June 15, 2009

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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June 12, 2009

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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June 11, 2009

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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June 10, 2009

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."

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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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June 9, 2009

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.

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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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June 8, 2009

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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June 7, 2009

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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June 6, 2009

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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June 5, 2009

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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June 3, 2009

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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June 2, 2009

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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May 29, 2009

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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May 28, 2009

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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May 26, 2009

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.

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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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May 22, 2009

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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May 21, 2009

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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May 19, 2009

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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May 15, 2009

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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May 14, 2009

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."

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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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May 13, 2009

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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May 12, 2009

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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May 11, 2009

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.

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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.









Powered by Podbean.com

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May 8, 2009

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:


Does health news reporting leave consumers out in the cold? (Part 1 of 3) @ Yahoo! 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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Posted by schwitz at 10:40 AM | Comments (1)
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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.

Posted by schwitz at 7:21 AM | Comments (0)
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May 7, 2009

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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Posted by schwitz at 8:32 AM | Comments (0)
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Does the Twin Cities need five children's hospitals?

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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.

Posted by schwitz at 7:44 AM | Comments (1)
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May 6, 2009

The new class clowns - TV reporters and the flu story

circus_07.gifThe 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.
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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."

circus_01.gifIf 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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May 5, 2009

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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May 4, 2009

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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May 1, 2009

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.

Posted by schwitz at 11:31 AM | Comments (0)
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April 29, 2009

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."

Posted by schwitz at 9:58 AM | Comments (1)
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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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April 28, 2009

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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April 27, 2009

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.

Posted by schwitz at 3:25 PM | Comments (0)
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Poison Pills

Poison Pills.png 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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April 23, 2009

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.

Posted by schwitz at 11:32 AM | Comments (1)
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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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April 22, 2009

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.

Posted by schwitz at 3:14 PM | Comments (0)
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April 20, 2009

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.


Posted by schwitz at 1:46 PM | Comments (0)
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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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April 19, 2009

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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April 17, 2009

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."

Posted by schwitz at 10:24 AM | Comments (5)
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April 16, 2009

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.

Posted by schwitz at 3:52 PM | Comments (1)
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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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April 15, 2009

Off to Seattle

I'm on 3 panels at the Association of Health Care Journalists annual conference this week in Seattle. healthjournalism09_225x220.gif

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.

Posted by schwitz at 11:05 AM | Comments (0)
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April 13, 2009

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.

Posted by schwitz at 9:01 AM | Comments (0)
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April 12, 2009

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.

Posted by schwitz at 10:11 AM | Comments (0)
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April 8, 2009

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."

Posted by schwitz at 3:44 PM | Comments (0)
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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: Insure Oklahoma.png

"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

Posted by schwitz at 10:17 AM | Comments (0)
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April 7, 2009

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.


Posted by schwitz at 7:40 AM | Comments (0)
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April 3, 2009

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.


Posted by schwitz at 3:11 PM | Comments (0)
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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.

Posted by schwitz at 8:23 AM | Comments (0)
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April 2, 2009

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.


Posted by schwitz at 7:37 AM | Comments (0)
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April 1, 2009

Wanna sell a book? Get bigtime newspaper coverage.

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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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March 31, 2009

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."

Visit msnbc.com for Breaking News, World News, and News about the Economy

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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March 30, 2009

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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March 27, 2009

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.

argusleader.png

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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March 25, 2009

How the red meat story was undercooked

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

"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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March 23, 2009

Never thought I was Cover Boy material

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

Mar_MNcov_.jpg

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Changing the daily drumbeat of health news

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


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March 17, 2009

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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March 13, 2009

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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March 12, 2009

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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March 11, 2009

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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March 10, 2009

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:

Reader's Digest BAck Pain cure cover.JPG Reader's Digest New Cures cover.gif

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.

Posted by schwitz at 6:33 AM | Comments (1)
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March 8, 2009

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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March 7, 2009

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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March 6, 2009

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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March 5, 2009

5 Monkeys Get JFK or 9/11 type spread

I'm just amazed.

Strib HIV headline.JPG

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.

Posted by schwitz at 7:38 AM | Comments (3)
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February 23, 2009

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!

Posted by schwitz at 1:36 PM | Comments (2)
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February 22, 2009

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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February 20, 2009

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:

Kaiser logo.png
Kaiser message.png

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February 17, 2009

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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February 16, 2009

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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February 15, 2009

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."

AJC virtual colonoscopy.png

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

WSJ virtual colonoscopy.png

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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February 14, 2009

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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February 8, 2009

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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February 6, 2009

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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February 5, 2009

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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February 3, 2009

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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January 31, 2009

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.

Sound Medicine.png


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January 28, 2009

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.

GMA reviews.png

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January 26, 2009

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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January 13, 2009

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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January 12, 2009

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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January 7, 2009

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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January 2, 2009

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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January 1, 2009

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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December 19, 2008

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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December 1, 2008

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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November 28, 2008

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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November 26, 2008

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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November 24, 2008

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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November 23, 2008

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.

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zeitschrift.png

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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November 21, 2008

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!"

Then, after getting into specifics of what was flawed with the story, Engber wrote:
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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November 20, 2008

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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November 19, 2008

"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.? "

She also cites our HealthNewsReview.org project in the piece.
###

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November 14, 2008

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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November 13, 2008

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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November 11, 2008

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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November 3, 2008

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. Matt & Nancy.png

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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October 29, 2008

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. Daily Beast.png

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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October 28, 2008

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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October 20, 2008

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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October 10, 2008

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. olivia.png

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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October 2, 2008

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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September 26, 2008

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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September 25, 2008

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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September 11, 2008

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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September 8, 2008

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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August 29, 2008

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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August 28, 2008

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?

Torres OR.png

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August 27, 2008

The cream and the crud of August health journalism

Over on HealthNewsReview.org, August has been a spotty month for health news quality.
10.jpg
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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August 18, 2008

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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August 16, 2008

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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August 15, 2008

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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August 7, 2008

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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August 6, 2008

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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August 5, 2008

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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August 2, 2008

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!’?
CNN cell phone.png

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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August 1, 2008

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. George Lewis.png

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

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

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

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

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

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

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

The U.S. Preventive Services Task Force states:

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

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

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

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

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

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

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

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

Medical industry interests 2, NBC viewers 0.

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July 20, 2008

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.

ABC miracle Alzheimers drug.png

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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July 14, 2008

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:

NYT.png

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:

Seattle times.png

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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July 7, 2008

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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June 24, 2008

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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June 19, 2008

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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June 18, 2008

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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June 13, 2008

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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June 3, 2008

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. cv_plme_05_05_large.jpg

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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June 1, 2008

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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May 27, 2008

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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May 20, 2008

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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May 16, 2008

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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May 9, 2008

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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May 8, 2008

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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May 6, 2008

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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May 4, 2008

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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May 1, 2008

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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April 29, 2008

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. 10680.jpg

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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April 27, 2008

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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April 19, 2008

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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April 17, 2008

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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April 4, 2008

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.

Photo 6.jpg

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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April 2, 2008

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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April 1, 2008

March 31, 2008

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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March 28, 2008

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 24, 2008

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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March 18, 2008

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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March 12, 2008

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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March 5, 2008

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.

Posted by schwitz at 7:36 AM | Comments (2)
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March 4, 2008

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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February 29, 2008

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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February 27, 2008

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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February 20, 2008

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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February 15, 2008

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.

Posted by schwitz at 8:25 AM | Comments (2)
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February 12, 2008

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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February 7, 2008

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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February 5, 2008

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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January 28, 2008

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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January 25, 2008

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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January 15, 2008

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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January 8, 2008

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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January 3, 2008

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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December 30, 2007

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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December 26, 2007

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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December 2, 2007

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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November 30, 2007

"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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November 21, 2007

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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November 20, 2007

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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November 13, 2007

The Whole Story

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

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October 20, 2007

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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October 16, 2007

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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October 10, 2007

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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September 20, 2007

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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September 19, 2007

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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September 18, 2007

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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September 16, 2007

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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September 10, 2007

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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September 7, 2007

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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August 20, 2007

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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August 14, 2007

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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August 13, 2007

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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July 27, 2007

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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July 26, 2007

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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July 25, 2007

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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July 23, 2007

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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July 18, 2007

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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July 10, 2007

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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June 18, 2007

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

Reader's Digest BAck Pain cures cover.JPG

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June 14, 2007

Mirror Award goes to HealthNewsReview.org

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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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May 23, 2007

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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May 21, 2007

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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May 15, 2007

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.

Poynter graphic.jpg

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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May 14, 2007

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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May 8, 2007

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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May 5, 2007

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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May 2, 2007

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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May 1, 2007

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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April 25, 2007

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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April 19, 2007

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.

Posted by schwitz at 8:13 AM | Comments (1)
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April 9, 2007

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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April 8, 2007

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.

Posted by schwitz at 8:58 AM | Comments (3)
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April 7, 2007

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 choices when the 2004 presidential election came around.?

“CBS, where the hell were you in reporting this when it happened. Everyone else who was paying attention knew we were being screwed by this legislation, that it was just a give away to the drug companies. but like all (mainstream media), you were totally going to let it pass. Shame on you for taking so long wake up.?

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April 1, 2007

Journalism or advocacy? Evidence or opinion?

I've written a new Publisher's Note on HealthNewsReview.org, and I'm posting part of it here.

Stories about Elizabeth Edwards’ breast cancer and Tony Snow’s colon cancer have led some news organizations to offer recommendations about cancer screening. Unfortunately, some of the recommendations are simply not based on evidence.

On the NBC Today show on March 28, Matt Lauer said the Edwards and Snow cases put “a huge spotlight on the importance of early detection.? Did they? The Edwards and Snow cases were not about early detection; they were recurrences. Theirs were not stories about cancer screening in the general population of people without symptoms. They were stories about follow up testing and recurrence in people who already had been treated for cancer. That’s an important distinction, glossed over in the kind of introduction Lauer used.

And to use the Edwards and Snow cases to stir up enthusiasm for early detection in ways that fall outside the boundaries of the best evidence is troubling.

Lauer brought on NBC News chief medical editor Dr. Nancy Snyderman and the two of them reviewed recommendations for screening tests for breast cancer, colon cancer, lung cancer and prostate cancer. But the discussion weaved in and out of the boundaries of evidence.

In discussing colon cancer screening, Snyderman explained that because she has a family history, she started having colonoscopies at age 40 in two to three year intervals. She says now that she’s over 50 she gets one every year. “And I get one more than my doctors really recommend because I just get a little nervous about it,? Snyderman said.

It’s fine for her to choose whatever path makes sense to her. But it is troublesome to use a national TV platform to leave even the perception that this is an evidence-based course. The frequency of her screening is far more aggressive than the intervals described by the U.S. Preventive Services Task force for most people in the viewing audience.

Annual FOBT (fecal occult blood testing) offers greater reductions in mortality rates than biennial screening but produces more false-positive results. A 10-year interval has been recommended for colonoscopy on the basis of evidence regarding the natural history of adenomatous polyps. Shorter intervals (5 years) have been recommended for flexible sigmoidoscopy and double-contrast barium enema because of their lower sensitivity, but there is no direct evidence with which to determine the optimal interval for tests other than FOBT. Case-control studies have suggested that sigmoidoscopy every 10 years may be as effective as sigmoidoscopy performed at shorter intervals.

http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm

Snyderman wrote off the value of sigmoidoscopy, saying it doesn’t go far enough (her words), and said that viewers must have colonoscopy.

But the U.S. Preventive Services Task Force recommendation says:

It is unclear whether the increased accuracy of colonoscopy compared with alternative screening methods (for example, the identification of lesions that FOBT and flexible sigmoidoscopy would not detect) offsets the procedure's additional complications, inconvenience, and costs.

Next, Snyderman turned her pro-screening enthusiasm to prostate cancer, advising men: “You turn 50, you just have to have a rectal exam to feel that prostate. And you get a prostate-specific antigen, a PSA test.?

Contrast that with the evidence-based guidelines:

The U.S. Preventive Services Task Force (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).

http://www.ahrq.gov/clinic/uspstf/uspsprca.htm

Journalists should not be advocates, especially if their advocacy is based on personal opinion, not evidence or fact.

A good source for an evidence-based assessment of these issues: “Should I Be Tested For Cancer? Maybe Not and Here’s Why,? by H. Gilbert Welch, M.D., MPH. (University of California Press, ISBN 0-520-23976-8).

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March 30, 2007

The Limitations of Drug Testing in Animals

A Wall Street Journal story today looks at an important question in science, in policy-making, and in journalism: "What do the results of animal studies really tell us about humans? That question still puzzles researchers even though guinea pigs, lab rats and their brethren have long been part of experiments."

Two examples from the story:

Many times, however, subtle results in animals are unclear and scientists just don't know what to make of them. In the case of the new Novartis drug Galvus, James Shannon, the company's global head of pharmaceutical development, told investors that Novartis researchers "do not understand -- do not know -- the mechanism of the skin findings" in monkeys. They do know that "humans appear to react to Galvus in a very different way."

Another example of the confusing disparities that can arise in testing is the case of the popular sleep drug Lunesta. It won FDA approval despite the fact that tumors appeared when rats and mice took huge doses of a closely related chemical cousin of the medication. Some FDA reviewers were concerned enough initially to recommend rejection of Lunesta. After further analyses, however, agency officials concluded the data from human testing didn't suggest a signal for cancer in people. But you won't see the issue highlighted in the company's ubiquitous green-moth commercials for the drug.

Journalists who report on preliminary findings from animal research without strongly emphasizing the inherent weaknesses in trying to interpret such findings are not serving the public.

Posted by schwitz at 9:09 AM | Comments (0)
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March 29, 2007

Whatever happened to the miracle obesity pill?

Earlier this week, I pointed out how - on one day - the Wall Street Journal appeared to favor positive drug news out of the American College of Cardiology meeting more than negative drug news. But day in and day out, the WSJ is one of the few news organizations to put negative drug news on page one. And today they should be praised for the spot they gave the story headlined, " 'Miracle' Obesity Pill Looks Less Miraculous." It begins:

"When Sanofi-Aventis SA reported data on a new obesity pill at a medical conference in March 2004, it generated instant buzz.

Hundreds of newspaper and television reports around the world the next day referred to the drug, Acomplia, as a "super pill" and a "miracle drug." With a new approach to obesity, Acomplia promised not only to help people shed pounds but also to raise good cholesterol and cut diabetes risk. It even showed signs of working as an antismoking aid.

"That is amazing. People are going to want this drug today, I'm sure," effused an anchor on ABC's "Good Morning America."

Three years later, Acomplia is looking less like a miracle. The drug still hasn't hit the market in the U.S. The Food and Drug Administration has asked for more data and repeatedly put off approval for the drug as an obesity treatment, while rejecting it for smoking cessation. Side effects associated with Acomplia -- including depression and anxiety -- are likely giving the FDA particular cause for concern, analysts and doctors say."

This episode is repeated many times each year: journalists trumpeting preliminary unproven claims made by drug companies or pharma-funded researchers without exercising appropriate skepticism and caution.

Thanks to the WSJ for not only pointing this out, for doing so in its prominent page one position.

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March 27, 2007

Important omissions in heart & cancer stories

Very preliminary findings from stem cell research got a lot of news coverage this week. Probably because there were local researchers involved, the Star Tribune put the story on the front page of Monday's paper. They reported:

An experimental treatment using adult stem cells was able to limit heart damage and improve the quality of life of patients suffering their first heart attack, according to a study of patients in Minneapolis and several other cities.

First, I balk at calling an experiment a treatment. It’s an experiment. Health lawyers have a term for this – “therapeutic misconception.? That means leading people to think there’s a certain therapeutic benefit from what is really an unknown undergoing experimentation.

The Star Tribune quoted four sources – which is usually good. But all four were connected with the research in some way, with a vested interest in reporting positive findings.

Especially since the work had only been presented at a scientific conference, which means that it had not yet been peer-reviewed, the story should have included independent perspectives.

Remember, questions have been raised about other stem cell research at the UMN – questions that are likely to come to the fore after peer review.

And ABC News recently reported on the drug Tykerb for metastatic breast cancer. But the story failed to mention that the drug is approved only for use with another drug (Xeloda) and that the combined cost of the drugs is $4,400 per month. It also failed to discuss potential harms of the two drugs.

It is hard to understand why/how such key components are so consistently left out of health news stories.

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March 26, 2007

Negative drug news doesn't get the same play as positive

You're seeing lots of cardiovascular news this week because the annual meeting of the American College of Cardiology is going on in New Orleans.

I applaud the health news coverage of the Wall Street Journal, but even their coverage shows a bias toward the positive and against negative findings.

In today's WSJ, the front page of the "Marketplace" section, page B1, has a story on the "blockbuster drug plavix" and a pack of new rivals on the horizon.

