Evidence/balance lacking in Philly story on “Don’t Fear The Finger” campaign

The Philadelphia Inquirer published a story, “Prostate cancer activists launch ‘the finger’ campaign to stem decline in testing.”  It begins:

Kristine Warner wanted an eye-catching way to encourage men to talk to their doctors about the complicated, controversial subject of prostate cancer screening.

Don’t Fear The Finger campaign was born.

Go ahead and snicker. It got your attention.

The finger in question, of course, is the one a physician puts up a man’s rectum to feel for cancer in his prostate gland. The rectal exam is usually paired with a PSA blood test.

Warner, a graphic designer, former lobbyist, and urologist’s daughter, is the volunteer director of the Pennsylvania Prostate Cancer Coalition. It launched Don’t Fear the Finger in the spring at a rally replete with 2-feet-tall foam cutouts of the digit. SEPTA buses sported posters of guys who aren’t afraid of the finger, including a lumberjack and a burly, tattooed biker dude.

Eye-catching.  Got your attention.  OK, but where is the independent vetting of the evidence in this story?

There isn’t any.

But there is an imbalance in the number of statements from urologists, who say things such as:

“Family doctors are confused. Even urologists are confused,” said Vincent Fiorica, a Johnstown urologist and president of the Urological Association of Pennsylvania. “In the last three years, the number of patients referred to us [by family physicians] has dropped dramatically. I’ve had conversations with oncology friends and they’re afraid we’ll go back to the old days where men show up with widely metastatic disease.”

Again, independent analysis of the evidence would help at times like this, but the story doesn’t provide any.  And why is a urologist speaking for all of those supposedly-confused family doctors?  No family doctor is interviewed.

The only counter to the urologists’ and pro-screening advocates’ statements is this part, late in the story:

African American men are another sensitive issue in the screening debate because they are more likely to develop and to die of prostate cancer than white men. Two Don’t Fear the Finger posters feature black men.

Such targeting worries Otis Brawley, chief medical officer of the American Cancer Society. He’s against screening, even though he is black.

“People think screening can only be good,” Brawley said. “But a lot of people, including doctors, are not up to date. They don’t tell the whole truth, and they don’t respect the man’s right to make his own decision.”

Whoa:  “He’s against screening, even though he is black.” ???

The story didn’t quote him saying he was against screening, and I wonder if he really did say that.  The quote that was used was about fully-informed, shared decision-making, about which Brawley has spoken often. Endorsing shared decision-making ? opposing screening.

I have followed what Dr. Brawley has said and written about prostate cancer screening for years and I have never seen or heard him state that he’s against screening.  In fact, I’ve frequently cited this video in which he says just the opposite:  “I must stress: we’re not against prostate cancer screening. We’re against a man being duped and deceived into getting prostate cancer screening.”

And what does “even though he is black” mean?  Is it supposed to suggest that this learned physician-researcher would evaluate evidence differently because of his skin color?

Finally, the story ends with two urologists stating their support for prostate screening.  I have often written that how a journalist ends a story may reveal the journalist’s own opinions about the topic at hand. So does the choice of whom to interview.  In all in this story, we hear from 3 urologists, a urologist’s daughter, a politician/prostate cancer survivor, zero supposedly-confused family doctors, and then this odd little section with Dr. Brawley.

That’s imbalance.

The coup de grâce is the final quote from one of the urologists:

“Discouraging a simple and inexpensive blood test is not the way to address concerns about appropriate treatment for a disease once it is diagnosed,” said Scott Owens, a Camp Hill urologist and coalition leader. “We should not throw out the proverbial baby with the bathwater.”

Letting him get away – unchallenged – with calling this a “simple and inexpensive test” contributes to the overall imbalance of the story.

There is nothing simple about the decision concerning cancer screening. And the things that make it complex – according to shared decision-making advocates – need to be considered before you roll up your sleeve or pull down your pants – before the screening begins.  And it’s not inexpensive if it leads to a cascade of tests and concomitant complications – all for things you might find that you’d really rather not find.

It’s interesting that, on this same day, the Wall Street Journal published a story, “Some Cancer Experts See ‘Overdiagnosis,’ Question Emphasis on Early Detection: Debate Among Doctors Looks at Whether Zealous Screening Leads to Overtreatment.” And that story quotes a respected urologist with a far different perspective than the one of the urologists in the Philadelphia Inquirer piece:

“We have thrown the net very, very widely and eliminated some of the sharks,” says Ian Thompson, a urologist at University of Texas Health Science Center and co-chairman of the NCI advisory panel. “But we’ve also netted a lot of goldfish and assumed they’d behave the same way.”

Is he throwing out the baby with the bathwater?

Whom you interview matters.  How you frame it matters.  How you end the story matters.

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