Schwitzer health news blog

CBS adds nothing to McAllen, TX story

Last week I praised the CBS Evening News for a piece on overuse of angioplasty.

Tonight I must criticize them for junk journalism on the McAllen, TX story.

They went to McAllen, admitting that they were simply following the Atul Gawande article, "Cost Conundrum" in The New Yorker.

But then they added nothing to the story, in fact, detracting from the original piece with this exchange:

"We need to think about reforming the payment system to start rewarding providers for providing better value not just for doing more services," says Dr. Elliott Fischer.

Back in McAllen, Ruben Ramirez, who sees four different doctors per month, says he should have all the care he needs for his bad back, diabetes and erratic blood pressure.

He told (the CBS reporter) he wants more care, not less.

"That's what I would like," he says.

A total non-sequitur. Is the value and are the services discussed by Fisher (yes, it's Fisher, not Fischer as CBS incorrectly put on its website) the services Ramirez needs?
We don't know. That would require journalism.

If you want to deconstruct the Gawande piece, there are many ways to do it. Lord knows, many have tried to do so in the past two weeks. But this wasn't one that contributed anything meaningful to the public discussion.

It simply showed, "Oh, yeah, we read The New Yorker, too!"

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WCBS physician-reporter promotes free brain scans. Evidence be damned.

This is how NOT to cover health care news. It is one more example in a long list of major media in this country promoting screening tests in the absence of evidence.

Dr. Holly Phillips of WCBS-TV in NY reports about a van that ...

..."travels around New York City and offers free MRI brain scans to virtually anyone. Neurosurgeon Dr. Patrick Kelly spearheaded the campaign and believes catching brain tumors early will save lives.

"We've scanned over 1,300 people and we have found some astounding things," he told CBS 2.

Nearly a million Americans are walking around with a brain tumor and don't even know it. About 25,000 of them are in New York City alone, and by the time brain tumors cause symptoms, often times it's too late for treatment."

This, on the other hand, is how you practice quality health care journalism:

The Cancer Letter (subscription or day pass required) did the same story, but reported that "Skeptics say these folks should have their heads examined. Screening experts ... say there's no evidence to support brain scans for asymptomatic people."

One of those skeptical experts said, "“The question is what is the best use of resources to deal with the brain tumor population? The incidence of brain tumors in a population per year is in the range of 6 to 10 per 100,000 population. So what you would have to do is perform MR scans on 100,000 people to find somewhere between 6 and 10 brain tumors, and of those 6 to 10, about half of those lesions would be benign. It wouldn’t seem to be a reasonable expenditure of resources.”

Things to think about as you compare the two stories:

• The first was done by a physician who has been put on the air as a journalist.
• What is her training in journalism?
• Does she think first like a journalist, or like a doctor?
• If the latter, then her inclination, from her medical training, is probably to test, test, test.

• The Cancer Letter is written by serious journalists.
• They think about evidence, harms along with benefits, and costs.

The latter type of journalism prepares us to think about health care reform.

The former exacerbates the mess we're in.

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Where's the beef?

So the President goes to Green Bay for a town hall forum on health care reform, and two of the three TV networks (ABC and NBC; I didn't see CBS) reported NOTHING about the health care discussion - showing instead only the cute little clip of Obama signing a "please excuse" note for the little girl who skipped school to attend.

Cute.

But where's the beef?

As usual, not on the evening news.

Except that it was the lead story on The NewsHour with Jim Lehrer.

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Gawande gets us talking

I'm honored to be included in a list of commenters recruited by the Kaiser Health News Service to react to Atul Gawande's New Yorker piece on "The Cost Conundrum."

KHN writes:

"The ... article is now being called one of the most influential health care stories in recent memory. The New York Times reported that President Obama made it required reading for his staff and cited it at a meeting with Democratic senators last week. His budget chief, Peter Orszag, has written two blog posts about the article. Health and Human Services Secretary Kathleen Sebelius referred to it in a speech at the John F. Kennedy School of Government last week. Lawmakers on the Hill also are discussing it. Congressman Jim Cooper, D-Tenn., for instance, says the article has "shifted perceptions on the health care industry."

Then they asked the following to comment - an interesting range of perspectives:

• Robert Blendon, Professor of Health Policy and Political Analysis, Harvard School of Public Health and John F. Kennedy School of Government

• Greg Scandlen, Senior Fellow, Heartland Institute

• Joseph W. Stubbs, President, American College of Physicians

• E. Linda Villarreal, Past President of the Hidalgo-Starr County Medical Society, Internist in Edinburg, Texas

• and me.

By the way, if you want to learn about health policy and if you haven't been following the recently-launched Kaiser Health News Service, you should be.

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CBS News deserves credit for angioplasty stories

CBS News has aired two pieces the last two nights that raise questions about the overuse of angioplasty, about the medical arms race, and about informing patients with true informed consent about harms and benefits.

Monday June 8 clip here.

Tuesday June 9 clip here.

The first (at least) was done in partnership with Business Week.

We wish that CBS - and the other TV networks - would pursue more stories more often that raise such vital questions about evidence, overuse, costs, and quality in health care. Instead of a regular diet of stories that convey that "more is better, newer is better" - this type of story is much more meaningful for health care consumers.

For now, though, we simply want to tip our hat to this week's efforts.

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ABC misses the whole point of the A1C diabetes testing story

They said the A1C test was new, but then said it's already widely available. Huh?

That's how unhelpful the ABC News story was on the proposed broader use of the A1C diabetes test.

They never once stated that this is a proposed new application of an old test - proposed by an international committee of diabetes experts.

One print story we read had no problem summarizing the news succinctly when it led:

"A blood test physicians use regularly to check blood sugar levels in people with diabetes is now being recommended as a tool to diagnose the disease."

Was that so difficult? Would that gobble up too much precious TV airtime?

Instead, much of the airtime was wasted on meaningless people-on-the-street interviews - a hackneyed technique that doesn't employ much in the way of sound journalism. Asking people whether they knew if they had diabetes is not directly related to the news about the expanded use of the A1C test - UNLESS those people had been tested in conventional ways and were left uncertain.

But the story also:

• failed to compare the A1C with existing plasma glucose or glucose tolerance tests;
• failed to describe the sensitivity or specificity of the test;
• failed to describe the cost implications of this proposed broader use.

So, all in all, this story didn't help viewer understanding very much. It just fed the "newer is better, more is better" mentality without scrutinizing - or even apparently understanding - what was before them.

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Good Morning America on incision-free surgery is not incisive

Our amazement with the amazement network TV morning programs show for any new medical technology continues.

ABC's Good Morning America reported on a new approach to weight loss surgery that is incision-less. The segment called it "remarkable" and "exciting" but then said its results weren't as good as one current approach and no better than another. The segment stated that the new approach had fewer complications than other procedures, but no specific information was given about its impact on body weight, health, or risk of complications, including death. Perhaps these data aren't yet available? If so, it's worth emphasizing that this procedure is still experimental and needs more study to know if it is safe and truly effective. It is novel to have a weight loss procedure that is incision-less, but incision-less doesn't mean "without risk" especially in this patient population. Overall, the story suggests that this is a risk-free way to lose weight and the only down-side is the cost -- clearly this is not true and is a mis-representation of the risks involved in general anesthesia for any patient with severe obesity.

An example of a story that was all hot fudge sundae and no broccoli. (See next blog entry below.)

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People need fewer hot fudge sundaes in their health news

William Heisel, who’s done some terrific health journalism at the LA Times and elsewhere, interviewed me for the “Reporting on Health” blog of the California Endowment Health Journalism Fellowship website.

He asked good questions, making it easy for me to give substantive (I hope) answers.

And he also elicited a couple of my analogies about health news coverage:

• Broccoli and hot fudge sundaes in health care news
(To my students: you’re not the only ones who get this line from me);

• O.J. and the white Bronco;

• Thirsty people trying to get a drink from a firehose.

You’ll have to read the article to get the context.

(Photo credit: Peppysis on Flickr)

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You should sign up for HealthNewsReview.org e-mail digests

That way, each week you can get summaries of the past week's news reviews sent to you by e-mail. such as:

ABC's Good Morning America, 2-star score

Homegrown Cure: Can Breast Milk Heal Adults?
Story on the potential for "harnessing the curative effects (of human breast milk) to fight terminal cancer." But it left viewers' heads spinning over what - if anything - is known.

ABC World News with Charles Gibson, 2-star score

A New Voice
High drama about one opera singer's struggle with and treatment for recurrent respiratory papillomatosis. But the story lacks info on costs, evidence, and harms. And it quotes only one expert.

Associated Press wire service, 4-star score

Immune System Taught to Fight Deadly Skin Cancer
A well written, balanced story about a trial which created a buzz at a national meeting of oncologists. It was clear, hopeful without hyping the new treatment, and included expert comment.

Los Angeles Times, 4-star score

Study finds antidepressant doesn't help autistic children
Story about the failure of Celexa to control repetitive behaviors in autistic kids does a solid job explaining why the study matters and its conclusions can be trusted. But read about 3 key flaws.

ABC World News with Charles Gibson, 0-star score

Personalized Cancer Care
This story is a marketing coup for a hospital, but its relevance to most cancer patients is unclear. This story failed on costs and on context, cheerleading for an approach that lacks evidence.

New York Post, 0-star score

Tomato Scoop
The best thing that can be said about this story is that it was short. For anyone thinking of lycopene supplements, this story failed to deliver the information they would need to make an informed choice.

New York Daily News, 3-star score

For many women, breast reduction means less pain and more activity
The story conveys the impression that the surgery is effective without providing any credible information to verify this. No mention of risks or costs. Egregious disease-mongering example.

Sign up at: http://www.healthnewsreview.org/get_e-mail_updates.php

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ABC News story on personalized cancer care needs treatment itself

This story is a marketing coup for a hospital, but its relevance to most cancer patients is unclear. This story failed on costs and on context, cheerleading for an approach that lacks evidence.

Andrew Holtz, former CNN-er, and past president of the Association of Health Care Journalists, was one of the reviewers of this piece. He recently joined the HealthNewsReview.org team of reviewers. I mention this because sometimes readers may wonder if the story reviewers have journalism - and, in this case, TV journalism experience. Between Andrew and me, we have more years (30+) of such experience than we may care to remember.

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Questioning the wisdom of executive physicals

This doesn't happen very often: a Minnesota researcher and a Minnesota journalist questioning the wisdom of the kinds of "executive physicals" performed so often at the Mayo Clinic.

"Unnecessary testing may cause more harm than good, owing to false positive findings, unwarranted follow-up visits and costs, needless worry, and harmful side effects of the tests themselves," wrote Dr. Brian Rank of HealthPartners about the practice.

Mother Mayo doesn't like to be questioned in this way - especially within its own home state.

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Tweeting from scientific meetings

Science blogger Andrew Maynard - who says he's not a journalist but a "social media commentator" - posts some interesting thoughts in an article, "To tweet or not to tweet - social media and the scientific meeting." Excerpt:

"Once upon a time, scientific conferences were predominantly about exchanging and examining new information with your peers - at least, they were in my field of research. Reporters just weren’t a part of the equation. Now, major conferences tend to be a media-fest - with the scientific community clamoring to have their messages and stories heard by all and sundry. There’s tremendous pressure to “sell” studies to the media - to work out what might appeal to a broad readership, then dress it up so it’s as attractive as possible. If you don’t believe me, just take a look at the press releases and media coverage surrounding something like an American Chemical Society meeting.

As a result there is a tendency - at some conferences at least - for presentations to be less about peer to peer review and discussion, and more about broad dissemination and promotion. In this context, people want their work to be communicated in the media - but on their terms. In other words, they love the media when they feel they are on control, but get antsy if they feel that control slipping."

How about tweeting from a meeting where non-peer-reviewed-data is being presented? Maynard writes:

If the aim of the meeting is to seriously assess and discuss someone’s unpublished research, I would hesitate to live tweet. I might blog - but only if it seemed appropriate given the state and significance of the research.

Journalists should be as transparent as this "social media commentator" is about how they're going to use social media to cover health, medicine, science. Will there be different criteria? Different codes of ethics? Thanks to Maynard for his contribution to the discussion.

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NY Daily News story on breast reduction surgery not up to challenge

In one of the worst examples of disease-mongering we've ever seen, the paper let a plastic surgeon get away with saying, “The pain that women with large breasts can have has been compared to when someone gets metastasized cancer of the spine.”

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Health care reporting requires years of experience to get it right

That's the sub-head of an article in the UC-Berkeley alumni magazine by David Tuller, who teaches health reporting at the University of California-Berkeley Graduate School of Journalism and who is helping to build a new master's program in public health and journalism there. He interviewed me for the article and reflected on my recent report to the Kaiser Family Foundation on the state of health journalism.

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Another bad morning health story on Good Morning America

Last week, ABC aired a story looking at the potential for "harnessing the curative effects (of human breast milk) to fight terminal cancer." Excerpt from HealthNewsReview.org:

The segment:

* failed to adequately document any evidence of the benefits of this approach in adults;

* failed to explain that breast milk has been shown to transmit viruses such HIV, hepatitis, and meningitis – an important point when discussing its use in immunosuppressed cancer patients who are especially vulnerable to infection;

* failed to include interviews with any oncologists, gastroenterologists, immunologists or lactation specialists.

It was described as “a highly alternative treatment.” What does that mean?

What did any of this mean to viewers? It went from saying there was "promising research that would indicate that in the future, the solutions for not only preventing cancer, but even treating and curing cancer might be within human milk" – to saying "there's no research that says...human breast milk will benefit a man, such as this man suffering from cancer."

Yet the network gave lots of airtime to the suggestion of potential benefits.

Such a “yes it can, no it can’t” use of network TV airtime is not a public service.

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If I visit, you may be changing jobs

On a trip to NYC last week, I visited Ivan Oransky at Scientific American. This week he announced he is leaving SciAm to become executive editor of Reuters Health.

I also visited Diana Mason, editor of the American Journal of Nursing. She announced that yesterday was her last day on that job.

Diana will have an endowed chair at the Hunter–Bellevue School of Nursing at the City University of New York. She will launch a center for health media and policy.

Ivan and Diana are two good friends, and two terrific journalists, both headed to exciting new opportunities. We wish them both the best.

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H1N1 news around the world

Interesting look at international coverage of the H1N1 flu story in a new analysis by the Project for Excellence in Journalism.

They studied 12 days of front-page newspaper coverage in seven countries around the world.

Key points from their summary:

• The three major U.S. papers studied offered some of the broadest coverage of the outbreak of any country studied, and all stories were staff-generated, as opposed to wire copy. Despite complaints in some quarters of excessive media hype, the level of coverage was relatively moderate when matched up against the number of confirmed U.S. cases.

• The number of cases of swine flu in a given country had little to do with the volume of coverage around the world. China, for example, had the fewest confirmed cases of any of the countries studied (1), but the paper studied, People’s Daily, offered about as much front-page coverage as the average paper in the U.S., which had over 2000 cases.

• In Mexico, extensive coverage by El Universal (20 front-page stories over the 12 days) cut across a broad range of issues, from the impact on businesses to the history of the virus. But the Mexican paper largely skipped any close assessment of its own government’s response.

• The French paper Le Figaro was more restrained but also controversial in its coverage. The paper ran just two stories on the front pages, but sparked an outcry by terming the outbreak “the Mexican flu.”

• In the Spanish-language papers in the U.S., one of the most striking findings was a heavy reliance by two of the three—El Diario and El Nuevo Herald—on U.S. wire service copy to fill their pages.

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Better late than never to honor Vietnam nurses

I meant to post this on Memorial Day.

But, in keeping with the theme, better late than never.

One of our health journalism grad students, Dr. Kay Schwebke, had a terrific article in the American Journal of Nursing in May, "The Vietnam Women's Memorial: Better Late Than Never." The article was based on her capstone project in our graduate program.

There are also podcasts related to the article online.

More recently, Schwebke had an important article posted on MinnPost.com, "As recession bites, Minnesota hospitals struggle with unpaid bills." It profiles some of the "hundreds of Minnesota hospital and clinic employees laid off within the past eight months, largely because of rising costs of uncompensated care."

Kay is a role model for new physician-journalists - diligent, health-policy-minded, inquisitive, able to think like a journalist writing for her audience - not just like a doctor.

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Problems with news coverage of early release of ASCO abstracts

This is a troubling trend. HealthNewsReview.org has now reviewed four stories based on abstracts for the American Society for Clinical Oncology meeting that won't even be held until next week.

Woloshin & Schwartz wrote the excellent paper pointing out the flaws of drawing conclusions from presentations at scientific meetings, but this stuff hasn't even been presented yet!

An ASCO "presscast" on May 14 drew special attention to just seven of the more than 4,000 abstracts released by ASCO two weeks in advance of the meeting. The four stories we've reviewed on HealthNewsReview.org covered three of those seven highlighted abstracts.

So if you think that all this news coverage is driven by independent vetting by journalists - think again.

The most troubling example is the following - because of the quality reputation of the newspaper and the reporter involved and because of the influence of this paper.

A Wall Street Journal story wasn't critical enough of a genetic test for colon cancer, according to HealthNewsReview.org reviewers, including former Washington Post health section editor Craig Stoltz, who wrote a clear and powerful review. He noted that a few hours after the not-critical-enough WSJ print story appeared, the WSJ health blog posted this:

Genomic Health was trading higher on data suggesting its test for early-stage colon cancer may help patients and doctors decide whether they needed chemotherapy after their tumors are removed with surgery. Read the WSJ story on the colon-cancer test here. (referring readers back to the print story.)

If, as was claimed in another WSJ story, this early release of ASCO news releases was supposed to prevent "past problems that resulted in trading on market-moving information before it was released to the general public," we wonder how well this policy is working.

We do know that the ASCO publicity machine worked.

We've also reviewed two other non-ASCO stories recently that let companies get away with making claims about research progress but without having all the data in hand. The message was sort of, "Trust us, this is really solid data, but we can't give it to you now because it's going to be presented in a month."

One was by the New York Times on the prostate cancer drug Provenge.

One was another Wall Street Journal story on the anti-clotting drug Brilinta.

Readers beware: what you're getting in these jump-the-gun stories may not be the whole story, may not have all the data, and may not scrutinize the quality of the evidence. Look for independent, non-conflicted voices in such stories but even then it may be difficult for other experts to comment because they haven't seen all the data.

This is a troubling journalistic trend - for all the reasons given.

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Inspired by the health journalists I met with in NY

I was very fortunate this week to meet - in total - with more than 100 very smart people who are dedicated to quality improvement in health journalism.

My visit to New York included:

• a talk to the NY chapter of the Association of Health Care Journalists at the CUNY Graduate School of Journalism. Twitter accounts of this presentation can be found using the #ahcjnyc hashtag.

• two days of meetings with various editorial and other folks at Consumer Reports. For years health care consumer advocates have said, "There's no Consumer Reports for health." Well there is now and there actually has been for some time. It may be under-appreciated that there are some very smart people at CR thinking very hard and long every day about how to educate consumers on vital health care and health care reform issues.

• a chance to talk with editorial folks at the American Journal of Nursing - again a very savvy group whose work may be under-appreciated. Think about the dominance of physician-dominated journals promoting a medical model of health care and you'll see why it's important to consider the perspectives and issues of other key health care providers like nurses - and why this Journal is important. Thanks to the AJN blog for a plug about our work and about our visit earlier today.

I think I contributed a little to these groups in my meetings in NYC this week, but I took away a lot - including new inspiration about how much quality journalistic work is being done in many different venues on vital health care and health care reform topics.

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Cartoonist depicts how science news is made

The Science News Cycle depicted on PhD Comics.

Thanks to my student Stephanie for the tip.

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HealthBusinessBlog: "I don't know what USA Today is thinking."

Read David Williams' blog posting about the USA Today story, "In patients' hunt for care, doctor database 'a place to start'".

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News orgs that let pharma make claims before releasing data

This may be a trend. And if so, it's a troubling one.

On HealthNewsReview.org, we've just posted a review of a Wall Street Journal story that we characterize as
"Another story that lets a drug company get away with making superiority claims without releasing data."

Many news orgs let the makers of Provenge get away with this just a few days ago.

Stock manipulation anyone?

Is it going to kill anyone to wait until the data is actually released when independent expert opinion can be sought?

We don't like this practice one bit.

Read how the the European Court of Justice views journalism that it equates with advertising.

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Physician-reporters at the forefront? I don't think so.

Dr. Jennifer Ashton, CBS news medical correspondent, in an interview on the Columbia j-school site, says:

"The people who are really at the forefront of medical media and medical correspondents - they are physicians."

I couldn't disagree more. Hundreds of non-physician journalists have toiled on this complex beat far longer, with more dedicated fulltime effort, and with a track record that in many cases surpasses that of most, if not all, physician journalists. Physician journalists often tend to bring their "member of the gang" medical mentality with them as they approach news topics. They are still more physician than journalist. Some give advice, not balanced news. Some promote the "medical model" - not a "public health model." Some tend to talk about medicine's terrific new toys without ever discussing costs, quality, access, disparities.

Some - not all.

I don't want to be guilty of the same stereotyping that Ashton used in blanketing all physician journalists - but her boast that her type is in the forefront of medical journalism is not supported by fact.

Case in point:

The CBS Early Show - where her segments often appear - has been reviewed six times so far in 2009.
Of the ten criteria we apply to the review of all stories, those segments have been judged satisfactory between 10-20% of the time. On important little things like cost, evidence, scope of the potential benefits and of the potential harms. Things consumers need to know in order to evaluate claims being made about new treatments, tests, products and procedures.

Here are reviews of three of her recent segments:

• http://www.healthnewsreview.org/review/review.php?rid=1975

•http://www.healthnewsreview.org/review/review.php?rid=1972

•http://www.healthnewsreview.org/review/review.php?rid=1966

Physician-reporter segments on the other networks have received similar poor grades. Give me an ink-stained wretch who applies basic healthy skepticism and journalistic fundamentals to these topics any day.

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Press releases from academic medical centers - continued

A healthy online discussion has begun over the Woloshin-Schwartz paper, published in last week's Annals of Internal Medicine, that concluded: “Press releases from academic medical centers often promote research that has uncertain relevance to human health and do not provide key facts or acknowledge important limitations.”

On the Columbia Journalism Review website, Earle Holland - assistant vice president for research communications at Ohio State University - scrutinizes that paper and news coverage thereof. And, in a followup comment, he gives a plug for our work, writing:

"The lamentation that news "releases are distributed directly to the public via the web, and the news spreads without any independent assessment" is easily fixed, if it is a concern at all. Journalists need to do a better job of evaluating the studies. A bit of time spent at Gary Schwitzer's great website, HealthNewsReview.org offers a great primer on what's good and bad about ongoing medical/biomedical reporting."

Read all of Holland's article. This is an important topic for discussion by those who care about the dissemination of health, medical and research news.

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Today Show, Nancy Snyderman, strike out again

Reviewers gave a zero-star score to a story on a device to screen for melanoma. Excerpts:

"This story abounds in pretty pictures and a tale of tragic loss, but it lacks any context or facts that would allow viewers to understand what is new or relevant about a device to screen for melanoma skin cancer. ...In the end, viewers are given hope and amazement, but no useful information."

A reminder: three different reviewers evaluate each story reviewed on HealthNewsReview.org. So this isn't just one person's opinion of quality, or lack thereof.

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What will Snyderman's one-hour program be like? We can only guess.