But negative findings on two other drug studies are relegated to pages B6 and B7, deep in the paper and deeper in that section.

Stories headlined "Crestor Fails to Clear A Bar in Arterial Study" and "Two Heart-Failure Drugs Fail to Reduce Death, Admissions" were important, but got neither the quality nor quantity of space given to the generally positive Plavix (and rivals) story.

American consumers need to be reminded that not all drugs are blockbusters, and that hopes at the beginning of trials are often dashed at the end. Page 1 placement would drive that point home.
(But at least the WSJ reports on the negative findings somewhere - don't get me wrong.)

Posted by schwitz at 8:24 AM | Comments (1)
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March 22, 2007

Lots of drug-related conflict of interest news this week

Gardiner Harris of the New York Times is all over issues about drug company influence on doctors and on the FDA this week. Today he writes:

Expert advisers to the government who receive money from a drug or device maker would be barred for the first time from voting on whether to approve that company’s products under new rules announced Wednesday for the F.D.A.’s powerful advisory committees.

Indeed, such doctors who receive more than $50,000 from a company or a competitor whose product is being discussed would no longer be allowed to serve on the committees, though those who receive less than that amount in the prior year can join a committee and participate in its discussions.

A “significant number? of the agency’s present advisers would be affected by the new policy, said the F.D.A. acting deputy commissioner, Randall W. Lutter, though he would not say how many.

Yesterday, Harris' story on "Doctors' Ties to Drug Makers Are Put on Close View" simply blew away the competition - better by far than any other story I saw on the subject in many media across the country - including right here in Minneapolis. He and Janet Robert reported on records in Minnesota, where drug makers are required to disclose payments to doctors.

The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products. Patient advocacy groups and many doctors themselves have long complained that drug companies exert undue influence on doctors, but the extent of such payments has been hard to quantify.

The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.

The reporting on this latter story was complete and comprehensive, with many examples of Minnesota physicians receiving surprising amounts of money from drug companies; ten doctors and one dentist received more than $500,000. You should read the entire story. But be ready to take an anti-anxiety pill when you're done.

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March 19, 2007

Premature talk of a cure

Many serious health journalists struggle with how to handle research stories in animals. Last night, KSTP-TV in MInneapolis-St. Paul presented a story that showed little attempt to put mouse research findings into a meaningful context.

It was on Rett Syndrome, which KSTP reported was "a disorder similar to autism." They said, "Doctors, who are testing mice, were able to reverse the symptoms of Rett Syndrome, an advancement beyond what many had even hoped for. ... The discovery is so monumental because it could lead not only to a cure for Rett Syndrome, but it could also help doctors working to cure autism. This is still in the research stage, a cure is at least ten years out. In the meantime, the Evert family and thousands of others are excited about a Rett Syndrome clinic set to open at Gillett (sic) Childrens' Hospital in Saint Paul."

First, the finding is not new; it is more than a month old.

Second, the story made little of the leap required from mice to humans. How can one even discuss "cure" with something that has not yet been tried in humans? How good an animal model is the mouse for this syndrome? What are the hurdles that lie ahead? We heard none of this. Yet we heard "cure" three times within seconds.

Finally, the story seemed to fall prey to a news release from a local hospital creating a clinic for Rett Syndrome patients, without any regard for the fact that such patients may receive specialized treatment at other area hospitals as well.

But, as evidenced from a listing of stories on the research on the Rett Syndrome Research Foundation website, KSTP was not alone. Many other news organizations used the word "cure" in describing this perhaps promising but certainly preliminary finding.

I would not dissuade people from finding hope wherever they choose to invest it. But I would dissuade journalists from promoting what may be false hope laden with more emotion than evidence.

Posted by schwitz at 7:00 AM | Comments (2)
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March 15, 2007

TVWeek profile of HealthNewsReview.org

The magazine TV Week this week profiles my efforts with the HealthNewsReview.org website.

On Friday, I’ll present data at the Association of Health Care Journalists annual conference in Los Angeles on our findings from the reviews of the first 300 stories in our first 11 months of experience with the site. It’s not a pretty story.

Stay tuned.

Posted by schwitz at 6:42 AM | Comments (0)
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March 14, 2007

Medicare Advantage sign-up dirty tricks

On the listserv of the Association of Health Care Journalists, a journalist raises an important issue that we don't hear enough about. That journalist wrote:

"May I suggest that while Washington is obsessing about Walter Reed, the rest of us should be paying attention to what’s happening in our back yards in the run-up to the deadline for switching Medicare Advantage plans? In many areas, plans have contracted with independent brokers/agents to make a last push to persuade beneficiaries to switch plans. Many broker/agents who signed beneficiaries up for one plan in the fall (to begin Jan. 1) are now urging them to switch before the deadline; that way, they collect commissions twice. There’s a lot of misinformation being spread, a lot of dirty tricks. By the time we get around to reporting on it, the March 31 deadline will have passed and the misinformation campaigns will have been successful."

Have you heard anything about this from your news organizations in your market?

Posted by schwitz at 10:16 AM | Comments (1)
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March 12, 2007

Erythropoietin bad news hidden late on Friday?

Merrill Goozner suggests that the FDA announcement late last Friday afternoon, issuing an official warning against giving cancer patients erythropoietin drugs (Epogen, Procrit, Aranesp) for anemia, was timed to minimize bad news or embarrassment. Goozner writes:

"What struck me most about yesterday's announcement was its timing. It has long been a hallmark of White House public relations staff that the best time to release bad news was late on Friday afternoons. That way, the least number of people will hear about it through traditional news media sources. It's too late to make the Friday evening newscasts; and the print stories usually wind up inside the Saturday papers, which are the least read of the week. (The New York Times story, at least, got mentioned on the front page.)

Is this what the FDA wanted for this important warning? Is this the best way to counter the torrent of direct-to-consumer TV ads touting this drug by asking "if you're ready for chemotherapy"?

This late Friday afternoon release shows as much as anything how the culture of the agency has been transformed in recent years from industry watchdog to industry lapdog."

Posted by schwitz at 9:22 AM | Comments (0)
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March 10, 2007

Are you anxious?

Dr. Sanjay Gupta’s HouseCall program on CNN today featured a story on anxiety disorders, and offered one of those handy self-assessments that allows you to diagnose yourself with almost anything under the sun.

Gupta said only one in five people with anxiety disorders get help. Then he offered a self-assessment from the Anxiety Disorders Association of America (ADAA). Gupta listed:

Do you have a (sic) anxiety problem?
• Excessive worry, occurring more days than not, for a least six months?
• Unreasonable worry about a number of events or activities, such as work or school and/or health?
• The inability to control the worry?

He said if you answered yes to any of these, you could seek help from your doctor or from ADAA.
He did not mention that the ADAA’s corporate advisory council is made up of drug companies Eli Lilly & Company, Forest Laboratories, Pfizer, Inc. and Wyeth.

I worry a lot about how commercial, how unquestioning, and how cheerleading much of CNN’s medical news is. It makes me very anxious and I am unable to control that worry. It only gets worse.

Posted by schwitz at 1:53 PM | Comments (1)
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March 9, 2007

"The Epidemic" of shoddy TV health news

Sometimes my own critics have said that I am unfair to those who practice television health news. They imply that because I once worked in that field I am bitter in my criticisms.

Well, veteran journalist Trudy Lieberman never worked in TV news, but you must read her comprehensive indictment of current TV health news practices in the current issue of the Columbia Journalism Review.

She writes about news stations accepting pre-packaged new stories created by health care behemoths such as the Cleveland Clinic or the Mayo Clinic, creating stories that are "a hybrid of news and marketing, the likes of which has spread to local TV newsrooms all across the country in a variety of forms, almost like an epidemic. It’s the product of a marriage of the hospitals’ desperate need to compete for lucrative lines of business in our current health system and of TV’s hunger for cheap and easy stories. In some cases the hospitals pay for airtime, a sponsorship, and in others, they don’t but still provide expertise and story ideas. Either way, the result is that too often the hospitals control the story. Viewers who think they are getting news are really getting a form of advertising. And critical stories—hospital infection rates, for example, or medical mistakes or poor care—tend not to be covered in such a cozy atmosphere. The public, which could use real health reporting these days, gets something far less than quality, arms-length journalism."

Read the full story. Then you'll see that it's not just me who thinks that much of TV health news is in critical condition, possibly creating more harm than good.

Posted by schwitz at 9:14 AM | Comments (2)
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March 7, 2007

New Mayo study questions value of lung cancer CT scans

The screen-at-all-costs mentality takes an intellectual hit with the publication of a new study in the Journal of the American Medical Association. The conclusions of those authors: "Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks."

Back in October, another study claimed quite the opposite, and many journalists failed to report with balance on those findings. (See summary on 8 stories on HealthNewsReview.org.) One journalist on the listserv of the Association of Health Care Journalists (AHCJ) has already pointed out this morning that some news organizations will have difficulty explaining the apparent flip-flopping findings today - if they did a naive job in October. Mike Taibbi of NBC News even went on the air in the fall reporting on his own CT scan after a life of smoking, and ended with a personal endorsement of the procedure. No spots on his lungs but now egg on his face.

One who wouldn't have a tough time explaining the latest study is former Miami Herald reporter Jacob Goldstein, who was recognized on HealthNewsReview.org for his excellent story in October. We've just learned that his excellence led the Wall Street Journal to lure him away as their first health news blogger.

Posted by schwitz at 8:13 AM | Comments (0)
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February 23, 2007

NNT - Number Needed to Treat

TIME magazine this week has an article on what it calls "medicine's secret stat," NNT or number needed to treat. The magazine uses the example of a study that might show that statin drugs lower the risk of heart attacks by 30%.

"But that number is meaningless unless you take into account the percentage of men in both groups who have heart attacks in the first place. If those people represent only a tiny fraction of the two populations, an improvement of 30% isn't much--maybe one heart attack fewer in a group of thousands.

The effort to handicap those odds is where NNT comes in. It answers the question, How many people have to take this drug to avoid one heart attack? The same principle can be applied to avoiding one recurrence of cancer or stroke or whatever end point you choose to measure. In healthy men, the NNT for statins is about 50 (depending on which of dozens of statins is taken, age, family history, lifestyle and so on). So 50 men have to take these drugs in order to prevent a single--not necessarily fatal, heart attack.

Presented that way, taking statins sounds like less of a no-brainer--especially given that the drugs cost hundreds of dollars a year, side effects could include liver and muscle damage and you have to take twice-yearly blood tests just in case. Still, factored out over the entire U.S. population, even a 1-in-50 figure means many thousands of heart attacks are avoided every year.

Since public-health officials want to save lives, they focus on the thousands and avoid the NNT. Since pharmaceutical companies are in business to sell drugs, they do the same. Those two forces have kept NNT from being a big part of medical education. We could all help change that by doing nothing more than asking for the number up front the next time we're handed a prescription."

But the TIME article didn't discuss how journalists could be and should be using NNT in their reporting.
That's why we put a little primer on the topic on our HealthNewsReview.org website. More consumers would understand the topic, and ask their doctors about it, if more journalists put the concept in more stories about research studies.

Posted by schwitz at 8:18 AM | Comments (0)
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February 21, 2007

Nonstop hiccup girl harassed by nonstop media pressure

You may have heard about the 15-year old Florida girl who started hiccuping a month ago and hasn't stopped. If you watch the network morning shows, your chances of knowing about her are better.

What you may not know is the level of harassment applied to book guests like her. The St. Petersburg Times reports: "The competition for her story became so frenzied over the weekend that NBC's Today show changed Jennifer and her mother's New York hotel after another network's exhaustive attempts to get an interview.

'You really never know what is going to gain that sort of attention,' said John Trevena, a Largo lawyer who has represented some high-profile clients. 'It seems once it starts, it spreads like wildfire. It becomes very exhausting for all involved.'

Representatives from ABC's Good Morning America called Jennifer's home 57 times on Sunday and slipped notes under her hotel room door, her family said.

On Monday, Jennifer and her mother did another interview with Today and one with Inside Edition before flying home.

Waiting for her were calls from the Ellen DeGeneres Show, and television stations from as far away as Canada and Britain."

Another chapter in the misplaced priorities of network news decision-makers.

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February 20, 2007

PBS ombudsman thinks Glaxo sponsorship isn't worth it

Broadcasting & Cable magazine reports:

"The sponsorship of a PBS program on obesity by diet drug maker GlaxoSmithKline has one veteran noncom TV watcher a bit exercised, but PBS says it is by the book.

Jeff Chester, executive director of the Center for Digital Democracy, and a frequent critic of what he sees as the increasingly commercialization of noncommercial broadcasting, has written to PBS ombudsman Michael Getler to complain about what he sees as too lax sponsorship policies.

Glaxo is underwriting the April broadcast of 'Fat: What No One is Telling You' ...

'We note that funding comes in part from GlaxoSmithKline,' Chester wrote Getler. 'The drug giant just happens to have a recently approved for over-the-counter drug on the market-under the brand name Alli, that is for 'use by overweight adults along with a reduced calorie, low-fat diet.' ...

PBS program executives need to 'cut the fat' out of their sloppy review of what's appropriate for underwriting,' said Chester."

Getler responded on his PBS ombudsman blog: "My view is that Chester’s eagle-eye provides a continuing, very useful challenge to PBS, a challenge that I agree with even though I sympathize with PBS’s constant search for funding, the difficulty of finding sponsorships to bolster more traditional funding, and that fact that some funders simply have an interest in seeing subjects aired and are willing to take their chances on how the program will come out. But in this case, there is little doubt how a program about obesity is going to turn out. Even though GlaxoSmithKline came in late and, under PBS policy, has no say in any of the content, this kind of possible conflict can undermine credibility and, without knowing the financial details, doesn’t seem worth it. "

(GS note: Thanks to one of my blog readers for tipping me off to this controversy.)

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February 17, 2007

More NBC News cheerleading rather than reporting health news

Last week it was NBC's hype of a drug for restless leg syndrome.

This week it was NBC using some of its airtime to promote a new "laser hair comb" for baldness. You figure a network newscast has about 22 minutes for real news. It chose to give a chunk of that time to this. The video can be seen on the MSNBC site.

What's going on with the NBC newscast? Is it cheerleading-in-TV news month? Perhaps, given that we're in the midst of a ratings-sweeps period.

On the HealthNewsReview.org site, we wrote: "There is an underlying tone of disease-mongering whenever a national TV network uses some of its precious 22 minutes of airtime to promote an expensive new product to "treat" - or as the story says at one point, "cure" - baldness - a condition that is a normal part of aging for many men.

The story didn't quantify benefits. People thinking of paying $550 for such a device should be given some estimate of how well it works.

But the bigger failing of the story was that it missed an opportunity to point out how such devices are approved by the FDA. Such new devices must only pass a test of "substantial equivalence" to products already on the market. The FDA lists 10 such products. So not only did the story fail to tell how well the device works, it failed to put the new idea into the context of existing alternatives.

No sources were cited.

Anchor Brian Williams' comment - "..when you use the expression "potential cure for baldness" in this country, you're going to be a multimillionaire overnight..." - is more cheerleading than reporting. If this story had to be reported as one of the few stories of the day in a network newscast, it should have offered more evidence and context than boosterism."

One wonders what the 47-million Americans without health insurance would think if they saw a story like this on the network news.

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February 11, 2007

Long-distance autopsy of Anna Nicole

Much of the coverage of the death of Anna Nicole Smith represented another low point in journalism.

CNN, which has billed itself as “the world’s most important network,? asked its senior medical correspondent, Dr. Sanjay Gupta, to comment on the death.

Wolf Blitzer introduced Gupta, saying, “Talk a little bit about what we know. A lot we don't know, Sanjay, about the cause of her death.?

Gupta led off saying, “There's a lot we don't know as well.?

Talk about a reason to stay tuned! But if you stayed tuned, you heard Gupta jumble together conjecture about “the heart as being the most likely culprit? – followed by “Why she would have heart problems? Not exactly sure.?

He continued: “Also lung problems. Could there have been some sort of a clot?... Could it have been some sort of medication problem??

Blitzer and Gupta then speculated about the flu, about her weight problem, about her addiction to painkillers, about a diet plan called Trimspa, about ephedra – much of it followed up with the reminder, “Whether that had anything to do with this, we don't know as well.?

So there you have it: virtual autopsy from long distance via speculation, rumors, and no direct knowledge of anything.

I am disappointed that Vioxx, Viagra, and the Virus of the West Nile were never mentioned.

As Blitzer introduced CNN anchor Jack Cafferty for another segment, Cafferty said: “Is Anna Nicole Smith still dead, Wolf??

BLITZER: “Yes, we're going to -- updating our viewers coming up shortly on...?

CAFFERTY: “I can't wait for that.?

