I love it when I see smart people blogging their critiques of health care news coverage. So I say "Hallelujah" in response to a hospital-chaplain-blogger's rant about a news story run by CNN and Health.com that made his skin crawl.
Recently in Disease mongering Category
A Bloomberg story reminds us that 6 years ago journalist Ray Moynihan in the British Medical Journal called female sexual dysfunction (FSD) "the freshest, clearest example we have" of a disease created by pharmaceutical companies to make healthy people think they need medicine.
Now that the Boehringer Ingelheim drug company has announced results of a trial of its female libido drug, flibanserin, the disease-mongering is in full bloom again.
Some journalists injected some skepticism - like Susan Perry of MinnPost.com in her article:
"The bitter irony of the FSD controversy, says the Guardian's Ottery, is "the disempowering message that women who are having sexual problems are all ill."
For women, one of the primary causes of loss of sexual desire is "relationship issues," she says, "so feeling empowered to communicate what you want could be crucial in resolving this. Nevertheless, some women will want a magic bullet solution to their sex life problems. It is a tempting idea in our time-poor lives to pop a pill and not take the time to work out the root cause of issues and address them."
As I said, get ready for more annoying commercials."
And get ready for more annoying news stories. The Newark Star-Ledger bombed on the story, in our reviewers' opinions:
• No cost data was provided for flibanserin. But an estimate of the potential U.S. market, up to $100 million in sales, was given. Those sales estimates had to be based on some price assumptions. What where they? It doesn't seem that you should provide the one number without providing the other.
• This story misses the mark by failing to address the larger issue of whether acquired hypoactive sexual desire disorder in pre-menopausal women is a condition being promoted by pharmaceutical manufacturers to create a market for a new drug and to sell more drugs.
• This article cites very little medical or scientific evidence. The story should have noted that more reliable information would have come from more rigorous research published in peer-reviewed scientific journals.
• No adverse effects of the drug were reported in the story. Safety data reported indicates that potential side effects include dizziness, nausea, fatigue, somnolence, and insomnia.
• Most of the benefits reported in the story were described in general, lay terms: having more sex, wanting more sex and experiencing less distress related to lack of desire. The story should have placed any benefits in context and noted that while results were statistically significant the medical or individual significance appears to be quite small. For example, the story should have noted that women taking flibanserin had an average increase of 1.7 "sexually satisfying events" over the course of 6 months compared to an average increase of 1 event in women taking placebo.
Leave me alone, LifeLine Screening!
They're at it again, with their direct-mail disease-mongering, telling me I need to have their screening tests if I want to be proactive about my health.
I don't want your tests.
I don't want your mailings cluttering my mailbox. Especially when this letter didn't even come from Peggy Fleming, whose name was on the last one.
Consumer Reports' terrific series of drug adwatch videos added a new one last week - and this is one of my favorites.
The same PR company that I've asked to remove me from their mailing list, which is the same PR company that sent me the news release on airplane seat covers to prevent disease, has now sent me another.
This one is even better (worse?). It tells me:
- that 20 million women are affected by unwanted hair in places where only males should have it!
- That it's an actual syndrome with a real big name.
- That they represent a doctor who can actually treat this problem with bioidentical hormones.
- And that they can arrange an interview for me with that doctor - can you imagine that? And they can arrange a patient interview as well. Gee, I wonder if that will be a happy patient.
I've decided I'm going to write about this company's unsolicited junk mail to me until they stop.
Oh, the PR company is called 5WPR.
They're probably happy about this: they can now claim "another media impression!"
I've asked a PR company to take me off their mailing list. They haven't done so.
So they asked for it. Today I got this dastardly piece of disease-mongering in the form of a news release in the mail. It reads:
It's the sniffles, tics and lice or even a far more serious disease--vulnerability while traveling has prompted fear within those bound for public transportation. Searching for an option to keep people safe and protected, Sure Fit, the nation's leading slip cover and accessories provider has created the newest must-have item to ease fears of catching the flu en route with the Transit Cover.
"Sniffles, tics and lice or even a far more serious disease!"
Be very afraid.
And then buy our product.
Gag me. I hope their campaign fails and their client's sales plummet.
An interesting story on a condition called FMD, or fibromuscular dysplasia, soon tumbled into an exercise in disease-mongering. Excerpts:
"I believe that a large number of Americans have FMD," says Jeffrey W. Olin, director of vascular medicine and a professor at the Mt. Sinai School of Medicine in New York City. "It's reasonable to say that many thousands could be saved from complications like heart attack, stroke, ruptured aneurysm and even death, by screening patients."
