Health News Review

Dear Harry,

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.

10_-_es_colonresults_310.jpg

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?

Comments

Marilynn Larkin posted on March 15, 2010 at 9:38 am

Re: ratings for the electromagnetic pulse “shovel” story–what concerns me most is how many sites simply picked up the story, including healthfinder.gov and other sites that presumably have some degree of credibility. If they don’t vet their feeds, what’s the point? Here’s a look:
http://www.google.com/search?source=ig&hl=en&rlz=&=&q=Electromagnetic+Pulses+May+Stem+Arthritic+Knee+Pain&btnG=Google+Search
(Publisher’s note: Marilynn is referring to a story reviewed on HealthNewsReview.org at: http://www.healthnewsreview.org/review.html?review_id=2613)

Gary Schwitzer posted on March 15, 2010 at 12:24 pm

From Maryann Napoli of the Center for Medical Consumers, who sent this comment:
Excellent points, Gary. There’s another missing element to the FOBT story. The RCTs that compared FOBT with usual care did in fact show a 30% reduced risk of colon cancer deaths in those who took the FOBT, but this benefit was canceled by an inexplicable increase in heart-related deaths. Our 2009 article mentions this largely unrecognized finding. See “How good are colonoscopies?”
http://medicalconsumers.org/2009/01/01/how-good-are-colonoscopies/

Roshan posted on March 15, 2010 at 7:02 pm

Another troubling aspect of all this is MNGI (Minnesota Gastroenterology) buying ads on WCCO TV promoting colonoscopy in the month of March. No wonder health care cost keeps rising.

jeff prescott posted on March 16, 2010 at 1:59 pm

Thank you for a great sidebar to the whole story!
As one who rails against “celebrities” for anything——and
ratings-grapping stunts for any old (bad) reason), I commend you.
Sure, CBS will go on-and-on about this………”if we saved just one life….”
But, I thank you.

Susan Older posted on March 16, 2010 at 3:40 pm

Having been a medical editor at USA Today (in the mid ’80s, when standards were high), I applaud you for doing the reporting that CBS should have done. I wonder: Does Katie Couric’s position at CBS now have anything to do with the decision to do this story — a total repeat of the story she did on her own colonoscopy while she was at NBC? I imagine it does. I’m sorry she lost her husband to colon cancer. I really am. And while It may be a little weird and out of our realm as journalists to do a first-person account in order to inform the public and save lives, I might overlook the “odd factor” if the piece were well reported and accurate. Thanks for setting the record straight. I just hope this draws as much attention as Harry’s colonoscopy. It doesn’t exactly fit, but I think I’ll post it on my Displaced Journalists site and Facebook page just to give it more attention. Well done.
Susan

J. T. posted on April 1, 2010 at 11:49 pm

I’m not defending Harry’s story but there are studies showing the effectiveness of colonoscopy as a method of screening.
http://www.ncbi.nlm.nih.gov/pubmed/20186003
Conclusions Colonoscopy is superior to FOBT in detecting colonic lesions at the first diagnosis of acromegaly.
Effectiveness of Colonoscopy to Prevent Death From Colorectal Cancer
http://www.annals.org/content/150/1/I-28.full
Retrospective, with a control group.
I guess the best news is that we may have some better answers soon.
http://clinicaltrials.gov/ct2/show/NCT00102011
In the interests of full disclosure, the FOBT missed my father’s colon cancer. He didn’t want a colonosocopy. By the time it was bleeding and he had a colonoscopy it was advanced enough that it had escaped. He’s survived 5 years (initial surgery, chemo, liver surgery (metastasis), radiation (another liver metastasis). Me? I’ll have a colonoscopy at the appropriate age.