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February 8, 2007

TV sweeps period produces health news panic

A San Antonio Express-News columnist reminds us that we're in the middle of the February TV ratings or sweeps period. And she laments the hype, including that of health news. Excerpt:

"Oh no, I woke with a headache. Boy, do I feel tired! Does that mean I'm at risk for a stroke?

I moved around extra slowly and carefully just in case.

What got me worrying was Monday night's Tanji Patton report on WOAI's 10 p.m. news: "A warning for women." It told how two women suffered a stroke — out of the blue — at widely different ages — one was 49; the other was 15 when she had her first — and suggested that women who show any similar health signs (like that nagging headache) might want to get their blood levels checked and consider lifestyle changes.

Yikes! I immediately made plans for earlier bedtimes and better food choices.

But before doing anything drastic like throw away my chocolate bars, I remembered something. And my mind was put at ease, at least a bit.

It's one of those months, I realized, when TV news operations try to put viewers on edge, make us fearful, a bit jumpy, so as to compel us to watch their newscasts.

It's February sweeps — a fact I almost forgot because of the many other biggies of the month: the Super Bowl, the many awards shows, such as the upcoming Grammys and Oscars."

I'd like to hear from anyone else around the country about their favorite TV sweeps pieces this month.

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February 6, 2007

Canadian paper bites on pharma-funded advocacy

A Vancouver Sun story is a good example of an imbalanced story that fails to address health policy issues with context and completeness. The story reports on an advocacy group report and, in so doing, takes a flawed advocacy stance itself.

The story begins: "Cancer patients are increasingly having to pay for important new drugs administered in public hospitals, the latest symptom of Canada's inconsistent and often inadequate funding of cancer treatment, an advocacy group reported Monday."

The story says, "One breakthrough leukemia drug is paid for by just a single province, (British Columbia)." The story didn't explain what qualifies as a breakthrough.

Then the story dipped into the language that is usually used when cost-effectiveness decisions are made by government officials - "rationing." The story says, " 'Essentially, we will continue to ration life-saving cancer treatment, and some Canadians will live and some will die simply because of where they live,' said the report."

Late in the story, it finally disclosed that the advocacy group was financed largely by pharmaceutical companies.

The report also looked at the availability of PET (positron emission tomography) scans and mammograms for cancer patients, raising questions about what the report said was underuse of the two technologies.

But overuse of PET and other scanning technologies is generally a bigger concern than underuse. And who's to say that women aren't choosing to forego mammography after weighing the evidence? The story certainly didn't look into that possibility.

Journalists will not contribute to a meaningful discussion on health care reform if they take the party line of a pharma-funded advocacy group as gospel.

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February 5, 2007

Restless viewers over NBC restless leg "story"

NBC News anchor Brian Williams delivered an awkward and unusual story lead-in last Wednesday, one which has touched off a firestorm of criticism of him even on his own blog.

Williams said, on the air: "If you watch this newscast with any frequency, then you've seen it - this ad playing behind me here on the screen - for a medication for something called restless leg syndrome. A lot of us had frankly never heard of the condition but we figured people must suffer terribly from it for there to be a medication to treat it. And so,motivated by a commercial by one of our own sponsors, we asked NBC News correspondent Josh Mankiewicz to do some checking. "

Mankiewicz’s story begins: “They show you the problem, and the solution. The syndrome, known commonly as RLS, affects millions and has been known to some for at least 60 years. But until recently, most people — even many physicians — had never heard of it. The drug company GlaxoSmithKline changed that.?

The story then quoted a doctor who said: "I'm not generally a big fan of direct-to-consumer TV ads. However, for this particular disorder, I think they've done a great service by spending most of the time identifying the problem." (You can read Williams' blog later to see what some viewers dug up about this "expert" source.)

The story went on to brag about Glaxo’s earnings from the drugs. And cited a single patient who said the drug “worked like a charm.?

The NBC hype didn’t end there. Brian Williams went on his blog to brag about the story.

But viewers went to the blog as well, many of them to criticize NBC and Williams, saying things like:

“Brian,
You said "We commissioned last night's story...."
And with whom did you commission that biased story?
(GlaxoSmithKline - the maker of the restless leg drug in the story)? I thought NBC was trying to cut commercials so we get more news. Does this integraded (sic) ad then count as news or advertising.?

Or

“This is only one of numerous examples of drug companies, trying to invent a disease or malady, or whatever, just to sell prescription drugs.?

OR

“it seemed to me the majority of writers were upset (as was I) about the blatant commercial you ran for for an advertiser?

OR

“Give anything a name, initials and a drug to "cure" it and you'll become a millionaire. Goes to show how gullible we have become in this country. And think about it, Brian, you're part of the problem/solution??

OR

“This time you've really crossed the fine line between journalism and advertising, and you owe your viewers an explanation and an apology.?

Had NBC, Williams or Mankiewicz done even a little research, they would have found, free on the web, an article entitled, “Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick.? Which is just what NBC did with this egregious example of disease-mongering. I am at least comforted that an intelligent viewing audience is starting to catch on to such examples of shoddy journalism.

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February 4, 2007

CNN's "House Call" Makes Some Bad Calls

You get a half hour on an international news network to report on health news and you use it to:

1. Tell people if you want to avoid the flu, "try to avoid getting too close to sick people."

2. Feature a doctor who lost 70 pounds by using lots of hot sauce, even though you admit "it doesn't really have any science behind it."

3. Promote a "permanent" wrinkle filler, while minimizing evidence - and failing to quantify potential benefits or harms.

That's what CNN did this weekend with its "House Call With Dr. Sanjay Gupta" program.

The first two were just laughable. The last was more dangeous.

The story described "ArteFill, billed as the first permanent filler." It said "known side effects are minimal."

But it's easy to find the following on the FDA website:

Side effects of ArteFill® include:

* Lumpiness at injection area more than one month after injection
* Persistent swelling or redness
* Increased sensitivity
* Rash, itching more than 48 hours after injection

Let's let consumers decide if those sound "minimal" or not. The story never mentioned that one of the conditions of FDA approval last fall was that a five-year study for safety be done after approval, a clear sign that reviewers were not convinced that all the evidence on safety was yet in.

Meantime, the story profiled a woman who had the injections: "In less than 30 minutes, (she) was sold. She thought she looked fresh with, if anything, her wallet, not her face, showing fatigue."

Let's let consumers decide if this sounded like a news story or a commercial.

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January 17, 2007

Sign of the times at the Star Tribune?

I have not written about the surprise December 26 sale of the Minneapolis Star Tribune to Avista Capital Partners. Clearly it was another sign of tough economic times in the newspaper industry.

Today's health section of the paper may be another sign of a paper limping through its routine. It's a weekly health section and there isn't one locally-produced piece in the section. Contributions come from the Washington Post, the Wall Street Journal and the New York Times. I'm not tying this anecdote to the new ownership; in fact, I've observed such a trend in this section before. When the paper announced its new redesign more than a year ago, the window-dressing nature of this weekly health section was obvious. No new resources or staffing were devoted to the coverage of health, medicine, or science. Just a weekly section, often filled with contributions from other sources.

Oh, well, at least the Star Tribune's editorial page today addressed local needs. The editorial states: "At a Capitol news conference last week, Gov. Tim Pawlenty had finished outlining his much-awaited plan to expand health insurance coverage when a reporter asked how many Minnesotans would gain coverage under its provisions. An aide consulted some notes and replied: 23,000 people, including 13,000 children.

That number is too low. It's a small fraction of Minnesota's 70,000 uninsured children, and less than one-tenth of its uninsured adults. In fact, it could be less than the number of people who lost coverage from state budget cuts in 2003. It shows a disappointing lack of leadership in a state that prides itself as a leader in health care -- and that now measures itself against states where Republican governors have embraced universal coverage."

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December 22, 2006

Lump of coal for heart stocking story

Two years ago, I wrote about how the Minneapolis Star Tribune had acted like a cheerleader on behalf of a local company whose product was a mesh-like sock to go around the heart in hopes of combating heart failure.

Over two straight days, the paper reported on the company's trial results with the sock. The stories did not have one comment from an independent medical source. But they did promote the company's "bullish" attitude about "the future of their unsual device as well as the company's prospects."

When the paper reported on a trial, in which the sock group was compared with a non-sock group of patients, the paper said the sock group scored better in "improvement" (not defined). There was no mention of complication rates. There was no discussion of whether the results were statistically significant, or whether they could have been due to chance.

The Wall Street Journal also reported on the sock study, but pointed out that the "sock didn't lead to a significant improvement in ejection fraction, the percent of blood that is pumped out of the left ventricle during a beat and a widely used measure of the strength of the heart."

The Star Tribune coverage felt naive and pro-local-business.

Last week, the cheerleading ended. The Star Tribune was forced to report, "The future of a New Brighton medical technology company remains unclear after a U.S. Food and Drug Administration panel ruled Friday that it may need to conduct a new clinical trial for the firm's sole product -- a unique device that treats heart failure. ...The company based its initial FDA application on a 300-patient trial. A similar study, if required by the regulatory agency, could cost Acorn an additional $20 million and take about three years to complete."

Journalists should review data and evidence and seek independent analysis of ideas in medicine, not local companies' bullish attitudes about their own products.

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December 18, 2006

Absolute vs. relative risk: an overlooked statistic

I teach my classes - even undergrads - that if I could change just one thing about the way in which research news is communicated to the public - for the sake of public understanding - it would be to include absolute risk/benefit data in each story or each message - not just relative risk/benefit data. On the HealthNewsReview.org website, we evaluate stories on whether they include absolute data. We also offer a brief primer on the topic. Failing to include absolute data may make the outcome seem much larger than it really is.

But even medical journals don't do a good job of demanding that absolute data be included in article submissions, according to a review in this week's BMJ. In it, Dartmouth/VA researchers looked at 222 articles over a year's time in six journals: Annals of Internal Medicine, BMJ, Journal of the American Medical Association, Journal of the National Cancer Institute, Lancet, and New England Journal of Medicine.

They found that 68% of articles failed to report the underlying absolute risks in the abstract of the article, and half of these didn't report absolute data anywhere in the article.

The authors' conclusion: "Absolute risks are often not easily accessible in articles reporting ratio measures and sometimes are missing altogether—this lack of accessibility can easily exaggerate readers' perceptions of benefit or harm."

The relative inaccessibility of absolute data is no excuse for journalists. If you're going to cover research news, you need to do it completely and correctly, and that includes getting at the absolute data - even if the journal article upon which you base your story doesn't include such data. Journalists should demand it from researchers they cover, just as journals should demand it from researchers submitting articles.

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December 16, 2006

Trying to serve two masters in health journalism

Competition among news organizations is a good thing. Readers and viewers already get far too many reports that are regurgitated in similar fashion from the same source.

But big media companies increasingly are going in the other direction: hiring big media names to serve two masters simultaneously.

The latest is CNN's Dr. Sanjay Gupta, who, according to Broadcasting & Cable magazine, will begin contributing up to 10 medical reports a year to the CBS Evening News.

OK, to whom does he give his best stuff? How would we know it's his best stuff? Is he saving a little extra for the CNN folks who gave him his break in TV news? Or does he save his "A" game for new viewers in his shot at one of the Big 3 audiences?

And CBS already has Dr. Jon LaPook, Katie Couric's doctor-friend. When might they hire a real medical journalist, rather than a doctor playing one on TV?

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December 12, 2006

Cross-media comparisons on lung CA CT scan story

On the HealthNewsReview.org website, we're making a new effort to compare how different news organizations did in covering the same story. Our broadest analysis yet is now posted in a Publisher's Note on that site.

It covers eight different stories by seven different news organizations on the recent study published in the New England Journal of Medicine on CT scan screening of smokers.

Summary:

* 6 of 8 failed to adequately discuss potential harms of such screening, which can include radiation exposure, needless anxiety after receiving a potentially false positive result and significant medical complications associated with biopsies.

* 6 of 8 stories failed to adequately address the availability of CAT scan machines that can be used for the lung cancer screening described.

* 4 of 8 stories failed to discuss the costs of such screening, which were discussed in the journal article upon which the stories were based. Estimates range from $200 to $1,000 per scan, so this is a significant issue that half the stories ignored.

* 5 of 8 stories relied on a single source (relying only on authors of the published study) and/or failed to present balanced, independent perspectives.

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November 21, 2006

USA Today Weekend special "breakthrough" edition

The HealthBehaviorBlog takes a poke at the most recent USA Today Weekend edition, which offers "13 scientific breakthroughs that could change everything" in medical care.

The blog post reads:

"Although the newspaper offers a blithe caveat that "there's no guarantee, of course," nine of the 13 magic bullets in the article were basically ads for drug or device manufacturers. Two of the remaining four were about advances in genetic engineering and only two were about improving health through behavior: the value of breastfeeding to prevent obesity in children as they grow, and surviving breast cancer through exercise.

The others deal with new drugs or machinery that may or may not do more good than harm, that are not yet fully proven and that are designed to help people recover from or repair ailments they might have prevented in the first place if more money were spent -- or made -- on researching human behavior. The design of these "breakthroughs" is quite simple: $."

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November 18, 2006

NBC reporter involvement/editorializing on lung scans

NBC news correspondent Mike Taibbi says he quit smoking after ABC's Peter Jennings died of lung cancer. Now Taibbi is telling his story on the air. Included in that story is Taibbi having a CT scan.

His main source is Dr. Claudia Henschke, who recently promoted the benefits of lung CT scanning with a new study. In the story last night, Henschke told Taibbi after his scan:

"Your lungs really look quite good. You're completely fine."

That misleads viewers about the certainty of these tests. For balance, Taibbi did include the comment of Dr. Peter Bach of Memorial Sloan-Kettering Cancer Center who said it was "outrageous" that Dr. Henschke estimated that 80 percent of lung cancer deaths could be prevented, and who suggested Taibbi was reading too much into his own clean scan.

Dr. Bach says it was simply too soon to rely too much on the scans as a basis for treatment. The story continued:

"If they're being told it will help them, they're being misled," he says.

But Henschke says there's no reason to wait years for the results of another study.

"Clearly, when you find lung cancer early you can cure it," she says.

That was my reason for getting tested, and it's why I feel good about the results. It's also why I know I won't smoke again, and why I'm committed to future scans as my best chance to know what next steps, if any, might be needed.

So despite the split opinions, and despite the argument against the evidence, Taibbi tugged on heart strings and editorialized and put himself into the story. He and NBC are wrong for failing to conduct an evidence-based discussion. That's not reporting. That's crusading.

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November 13, 2006

eHealthcare Leadership Award to HealthNewsReview.org

Last week in Atlanta, at The Tenth Annual Healthcare Internet Conference,
HealthNewsReview.org won an eHealthcare Leadership Award for "best community benefit."

2006 Award Logo 1 1-4 inch.gif

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October 30, 2006

Medicine in conflict

Business Week has an interesting special report on "blurring the lines between objective science and financial gain. "

The magazine profiles a New York heart specialist who is chairman of the Cardiovascular Research Foundation in New York. Excerpt: "The foundation uses donations and fees from medical device companies to stage (an) annual conference, called Transcatheter Cardiovascular Therapeutics (TCT). A professor of medicine at Columbia University, he has helped start a handful of cardiac device companies through a corporate "incubator" he co-founded. He also has served as a paid scientific adviser for several other startups. Over the years, companies to which he has had close ties have been featured prominently at TCT, creating at minimum a perception that the companies' products are favored for reasons other than medical merit. ... Beyond the danger that conflicts may distort individual clinical decisions, some TCT observers worry that the event engenders a general excess of enthusiasm for complicated device-based procedures. From 1986 to 2003 the number of nonsurgical cardiac procedures, such as propping open arteries with wire-mesh stents, rose twelvefold, according to the American Heart Assn. Such procedures "are uncomfortable, relatively expensive, and might be taking the focus away" from less invasive, equally effective treatments, such as taking medicine, says Dr. David D. Waters, chief of cardiology at San Francisco General Hospital."

Read the entire report. It paints a picture that is now being seen more often in medical research - a tangled web of conflicts of interest with big dollars at stake. And where, in all of this, are consumer interests represented?

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October 29, 2006

Newspaper reader: "Don't promote unproven therapies"

Sometimes you see a letter to the editor of a newspaper that you just want to frame. One such note appeared in today's Star Tribune.

The letter stated:

"Why not a more accurate headline for your Oct. 23 Business article "Massage that offers a healing message"? I suggest "St. Thomas prof sees business opportunity in quack remedy."

Would the Star Tribune's "Small Business" feature have endorsed treating breast cancer by manipulating the patient's "energy"? Would a St. Thomas professor (mindful of that institution's business ethics program) have cited the fact that breast cancer patients are "very likely to take on alternative therapies" as a marketing advantage?

As an Asperger's parent, I'm tired of being treated as a sucker and cash cow for unproven remedies. When looking at possible medical treatments, businesspeople, writers, editors and "experts" owe the public the truth. If the "evidence" for effectiveness is just someone's personal story and there is no scientific rationale, it may be all right to study the treatment, but it is evil to commercialize it."

