Gary Schwitzer's HealthNewsReview Blog

Overactive bladder is one of the poster children for disease-mongering. Some have written that it's a "created new disease."

Others have analyzed that its prevalence has been over-estimated.

The folks at WorstPills.org (Best Pills, Worst Pills - a project of the Public Citizen's Health Research Group) write that there are huge questions about the drugs created to treat it:

"All of the drugs currently approved in the U.S. to treat overactive bladder work about the same. The results are all statistically significant, and they are better than nothing, but their effect is minimal (a reduction of about one urination per day compared to a placebo)."

They explain that the six drugs - yep, count 'em: six drugs for overactive bladder - are so-called anticholinergic agents.

"Unfortunately, these anticholinergic effects are both what makes them effective and what makes them potentially harmful. Although for patients with overactive bladder difficulty urinating is the intended effect of the drug, that same difficulty is, in a sense, a side effect of the drug. Taking more of the drug strengthens all of the side effects -- including both the desired effects, such as reduced urination, and the ones you do not want."

Hmm. Did you learn any of that in the TV drug ads?

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Last week the website reported that the FDA approved a drug for claw hand - a painful condition that causes bent fingers. That was the news of the day. But ABCNews.com only briefly discussed claw hand before catapulting into a non-stop promotion of possible off-label use of the drug for Peyronie's Disease - a condition in which the penis becomes painfully bent.

Look at how ABC framed this:

The headline is hype. It's not a penis-straightening drug in the eyes of the FDA. It hasn't been submitted for approval for that use.

And is that really an appropriate stock photo to use for this story?

But this story repeatedly promotes off-label use - something the drug company would get in trouble for if they had done it. What was the company's role in this story? The story says the drug company "says that - as a safety precaution - it will do everything it can to discourage off-label use." Yet, the drug company PR guy is quoted citing specific data on alleged effectiveness of the drug for Peyronie's Disease. And the story ends, "If all goes well, (the drug company) says they hope to have the drug approved for Peyronie's within two years."

Hmmm. That makes the Peyronie's benefits of the drug sound pretty good and pretty certain.

And let's count the ways the story promoted off-label use with these excerpts:

1. "may serve as double-duty as a penis-straightener"
2. "The release of the drug this spring may lead to off-label use for Peyronie's Disease."
3. "urologists and patients will find frustrating" any company attempt to discourage off-label use.
4. "...there is great demand for any drug that could be shown to work (for Peyronie's). Xiaflex may be that drug."
5. "Peyronie's sufferers may be 'very motivated' to take risks, especially since few other treatments work."
6. "I'm sure there will be pressure [on urologists] to use it off-label...they have a cohort of patients waiting." (urologist's quote)

Only deep in the story - 665 words deep in a 795 word story - after all of this off-label promotion took place - was there specific discussion of the safety concerns that could burst this balloon. Excerpt:

"It is an invasive procedure with potential bad side effects [such as] impotence [or] penile fracture. I don't think too many urologists will do off-label use until FDA approval for use in Peyronie's Disease," (a UCSF urologist) says.

Bruising, pain, and swelling at the injection site has also been reported in clinical trials of Xiaflex.

And even this came after a bold heading, "Relief Will Have To Wait."

Why would ANYone report on a drug study that has yet to be completed, has not been subjected to peer review and is for an off label use?

Because ABC could put "penis-straightening" in the headline and draw more traffic?

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We're pleased to see that Wikio.com this month has ranked this blog as the 9th most widely-referenced health blog.

Questions about journalism ethics, fabricating quotes, distortion of science - all wrapped up in one story in The Sunday Times of London. A couple of weeks ago Christina Jewett of the California Watch /Center for Investigative Reporting wrote about this, and now Craig Silverman has addressed it in his "Regret the Error" column on the Columbia Journalism Review site.

Let's start with Jewett's account, which I've excerpted:

A UC Santa Barbara professor made a small but significant finding in the field of evolutionary psychology a few months ago that escalated into an international sensation over the weekend.

It's a story that could have ended with an angry mob of blond women chasing him with pitchforks. "I haven't had that happen yet," said the psychologist, Aaron Sell, "but who knows."

Here's what did happen.

Sell and a team of researchers embarked on a study to learn more about the nature of anger, submitting a lengthy survey to nearly 300 men and women.

Their findings? Women who consider themselves particularly attractive are quicker to anger, as they tend to have a greater sense of entitlement. Men share that trait with women, and men who report that they are physically strong are also more quick to anger.

The findings were published in the September issue of the Proceedings of the National Academy of Sciences without overwhelming fanfare.

And then a reporter from the Times of London called Sell seeking to test a theory of whether blondes held an even greater sense of entitlement than brunettes.

Willing to help the reporter, Sell went back to his data and found that no such phenomenon exists. He communicated as much via e-mail, Sell said.

Before the professor gave it another thought, the headline appeared in the Times of London: "Blonde Women Born to Be Warrior Princesses."