Several people have asked me to comment on the news that Nancy Snyderman, M.D., chief medical editor for NBC News, will anchor a one-hour daily show about health news and issues that will air on MSNBC beginning June 29.

I can't comment on a program that hasn't begun to air yet.

I can only point toward past reviews of Dr. Snyderman's work.

Birth Control for Men: May 5, 2009

Excerpt of review: “In almost every way, this story overstates the benefits and essentially ignores the risks and limitations of testosterone injections for male contraceptive use.”

Can you recover from autism? April 17, 2009

Excerpt of review: “This story dangles hope of recovery in front of parents of children diagnosed with autism. Indeed, the word "hope" is invoked four times. However, the story provides neither evidence that the therapy program is responsible for the improvement in the featured patient nor any details of how this intervention differs from standard therapies used to manage the symptoms of autism.”

Lose weight while you sleep? February 9, 2009

Excerpt of review: “NBC gave 5.5 minutes of free publicity to Glamour magazine's pseudo-scientific experiment, then made bold, baseless projections that women would "probably add about 7 years to their life". Amazing.”

Today’s Matters of the Heart: Dr. Nancy’s Personal Wake-up Call; February 4, 2009

Excerpt of review: “A 6-minute segment almost completely devoid of evidence and data, riding the single personal anecdote of the network's medical editor. Disease-mongering. Incomplete story on heart CT scans.”

Nothing but miracles, breakthroughs, rainbows and unicorns for Today Show; February 5, 2008

Networks' pro-screening enthusiasm; March 30, 2007

These were all short segments.

Imagine what they can do with a full hour!

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My interview on the Local TV Now podcast

Local TV Now is a weekly podcast covering the business of local television. One of the hosts interviewed me last week.

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Society of Professional Journalists Town Hall Forum on health journalism - videos now online

Last week's event, "Fever Pitch: Does health news reporting leave consumers out in the cold?", co-hosted by the Minnesota chapter of the Society of Professional Journalists, the Minnesota News Council and the Silha Center for the Study of Media Ethics and Law, is now available for viewing online.

The full event is broken up online into three video clips. The introductions, and my talk, are in the following video:

The event offered a chance for an open dialogue about issues confronting those trying to cover health care issues. This photo shows me locking in on a point made by Jeremy Olson of the St. Paul Pioneer Press while Dave Hage of the Star Tribune listens.

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TV networks ignore health story costs and evidence

Bad week on network TV.

Stories on...

• a male contraceptive

• robotic surgery

• a new MRI device

* and a new skin cancer detection device

all failed to discuss costs, to quantify benefits and harms, or to give independent perspectives.

Viewers of these programs got one-sided, incomplete, imbalanced portrayals of health care treatments, tests, products and procedures.

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Diane Sawyer learns how to be robotic surgeon

See HealthNewsReview.org review of Good Morning America's latest medical technology cheerleading story. Excerpt:

A few minutes of techno-tainment with inexcusable, almost inconceivable lapses in journalistic hygiene. No discussion of cost, of evidence for benefits or harms, and no independent insight.

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Does the Twin Cities need five children's hospitals?

This story has barely been touched by local Twin Cities news organizations. But a student journalist, Emma Carew, reported on it as her last story at the Minnesota Daily before graduating and before going to work for the Washington Post this summer.

As you'll see, the story touches on issues of duplication of services, increased costs, competition and the medical arms race.

A 1,200-word story by a student journalist on an important topic for local discussion.

In the inquisitiveness and determination of young journalists, there is hope for health care journalism. This is one shining example.

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The new class clowns - TV reporters and the flu story

The Radio-Television News Directors Association website posted an article by RTNDA chairman Stacey Woelfel, reflecting on the high school class clown who did an oinking and squealing routine whenever anyone mentioned swine flu back in 1976. He doesn't hear oinking today but, rather, "the sound of hundreds of reporters beating this story to death."

Woelfel writes:

"The rampant coverage stems from the fact we’re in a good, old-fashioned arms race. That’s right, an arms race just like the ones the U. S. and the Soviet Union were having back when Gerald Ford was getting his swine flu shot. But the current arms race doesn’t have anything to do with out-nuking each other. It has to do with the escalating competition between media outlets to grab an ever-shrinking audience for our product. I must give credit to Robert Frank and his terrific book The Economic Naturalist for opening my mind to the current arms race scenario. Frank describes the race in economic terms, focusing on why businesses do what they do—even it seems illogical. That illogic is, I believe, at the heart of our swine flu crisis. We fight to do more and more on this mostly-trivial disease because we fear our competitor will have more than we do. But what we miss is that our audiences are laughing at us every bit as hard as I did when Ken Kosciulek (his old class clown classmate) started his pig noises.

Should we end all swine flu coverage? No. But our goal should not be to have the most coverage—just the best. And best may include not covering it at all when there’s nothing new to report. At least put the current news in context. I’ll risk mentioning another book all news directors should read. Pick up a copy of Barry Glassner’s The Culture of Fear: Why Americans are Afraid of the Wrong Things. Even though the book’s now ten years old, it still speaks to our role in frightening the American public for no good reason. Again, I’m not saying we shouldn’t cover stories that might be a little scary. But we should put those scares in the context of the odds—the odds of catching swine flu, the odds of dying from it, the odds you’ll even know you have it. That gives the audience a fighting chance to decide just how important the story is and to make an intelligent decision to tune elsewhere when they tire of it."

If only RTNDA and its chairman and its website and its terrific code of ethics seemed to make any difference with its members! Sadly, that often doesn't seem to be the case on journalism ethics issues - and certainly not regarding shoddy coverage of health news stories.

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Swine flu-HIV could devastate human race: worst story yet?

There's considerable discussion on the listserv of the Association of Health Care Journalists about this UPI story - with the above headline - being the worst yet on flu coverage.

Among the comments journalists posted:

• The paragraphs about HIV looks like someone stuck it in there, as it bears little resemblance to the rest of the story.

• It says "Health authorities are particularly worried that the capability to mutate already exhibited by the virus could eventually let it combine with the human immunodeficiency virus, which causes AIDS." Then it gives a sentence comparing that to the Spanish flu, and that's the end of the possible "mixing" with HIV. No sources on this at all, only the very ambiguous "health authorities."

• It throws out completely unsubstantiated data with no source. There is also no background info on that--even in the absence of resources, it gives no background on why anyone would think that it could combine with HIV, or how that could even happen. Or what makes this flu strain so special that it would have a special affinity for HIV.

• Reuters uses some pretty loose language too. I think they're both overinterpreting the WHO statement, which discusses the comorbidity of the two infections, not some apocalyptic biological combination.

• There is no scientific basis for such speculation, or evidence that it has occurred in the decades that both viruses have been around.

• The speculation makes about as much sense as saying that because dogs and cats are both pets, some day they might combine to produce a dat or cog.

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Problems with news releases from academic medical centers

Great paper by Woloshin & Schwartz (and others) in the current Annals of Internal Medicine, "Press Releases by Academic Medical Centers: Not So Academic?"

Excerpts from the Discussion section of their paper:

Press releases issued by 20 academic medical centers frequently promoted preliminary research or inherently limited human studies without providing basic details or cautions needed to judge the meaning, relevance, or validity of the science. Our findings are consistent with those of other analyses of pharmaceutical industry and medical journal press releases, which also revealed a tendency to overstate the importance and downplay (or ignore) the limitations of research.
…
The quickest strategy for improvement would be for centers to issue fewer releases about preliminary research, especially unpublished scientific meeting presentations, because findings often change substantially—or fail to hold up—as studies mature. Forty percent of meeting abstracts and 25% of abstracts that garner media attention are never subsequently published as full reports in medical journals. Similarly, centers should limit releases about animal or laboratory research. Although such research is important, institutions should not imply clinical benefit when it does not exist (and may not for years, if ever): Two thirds of even highly cited animal studies fail to translate into successful human treatments.

When press releases are issued, they should include basic study facts and explicit cautions. For example, press releases should remind journalists that strong inferences cannot be drawn from uncontrolled studies, or that surrogate outcomes do not always translate into clinical outcomes. Although good press releases will probably help, quality reporting also requires good critical evaluation skills. Fortunately, journalists have opportunities to acquire these skills, through such programs as the Association of Health Care Journalists seminars; the Knight Science Journalism Medical Evidence Boot Camp at MIT; and "Medicine in the Media: The Challenge of Reporting on Medical Research," a workshop sponsored by the National Institutes of Health, the Dartmouth Institute for Health Policy and Clinical Practice, and the Department of Veterans Affairs.

Investigators can also do better. They could forgo requesting releases for studies with obvious limitations and review releases before dissemination, taking care to temper their tone (particularly their own quotes, which we often found overly enthusiastic).

By issuing fewer but better press releases, academic centers could help reduce the chance that journalists and the public are misled about the importance or implications of medical research. Centers might get less press coverage, but they would better serve their mission: to improve the health of their communities and the larger society in which they reside.

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Folkenflik on flu news coverage

NPR's media correspondent interviewed me for this segment on "How Well Have Media Covered the Flu Outbreak?"

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A half million dollars to prevent one case of prostate cancer?

Why doesn't this kind of cost analysis make it into stories?

An AP story last week on Avodart being tried for prostate cancer DID give the NNT or number needed to treat, but didn't project the cost analysis behind that NNT.

The story said that "to prevent a single case of cancer, 71 men would have to take finasteride [a similar drug] for 7 years." But it didn't then do the math. The story says Avodart is $3 per pill, so---

71 men x 365 days/yr. x 7 yrs. x $3/pill = $544,215 to prevent a single case of prostate cancer.

How can these kinds of numbers be left out of stories?

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NJ hospital reverses its ban on newspaper that asked tough questions

Intro to Hospital Public Relations: How to learn from bad examples.

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CNN adds to the cacophony - "Bracing For The Worst"

James Rainey of the LA Times writes that some news organizations "seem to have a congenital inability to tell this story with precision or proportion."

This story being the flu story.

I have stuck to my diet: I've still not watched one second of TV news coverage of the flu. The healthiest diet I've ever pursued.

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Swine Flu and TV sweeps: a recipe for disaster

The ShopTalk newsletter today describes the ugly TV news "shoving match" in Orlando over "the first report that a case of the swine flu was confirmed in Orlando." ShopTalk writes:

"Pity the poor viewers, who have to sort through all the hype and hysteria to find the facts."

Baltimore Sun TV critic David Zurawick writes:

"Dr. Sanjay Gupta, the CNN and CBS medical correspondent, was reporting from outside a hospital in Mexico City using such terms as "ground zero" and "chaos" to describe the situation.

Tuesday morning, on NBC's top-rated Today show, Dr. Nancy Snyderman, the show's health expert, was reporting "a couple of unconfirmed cases in New Jersey." ...

I can't imagine why Snyderman and Today were reporting unconfirmed cases. That seems to me one of the worst things a journalistic enterprise -- and Today is produced by NBC News -- should be doing. Wait for confirmation when reporting such data. ...

Even though Gupta is primarily known as the lead medical correspondent on CNN, he also works for CBS News, and I saw him Monday night on The CBS News with Katie Couric standing in front of a Mexico City hospital. He had his own mask -- down about his throat. Overly dramatic? Maybe.

I hated Gupta describing his location as "sort of ground zero" and reporting what he described as a lack of basic supplies for medical workers at the Mexican hospital as "sort of the chaos here," but he was the reporter on the ground. I just wish the language he used would have been prudent and less sensational."

Kudos to the Wall Street Journal, for including some perspective I've not seen anyone give quite this way:

"Many people assume a pandemic is a deadly scourge, but two of three flu pandemics that circled the globe in the 20th century were relatively mild. "Pandemics can range from being relatively mild to being extremely severe," said Keiji Fukuda, the World Health Organization's acting assistant director for health security and environment. "My own sense right now is it too early to make a call."

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SPJ Town Hall Forum on health journalism

We're involved in another health journalism-related event on the University of Minnesota campus this week.

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All flu all the time on cable news

I don't watch much TV news anymore. As I wrote yesterday, I haven't watched ANY TV coverage of the flu story.

But Howard Kurtz has, and he writes today about some of the pitfalls of the "fever pitch" coverage as he calls it.

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So far, calm, cautious news coverage of flu

Only a comment because I've been asked: I've been favorably impressed by most of the flu news coverage I've read.

Haven't watched any TV coverage - generally a healthy habit.

Of course, if any readers have seen any examples they want to bring attention to, the forum is open.

The Knight Science Journalism Tracker offers a nice overview of news coverage.

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Poison Pills

Finished Tom Nesi’s book, “Poison Pills: The Untold Story of the Vioxx Drug Scandal.”

Chilling.

Sickening.

Everyone should read this story.

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The black hole of TV health news ethics

Another chapter has been written in the sorry series of unethical practices by local TV news operations in covering health news.

Al Tompkins of the Poynter Institute criticizes the Radio-Television News Directors Association and a local Maine TV station - and rightly so. Excerpt:

"I disagree with Radio-Television News Directors Association Chairman Ed Esposito's decision to allow WGME-TV to keep its Edward R. Murrow Award for a series of stories it produced about a medical team's work in China.

Maine Foundation for Cardiac Surgery paid for WGME's nine-day trip to Shanghai, which the Portland, Maine, station clearly disclosed at the beginning of each segment of its project, "The China Journey." The stories were well-told, and the photojournalism and editing was strong. ...

The station's heart was in the right place, but it should have put its wallet there too. Not doing so now gives stations nationwide an out when the boss comes knocking with a free trip to cover a worthwhile story."

Many stations may also make the claim that "their heart was in the right place" when they also accept medical industry money for sponsored segments that feature only the sponsors' experts - without disclosing that on the air.

RTNDA needs to wake up to how its own code of ethics - a strong document - is only a meaningless piece of paper if it isn't discussed and embraced by its members.

On Tompkins' site, the Maine news director responds: "The foundation NEVER tried to influence our coverage in any way."

They paid for the trip and got the coverage, didn't they? And that was coverage they would not have received if they didn't pay for the trip. To me, that's pretty clear influence.

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Documentary screening: Money-Driven Medicine

Minnesotans, wake up from your winter doldrums and get your heads around health care reform issues.

Tomorrow (Friday April 24) - free documentary screening of Alex Gibney's film on Maggie Mahar's book , "Money-Driven Medicine."

Link to map of Murphy Hall location. Parking in Washington Avenue ramp two blocks east of this location.

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Shoddy stories on autism, fertility treatments

Two more weak stories reviewed on HealthNewsReview.org:

• NBC Today show: Can you "recover" from autism?

Our review:
This story dangles hope of recovery in front of parents of children diagnosed with autism. Indeed, the word "hope" is invoked four times. However, the story provides no evidence to back up this hope.

• NY Daily News: Have a baby at new low, low price, says fertility doctor

Our review:
Is cheap really the whole story? This piece focuses on an infertility or subfertility treatment and promotes one doctor’s clinic in so doing. But cost, evidence, data are all weak points.

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Vague and vapid CBS segment on the pill

Another zero-star bottom-dweller for the CBS Early Show.

We now have three zero-star network morning show health segments reviewed on the home page of HealthNewsReview.org.

They're going for an 0-for-April.

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Bipolar children a purely American phenomenon

Christopher Lane interviews journalist Philip Dawdy, who has written about the "astonishing" rise in the number of diagnoses of ADHD and bipolar disorder in teens and preschoolers.

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Seattle was health care journalism heaven these past 4 days

Bloggers and Tweeters wrote about my presentations on 3 panels at the Association of Health Care Journalists conference in Seattle.

• On Washington state law encouraging shared decision-making.

• On the importance of covering costs in health care stories.

• Some folks followed my panel on "How To Report on Studies" on Twitter.

#ahcj09

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Feeble, fawning NYT story on Provenge

It is not with any relish that HealthNewsReview.org publishes its worst review ever of a New York Times story.

Summary of our review:

"This story about a drug company's announcement of positive study results fails readers in every important way.

It portrays a "decisive" clinicial trial that shows a first-of-its-kind prostate cancer drug "prolonged the lives of men." It spins the tale of a determined company rewarded for its persistence against a slow-witted bureaucracy, whose earlier inaction led to the loss of "a lot of good men." It presents testimony of a cancer-stricken patient "looking into the abyss," seeking only "a chance." It anticipates the drug's approval, and documents Wall Street's instant validation of the study findings.

Not until paragraph eight does the story state that the company has not released the results, that the findings will not be discussed in public for two weeks, and that even then they will not have been peer-reviewed or published. It does not say that the results of this medical study were announced in a conference call to investors.

It recklessly, even perversely, suggests that the FDA's earlier inaction, combined with patient protests and what are now claimed to be positive results, constitute proof of efficacy.

It's hard to imagine why a story would delay and omit key information, imply efficacy had been demonstrated in the absense of evidence, or fail to balance all the positive views with those of a skeptic, or at least someone who urges prudence until the data are made public.

It is true that this story was originally published in the paper's business section. But all journalists share a common responsibility to the public when writing stories about diseases and treatments. In today's media environment, where a story's readers usually encounter it out of context of a "section," few readers will be "savvy" enough, if that is the word, to bring lower expectations of accuracy, balance and fairness to a story about what a drug can do for a deadly disease merely because it was originally written for the "business" section.

It's painful to imagine how families affected by advanced prostate cancer may respond to this article, and then to what they will subsequently learn. Even investors are badly served by such an unbalanced, incomplete story.

In any case, it is distressing to see such credulous, feeble, negligent journalism published anywhere in the New York Times."

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CBS Early Show joins ranks of zero-star health stories

Another terribly incomplete story on a morning segment on network TV.

It was about an osteoporosis drug now being looked at for poorly healing bone fractures.

CBS put a crawl under this story reading "Stem cells to build better bones." And then failed to mention stem cells even one time in the story.

They also had:

* No discussion of costs - which are significant.

* No discussion of evidence, which is limited.

* No discussion of the source of the information, but we can assume it was a recent study for which there was no control group to compare the results to. Furthermore, that study has not yet been published and the full results have not been reviewed by other experts. These are important caveats that the story should have mentioned.

Instead of data, the segment gushed calling it "godsend...really exciting...very important...could be lifesaving."

Complete story review on HealthNewsReview.org.

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What if?

A posting on the WhatIfPost.com site - short for "What if America Had a Health Care System That Worked?" - discussed my recent report to the Kaiser Family Foundation on the state of US health journalism.

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Off to Seattle

I'm on 3 panels at the Association of Health Care Journalists annual conference this week in Seattle.

Friday at 11 a.m.: Explaining costs in health care stories.

Friday at 3:15 pm: State legislation encouraging shared decision-making. Clinical, policy, legal views in one session.

Saturday at 2:30 p.m.: "How To Report on Studies" workshop. This session will mark the first time that the original publishers of the Australian, Canadian and US teams that have graded more than 2,000 health care stories will appear together on the same panel. It's Dr. David Henry - now in Toronto - who was the pioneer with the Media Doctor Australia website, Alan Cassels of the University of Victoria who started the Media Doctor Canada website, and me - publisher of the HealthNewsReview.org website. Should be fun.

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TVWeek's special issue on health journalism

Each year, timed to the Association of Health Care Journalists annual conference (which is this week in Seattle), TVWeek publishes a special issue on health journalism.

An index of this year's articles is available online.

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Bad week for Good Morning America

In a little more than a week, 3 health segments on ABC's Good Morning America received pretty bad reviews from health care and journalism observers on HealthNewsReview.org. All 3 stories are currently on the site's home page.

The story, "Cutting Edge Nail Cure" got one of our rare, lowest, zero-star scores:

The advantages were unsubstantiated, the harms unstated and the effectiveness exaggerated. Network TV promoting an off-label use. Disease mongering at its worst. A new low. Stay tuned for lower.

The segment, "DNA tests replace Pap smear?" made a decent effort on an important topic, but, in the end, our reviewers felt:

This story gave lip service to an important new study, but fell far short on details. Didn’t quantify benefits or costs or discuss the possibly limited impact in developed countries.

And the segment, "New treatments for America's #1 killer," deserved this review:

Story on coronary calcium test fails to discuss evidence, cost, or problems with false positive tests. But it hypes the test and disease mongers – telling us it’s a wakeup call we all need. Not so.

Instead of starting your day with this kind of health news, you'd be better off going for a walk before work.

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So many news stories drool over DaVinci

These are actual headlines from newspapers across the US on the DaVinci robotic surgical system:

• Robot doctor - surgery of tomorrow

• Da Vinci puts magical touch on the prostate

• Cancer survivors meet lifesaving surgical robot

• Robotic surgeon's hands never tremble

• Da Vinci is code for faster recovery

• Surgical Maestro

• DA VINCI ROBOT IS SURGERY WORK OF ART

• Hospital hopes robot surgery will lure patients

The last one is closest to the truth.

We reviewed another one today on HealthNewsReview.org.

It's hard to understand how so many stories could be so fawning, drooling over new technology, without discussing evidence of harms and benefits, which is limited.

As we said in our review of the latest story:

"(The story framed) the procedure like playing video games - "It's like shooting at space ships." Even though the surgeon interviewed said this, it would have been interesting to get a primary care doc's reaction to this comment. In fact, any independent source would have been appreciated.

Legitimate questions can and should be raised about any new medical technology. This story raised few, but let true-believer-surgeons promote their pet technology. One said he "loves his robot."

Even with prostate cancer, for which robotic systems have been used most often, the US Agency for Healthcare Research and Quality says there isn’t enough research yet to tell us how well robotic surgery works compared with other treatments."

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More health-related paid-for news

The Tulsa World reports that the state of Oklahoma "is paying more than $3 million to an Oklahoma media company, Griffin Communications, to advertise a state (health) insurance program, and the company has promised to air television news stories on its Tulsa and Oklahoma City stations as part of the deal."

The story explains:

"Griffin employs former KWTV, channel 9, television reporter Angela Buckelew as the campaign's spokeswoman. She appears during news programming on both KOTV, channel 6, and channel 9 to talk about the Insure Oklahoma program.

The media spots aired as part of Griffin's marketing campaign blend seamlessly into the newscasts of KOTV and KWTV, with Buckelew acting as reporter and telling the individual stories of employees of small businesses who have benefited from the subsidized health insurance plan."

It's interesting to follow the online thread of reader comments, including these:

• TV news isn't very worthwhile anyway. Arrangements like this certainly won't make it better.
• What a pathetic corporation. If it's paid for, it should be labeled as a paid infomercial. Why would any self-respecting journalist work for this kind of an organization?
• This is an incredibly slippery slope.
• PAID content, person ACTING as REPORTER, blended into their NEWSCASTS........shameful

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This news coverage doesn't help women with breast cancer

A drug company applies to expand its approval for a drug (Tykerb) for advanced breast cancer in the US and Europe. And the only source AP quotes in the story is an employee of the drugmaker. That is not sound journalism.

The story is one of the resounding majority (72%) of health news stories I’ve tracked in the past 3 years that failed to discuss the cost of the product being discussed.

But a woman on a breast cancer discussion board recently claimed:

“The drugs cost almost $6000 per month. I make only $1000 more per month than that. All my savings is wrapped up in real estate and I can't even sell a house right now to pay for these drugs. How can ANYONE afford these drugs if not covered by insurance?! If anyone has been on this treatment and the drugs have stopped working for them and you have an unused supply, I would appreciate hearing from you. Please don't throw these expensive drugs away. There are people out there who can use them!”

