Recently in Health care journalism Category

German science journalists gather in Bremen, Germany next week for the annual Wissenswerte conference. I'll speak on a panel there on Monday.

I've also been asked to consult with a group there that is hoping to launch a German version of HealthNewsReview.org.

I was also recently approached by an Italian journalist who is interested in the concept for his country. This idea has certainly taken off - from the pioneering efforts in Australia, to Canada, the US, Hong Kong, and now potential for more countries to begin reviewing the quality of health/medical/science news coverage.

The UK also has a "Behind the Headlines" project with a somewhat different approach.

I've told my students that covering health care conflicts of interest could be a fulltime beat - and you still wouldn't keep up.

The NY Times today reports:

In the first half of this year, the drug giant Eli Lilly paid 3,971 doctors and other medical professionals an average of about $11,230 each. The payments were for participating in an average of 12 speaking or consulting engagements during those six months, according to a company spokeswoman.

Dr. Manoj V. Waikar, for example, a physician among the top five earners this year, received $74,850 for consulting and speaking at 51 events, according to Lilly's on-line faculty registry. The company caps payments at $75,000 for each health care provider in any calendar year.

He's an adjunct instructor at Stanford. Stanford's ban on regular faculty members participating in drug company speakers' bureaus doesn't apply to adjuncts - as long as they're not using the Stanford name.

As blogger Merrill Goozner writes:

Waikar gave 51 talks last year to earn that $75,000. That's one a week, week after week, all year at $1,500 a pop. Think about it. Same slides, same talk. Just show up for two hours and the check is in the mail. Do that for three companies and you're earning over $200,000 annually. And you were wondering how the man earns a living on an adjunct faculty's salary.

Meantime, it doesn't take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug - with the company's logo on it, and with the beginning of each chapter crediting the drug company.

The student journalist also pointed out that the University of Minnesota has no policy to ban such practices.

It's good that this student journalist starts looking at conflict of interest issues now. If she stays on this beat, she's going to be busy on COI stories for a long time.

Amidst the flood of stories that only reflect the benefits of cancer screening, here's a story from the UK - and the Sunday Times - that delivers the perspective of the harms of screening that we seldom hear. It begins:

Jane Flanders was not aware of the risks involved in being screened for breast cancer when she received her invitation from the National Health Service four years ago.

After being diagnosed with cancer and undergoing extensive surgery, the mother of two now wishes she had not attended. She believes she was the victim of over-diagnosis.

The 56-year-old maths teacher from Basingstoke, Hampshire, was diagnosed with ductal carcinoma in situ, a dormant cancer which was not spreading and may never have caused problems.

Doctors advised her to have radical treatment -- including a mastectomy -- in case it might spread.

"Screening has caused me considerable and lasting harm. It has certainly not saved or prolonged my life," she said.

"The reality of this diagnosis has been two wide excisions, one partial mutilation (sorry, mastectomy), one reconstruction, five weeks' radiotherapy, chronic infection, four bouts of cellulitis (a bacterial infection), several general anaesthetics and more than a year off work."

Flanders believes it is "outrageous" that the NHS has withheld information on the risks. The government has been forced to rewrite its advice to include warnings about potential harm caused by the screening process.

It's a TV sweeps ratings period, and it's also breast cancer awareness month, so any boob could see this coming.

The Washington Post makes a big deal of the fact that DC station WJLA is making an even bigger deal about:

"...breaking TV's unspoken taboo by showing two women fully exposed on its late-afternoon and evening newscasts."

...

WJLA acknowledges, however, that the timing of its stories may raise some eyebrows: The reports will air on the first two days of TV's traditional "sweeps" month, a period in which stations air their most eye-catching stories to boost ratings that are used to set advertising rates.

WJLA general manager Bill Lord said he had no qualms about the timing of the reports, or in promoting them beforehand. "People will say we're doing it just for ratings," he said. "But we're a commercial television station -- we're trying to get people to watch us. Yes, this is an attention-getting story, but it's also an important story."