I recall reading the story in question (but was unable to find it now in the Star Tribune archives), and I recall my reaction was not far from this woman's reaction. But, as I've stated before, newspapers seem to have a different set of guidelines - and perhaps a different standard of ethics - for the Business section. There seems to be a lower standard of evidence if the story promotes any local product or company.

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October 23, 2006

Are U.S. breasts different?

My friend Andrew Holtz asked journalists on the Association of Health Care Journalists' listserv, "Why did this week's Cochrane review examining the balance of risks and benefits of mammography get widespread coverage in the UK, but almost no mention in the US news media? Of the two dozen stories picked up in a Google News search, almost all were from the UK, Australia and other Commonwealth nations, but there were no U.S. news stories found. The story hasn't appeared on NYTimes.com, Washingtonpost.com or LATimes.com. CNN.com mentioned it only in its international section as part of a world news digest. So the BBC and others had headlines like: "Breast Screening Concerns Raised" and "Researchers question benefits of breast cancer screening." Meanwhile, US news outlets ran story after story on breast cancer that never mentioned the potential downsides of mammography... with rah-rah leads such as "Mammograms are good" and "No more excuses for not getting mammograms." It seems British and Australian editors have a different view from those in the US about what sort of info is relevant to their readers and viewers."

You can read the BBC story as an example of what you didn't get here. Excerpts:

"They found that for every 2,000 women screened over a decade, one will have her life prolonged, but 10 will have to undergo unnecessary treatment."

"...The scientists found mammograms did reduce the number of women dying from the disease. But they also discovered it was diagnosing woman with breast cancer who would have survived without treatment, meaning they were undergoing unnecessary chemotherapy, radiotherapy or mastectomies. About a fifth of cancers picked up by screening are in the milk ducts of the breast. Some of these cancers will progress while others will not - but there is no way of predicting what will happen. This means women and doctors have to decide whether or not to risk doing nothing, or go ahead with treatment which might be unnecessary. They also revealed a further 200 women out of every 2,000 experienced distress and anxiety because of false positives - a result that indicated a cancer was present but was later found to be wrong."

Some journalists responded on the listserv that the Cochrane Library review was just that - a review of past studies - and therefore, not news. Others responded with emotion - not evidence - about a woman's "need" to, or "right" to, have regular mammograms. (These were supposedly even-handed journalists, mind you.)

Holtz's observation about British and Australian editors having a different view from those in the US about what sort of info is relevant to their readers and viewers is interesting, and it may reflect an American cultural bias toward more screening and more aggressive treatment, regardless the evidence.

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October 13, 2006

Cool Site of the Day designation drives hot traffic

Another one of my web efforts, HealthNewsReview.org, was named Cool Site of the Day by The Kim Komando Show one week ago today. Komando says she “hosts the largest talk radio show about computers and the Internet.? The program is heard on over 450 stations throughout the United States. One thing is known: traffic to HealthNewsReview.org soared. This week, the site registered more than 1.3 million hits and had more than 30,000 unique visits. Almost 400 of those visitors became registered users.

After just six months of operation, we have reviewed 208 health news stories on the site.

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October 5, 2006

Milwaukee editor says media must pay more attention to health care crisis

The editor of Milwaukee Magazine writes: "Perhaps the most under-covered issue in the Milwaukee metro area is the cost of healthcare. Medical costs are killing this community in both public and private sectors.

Last week, a study by the Greater Milwaukee Business Foundation on Health Inc. found that physician fees for 13 procedures done by specialists are 30% to 40% higher in the Milwaukee area than in several other Midwestern cities. The group previously found that hospital costs in the Milwaukee area were among the nation’s highest. And past studies by others have shown that Milwaukee’s overall medical care costs were 25% higher than in other metro areas. ...

How can you possibly freeze taxes and continue services when your operations, as is true of all governments, are heavily driven by personnel, by employees who get health insurance coverage? When one of your biggest costs has gone up 87%, more than four times faster than inflation, how do you avoid budget increases? Adding to the irony is that any property tax increase to help defray these costs will not be paid by hospitals because they are tax-exempt nonprofits, even though they annually report “profits? and pay their executives mega-salaries.

Meanwhile, consider the impact on the private sector. How can Milwaukee’s businesses compete with those elsewhere when they are forced to absorb a cost for health insurance premiums that is so out of control? The business lobbying group, Wisconsin Manufacturers & Commerce, jumps on every tax that impacts businesses. Meanwhile, it seems to ignore a tidal wave of annual added costs coming from medical care inflation.

Ironically, local business leaders sit on the boards of local hospitals that are helping to drive these costs ever upward. Traditionally, these volunteers help raise donations for hospitals. Today, their time might be better spent demanding an explanation of rising costs.

I don’t claim to have any solutions to this crisis. But it’s a safe bet nothing will happen until more attention is paid to the issue. And the media can help make that happen." (my emphasis added)

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September 19, 2006

Award for HealthNewsReview.org

I was at the National Press Club in Washington, D.C. yesterday to accept a Knight-Batten Award for Innovations in Journalism for the creation of the HealthNewsReview.org website. It was a terrific event, hosted by the J-Lab, The Institute for Interactive Journalism at the University of Maryland.

The news release about the event is available online.

About our efforts, the judges said: "Strong methodology, great content, and a great service for reporters and the public."

It was motivating and encouraging to see the inspiring work of so many creative journalists who, true to the mission of the awards, use "new information ideas and technologies to involve citizens in public issues."

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September 13, 2006

Katie's Colon & CBS' New On-Air M.D.

The New York Observer reports that Dr. Jonathan LaPook, recently named medical reporter for the CBS Evening News (with Katie Couric), also helped arrange Katie's on-air colonoscopy in 2000. The Observer also reports:

"Over his quarter-century in medicine, he has consulted with some of that network’s most important figures: former news division president Howard Stringer; Andrew Lack, the creator of the newsmagazine West 57th and a former senior executive producer of CBS Reports....His father-in-law is Norman Lear, the television legend and creator of CBS hits All in the Family and Maude.

In August, Dr. LaPook officially joined the payroll. Still a practicing physician and a member of the faculty at Columbia Presbyterian Hospital, he is now also the medical correspondent for Ms. Couric’s CBS Evening News. That evening-news job was previously held by Elizabeth Kaledin, a practicing journalist who has covered the medical beat for the network since 1996.

Ms. Kaledin was still under contract when Dr. LaPook replaced her, and the contract will not be renewed when it expires at the end of this year, according to three network sources. ...

Dr. LaPook declined an interview request because he was “seeing patients and crashing a story,? said a CBS News spokesperson. Ms. Kaledin declined to speak at length because of the sensitivity of her position at the network.

“The thing I’d feel most comfortable saying, which is the truth, is that I am heartbroken by the loss of my job and have spent 20 years working to get to this point, only to be replaced by someone with no journalistic experience only because he’s a doctor,? she said. “I have worked incredibly hard from the smallest markets in TV to get to this point. I have never pissed anybody off. My reporting career is unblemished. I’m well-liked. I work hard. I’ve been loyal to CBS.?

All maybe true, Elizabeth, but you didn't help arrange the famous colonoscopy and you're not a "popular Upper West Side gastroenterologist." You were only, apparently, a journalist.

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September 9, 2006

Dutch scientists dampen diabetes hype

A Dutch epidemiologist and colleagues warn in the BMJ this week that news coverage of a diabetes finding may raise unrealistic expectations. They write that a New York Times story earlier this year quoted a diabetes researcher saying the gene discovery (a variant of the TCF7L2 or transcription factor 7-like 2 gene) could lead to a diagnostic test to identify people who carry the variant gene.

They say that a Scottish scientist headed the research team, which led the Glasgow Herald to report, "Discovery of holy grail will help scientists treat diabetes."

The editorial acknowledges that the discovery is undeniably noteworthy. But the claim that this discovery will lead to a diagnostic test - and the chance to prevent type 2 diabetes - may not be true and may mislead the public.

“Raising unrealistic expectations – even inadvertently – could distract attention from what can be done by applying what we already know to prevent diabetes and its complications," they conclude.

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September 1, 2006

Wide variations in way journalists cover cancer gene therapy story

What a flashback! 21 years ago, National Cancer Institute researcher Steven Rosenberg became a media darling because of his work with Interleukin-2 against cancer. Magazine covers, newspaper headlines, Today show appearances. Much of it hype.

Yesterday a new media feeding frenzy was kicked off when the journal Science published a Rosenberg (et al) paper about remissions in two people with advanced melanoma using genetically altered white blood cells from the patients themselves. The 15 other people in the trial died.

The Knight Science Journalism Tracker website comments on the variation in the way journalists covered the story:

"Gene therapy has failed so many times to live up the hype of a generation ago (much of it abetted by journalists) that good reporters are usually cautious in writing about it. So it was that some who covered this put the experiment’s limitations ahead of its achievements. The Baltimore Sun’s Michael Stroh, for example, wrote a lede that started: “In a small study…? Lauran Neergaard of the AP went with a more upbeat lede: “Government scientists turned regular blood cells into tumor attackers that wiped out all signs of cancer in two men with advanced melanoma,? but followed with a second graf that started “But? and said the treatment failed in 15 others.

A sampling: The Washington Post’s David Brown was careful to note that none of the scientists would claim the two patients were cured, a verdict that would have to wait at least five years; however, Karen Kaplan, writing in the Los Angeles times, called the treatment a “cure.? Sabin Russell in the San Francisco Chronicle appropriately called the study “tiny?; Joe Palca had a good backgrounder-cum-news story on NPR Thursday afternoon; The Telegraph’s Roger Highfield in the UK was unusually upbeat, spinning a heartwarming anecdote of one patient in whom the treatment worked through nine paragraphs before telling his readers that the treatment failed in 15 others."

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August 24, 2006

Health care industry worried about Michael Moore's "Sicko"

AdAge.com is the latest publication to report that Michael Moore's pending documentary on the health care industry has industry execs rattled.

AdAge.com reports that drug company execs have told their employees not to talk with Moore. Quotes in the article:

"A review of America's health-care system should be balanced, thoughtful and well-researched to pin down what works and what needs to be improved," said Ken Johnson, senior VP for the Pharmaceutical Research and Manufacturers of America. "You won't get that from Michael Moore."

Added a spokesman for one of the top 10 pharma companies: "We expect it will be one-sided and
biased, just like his other documentaries."

Hmmm: one-sided and biased. Kinda like direct-to-consumer drug ads, in other words?

Moore has written, "I don't think the country needs a movie that tells you that HMOs and the pharmaceutical companies suck. Everybody knows that. I'd like to show you some things you don't know. So stay tuned for where this movie has led me. I think you might enjoy it."

The movie may not be released until early 2007.

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August 23, 2006

Local TV news fails on Bush visit

I watched the 6 o’clock TV news on the 3 leading Twin Cities TV stations last night and I give them all an F on covering the President’s visit to the area.

Were issues covered? No.

He met with a health care panel and signed an executive order to make more health care cost and quality information available to consumers.

But the TV newscasts had more silly discussion about traffic jams caused by the Presidential motorcade and Air Force One than there was attention to issues. One station even offered live cut-ins of the president waving as he got back on the plane and then again as Air Force One began to roll on the runway. Wow, that's good and important TV.

Come on! This is the 14th largest broadcast market in the country. And this is the best we can get on substance? On issues?

If this was just a political fundraising trip, why not call it that? If there was no substance to the alleged policy announcements, why not report that?

What value was there in the President’s ideas and in the executive order? Where was the reporting? Was the biggest issue the traffic jam caused by his visit?

I think not, not given rising health care costs, problems of the uninsured, calls for universal national health insurance, questions about integrity in science at the federal level, etc., etc. etc.

Shame on the local media.

Bush healthcare.jpg
(AP Photo)

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August 8, 2006

Apple-eating mice: rejoice!

"An apple (or two) a day may help keep Alzheimer's away -- and fight the effects of aging on the brain," according to a story posted on WebMD.

The story should have said clearly, boldly and early: "IF YOU ARE A MOUSE."

But the story, reporting on a study funded by the U.S. Apple Association and the Apple Products Research & Education Council, didn't mention mice until seven paragraphs deep in the story. No important caveats appeared in the story.

In fact one quote was the exact same quote in a U.S. Apple Association news release.

Here's a caveat for news and health care consumers: Yesterday CBS News announced it was partnering with WebMD in an effort to "expand its medical and health coverage." Let's hope the partnership doesn't result in more mouse breakthroughs on the network newscasts.

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August 1, 2006

Star Trib deals double dip of premature health hype

Monday’s Minneapolis Star Tribune had two stories that wore the pom-poms of cheerleading better than the ink-stained wretchedness of good journalism.

Back in February, the Star Tribune was among the local Minneapolis-Saint Paul media that hyped an announcement of the reversal of diabetes in a few monkeys over a short term by transplanting insulin-producing cells from pigs.

Monday’s story, “From pigs, a cure for diabetes?? profiled “a Duluth businessman's vision: cells from pigs … will help U researchers.? The story said that “In February, a scientist at the U announced that he and other researchers had cured diabetes in monkeys by injecting cells from pigs.? I don’t recall the scientist ever using the word “cure,? nor did the University news release.

Even if he did, what does that term mean to readers? If you asked 100 people about a cure for diabetes, what would they say that means? A short-term reversal in some (but not all) animals on which it was tried? I doubt that would be the accepted definition.

The paper also wrote: “The Food and Drug Administration has yet to approve clinical trials of the pig islets' use in humans, but clearance is expected.? Better not bank on that one until it’s in hand. The trail of tears of expected FDA approvals that never happened is longer than you may think. But if you’re in cheerleading mode, you bet on the hometown team, right?

Then, in Monday’s business section, the Star Tribune had a story, Hypertension implant has promise,? “reporting that “ a Maple Grove firm's device to lower stubbornly high blood pressure is attracting attention -- and deep-pocket investors, as well.?

The story, also in cheerleading fashion, describes a photo taken during the first human implantation of the device, with a masked surgeon in an operating room holding up a piece of notebook paper on which he's scrawled, "It works."

Good science and good journalism demand more than a thumbs up after just one case.

Indeed, the story says the device “still is undergoing clinical trials and has a long way to go to win regulatory approval as being safe and effective.?

The paper quotes a company exec who says it's too soon to say how much the system might cost, but it's likely to be between $6,000 - $35,000, with an initial U.S. market of up to 2 million patients.

Hey, how’s that for letting the manufacturer use your newspaper to create demand while setting a narrow price range – only a $29,000 swing in price possibilities!

Couldn’t this story have waited until some more data and evidence were in hand?

Or is this not journalism? Is it cheerleading? You can’t do both.

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July 31, 2006

Media manipulated by "Morgellons Disease" advocates

You would think it was the war in Iraq, or the Israeli-Lebanese conflict. The amount of news coverage being given, sometimes seemingly unquestioningly, to a questionable condition some call “Morgellons Disease? is staggering.

Just in June and July, the “Morgellons Research Foundation? boasts on its website of appearances on ABC, NBC, CNN, and on local stations in Tulsa, South Bend, San Diego, San Antonio, New York and Salt Lake City. The ABC Good Morning America show and NBC Today each featured stories on Morgellons last Friday at almost the exact same time.

Also just in the last two months, print coverage of Morgellons has appeared in Time magazine, Popular Mechanics, the Washington Times, Chicago Tribune, Pittsburgh Post-Gazette, Minneapolis Star Tribune, Dallas Observer, and the San Francisco Chronicle.

The “Morgellons Research Foundation? lists these signs of the “disease?:

1. Skin lesions with intense itching.
2. Crawling sensations, both within and on the skin surface.
3. Significant fatigue.
4. Cognitive difficulties described by patients as "brain fog".
5. Behavioral effects are common in many patients. Many have been or will be diagnosed as Attention
Deficit Disorder, Attention Deficit Hyperactivity Disorder, Bipolar Disorder, or Obsessive-Compulsive
Disorder.
6.“Fibers? are reported in and on skin lesions. They are generally described by patients as white, but
clinicians also report seeing blue, green, red, and black fibers, that fluoresce when viewed under
ultraviolet light.

Yet what suddenly made this such a hot story?

Many stories quote or cite just one researcher from the Oklahoma State University Center for Health Sciences & College of Osteopathic Medicine.

But stories don’t seem to discuss who named this a disease.
Journalists don’t seem to push for much evidence.
And the journalists seem to have short memories, forgetting past, very similar stories.
They also don’t seem to mind that they are being manipulated: breast cancer, prostate cancer or heart disease aren’t even getting this kind of attention. And what do they really know about the people making the claims?

But someone is pushing all the right media manipulation buttons – something that is increasingly easier to do these days.