...Dr. Olin has prepared a top-10 list of doctors' misconceptions and missteps. They include, "Telling patients that the symptoms are all in their head. Telling patients that FMD is a rare disease. Telling patients with severe headaches with FMD that there is nothing that you can do for them."
..."Three to five percent would be a very reasonable estimate in the general population for FMD," says Thom W. Rooke, vascular medicine professor at the Mayo Clinic. That works out to there being possibly 10 million Americans who have FMD, he says. By comparison, an estimated 3 million Americans have epilepsy, 2.5 million have breast cancer, more than 2 million have schizophrenia and 725,000 have melanoma.
Dr. Rooke says many FMD patients might never have symptoms, and only a few are likely to experience severe problems. But, he says, many "vascular catastrophes," such as heart-rhythm deaths and strokes in young people, may stem from FMD.
The screening assertion is never clarified nor challenged. It is just left hanging out there: maybe 10 million Americans with this silent problem. If only we screened for it!
Whom would you screen?
When would you start?
What's the number needed to screen in order to prevent one event?
What evidence is there for effectivness of such screening?
The WSJ reporter in question has done this kind of story before - pro-vascular-screening advocacy without the perspectives of anyone who might challenge the prudence of such screening recommendations.
Dartmouth's Dr. Gil Welch, in response to that previous pro-screening story, wrote me: "Screen many, to find the few -- while many others get labeled at risk in the process. And thus many will be treated "wrong." "
Why isn't that important perspective included in this kind of story?
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.”
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.
Almost 5 minutes of network airtime to discuss a "new cure" for toenail fungus.
How was it disease mongering?
• ABC said, "About half of all Americans over the age of 50 are struggling with this problem." Struggling? Really? Enough to warrant a $1200 treatment ($120 per toe) that is NOT covered by insurance (thank God)? This is part of the 16% of the GDP that Americans spend on health care.
• ABC profiled one woman: "Meghan, like millions of Americans, has had her toe fungus for 15 years. It's unsightly, embarrassing. And like others, she suffered in silence, not wanting to talk about it." Millions of us like poor Meghan - suffering in silence? But not silent any longer - thanks to almost 5 minutes of network news time.
A physician promoting the laser on the program offered up this clear-as-mud analysis:
"Long-term studies need to be done. Studies have only been done since 2007. It was FDA-cleared in 2008. And I want to make it clear that this is an off label use right now.”
So long term studies need to be done. But it's been FDA "cleared". But it's an off-label use right now - meaning it hasn't been cleared for this use. HUH??????
And does anyone at the FDA care about such blatant off-label marketing on network TV.?
A classic example of disease mongering. That's what blogger John Mack writes on his Pharma Marketing blog - about a slide presentation he found from a drug company exec pushing the drug, Detrol, for overactive bladder.
"I remembered being present at the 2002 meeting and how shocked I was that a pharmaceutical VP would actually be so transparent in discussing how "overactive bladder" was a "new" disease that he and his company created specifically to increase the sales of Detrol!"
In her book, "Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs," Melody Petersen wrote that too many journalists fall too easily into drug company plans to create a market for a drug – citing the coverage of Detrol. “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 writes. “Editors and television news directors loved these reports. Silly stories of people running to the toilet brightened the day’s news.”
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.
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.
"You are pre-diseased." That's the title of a CBC radio program with Alan Cassels exploring "the gestalt of our time in a world where, it seems, more and more overdiagnosis is becoming the norm, where everyone is, more or less, prediseased."
(Part one airs tomorrow night - part two next week.)
Cassels interviews Dartmouth's Gil Welch, who says:
"I think the generic problem is somewhat like the "check engine" lights on your car. Do you have check engines lights? My first car was a '75 Ford Fairlane. There were only two things monitored: my oil pressure and my engine temperature. I now drive a Volvo that is 10 years old, but it is checking about 25 different engine functions. And sometimes a check engine light comes on, and you’re really glad to know, and it leads to something you want to do something about. Sometimes the check engine light is just a nuisance, and it just keeps flashing on and off and the mechanic can’t fix it. And some of the audience might have this experience where they went to get it fixed and it made matters worse. And if you had that experience, you’ve had some of the experience of overdiagnosis and that’s what I’m worried about. We’re putting more and more check engines lights on the human body. We have to ask ourselves if that is really the best way to get to a healthy society. We’re constantly monitoring for things to be wrong. Is that really the best way to achieve health?"
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.