prescribe a certain number, percentage of generics, whether it's in the best interest of the patient or not." If I were told that, I would immediately protest and possibly contact an attorney. I have never been told to do anything whether it was in the interest of the patient or not, and I hope anyone who is would speak up.

Individual doctors do not get bonuses. Our financial rewards go to the medical groups – not individuals. Some medical groups use the money to further improve care for patients. For example one medical group used HealthPartners bonus to purchase a glucometer for their clinic so that diabetes patients could test their blood sugar and have the results in the exam room. The group was motivated to improve care for diabetes patients which is another measure in pay for performance.

If WCCO - or any news organization - invested in a full-time health care journalist - someone who fully developed health care reform issues such as generic substitution and "pay for performance" in its entirety - such pieces of naive, incomplete, pseudo-investigative journalism would not see the light of day. And the viewing audience would be better off.

The Whole Story

Minnesota Medicine this month has a good summary of our work to date with HealthNewsReview.org.

Exuberance over Exubera comes to crashing halt

No Monday morning quarterbacking here. Just the usual reminder to journalists and consumers that - while in the opera, it ain't over till the fat lady sings - in health care and medical research, exuberance over new ideas such as new drugs maybe ought to be restrained until long-term evidence is in.

Pfizer's announcement this week that it would shelve the insulin-inhaler drug Exubera and take a $2.8 billion pretax hit on the product is a real world reminder. The company faced a far weaker sales market than anticipated, perhaps much of it due to doctors' safety concerns about the drug.

Back when the drug was approved in January 2006, on our HealthNewsReview.org website, we reviewed an AP story about the drug's approval and noted about that story:

"Overall, there is little quantitative information on the efficacy of the new form of insulin compared with the existing method of insulin delivery. While investors may be interested that this could be a "$1 billion a year seller for Pfizer", diabetics who are considering inhaled insulin would appreciate quantitative information on the risks and benefits of Exubera."

I hope journalists are paying attention.

Annual checkups overrated

The Chicago Tribune today has a good story about how annual medical checkups are overrated. As the story explains:

That's because there is scant scientific evidence showing that yearly checkups help prevent disease, death or disability for adults with no symptoms. Many tests and procedures performed during the visits have questionable value, experts say.

When many journalists continue to push checkups and screening tests in the absence of good evidence, it is refreshing to see an evidence-based story like this.

Bitter SCHIP recipe

On this blog I have been remiss not to weigh in on the recent and ongoing debate over children's health insurance and the SCHIP or State Children's Health Insurance Program.

Not surprisingly, some of the wittiest commentary has come from Jon Stewart and Stephen Colbert. Their segments within the past week should not be missed.

Stewart's coverage on the Daily Show includes a biting commentary from John Oliver.

On the Colbert Report, the host said:

"If we really care for our kids, we should deny them health insurance now to immunize them against expecting it as adults. If we don’t, when they grow up, who knows what other unrealistic things they’re going to expect? You know, if we fund Head Start now, later, they’ll expect education. If we fund school lunches now, later, they’ll expect food."

Who spent more time exploring the issues and looking at the debate: Comedy Central? Or ABC, CBS, NBC, CNN, MSNBC, Fox?