One skeptical website, though, may be publishing more than the advocates. See Morgellons Watch, a site dedicated to examining the claims made regarding this phenomenon. The site’s host writes: “I believe that much of the current media coverage of Morgellons is inaccurate and sensationalist. This is misleading sick people into thinking they may have a terrible disease, when the evidence does not indicate that such a disease actually exists. People have very real physical symptoms, but those symptoms have many possible causes, which have very real treatments. Misdirecting people into a wild goose chase, after a disease that probably does not exist, is wrong.?

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July 21, 2006

Erosion of trust in medical journals

The editor of the Journal of the American Medical Association says that for the third time in three months, the Journal was misled by authors failing to disclose their ties to drug companies. This time it was in a study appearing in this week's Journal linking migraines to heart attacks in women. All six authors of the study have had financial ties to drug companies making products for migraines or heart problems.

The Associated Press reports that "the authors said they did not report their financial ties because they did not believe they were relevant to the study."

JAMA was burned last week when authors of a depression study failed to report their connections to drug companies making antidepressants. And two months ago authors of a study on arthritis drugs and cancer failed to fully disclose.

The engtanglement of conflicts of interest in the dissemination of health, medical and science news is worsened when journalists don't question researchers about potential conflicts of interest, or when they take as gospel anything that is published in a journal. Consumers are hurt when there is not full disclosure. They're not getting the full story. That's why, on our HealthNewsReview website, we give an "unsatisfactory" score to any news story that fails to pursue questions of conflicts of interest in the sources used in a story.

This situation must change.

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July 20, 2006

Medical Arms Race

Jeremy Olson in today's St. Paul Pioneer Press reports on concerns about the "medical arms race" -- "relentless drive to buy the newest technology to stay competitive and offer the industry standard in care."

But, as he reports, that comes with high costs and questions about benefit.

You've seen the marketing for CT scans, da Vinci robotic surgery systems and the Cyberknife.

Read his story. There should be more like this in more news outlets more often.

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July 17, 2006

Paper doesn't disclose who's paying Flying Nun to fly

"Celebrity sickness" campaigns will always be less than truthful if they fail to disclose who's paying the bills for the campaign. When journalists join in by giving free advertisiing - disguised as news - to drug-company sponsored celebrity campaigns without disclosing the drug company funding, it is a travesty. I have written about how CNN failed to disclose former NFL-er Joe Theismann's drug company support on a tour promoting prostate health.

The latest example I've seen was in The Oregonian last week. The paper ran a story that proclaimed that "Actress Sally Field joins the women who are fighting osteoporosis with medicine, supplements and exercise." Not surprisingly, there was an overt plug for a drug: "Field chose to take Boniva, a once-a-month medication from Roche Therapeutics." And the paper let her get away with this: "I feel it's kind of a miracle."

Nowhere did the paper mention that Roche pays for the former Flying Nun to sprout her wings for its drug Boniva, something that is easily found on the Web.

Readers of The Oregonian deserve better. The "Nun", proclaiming miracles, is just an actress being paid in a new role, following a script.

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July 14, 2006

Consumer-driven Health Care Marketing Disguised As News

The Star Tribune bought a UnitedHealth Group news release hook, line and sinker this week. United announced the findings of a three-year study of "consumer-driven health care plans." It reported "that the cost to employers per member in a high-deductible plan declined 3 to 5 percent, while increasing 8 to 10 percent for others."

The paper provided no details of the group surveyed. How old were they? How well-educated were they? What was their average income? Was this a cherry-picked group of healthy, higher-motivated, higher-educated, better-informed, better-able-to-shop-around employees? These are essential questions. The answers were not provided.

The Star Tribune at least did note some other opinions: one that such plans are not necessarily cheaper than traditional plans for employers, and another that these results may be preliminary. But the story still tilted far too much to the insurance industry party line, that "consumers are more discerning when they are confronted with prices and are less inclined to pay for expensive visits to the emergency room to treat something basic such as a fever or an ankle sprain."

The "put-consumer-skin-in-the-game" philosophy, in the absence of sufficient tools to help consumers play the game, is wrongheaded.

In their own city, the paper could have turned to skeptics such as former U.S. Senator David Durenberger, who recently wrote: "It’s in my best interest – and that of my children and grandchildren – to live in communities of integrated health, medical and long term care systems. It is in such communities that responsibility is shared equally among consumer, professional and insurer, and where greater accountability is demanded of those whose mixed motives might conflict with serving the consumer’s primary interest. Dis-integration is the goal of consumer-driven health care and its principal supporters in the individual insurance industry."

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July 6, 2006

How drug companies squelch negative findings

Scott Hensley of the Wall Street Journal published an interesting piece last week headlined, "Quest for youth: how research on anti-aging pill lost momentum."

In it, he writes; "Four years after Pfizer Inc. ended a clinical test of an experimental anti-aging pill and stopped its development for that use, the results of the study still haven't been published in a scientific journal, where other researchers could take advantage of them.

The lag highlights an enduring issue in pharmaceutical research: the fate of data from trials of drugs that fail to live up to expectations. In recent years, drug makers have come under attack for failing to disclose negative research about medicines they have on the market. But there's another twist to the data dilemma that concerns drugs that don't get that far.

The research behind medicines that get nixed in the trial stage could be valuable to the scientific community. But that information may not immediately reach people, working in academia or at other companies, who might be able to solve the problems or otherwise build on the results."

But, oh, did Pfizer enjoy the publicity after small exploratory studies "showed promise." And journalists continue to cover non-peer-reviewed presentations on the drug at scientific meetings. See one review of one recent story. Journalists must realize they're not getting the whole story when they report on "revelations" at scientific meetings.

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June 29, 2006

Important questions about medical errors study

Don Berwick and the Institute for Healthcare Improvement have done important work in addressing health care quality issues. But they may have overstepped the boundaries of evidence with a recent study that drew a lot of news coverage, claiming that hospitals they worked with saved over 122,000 lives by cutting down on errors and improving care.

"The Numbers Guy" column by Carl Bialik in the Wall Street Journal says the studies warrant a second opinion. Bialik quotes Dr. Bob Wachter of UCSF, author and lecturer on medical errors: ""I don't think it saved 122,300." He added that, like in a political campaign, the health-care campaign used "statistics selectively to try to mobilize your base to do good. It's understandable. It's not good science."

Dr. Gil Welch of Dartmouth and the VA said, "I think there's been a tendency in the errors business to first overstate the size of the problem, and now, I'm afraid, to overstate the effect of interventions on the other side."

Read Bialik's full article. It does a good job of questioning claims and pointing out how well-intentioned advocates may be driven by passion more than by evidence, and how journalists can easily get sucked into the vortex. (Bialik points out how the Wall Street Journal reported the Berwick claims, along with the Associated Press, U.S. News & World Report and many other media.)

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June 22, 2006

Gannett stuffs newspapers with "HealthSmart" ad section

The Gannett Company has sold a 32-page issue of an insert entitled "USA Weekend HealthSmart" to drug company advertisers and to newspapers across the country. The New York Times reports that the insert appeared in 76 newspapers with an estimated circulation of 7.5 million.

I was one. I am no smarter for having scanned the section. I have, however, become familiar with many more drug ads thanks to this piece of fish-wrap. You can't call it news. There's lots of "advice." And then there are all the ads.

There is one four-page spread from Astra-Zeneca that could lead just about any reader to self-diagnose with bipolar disorder. The ads ask if there's ever been a period when you flew off the handle at little things...needed less sleep...felt irritable...were much more interested in sex than usual, etc. If so, the ad goes, you may need treatment for bipolar disorder. Gee, that's about 100% of us. What a nice market!

Sadly, this won't be the last of such bombardments. The Times reports: "Executives at USA Weekend initially considered the issue to be a test. But after seeing the results — more than 16 advertising pages, from marketers like AstraZeneca, Johnson & Johnson and Pfizer, bringing in more than $3 million in revenue... they are already looking at publishing HealthSmart again, perhaps as soon as the fourth quarter."

And the Times story suggests this is a sign of the health of U.S. newspapers. If this is healthy, I don't want to see sickness.

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June 21, 2006

CNN's questionable screening test advice

At least CNN doesn't discriminate based on gender when it gives screening test advice that clashes with evidence-based guidelines.

Back in February, CNN's Sanjay Gupta gave screening test recommendations to men at various ages. The advice flew in the face of unbiased, authoritative guidelines of the U.S. Preventive Services Task Force (USPSTF).

Then on Mother's Day weekend in May, CNN's Elizabeth Cohen gave women screening test advice that also conflicted with USPSTF recommendations.

See my full commentary on this topic.

To promote screening in groups for whom the evidence of benefit is not clear and for whom the evidence of some harm is significant is not good journalism. It is a form of advocacy journalism that is advocating the wrong things.

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June 20, 2006

More caution about news from scientific meetings

Dartmouth's Steve Woloshin and Lisa Schwartz have studied the pitfalls of news coverage based on scientific meetings. Their new work, in the Medical Journal of Australia, looked at print and broadcast news stories based on research reports at five major scientific meetings on heart disease, AIDS, cancer, neuroscience and radiology.

Results: "34% of the 187 stories did not mention study size, 18% did not mention study design (another 35% were so ambiguous that expert readers had to guess the design), and 40% did not quantify the main result. Only 6% of news stories about animal studies mentioned their limited relevance to human health; 21% of stories about small studies noted problems with the precision of the finding; 10% of stories about uncontrolled studies noted it was not possible to know if the outcome really related to the exposure; and 19% of stories about controlled but not randomised studies raised the possibility of confounding. Only 29% of the 142 news stories on intervention studies noted the possibility of any potential downside. Twelve stories mentioned a corresponding 'in press' medical journal article; two of the remaining 175 noted that findings were unpublished, might not have undergone peer review, or might change."

This is important work, pointing out that "the public may be misled about the validity and relevance of the science presented."

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June 19, 2006

TIME magazine fails to disclose glaring conflict of interest

What ethical standards still exist at Time magazine? Or do they exist and they're just being ignored?

The Center for Science in the Public Interest points out that this week's Time magazine includes a column by Dr. Andrew Weil touting the benefits of fish oil supplements. CSPI says, "The column was sparked by a recent report in the Journal of the American Medical Association showing that fish oil supplements did not reduce the risk of serious abnormal heart rhythms. The article failed to disclose that Dr. Weil sells his own brand of fish oil supplements on his website.

I've pointed out other questionable advertising-related editorial practices at TIME in the past.

Let the reader - and the buyer - beware.

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May 19, 2006

Nurse criticizes Strib for promoting cancer magic bullet

First, this is not "beat up on the Star Tribune week." There's no agenda here. Sometimes events and patterns unfold before one's eyes.

On Monday, in my "Proportionality in Journalism" entry, I wrote about Mother's Day weekend stories in several media - "endless weapy stories about breast cancer. But few hard issue-oriented stories about breast cancer. About the dilemmas in diagnosis and treatment, in funding, in consumer decision-making."

Today, a woman who describes herself as a veteran oncology nurse has a letter to the editor in the Star Tribune.

She writes: "As a longtime oncology nurse, I was pleased to see the May 15 front-page story about the Susan Komen Race for the Cure. As the name of the event implies, there is not yet a cure for metastatic breast cancer. This important fact was then obscured by the reporter's choice to focus on a young woman who is seeking treatment unsupported by the type of rigorous scientific study that the Komen Foundation funds. The story pulls at the heartstrings, but fails to inform us about proven treatments and the progress that has been made in prolonging and improving the lives of women with breast cancer. A physician who offers his treatment as the 'only hope' is, sadly, too good to be true."

Her letter is a call for evidence-based medical reporting. And proportionality. That's the backbone of my week-long tirade about what I've seen - and not seen - in Twin Cities health news this week.

It may be time to listen to the readers and viewers. They're not happy. That may be why readership and viewership are declining.

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May 12, 2006

You can tell it’s TV sweeps-ratings time

As my research has shown, whenever ratings-sweeps periods roll around, television news departments miraculously find time to cure the problem of not having enough time to devote to health news.

In my market, Minneapolis-Saint Paul, the May sweeps period has been filled with tears, joy and new hope surrounding dramatic breakthroughs and promising developments for victims of illness. (There, I just polished off my “seven words you shouldn’t use in medical news? in almost the same time as the normal TV anchor lead-in.)

This week on local TV, I saw:

• The “countdown to separation? for conjoined twins. And I saw it over and over and over on all local stations. All conjoined twins all the time. Like it's never been done before. You'd never know there were 45-million uninsured in this country but you sure know a lot about these two kids.

• A single-source story, “Doctor Has New Method To Break Up Kidney Stones,? with no input from any independent source

• “Minnesota Twins’ wives step up to fight cancer?

• “States prepare for bird flu fears, pandemic? – how health officials from California to New York were taking steps to allay any fears that might arise from the TV movie "Fatal Contact: Bird Flu in America" – a local ABC affiliate story about the ABC network movie that was panned by critics. Nice cross-promotion, huh? Or, the local affiliate could have just refused to air the sappy production.

• Another station posted on its website, “Bird Flu Preps,? asking the tough questions for which we all want answers, such as: “But what happens if there's no one to anchor the news? No one to operate the cameras? And no reporters in the field to tell us what's going on??

To be fair, I saw only a portion of one story that reported: “An organ donation group that gives priority to members over others in need is causing medical ethicists to question its appropriateness.? This is the kind of issue-oriented health news story that is lacking in many TV newscasts. So credit should be given to KSTP-TV for digging beneath the surface of news releases on breakthroughs and cures.

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April 20, 2006

Reasons for improved longevity in U.S.?

OK, so many news stories today are reporting the new statistics suggesting (with lots of head-scratching and remaining doubts by some observers) that the U.S. had the biggest single-year decline in deaths since 1938.

If true, who or what gets the credit?

The Star Tribune, in its first sentence,says it's "a powerful testament to medical advances." It quotes a state health department official attributing it to "technology" and drugs.

Whoa! Where is any discussion of prevention, of lifestyle changes, of a "powerful testament to public health"?

This journalism-juiced love affair with high tech and emphasis on medicine with minimal or no mention of public health is troubling, sensational, and short-sighted. We need to remember: the U.S. spends more on health care than any other country and has outcomes worse than many other countries. People in countries that spend less on technology and drugs live longer than Americans.

Not only do these statistics demand more scrutiny, as many have already stated, but so do the possible explanations for any possible decline in the death rate. Journalists, don't be cheerleaders for high-tech and drugs if you don't have the evidence to back that up.

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April 18, 2006

Thousands go to HealthNewsReview.org

First day traffic to the new HealthNewsReview.org website was strong yesterday, with thousands of journalists and consumers visiting the site.

Public comment has been overwhelmingly positive.

Merrill Goozner of the Center for Science in the Public Interest wrote on his blog: "...I'm hoping a new effort by journalism professor Gary Schwitzer of the University of Minnesota has some impact on the profession. ... He's deployed several graduate students to monitor stories in dozens of newspapers and broadcasts and grade them with one to five stars -- just like the movies! By hacking around his website for a few minutes, I quickly discovered that the grades were based on solid, objective evaluation criteria. Any reporter looking to see why their work earned a poor rating could learn a lot by delving into the details of the critique.

Schwitzer, a former journalist who works closely with the Association of Health Care Journalists, goes to great lengths to explain that he isn't trying to belittle the reporters whose work is highlighted (I saw at least one got five stars). "We hope that U.S. journalists find our reviews helpful and accept the constructive criticism," he writes. "This project is intended to support excellence in health and medical journalism."

I wish him well in his efforts. Health care journalism has to get off the dead end track of reporting the latest study du jour, which is a one-way ticket to flacking for the drug industry. If there are any reporters reading this blog, I encourage you to check out his site. It's got a lot to offer."

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April 17, 2006

Debut of HealthNewsReview.org

I’m proud to unveil a project I’ve been working on for 8 months. Please visit HealthNewsReview.org to see a new attempt to help improve health journalism in the U.S.

A team of more than 20 reviewers from journalism, medicine, public health and health services research will evaluate and grade health news stories that include claims of efficacy or safety about treatments or procedures in health care.

An Associated Press story on the launch today quotes one observer saying she hopes the site doesn’t "end up being another media-bashing exercise." This website is not about media-bashing. It is quite the opposite: it is about supporting excellence in health/medical journalism.

We hope that journalists and consumers will use HealthNewsReview.org each day to help improve critical thinking and scrutiny of new ideas in health care. And we welcome your feedback.

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April 13, 2006

More fake news followup - from the nation's 2nd biggest market

Here's more followup to the Center for Media & Democracy's report on the use of Video News Releases last week.

The LA Daily News picked up the story and reported that one of the culprit TV stations found to use VNRs is in that second biggest TV market in the country - KABC.