The story also gave an incomplete accounting of side effects and never quantified the benefits that the drug company put in its application for expanded approval.

Finally, the story failed to give the highly significant context that just last month the UK's National Institute for Health and Clinical Excellence (NICE) recommended that the drug "should not be used, except in the context of clinical trials, as it is not a cost effective use of resources."

HOW CAN ALL OF THIS BE LEFT OUT OF A NEWS STORY?

And before anyone counters, "This is meant to be a business story, not a health news story," let me just ask if business news readers don't deserve information on costs, from more than a single conflicted source, and context about steps one government agency has already taken to recommend against the drug.

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Bernadine Healy and the President's prostate

Should Obama Get a PSA Test? On Prostate Cancer Screening and Comparative Effectiveness. That's the headline of Dr. Bernadine Healy's blog entry on the US News & World Report website.

I felt obliged to respond online with a comment in reaction. I wrote:

Dr. Healy writes: "Prostate cancer mortality rates have plummeted in the United States over the past 20 years, coinciding with the widespread use of PSAs. (No such drop has occurred in Europe, where PSA screening, by policy, is uncommon.) This suggests—though it certainly doesn't prove—that PSA screening saves lives."

However, if more silent cancers that never would have killed American men are now being found because of more American PSA testing, then by default, the mortality rate would plummet. You're now calling more things "cancer" – many of which wouldn't have killed a man anyway. Dr. Barry Kramer of the National Institutes of Health calls it a pseudo-epidemic. So Dr. Healy’s example certainly DOESN'T prove that PSA screening saves lives.

And the entire premise of the article about whether the President should get a PSA test - while provocative and probably meant to catch eyeballs - misses the conclusion most experts reached after the recent studies. When evidence raises so many questions about PSA screening, it becomes essential that a man discuss the potential benefits AND harms with his own caregiver. It's not an item up for debate by a magazine or by a urologist who won't even see the President.

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News about Gooz is our loss

Merrill Goozner, who headed the Integrity in Science Watch project at the Center for Science in the Public Interest for the past five years, has been axed by CSPI.

The good news is that he'll now have more time to devote to his terrific blog, GoozNews.com, for which, in the past, he had to cobble together an hour or two in the morning or an hour or two in the evening - or more - to fuel the blog. Or maybe he'll come up with a new initiative worth watching. He won't sit still - although he says a few rounds of golf will come first.

Gooz helped put health care conflict of interest on the public radar screen during his five years at CSPI. He has an eye and an intellect to hone in on troublesome tidbits that others may miss. We can't lose his regular contribution to journalism in whatever form that takes.

We wish him the best.

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To Screen Or Not To Screen - That Is The Question

My Canadian friend and colleague Alan Cassels (along with two other colleagues) has published a new analysis warning "that private clinics selling high-tech services to screen healthy people for disease could be harming Canadians and placing an undue burden on the public health system. ...The results of the study found that there are prevalent misconceptions about the safety and regulation of CT and PET screening technologies."

He's also written a consumer guide, "To Screen Or Not To Screen, That is the Question," available at the same link above.

Alan is publisher of the Media Doctor Canada website - the Canadian counterpart to our HealthNewsReview.org project. Alan will join me and David Henry - the original publisher of the Media Doctor Australia website - in a panel at the Association of Health Care Journalists conference in Seattle in two weeks, where we will try to teach journalists about how to do a better job reporting on research and studies.

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Wanna sell a book? Get bigtime newspaper coverage.

A radical approach, lacking in evidence on harms and benefits, gets bigtime coverage from a bigtime newspaper - the LA Times.

But, after all, it's based on the promoter's new book, so it must be legit.

See the story review on HealthNewsReview.org.

As if the TV networks' morning "news" programs don't give enough free pub to any author with an agent.

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Is the UK having better debate about mammography benefits and harms than US?

We need more stories like the one in today's New York Times that addresses legitimate questions about mammography now being raised in the UK.

It started with an article in the BMJ about the inadequacy of British informational brochures on mammography. Then a letter to The Times of London entitled, "Breast cancer screening peril: Negative consequences of the breast screening programme."

Legitimate questions - and demands for better information to be given to women.

In the Times story I'm particularly struck by the 75-year old woman diagnosed with DCIS - which creates anxiety and confusion for thousands of women. She says: "You don't know about all the uncertainty until you're one of the unlucky ones."

The story details leading experts' questions about whether mammography has been oversold to American women as well.

Dartmouth's Dr. Lisa Schwartz wraps up the Times article with this:

“You’re not crazy if you don’t get screened, and you’re not crazy if you do get screened. People can make their own decision, and we don’t need to coerce people into doing this. There is a real trade-off of benefits and harms. Women should know that.”

I can already hear the rabidly screen-everybody-all-the-time advocates screaming about this story. But before they scream too loudly, they should walk a mile in that 75-year old woman's shoes.

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Must see TV - Frontline's "Sick Around America"

Jon Palfreman, who has produced some of the smartest health care and science documentaries anyone has ever produced, rolls out his newest tonight.

PBS Frontline. "Sick Around America."

It follows his earlier "Sick Around The World" film.

And it will show once again how you can cover vital health policy issues on TV if you put your mind and creativity to it.

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NBC goes nuts over Polypill

NBC said it "could be the magic bullet for preventing heart disease and strokes." They threw up a "BREAKING NEWS" banner even though they acknowledged that each of the five pills in the "polypill" has been "around for a long time."

The anchor called it "really big." The NBC medical editor called it "very cool." Then the anchor amplified by calling it "very promising."

We call their hyperbole "very premature."

The story contained none of the caveats contained in an AP story, which concluded:

“It won’t be for everybody,” (one expert) said. Some people would be overtreated by getting medicines for conditions they don’t yet have, such as high cholesterol. Others may be undertreated by too-low doses in the combo pill. Several polypills of different strengths may be needed, he said.

“We have to be cautious about assuming that one size fits all,” (another expert) said. “Treating risk factors is a lot like cooking — the ingredients count.”

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Required reading on industry-funded CME

A devastating indictment. That's what Dr. Daniel Carlat - on his blog - called yesterday's piece in the Milwaukee Journal Sentinel, “Drug firms' cash skews doctor classes: Company-funded UW courses often favor medicine, leave out side effects.”

I'm late in weighing in on this, so I'll just refer you to Carlat's analysis.

But I will add this: somehow that little paper in Milwaukee continues to publish top-notch tough investigative health care journalism and their readers should appreciate what they're getting while they're still getting it. This story was more than 2,500 words of important news - not the usual 300 word drivel trumpeting breakthroughs from the medical journals. Carlat said "Occasionally, a piece of investigative journalism sets into motion processes that strike corrupt business practices at their core. ...it will become required reading for all those involved in health care policy."

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Please, PLEASE use absolute risk data

Based on my reading of a New York Times story in my local Star Tribune today, I was ready to blast the Times.

I was reading the story out of the American College of Cardiology meeting on the new data suggesting that statins can reduce the risk of venous thromboembolism.

By how much can statins reduce the risk? Depends on which version of the NYT story you read.

The Times reports:

"With the relatively healthy people in the study, the number of clots was small — 94 total — but the placebo group developed 60 of them, compared with 34 for those taking the statin."

But the Star Tribune version of the Times story doesn't include that absolute risk reduction figure and, instead, only lists the more impressive sounding relative risk reduction figure:

"relatively healthy people who took a potent statin were 43 percent less likely than those who took a placebo to get a blood clot known as venous thromboembolism."

The Wall Street Journal's simple language was the most helpful for readers:

"34 participants who were taking Crestor developed VTE compared to 60 who were taking a placebo - a small absolute benefit but a relative risk reduction of 43 percent."

To editors who trim wire stories - or who don't know to look for absolute data - I can't state strongly enough how incomplete your stories are if you don't include absolute risk data.

Borrowing an analogy from Woloshin and Schwartz of Dartmouth, citing relative risk only is like having a coupon for 43 percent off. But you don't know whether it's 43 percent off the cost of a Lexus or off the cost of a lollipop.

GIVE US THE ABSOLUTE DATA OR DON'T GIVE US THE STORY AT ALL!!!

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Good Morning America Zeroes In

By zero we mean zero stars - our lowest score - on HealthNewsReview.org.

The ABC program's segment last week, "Life Saving Test: How One Minute Can Save Your Life," received one of our rare ZERO scores.

One of our reviewers even ran a stopwatch on the "one minute" test.

It took 5 minutes on live TV. Maybe it's the lights.

But how long the test took was a relatively minor issue.

The segment was so bad that a leading gastroenterologist wrote to me asking us to review the story - something that was already underway when he wrote. I know he wrote to an ABC News producer as well. But that producer has told me he doesn't share our reviews with his staff because he doesn't think they are fair.

Maybe he likes the criticism of the letter-writing gastroenterologist better - who used terms like "disservice to the public...distorted...sensationalized...served fear and commercialized interests."

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Sioux Falls Paper Violates Ethical Standards, Endorses Calcium Scans

The Argus Leader newspaper of Sioux Falls recently reported that two local hospitals were offering $50 heart screenings to check for excess calcium buildup.

Let me count the ways this story was poor journalism:

1. The headline: "Cost of saving a life: $50." Cost-effectiveness has not been established for this procedure. This is a headline that only an ad agency and a client could love.

2. The story never mentioned that such screenings are not recommended by the American Heart Association nor the American College of Cardiology (despite the praising comments from a South Dakota AHA spokesman who clearly isn't up on the science). It took me about two minutes to find this guideline statement online from AHA and ACC:
"The Committee does not recommend screening of the general population using coronary artery calcium measurement."

3. The story said "Both hospitals say they lose money on the program, that the tests and consultation amount to several hundred dollars worth of services. The gains come in prevention." How naive! Talk about a loss leader! And don't think that somebody somewhere in those hospital systems isn't paying for these scans somewhere in their bill.

4. The newspaper practiced "participatory journalism" and sent its reporter in for a scan. At the end, he abandons all journalistic objectivity and announces in an online video, "I would recommend it if it does what it says it does." This is a clear violation of the Society of Professional Journalists' code of ethics.

The wisdom of the crowd - in some of the online comments following the story are far more skeptical. One says, "Don't confuse science with marketing. What we're seeing here is marketing."

Health care reform is going to be very difficult to achieve in this country if we continue to set unrealistic expectations in the minds of the public, feed the worried well, drive up demand for unproven technologies, and promote technologies outside the boundaries of evidence-based recommendations.

On this scorecard, this story failed Sioux Falls readers horribly.

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How the red meat story was undercooked

"Killer Meat" - headlined an LA Times online column.

"Want to Live Longer? Cut Back on Red Meat" - pronounced CNN.com.

"Daily Red Meat Raises Chances Of Dying Early" warned washingtonpost.com.

It all sounds so certain.

But this was an observational study - not an experiment. It was based on responses to a questionnaire.
Such a study CAN NOT - simply CAN NOT - establish cause-and-effect and therefore CAN NOT establish risk.

So any story that said "higher risk" or "chances of dying" was simply wrong.

Stories on such studies are obliged to point out the potential weaknesses in such studies.

Journalists and consumers should read a column we published on HealthNewsReview.org, entitled "Does Your Language Fit the Evidence?"

And stories that gave these kinds of percentage (as the Washington Post did) are obliged to give you more:

Among women, those who ate the most red meat were 36 percent more likely to die for any reason, 20 percent more likely to die of cancer and 50 percent more likely to die of heart disease. Men who ate the most meat were 31 percent more likely to die for any reason, 22 percent more likely to die of cancer and 27 percent more likely to die of heart disease.

35% of what? 20% of what? 50% of what?

That's like having a 50% off coupon and not knowing if it applies to the purchase of a Lexus or the purchase of a lollipop. Give the absolute risk reduction figures.

I gave my undergrad health journalism students about 5 minutes to analyze one such story yesterday. They easily came up with the above flaws and more.

Come on, folks. We have to get smarter about evaluating studies - and news coverage of studies.

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Never thought I was Cover Boy material

Cover story for UMN Alumni Association magazine this month. George Clooney wasn't available.

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Changing the daily drumbeat of health news

The new issue of Nieman Reports includes my article,
"Changing the Drumbeat of Typical Health Reporting."

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Times story ticks off doc

A physician in NY wrote to me today about an article in the New York Times, "After a Stroke, Freeing Muscles With Botox."

The physician wrote because he felt the article didn't explain the exact indications for the approach described in the story, didn't discuss the evidence, and didn't quantify the alleged benefits. He wrote:

I highlight this because I run into this problem all the time and I could see a run on, "doc, I need this."

He's right: none of that information is in the story.

But here is what IS in the story: a projection from one true believer-physician that "only about 5 percent of the stroke patients who could benefit from its use ever get it." The story goes on to disclose that that doc "gets financing from three botulinum toxin producers."

Hmmmm.

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Well-deserved journalism award on clinical trial ethics story

St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto have been awarded a Frank Premack Public Affairs Journalism Award for their series on the death of Dan Markingson in a clinical trial at the University of Minnesota.

The Premack judges wrote: “Through the eyes of one patient, this story shed considerable light on the complicated and competing interests between the development and path to market of new drugs, funding needs of the University and the integrity of medical research. The judges are hopeful that the new ethics task force implemented at the U of M is resulting in changes in conflict of interest policies.”

Also this week, Professor Carl Elliott of the University of Minnesota Center for Bioethics published an editorial in the Pioneer Press, "Create counterweights to the influence of money on drug studies," regarding the Markingson story. In it he concludes:

"Any serious attempt to clean up industry-sponsored research must do at least two things. First, it must minimize the internal pressure faced by researchers to raise money for their departments. Second, it must eliminate the external financial incentives that lead researchers to recruit patients into studies instead of giving them proven treatment. Unless these conflicts of interests are eliminated, universities will continue to repeat the mistakes that preceded the death of Dan Markingson."

Congratulations to Olson, Tosto, and the Pioneer Press for this terrific investigative piece. Kudos to Professor Elliott for addressing the ongoing ethical issues in clinical trials.

We can't lose this kind of important contribution in daily journalism at the local level.

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Today Show tries to atone for past sins on screening info

I will give the NBC Today Show some credit for trying to address the issue of too much cancer screening and the overtreatment that results.

Matt Lauer acknowledged that the segment would counter much of what the program had told viewers over the past 10 years or so. What he didn't say is that the questions about cancer screening are NOT new and that the Today Show had actually misinformed viewers in many of their earlier messages.

But despite the good effort, today's program was given too little time, was too loosely organized, and probably left viewers horribly confused.

Thank goodness they had one of the best evidence-based minds on the set to address the topic - Dartmouth's Dr. Gil Welch.

Lauer half-promised there would be more segments in the future on this topic. I hope they live up to that.

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What I would emphasize about the state of health journalism

Podcast, webcast, survey of Association of Health Care Journalist members and my report on the state of health journalism are all available online.

The University of Minnesota News Service videotaped the following interview with me about the higlights of the report.

Personally, the 50 hours or so of indepth interviews I conducted with health care journalists for this report was a buzz kill. I spent a lot of time with smart, dedicated, hard-working people who didn’t feel they were able to do their best work anymore. Coast to coast, all media types, all market sizes, all experience levels.

But from a public policy – public discussion perspective, this report should be the strongest of warnings to managers of news organizations and to policy makers.

• Ninety-four percent of survey respondents say the bottom line pressure in media organizations is seriously hurting the quality of news coverage of health care issues;

• 88% of survey respondents think health care coverage leans too much toward short “quick hit” stories, and two-thirds (64%) say the trend toward shorter stories has gotten worse in the past few years.

• A majority of respondents (52%) say there is too much coverage of consumer or lifestyle health, and too little of health policy (70%), health care quality (70%), and health disparities (69%).

• Just under half (44%) of staff journalists participating in the survey say that their organization sometimes (33%) or frequently (10%) bases stories on news releases without substantial additional reporting.

• About one in 10 staff journalists in the survey (11%) say his or her own organization sometimes or frequently allows advertisers, sales staff or sponsors to influence story selection or content and more than a quarter of respondents (28%) say they personally get story ideas from public relations firms or marketing outreach somewhat or very often.

So on the eve of what may be the most important health policy discussion in this country in 15 years, we’re covering these topics less frequently.

Instead, our news organizations often cover cutesy, soft, fluffy, news you can use.

Or our news organizations often make it seem like every medical journal, every scientific meeting is like Christmas Day with terrific new toys under the tree that have no side effects and no price tag.

The “more is not always better, newer is not always better, screening tests don’t always make sense” evidence-based wisdom of so many of our veteran health care journalists is either not appreciated or it’s being lost to cutbacks, buyouts, layoffs.

The improvement in health journalism – in pockets across the country – has been one of the major advances in all of journalism in the past decade. And it could be one of journalism’s greatest losses.

So while we know that the cutbacks hitting the health beat affect ALL of journalism, the argument could be made that these topics in these times can least afford setbacks.

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Reader’s Digest stops drinking the Cure Kool-Aid

Get out and buy the April issue of RD and frame it.

RD has a history of proclaiming more cures than a ham processor. Two examples:

But “the little magazine that could” finally did publish an evidence-based health journalism piece.

Shannon Brownlee’s thoughtful “What’s Wrong with Cancer Tests” piece will be good bathroom reading for thousands, we hope.

Sorry I can’t offer a link. RD doesn’t offer them.

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Ethical issues for CNN & Sanjay Gupta

Longtime Poynter Institute ethics guru Bob Steele - now a professor at DePauw University - published a column, "Dr. Sanjay Gupta Covers Obama's Health Care Policies with Competing Loyalties." Excerpts:

"My heightened concern focuses on the erosion of Gupta's journalistic independence given his two-plus months of discussions with the Obama administration about becoming surgeon general. ...

Gupta's withdrawal from consideration deserved scrutiny it did not receive on CNN Thursday night. Larry King had a buddy-buddy chat with Gupta that elicited little insight. But King's show is more entertainment than journalism.

However, on "Anderson Cooper 360," which is a news program, Cooper said how happy he was Gupta was going to stay at CNN and lobbed a few simple questions his way. There was no serious attempt to probe why Gupta had stayed in contention for over two months only to withdraw now. No effort to report on what his pulling out might mean to an Obama administration that has lost a number of appointees. No references to concerns about Gupta voiced by some politicians. ...

It was ironic that CNN used a breaking news label for the interview, imparting the event with that sense of importance, then treated Gupta's interviews like soft news. ...

It sure appears to me that CNN and Gupta are on a collision course filled with competing values and competing loyalties, one that could affect future coverage. In his wrap-up of the interview, Cooper teased Gupta's upcoming coverage of the administration. ...

For a couple of months we've had Sanjay Gupta in the running to be one of Obama's trusted allies. As surgeon general he would have had a key voice in the President's health care policy. While Gupta was, in essence, interviewing for the surgeon general's position, he was likely interviewing the President as well, not as a reporter but as a potential team player. He was bound to learn some insider information.

That's where the ethical challenges surface. To whom does Dr. Gupta owe loyalty? Can he serve the public with comprehensive reporting uninfluenced by his White House connections? Can he fairly report on an administration he almost joined? Can he fairly report on critics of Obama's health care plans?"

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Journalists must learn: association doesn't equal causation

Let's revisit this oft-violated tenet of scientific communication.

Just because an association is established, it doesn't mean a causal link has been established.

The latest botching of this message was two weeks ago when the Journal of the National Cancer Institute published a study looking at women, how much alcohol they drank and how often they got cancer.

The study's lead author told The Guardian, "Given that this is the largest study in the world to look at this, it’s clear that even at low levels of alcohol consumption, there does seem to be a very significant increase in cancer risk, and most women are probably not aware of that."

Several friends wrote to me about news coverage of this study.

It was page one news in the Washington Post, for example, where the headline incorrectly states: "A Drink A Day Raises Women's Risk of Cancer."

One Post reader wrote the following to me:

It is a good example of what confuses the public. The Post article overflows with causal language, using phrases such as "increases the risk," and "may cut the risk" multiple times. The writing is naïve and I am doubtful that he understands the hierarchy of evidence, or the difference between observational and experimental. Unfortunately, the investigators are complicit here, as well. The reporter quotes the investigator saying "increasing your risk," which is consistent with her language, "Low to moderate alcohol consumption in women increases the risk of certain cancers..." in the abstract of the paper itself.

(The journal article) uses associative language quite a bit as well and I'll bet the authors understand the difference. Why they slip into causal language, I don't know. I guess it sounds better and varies the syntax. Or it sells better. I have observed a lot of this in the scientific literature---in JAMA, the NEJM, JNCI and others. This is frustrating because it leads the journalists down that path, wittingly or not. Makes it harder to educate the journalist, if you are having to instruct them that the investigators are sometimes wrong and may mislead them.

Another friend sent me a link to an online article by Patrick Basham and John Luik, " Women, keep drinking: Why was a flimsy study apparently showing a link between booze and breast cancer so uncritically accepted?" Excerpts:

Allen (the lead author) came across with even scarier news for Americans, telling the Washington Post that the ‘take-home message’ was this: ‘If you are regularly drinking even one drink per day, that’s increasing your risk for cancer [since] there doesn’t seem to be a threshold at which alcohol consumption is safe.’

One can’t help but wonder just what Allen herself has been drinking... After all, her public pronouncements, her recommendations to government, and the reports about her study in the media are certainly not supported by her results.

First, Allen’s study is an observational one, based on data from the UK’s Million Women Study, which is a study about the association between Hormone Replacement Therapy and cancer and heart disease. Allen’s study comes from self-reports about the drinking habits of women in that study.

This means that the study, as an observational study – the weakest kind of epidemiological endeavour and certainly nothing close to the gold standard of a randomised controlled trial – is inherently unable to draw any causal conclusions about a link between drinking and cancer.

Second, the study fails to meet even the most basic requirement of science – that is, being able to validate its measurements – since it is entirely based on the women’s self-reports of their recollection of their drinking. None of these reports was checked and the authors can make no claim about how reliable they are. No one knows how much or how little these women really drank since no one bothered to measure it.

This makes any conclusions based on such ‘evidence’ just a tad dicey. At its foundation, therefore, the study can’t warrant that any of its data about the key fact – the drinking habits of its subjects – is accurate.

Basham and Luik went on to point out that "teetotallers had a higher population incidence of cancer than those consuming up to 14 drinks a week!" And that "of the cancer-drinking correlations examined, virtually none was statistically significant."

Their conclusion:

What is the real take-home message of this study? Perhaps it should be to avoid drinking policy advice produced by Oxford epidemiologists.

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Terrific WSJ story on FDA device approval

Front page. More than 2,000 words. The kind of story Americans need to understand. We're fortunate to have the WSJ on days like this with stories like this. - "FDA Backs Knee Device After Long Lobby Effort."

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5 Monkeys Get JFK or 9/11 type spread

I'm just amazed.

The headline is WRONG. It DIDN'T block HIV. The H in HIV stands for "Human." This was research on SIV - S is for Simian - so we're talking about a virus in monkeys.

I am not anti-science. And I'm certainly all in favor of educating people about advances in research. But there is a weight and an emphasis given to this kind of placement. And so, even though the story has caveats, they are overwhelmed by the enthusiasm, the pull quote, the breakthrough language.

5 monkeys followed for two weeks, one of whom did, indeed, become infected when you follow it out for five months.

Interesting? Yes.

Important? Yes.

Page one breakthrough? Not in my book.

And let's go down the boulevard of broken dreams of hope that didn't pan out - a headline one year ago - "Anti-AIDS gel disappoints, researchers say."