Tell me that even this dramatic viewer warning about their online video isn't meant to titillate:

But the Post story buries the real story, only deep in the story getting to the question of how newsworthy this really is:

"The effectiveness of self-exams as an early cancer-detection method, however, has been questioned in recent years. The National Breast Cancer Coalition says medical studies suggest that the exams are not useful and can lead to "elevated anxiety, more frequent physician visits and unnecessary biopsies of benign lumps."

The American Cancer Society says self-exams play only "a small role" in finding breast cancer. On its Web site, the society says "it's okay not to do [a self examination] or not to do it on a fixed schedule."

At least the Post touched on these issues. The WJLA report never did.

But good luck telling that to a TV news director in the middle of a ratings period.

And good luck trying to talk about evidence (or lack thereof) when a naked breast can give you the bump in the ratings you need so badly.

Now, will they do the same thing for testicular cancer?

In the circles I run in, there's been a buzz about an announcement first made last December about a "partnership" between the FDA and WebMD. Yesterday the two entities announced an expansion of that partnership "to provide increased access to FDA's consumer health information."

I can appreciate the FDA's interest in reaching the public more directly with its messages.

But WebMD has turned over its "channel" - some of it marked "news" - to a government agency. Should journalists "partner" with a government agency for news and information?

And they boast that "Since the launch, over 150,000 consumers have accessed the FDA destination on WebMD ... The FDA's consumer information is also available through WebMD the Magazine, distributed ten times a year and reaching an additional 11 million consumers with each issue."

And I would remind the FDA that, while there may not be any ads on the FDA pages of the WebMD site, users are just a link away from ads on WebMD material. I just visited and quickly found myself viewing ads for drugs for fibromyalgia, depression, coronary artery disease and others. Is that appropriate for the FDA?

Something doesn't feel right about this - for either party - or for the public.

Sandy Szwarc of the Junkfood Science blog looked at this in greater detail when the partnership was first announced in December.

Excerpt from Dr. Len Lichtenfeld's blog posting, criticizing both the JAMA article and the NYT article this week that raised questions about screening.

"This was an opinion piece, not original research. It reiterated arguments that have been made before, and are certainly valid. But they represent the thoughts of several respected scientists, but not all who are involved in trying to reduce the burden of cancer in this country and throughout the world.

And while we may agree with the comments about prostate cancer, we do not agree with the negativistic comments about breast cancer. As noted in the New York Times article, when the public gets a mixed message it takes that as a reason not to move forward with the most effective breast cancer screening modality we have available today. ...

The sad part is that the women in this country may only read the New York Times, and leave it at that. They will miss the nuances of the experts' arguments. They will not read the conclusions of the JAMA study, and if they do they probably won't have the working knowledge that would put it in context.

Hopefully they won't miss the nuances that could impact their lives. That would be a tragedy. But such is the risk of living in a sound bite world."

Gina Kolata had her article in the Times - subject of my blog earlier today (below).

Later, the American Cancer Society issued this news release (Is it a retraction? Is it a correction? Is it 'we wish we hadn't said that to the NYT?' Is it "Gina Kolata got it wrong?' What is it?).

CBS News last night proclaimed the drug peramavir as a "lifesaving drug" for serious cases of H1N1 infection.

Lines from the story:

• "Experts caution its too early to see Peramivir as a miracle drug, but there's no doubting the drugs connection to some miraculous results."

• "Human clinical trials in the U.S. and Japan have called Peramivir safe and effective."

But not one shred of evidence was provided.

Instead, the story used the framing that the FDA was dragging its feet - as the website subheading read: "Doctors Say Intravenous Drug Peramivir Effective in Serious Cases; But It's in Trials and FDA Makes Few Exceptions"

Folks: it's the trials that determine benefits and harms. Not hyperbole about people being deprived of a wonder drug. Data - evidence - is what counts, and CBS didn't provide any in this story.

CBS 60 Minutes once again devoted a big chunk of prime time last night to an unproven idea - which is fine, if you're going to devote your show to such explorations of basic science all the time. But they don't. And it shows.