They reported: "Last September, Channel 7, the ABC affiliate for Los Angeles, aired a story during the 5 p.m. Tuesday newscast about a blood test to find allergies in kids. It looked like a legit news story, with interviews, graphics, cute kids and a voice-over by a Channel 7 news reporter. It wasn't, though. The report was a canned video news release, or VNR, produced for and paid by Quest Diagnostics, a company that runs labs around the country that do this very sort of testing. There was no disclosure by the station that the piece was an advertorial."

KCBS and KTLA in Los Angeles were also found to run VNRs without disclosing it.

In all, the report found 36 VNRs airing on 77 stations all over the country, and every newspaper in those cities should be telling the story, as the LA Daily News did.

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March 20, 2006

"Just add water" TV health reporting

The Grade the News (GTN) website reports on the questionable medical “reporting? done by syndicated TV and radio celebrity Dr. Dean Edell, who calls himself “America’s Doctor.?

Edell appears on San Francisco’s KGO Channel 7 with introductions that often say, “Dr. Dean Edell reports.? But the story points out that Edell does no original reporting in many of the stories.

GTN reports: “Many of his TV stories, along with transcripts under his byline on the KGO Web site, were taken nearly verbatim from a low-profile news service in Florida that mails out prepackaged video reports to more than 100 TV stations across the country.

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.?

Edell doesn’t practice what he has preached, according to GTN: “In his writing and in news stories on television, Dr. Edell has condemned the unattributed use of video news releases -- ready-to-run stories produced by companies or government agencies looking for publicity.

In an opinion piece he wrote for the Knight Ridder news service in 1997, ‘Beware the Television Report of 'Important Medical Breakthrough,' ‘ Dr. Edell scolded health journalists ‘faced with shrinking budgets and staffs, pressure to produce more segments, and shorter deadlines’ who succumb to self-interested parties pushing ‘pre-packaged video tape complete with ready-made scripts.’ “

It’s worth noting that the main product of Ivanhoe – the company from which Edell’s station buys ready-made news – is called “Medical Breakthroughs.? But he was correct in his 1997 warning: this kind of "just-add-water" TV health reporting is proliferating.

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March 16, 2006

Crusading for colon cancer without evidence

Katie Couric and the NBC Today Show are at it again, with a weeklong series entitled "Confronting Colon Cancer," and a subtheme of "The Fight For More Screening."

I heard today's segment and do not yet have access to a transcript. But what I heard was a confusing jumble of recommendations - some of which included references to recommendations for screening everyone - and how cost-effective that could be. The CDC's Julie Gerberding talked about "evidence-based" recommendations on the same segment.

The fact is that there is NO evidence-based recommendation for screening the entire population before age 50. Evidence-based guidelines state that high risk individuals may derive benefit from screening before age 50, but there is no such recommendation for the general public.

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March 14, 2006

Cascade of cardiology stories

Sorry I've been a little slow with posts in the past few days.

First, there's digging out from under a foot of new snow in the Twin Cities.

Second, there's digging out from under an avalanche of cardiology-related news coming out of the American College of Cardiology meeting.

It reminds me of the excellent paper by Woloshin and Schwartz in JAMA a few years ago, "Media Coverage of Scientific Meetings: Too Much, Too Soon?". Their conclusion: "Abstracts at scientific meetings receive substantial attention in the high-profile media. A substantial number of the studies remain unpublished, precluding evaluation in the scientific community."

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March 9, 2006

More questions about TV health news

A study in this month's American Journal of Managed Care (not to be published online until next week) confirms some of what I've reported in earlier studies: local TV health news is troublesome. (The Milwaukee Journal Sentinel has a story on the study.)

Researchers from the University of Michigan and the University of Wisconsin-Madison analyzed one month of news coverage on 122 stations in the nation's top 50 media markets.

A Michigan news release states that: "The average story was 33 seconds long, and most did not give specifics about the source of the information presented. Items about specific diseases tended not to contain recommendations for viewers, or information about how common the disease was - which could help put the news into perspective with other health issues. But most disturbing, the study's authors say, were the egregious errors contained in a small minority of studies - errors that could have led to serious consequences."

One author said, "The fact that one of the most-covered stories in the study was about the removal of warts using duct tape, a topic which has questionable public health value, and that the story originated in a press release from a renowned medical journal, shows that we in the health community have work to do."

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March 4, 2006

Health journalists can't rely on the news release

CJRDaily.org features an interview with Wall Street Journal health columnist Tara Parker-Pope. The interview focuses on her opinion that "a flawed communications effort led to widespread misinterpretation of results by the news media and the public" regarding the Women's Health Initiative (WHI) and its findings on how low-fat diets, consumption of calcium and vitamin D, and hormone replacement therapy affect women's health.

In the interview Parker-Pope says, "I also think 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. I read the study first, because I don't want to be swayed by what the press release says. That's what you have to do with any kind of scientific research -- ask what is really being asked here, and how much is really being answered?"

She also says that science doesn't work in soundbites. "But I also think just because we have 15 seconds or 800 words or whatever the amount of time we have to tell our story, we still have to get it right. It's challenging but it's also what's kind of fun about being a health writer -- taking this really technical, complicated stuff and distilling it down into something that people can understand and use to make decisions about their health."

I'm part of a team that has been working for months on a system to evaluate and grade U.S. health news coverage of clinical research. A website displaying these evaluations will be launched in about a month. It's meant to support excellence in health/medical journalism, but also to help people become smarter consumers of news and of health care. More details on this website in the weeks to come.

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March 1, 2006

Ethical concerns about holes in the news/ad wall

The wall that once existed between news and advertising has many gaping holes in it.

The Bulldog Reporter's Daily Dog website says that some readers of the Charlotte News & Observer were bothered by the paper's handling of two pieces on the GlaxoSmithKline drug company this past Sunday.

The website says: "Big pharma giant GlaxoSmithKline got a lot of attention in last Sunday's News & Observer in Charlotte. On the front page was a story headlined, "GSK scientist pursues Alzheimer's treatment," that featured the pharmaceutical company's efforts to produce a breakthrough drug to treat or prevent the disease, reports Ted Vaden, a staff writer for the daily.

On the front of the Classified section was another story titled, "It takes a vast team to introduce a new drug." The story focused on the GSK drug Valtrex, used to treat genital herpes and other afflictions.

Even though one GSK story was in the news section and the other in advertising, their conjunction caught the attention of some readers.

"I was just blown away, as a consumer advocate, by the GlaxoSmithKline one-two punch," said Adam Searing, a healthcare advocate with the N.C. Justice Center. "The first was the real puff piece about an Alzheimer's treatment that's two or three years away. Then I opened the Sunday Classified and it seems like Glaxo has bought half the classified section, and it's not even identified as advertising. I don't think it serves your high standards to allow someone like Glaxo to have such an influence on the newspaper."

The paper says the Classified story was not an ad. It just looked that way to some. They say it was actually a story written by a freelancer hired by the advertising department. (Doesn't that make it an ad?)

A North Carolina ethics prof said, "I don't think the line between advertising and editorial is as clear in your readers' minds as it is in your offices."

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February 23, 2006

Milwaukee TV medical reporter canned

The Milwaukee Journal-Sentinel reports that WTMJ-TV in Milwaukee dismissed its medical reporter Kimberly Kane last week. Kane had worked at the station for seven years. The station’s news director did not respond to the newspaper’s e-mails asking about the reporter’s status.

The TV reporter told the newspaper in an e-mail: "When the most recent administration took over leadership of our newsroom, it was made clear to me their commitment to health was different. I was told to take my stories in a different direction: more controversies, more excitement . . . "

She said some of these changes made her "uncomfortable."

No one on the outside can judge a personnel matter. But her statement that management was pushing her toward more controversies and more excitement certainly aligns with what most of us receive in local TV health news – an abyss for consumers who need fact more than flash, who need evidence-based reporting more than emotion, who need health policy news more than breathless breakthrough gee-whiz gushing.

Incidentally, the station in question, WTMJ, is where I began my journalism career 34 years ago. The newsroom then had a bunch of veteran newspeople. Many were much older than anyone you see on the air today. They were much more than pretty faces. They knew the city and they knew its people and politics and budgets. They knew what viewers cared about and they reported what they needed to know – not what some consultant told them people wanted to see. They knew B.S. when they heard it. And they never – NEVER – followed what was in the newspaper. They originated their own stories. Show me a TV station that matches that description today. And never would someone have been canned because he/she didn't generate enough controversy or excitement in the news. But that was a long time ago.

Posted by schwitz at 7:27 AM | Comments (0)
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February 22, 2006

Twin Cities media ready to cure diabetes - even if the science isn't there yet

University of Minnesota researchers announced Sunday that they were able to reverse diabetes in monkeys by transplanting insulin-producing cells from pigs.

The Star Tribune's sub-head read, "A new study raises the potential for an endless supply of insulin-producing cells to cure the disease that affects 20 million Americans." Mind you, this work was done on a few monkeys. Yet the headline trumpets a potential impact on 20-million Americans. At least the first line of the story read, "They're not ready to try this with people yet. "

KMSP TV wrote "Scientists at the U of M are closing in on a cure."

WCCO TV wrote this was a "breakthrough that could lead to the end of injections for tens of thousands of diabetes patients."

KARE TV wrote "While many consider pigs a cure for hunger, they could also harbor the key to curing Type 1 diabetes."

The Pioneer Press headline read, "U finds pig cells can treat diabetes." Treat? Yeah, in monkeys. The story went on to say this development gives "renewed hope that a better treatment, or even a cure, may soon be available." Soon? The researcher says human trials are three years away. How would you define soon?

Read my "Seven Words You Shouldn't Use in Medical News.". Cure, breakthrough, and hope are all on the list. And I didn't create the list. Sick people provided the impetus. This important piece of diabetes research could have been told with a lot less sensationalism. The story didn't need it. Neither do sick people.

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February 14, 2006

Looking for conflicts of interest

The Center for Science in the Public Interest offers a newsletter called “Integrity in Science Watch.?

You can subscribe by writing to: science@cspinet.org.

Last week’s newsletter had this item:

New York Times Fails To Disclose Researcher's Ties to Antidepressant Makers

A new study published this week in The New England Journal of Medicine showed an increased incidence of lung disease in children born from pregnant women taking antidepressants like Paxil, Prozac, Celexa and Zoloft. While the New York Times report quoted a Food and Drug Administration official calling the results "very worrisome," it countered with study co-author Christine Chambers of the University of California at San Diego, who downplayed the risks. "We don't know for certain that the drugs actually caused persistent pulmonary hypertension, and that if they did, the risk is still low, about one in a hundred," she said. The Times failed to report that Chambers and her co-authors have numerous ties to pharmaceutical firms, including Barr Laboratories, Par Pharmaceutical, Teva Pharmaceuticals, Sandoz, and GlaxoSmithKline, all of which make at least one of the drugs in the test.

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February 12, 2006

"Baked Kolata, Hold the Caveats"

There’s a thoughtful news criticism piece on the CJR Daily website. It’s headlined, “A Heaping Serving of Baked Kolata, Hold the Caveats.?

It questions why the New York Times put on its front page Gina Kolata’s story on a study questioning the impact of low-fat diets on postmenopausal women. Meantime, the piece explains that the Wall Street Journal put the story “deep, deep, deep inside the paper. Specifically, under a one-column headline on page D5. And even though the Journal's article about the federal study was less than half as long as the Times' piece, it managed to bring to the topic twice the skepticism.?

The criticism concludes: “what a paper such as the Times chooses to include on its front page is at least as important as what it excludes. On this one, we recommend a little less Kolata in the diet, and a few more caveats.?

Veteran health journalists have not forgotten the Kolata page one hype of a “cancer cure? in 1998. For that background, see another Columbia Journalism Review piece. It provides one more piece for the archives of questionable editing at the Times (Judith Miller? Jayson Blair?).

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December 21, 2005

Top ten health/health care stories of 2005

The blog will be on hold for a few days over the holidays. But first, here is my list of the top ten stories in health, health care, medicine and science over this past year.

1. Conflicts of interest in health care, medicine, research (just one example: the recent news from the Cleveland Clinic)

2. Avian flu (including hype of unproven Tamiflu)

3. Medicare’s prescription drug benefit – “greatest advance for seniors in 40 years? or “a boondoggle??

4. Medicaid cuts – impact on states

5. Fallout from aggressive marketing of Cox-2 inhibitors

6. Science stifled by Bush administration

7. Drug prices continue to outpace inflation

8. Continued cost-shifting to employees (AKA consumer-driven health plans)

9. What’s going on at the FDA?

10. Lots of news about two people – Terri Schiavo and Peter Jennings – but relatively little news about 45-million Americand who are uninsured and perhaps twice that number who are under-insured.

A year from now, it would be terrific if the contents of this list would be markedly different.

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December 16, 2005

Kudos to ABC for primetime report on uninsured

A special tip of the hat to ABC News for last night's one-hour special, "Peter Jennings Reporting: Breakdown — America's Health Insurance Crisis." It was the last report Jennings worked on before he died.

"Over the course of Peter's long career at ABC News he made more than 60 prime-time documentaries, many of them covering public health issues. He had planned for this broadcast to be the first of a series confronting the problems in the American health-care system — a subject he believed was critical to all Americans," said Tom Yellin, executive producer of Peter Jennings Reporting.

With an estimated 45-million Americans without health insurance, it should not be unusual to see such primetime coverage of an embarrassing national issue -- but it is unusual.

While the report was not perfect (it lacked continuity, appeared to be glued together somewhat hastily after Jennings' death, and relied too much on too few interviewees), it was still television worth watching. Especially since the other networks at that time were airing "The Apprentice," and "Without a Trace."

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December 1, 2005

Gannett TV stations push profits and ethical limits

That troublesomely fuzzy TV ethics line just keeps getting fuzzier.

The Star Tribune reports on Minneapolis station KARE joining a list of other Gannett-owned stations around the country that charge advertisers to talk about their products on a talk show. Advertisers will pay KARE $2,000 to $2,5000 for 5-minute segments on the show. Station news veterans will host the paid-for appearances. My University of Minnesota colleague Jane Kirtley calls this a "logical extension of the whole pernicious practice of infomercials."

The Washington Times reports on that same Gannett trend and on an even more troublesome practice. The Times reports that WUSA in Washington charged the D.C. government as much as $100,000 a year to promote breast cancer awareness during the station's newscasts. So here's a station wrapping itself in the pink ribbon of breast cancer awareness while demanding a premium fee to do so.

Let me remind you: the Radio-Television News Directors Association code of ethics has clauses that dictate that professional electronic journalists should: "Not accept gifts, favors, or compensation from those who might seek to influence coverage; Determine news content solely through editorial judgment and not as the result of outside influence; 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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November 29, 2005

NBC Today show hypes medical technologies

This week the NBC Today Show offers a series the likes of which makes my skin crawl. With 45-million uninsured Americans, the Today Show reports on "Saving Your Life: Modern Medical Miracles." If a miracle were available but nobody could afford it or access it, would it still be a miracle?

Riding the appeal of reporter involvement, the Today Show had Matt Lauer get a 64-slice cardiac CT scan. The MSNBC website explains that the machine is made by GE. The website says: "GE Healthcare's LightSpeed VCT is the world's first machine that enables physicians to capture images of a human heart in just five heartbeats — something no other CT system can offer." The website does not remind viewers that GE owns NBC. But why bother with disclosure when we're talking about miracles? And why bother with a discussion of the arguments against using such scans in healthy people?

Then, in a segment entitled "Magic Pill Scans Your Insides," Katie Couric swallowed a camera-in-a-pill to show us more of her insides that you may have missed from her last colonoscopy on the air. There was only scant discussion of costs and insurance coverage and no meaningful discussion of why we needed such a camera-in-a-pill in our growing medical armamentarium.

Please bring back Dave Garroway and the chimp.

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November 28, 2005

How the media caught Tamiflu

A journalist bemoans the lack of skepticism in news coverage of Tamiflu in last week's edition of the BMJ.

"From a bit of a dud to the world's most sought after drug in the space of six months" is the way the writer describes Tamiflu's recent fate. "Despite a silly name and a lack of convincing evidence that it will have any real impact on an influenza pandemic, sales and recognition of the drug frequently dubbed 'our best hope against bird flu' have leapt through the roof."

He describes a British researcher who "routinely provides the media with positive comments about Tamiflu and has even appeared in promotional videos for the drug." Yet the man's ties to Tamiflu's manufacturer are rarely mentioned in the news. Another British researcher observes, "Perhaps the media should speak to more than one person when it's looking for comments or information. Somehow the mainstream media needs to think more on what it's going to do about this."

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November 16, 2005

News director responds to my criticism

Former WFLA-TV Tampa news director Forrest Carr wrote me a long e-mail criticizing my BMJ article of last week, in which I reported my analysis of 3 top TV stations' performance in covering (or not covering) health care reform or health policy issues in the 2004 election year.