The leap from animal research to human efficacy is huge. It can't be stated often enough.

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A story that sucked about a procedure that sucks

Someone stop me if you ever hear me say that I've seen the worst TV health news piece. The bottom keeps dropping.

This piece is a contender for bottom-dweller.

(Note: before you can actually enjoy the piece, you'll have to watch a CBS promo in this clip for all the awards they've won. And you'll see at the end their tagline, "Very Good News." This piece, I warn you, will not win an award and was NOT very good news.)

Watch CBS Videos Online

Let's recap:

A young woman whom the anchorman calls "healthy...gorgeous" but who wants to rid herself of a tiny fat pouch in her belly gets lunchtime liposuction. The surgeon comes on the set with her to chat with the anchorman. But in more than 5 minutes (an eternity in TV news!), they fail to discuss:

• evidence
• how widely the costs vary from the $3,000 the promoting-surgeon cited
• whether insurance pays for it.

Viewers should ask themselves: if this "healthy, gorgeous" young woman wanted to have a little fat pouch removed and if she were in your insurance pool and if insurance covered it, would you want your premiums to go up as a result?

Why don't we have news stories about that?

That would be journalism. This was free advertising: 5 minutes worth!

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PR Diarrhea

If there's any doubt about the impact of public relations efforts on news coverage of health products, look at what the PR company Fleishman-Hillard brags about on its website. They describe a campaign for a diarrhea vaccine. From their website:

Don't Leave Home Without It

Fleishman-Hillard launches Dukoral. A three-pronged media relations campaign resulted in 19 million impressions (triple the project goal), physician acceptance and consumer demand for Dukoral.

Dukoral, the first and only oral vaccine for protection against most common causes of Traveller's Diarrhea. For the project spokespeople were identified in key Canadian Markets (Vancouver, Toronto, Montreal-bilingual) willing to speak to the media about Dukoral. The spokespeople represented Dukoral to travel, healthcare and consumer media. All media coverage has had a direct impact on the target audiences. Media coverage incorporated key messages about Travellers' Diarrhea and Dukoral's role in the prevention of this potentially serious illness. Attributed to the extensive media coverage physician have reported to sales team that many patients have asked for Dukoral bringing in articles consumers themselves have read.

Journalists love toilet jokes in their stories. Melody Petersen, in her book, Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, wrote that too many journalists too easily fall into drug company plans to create a market for a drug, such as, in one case, a drug for “overactive bladders.” “Dozens of journalists at newspapers and television stations across the country wrote stories about the disorder said to be destroying the lives of millions of Americans,” she wrote. “Editors and television news directors loved these reports. Silly stories of people running to the toilet brightened the day’s news.”

Dukoral is not yet approved by the FDA.

Thanks for the tip to Alan Cassels, who also points out questions about the vaccine's effectiveness and its cost.

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Report and news conference on the state of health journalism

Last year the Kaiser Family Foundation asked me to research and write a report on the state of health journalism in the US. That report will be released and discussed at a news conference in Washington, DC, in three weeks. The announcement was made yesterday:

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Disease-mongering by the Washington Post: here we go again

There are WMD’s lurking inside your body. And you better find them ASAP.

In its health section today, the Washington Post gives men of all ages screening test advice – much of it not grounded in the best medical evidence or at least not reflecting real controversies in health care.

They do one of those “What To Do In Your 20s, 30s, 40s, 50s…” columns that news organizations find so appealing and that I find so incomplete.

Sanjay Gupta and CNN have done the same thing

So has the Star Tribune and many other news organizations.

Among the questionable advisories from the Post:

• Telling men in their 30s to “sign up for complete physicals”
• Telling men in their 40s to get a complete physical every two years

There was no mention of the controversies surrounding such recommendations - some experts calling it wasteful.

• Telling men in their 40s to start skin cancer screening.

Aren’t they aware that the US Preventive Services Task Force just last week stated :

“ the current evidence is insufficient to assess the balance of
benefits and harms of using a whole-body skin examination by a
primary care clinician or patient skin self-examination for the
early detection of cutaneous melanoma, basal cell cancer, or
squamous cell skin cancer in the adult general population.” ???

They go on to tell men in their 50s to have prostate cancer screening. (They do say the pros and cons should be discussed, but the recommendation for such screening stands nonetheless.)

Again, the USPSTF states: “the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.”

What the Post promotes may be one doctor’s – or some doctors’ - opinion(s). But for a major newspaper to state these as if they were handed to Moses on stone tablets is wrong. There are uncertainties. There is controversy. Screening tests can cause harm - not just benefit. And good journalism should reflect that.

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Health journalism competing with Britney?

Some of the very disparate views about how health news should be covered in the daily news media were on display recently at a debate, sponsored by the Guardian newspaper, held during a Lancet conference in London. BMJ associate editor Rebecca Coombes wrote about it in last week's journal. Excerpts:

The event exposed the gulf between detail obsessed academics and time poor, space hungry, national newspaper journalists. As doctor, research fellow, and Guardian columnist, Ben Goldacre bemoaned the Daily Mail for its insistence on "dividing all the inanimate objects in the world into those which can cause or cure cancer," the professional journalists became exasperated with him for seeing the media as a monolithic organisation.
...
But journalists could not be straitjacketed into writing like academic researchers (said one journalist who) referred to a "prescriptive and irritating" code of conduct issued by the Royal Society a few years ago, which gave journalists a checklist to use before filing any story. It asked questions such as, is your story scaremongering? If reporting on a clinical study, make sure all conflicts of interests are identified, that independent sources were used, and so on. "All this in a 200 word story, give me a break". There was, he said, a breed of "academics who want journalists to act as a transmission belt for their ideas."

"Scientists expect us to include every counter story, every caveat, but you don’t have that luxury [as a journalist]. And your stories are competing with every other field of human knowledge. The person I have in mind when I write a story is the man or woman on the tube holding on to the bar, or the person online who is only two clicks away from a story about the latest antics of Britney Spears."

I wish I could have been there.

The "prescriptive and irritating code of conduct" and the "checklist" sounds very much like our HealthNewsReview.org approach - although I would never refer to it as a code of conduct. But, yes, some US journalists might call it prescriptive and irritating.

Most that we've heard from don't, though.

We actually have two surveys out in the field right now:

1. Of all members of the Association of Health Care Journalists;
2. Of all journalists whose work we've ever reviewed on HealthNewsReview.org

The response rate has been abysmal. I know that health journalists feel they have been surveyed to death. Nonetheless, here are some responses:

• I love it. There's so much awful health reporting out there in very respected publications. It is important to train reporters and to make the public aware of what to look for in stories. Keep up the great work.
• Wish we'd known about it sooner.
• You're doing good work and maybe I just need to be reminded more to use it.
• The web site is helpful in forcing me to improve the quality of my work.

And then this:

You live in a bubble. Newspapers are imploding, we are struggling to deal with virtually no resources and increased demand for content and you offer no insight into how to produce quality stories under the circumstances. In a perfect world, we would all gladly embrace your guidelines, but it's far from a perfect world and you're obviously not acknowledging that.

This is why we need a conversation. Our ten criteria are our attempt to give insight into how to produce quality stories under the current circumstances. And I don't live in a bubble. Next month the Kaiser Family Foundation will release a report I wrote based, in part, on interviews with about 50 health journalists.

Our ten criteria are not an academic exercise. They are not an attempt to turn news into a medical journal. They are key questions we think any consumer should ask about any claim made by anyone about new health care treatments, tests, products or procedures.

I always ask journalists: if not our criteria, what criteria do you employ in choosing health news stories and in deciding how to write about them?

That tends to be a very short discussion, because there usually isn't a comeback.

Because too often health news is treated as if it is only two clicks away from Britney Spears news in the paper. And maybe readers don't want that. And maybe that's why you're losing them.

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Virtually no news about virtual colonoscopy questions

Newer is not always better. Evidence is important. Simple themes, oft forgotten in health journalism.

Back in October, an Atlanta Journal-Constitution story talked of the wonders of virtual colonoscopy, saying it replaced the dreaded colonoscope and lessened patient risk. It used these words to refer to the technology: "science fiction, Star Wars, video game, Disney World."

Also in October, the Wall Street Journal promoted the growing popularity of virtual colonoscopies.

Neither story mentioned the fact that the U.S. Preventive Services Task Force had stated that same month that “The evidence is insufficient to assess the benefits and harms of computed tomographic colonography as a screening modality for colorectal cancer.�?

Last week's announcement that Medicare may stop paying for virtual colonoscopies also got little news attention. At least the New York Times reported it. Excerpts:

The Centers for Medicare and Medicaid Services said in a decision posted on its Web site that there was “insufficient evidence�? to conclude that virtual colonoscopy “improves outcomes in Medicare beneficiaries.�?

…the United States Preventive Services Task Force, which advises the government on prevention, said last year that there was insufficient evidence to assess the benefits and harms of the CT technique. Some private insurers pay for the tests; others do not.
…
In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare’s older population.

For instance, older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater. That would make the CT scan less cost-effective.

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No need to buy Harry & Louise ad time when you have CNN

"The specter of the government coming between doctor and patient raised its head again," Trudy Lieberman writes, about a CNN segment that she says "ranks among the most irresponsible health stories I’ve seen over the past year."

Which reminds me: what's the update on the Surgeon General choice?

Do you think Daschle's conflict of interest issues may have given the President second thoughts?

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Wow! A front-page evidence-based screening story!

Kudos to Chen May Yee and the Star Tribune for a front-page story on how screening tests offered by for-profit companies may cause more harm than good and may be a waste of money.

I slammed the Strib almost exactly one year ago for a non evidence-based article promoting screening tests.

So let this blog posting be further evidence that I'm not out to bash all health care news - just the schlock.

Today's Strib story - by a smart, dedicated journalist - showed enterprise, depth, and a concern for how readers may be misled and hurt by profit-driven screening promotions.

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One health news unit closes; another should consider doing so

The Boston Globe may be shutting down its venerable health/science news section. Details and speculation here.

And NBC News should consider shutting down its health coverage if it can't get any better than this.

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Congratulations to Milwaukee Journal-Sentinel health news team

That paper was honored yesterday by the Foundation for Informed Medical Decision Making with an award for Excellence in Health Journalism. The Foundation, which presented the award yesterday at its Research and Policy Forum in Washington DC, chose the Milwaukee newspaper because of its consistently high ratings by HealthNewsReview.org- the only organization of its kind in the US that reviews the quality of health news reporting nationwide each day.

"We were very surprised and pleased by this recognition," said Becky Lang, the Journal Sentinel's health and science editor. "In the current media environment of instant Internet coverage and reduced staffing in credible news outlets, the pressure is on for us to keep the standards high. It is even more important than ever for us to provide health stories that are meaningful, accurate, reader friendly and that delve deeper than the surface. We welcome this kind of oversight."

HealthNewsReview.org reviewed a dozen Journal-Sentinel stories and nine of them received high marks with four- or five-star reviews, more than any other newspaper of this size in our experience so far.

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Wikio ranks my blog in top 20

I’m always amazed that my little blog gets any traffic or draws any links or whatever drives the various ranking services. I usually do this stuff at 6:30 in the morning after one cup of coffee at home - like now. So I'm amazed that my blog has achieved a top 20 health blog ranking from the folks at Wikio. If you visit their site today, you’ll still see a #25 blog ranking for this site. They tell me the #20 ranking will be posted onThursday.

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Hoosiers get health journalism lecture on the radio

The first part of a two-part, two-weekend interview appeared on Indiana Public Radio this weekend.

The guest: me.

The topic: health journalism.

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Improvement in health news grades

Some good things are happening in health news coverage.

Of the first 12 stories reviewed in 2009 on HealthNewsReview.org, five have received the top five-star score.

In the three years of the project, there have never been so many highly-rated stories in such a sport span. In fact, only 13% of all 712 stories reviewed so far have received five-star scores.

Next week in a talk at the Foundation for Informed Medical Decision Making's Policy & Research Forum in Washington, DC, I'll also be presenting some new data that shows small - but I think significant - improvement on some of our criteria on which journalists have traditionally done most poorly.

This is especially significant, in my view, given the terrible times in newsrooms these days.

• bottom line pressure hurting the quality of health news.
• lack of training
• impact of layoffs and cutbacks
• shrinking news hole for health care news overall
• weakened newsrooms more vulnerable to PR and ad pressures

Many people continue to work hard every day to report health news in depth, emphasizing evidence, context and integrity. We applaud them.

At the same time, network television health news pieces continue to disappoint. Look at the thumbnail below of two recent ABC Good Morning America segments. One got zero stars, the other two.

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Milwaukee paper keeps hammering on conflict of interest

The Milwaukee Journal Sentinel has done it again.

This tough "medium market" (if I can call it that) newspaper faces tough economic times by scrapping to do more tough journalism. Just two weeks ago we blogged about one of their stellar health journalism efforts.

Yesterday they published a 1,700-word story (that's rare these days) raising more conflict of interest questions at the University of Wisconsin medical school. It begins:

The conclusions were clear: Women who took hormone therapy drugs were at increased risk for breast cancer, heart disease, stroke and blood clots.

The findings were so strong that researchers stopped a clinical trial in 2002, five years early, because it would have been unethical to continue giving the drugs to women.

But that same year, the University of Wisconsin-Madison's School of Medicine and Public Health began a medical education program for doctors that promoted hormone therapy, touted its benefits and downplayed its risks.

For the next six years, thousands of doctors from around the country took the online course that was funded entirely by a $12 million grant from Wyeth Pharmaceuticals, which makes the hormone therapy drugs used in the study, Prempro and Premarin.

The university received $1.5 million of that total, and university faculty received money as well.

Even after the course was no longer available, the Web site and course material remained on the Internet, accessible to consumers and doctors. The university dropped the site Jan. 15, one day after the Journal Sentinel began questioning UW officials about the propriety of the program.

The influence of drug companies on doctors - and, by extension, medical schools - is coming under increased scrutiny, with critics saying programs like the UW one are essentially marketing exercises.

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Are doctors loyalties divided?

The Milwaukee Journal - a paper facing all the struggles (and maybe some more) that any news organization faces - continues to shine through it all with its health news coverage.

Reporter John Fauber has a two-part series this week on "doctors moonlighting for drug companies." Excerpt:

It's a practice that increasingly is drawing criticism because of concerns that it can influence patient care and raise the cost of treatment, in addition to blurring the line between research and marketing.

The deans of the state's two medical schools say they would like to ban the practice or severely limit it.

"I am very bothered by our faculty using our school's name in giving non-academic promotional, marketing talks," said Robert Golden, dean of the UW medical school. "It's a major issue we are talking about now."

In October, the Wisconsin Medical Society, as part of its recommendations for ethical behavior, said doctors should not serve as speakers. The group has no authority to regulate or stop the practice.

See part one.

And part two.

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The Gupta Chronicles

While I was on vacation last week, many web surfers found my name when searching for articles on Sanjay Gupta’s work after the announcement that he was being considered for the Surgeon General position.

Because of a failure in search engine functioning, some surfers weren’t able to find what they were searching for and asked me to provide an index. Here’s some of what I’ve written:

• on non-evidence-based screening test advice for men

• on an “unquestioning – almost cheerleading – approach to health news�?

• about a journal article that pointed out his involvement in a doctor’s office waiting room video program that “overtly offers sponsors, including drug companies, the chance to boost sales of their products.�?

• about the political newsletter CounterPunch and the Chicago Tribune asking readers:"Do you trust CNN's Dr. Sanjay Gupta?"

• about Trudy Lieberman’s article describing ineptitude by CNN and Gupta in coverage of health policy news.

• about Gupta vs. Michael Moore regarding “Sicko�?

• about the waste of air time speculating over the cause of death of Anna Nicole Smith.

• about a one-sided view of the controversy over mammography for women in their 40s.

• about a Pfizer ad for Pfizer’s sponsorhip of the “Paging Dr. Gupta�? program.

• about some laughable, some dangerous coverage on Gupta’s “Housecall�? program

• about bad judgment employed in his live TV news coverage of Raelian cloning news conference.

Two of his stories were reviewed on HealthNewsReview.org:

• about disease-mongering of wrinkles on CNN

• a review of his CBS story about a treatment for addiction to painkillers that got one of our lowest scores.

One of the smartest pieces I saw was by Sandy Szwarc on her Junkfood Science blog.

My summary:

1. What does the President want from a Surgeon General? Is it just PR & glitz? Then let's stop the charade and abandon the position. Like ending the Pony Express - a once good idea whose usefulness is past.

2. What does the American public need from a Surgeon General? I suggest "Nothing."

3. The prevention & wellness messages that Gupta so often promoted on CNN can go too far - pushing screening tests outside the boundaries of evidence and ignoring that such screening may cause more harm than good. If that is the message that he would promote as Surgeon General, I would consider that a non-evidence-based abuse of the bully pulpit. And a huge mistake by the Obama administration. See Gilbert Welch's pre-election essay in the NYT on the overpromotion of screening/prevention by both Obama and McCain.

4. The industry conflict of interest questions that have arisen are cause for concern. Usually where there's smoke, there's fire.

5. On the air at CNN he too often acted as a doctor not as a journalist. That's because he really wasn't a journalist. He wasn't trained as one - CNN threw him into that situation. There are countless more pre-eminent doctors and countless better health communicators than Sanjay Gupta. So what's his qualification?

6. Presumably Surgeon General Gupta would work closely with new HHS secretary Tom Daschle. Several passages from Daschle's book, "Critical: What We Can Do About the Health Care Crisis," raise questions in my mind about the Gupta appointment. Daschle wrote about "using evidence-based guidelines and cutting down on inappropriate care" as effective ways to control rising health-care costs. But Gupta's reporting, as noted in the entries above, often didn't reflect a great appreciation for evidence-based health care. Daschle also wrote, "It is relatively easy to misinform the public and stoke fears, no matter how strong the desire for reform." Promoting screening outside the boundaries of evidence is fear-mongering. These are potentially troublesome disconnects for an Obama health care team.

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We interrupt this vacation.....

Can't I just have a few days away without feeling the need to comment on health care/health journalism news?

I've been away from the mainland for two days and now I hear that:

1. CNN's Sanjay Gupta may be picked as Surgeon General.

2. One of the best health news bloggers in the U.S. - Ed Silverman of the Star Ledger of New Jersey's Pharmalot.com blog, has taken a buyout and will no longer run that blog.

I'm shocked by both pieces of news.

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TV news directors make another bad deal on health care news

In this economy I don't begrudge anyone's ability to make a buck. There are companies that make a lot of bucks selling "breakthrough" TV health news segments to TV stations to fill air time. Presumably the stations don't think they need their own fulltime health reporter, can't afford to hire one, and/or find it cheaper to pay for this "off the shelf" TV health news product from an out-of-town provider.

The Grade The News website gave a thorough description of the practice with one company. Excerpt:

"The company, Ivanhoe Broadcast News, allows local reporters to put their names on stories they didn't report, film or write -- without mentioning Ivanhoe. Stations also are permitted to omit geographical information, giving viewers the false impression that the stories were locally produced and the patients and doctors quoted in the stories could be their neighbors."

The company’s signature product is called “Medical Breakthroughs reported by Ivanhoe.�? More power to entrepeneurs like Ivanhoe who make money (actually a lot of money) doing this. That’s a business decision.

Shame on the stations that take this "quick and dirty" route to health news coverage. That’s a journalism ethics decision.

I wrote recently about a local TV health reporter who blogged about this practice - only to discover that the station news director hijacked the reporter’s blog and deleted the blog entry. Pretty clearly this is not something stations are proud of - nor should they be.

Well Ivanhoe is back in the news and this time it's with the blessing of the entire TV news industry's professional group - the Radio-Television News Directors Association, which announces:

"In celebration of Ivanhoe Broadcast News’ 30th anniversary, Ivanhoe and The Radio and Television News Directors Foundation have joined forces to provide two new training opportunities for journalists.

RTNDF and Ivanhoe are offering a post-graduate internship for a recent journalism graduate. The three-month internship will provide professional training in health reporting at Ivanhoe headquarters in Orlando, Florida, in the summer of 2009.

The second opportunity is for a working reporter or producer at a television station, who will receive a two-week fellowship to travel to the Ivanhoe headquarters to focus on health and medical reporting."

When my friend and fellow former CNN medical correspondent Andrew Holtz heard of the RTNDA-Ivanhoe partnership, he wrote to me:

"The first question that came to my mind was: What are they going to teach... how to do single source stories where only the providers of a product or service are interviewed?"

Indeed, when you look at stories on the Ivanhoe website, you find single source stories with one spokesman from one institution touting one idea. No independent analysis. In fact, the online stories post a PR contact at each institution.

So it's a win-win for almost everyone:
• The health care institution gets the publicity they covet.
• The TV station can say it covers health news - even though it really doesn't.
• Ivanhoe makes more money.

The only loser? The audience - which gets "just add water" TV news slipped into the newscast as if it is the most important news of the day for that community. And it isn't.

Why doesn't RTNDA partner with the NIH Medicine in the Media workshop or the MIT Science Journalism Fellowships or with the Association of Health Care Journalists or with our HealthNewsReview.org project? (I wrote to RTNDF three times in 2008 without getting a response.)

Any one of the above organizations could help improve the state of TV health news – and help TV reporters assess questions of evidence, of cost-effectiveness, of harms (instead of always just the benefits of a new idea), and of conflicts of interest in health care and in story sources.

The RTNDA/RTNDF deal sends the wrong message to the industry: a message that promotes “breakthroughs�? instead of explaining to audiences that breakthroughs are rare and that health care news demands more careful scrutiny at the local level every day.

2008 was a bad year for TV health news, with Eau Claire, Wisconsin news director Glen Mabie quitting over a decision his station had made to partner with a local medical center for delivery of that medical center's health care news. RTNDA was mostly silent on these quite common TV station arrangements with local hospitals.

2009 could be better. It's not off to a great start.

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New England Journal of Medicine editorial on health care journalism

Susan Dentzer, editor-in-chief of Health Affairs and health policy analyst for the PBS NewsHour with Jim Lehrer has a commentary in this week's New England Journal of Medicine, "Communicating Medical News — Pitfalls of Health Care Journalism." Excerpt:

"In my view, we in the news media have a responsibility to hold ourselves to higher standards if there is any chance that doctors and patients will act on the basis of our reporting. We are not clinicians, but we must be more than carnival barkers; we must be credible health communicators more interested in conveying clear, actionable health information to the public than carrying out our other agendas. There is strong evidence that many journalists agree — and in particular, consider themselves poorly trained to understand medical studies and statistics.5 But not only should our profession demand better training of health journalists, it should also require that health stories, rather than being rendered in black and white, use all the grays on the palette to paint a comprehensive picture of inevitably complex realties. Journalists could start by imposing on their work a "prudent reader or viewer" test: On the basis of my news account, what would a prudent person do or assume about a given medical intervention, and did I therefore succeed in delivering the best public health message possible?

Although the primary responsibility for improving health-related journalism must lie with journalists, clinicians and researchers can help. When interviewed by journalists about a news development, such as a new study, they should offer to discuss the broader context, point reporters to any similar or contradictory studies, refer journalists to credible colleagues with differing perspectives, and mention any study limitations or caveats about the results, as well as any potential or real conflicts of interest among the study authors. It will take many expert hands to ensure that the health news the public reads really is fit to print."