The subject was the pie-plates-and-radiowaves cancer experiment of inventor John Kanzius - which CBS has now profiled three different times - in April 2008, in July 2008, and now on October 18, 2009.

Correspondent Lesley Stahl exhibited some of the same breathless awe that she showed in previous segments, saying at one point, "we don't want to be in a position to hype this."

Too late, Lesley, you already have - with three segments in 18 months for something that isn't even in human trials.

I can only wonder what all the other cancer researchers watching think when they see such cheerleading for such little evidence.

A writer posted a query on the Association of Health Care Journalists (AHCJ) listserv last week asking for ideas about state-of-the-art but underused treatments.

Many of the responses were troubling. Some AHCJ members wrote in suggesting:

• MRI is far superior to mammograms for detecting breast cancer (leading another member to write in asking where was the evidence for that "superior" performance in lower mortality rates)
• robotic surgery for prostate cancer (ignoring a study published last week that tracked the runaway use of robotic surgery despite questions about evidence)
• cardiac CT for calcium scoring
• proton beam therapy

None of these can be considered underused given the questions of evidence with each of them.

But this is how some journalists responded when asked.

Thankfully, some voices of reason eventually chimed in on the listserv. Other writers called "state of the art" a marketing term and suggested that it be viewed as a red flag and that writers should "push back against editors who want us to write breathlessly about these gee-whiz procedures and techniques."

Yes, such push back against editors is important. But you can't blame editors for the ideas that writers bring to them. Given our experience on HealthNewsReview.org, where we've seen about 70% of stories fail to adequately discuss costs, benefits and harms of such new approaches, there still is huge problem of gullibility and gee-whiz-ness even in the rank and file of health care journalists.

Maggie Koerth-Baker's interview with me about HealthNewsReview.org- and how she connects it with her grandfather raising semi-feral chickens. !!!

HealthNewsReview.org review summary:

A 183-word story just can't do much. And this story didn't.

The NY paper clearly picked up the story from the BBC and passed along erroneous information about basic information such as where the study was published.

But at the heart of the story was the improper and inaccurate use of causal language from an observational study that can't establish causation, but only association. It is wrong when the story states, "The diet...has a positive effect on mood."

This kind of research news via briefs and pickups from other news organizations is a waste of time and space.

Dr. David Gorski writes:

The quantity of misinformation in that single six minute video is far beyond the scope of this article. .. I leave the dissection of this pièce de résistance of disingenuousness and misinformation as an exercise for readers (of his blog).

Andrew Wakefield, who has linked vaccines to autism, was given a new platform by CBS News now with new claims about the potential dangers from hepatitis B vaccine - based on research on 13 vaccinated monkeys.

The only other source cited was Wakefield's collaborator and co-author.

Here is how CBS summarized any past controversy:

The study became the centerpiece for an ongoing and nasty fight between vaccine safety advocates who embrace Wakefield's research and believe vaccines can be administered in a safer fashion, and public health and government officials who attack Wakefield and believe his ideas threaten international vaccination programs.

Notice the framing: vaccine safety advocates "embrace" his research while public health and government officials "attack" it.

Why would CBS not include any independent source to evaluate these claims from research in 13 monkeys? Why would they not mention the allegations from earlier this year that he falsified data in his 1998 study published in The Lancet, widely available online. Excerpt from one story:

10 of the paper's 13 authors -- not including Dr. Wakefield -- retracted the paper's conclusion that the MMR vaccine may cause autism.

Paul Offit, M.D., a pediatrician at Children's Hospital of Philadelphia, and a prominent critic of Dr. Wakefield, said the new allegations cannot really undermine the credibility of the MMR-autism theory because it had already been disproved.

A series of population-based studies have failed to find evidence that vaccines cause autism.

"I'm not sure what more people need to say than that this man and his theory are discredited," Dr. Offit said.

He said there was no longer a scientific controversy about the role of vaccines in autism.

At the same time, he said, the Times report is unlikely to change the minds of those who believe in the link.

"There is not one shred of his hypothesis that has held up," Dr. Offit said.