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:
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 afraid.
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.
I'm breathless.
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.
Mack writes:
"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.
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.
"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.
Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen, released this statement yesterday:
"It is a sad day when two superb Olympic athletes - whose performances earned a total of 14 gold medals combined - prostitute themselves for undisclosed amounts of money to help Allergan sell Botox. Instead of tens of millions of people watching the athletes’ performances in the past as they strived for their personal best, people will now be able to watch videos of doctors’ performances as they inject former swimmer Mark Spitz and former gymnast Nadia Comaneci with Botox.This sends a terrible message to athletes, young or old, and to others that they should not accept the way they look as they age but, rather, should try to look their "personal best" by the Botox-enhanced pretense that they are younger than they really are.
Another trouble with this slick marketing campaign is that botulinum toxin (available as Botox and Myobloc) can cause life-threatening adverse reactions. In January, Public Citizen petitioned the Food and Drug Administration (FDA) to immediately increase its warnings about Botox and Myobloc; adverse reactions can include paralysis of the respiratory muscles and difficulty swallowing (dysphagia), a condition that can allow food or liquid to enter the respiratory tract and lungs, causing aspiration pneumonia. While the data in our petition mainly related to problems associated with the medical use of Botox, adverse reactions can occur with cosmetic use as well. Since when did "personal best" involve subjecting oneself to a risky procedure?
Two weeks after we filed our petition, the FDA issued a press release warning of the dangers of injecting botulinum toxin but stopped short of forcing drug makers to send out warning letters to doctors or putting a black box warning on the drug as we had requested.
By peddling a product that can seriously injure people, these athletes are tarnishing their past athletic achievements. Botox is nothing to play around with. The public should not be lulled into a false sense of security by Allergan’s outrageous caper."
Read the Allergan news release for a lesson in disease-mongering and marketing. They're coining a new condition called "The 11" - as explained by Comaneci: "About five years ago, I realized that while I exercised and ate right most of my life, there was nothing I could do on my own that would get rid of those two stubborn frown lines stamped on my forehead. They looked like an '11' and made me upset with the way I looked, and that's when I decided to talk to my physician about BOTOX(R) Cosmetic treatment. I attained a perfect '10' at age 14, and I'm working hard to stay close to that in all that I do." Then they go on to describe "How the '11' makes people feel." Including Spitz saying, "As a financial advisor and motivational speaker, my facial expression is a very important part of my message. When I am serious, my '11' makes me look angry and unapproachable rather than congenial. I knew I had to do something about it, but for a long time, I just didn't know what my options were. Then I heard about Botox."
I've always loved the Willie Nelson song lyrics:
This Face is all I have, worn and lived in
And lines below my eyes are like old friends...
This face of mine
And I kept believing the reflection on the wall
Who needs to be the fairest of them all
I never looked like you, cool and streamlined
I have this honesty that grows with time
And when cracks appear they suit me fine
Like a good old dog you won't hear me whine
And this face is all I have, worn and lived in.
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.