Let's not lose sight of the fact that medical journals like the New England Journal of Medicine also play a role in this picture. As Trudy Lieberman points out on the Scientific American website,

"...much of daily health reporting these days is based on findings reported in medical journals. They, too, have come under criticism recently for failing to disclose authors' potential conflicts of interest, such as their ties to companies that paid for the research (those caveats are becoming more transparent). But journals usually publish "good" news — a phenomenon detailed in several studies this year that showed how rarely pharmaceutical companies publish studies with negative findings.

The journals, Lieberman notes, have same interest as the mainstream media. "They want to build an audience and hope because the American healthcare system is built on hope and money."

Unfortunately, neither the NEJM essay nor the Scientific American article mention the HealthNewsReview.org project, which, for almost 3 years has given daily evaluations and grades of health news coverage - e-mailing journalists to help them improve. Interestingly, one of the commenters to the Scientific American article did refer readers to HealthNewsReview.org as a "great learning resource for those who want to develop their critical thinking in this important area."

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Conflicting and crusading news coverage of colonoscopies

An important study was published this week showing some of the limitations of colonoscopy.

Journalists' reactions to the story were - predictably - all over the map.

The New York Times reported under the headline, "Colonoscopies miss many cancers, study finds." Excerpt:

"Instead of preventing 90 percent of cancers, as some doctors have told patients, colonoscopies might actually prevent more like 60 percent to 70 percent.

“This is a really dramatic result,�? said Dr. David F. Ransohoff, a gasteroenterologist at the University of North Carolina. “It makes you step back and worry, ‘What do we really know?’ �?

Dr. Ransohoff and other screening experts say patients should continue to have the test, because it is still highly effective. But they also recommend that patients seek the best colonoscopists by, for example, asking pointed questions about how many polyps they find and remove. They also say patients should be scrupulous in the unpleasant bowel cleansing that precedes the test, and promptly report symptoms like bleeding even if they occur soon after a colonoscopy.

But ABC News didn't care for the Times story, posting this online: "Our medical experts were not convinced that there was the need for the urgent sense of the story providing us with scary news about a test that is pretty darn effective." The ABC posting was under the headline, "The Case for Keeping Colonoscopy."

Who ever said anything about not keeping colonoscopy? Seems like a false dichotomy if I've ever seen one.

And CBS News, predictably, with colonoscopy-advocate Katie Couric at the helm, again crossed the line into non-journalistic crusading, with Couric ending a segment on the study preaching, "And don’t use this study as an excuse not to get screened."

Huh? Is that journalism?

Healthy skepticism is a missing element in much health news coverage. It is very difficult for some journalists to question the effectiveness of screening tests. And they do a disservice to their audience by touting opinions, not evidence. The classic clash between intuition and science.

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Conflict of interest on NPR's "On the Media"

NPR's "On the Media" program this weekend looked at drug industry influence on media messages, including an interview with Senator Charles Grassley about his investigations of the industry.

The program also featured an interview with me about our HealthNewsReview.org project and about other issues involving health care news sources' conflicts of interest.

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Which headline tells the story?

Here are two headlines on the same New England Journal of Medicine article this week, on a study from Johns Hopkins.

The local paper - the Baltimore Sun - had the cheerleading headline: "Hopkins study supports use of CT scan of heart."

The Wall Street Journal, on the other hand, had a quite different headline: "Heart scans sometimes fail to identify blockages, study finds."

Granted, the Baltimore story had some strong caution, such as this quote:

"I think [the study] is overly optimistic about CT angiography," said Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic. "In the real world, as opposed to in a carefully designed study, CT angiography does not perform as well as was reported in this study."

But the headline sets reader expectations of what is to follow. We think the WSJ outshined the Sun on this one.

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Tough questions on health blog censored by TV news director

All over the country, daily journalists working on newspapers or on radio or TV are now also being asked to publish blogs – often without any additional pay for the additional work.

But I recently discovered a case where a reporter pressured to do a blog had that blog censored by a TV news director because he didn’t like what was in the blog.

The reporter – a TV health reporter – posted two entries about some questionable (I would call them unethical) practices in TV news. One referred to the practice of medical centers buying air time within newscasts and having the message appear as news. The posting asked blog visitors:

“What do you think of commercials for local health care behemoths that look like news? … Are you able to tell they are clearly commercials?�?

The other blog entry was about subscription services that provide health news for stations to fill their newscasts. The reporter, whose station often uses such a service, wrote on the blog:

“I've noticed a lot of the subscription reports have to do with research. And not that I have anything against research -- in fact, I think it's a very important part of medical advancement -- but I believe the mass media need to be very careful about highlighting investigational procedures, products, and techniques. …I worry sometimes these packages peddle false hope, or at least, premature hope.

What do you think of these subscription pieces? Can you tell when it's something I've written versus a (subscription) piece? Do you think stations should even subscribe to (such) services?�?

Without being told in advance, the reporter noticed that the blog entries had been deleted. The news director then called the reporter on the carpet and said that “He didn't think it was right to ask viewers what they thought about something management had already decided to do.�?

The reporter no longer blogs on the station website. That reporter asks if other reporters have had similar experiences, stating “it's about reporters everywhere having viewpoints about what their own industry does, and not being able to express their views without fear of reprisal.�?

Please weigh in if you know of other such in-house censorship of the free flow of ideas. In an era of transparency, there are apparently some editorial decisions that some news managers – at least this one – don’t want to shine a light on. That may be the best evidence there is for why the practices in question should be re-assessed.

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Anemic health news coverage

"Anemic." That's what the Wall Street Journal Health Blog calls the fact that health news made up 3.6% of all the news content analyzed by the Kaiser Family Foundation and the Pew Research Center’s Project for Excellence in Journalism over an 18-month period ending in June.

One data point I locked into is this:

Despite ongoing debates about the future of our health care aystem, health did not become a dominant part of the 2008 primary campaign narrative. Looking at all of the presidential campaign coverage over the first six months in 2008, health-focused stories made up less than 1% of the coverage.

While the analysis ended in June, I'll go further and predict that a systematic analysis of the June - November period would show that health policy coverage didn't improve any.

The report concludes:

"Given the small portion of national news information that is dedicated to the health care system, it may be difficult for the public to become fully knowledgeable about the state of our system and potential changes under debate."

See the full report here.

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At least the Germans are interested....

Earlier this year, when I published our data on our first two years' experience on the HealthNewsReview.org project, I thought that surely leading U.S. journalism publications such as Columbia Journalism Review or American Journalism Review would be interested in some kind of summary.

Wrong. Not a word of interest.

But internationally, journalism bloggers from several countries picked up on the story immediately. And now a German journalism magazine, Message: Internationale Zeitschrift für Journalismus, has republished the PLoS Medicine article.

I hope we can get an international discussion started - backed by the experiences of my colleagues on the Media Doctor Australia and Media Doctor Canada projects.

Our combined pool of news stories reviewed in the 3 countries now totals over 2,000 - a very clear picture which shows how many news stories across the globe fail to deliver important details on health news stories such as:

• How much is this going to cost?
• How small is the potential benefit?
• How large are the potential harms?

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How did a nonstory based on an iffy study end up in a New York Times blog?

Capping quite a week in criticism of health-medical-science journalism (see my two previous posts), Slate offers a column, "Bullies Like Bullying: How did a nonstory based on an iffy study end up in a New York Times blog?" Daniel Engber's column targets the work of New York Times health blogger Tara Parker-Pope. Excerpts:

"Last Wednesday, she posted about a team of neuroscientists from the University of Chicago who had shoved a handful of bullying teenagers into an fMRI scanner to see what was going on inside their heads. "In a chilling finding," she wrote, "the researchers found aggressive youths appear to enjoy inflicting pain on others."

Bullies like bullying? I just felt a shiver run up my spine. Next we'll find out that alcoholics like alcohol. Or that overeaters like to overeat. Hey, I've got an idea for a brain-imaging study of child-molesters that'll just make your skin crawl!"

In this case, I'm less interested in the science than the lamebrained science journalism. The New York Times did something worse than covering a nonstory—it shamelessly promoted it. Take another look at Parker-Pope's write-up, and now read the University of Chicago press release that went out the week before. Three entire paragraphs (including an extended quote) make it from the release into the six-paragraph Times post, virtually unchanged. The rest is paraphrase.

It's no wonder she missed some potential flaws in the bullying study. A quick look through the archives suggests that Parker-Pope makes a regular practice of touching up university-wire stories without any discernable reporting of her own. On Oct. 29, she posted on a study of stress and decision-making in seniors. The material was reworded slightly, but all of it—including the quotes—had previously appeared in a USC press release. In this piece from Nov. 4 on a study showing that children are safest under their grandparents' care, she acknowledges pulling a quote from a Johns Hopkins release but never acknowledges that the rest of the information she cites also appears in that release. Same goes for a Nov. 10 post on how drivers respond to speed limits, which consists entirely of information that appeared in a release from the Purdue University news service.

I don't mean to suggest it's a crime to take material from a press release. But it's certainly lazy, and there's every reason to believe that Parker-Pope knows better. In her short tenure at Well (and in her previous gigs), she's shown a knack for smart and skeptical science coverage: Posting on a study of how television affects teen pregnancy rates, she goes out of her way to complicate the sexed-up angle from the press release. Indeed, two years ago, she informed the Columbia Journalism Review that, "as reporters, we should never take anything at face value. I think a mistake that a lot of people might make is to read the press release. I almost never read the press release."

Go to the link above and read the entire column. The hyperlinks on the Slate site add depth to this discussion.

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Entanglement of medical journalists & Big Pharma

In the BMJ this week, Steve Woloshin, Lisa Schwartz and Ray Moynihan raise new questions about "who's watching the watchdogs?" Excerpts:

"Industry sponsorship of training and further education of journalists now occurs in a variety of contexts—universities, conferences, and professional associations—raising similar concerns to those that apply to education of doctors.

The University of North Carolina’s master’s degree in medical journalism, one of the first in the United States, has at least two important forms of financial relations with drug companies. ...

Like some university programmes, the American Medical Writers Association, whose members include reporters and public relations specialists, receives sponsorship from the drug industry. Eli Lilly was a key sponsor of the association’s 2008 annual conference, and the company also sponsors its student scholarships.
...
One of the more astonishing forms of financial ties between journalists and drug companies is the sponsored award, which often involves lucrative cash prizes or opportunities for international travel. For example, Eli Lilly and Boehringer Ingelheim have co-sponsored an award for "reporting on urinary incontinence," carrying a prize of international travel. Boehringer has an award for reporting on "chronic obstructive pulmonary disease," offering prizes worth $5000 each, Eli Lilly one for reporting on oncology, and Roche one for "obesity journalism," with a prize of $7500. Sometimes awards are sponsored by organisations that are themselves heavily funded by industry, such as the non-profit Mental Health America. Its 2007 annual report shows that almost half of its funds came from drug companies, including more than $1m each from Bristol Myers Squibb, Lilly, and Wyeth.
...
A powerful contemporary example of entanglement involves a television network called Accent Health (whose logo includes the words "Your target is waiting"), said to be watched monthly by more than 10 million viewers in US medical waiting rooms. The network, which is produced by CNN, overtly offers sponsors, including drug companies, the chance to boost sales of their products, by, for example, putting "your brand in front of the valuable Baby Boomer population just before they discuss their health conditions with their doctor." One of the hosts is Sanjay Gupta, CNN’s chief medical correspondent and host of at least one other CNN health programme that is funded partly through drug company advertising. ...

As researchers and writers acting to improve medical journalism, we encourage journalists, educators, and professional associations to scrutinise their own relations with the industry as intensely as they do those between doctors and drug companies and to develop workable solutions. And, if they are to be good watchdogs, journalists need to mark their territory and clearly establish boundaries between themselves and the industry to avoid unhealthy entanglements.

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"Science reporting by press release"

Cris Russell has a column under the headline above in the Columbia Journalism Review. Excerpts:

"A dirty little secret of journalism has always been the degree to which some reporters rely on press releases and public relations offices as sources for stories. But recent newsroom cutbacks and increased pressure to churn out online news have given publicity operations even greater prominence in science coverage.

“What is distressing to me is that the number of science reporters and the variety of reporting is going down. What does come out is more and more the direct product of PR shops,�? said Charles Petit, a veteran science reporter and media critic, in an interview. Petit has been running MIT’s online Knight Science Journalism Tracker since 2006, where he has posted more than 4,000 critiques involving approximately 20,000 articles. He is concerned that science news “spoon-fed�? directly to the media through well-written press releases and handouts has “become a powerful subversive tool eroding the chance that reporters will craft their own stories.�? In some cases the line between news story and press release has become so blurred that reporters are using direct quotes from press releases in their stories without acknowledging the source. ...

“The problem is worsening,�? agreed Paul Costello, who heads the Stanford University School of Medicine communications and public affairs office. He said that the “shift to new media Web site traffic�? is putting added pressure on reporters, leading some to cut corners in the name of more copy, “often writing right off press releases, even at the good papers.�? "

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Saga of the heart sock continues

I've been tracking news coverage of a Minnesota company's heart "sock" device for heart failure for four years. Four years ago, I questioned Star Tribune coverage.

Two years ago, questions of evidence started to surface.

Today the Star Tribune reports:

"The high-profile consumer advocacy group Public Citizen expressed "deep concern" this week about whether the company's experimental device has been sufficiently reviewed by federal regulators. ...

Two advisory panels for the FDA have recommended against approval of the Acorn device after reviewing the company's application and holding public hearings. The agency itself has rejected the company's application three times. Acorn has even taken its case to a dispute resolution panel, a highly unusual move in the device world, which also voted against approval of its device.

Normally, a company in this situation would have abandoned the rather-expensive effort, especially a start-up like Acorn, which has no other products on the market.

But Acorn has been encouraged along the way by Dr. Daniel Schultz, a surgeon who is head of the FDA's device division, and the company subsequently reached an agreement with the agency to conduct a second, albeit smaller, clinical trial involving 50 patients. If that study is successful, the device could be approved by the agency without being first reviewed by an advisory committee and without a public hearing, according to Public Citizen.

In a Nov. 12 letter to Schultz, Public Citizen said the design of the new study "is so poor that it is unlikely to provide reliable data that would contradict the negative findings of the data so far submitted to the FDA." The number of patients enrolled in the study is too small, and they will not be followed for a sufficient amount of time, Lurie said."

I never would have picked up on the scent of this story had not the Star Tribune given such favorable coverage to the company and its product four years ago.

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AP pronounces AIDS cure

You can split hairs all you want about what the Associated Press actually reported about an American living in Germany who was treated with a bone marrow transplant for his leukemia, a treatment now being reported to have had an impact on his HIV/AIDS status.

But these words were used:

"Doctors say marrow transplant may have cured AIDS."

"...appears to have been cured of the disease...."

"...he no longer shows signs of carrying the virus..."

Despite some caveats in the story, one can question why the AP reported this story at all.

Perhaps no one remembers as vividly as I do how CNN reported on a hyperthermia "cure" for AIDS back in 1990. I remember because, as head of the CNN medical news unit at the time, key people at the network went behind my back, then spurned my advice, and reported this "cure." It didn't take much and it didn't take long for the facts to show how foolish and how inappropriate that reporting was. That incident was the leading factor in why I resigned from the network within a few months.

Does journalism ever learn about "cures"?

About verification?

About replication of results?

About the impact such stories have on sick people?

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Statin study: "Everybody's talking at me; I don't hear a word they're saying."

OK, turn it over to some journalists and we'll have statins coming out of the kitchen faucet tomorrow.

On HealthNewsReview.org, we reviewed a story on the Jupiter-Crestor-CRP study done by the once-venerable Los Angeles Times. Excerpt of our review:

This news report about a significant clinical trial on statins and heart disease fails to look skeptically at the claims of the self-interested researchers. Rather than pushing back against the exaggerated claims of efficacy, safety, and imminent transformation of treatment protocols, the report magnifies them.

The report's failures are largely due to emphasis rather than omission. The caveats are noted, but buried or otherwise minimized. For example:

* The report states that the study and its lead author are funded by the drug maker. But these facts are added as asides, and follow dramatic claims of benefits high in the story.
* Halfway into the story, the reporter cites unnamed "critics" who "charged" that wide adoption of the treatment protocols would be too expensive to justify. But this is followed immediately by a dismissal and a prediction that the changes will come anyway.
* The report eventually states how many people would need to be treated with statins in order to prevent one event--but this comes long after several enthusiastic declarations and statistical formulations supporting statins' power to prevent heart events and save lives.
* The report mentions a small risk of side effects--but ignores previous reports, including one by the same journalist, that the statin in question has a worse side effect profile than most statins.

In all, 16 paragraphs make positive statements about the results. Four paragraphs call the findings into question.

The story also fails to parse facts about CRP. The study looked at people with presumably safe cholesterol levels but high CRP levels. Because the drugs reduced both cholesterol and CRP, the results are silent on whether the benefits are related to a reduction in CRP. Yet the reporter allows the lead author--who holds a patent on the CRP test used in the study--to make this assertion.

Given the obvious financial interests of the researchers and their sponsors, and the extravagant predictions of population-wide benefits, the reporter should have made an extra effort to find disinterested sources who could put the news in context.

This would not have been difficult. The article cites an editorial in the same issue of the journal urging cautious interpretation of the results. The reporter could have at least used that editorial or an interview with the writer to inject a balance that was missing from this overly enthusiastic report.

NBC’s Robert Bazell didn't have one skeptical comment in his network news report that - thankfully - reaches fewer people these days because of a decline in network news viewing. He never mentioned the appropriately skeptical, cautious comments in an editorial accompanying the New England Journal of Medicine article - something that is low-hanging fruit for any reporter covering the story.

Viewers of the CBS Early Show got one of the most one-sided reports of all. Anchor Harry Smith asked the doc-of-the day:

"So if I’m one of those people of a certain age who might have high certain other markers, should I be running to my cardiologist today, saying ‘Give me the test for this inflammation so I know that maybe I ought to be on this stuff’?"

And she responded:

(Dr. Suzanne Steinbaum:) Absolutely. If you have any risk factors—high blood pressure, high cholesterol, diabetes—but all of these things are sort of borderline and you’re not taking a statin, really this inflammatory marker, the CRP, might tip the doctor over the edge to give you a statin like Crestor.

Let's all rush in tomorrow. We're healthy but we don't know we're dying. Let's find out what bad shape we're in so that we can all be statin-ized ASAP. Wow. What a job journalism is doing in selling sickness and drugs.

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On-air spat between anchor and medical correspondent

Dr. Nancy Snyderman of NBC News appeared on the Today Show with Matt Lauer last week, profiling a physician-author who has written that the best science does not establish a causal link between childhood vaccines and autism.

Lauer, in a followup question, mis-spoke and called it a "casual" link - not causal. One wonders whether he truly knows what the words mean.

Snyderman talked about how the physician-author, Dr. Paul Offit (author of "Autism's False Prophets"), has received death threats. Snyderman herself said she had been physically ambushed by those who contend that vaccines cause autism.

As Snyderman was wrapping up the segment, Lauer said - in typical anchor throwaway language:
"Controversial subject ..."

Snyderman immediately shot back, "Not controversial subject , Matt. ...It's time for kids to get vaccinated. The science is the science. It's not controversial."

You can see the video here or here.

Kudos to Snyderman for educating her big-bucks anchor colleague live on-the-air.

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Journalists' screening bias piece on The Daily Beast

I'm pleased to be able to contribute a piece for The Daily Beast on the rash of stories that fail to tell the whole story about screening tests.

I write in that piece:

"A few simple reminders could guide journalists and the public:

* Newer isn’t always better.
* More isn’t always better.
* Screening doesn’t make sense for everyone.
* Many screening tests do good; many also do harm.

Such stories stoke the fears of the “worried well.�? They raise undue demand for unproven technologies. They raise unrealistic expectations of what screening—and health care—can achieve.

And they overlook evidence, harms and costs.

Trudy Lieberman wrote a column for the Columbia Journalism Review asking if journalists deserve some of the blame for the high cost of health care when they write stories like this.

We spend more on health care than any other country on the globe, yet we have outcomes for some conditions that are worse than developing countries. And we still have more than 40-million neighbors who are uninsured.

That might be a better reference point for a discussion on health care reform and health policy than what we get from stories that make us all think that we should be screened because we all have something silent lurking inside us that should be found and treated."

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Tidbits from the vast wasteland of TV health news

Trudy Lieberman, in Columbia Journalism Review, describes what the magazine calls ineptitude by CNN and Dr. Sanjay Gupta in coverage of health policy news. Excerpt:

"Gupta’s attempt to explain John McCain’s health plan offered a confusing and ultimately misleading picture of how the candidate’s proposals might work. McCain, you may recall, has proposed giving every family a $5,000 tax credit and every individual a $2,500 credit to help buy insurance policies in the commercial market. So it was reasonable for Gupta’s show to ask: How far will five grand really get you? Too bad it didn’t answer the question.

Gupta began by citing a study done a couple of years ago by America’s Health Insurance Plans (AHIP), the insurance industry trade association. Gupta was wrong at the outset when he called AHIP “the largest provider of health insurance.�? AHIP is a lobbying organization for its insurance company members. It does not—does not—provide health insurance. Gupta said AHIP had found that the average family’s premium was $5,799; he didn’t say that the data had been collected two years ago, and he didn’t explain that any study done by an insurance trade association is necessarily of limited value. (In fact, no organization has adequately studied the so-called individual market, where McCain wants people to buy their policies with his tax credit.) The take-away for viewers, though, was that a family could buy a policy for the amount offered by McCain’s tax credit.

I asked a neutral insurance expert, Paul Fronstin, who directs research for EBRI, the Employee Benefit Research Institute, to translate Gupta’s wonk talk. Fronstin said Gupta “gives a gross oversimplification.�?

Instead of all the red-white-and-blue sets and the computer games, CNN should have invested in someone who could explain the issues that are of such importance to voters."

Within the past two weeks, ABC and NBC have had forgettable health stories, reviewed on HealthNewsReview.org.

ABC's Good Morning America had a segment on "detox diets." The review summary of that story:

"A waste of air time. More like free advertising than anything you could describe as journalism. Anecdote, not evidence. No independent expert interviewed. No harms or costs discussed. Awful."

The NBC Today Show had a segment on vitamin D deficiencies.The review summary stated:

"This segment didn’t tell viewers who had made the new recommendation, how the conclusion had been reached, how great the danger was, or how much benefit they might hope to gain."

I don't know why I don't go into business for myself. It would be so easy to promote one's product or idea through today's unquestioning free-for-all, free-advertising that we call TV health news.

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Why is an evidence-based statement being ignored?

The Wall Street Journal today has a big splash, "CT Scans Gain Favor as Option for Colonoscopy." But in this 1,300-word article, there isn't one mention of the recent statement by the U.S. Preventive Services Task Force "that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography" and that "there is potential for both benefit and harm. Potential harms arise from additional diagnostic testing and procedures for lesions found incidentally, which may have no clinical significance. This additional testing also has the potential to burden the patient and adversely impact the health system."

This insistence by journalists to trumpet new technologies and their refusal to acknowledge an independent, evidence-based conclusion is very troubling.

I just don't get it.

The USPSTF statement was issued just 3 weeks ago, so it isn't like it gathered dust or is outdated.

And it's written by independent experts from various fields with no skin in the game - not by radiologists or gastroenterologists or by any interest group.

Evidence insufficient. Harms may occur. Newer isn't always better. Why isn't that part of the story?

