Health News Review

In the past month, I spoke on media ethics to undergraduate students at the University of Minnesota School of Journalism, spoke to physicians and researchers at the Mayo Clinic, spoke to journalists at the Knight Science Journalism Fellowships at MIT’s Medical Evidence Boot Camp, and then spoke to the KSTP-TV newsroom staff in Minneapolis-Saint Paul.

But to try to reach Everyman, talk radio helps.  So when Tom Hauser of KSTP-TV filled in for Joe Soucheray’s Garage Logic program on KSTP-1500 radio, and he asked me to fill some of the time with him, I agreed.

You don’t turn down Garage Logic invitations.  It’s an institution in radio, celebrating its 20th year on the air this past year.  20 years is an incredible run in radio.

You can listen to the segment by clicking on this link:

MP3 audio file of Gary on Garage Logic 12-5-13

Garage Logic regularly pokes fun at health care news that seems to make no sense, and they introduce many such segments with the theme song from the old Ben Casey TV show.  Our discussion was undoubtedly more complicated and more serious than the usual Garage Logic fodder, but I was pleased to have the chance to talk about our work in this forum.

So now, I can retire.  My career has reached its pinnacle.  I’ve been on Garage Logic, even if the Mayor himself was away for the day.

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Comments

Laurence Alter posted on December 9, 2013 at 10:35 am

Dear Gary:

I have listened to almost all of your remarks on this (commercialized/for the masses/watered-down) radio program.

You state (excuse the paraphrase) that a doctor from the U.K. stated: “all screening tests cause harm, and some actually provide benefit.” Excuse the paraphrase. Can I learn how a TEST harms? (assume it is performed by a reputable medical facility). I believe you mean what a patient DOES with the test results through misinterpretation might be harmful. Kindly clarify.

Regarding prostate cancer and your generalization that most of the mass media does not provide negative aspects/poor results/conflicting views, well, I happen to have read two articles from magazines. One was on breast cancer and it appeared in “The New Yorker”; one appeared in (forgive my memory) one of the two popular men’s magazines, either “Men’s Health” or “Men’s Journal.”

Now in BOTH cases – “The New Yorker”(‘s article on breast cancer) and the men’s magazine (on prostate cancer) – both sides were given. In the men’s magazine (can’t recall which one) the article writer gave ample space to the urologist’s viewpoint (from the medical organization in the U.S. that represents this medical specialty) and the U.S. government’s Task Force viewpoint. It was a commendable article and ran a few pages.

Now, while “The New Yorker” is an intellectual magazine and considered elitist, you might conclude the average person does not read it. Sadly, you are not promoting this *type* of magazine journalism EITHER (but that is another – relevant nevertheless – issue). However, the men’s magazine is NOT intellectual and not anything ‘special.’ I would imagine that many common men with common educations who read magazines would have come across this magazine.

So, why do you slam magazine journalism? IF not, why don’t you make a distinction between magazine journalism ['print journalism' but not newspaper reporting] and television/radio reporting ['broadcast journalism']?

“The Economist” periodically reports on health science news, too. Are you familiar with this publication and how would you rate its knowledge? If a person, hypothetically, ONLY read “The New Yorker” and “The Economist” for his/her health news, how uninformed would they be?

OR: suppose a person ONLY read a few reputable university health newsletters (example: the University of Maryland Medical Center’s health letter or U.C. Berkeley’s health letter or Johns Hopkins health news letter). How you you rate their knowledge?

Respectfully,

Laurence Alter

    Gary Schwitzer posted on December 9, 2013 at 3:22 pm

    Laurence,

    For one who appears to criticize many of the things that I publish, you are terribly uninformed about our work.

    And I’m going to repeat some things I’ve written to you before:

    • I currently have no help on this site. I can’t do everything. And I can’t respond to every comment you leave on the site. But I’m not going to post inaccuracies left by you, either. So, in the future, I may not post what I know is wrong but what I don’t have time to respond to.

    • Even without any funding, and even though I’m doing this by myself, we review more health care media messages than any other such “watchdog” effort in the US and perhaps anywhere. If that’s not meeting your needs, you may wish to look elsewhere. Or start your own blog.

    Now, to your comments:

    First, anyone who reads my blog must have read something about the harms of screening tests. I’ve written about them dozens of times. But, to try to bring you up to speed on what you’ve evidently missed in what I and many others have written about the harms of screening, here is what the US Preventive Services Task Force says about breast cancer screening harms:

    The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

    Adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered, although the main components of the harms shift over time. Although false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups.

    There is adequate evidence that teaching breast self-examination is associated with harms that are at least small.

    And here is what the USPSTF says about prostate screening harms:

    Harms Related to Screening and Diagnostic Procedures

    Convincing evidence demonstrates that the PSA test often produces false-positive results (approximately 80% of positive PSA test results are false-positive when cutoffs between 2.5 and 4.0 μg/L are used). There is adequate evidence that false-positive PSA test results are associated with negative psychological effects, including persistent worry about prostate cancer. Men who have a false-positive test result are more likely to have additional testing, including 1 or more biopsies, in the following year than those who have a negative test result. Over 10 years, approximately 15% to 20% of men will have a PSA test result that triggers a biopsy, depending on the PSA threshold and testing interval used. New evidence from a randomized trial of treatment of screen-detected cancer indicates that roughly one third of men who have prostate biopsy experience pain, fever, bleeding, infection, transient urinary difficulties, or other issues requiring clinician follow-up that the men consider a “moderate or major problem”; approximately 1% require hospitalization.

    The USPSTF considered the magnitude of these harms associated with screening and diagnostic procedures to be at least small.