It was an exhaustive analysis, in which I studied 326 hours of newscasts -- the stations' showcase late newscasts. But Carr wrote:

"Your conclusion that the local TV news media "don't want to cover" health policy stories based on a study of this one time period is not sound. WFLA-TV, for instance, does 5 hours of news each weekday. To make a broad conclusion about the station's overall journalistic efforts on any topic based on a study of that one unique 11 p.m. half-hour program is like studying the metro section of your morning newspaper to the exclusion of all else, then concluding on that basis that the newspaper doesn't cover national news. It just doesn't hold up. To claim that WFLA-TV covered "only three stories in ten months on Medicare, totaling less than 2.5 minutes" is flat wrong."

No one in TV news would dispute that their late newscasts are their showcases -- their money-makers. They want to put their best product on the air in those newscasts. Yet very little news about health policy or health care reform appeared in 10 months of these newscasts during an election year. The data don't lie, mislead or distort.

Carr also wrote: "...as long as we fund TV news the way we fund it now -- through advertising dollars awarded in proportion to the size of the audience attracted -- you're going to get what we've got, specifically, newscasts that balance public service against the business needs to grow ratings, with business needs usually taking priority. Even if you do manage to somehow force changes in the program to present more of the kind of content you and a thousand and one other special interest constituencies want and demand, unless you somehow manage to find a way to tie people to their chairs, you still can't make the public sit through it -- at least not in large numbers."

TV viewership has declined in most analyses. Maybe it would rise again if news departments -- and the corporations to whom they answer -- addressed vital citizen issues instead of some of the pablum they now put on the table.

I respect Forrest Carr as one of the good guys in TV news. He is smart and he cares. But it is the job of journalists to mirror and address the needs of the population. And health care reform is one of the biggest such needs. I don't represent any special interest constituency. But there are 40-million Americans without health insurance and millions others lost in a tsunami of confusion over Medicare and prescription drug testing/marketing/pricing issues. They deserve more serious journalism in the newscasts which TV stations hold up as their best.

TV stations don't own the airwaves. They've been granted a license to serve the audience. On this issue -- one of the most important facing the nation -- my analysis showed a failure to earn the license.

Posted by schwitz at 9:35 AM | Comments (0)
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November 7, 2005

Tamiflu hype

There's been too much hype about the antiviral drug Tamiflu as an answer to stopping an avian flu pandemic. U.S. Health & Human Services Secretary Michael Leavitt reminded Congress last week that Tamiflu has not yet been proven as a treatment for avian flu, adding, "Any sense that Tamiflu is synonymous with preparedness is wrong."

Posted by schwitz at 12:03 PM | Comments (0)
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November 4, 2005

TV news runs from healthcare reform news

See my article in the BMJ this week about the shameful performance of three leading local television stations as they failed to cover health policy issues in any meaningful way in the 2004 election year - on the local, state, or federal level.

I analyzed 10 months or 326 hours of late newscasts on award-winning stations in Seattle, Chicago and Tampa.

KIRO/Seattle had only three stories in ten months, totaling 79 seconds, on any aspect of the George W. Bush or John Kerry health proposals in the 2004 presidential campaign.

WMAQ/Chicago had nine stories, totaling less than four minutes, on presidential candidates health plans. WMAQ had almost twice that many stories (16) on low-carb diet stories, including commercial-like promotions for new low-carb products offered by Wendys, Kentucky Fried Chicken, Starbucks, and Jack Daniels.

WFLA/Tampa devoted only 84 seconds to Bush-Kerry health platforms in six stories. Serving the senior-heavy Florida Gulf Coast, WFLA managed only three stories in ten months on Medicare, totaling less than 2.5 minutes.

With 40-million-plus Americans uninsured, in 10 months these three award-winning stations reported only one story on the uninsured. It was about an uninsured man with melanoma who won a state lottery.

There are many in this country who now accuse the President of shifting the focus from bad news to better news. I submit that public officials are able to do that only to the extent that journalists let them. And these TV journalists let important health policy issues fall off the radar screen.

Posted by schwitz at 7:15 AM | Comments (0)
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October 30, 2005

Another ill-advised use of "cure"

When are journalists and scientists going to learn? "Cure" just isn't an acceptable term to use in describing test tube research, unless you're talking about a new way to treat ham.

An Associated Press story Friday began: "Scientists at the University of Michigan Medical School are part of a team that has discovered a possible cause of prostate cancer, a finding they say could result in better forms of treatment or possibly a cure."

Maybe this is an important finding. Maybe years from now it will lead to a treatment. But cure? It's a bit premature to talk about possible cures when you haven't even treated one person based on the new finding.

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October 21, 2005

New Herceptin study > new hype

Herceptin has been used to treat advanced breast cancer, but three New England Journal of Medicine articles this week suggest the drug could work against an aggressive early-stage breast cancer.

Some news stories allow researchers (including a National Cancer Institute researcher) to use words like "cure" in describing the drug. Other experts were quoted calling the latest studies on the drug "revolutionary...stunning...jaw-dropping." And some stories didn't challenge those claims or that language.

But Rita Rubin of USA Today included caution in her story: "Barbara Brenner of Breast Cancer Action, an education and advocacy group, called use of the word 'cure' in this case 'outrageous,' because the studies on average followed women for only a year or two."

In the San Jose Mercury News, Brenner was quoted again: "The annals of breast cancer are filled with stories like this one in which the hype hurts thousands of women and their loved ones."

Jeff Donn of the Associated Press had a quote in his story: "I think it's way too soon to talk about a cure,'' said Debbie Saslow, director of the breast cancer section of the American Cancer Society."

Good science doesn't need hype. Good drugs need to stand the test of time. Thank goodness some journalists are countering the hype that they're encountering and concentrating more on evidence than emotion and excitement.

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October 12, 2005

Tone down the stem cell hype

The University of Minnesota issued a news release this week reading, in part: "For the first time, stem cell researchers at the University of Minnesota have coaxed human embryonic stem cells to create cancer-killing cells in the laboratory, paving the way for future treatments for various types of cancers (or tumors). The research will be published in the October 15 issue of the Journal of Immunology."

Local media picked up the story, including a WCCO report that said, in part: "Researchers expect to begin testing on animals within a couple of months, but it will be a few years before the research will be tested on people. The research will be published in the Oct. 15 issue of the Journal of Immunology."

If such a result had been reported by the University of Wisconsin or the University of Iowa, you can bet that WCCO would not have reported on it. Tell me the last such study they reported on from the Journal of Immunology. But because it was local, it was newsworthy. I don't buy it. It was a preliminary finding in lab dishes -- not even in mice yet. Good science, no doubt. But let's apply consistent news judgment to such preliminary science stories.

KSTP reported: "Researchers at the University of Minnesota have made progress in fighting cancer." That's hyperbole. They made progress in a test tube. Nothing has yet been shown in people -- not even in mice.

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October 5, 2005

A different kind of awareness for Breast Cancer Month

Canadian drug policy researcher Alan Cassels observes October as breast cancer awareness month by analyzing the hype of breast cancer drug Herceptin. He writes: "The media pushed the glee meter into the red zone, with words like 'breakthrough,' 'wonder drug,' and 'impressive advance,' overblown, laudatory adjectives that I admonish journalism students to strenuously avoid."

Cassels concludes his column: "We all want new and better breast cancer treatments, but that doesnt mean we should allow selective and misleading reports of a drugs benefits to drain our public health care system of precious dollars, and put suffering patients on a roller coaster of hope and despair."

Posted by schwitz at 8:34 AM | Comments (1)
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September 19, 2005

Incomplete story on digital mammograms

Many news stories on last week's study on digital mammography in the New England Journal of Medicine were shallow and incomplete.

Many ran with a single theme that digital mammograms are 15% to 28% more effective than traditional film mammograms in the detection of breast tumors in women younger than age 50, women with dense breast tissue and pre- or peri-menopausal women.

But I didn't see any stories questioning how many cases of DCIS or ductal carcinoma in situ were picked up by digital mammograms. This pre-cancerous, pre-malignant "non-invasive" condition leaves women and their doctors in a quandary about treatment options since it's not known how many stay non-invasive and how many go on to become invasive. If the new technology picks up more of these cases, it may be a double-edged sword.

Few stories carried any skepticism such as that reported in the Washington Post by a spokesperson for the National Breast Cancer Coalition: ""I think it is very misleading to tell people that digital mammography is a better alternative. We don't know that yet. Catching more cancers doesn't necessarily mean you're going to avoid more deaths from breast cancer"

Posted by schwitz at 11:54 AM | Comments (0)
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September 12, 2005

Dumbing down science news

A funny, witty column on medical science news coverage appears in the British paper, The Guardian.

The author writes about the three types of science stories: wacky, scare and breakthrough. Their central theme? There is no useful information in most science stories. Read the article to hear the columnist's ideas on why this happens.

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September 5, 2005

TIME's heart cover story raises serious ad/news questions

TIME magazine must be very happy with whatever deal it struck with Pfizer for advertising in the September 5, 2005 cover story, How To Stop A Heart Attack.

But let me count the ways this story and the ads bother me:

1. Inside of the cover story article is a fold-out three-page ad spread for Lipitor, a statin drug made by Pfizer. Thats a fold-out right in the middle of the editorial content. What wall between editorial and sales is supposed to exist?

2. The ad says, Reduce your risk of a heart attack by 36% if you have multiple risk factors for heart disease. OK, but thats 36% of what baseline risk? This is another abuse that happens when journalists or advertisers cite only the relative risk, not the absolute risk. Could it be a change from 3 in 100 to 2 in 100? Thats about a 36% relative risk reduction. But only a 1% absolute risk reduction, not quite as impressive. People selling drugs tend to use only relative risks for obvious reasons.

3. Three pages later is another Lipitor ad citing the same 36% risk reduction statistic and the ad even says, Its certainly worth repeating. I would say its certainly worth clarifying and telling the whole story. This second ad also appeared within the body of the TIME cover story.

4. On the next page is a story that asks readers, Do You Know Your Calcium Score? under the heading The Newest Risk Factor. Since when? Which evidence-based scientific body proclaimed a calcium score as a new risk factor? And at what level? While the sidebar does contain some caveats, its hard to get past the disease-mongering style of the headline, implying that readers should, indeed, run off to be tested to find how much calcium is in their arteries. Maybe it'll even lead to a new prescription for Lipitor.

5. Six pages later in the same issue is a Pfizer ad announcing that it sponsors the Paging Dr. Gupta program on CNN. TIME and CNN are owned by the same conglomerate. (21 pages later in the same issue is a Pfizer ad for Viagra. Must have been a red letter day for the sales department!)

6. Four pages later in the same issue is an ad pointing readers to a Pfizer-sponsored section on the TIME website, time.com/heart.

7. When I went to that site, I found 3 ads for, or mentions of, Lipitor, Pfizers statin heart drug, on the home page. I found stories, one five years old, praising statins. This story used only relative risks in saying that statins had been proven to reduce deaths among heart attack survivors by 40% (40% of what?).

Commercialism in the spread of health and medical news is, I believe, the most disturbing trend in health journalism. This TIME cover story is a prime example.


Posted by schwitz at 3:29 PM | Comments (0)
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August 31, 2005

Is AP Radio inviting fake radio health news?

A friend sent me a notice found on the Bulldog Reporter website, which is designed to help public relations people pitch their stories to journalists.

The item was entitled, "AP Radio Welcomes News and Information Related to Healthcare, Eldercare." It appears to be a clear invitation to PR people to send audio clips along with news releases because that might improve their chances of getting their message on the air.

The notice read: "Include audio in your release. New technology allows AP Radio to put more natural sound into news reports, and this allows for new PR opportunities. "Provide bits and pieces of your news release in audio," AP Radio news general manager Thomas Callahan suggests. "Everyone sends printed releases, but attaching an MP3 with excerpts might attract attention."

It is surprising to see such an open invitation from a journalism organization to PR people, especially given the myriad concerns raised in recent months about the dissemination of video news releases in TV news. How will listeners know which audio clips and which stories came from the work of independent journalism, and which came from a source hawking a product or some other vested interest?

By the way, the notice bragged that AP's radio division serves more than 4,300 stations with text, audio and/or web content, reaching more than 1 billion people around the world who see or hear an AP story every day. And now that may be more than 1 billion people every day who hear unfiltered PR hype.

Posted by schwitz at 9:16 AM | Comments (0)
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August 17, 2005

Flaws in peer review

The Boston Globe offers a good look at how peer review of medical research by medical journals is not perfect.

In the Globe: "Now, after a study that sent reverberations through the medical profession by finding that almost one-third of top research articles have been either contradicted or seriously questioned, some specialists are calling for radical changes in the system."

The Globe says it is difficult to discover what goes wrong in peer review when it does go wrong, largey because "peer reviewers are unpaid, anonymous, and unaccountable. Moreover, their reviews are kept confidential, making it impossible to know the parameters of the reviews."

The take-home message for journalists and consumers is: if you're going to treat each journal article as gospel, you're putting your faith in a flawed process.

Posted by schwitz at 7:54 AM | Comments (0)
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August 16, 2005

Doctor/"reporter" sells cream on QVC

Unbelievable.

The Pittsburgh Post-Gazette reports that a KDKA-TV medical "reporter," who is a physician, was "peddling Joint Formula 88 joint pain relief cream ($21.90) on QVC." Worse, if it can get worse, is that the cream is his product.

Did anyone talk to this guy about journalism ethics before hiring him?

I just spoke to a group of California journalists about the entanglement of conflicts of interest in the dissemination of health news and information. My recurrent message to them is what I would tell this "M.D.-reporter" -- YOU HAVE TO DECIDE WHETHER YOU'RE GOING TO BE A JOURNALIST OR A PR-ADVERTISING PERSON. You can't do both.

Add this egregious example to the long list of commercialism and conflict of interest incidents in journalism which I previously reported.

Posted by schwitz at 7:56 AM | Comments (0)
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August 15, 2005

Nailing a story

Often I criticize health news coverage in this blog. Today, I praise a reporter for nailing a story.

Andre Picard of the Toronto Globe and Mail hit a home run with his story, "Be Skeptical About the Herceptin Hype."

Herceptin is a drug intended for certain types of breast cancer. Picard writes:

"The most eye-popping claim is that, for this select group, the drug cuts the risk of recurrence by half. In clinical trials, women who took Herceptin along with a standard chemotherapy drug saw their risk of recurrence fall 52 per cent, compared to women who received chemo alone. That is an impressive relative risk reduction.

But what matters in the real world is absolute (not relative) risk reduction. Practically speaking, 15 per cent of women taking Herceptin and chemo had a recurrence of breast cancer within four years of diagnosis, compared to 33 per cent of women who took chemo alone. That is an absolute risk reduction of 18 per cent.

Nobody wants a recurrence, but what matters ultimately is survival. Herceptin, according to the studies, cut the death rate by one-third. That sounds impressive, but relative risk reductions always do. In reality, the difference in the death rate between the Herceptin and non-Herceptin groups was 2 per cent after three years, and 4 per cent after four years.

Based on those numbers, can we honestly say that Herceptin is an essential lifesaving drug?"

If more reporters knew the difference between relative and absolute risk, and reported the difference, we'd have a lot less hype in health news coverage.

Posted by schwitz at 7:26 AM | Comments (0)
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August 10, 2005

Need facts, not emotion, in disease awareness campaigns

Suddenly lung cancer is a hot topic in newsrooms. Peter Jenning dies one day. The next day Christopher Reeve's widow announces she has lung cancer. So it is understandable that some well-intentioned "disease awareness" efforts would come forward.

But journalists should employ facts and full disclosure when giving attention to such disease awareness campaigns. (The "Selling Sickness" book by Moynihan and Cassels gives many reasons why.)

CNN gave several minutes of airtime yesterday to a founder of the group, Women Against Lung Cancer. The network never revealed that the group receives financial support from the drug industry -- from makers of lung cancer drugs. But CNN also allowed the guest to talk about "studies looking at special spiral CAT scans of the chest so that we can pick up tiny nodules, hopefully before they have a chance to get into the bloodstream and spread." What neither the guest nor CNN disclosed is that many scientists don't think there is proof that such scans prevent premature death. And many see risks in such screening, even the possibility that they do more harm than good when scans lead to unnecessary followup testing that carries its own risk. That's why they're doing the studies. It's not a slam dunk that benefits will outweigh risks.

Those would have been balanced facts to present. Not just the promise of early diagnosis discussed during the emotional reaction to two celebrities' diagnoses.

When you hear about "disease awareness" campaigns, always look for facts in context and full disclosure.

Posted by schwitz at 8:05 AM | Comments (0)
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August 9, 2005

Selling Sickness

I just finished reading an important new book, "Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients," by Ray Moynihan and Alan Cassels.