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Entanglements of conflicts of interest in health care news

The Integrity in Science Watch project of the Center for Science in the Public Interest, in this week's e-newsletter, has two different but related "jeers" for failure to disclose conflicts in two different health journalism efforts. Their posting:

Jeer to the National Press Foundation for an omission on its agenda for the Oct. 23 forum for journalists on “The New Understanding of Pain,�? which was funded in part by the unit of Johnson & Johnson that makes pain medications. The agenda does not disclose that presenters Howard Heit of Georgetown Medical School and Aaron Gilson of the University of Wisconsin have consulted for Purdue Pharma, maker of the controversial pain medication OxyContin, and other manufacturers of pain medications.

Jeer to Erik Eckholm and Olga Pierce of the New York Times for failing to disclose in an August 15, 2008 article on methadone risks that Howard Heit of Georgetown Medical School, who is quoted warning about those risks, has served as a consultant for Purdue Pharma, maker of OxyContin, a rival drug.

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Hopelessly devoted to imbalanced advice on network TV

The CBS Early Show let actress-singer Olivia Newton-John appear on their program this week to promote a commercial product without a balanced review of the evidence.

In fact, the anchor led in to the relevant part of the interview by prompting the celebrity, “Tell us about your crusade.�?

(Newton-John:) “I’d like to introduce the Liv Aid, which is a Breast Self Examination kit to encourage women to do regular breast self-examination, because early detection is key.�?

Newton-John went on to remind viewers that she found a lump during breast self-exam 16 years ago. She said she was working with the Curves chain to try to get these LivAid kits to one million women.

But a recent review of the scientific literature by the Cochrane Collaboration stated:

"Data from two large trials do not suggest a beneficial effect of screening by breast self-examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. At present, screening by breast self-examination or physical examination cannot be recommended."

There was never a mention of this in the CBS program - only free airtime for a "crusade" - and a commercial one at that.

Shame on CBS for providing one-sided, incomplete information to its viewers.

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Health journalism Quote of the Day

Phil Galewitz, health writer for the Palm Beach Post, in the current issue of HealthBeat, the newsletter of the Association of Health Care Journalists:

"It used to be, in journalism, your goal was to c omplete a major investigative project or win a major statewide or national award. Today, journalists like me are worried about just surviving."

As editor of HealthBeat, Galewitz tracks cutbacks on the health beat across the country. He writes that The Miami Herald and The Rocky Mountain News no longer have fulltime health writers.

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Chicago Tribune's "United States of Anxiety" series

The Chicago Tribune, in the middle of a good story with a catchy headline - "The United States of Anxiety: Worried Sick Over Our Health Care" - includes some vital messages:

"Polls show voters worry a lot about health care and how much they spend on it. Presidential candidates John McCain and Barack Obama have responded by peddling plans they claim will help more Americans attain and afford care.

But neither candidate has focused publicly on treating the real problem: why American medical care costs too much and isn't as good as it should be.

We waste money on tests and visits to specialists that don't make us better. We spend big to add a few weeks or months to the inevitable end of a dying patient's life. We use expensive technology at any cost, even when it exceeds our needs, and we fail to encourage simple, proactive steps that would keep us healthier and save us money. We often don't know which treatments work the best, so we err on the side of too much care, for too much cost, with sometimes damaging consequences.

As a result, Americans pay significantly more for medical care than anyone else in the industrialized world. Every year, we spend a bigger chunk of our family budget on doctor bills, hospital stays and prescription drugs. Yet we trail several other nations in health-care quality, access and efficiency.

Most Americans have long assumed that more is better when it comes to their health: more doctors, more tests, more hospital time. But a decade of comprehensive studies suggests that all those visits and tests and hospital stays are often a waste of money—and sometimes a drag on our well-being."

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Cheers & jeers for health news coverage of virtual colonoscopy

In its weekly e-newsletter, the Integrity in Science Watch project of the Center for Science in the Public Interest offers its "Cheers & Jeers" section on health journalism's coverage of conflicts of interest among sources. This week they wrote:

Cheer to Mike Stobbe of the Associated Press for reporting the financial ties to General Electric of C. Daniel Johnson of the Mayo Clinic, who was lead researcher for a study published in the New England Journal of Medicine last week that showed virtual colonoscopy using CT scanning machines, which GE manufactures, was just as effective as regular colonoscopy for detecting colon polyps that can lead to cancer.

Jeer to Judith Graham of the Chicago Tribune for failing to note Johnson’s ties to GE in her story on the colon cancer screening study.

Jeer to Liz Szabo of USAToday, who quoted Harvard Medical School emeritus professor Robert Fletcher touting the availability of new and better colon cancer screening tests, for failing to note that Fletcher is a financial consultant to Exact Sciences, which is seeking Food and Drug Administration approval for a stool DNA colon cancer screening test. Fletcher's ties to Exact Sciences were revealed in an NEJM editorial.

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Science by news release

Sandy Szwarc, on her Junkfood Science blog, blasts lazy news coverage this week of "a study reportedly finding that acupuncture works to reduce the side effects of breast cancer treatment as effectively as conventional medicine, without the side effects."

She counted at least 144 news stories and tied them to a news release issued by the Henry Ford Health System. She wrote:

"Whether it’s been from WebMD to the New York Times and every media outlet in between, the medical news has all simply repeated the script provided in the press release. ABC’s medical science reporter, John McKenzie, hadn’t even read the press release carefully to catch the date the abstract was to be presented and in his story published three days before it happened, he said the findings “were presented today at the ASTRO annual meeting,�? as if he’d been there!

What are press releases? Marketing, of course. ...

The level of media hype this week far outstripped the scientific merits of this research, but, no doubt, will encourage the spending of countless dollars on a modality that the strongest evidence suggests is little more than a placebo. That concerns us, too. At a time when everyone is talking about how expensive our healthcare system is, we can’t afford to waste public resources, or our insurance premiums. Dr. Walker was quoted in USA Today this morning lamenting that “many insurance plans don’t cover acupuncture,�? while they do cover the medication. Surely, all of this marketing wasn’t about money.

Saddest is the false hope and misinformation that untold numbers of breast cancer patients heard this week, the subtle reinforcement of feelings of distrust and inferiority of their medical care and modern medicine, and the disservice these media stories provide by exploiting women at the most vulnerable time in their lives."

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Roanoke editor disavows any hospital pressure

See his memo to staff now posted online.

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Hospital ad pressure on a newspaper?

CJR's column, "Something's Rotten in Roanoke," raises some important questions, although it doesn't answer any of them.

It is clear that the once formidable wall that once stood between the advertising departments and the news departments now looks like Swiss cheese in many news organizations.

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Not standing down yet on "Stand Up To Cancer"

If you thought I had criticisms of Friday night's "Stand Up To Cancer" telethon, read Sandy Szwarc's much more in-depth analysis on her JunkFood Science blog.

Don't look for this kind of critical analysis in any of the mainstream media; many of them were "partners" in the deal.

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International journalists can't believe our health news

I met yesterday with the World Press Institute's 2008 International Fellows. They came from Argentina, Brazil, Bosnia & Herzegovina, China, Hungary, India, Lithuania, South Africa and Spain.

We reviewed recent examples of U.S. health journalism.

Several of the Fellows expressed amazement at what they saw. Among the comments:

• They couldn't believe that stories promoted drugs without better discussion of evidence.
• They couldn't believe that drug company spokesmen were interviewed in stories.
• They couldn't believe that someone in news organizations didn't say "NO" to some of the stories they saw here.

Welcome to our world.

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Celebrity shoulder surgery "LIVE" on CNN

CNN went "live" yesterday from the operating room where Olympic swimmer Dara Torres was having arthritic shoulder surgery.

Why?

And why have the reporter in the room saying "Hi" to her while the anesthesia is about to take her under?

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The cream and the crud of August health journalism

Over on HealthNewsReview.org, August has been a spotty month for health news quality.

The good news: five stories have been given the site's top five-star score. That's a record for one month. They include stories by the New York Times, the Wall Street Journal, the Washington Post, and the Associated Press (two). All can be found here.

Then there was the crud:

• a one-star story by the Wall Street Journal on a depression drug being tested for chronic pain. At only 189 words, it was still wasted space. It apparently stole a quote from a news release without attribution.

• a one-star story by the CBS Early Show on an "artificial pancreas." CBS called it a "medical miracle." The anchorman gushed, in interviewing a patient:

* "How life-changing was it for you when you tried this thing?"
* "Wow. Wow. How much would you love it if this thing actually came on the market?"

• a zero-star story by the CBS Evening News on a form of 3-D optics to help surgeons. The HealthNewsReview.org summary on this one:

"CBS exaggerates benefits, fails to explain what’s really new, doesn’t mention costs and cites no evidence about whether the machine produces better outcomes or carries any additional risks."

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More than everyone in the world will be obese

I love Carl Bialik's "Numbers Guy" column in the Wall Street Journal and last week he had another gem, headlined, "Obesity Study Looks Thin." Excerpt:

In 40 years, every single American could be overweight, according to a recent study. Employing that same logic, 13 out of every 10 adult Americans by then won't have landlines.

The phone forecast is impossible, of course, but it's arguably no less solidly grounded than the obesity forecast. The weight projection uses three data points spread out over nearly three decades to estimate a linear trend -- then brazenly draws that line into the future.

The result: 86.3% of American adults will be overweight or obese in 2030, compared with 66.3% by the government's latest estimate. By 2048, the percentage will reach 100%. The study doesn't go beyond that date, but that upward trend would reach logical impossibility the following year.

"Extrapolations are dangerous," says Donald Berry, chairman of the department of biostatistics at the University of Texas M.D. Anderson Cancer Center. "Especially dangerous is to assume that trends are linear. Otherwise we'd conclude that Olympic swimmers will one day have negative times, there will be more Internet users than people, and more people on Earth than molecules in the universe."

The problems with obesity are bad enough and clear enough. They don't need a boost from statistical sensationalism.

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Sick sensationalism

The Star Tribune this week published a story under the headline, "A New Heart, A Dark Heart?" (It's interesting that this headline does not appear on the online version today, although search engines still find the original headline.)

The headline is pretty clearly meant to imply that a newly-transplanted heart drove a young man to plan a gruesome murder.

I thought the headline was awful, but I thought, at first, that I may be alone in that judgment.

Then I saw a letter to the editor in today's Star Tribune:

The Aug. 14 headline, "A new heart, a dark heart?" that accompanies the story about the boy from Woodbury who had a heart transplant and is now charged with felonies was so sadly sensationalistic.

Although I am not in the medical field and have no medical expertise, I feel pretty confident that the idea that the heart of an 11-year-old boy, whose grieving parents generously donated to save another boy's life four years ago, could be "dark" is ridiculous. You didn't need that headline for people to read that story. I hope that all families involved in this tragedy were spared from seeing this headline.

Has the decline in circulation led to this much of a decline in standards?

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Hospital ads and hospital hype

See Maggie Mahar's entry on the HealthBeat blog.

And for a little wisdom of the crowd, here is one online reader reaction to Maggie's post:

"Our local CBS station has a regular feature called "Breakthroughs Everyday" featuring one healthcare network. I've written to the news director at this station requesting, in the interests of fair and impartial journalism, that they also have a regular feature entitled "Failures Everyday" and start reporting on the stories of patients from the same hospital. No reply. ... The hospital PR has disgusted me for years."

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Yes, still another case of "journalist" pro-screening bias

Over on the HealthNewsReview.org website, we've reviewed another example of a journalist giving pro-screening test advice that is not supported by medical evidence.

This time it was the CBS Early Show, using physician-"reporter" Dr. Holly Phillips from WCBS-TV in New York to do a followup on actress Christina Applegate's diagnosis of breast cancer.

We said in that review:

The story engages in disease-mongering in its conclusion: "What's most important is to screen. One in eight women nowadays is going to get a breast cancer in her life, so as long as you get in for screening, I'm happy." The 1 in 8 statistic requires explanation. It is a lifetime incidence estimate. Many women misinterpret this to think that they have 1 in 8 chance right now at this time in their life. It is one of the misused and most misunderstood statistics in health care. The National Cancer Institute estimates that a typical 40-year old woman has less than a 2% (1 in 50) chance of developing breast cancer before 50, and less than a 4% (1 in 25) chance of developing it before age 60.

But the story also states, "But generally, we start home breast exam at age 20. I suggest every month, at the same time of the month, examine your breasts at home and get into your doctor for a breast exam at least every three years, earlier if you can." This is not an evidence-based recommendation and involves a physician-reporter giving personal advice and perhaps forgetting that she is now a reporter.

There is little evidence that breast self-examination (BSE) lowers deaths from breast cancer, and SBEs are not recommended by themselves for detecting breast cancer, especially in higher-risk women.

Experts disagree that mammography screening "should begin at 40", especially for women at low to average risk. See: http://www.annals.org/cgi/reprint/146/7/I-20.pdf .

The story had many of the elements of today's TV health stories:

• a young female celebrity angle
• a young female physician-reporter
• fear and promotable content.

Unfortunately, as with many of today's TV health stories, it also lacked details on evidence.

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You can find conflict-free experts in health care, medicine and science

We've posted the following Publisher's Note on HealthNewsReview.org.

Conflicts of interest among sources of health/medical news and information represent an enormous – and growing – problem.

Health care consumers, and news consumers, are often not told of the biases that may exist in medical research, in clinical care, or in health care professionals’ continuing medical education because of financial ties to drug companies and medical device manufacturers.

Journalists, broadcasters, editors, and producers too often rely – wittingly or unwittingly – on drug industry sources. The result: medical news often helps sell drugs to the public, accentuating the positive and minimizing risks, rather than giving readers a balanced, accurate view.

To counter claims that it is impossible to find experts who are not on the payroll of industry, independent journalists Jeanne Lenzer and Shannon Brownlee have compiled a list of more than 100 experts from several nations with expertise across a wide range of disciplines. There are two parts to the list. One part includes experts who have no financial conflicts of interest, or conflicts that are irrelevant to most stories. The second part includes experts with a variety of potential conflicts. Some of these experts have ended their pharma ties – but only within the past five years. Others may have current financial conflicts of interest. These experts, despite their commercial ties, are included in the list because they have provided important insights into the inner workings of industry – effectively biting the hand that fed them in some instances --and/or because their conflicts did not limit their ability to comment in areas unrelated to the conflicts.

The experts include: two former editors of the New England Journal of Medicine, the former editor of the western journal of medicine, current editors of American Family Physician and Public Library of Science-Medicine; former FDA advisors; physician educators; researchers; bioethicists; epidemiologists, methodologists, geneticists, and clinicians from a various specialties; medical whistleblowers; and several medical journalists.

Information about the list appears in the “Journalist Toolkit�? section of the site at: http://www.healthnewsreview.org/independentexperts.php. If you’re a journalist, you’ll be given instructions about how to acquire the list, complete with experts’ contact information. The general public will be able to see the list of names without any contact information.

It’s our hope that this list helps journalists find and use sources who do not have financial conflicts of interest. We hope that the general public understands the gravity of these issues and their impact on the integrity of medical science.

For further information on the list see: Naming Names: Is There an (Unbiased) Doctor in the House? BMJ July 23, 2008.

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Ethical small-town journalist gets well-deserved big-time award

It is a joy to pass along news like this:

"He no longer has a job directing news, but Glen Mabie now has an ethics award to add to his journalism credits.

The Society of Professional Journalists announced Monday that Mabie, former WEAU TV-13 news director, won the organization's national Ethics in Journalism Award, awarded annually to journalists who act in accordance with the SPJ code of ethics. The award will be given Sept. 6 in Atlanta.

Mabie was recognized for the award after resigning from his news director position in January when he objected to an agreement between the TV station and Sacred Heart Hospital in which TV-13 would run medical stories featuring Sacred Heart employees and not those of other Chippewa Valley hospitals or clinics.

Broadcasting programming featuring Sacred Heart content exclusively didn't sit well with Mabie, who noted the resulting conflict of interest that called the newsroom's objectivity into question.

Mabie and other TV-13 newsroom staff protested the agreement but were initially unable to convince management to cancel the deal. Mabie subsequently resigned, and the TV station's management canceled the deal with Sacred Heart.

Mabie said he is humbled by the award and credited his former TV-13 news colleagues with their protest of the agreement.

"Many of the people in that newsroom deserve this honor just as much as I do," he said. "To see those people stand up for those ethical guidelines was really neat."

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New prostate recommendations - new lessons for crusading journalists

Just four days ago, in response to an NBC News story in which reporter George Lewis recommended that all men over age 50 get annual prostate exams including the PSA blood test, I cited the statement of the U.S. Preventive Services Task Force to show that Lewis' advice was not based in evidence:

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.

Yesterday the USPSTF updated its recommendation and it makes Lewis’ on-the-air statement to all of NBC’s viewers all the more problematic in its crusading advocacy that is not supported by evidence:

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.

Older men, African-American men, and men with a family history of prostate cancer are at increased risk for diagnosis of and death from prostate cancer.1 Unfortunately, the previously described gaps in the evidence regarding potential benefits of screening also apply to these men.

The yield of screening in terms of cancer cases detected declines rapidly with repeated annual testing. If screening were to reduce deaths, PSA screening as infrequently as every 4 years could yield as much of a benefit as annual screening.

Journalism is supposed to be about evidence and facts, not crusading advocacy.

"We don’t have any studies that show prostate cancer screening saves lives," explains Dr. Otis Brawley, chief medical officer for the American Cancer Society.

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Cell phone cancer scare on Larry King Live

The Cancer Letter (subscription required) does its usual excellent job in reporting on the latest network TV free-for-all on cell phones and cancer. Excerpts:

"A teaser for the Larry King Live news show July 29 got to the quintessence of the scientific controversy over cell phones:

“A prominent cancer researcher says, ‘Put down that phone right now, if you want to reduce the risk of cancer!’�?

The researcher in the spotlight was none other than Ronald Herberman, a respected immunologist and founding director of the University of Pittsburgh Cancer Institute.

A week earlier, Herberman stunned his colleagues by sending out an e-mail blast to his cancer center’s 3,000 employees, urging them to limit their exposure to cell phones. This exploded into an international story: director of an NCI-designated cancer center sounds alarm over dangerous occupational exposure.

Meanwhile, Herberman’s peers—including current and former directors of comprehensive cancer centers—say privately that they are watching with considerable surprise as the formerly cautious, conservative immunologist is staking his well-deserved, hard-earned prestige on a cause where data have been weak and findings cherry-picked.

“This whole thing makes no sense to me,�? said one prominent researcher. “What was the urgency?�? asked another peer. Scientists who know Herberman only by his publications were equally surprised. “I can’t help but wonder just what on earth Dr. Herberman was smoking when he decided to issue this warning,�? David Gorski, a surgical oncologist at Barbara Ann Karmanos Cancer Institute, wrote on a quackbusters’ blog called Science-Based Medicine. “Scaring the nation based on ‘early unpublished data’ that can’t be examined by the entire medical and scientific community is generally not a good idea. That’s why I’ve been asking over the last few days: Why on earth did Dr. Herberman do it?�?

Otis Brawley, chief medical officer for the American Cancer Society, was similarly surprised. “I am afraid that if we pull the fire alarm, scaring people unnecessarily, and actually diverting their attention from things that they should be doing, then when we do pull the fire alarm for a public health emergency, we won’t have the credibility for them to listen to us,�? Brawley said on the CNN show."

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Awful week for health news on NBC

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.

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.

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?

• 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.

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ABC proclaims a miracle

Journalistic hype of health news never stops.

The latest: ABC News last week called the drug Dimebon a "miracle drug" for Alzheimer's Disease on its website.

It was tested in about 100 people. It was only tested against placebo, not head-to-head with any other existing Alzheimer's treatment.

ABC News didn't interview the principal investigator in the story that aired last Thursday night. HealthDay did, and she told them: "This is not a cure for Alzheimer's disease, but the benefits could last for a long time. The drug appears to slow the clinical progression of the disease."

Sounds like the PI is much more cautious than the "journalists" at ABC.

HealthDay also reported that the PI is on the Scientific and Clinical Advisory Board of the company that makes Dimebon and has stock options in the company. None of this was revealed in the ABC story.

And nothing that warranted calling it a miracle.

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How a headline can ruin a health/science story

Recently a physician friend brought the following to my attention. The same story, written by the same person, but appearing under two very different headlines.

Here's the original New York Times headline:

The story stated at one point: "No one knows whether vaccinations had anything to do with the girls’ health problems, and the scientific significance of individual cases is always difficult to assess."

But the Seattle Times picked up the NYT story and used this headline:

The Seattle headline gives the misleading impression that there's a causal link between autism and vaccines. This is the kind of thing that gives headline writers a bad rep.

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More than 600 stories reviewed on HealthNewsReview.org

In case you don't visit the HealthNewsReview.org site often, I wanted to let you know about a new Publisher's Note just published there. It reads:

Our database of stories reviewed now numbers more than 600.

113 of the stories were by the Associated Press, which feeds most newsrooms. We've reviewed 38 stories by the Los Angeles Times, 37 by the New York Times, 33 by the Wall Street Journal, 21 by the Washington Post, and 19 by USA Today.

Of the television networks' morning programs and evening newscasts, we've reviewed 52 stories by ABC, and 45 each by CBS and NBC.

As you know, our highest rated stories get 5 stars, our lowest-rated get none. After 603 reviews, 12% got 5 stars, 24% got 4 stars, 29% got 3 stars, 27% got two stars, 6% got one star and 3% got zero stars.

But sometimes the star score doesn't tell the whole story. With a movie review, you wouldn't only be interested in the star score the reviewer came up with. You'd want to read WHY the reviewer loved or panned the flick. Similarly, you need to read the meat of our reviews - the criterion-by-criterion comments and the summary review - in order to get the full feeling for what we thought about a story.

For example, an ABC Good Morning America piece, "Breakthrough Cancer Study: Change Lifestyle, Change Risk", recently got a 4-star score. That's what it got when we applied our ten review criteria. But we didn't like the story all that much. Our review summary stated, in part:

There are times when our "star" scores are misleading. In this case the star score is deceptively high for how we really feel about the story. That is why these summary comments are important. This piece may have addressed many of our criteria, but was lacking in balance, independent perspectives, details about the actual study results and details about the types of patients who might be candidates for this lifestyle intervention. Viewers may have been given a far too optimistic picture of an early pilot study.

We've had other instances in the past where a story "felt" better than the low number of stars it got from a fair application of the ten criteria. So please read the whole review or you're not seeing the work and the thought that went into our analysis.

Finally, we want to praise a series that we have not reviewed. On Sunday June 29, the New York Times published a story, "Weighing the Costs of a CT Scan’s Look Inside the Heart". It was a terrific story and one that all of our readers should be sure to read. Then, on Sunday, July 6, the Times published "Costly Cancer Drug Offers Hope, but Also a Dilemma".

These stories were published under the series title of "The Evidence Gap" which the Times describes as a series that "will explore medical treatments used despite scant proof they work and will consider steps toward medicine based on evidence."

Please come to our Discussion Forum and offer your thoughts on our reviews, or on any aspect of health and medical news coverage.

Thanks for your continued interest in our project.

Gary Schwitzer
Publisher

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We're #5! We're #5!

OK, we're not #1.

But we're a busy little blog, as shown by the fact that this blog has just become the 5th most active blog out of 6,336 blogs with 15,465 authors hosted on the University of Minnesota Libraries.

