There’s nothing wrong with advocating for more awareness of colon cancer screening – although we don’t think that crusading advocacy is a role for journalism, which is supposed to independently vet claims of evidence.
So, instead of all the promotion of your live colonoscopy last week, you and CBS could have investigated the evidence about colon cancer screening.
And if you had done that, you might have reported on some of the questions about colonoscopy – instead of cheerleading for it.
In this month’s journal, Gastroenterology, is an article “Colorectal Cancer Screening Guidelines: The Importance of Evidence and Transparency,” by Dr. James Allison, Clinical Professor of Medicine Emeritus, University of California San Francisco.
As a network news operation, CBS should really be on top of this information, but I’m going to bet no one in the network has read this, so I’ll offer some excerpts:
“The only screening test for colon cancer shown by randomized controlled trials to decrease colon cancer mortality and incidence is fecal occult blood testing (FOBT).”
Did you know that? Did you consider doing a live promotion of the stool blood test? Granted, it might have been a little gross, but we did see your colonoscopy. And it appears that this kind of colonoscopy promotion is what helped make it the most popular colon cancer screening test, despite the evidence (or lack thereof).
“Medicare data reveal that the use of sigmoidoscopy fell by 54% from 1993 to 2003 with most of that fall occurring after Congress bypassed the Centers for Medicare and Medicaid Services (CMS) and approved Medicare reimbursement for screening colonoscopy in 2001. The reasons for the decrease are multifactorial, but include gastroenterology thought leaders and the lay press.
Katie Couric had her own colonoscopy televised on The Today Show, and shortly after proclaimed: “It’s considered the most effective test for detecting colon cancer.” …If all these admonitions and recommendations for colonoscopy screening were not enough to discourage use of flexible sigmoidoscopy, the government decreased reimbursement, thereby making the office cost for doing sigmoidoscopy above that covered by the reimbursement.”
Wow, as a journalist, doesn’t that sound like a good story? How about the author’s questions for “the American Cancer Society, the US gastroenterology societies, and the American College of Radiology” about “to whose benefit are assertions, unsubstantiated by the evidence” that FOBT is a poor second choice to colonoscopy? Doesn’t that sound like there might be a story there?
If CBS had covered the recent NIH state of the science conference on colon cancer screening last month, you would have heard some of these issues, wide open in public discussion. But, to the best of my knowledge, you didn’t cover that meeting. So the following excerpt of the journal article is probably all new to you.
“Thus, the available evidence suggests that repeated screening with highly sensitive FOBT may be as effective and cost effective at preventing colorectal cancer-related deaths as screening colonoscopy every 10 years.
Some now question whether the effectiveness of colonoscopy is “good enough” for population-based screening. The costs of population screening with colonoscopy should be of particular concern at a time when the US federal deficit has been projected to hit a record of >1 trillion dollars. Our health care resources are not unlimited.
One recent editorial stated that with regards to guidelines, the public is best served by a relatively structured, comprehensive, transparent approach in which the entire body of evidence drives the recommendations. Another stated that only when likely biases of industry and specialty societies have been either removed or overcome by countervailing interests can impartial recommendations be achieved.”
Even if you missed the Gastroenterology article or the NIH conference, you couldn’t have missed the recent AP story that discussed the “overselling and overpromising” of colonoscopies.
So, you’ve now learned that you’ve used your television platform to promote a screening approach that, while it definitely has its merits, has never been shown to be better than a much easier, cheaper test in a randomized clinical trial. You’ve learned that special interests and biases may be responsible for making colonoscopy the most popular colon cancer screening approach. And you’ve learned that you and your media colleagues have done your part as well.
Now what are you going to do about that? A make-good perhaps? A followup? A correction? Has CBS ever reported on the issues above? If not, why not?