    Harms Related to Treatment of Screen-Detected Cancer

    Adequate evidence shows that nearly 90% of men with PSA-detected prostate cancer in the United States have early treatment with surgery, radiation, or androgen deprivation therapy. Adequate evidence shows that up to 5 in 1000 men will die within 1 month of prostate cancer surgery and between 10 and 70 men will have serious complications but survive. Radiotherapy and surgery result in long-term adverse effects, including urinary incontinence and erectile dysfunction in at least 200 to 300 of 1000 men treated with these therapies. Radiotherapy is also associated with bowel dysfunction.
    Some clinicians have used androgen deprivation therapy as primary therapy for early-stage prostate cancer, particularly in older men, although this is not a U.S. Food and Drug Administration (FDA)–approved indication and it has not been shown to improve survival in localized prostate cancer. Adequate evidence shows that androgen deprivation therapy for localized prostate cancer is associated with erectile dysfunction (in approximately 400 of 1000 men treated), as well as gynecomastia and hot flashes.

    There is convincing evidence that PSA-based screening leads to substantial overdiagnosis of prostate tumors. The amount of overdiagnosis of prostate cancer is of important concern because a man with cancer that would remain asymptomatic for the remainder of his life cannot benefit from screening or treatment. There is a high propensity for physicians and patients to elect to treat most cases of screen-detected cancer, given our current inability to distinguish tumors that will remain indolent from those destined to be lethal. Thus, many men are being subjected to the harms of treatment of prostate cancer that will never become symptomatic. Even for men whose screen-detected cancer would otherwise have been later identified without screening, most experience the same outcome and are, therefore, subjected to the harms of treatment for a much longer period of time. There is convincing evidence that PSA-based screening for prostate cancer results in considerable overtreatment and its associated harms.
    The USPSTF considered the magnitude of these treatment-associated harms to be at least moderate.

    I really shouldn’t have to post this for you. You can look up either of these statements. They are available free and in great detail for anyone to read online. You can find evidence-based statements about the harms of many other forms of screening as well.

    On the radio program you admit you listened to incompletely (“almost all”), you may have heard the part in which I cited evidence for what we’ve seen in 1,900 systematic story reviews. The media sources we reviewed when we had funding to do so (I currently have no funding and have discontinued this part of our publication) are listed at http://www.healthnewsreview.org/about-us/how-we-rate-stories/ – see “Which news organizations are reviewed.”

    We can’t review all news sources. We couldn’t even do that when we had full funding. I certainly can’t do it now. So, no, we did not regularly review The New Yorker or Men’s Health or The Economist or several hundred other publications you could cite. You certainly have lots of ideas, so if you have the wherewithal, I would encourage you to start a news review website of your own that could take on the entire universe of media that you’d like to review…and in the manner you’d like to review them.

    Your other comments about not distinguishing among media types are simply inaccurate. We cite specific media sources whenever we post a critique.

    And you are simply wrong when you say that I “slam magazines.” You mentioned Men’s Health. Well, did you bother to see that I had written two pieces that applauded Men’s Health articles on prostate cancer?

    Men’s Health piece on proton beam for prostate cancer.

    Men’s Health feature: The $6 Million Dollar Gland

    And I cited award-winning magazine pieces by Men’s Health, Vanity Fair and The New Yorker.

    So your criticism is, again, inaccurate.

    Look, Laurence, I always try to respond to comments that readers leave. But you leave more comments that are more inaccurate and require more of my time to respond to than any other reader of this site. Please don’t be surprised if I sometimes don’t respond to what you write. I am flying solo, running this site all by myself right now. I can’t devote this much time responding to everything you comment on.

    As I’ve suggested before, why don’t you start your own blog? You could write whatever you wanted, cover the universe of media as you seem to think is easy to do with no funding and no staff, and then perhaps both of our days would be more productive.

Laurence Alter posted on December 16, 2013 at 10:17 am

Dear Gary:

I’m feel guilty you have devoted some much of your spare/free time for my personal edification.

It is truly appreciated; I’m sorry you felt the need to reiterate what is obvious to your regular readers; I am humbled.

I am printing out your letter to be used as a reference.

May I simply say that the fault of screening testing is the INTERPRETATION OF THE test AND/OR THE REACTION to the test (psychological over-reaction). THIS IS NOT DUE TO A DEFICIENCY IN THE TEST OR A FLAW IN THE TEST PROCEDURE OR IN THE EXAMINER. It seems surprising to me that you don’t make this crucial distinction. This – as I stated in my letter – is assuming a properly qualified testing facility (and properly informed and properly communicating medical staff).

Lastly, it would be seem a true benefit to provide a list the ‘least worst’ sources from the media (the sources that have the best ‘record’ in accuracy of reporting and analysis). You surely have the raw data.

It is commendable how you provide such unparalleled attention to your readers.

With respect,

Laurence Alter

    Gary Schwitzer posted on December 16, 2013 at 10:31 am

    Laurence,

    No, the potential harm from screening test is NOT simply in the interpretation of the test. The potential harm is initiated as the test is done.

    The informed decision making that must take place regarding screening tests must take place BEFORE the test. You can’t “shoot first and ask questions later.”

    Once the test is done, it may kick off a cascade of events (as I have already documented) that you can’t control, including a known rate of false positives and overdiagnosis.

    So once you roll up your sleeve for a PSA blood test, you can’t pull back. So the potential harm is in having the test itself. It is the act of having the test that initiates the harm.

    Regarding your other request, you can find an interactive chart on our site that allows you to compare grades of competing news sources.