What we rank 5th in is in the number of entries. Since September 2004, I've posted 866 entries on this site. And counting.......

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Disease-mongering by Russert pundits

There has been a lot of speculation about what happened to and what could have saved Tim Russert.

Some, like a Wall Street Journal piece, "A Visceral Fear: Unexpected Heart Attacks," bordered on disease-mongering. That story discussed:

"...experts who think wider use of coronary calcium CT scans could help spot more people at risk of soft-plaque blockages. The noninvasive procedure takes about 15 minutes and costs a few hundred dollars. But few insurers cover it because there is scant evidence that treating people on that basis saves lives.

At a minimum, seeing a picture of the calcium lining their arteries can be a wake-up call for patients to take their coronary-artery disease seriously and to be diligent in taking medication, exercising and making other healthy lifestyle changes."

I'm sure there are such experts. But there are many other experts who do not support wider use of such scans. It's not just insurers who are reluctant. The story makes the procedure sound quick and inexpensive. But that is on the individual level. Who should be screened? Everyone over 40? The entire population?

Pictures - even those of the insides of our coronary arteries - don't tell the whole story. And neither did this piece.

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Tracking conflict of interest news coverage

From time to time, I've highlighted how the Integrity in Science Watch project of the Center for Science in the Public Interest tracks news coverage (or lack thereof) of conflicts of interest in medicine and science.

This week's offering:

• Cheer to Andrew Pollack of the New York Times for disclosing that Eric L. Matteson, chairman of rheumatology at the Mayo Clinic, has consulted for many companies developing arthritis medication. Matteson is author of a recent study examining the link between various arthritis medications and cancer.

• Jeer to Audrey Grayson of ABC News’ Medical Unit for failing to note that Michael J. Manos, head of the Pediatric Behavioral Health Center at the Cleveland Clinic’s Children’s Hospital, consulted and served on the speakers’ bureaus of Eli Lilly, McNeil Consumer and Specialty Pharmaceuticals, and Shire US. Manos was quoted supporting use of pharmaceuticals to treat Attention Deficit and Hyperactivity Disorder rather than St. Johns Wort.

• Cheer to Marilynn Marchione of the Associated Press for disclosing that Michael Gnat, a professor at the Medical University of Vienna, consults for Novartis, AstraZeneca, and other breast cancer drug makers. Earlier this month, Gnat announced results of his recent study showing Novartis’ bone drug, Zometa, can slow the spread of breast cancer.

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NY Daily News unhealthy Father's Day prostate promo

Add the New York Daily News to my list of news organizations taking an unhealthy advocacy stance for screening tests.

A promotion in the paper screams out, "Get your free prostate cancer screening, courtesy of the Daily News":

Beginning on Father's Day, New York's hometown newspaper offers these free tests every year, because we believe we should help New Yorkers take care of themselves.

So far more than 120,000 men have taken our free tests, and almost 10,000 have found that they need further action.

The screening is quick and easily performed.

Let's stop and break that down. More than 120,000 men have taken the free tests and almost 10,000 found they need further action? How many were false positives? How many faced further testing, treatment and anxiety that lead to nothing?

The screening is quick and easily performed? Does that mean that the decision about whether to have it should be quick and easy? Or should a man slow down and consider some of the cascading consequences of this "quick and easy blood test?"

Back to the newspaper promo:

The American Cancer Society recommends that men take the screenings from the age of 50, but high-risk males who include African American men and those with a family history of prostate cancer.

The Cancer Society may recommend that, but the group viewed as the "gold standard" in making preventive health recommendations, the U.S. Preventive Services Task Force, does not. USPSTF states:

The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes. Screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient's health. The USPSTF concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population.

Why, oh why, don't news organizations tell the other side of this story? Why don't they tell the evidence-based side of the story, instead of playing on peoples' fears to help sell newspapers?

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News coverage about my health news coverage journal article

Almost no mainstream news organizations reported on my paper, "How do US journalists cover treatments, tests, products and procedures? An evaluation of 500 stories," in last week's PLoS Medicine journal.

That's probably not surprising. Why would you publish a story about an analysis that showed that you and your industry did a sub-par job in covering health news?

However, some journalists and top bloggers gave the study a good look.

Scott Hensley at the Wall Street Journal Health blog had some fun with it.

Maggie Mahar took a long look on her HealthBeat blog.

Minnesota Public Radio covered it on the air and online.

And, although I have no idea what they wrote, bloggers in France and Germany wrote something about our work. I hope it was helpful to those French and German surfers.

And I hope the dissemination of our results does some good in improving health journalism.

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Connecting the dots in health care reform news

As we flip the calendar over from a very busy May into a sunny June, I want to reflect on the common themes in the blog entries of the past four days:

1. My PLoS Medicine article, “How Do US Journalists Cover Treatments, Tests, Products and Procedures? An Evaluation of 500 Stories.�?

2. The Commonwealth Fund analysis on variations in child health care across the US.

3. Another "more care isn't always better care" study - this time in JAMA.

4. Consumer Reports releasing an online tool using Dartmouth Atlas data to allow you to look at aggressive vs. conservative care - comparing hospitals on this scale.

Connect the dots. Jack Wennberg's work rings through these themes.

Inexplicably widespread variations exist in the way health care is practiced in this country and more data comes in every day. More evidence also comes in every day that "more and newer isn't always better" in health care. And journalists are spending too much time on the "more" and the "newer" rather than on questions of evidence, costs, quality and access to care.

As a result, many consumers aren't getting much smarter at a time when some policymakers, employers and insurance company marketing folks push "consumer-driven health care" plans. Americans don't know what they're buying with the health care dollar and giving them more "skin in the game" doesn't make them smarter - only makes them hurt more - if they're not educated in the dots.

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The "kid in the candy store" picture of US health care

The following Publisher's Note has been posted on HealthNewsReview.org:

We often benefit from some of the best health care journalism the world has ever seen. It's investigative, in-depth, analytical, creative, gutsy, important and helpful. It raises questions about health policy and health care reform, about conflicts of interest in medical research, and about the way things are done in the massive health care industry.

But on stories about new treatments, tests, products and procedures, US news organizations day in and day out don't do a very good job.

We are pleased that the journal PLoS Medicine has published our paper, “How Do US Journalists Cover Treatments, Tests, Products and Procedures? An Evaluation of 500 Stories.�? It summarizes our first two years’ experience on HealthNewsReview.org.

The brief summary is that between 62-77% of stories failed to adequately address costs, harms, benefits, the quality of the evidence and the existence of other options when covering health care products and procedures. You could call it a “kid in the candy store�? portrayal of US health care, whereby everything is made to look terrific, risk-free, and without a price tag. Nothing could be further from the truth.

PLoS stands for Public Library of Science. The journal is a peer-reviewed, international, open-access journal.

The journal’s editors published an editorial, "False Hopes, Unwarranted Fears: The Trouble with Medical News Stories" In it, the editors write; “Schwitzer’s alarming report card of the trouble with medical news stories is thus a wakeup call for all of involved in disseminating health research—researchers, academic institutions, journal editors, reporters and media organizations—to work collaboratively to improve the standards of health reporting.�?

And three Australian researchers commented on our website’s routine analysis of news stories “for any signs of disease mongering�? in an essay entitled “Disease Mongering Is Now Part of the Global Health Debate.�?

We’re pleased that PLoS Medicine acknowledged the complicity of different parties in the often-messy health/medical news-making sausage factory. They even looked in the mirror and saw the role that journals play in promoting hype and the role they could play in educating journalists and – through them - consumers. We don’t mind telling you that a similar manuscript was rejected earlier by another medical journal. Part of the rejection note stated:

“While we applauded the standards (that HealthNewsReview.org employs), some of us wondered if it was realistic to expect that most physicians and scientist-authors, let alone journalists, could realistically meet those standards given the generally poor training all receive in the systematic review and interpretation of evidence, and the presentation of that evidence and its contexts in written form.�?

We could not disagree more. Is this to say that physicians and scientist-authors – much less journalists – should be let off the hook for their inability to accurately present and interpret evidence? We were shocked by this response. It may, in large part, explain why we get what we get from some journals and from some news stories that rely on journals.

So we are grateful for the peer-reviewed publication opportunity through a journal like PLoS Medicine.

We are also happy to report that recently we have been contacted by researchers in China and Japan who are interested in launching web projects similar to HealthNewsReview.org in their countries.

We welcome your comments on this note, on our journal article, and/or on the accompanying editorials.
Click here to visit our forum.

We also invite you to listen to the video clip with some of my additional thoughts and perspectives on this work.

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The good and the ugly in TV health news

Last weekend I watched examples of the good and the ugly in TV health news.

The good was a segment on Bill Moyers Journal on PBS, in which journalist Melody Petersen discussed her new book, "Our Daily Meds," and how drug companies sell their products.

The ugly was on CNN's House Call during which CNN again gave unsupported, non-evidence-based health test advice to women of various age groups. And they featured an interview with Dr. Christiane Northrup, author of "Women's Bodies, Women's Wisdom," in which they let the author get away with saying - unchallenged:

"I had a big old fibroid, big as a soccer ball, right side, OK? Right side, typically the masculine side, or the men in your life. And I believe that fibroids, which 40 percent of women have, are creativity that hasn't been burst yet, or they are creative energy that we have pushed into a dead end job or a relationship."

There was no counter to that statement, no challenge, not even a look of incredulity. What did that mean?
What kind of journalism is that to let someone say that on the air without explanation? Believe me, it burst my bubble when I heard it!

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Why isn't it called plagiarism in TV health news?

"It's not their story and they're sticking to it," is the headline of Florida media critic's piece on a phenomenon in local TV news that we've written about before.

Across the country, on many local TV stations' health reports, you are being deceived if you think that the "reporter" was actually a "reporter." He/she may only be putting his/her name on a story produced by an outside company. The St. Pete media critic found at least 9 TV stations that used the exact same story with the exact same wording - with the only difference being that each station stuck their logo on the screen as if they did the piece.

Excerpt of the story:

"In the print world, presenting another outlet's work as your own without attribution would be called plagiarism. But TV stations often present stories written by other news services or affiliate stations without notifying viewers. ...

Many TV professionals say this is a routine practice. TV reporting, after all, is a team sport where producers, camera operators and on-air reporters collaborate to create a single story.

I've always felt reports branded with the name of a specific personality are different. There's an expectation that health reports bearing (a reporter's) name were actually reported by her — and the fact that stations don't really identify when their personalities are reading reports developed by a news service, indicates they know this, too.

Critics of this practice say it helps make local TV reporting more generic across the board, with station Web sites and broadcasts across the country featuring the same story within days of each other.

It's also a further blurring of ethical lines prompted by economics, allowing a single reporter to present more stories in a week than he could possibly research on his own."

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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.

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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.

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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.

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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."

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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."

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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.

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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.

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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.

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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.

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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.

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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."

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Stop running scared

Shannon Brownlee on disease-mongering.

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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?"

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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.

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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.

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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?"

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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.

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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.

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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.

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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?

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"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."

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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."

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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.

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The Whole Story

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

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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.

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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.

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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?

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The corruption of health journalism awards

Australian journalism Melissa Sweet, in a piece entitled, "The ties that bind: how big pharma buys a good press," in the Australian online magazine Crikey (subscription required but free trial available), writes:

"The media is often quick to get on its high horse about the pharmaceutical industry’s wining and dining of doctors, but is much less upfront about the lucre that journalists accept from drug companies and other health organisations.

These take the form of journalism prizes -- the booty for the Pfizer Eureka Prize for Health and Medical Research is a hefty $10,000 -- and sponsored trips to attend conferences or other such events.

Organisations as august as the National Press Club take sponsorship for health journalism awards from groups with clear vested interests, such as the pharmaceutical industry lobby group, Medicines Australia, and the drug company, Pfizer Australia.

Indeed, so many vested interests are involved in medical journalism awards that it’s verging on the ridiculous. Roche funds an international award for obesity journalism, and is also one of the companies behind an international osteoporosis journalism award. My personal favourite is the Embrace Award, jointly sponsored by Eli Lilly and Boehringer Ingelheim, for "accurate, responsible and sensitive reporting on urinary incontinence".

Other awards are funded by professional or advocacy groups eager to promote themselves or their issues. The Australasian Society of Clinical Immunology and Allergy has an award "to recognise outstanding medical and health reporting on allergic and immune diseases in Australia and New Zealand". The Royal Australian and New Zealand College of Ophthalmologists gets up to 30 entries each year for its awards - two of $3,000 each - for journalism promoting "understanding of eye care issues specifically related to the work of Australian and/or New Zealand ophthalmologists".

Organisations such as the National Press Club stress the independence of their awards and the judging process, and just about everyone involved in such awards emphasises that their aim is to support and encourage good journalism. That may be the case but of course there are also other agendas, whether generating positive corporate PR, building relationships with key journalists and organisations, or promoting particular issues/products. The Embrace Award at least is upfront about this, saying it aims to "empower women to seek help" - presumably from one of the sponsors’ products."

The Statement of Principles of the Association of Health Care Journalists includes a clause: "...weigh the potential benefits of accepting awards from organizations sponsored by an entity with a vested interest in health care against our need for credibility."

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Health news that is too brief to matter

On our HealthNewsReview.org website, we've posted a new Publisher's Note to foster discussion about what's missing in so many of those "health news briefs" or "health watch" digests or "medical minutes."

In the 17 months that we’ve been reviewing stories from about 60 major U.S. news organizations, we have given our top five-star score to only one story of less than 300 words.

We’re coming to the conclusion that such “briefs�? may do more harm than good. Almost by default they oversimplify medical research stories. They generally fail to adequately explain how big is the potential benefit of the idea being discussed, or how big is the potential harm. They fail to scrutinize costs, conflicts of interest, or the quality of the evidence.

A case in point is a 191-word story, “Keep an ovary, preserve a brain,�? by Katie Hobson, senior editor, health/medicine, for U.S. News & World Report magazine. We rated the story as unsatisfactory on four of our ten criteria.

Katie wrote to us and allowed us to publish her comments:

“Thanks for your site, and for updating reporters on when our articles are reviewed. I have absolutely no quibble with the need for your site and for more stringent reporting standards for health, medicine and science.

That said, I do have a quibble with reviewing less-than-200-word items done for our HealthWatch page, which is a quick digest of the week's health news. These items -- including the one by me that you just reviewed -- are almost always condensed versions of far longer stories that appear first on our website, during the week. So first, it seems fair to review the original article rather than the brief summary (in my case, the larger piece might have answered some of your questions, might not have, since it was a Q&A). More broadly, why review briefs at all? There are plenty of long stories in the magazine and on the site which definitely merit review and your criteria should be applied to them to see how they hold up. But given that your list of criteria is literally almost as long as the items themselves, it doesn't seem appropriate to expect a health digest to be comprehensive; there simply isn't room. It's as if you went through the front section of the NYT and criticized the regional briefs for not giving the complete history of a conflict and not consulting outside experts.

Certainly, there's a larger question as to whether a digest section should even exist, since it's impossible to include all the facets of a study in that tiny space. But shouldn't that issue be debated, rather than applying standards that seem more suitable to longer (even over 300-word) articles, rather than quick news hits?

Thanks for reading,

Katie�?

Katie and I have exchanged some thoughts in a followup e-mail and she welcomes an open discussion about some of the issues she raises.

Our stance:

Not all USN&WR readers use the USN&WR website; all they see is the magazine. That’s why we think it’s fair and legitimate to review what’s in the magazine.

To the question “Why review briefs at all?�? we are clearly countering with the question “Why publish briefs at all?�? Katie writes about the limitations of addressing our criteria – “there simply isn’t room…in that tiny space.�? But the magazine has decided these stories are only worth a tiny space; they could easily find more space. It’s an editorial decision we’re trying to change.

And that’s the larger question Katie and I (and probably many other journalists) think should be discussed and debated openly. Clearly, you can’t fault the writers and reporters who do their best to cover topics when assigned to write a brief or digest. But editors and publishers should take a hard look at the issues we raise about what’s left out – perhaps to the harm of the reader – for the sake of brevity.

And this is not just a magazine phenomenon. Network TV news health stories – across the board – get weaker reviewers than any other medium in our first 17 months. And self-imposed time limits are usually at the root of the weak review. Yet time is found in many newscasts for Anna Nicole Smith, for Lindsay Lohan, etc.

And newspapers? Last week my local Star Tribune had a full-page (except for a 10�? X 13�? ad) of eight news briefs on one page – none reported locally, all from wire services. Five were health stories - None more than 225 words. Even a “New York Fashion Week�? story on page A2 got more words than that – complete with description of Jennifer Lopez’ design of “denim boy shorts with a sparkling brown hoodie.�?

Space is available. It’s a matter of editorial decision-makers choosing how to allocate it.

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Another news story about the limitations of some studies

Yesterday we profiled a Wall Street Journal column about the statistical flaws in some studies. Today we point out a Los Angeles Times column that gives readers a better understanding of the strengths and weaknesses of epidemiologic studies. Excerpts:

"(Critics say that) far too many of these epidemiological studies -- in which the habits and other factors of large populations of people are tracked, sometimes for years -- are wrong and should be ignored.

In fact, some of these critics say, more than half of all epidemiological studies are incorrect.

The studies can be influential. Often, in response to them, members of the public will go out and dose themselves with this vitamin or that foodstuff.

And the studies also influence medical practice -- doctors, the critics note, encouraged women to take hormones after menopause long before their effects were tested in randomized clinical trials, the gold standard of medical research.

Some of epidemiology's critics are calling for stricter standards before such studies get reported in medical journals or in the popular press.

(One) of the foremost critics argues that epidemiological studies are so often wrong that they are coming close to being worthless. "We spend a lot of money and we could make claims just as valid as a random number generator," he says.

Epidemiology's defenders say such criticisms are hugely overblown.

They are "quite simplistic and exaggerated," says Dr. Meir Stampfer, a professor of epidemiology and nutrition at the Harvard School of Public Health and a professor of medicine at Harvard Medical School.

...The debate is unlikely to be resolved any time soon. "If you put five epidemiologists and five statisticians in a room and have this debate," (one critic) says, "and try to get each one to convince the other side, at the end of the day it will still be five to five."

The important thing for journalists and for readers to understand is that there is a hierarchy of evidence - and that not all studies hold equal weight or power to point to a conclusion. Both the Wall Street Journal and Los Angeles Times stories are important in reminding us of that.

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20/20 lacks vision on Stossel health care special

Just watched John Stossel's special, "Whose Body Is It Anyway? Sick in America," on the ABC News 20/20 program.

Wow.

Simplistic. Superficial. Shallow. Superfluous.

Just one example: he used laser eye surgery and cosmetic surgery as two examples of how the competitive marketplace can bring health care costs under control. No discussion of quality. No discussion of evidence. No discussion of overuse.

No discussion about some of health care's true challenges: management of diabetes, chronic heart or lung disease, care for the elderly, care for anyone with multiple chronic conditions.

I wasted an hour.

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Reporters not asking right questions on health care reform

Johns Hopkins University president William Brody, in a speech at the National Press Club on Friday, said journalists are not asking presidential candidates the right questions about health care reform.

“If you’re only reporting cost and coverage issues, you‘re missing a big part of the story,�? Brody said.

Brody said that almost no one -- candidates or reporters -- is addressing equally essential elements of the health care puzzle: the quality and consistency of care; the complexity of medical practice today; and the role of chronic disease, the treatment of which threatens to monopolize health care resources. These “three C’s�? of health care -- consistency, complexity and chronic disease -- need to be front and center in any reform efforts, Brody said.

“The fact is, cost and coverage solutions alone will not solve our problems,�? Brody said. “We can’t provide health insurance for all unless we control the spiraling costs of health care. But we won’t control costs until we deal with these other issues.�?

Brody said he will help get the right questions on the table by participating in a planned series of televised conversations with presidential candidates. Brody said that Johns Hopkins is working with the nationally distributed Retirement Living TV network and the National Coalition on Health Care to produce and air Presidential Spotlight on Healthcare ’08: Which Way Forward? during the primary season. In half-hour discussions, Brody will provide the presidential candidates a platform to explain their health care proposals in terms that address all age groups of Americans.

Brody urged reporters and voters to question presidential candidates closely on how they propose to bring rationality and order to what he described as the industrialized world’s most inefficient medical system.

“At The Johns Hopkins Hospital, we have to bill more than 700 different payers/insurers, such as HMOs, PPOs, Medicare and Medicaid,�? he said. “Each one has its own set of rules regarding what services are covered, the level of reimbursement, and what kind of documentation and pre-approval is required. Nationally, this kind of inefficiency costs patients billions of dollars every year.�?

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British M.D.-journalist slams journalists for conflicts of interest

Ben Goldacre, in this week's BMJ writes:

I was surprised last week by an email circular I received from a science writers' mailing list. It was from the Aspirin Foundation, a group funded by the drug industry, and it was offering—on behalf of Bayer Healthcare—to pay expenses for journalists to attend the European Society of Cardiology's conference in Vienna.

Now aspirin is without doubt an excellent and cheap drug. But in my naivety I had no idea such things went on. I pinged off a few emails to friends and colleagues. Most poked fun at my innocence—quite rightly—but some were helpful. Not only is it extremely common for journalists to take money from drug companies, but there have been some astonishing cases in recent history, including one memorable case where a PR company invited journalists to "an exclusive preview" of new laser eye technology, with the offer to "discuss free treatment in return for editorial features."

"I organise the media programmes for a number of medical conferences run by scientific societies," said one person who, without wishing to be melodramatic, has asked to remain anonymous, "and I reckon at least 50% of the journalists present are paid for by drug companies. They get pretty well looked after too—first class travel, five star hotels, posh dinners, etc. Some of them indulge in double dipping, where they are paid by the day by the drug company and then by the publication that takes whatever they have written. Sometimes they don't even use the press room, spend all their time in company hospitality suites, and just go to company sponsored satellite sessions and press conferences."

Perhaps I'm naive, but I don't buy Ben's claim that it's "extremely common for journalists to take money from drug companies." But the points he makes about pharma's pervasive and troublesome influence on some journalists and news organizations is worth noting. He wrote:

"...There are real dangers in being too close to PR people: lovely though they may be, their trade is, by definition, manipulation. Drug companies are businesses, with responsibilities to their shareholders, and they wouldn't pay for journalists to attend their events if they didn't think it would affect media coverage of their product. After all, a journalist's article is far more credible than a paid advertisement, for anybody's money, and more likely to be read by potential consumers. ...

It's much easier to get someone to take your calls when they've taken your money. And I, for one, will in future read outraged media reports of academic conflicts of interest with a wry smile indeed."

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HealthNewsReview.org a finalist for a FREDDIE award

We've been notified that HealthNewsReview.org has been judged to be a finalist in the category of Web Sites in the 2007 International Health & Medical Media Awards.

All category winners will be named by September 17.

HealthNewsReview.org is now 15 months old, has reviewed more than 400 stories, and has already won a Knight-Batten Award for Innovations in Journalism, an e-Healthcare Leadership Award, and a Mirror Award for media industry reporting.

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Tough questions missing on robot story

The Star Tribune offered a business section feature yesterday on local doctors finding new uses for the $1.2 million Da Vinci robotic surgery devices.

At $1.2 million, you bet they want to and need to find new uses.

The story explained that the robotic device came on the market just 8 years ago, that Minnesota hospitals started using it just three years ago., and that there are already nine da Vincis in the state.

