Physician’s perspective on why harms matter in news stories
Karen Carlson, MD, One of our medical editors
Why this matters to patients
Howard Harwell is an 89-year old retired engineer. When bypass surgery was recommended to treat his coronary artery disease, the potential harms of the treatment was a key factor in his decision to decline the operation.
Why does this Matter?
- There are tradeoffs involved in any health care decision. No matter what you choose to do, you stand to gain something and you stand to lose something. All treatments have side effects, risks, and complications.
- Ideally you’d want to know both the frequency and severity of adverse effects of treatments. Some so-called .minor. side effects may have dramatic impact on individuals’ lives.
- There can also be harms involved even in getting a screening test. A test may produce a false positive result, which causes anxiety, and will probably lead to more testing and possibly treatment that comes with its own harms.
- When you hear someone say that a new approach “appears to be safe,” think twice. Appearances can be deceiving. You want evidence . not appearances.
- The majority of news stories we’ve reviewed fail to adequately tell readers and viewers the scope and severity of the harms that may occur.
Thumbs Up Examples
The story mentions the “much greater risk of serious adverse side effects” in the same sentence that delivers the positive results. Placing the “bad news” of side effects right alongside the “good news” of improvements is a best practice for which this reporter should be commended.
Later in the story the reporter lists these side effects and provides data on the number, severity and duration of the side effects. The story also mentions the death that resulted from the surgery.
The story mentions several harms of PSA testing, including false positive results and overdiagnosis, both of which could lead to unnecessary treatments associated with significant side effects.
The story allowed a spokesperson from a company marketing this compound to say that there were no known harms. However, this was countered by a comment from a scientist at the National Institute on Aging who stated that everything has a toxicity and that safe levels for resveratrol remain to be established.
Thumbs Down Examples
We don’t think it’s adequate to accept at face value a comment from one physician about his experience with 70 to 80 patients over the last 18 months, reporting “few side effects” and not “even a hint of a failure.” What WERE those side effects? Exactly how few? How did patients feel about them? And how do you measure success or failure in such a short time span?
The ABC anchor says the therapy is “basically safe.” Is that akin a little bit pregnant? No details given on safety.
But the New York Times reported, “several doctors emphasized that platelet-rich plasma therapy as it stands now appeared ineffective in about 20 to 40 percent of cases, depending on the injury.” So that’s $2,000 for a treatment that fails 20-40% of the time. Some people might consider that a harm.
Enthusiasm for early tests is often not supported by evidence. There can be harms from doing screening tests in people without symptoms when the evidence doesn’t support such screening. This segment never acknowledged this very real possibility.