It documents disease-mongering, how drug companies foster the creation of medical conditions to create markets for their pills, the marketing of fear, the "medicalization" of normal states of health, the hidden agendas of "disease-awareness campaigns," problems with drug company relationships with celebrity spokespersons and patient advocacy groups, and other issues about which most consumers don't have a clue.

As one skeptic says in the book, "We're changing the experience of what it means to be human."

It also points to numerous instances of what the authors call "sycophantic media coverage" and an "indictment of the flaccid culture of much medical reporting."

I highly recommend the book.

Posted by schwitz at 12:22 PM | Comments (0)
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August 6, 2005

Can't mix news and PR jobs

This is becoming a recurring theme: journalists working in news rooms while also doing paid public relations work.

A Minneapolis-St. Paul TV anchor did it.

A Nashville TV reporter did it. (Although she called me yesterday to explain that she's not doing it anymore.)

And now Detroit Medical Center announced that it has named a former WDIV-TV anchorman to be its communication director, "providing guidance on media issues and serving as a principal spokesperson" for the medical center. That's fine. But in the next breath, it's revealed that the anchorman also has a long-term agreement with WDIV-TV to produce periodic in-depth documentaries for this Detroit-based NBC affiliate.

How does the audience know which hat the anchor/PR man is wearing at which times?

As critics said at the time of the Minneapolis incident cited above, journalists who cross these lines between journalism and public relations raise warning flags. Questions of credibility, conflict of interest (real or perceived), and truthfulness arise when you're being paid by someone to make them look good in the media -- at the same time you're supposedly being an independent, objective journalist in other venues.

Posted by schwitz at 8:31 AM | Comments (1)
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August 3, 2005

Stem cell superlatives without caveats

ABC World News Tonight broadcast a story last night, a portion of which is captured on their website, about patients' own stem cells used to build new blood vessels.

It is interesting clinical research, but the story offered only breathlessly optimistic projections -- no caveats, warnings, unknowns or uncertainties. An excerpt: "Results in more than 100 patients show that, within just three months after the stem cell injections, patients see a significant improvement in blood flow to the heart. The heart muscle itself actually doubles its ability to squeeze or contract.

The short-term results (3 months) send up one red flag. Another is the use of what are called surrogate endpoints. In other words, rather than reporting that people lived longer (which of course would be a pretty empty projection after only 3 months), they reported a different marker or endpoint to measure "success." That is, blood flow to the heart.

But the coup de grce comes with the next line of the story: "Researchers say these adult stem cells might help tens of millions of heart patients each year."

Or, the story could be just as true to the facts and conclude, "Maybe not." The science behind this work holds great potential. It doesn't need hyping of short-term research measuring only surrogate endpoints that extrapolates these early findings to tens of millions of people.

Posted by schwitz at 7:59 AM | Comments (0)
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July 27, 2005

Roles and responsibilities of health journalists

Eight authors, including me, discuss the roles and responsibilities of journalists who disseminate health information in a PLoS Medicine special edition.

PLoS Medicine is a relatively new peer-reviewed open-access journal.

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July 26, 2005

Commercialism in TV health news

See my article on the Poynter Institute website, documenting perhaps the most disturbing trend in television health news coverage today.

Posted by schwitz at 8:18 AM | Comments (0)
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July 13, 2005

Journalists shouldn't live by weekly journals

A review in JAMA shows that journal article findings that a treatment worked were contradicted 16 percent of the time by later studies. And another 16 percent of the time, studies found weaker results than earlier suggested. So nearly a third of original published results did not hold up to further scrutiny.

Dartmouth and VA researchers Steve Woloshin and Lisa Schwartz have warned about news coverage that is "Too Much Too Soon" in coverage of presentations at scientific meetings.

For those journalists who live off weekly journals for their stories, and who fail to follow up on subsequent findings, the same "too much too soon" message is valid.


Posted by schwitz at 9:02 AM | Comments (1)
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June 30, 2005

Separating the puppets from the pros in TV health news

See my article on the Columbia Journalism Review's CJR Daily website.

In recognition of the sorry state of television health news, it's a call for certification of TV health reporters. TV meteorologists get certified by the American Meteorological Society after they prove some level of knowledge and skill. But the audience doesn't know anything about the credentials of the people who forecast cures, breakthroughs and health scares. Read my rationale in the article.

Posted by schwitz at 7:50 AM | Comments (0)
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June 24, 2005

TV news doesn't cover health policy news

40-million uninsured Americans. 15 percent of the GNP spent on health care. Medicare in trouble. States squeezed to manage Medicaid. Just a few things in the news, yet local TV news doesn't find time for many of these issues.

See my J school's summer magazine for a glimpse of my 2004 election year research on TV news health policy (non)coverage, and for a look at some of my colleagues' health communications research interests.

Posted by schwitz at 8:56 AM | Comments (0)
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May 26, 2005

WebMD story hypes Levitra

WebMD posted one of those stories that makes my skin crawl. The formula: use a cute, sexy headline and lead sentence, then follow with weak caveats, leaving the reader with nothing useful at the end.

The story is headlined, "Levitra a Day May Keep the Doctor Away." It promotes Levitra use with its lead sentences, "Men now have two new reasons to take erection-enhancing drugs every day. Those reasons: The drugs may lower a man's risk of heart disease and of noncancerous prostate symptoms." But then it follows with, "This provocative speculation is based on short-term data from a small study." And it ends with, "But it's not yet time to start popping those little pills along with your daily vitamins. The study findings... are preliminary."

How do you justify the headline and the lead with the caveats? And this story was reviewed by a physician? Perhaps the editorial and physician review team need to be reminded of the number of preliminary findings presented at scientific meetings (as this was) that never pan out. And when that happens, journalists like these aren't around to correct the record.

Chalk it up as a waste of time and space. Come back when you have large-scale, long-term findings to report.

Posted by schwitz at 8:43 AM | Comments (0)
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May 13, 2005

Caveat Viewer

Jessie Gruman, Ph.D., of the Center for the Advancement of Health, offers a column on the dangers of television health news and information. Excerpt:

In Oklahoma City, a popular new local television program based on the ABC networks Extreme Makeover takes women eager for a new look and sets them up with plastic surgeons, Lasik practitioners and cosmetic dentists.

In Baltimore, a local news program airs community service features about new developments in pediatric care and womens health.

In Washington, D.C., a station gravely reports on the prognosis for Peter Jennings (who airs on a competing channel) and then suggests free CT lung scans at a local hospital for long-time smokers.

What is wrong here?

In the first instance, the makeover artists are licensed health care practitioners and a university medical center paying for the right to inflict medically unnecessary and risky cosmetic surgery. In the second instance, two large hospitals one a university medical center are buying time on the newscast with the hope of luring high-paying or well insured patients to boost the bottom line in a competitive market. In the third case, viewers are not told that the free lung scans are part of an international clinical trial that by its very nature entails some measure of risk.

It would seem there is another health risk at work here the local broadcast news media.

Posted by schwitz at 7:58 AM | Comments (2)
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May 11, 2005

Journalists suggest scientists know more than they do

Three of my former Dartmouth colleagues published an excellent review in the Washington Post on how news coverage last year "probably misled readers about both the size and certainty of the benefit of aspirin in preventing breast cancer."

More than just pointing a finger, the researchers explain how the research was misinterpreted and offer some lessons about interpreting medical research.

Since they cite stories that appeared in the Washington Post, the Wall Street Journal, the New York Times, USA Today and the major television networks, it is a lesson worth learning.

Posted by schwitz at 7:56 AM | Comments (0)
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May 3, 2005

Reporters are not the story

Old school journalistic values are still important: its vital to try to preserve objectivity and distance from your subject and sources. You may not always achieve it, but you dont throw these values away willy-nilly.

Then comes TV news ratings/sweeps periods.

KSTP-TV in Minneapolis began a two-part series on one of their reporters ovarian cancer last night, two days into a new ratings period. Im quoted in the Star Tribune criticizing the decision. Station executives use predictable defenses to justify their decision.

Whats not in the paper are some of my other concerns:

1. Who says her case is representative of other cancer patients or even of other ovarian cancer patients? Then why is it newsworthy?
2. Why is it newsworthy? What editorial decision-making took place to lift her story to air worthiness? Whats the last story they did on ovarian cancer? Does it take someone on the on-air staff being diagnosed with something to get a station to report on it? What were the factors that made this newsworthy?
3. In weighing newsworthiness before a sweeps period, did they give any thought to covering the 20-30,000 Minnesotans who might lost MinnesotaCare coverage under current legislative proposals? Are the 30,000 less important than the one in-house story?
4. The station says that there is important public education to be achieved by publicizing such a case. If thats so, what was the last story they did on ovarian cancer prior to this?

This is not an isolated case. Its just the latest of many, in which TV people think their celebrity status is at such a level that their stories rise to newsworthiness, whereas the plight of the great unwashed remain unknown.

Posted by schwitz at 6:52 AM | Comments (0)
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May 2, 2005

CNN fails straight facts on gay foster parents debate

CNN, in a new struggle with the definition and practice of credibility, played matador in allowing questionable statistics on the air in a debate over a Texas legislative move to prevent same-sex couples from becoming foster parents. CNN allowed a supporter of the legislation to claim that research showed that children in foster homes with same-sex parents are 11 times as likely to be sexually abused as those with heterosexual parents.

The Numbers Guy column in the Wall Street Journal nailed the shady stat: To get on CNN, that number snaked through a twisting path, from a little-noticed Illinois study published by an antigay scientist/activist in a psychological journal, to several conservative Web sites, to, finally, the attention of a Texas activist who presented her misinterpretation of the study on national television, essentially unchallenged. It's a textbook example of how flawed numbers can gain national attention if advocates work hard enough -- especially when there aren't widely-known conflicting estimates.

The CNN anchor, supposedly moderating the debate, allowed the claim to go unchallenged. Jon Stewart of The Daily Show showed up CNN by capturing the moment on the air, and archiving it on his website (see Gaywatch video section).

Posted by schwitz at 7:41 AM | Comments (1)
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May 1, 2005

Hyperbole's new heights (or depths)

When one reader saw my posting about CNN's declaration that a pediatric surgeon was a "god" doing "miracles," he referred me to a similar story in the Onion, entitled "Amazing New Hyperbolic Chamber Greatest Invention In the History of Mankind Ever."

Read it. It may remind you of something you've seen in TV health news.

Posted by schwitz at 8:27 AM | Comments (0)
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April 28, 2005

Deifying a doctor; fawning sensationalism

Excerpt from the Paula Zahn Now program on CNN from last Wednesday, April 20:

"Reporter" Sharon Collins had the People in the News profile of a pediatric heart surgeon.

Zahns intro said the surgeon performs small miracles for desperate parents.

Collins, early in the piece said, That man is Mohan Reddy or as many parents call him, the miracle man.

Collins question: When people call you miracle man, how does that make you feel?
Reddy answer: I tell them miracles are only done by gods.

Collins track: "But in the surgical theater, Reddy is a god."

Collins question: Im looking at this tiny baby with little bitty hands and you operated on his heart. Werent you scared even a little bit?
Reddy answer: No I really was not scared.

Late in the piece, Collins said Reddy doesnt like being called a miracle man.

Paula Zahn tag: He may not want to be called a miracle man but as you can see, he is one.

If you're scoring at home, that's Miracles 6, Gods 2, Audience 0. This is fawning sensationalism of the worst kind.

Posted by schwitz at 7:11 AM | Comments (1)
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April 25, 2005

Alzheimer's gene therapy hype

This story appeared in my local paper today: "The first attempt at gene therapy for Alzheimer's patients appeared to significantly delay worsening of the disease in a few people who have tested it so far. Scientists took skin cells from eight patients in the early stages of Alzheimer's and modified the genes to secrete a protein found in healthy brains called nerve growth factors or NGF. They then implanted the NGF-producing skin cells directly onto Alzheimer's-injured spots. Six patients were tracked for almost two years. Tests found their rate of cognitive decline slowed by 36 percent to 51 percent, better than is usually seen with medication."

How do I criticize thee? Let me counts the ways.

1. This brief omitted the critical cautionary second sentence of the original AP story: "Far more research is needed to see if the experimental treatment, which requires a form of brain surgery, really helps."

2. It omitted the following cautionary quote from the original AP story: "These results need to be interpreted with cautious optimism," said William Thies of the Alzheimer's Association. With so few patients in the study, "it's really impossible to tell whether the benefit was due to the treatment or natural fluctuation in symptoms," he said.

3. It omitted the following cautionary quote from a researcher involved in the work: "It's cautious optimism with a big C. It can't be a cure, obviously ... but maybe it'll do something."

Posted by schwitz at 7:36 AM | Comments (1)
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April 22, 2005

Broadcasters should have to disclose all commercial sources

At a panel I organized and moderated entitled "Creeping Commercialism in TV News" at the Broadcast Education Association conference in Las Vegas yesterday, WFLA-TV Tampa news director Forrest Carr called for FCC regulations requiring stations to disclose any commercial source of guest interviews, video, or on-air information.

He said what the FCC recently stated regarding video news releases disclosure (see April 15 entry on this site) must be duplicated and expanded when it comes to news show or talk show guests representing drug companies or other interests. Disclosure, he says, must be legislated. It is the only way to turn around an ugly situation in television news.

Carr also constructively criticized my panel title, saying there's nothing "Creeping" about commercialism in TV news. It is, he said, already rampant.

Posted by schwitz at 9:01 AM | Comments (1)
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April 18, 2005

Confessions of a VNR user

The Post-Standard of Syracuse profiles a local TV station that used a Medicare video news release in February.

How did it happen? The general manager says since they got it from the CNN Newsource news feed, they thought it was legitimate news. CNN's Newsource transmits not only news but news releases to subscribers around the country. He says the Medicare VNR was not clearly marked as such. The GM also said his station added its own narration to the Medicare-provided video.

But John Stauber of the Center for Media and Democracy in Madison, a nonprofit media watchdog group, says taking someone else's reporting and pretending it's your own is plagiarism at the very least.

Posted by schwitz at 7:51 AM | Comments (0)
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March 17, 2005

Why so much hype for one procedure?

The New York Times and at least one television network newscast profiled a first-of-its-kind aortic valve implant done through a catheter feeding the device through a vein in the patient's leg rather than by open heart surgery.

Why such hype? As the Times reports, the operation was the first of at least 150 that federal regulators will require before considering approval of the technique for widespread use.

If the trial fails, will the story get this much coverage? Why can't we wait until there's some evidence?

And costs? The new valve implants are expected to cost between $10,000 and $12,000, which is double the price of surgically implanted valves.

Posted by schwitz at 3:20 PM | Comments (0)
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March 2, 2005

Beyond cures, breakthroughs and news releases

Please see my article on the Poynter Institute website today.

It touches on cheerleading in coverage of health news, on commercialism in health news coverage, on widespread conflicts of interest in the dissemination of health news, on the power of words in health news, and on some of the good things being done to improve the state of health journalism.

Posted by schwitz at 7:38 AM | Comments (0)
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January 5, 2005

Journalists: how will states handle Medicaid this year?

Journalists should scrutinize their state legislatures' handling of Medicaid in 2005. Feeling squeezed by the feds, states are caught in a bind. Minnesota Public Radio quoted the state finance commissioner: "Health and human services is growing 20 percent from one biennium to the next. We don't have revenues growing at that rate. And that's a large portion of our budget. And so that's an unsustainable kind of growth in a spending program."

A Star Tribune editorial says that health care cuts made in the 2003 Minnesota state budget didn't save the state very much. Costs that came off the state budget were simply shifted onto someone else.

When is the last time you saw a story on health care cost-shifting in your local news reports?

Posted by schwitz at 4:34 PM | Comments (0)
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December 21, 2004

Journalists (and scientists) should use absolute risks

Stories like today's about naproxen causing "a 50 percent greater risk of heart attacks and stroke than placebo" can be meaningless if they don't provide the ABSOLUTE risk. The 50% figure is the relative risk -- naproxen's rate relative to placebo. But we're not told the ABSOLUTE rate: how many people actually had heart attacks and strokes in each group. The difference could be very small if the ABSOLUTE numbers are small.

But it's not just journalists who fail to give the absolute risk figures. The New York Times reports that those making the naproxen announcement yesterday would only say that 70 people out of 2,500 in the study experienced heart attacks and strokes. They would not give the numbers for each group. You can do the math to figure it out, but consumers shouldn't have to do the math. Government officials and journalists should help.

Mea Culpa Disclosure: I violated the absolute risk tenet myself in my Dec. 17 entry when I wrote, "Pfizer has stopped a clinical trial for its blockbuster drug Celebrex because it was shown to cause 2.5 times more heart attacks than did placebos."

Posted by schwitz at 9:37 AM | Comments (1)
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December 6, 2004

Ten Troublesome Trends in TV Health News

See my review article in this week's British Medical Journal.

http://bmj.bmjjournals.com/cgi/content/full/329/7478/1352


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