But the story failed to address the obvious followup questions: how many does a state or a community need? Who's asking these questions?

The story was also completely devoid of any performance data on risks and benefits.

Finally, the story included a quote from a urologist using the device, who said

that getting the da Vinci was "physician driven," as doctors saw its benefits. Then its use became "patient driven," as people went to the Internet and discovered there was another way to have their surgeries done.

Such a comment can't go unchallenged. If physicians and hospital marketing folks weren't pushing the expensive devices, there would be no "patient driven" move.

Medical technology assessment in the U.S. is a huge question. This story didn't deliver many answers.

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Under the influence of drug marketing

The Los Angeles Times last week published a series of articles on drug marketing.

Excerpts:

"In a nation that consumed $279-billion worth of prescription medications in 2006 - spending 80% of that on brand name drugs - their efforts appear to be paying off. Americans filling a prescription choose brand-name products 37% of the time, even though three quarters of all prescription drugs in the U.S. are available in cheaper generics."

"Each day in the United States, an army of roughly 100,000 pharmaceutical company sales reps storms the waiting rooms and offices of the nation's 311,000 office-based physicians."

"The drug industry, according to estimates by the Center for Public Integrity, has spent $758 million on lobbying - more than any other industry - since 1998."

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Radio appearance

Minnesota Public Radio invited me as guest on their "Midmorning" program today to talk about the state of health care journalism.

You can hear the clip at: http://www.publicradio.org/tools/media/player/news/midmorning/2007/07/27_midmorn2
(Real Player required to download and listen)

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Do you trust CNN's Dr. Sanjay Gupta?

The political newsletter CounterPunch, the Chicago Tribune and some of its readers weigh in on the question:

"Do you trust CNN's Dr. Sanjay Gupta?"

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Paid-for TV health "news"

I always talk a great deal with my students about the blurred line between news and advertising in many settings these days. Now some of my past students are seeing it for themselves.

For whatever reason, a disproportionate share of one year's graduating class is working in Sioux Falls, South Dakota, where today the Argus Leader newspaper reports:

"A local television affiliate is ramping up its health care coverage, thanks to a partnership with Avera Health.

KSFY-TV this month began a partnership with the Sioux Falls-based health care system, broadcasting live and taped segments with doctors and other Avera professionals and patients.

"We're telling patient stories and conveying the good work that our physicians are doing," said Kenyon Gleason, spokesman for Avera McKennan, the health system's flagship hospital in Sioux Falls.

KELO-TV and Sanford Health - Avera's cross-town rival - have had a similar relationship for several years."

I was interviewed for the story about the propriety of such arrangements, which give the appearance of independent news decision-making even though it's a stacked deck - delivering only the news of the sponsoring health care institution. The new Sioux Falls sponsored segment will be called the "Avera Medical Minute." Guess how many Avera competitors will show up in those segments?

Meantime, another past student of mine, hearing about the Sioux Falls stink, wrote from a a different Midwest TV market:

"We have health segments. They're strictly advertisements, aired during the breaks in our newscasts with our logo on them. However, they're created to look like news stories, with a "reporter" asking doctors questions. We get calls all the time, asking about this story we aired... and we have to say, sorry that's a commercial... don't know anything about it..."

It's easy to understand viewers' confusion. But it's sad to see my former students' early disillusionment with an industry that is starting to tear down the walls between the news side and the advertising side.

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When news, advertising and new media clash

At StreetAnatomy.com, see what happens when "smart systems" search for relevant terms in news stories so that related ads can be placed on that web page.

It's not always a good idea.

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NBC still hyping restless leg syndrome

NBC apparently doesn't understand the concept of disease-mongering. Or else they don't care. Because they keep practicing the same flawed reporting on restless leg syndrome.

See my entry on The World Health Care Blog.

And for anyone with legitimate restless leg syndrome, please read the entire column before writing to me. I'm not questioning your symptoms. I'm questioning news coverage. And if you represent a drug company that makes a drug for restless leg syndrome, don't bother to write. I am aware of your astroturfing campaigns.

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Michael Moore blitzes Wolf on CNN

Michael Moore came out swinging in “The Situation Room�? with Wolf Blitzer on CNN last evening. First, CNN replayed a several-days old report by Sanjay Gupta that concluded that Moore “fudged the facts�? in his “Sicko�? documentary on the U.S. health care system.

Then Blitzer led off with an insipid, insulting introduction of Moore: “Give us a couple of headlines, what you'd like to say.�?

MOORE (excerpts of a long answer): “I don't talk in sound bites. That report was so biased. I can't imagine what pharmaceutical company ad's coming up right after our break here. … I mean, you guys have such a poor track record. … And I'm just curious when are you going to just stand there and apologize to the American people for not bringing the truth to them that isn't sponsored by some major corporation?�?

BLITZER: “Just in fairness, we had a lot of commercials for "Sicko" that we've been running on CNN as well. So we have commercials. This is a business, obviously. But let's talk a little bit about ...�?

MOORE: “You have a nightly medical report. You have something called "The Daily Dose." I watch CNN. You have it every day. "The Daily Dose" sponsored by -- fill in the blank. And you are funded by these people day in and day out. Don't even compare that to my movie being out for a couple of weeks and a couple of rinky-dink ads for 15 seconds. Come on. Come on, Wolf!�?

Did Blitzer actually claim that CNN was being fair to Moore by taking his money to run his commercials? Does this acclaimed anchorman actually believe that commercial content should be taken into account when one judges editorial balance? Or was Blitzer suddenly commenting on CNN’s ad sales policies? Either way, I’ll join Moore’s plea: “Come on. Wolf!�?

CNN doesn’t have a journalist that can stand up to Moore on a discussion about health care policy issues because it doesn’t have a journalist that has researched health policy issues in this country as much as Moore and his documentary team has. And that was clear in yesterday’s silly situation as Wolf got Blitzed in “The Situation Room.�?

The complete CNN transcript is available online and the complete video clip is available on Michael Moore's website.

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No cure for Reader's Digest hype

The cover of the July Reader’s Digest refers to back pain “cures.�? The inside headline refers to seven “breakthroughs.�?

C’mon Reader’s Digest: stop the hype. Here are the seven:

1. A neurostimulator for which RD provides not one shred of evidence – only anecdote.
2. An infrared belt which the inventor “is trying to get approved.�? Cost: $2,335!
3. A “magic�? spine wand. (I’m not into the Harry Potter School of Health Care Devices.)
4. A flexible spine support system as an alternative to fusion. Again, no evidence provided, only anecdotes.
5. Stem cells to regenerate damaged disks. The story admits that human trials are two years away. Kinda early to be talking “cures�? and “breakthroughs.�?
6. A “grow a new backbone�? idea that’s only been tested in rats and mice. Good news for rodents with back pain.
7. Get a new bed. Even the article admits “it sounds like cheerleading from bedding companies�? and discloses the study was partly sponsored by a sleep products trade group.

Final score:
Headline hype: 7
Cures & breakthroughs: 0

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Mirror Award goes to HealthNewsReview.org

Just back from New York, where one of the inaugural Mirror Awards honoring excellence in media industry reporting was given to HealthNewsReview.org.

The other awards went to:

Clive Thompson, New York Magazine

Philip Weiss, New York Magazine

David Carr, The New York Times

Andreas Kluth, The Economist

American Journalism Review

Dean Miller, Nieman Reports

Lifetime Achievement Award: Peter Bart, editor-in-chief, Variety

Details, including links to the winning work, are on the Mirror Awards website.

It's been an eventful first year for HealthNewsReview - winner of a Knight-Batten Award for Innovations in Journalism, an e-Healthcare Leadership Award, and now the Mirror Award.

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HealthNewsReview.org honored again

One of my day jobs - as publisher of HealthNewsReview.org - has been rewarding and the work has also been awarded - again.

The site has been named a finalist in the first-ever Mirror Awards honoring excellence in media industry reporting. There are 22 other finalists, including the New York Times, the Washington Post, National Public Radio, The New Yorker, The Economist, The Wall Street Journal and others.

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No surprise: Americans confused about cancer

A study in the journal Cancer Epidemiology, Biomarkers and Prevention reports widespread confusion in America about cancer and cancer prevention.

Nearly half of respondents (47.1%) agreed that "It seems like almost everything causes cancer," 27.0% agreed that "There's not much people can do to lower their chances of getting cancer," and 71.5% agreed that "There are so many recommendations about preventing cancer, it's hard to know which ones to follow."

I'm a journalist so I always look in the mirror first and I blame journalists for creating much of this confusion. The "cure" or "killer" emphasis in many stories - in order to compete for space or airtime - shows no appreciation for public understanding. Fulltime health, medical and science reporting jobs are being slashed all over the country.

Just look at how some top news organizations recently handled cancer screening stories.

And then we have health insurance marketing people shoveling "consumer driven health care plans" at us. This study is further evidence of how far away many Americans are from understanding how to be in the driver's seat of their own health care - admirable though that goal may be.

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Unhealthy advocacy: journalists and screening tests

The Poynter Institute website has published my overview of some journalists' apparent pro-screening bias in coverage of some screening tests. The incidents I've tracked involve screening for cancer (prostate, breast, lung, colon) but also for cardiovascular disease and diabetes.

The piece documents more than a dozen incidents of pro-screening stories and gets perspectives from some health journalists about why this is happening.

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Michael Moore's "SICKO" has 'em on the edge of their seats already

Documentary producer Michael Moore's new film, "Sicko," will be in theaters this summer, he promises. But it's already getting lots of publicity, some of which he's drumming up around a Treasury Department investigation of Moore. It involves Moore's team taking some sick Sept. 11 rescue workers to Cuba for one segment in the film.

Moore's letter to Treasury Secretary Henry Paulson is on Moore's website. In it, he writes:

"The health care and insurance industry, which is exposed in the movie and has expressed concerns about the impact of the movie on their industries, is a major corporate underwriter of President George W. Bush and the Republican Party, having contributed over $13 million to the Bush presidential campaign in 2004 and more than $180 million to Republican candidates over the last two campaign cycles. It is well documented that the industry is very concerned about the impact of SiCKO. They have threatened their employees if they talk to me. They have set up special internal crises lines should I show up at their headquarters. Employees have been warned about the consequences of participating in SiCKO. Despite this, some employees, at great risk to themselves, have gone on camera to tell the American people the truth about the health care industry. I can understand why that industry's main recipient of its contributions -- President Bush -- would want to harass, intimidate and potentially prevent this film from having its widest possible audience."

An Associated Press story has many more details on the reason for the Treasury Department investigation.

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The true harms of a false positive test

The London Daily Mail reports on a man diagnosed with cancer who was told he had less than a year to live.

"The 62-year-old council worker quit his job, sold his car, stopped paying his mortgage and dug into his life savings so he could treat himself and relatives to expensive restaurant meals.

He even sold all his clothes but for the black suit in which he expected to be buried.

A year later, however, with no sign of the Grim Reaper coming to call, he went for tests - which gave him a clean bill of health. He had never had cancer at all."

I've written before on this blog about journalists who seem to have a pro-screening test bias, never mentioning the harms that can occur from some tests. While this story was about a diagnostic test, not a screening test, it nonetheless should serve as a reminder that there are harms of false positives - which occur often in mass screening campaigns which some journalists endorse in the absence of the best evidence.

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Medicare rejects depression device the media helped hype

Wish I had a nickel for every story about vagus nerve stimulation that trumpeted it as a treatment for depression.

This week, Medicare rejected Cyberonics’ implantable nerve stimulator, saying the device, the VNS Therapy System, hasn't been shown to be necessary. The $25,000 device is already approved for epilepsy. Cyberonics wanted to expand its use.

Bloomberg News reports “The Food and Drug Administration approved the device in 2005 to treat depression, overruling 20 agency advisers who urged rejection.�?

On the Cyberonics website the company boasted of dozens of news stories from across the country over the past two years, with headlines such as:

"Implant can relieve depression: VNS Therapy is proving beneficial."

"Omahan says she's proof device zaps depression."

"Emerging from the depths of depression."

"The Pacemaker for the Brain" is Saving Lives."

"Up from hopelessness."

"Implanted device helps fight drug-resistant depression - Giving new hope"

Among the media reporting the potential for the device:

U.S. News & World Report
Saturday Evening Post
Redbook
Reuters Health
Arizona Daily Star
San Antonio Express News
El Paso Times
Corpus Christi Caller Times
Toledo Blade
Omaha World Herald
Chicago Tribune
KSAT, San Antonio
WMUR Manchester, NH
WCCO, Minneapolis
KETV, Omaha
KUTV, Salt Lake City
KSL, Salt Lake City,
WBZ, Boston
WCBV Boston
WISN, Milwaukee
WKYC, Cleveland
KTBS, Shreveport
KOMO, Seattle

Each one of those news organizations owes it to their audience to play up the Medicare rejection of the device as prominently as they promoted the potential in the giddy glory days.

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Lack of sustained coverage of health care crisis

Former Philadelphia Inquirer executive editor Gene Roberts, whose paper won 17 Pulitzers in his 18 years in that job, was asked in an interview, “Are there any beats you would suggest the mainstream press is missing today?�?

Roberts: “One of those is the medical crisis in the country. People write about it, but I don't see the kind of sustained week-in, week-out coverage that the situation calls for.

You read now and then about the crisis in the emergency rooms and how many Americans are uninsured, but it isn't really set up as a beat, so you have different reporters switching in and out of a story and you don't get the expertise and the continuing coverage that would have if more reporters covered it as a beat. …

The FDA, the Food and Drug Administration, is another one not well reported by newspapers. The whole question about how rapidly and safely drugs get out to the public is another thing that is going uncovered.�?

Roberts is now a journalism prof at the University of Maryland. He won a Pulitzer of his own last month for his book, “The Race Beat.�?

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News coverage of a new prostate cancer test

For a look at how two different news organizations covered the news of a potentially more accurate test for prostate cancer, see the HealthNewsReview.org review of a weaker ABC News story in contrast with the review of a stronger Baltimore Sun story.

However, neither story adequately addressed the fact that while a more accurate test may tell who has prostate cancer better, it still does not tell which men need treatment in their lifetime and which men don't, which is the real problem in prostate cancer screening. So, both stories left readers and viewers with an overly optimistic view of what screening can do.

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Chicago Sun-Times' imprudent prostate campaign

I am continuing my criticism of journalists and news organizations that crusade for screening tests – seemingly oblivious to the controversies and the debates that swirl around many of these screening tests. When a news organization takes an advocacy stance for a controversial cause, it should know the facts and the facts are that some people will be hurt by their advocacy efforts.

The latest example is the Chicago Sun-Times, which is sponsoring free prostate cancer screenings throughout the Greater Chicago area this week. A Sun-Times news release states: “Men ages 40 and older are urged by the health officials to take advantage of the screenings�? which include a PSA blood test and a digital rectal exam.

But the U.S. Preventive Services Task Force (USPSTF) – perhaps the nation’s best, unbiased, balanced source on such questions 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).�?

But the Sun-Times didn’t stop by sending out news releases. It ran a story about its own campaign.

The story stated, under the heading “GET TESTED,�? “Men ages 40 and older can stop by one of the mobile clinics for the free, private prostate cancer testing and physical exam.�?

The USPSTF tells men that “screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient's health. The USPSTF concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population…. Screening may result in harm if it leads to treatments that have side effects without improving outcomes from prostate cancer, especially for cancers that have a lower chance of progressing. Erectile dysfunction, urinary incontinence, and bowel dysfunction are well-recognized and relatively common adverse effects of treatment with surgery, radiation or androgen ablation.�?

John Cruickshank, Sun-Times News Group Chief Operating Officer, is quoted in his news release saying, “The program demonstrates how the Chicago Sun-Times provides our readers with important, and in this case, life-saving information for residents of the Chicago region.�?

The story should be that the Chicago Sun-Times ignores the best evidence in promoting prostate screening to all men – and in promoting it to men in their 40s, they have not only taken an advocacy stance but a radically aggressive stance that may find a few cancers but will also certainly expose some men to unnecessary harms. One can only wonder what the informed consent form looks like during these quickie exams (20 minutes, says the news release) in these mobile clinics.

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More pro-screening bias by some journalists

There’s a saying about the some of the problems with screening tests: How much disease you find may be a matter of how hard you look.

Recently, I have evidence that how many problematic news stories on screening tests you find is only a matter of how hard you look.

I won’t repeat episodes I’ve already written about on this blog. Just click on the screening category - http://blog.lib.umn.edu/schwitz/healthnews/cat_screening.html - to see the past evidence. But here are some new examples.

1. Tom Burton, in the Wall Street Journal this week, had an article under the headline, “Three Tests May Foil Artery-Disease Deaths.�? He wrote: “Three simple tests that can potentially save thousands of lives from strokes, aneurysms or other arterial problems are getting a big endorsement today. …As of today, the Society for Vascular Surgery, representing the nation's 2,400 vascular surgeons, is for the first time recommending these three tests to screen for artery disease in many people 55 years old and over.�?

But the only professional perspectives he included were from vascular surgeons. He could have easily included a perspective such as the one I elicited from Dartmouth’s Dr. Gil Welch, in response to the story: “Screen many, to find the few --while many others get labeled at risk in the process. And thus many will be treated "wrong", have an immediate operation for which the risks exceed the benefit. To see the full effects, you need to randomize. And there has been no randomized trial showing its net effect.�?

This story was reported by a veteran, Pulitzer-winning journalist at one of the newspapers whose health coverage I respect the most. Yet he reported a one-sided story with a clear pro-screening emphasis.

2. CNN’s Elizabeth Cohen last week had a story in which she listed an entire litany of screening test recommendations for women – many of them unsupported by the best medical evidence. Perhaps the most glaring was this: “At 40 … women need to start having mammograms every year.�? Are she and CNN totally unaware of the controversy over mammography in the 40s, fired anew most recently by the American College of Physicians just two weeks ago? Her statement – as if fact – is simply not supported by the ACP or the U.S. Preventive Services Task Force, perhaps the most balanced, unbiased source on such questions.

3. Georgia Public Radio last week aired a special report, “Breast Cancer in the African American Community.�? On the air they stated, “Typically every woman should start having mammograms at age 40.�?

On their website, they stated: “The American Cancer Society recommends that every woman over 40 have a regular screening mammogram.�?

It is another example of journalists appearing to be oblivious to the contrary recommendations of other learned bodies of experts in this country.

What accounts for this apparent pro-screening bias seen in some stories? I’m going to continue to track these practices and try to investigate journalists’ rationale.

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Interesting new health blogs

I want to give a couple of plugs for interesting new health news blogs.

The Wall Street Journal health news blog is terrific.

One recent entry was on the trial that “showed that using stents in stable patients with mild to moderate chest pain doesn’t reduce the risk of heart attacks compared with drugs alone. … The Health Blog’s take-away: The idea of clearing out clogged arteries is so appealing, and the idea of leaving them clogged so terrifying, that patients and doctors are inclined to open them up, even if the data say that won’t do much good.�?

And another entry analyzed the new questions about the benefits of mammography for women in their 40s. It included a quote from a mammography expert: “The evidence shows that it does help some women [in their 40s] — but the evidence shows that it’s only six out of 10,000 over a decade.�? If only some mainstream news media could analyze the data as concisely as that.

Another noteworthy blog is Pharmalot.com - “a home for lively discussion about news and trends in the pharmaceutical industry. The guy behind the curtain is Ed Silverman, a veteran journalist for The Star-Ledger of New Jersey.�? Interestingly, this is Ed’s fulltime baby. He doesn’t even file for the paper anymore.

It's good to see that some news organizations are catching on to this Web thing.

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CNN's one-sided view of mammography controversy

CNN’s House Call with Dr. Sanjay Gupta once again showed its one-sided, pro-screening bias this weekend. Excerpt:

We're starting with a change in what's been standard medical advice for a long time. For years, women over 40 have been told they need routine mammograms. Now the American College of Physicians says women with no risk factors for breast cancer should talk to their doctors first, that perhaps they could postpone their mammogram until they turn 50.

The American Cancer Society says annual mammograms starting at age 40 are still the way to go. You know what? It's leaving a lot of women wondering who they should believe.

So here to clear things up is Dr. Larry Norton. He's director of Breast Cancer Programs at Memorial Sloan-Kettering Cancer Center.

Well, Dr. Norton doesn’t accept the College of Physicians’ reasoning, writing them off as “an organization of internists�? – not cancer specialists or surgeons. He said:

"But the fact is that every woman that I speak with would much rather have a needle biopsy, which is not such a big deal, to make sure that the thing that the mammogram finds is not cancer, than actually miss a cancer that could cost her her life, or cost her her breasts."

OK, but that's personal anecdote, not evidence. There's an old saying: the plural of anecdote is not data. One big chunk of evidence he didn’t address is DCIS – or ductal carcinoma in situ – which shows up more often in earlier mammograms and leaves women confused about whether it’s a cancer, or, as it’s often called, pre-malignant or precancerous. And there is no consensus about what to do about DCIS once you find it. Why didn’t he talk about these cases? And why didn’t Gupta ask about them?

And why did Gupta and CNN only give airtime to one side of the argument? The perspective of the American College of Physicians (ACP)- the largest medical specialty organization and the second-largest physician group in the United States, representing 120,000 members - was simply not represented.

The ACP says its "clinical guidelines are developed in an explicit, rigorous process based on extensive review of available scientific evidence. They are considered 'evidence-based' rather than “expert-opinion�? or consensus guidelines. In addition to publications from the original mammography trials, ACP reviewed 117 studies to evaluate the evidence about the risks and benefits of mammography screening for women between the ages of 40 and 49."

Yet CNN didn't give ACP a voice in this segment, and let its guest get away with saying "We still need to figure out why they made this recommendation." Why not ask them on the air?

Three times in the segment, Gupta said his guest “cleared up�? the confusion. I guess it’s easy to view something as clear if you only open your mind to what you want to believe.

CNN has shown a pro-screening, evidence-be-damned mentality before. It is not balanced. It is not complete. And it is not journalism. It is advocacy.

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60 Minutes on pharma influencing Congress - but why so late?

If you didn’t see 60 Minutes last Sunday (April 1), go to their website and read the story and watch the video link for the segment called “Under the Influence.�? It’s the story of the incredible manipulation of Congress by the drug industry that took place to get the Medicare Part D legislation passed.

Excerpt:

The unorthodox roll call on one of the most expensive bills ever placed before the House of Representatives began in the middle of the night, long after most people in Washington had switched off C-SPAN and gone to sleep.

The only witnesses were congressional staffers, hundreds of lobbyists, and U.S. Representatives like Dan Burton, R-Ind., and Walter Jones, R-N.C.

"The pharmaceutical lobbyists wrote the bill," says Jones. "The bill was over 1,000 pages. And it got to the members of the House that morning, and we voted for it at about 3 a.m. in the morning."

Why did the vote finally take place at 3 a.m.?

"Well, I think a lot of the shenanigans that were going on that night, they didn't want on national television in primetime," according to Burton.

"I've been in politics for 22 years," says Jones, "and it was the ugliest night I have ever seen in 22 years."

Despite what a terrific piece this was, one wonders why it took 60 Minutes several years to catch up to this story. Some viewers wrote to CBS about how late this report came. Examples:

“Great story, AWESOME Story!!! Too bad CBS & 60 minutes waited over 3 YEARS after President Bush Jr. signed the bill into law to report on this. Perhaps if we the American people had heard this story back in early 2004, we would have made different choice