The article suggested that Sell's researchers had concluded that blondes "exist in a 'bubble'" and are more likely to "'go to war'" than women with red, brown or black hair. The reporter John Harlow's article quoted him:

"We expected blondes to feel more entitled than other young women - this is Southern California, the natural habitat of the privileged blonde," said Aaron Sell, who led the study which has been published in the Proceedings of the National Academy of Science. "What we did not expect to find was how much more warlike they are than their peers on campus."

Soon the BBC picked up the story. It got more than 1,200 hits from Twitter. (I confess, I Tweeted the "warlike" finding before calling Sell yesterday.)

The Times' story left Sell flabbergasted. The quotes were not what he said, and his study made nary a mention of hair color, he said.

Sell and colleagues wrote a strongly worded letter to the Times of London.

"To be clear, I have never published any research about blonde women, nor have I ever conducted any research on blonde women, or about their supposed differences from other women."

On the Psychology Today site, Satoshi Kanazawa wrote:

In April 2008, I wrote that British journalists interpret "freedom of the press" to mean that they can make up anything they want and publish it as fact in British newspapers. Now another evolutionary psychologist has learned the lesson the hard way.

Molika Ashford wrote about it as well on Stinkyjournalism.org.

Stinky journalism, indeed.

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The Akron Beacon Journal reports:

Akron General Health System recently began advertising up-to-the-minute wait times for its emergency rooms on billboards throughout town. Six digital billboards in Akron are automatically updated every 20 minutes to show current average wait times to see a doctor at the main ER in downtown Akron and in satellite ERs in the Montrose area and Stow.

The same info is on the hospital system's website:

The newspaper provides some background on this trend:

"Local hospitals increasingly are competing to grow their share of ER business, particularly since Akron General opened its satellite emergency departments in Bath Township and Stow in recent years.

Akron-based Summa Health System is working on a plan to share updated ER wait times and other information via mobile devices, spokesman Mike Bernstein said.

''We expect to begin offering this service in the next several weeks, beginning with Summa Akron City Hospital, and then we will begin to roll it out to the other hospitals throughout the year,'' Bernstein said.

More hospitals nationwide are starting to advertise their ER wait times through billboards, Web sites, text messages or social media sites, such as Twitter.

Some emergency medicine doctors, however, see this as a dangerous trend.

By viewing wait times, patients with serious problems might mistakenly drive across town to see a doctor quicker when, in fact, ER personnel make sure those with the most critical problems are seen immediately, said Dr. David C. Seaberg, a member of the board of directors of the American College of Emergency Physicians.

''I just think there are some real problems with doing this,'' said Seaberg, dean and professor at the University of Tennessee College of Medicine in Chattanooga.

Although emergency departments routinely monitor their wait times to try to improve, sharing the data publicly ''is really just a marketing tool more than anything else,'' he said. ''I worry about the potential harm that may be done by doing this.''

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This week the National Institutes of Health convened an "NIH State-of-the-Science Conference on Enhancing Use and Quality of Colorectal Cancer Screening."

The only story I could find on it was in the Columbus Dispatch.

But I've seen no news coverage about what a friend who attended the conference reported to me.

I've now verified with various attendees that there were clear new signs of the turf war between gastroenterologists - keepers of the traditional colonoscopy approach - and radiologists - who are more inclined to favor the new kid "virtual colonoscopy."

More than just "inside baseball" about "inside your colon," this is another war over evidence in health care.

The NIH panel was not charged with judging the relative value of different colon cancer screening methods.

But it sounds like some of the parties who attended had a different expectation and so the conference they got was not the conference they wanted.

I'm told that radiologists were upset - demanding at least more recognition of the benefits of virtual colonoscopy (or CT colonography) if not a downright endorsement. Some stated their disapproval of the U.S. Preventive Services Task Force statement that "the evidence is insufficient to assess the benefits and harms of computed tomographic colonography (ed. note: and fecal DNA testing, for that matter)." And they're upset about the subsequent decision by the Center for Medicare & Medicaid Services not to cover the newer test.

Radiologists wanted more recognition of the large American College of Radiology Imaging Network trial.

I'm told that there were several radiologists who got up and basically screamed at the panel members for being in the "dark ages". They cited the American Cancer Society recommendations that conflict with the USPSTF on the virtual colonoscopy and also evoked what they called the "mammography disaster," referring to the USPSTF mammography recommendations released last November - another time the USPSTF and Cancer Society disagreed.

One of the speakers at the NIH conference said that the Cancer Society does not use a formal process for evaluating the evidence, does not provide details about how they come to their conclusions and includes only sub-specialists on their panel - raising questions about conflict of interest in their recommendations.

So even though that's not what the meeting was about, there was scuffling over screening method vs. screening method, turf wars, and conflict of interest in the setting of guidelines or recommendations.

So this one isn't over.

And it's difficult to understand why this didn't get news coverage. It sure sounded newsworthy to me.

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Got your attention with the first two, didn't I? And that's the point behind celebrity spokespeople pushing health campaigns. NASCAR driver and lingerie ad model Danica Patrick is now promoting an online "screener" for COPD or chronic obstructive pulmonary disease.

John Mack gives details on his Pharma Marketing Blog, where he put together this photo montage.

But Mack also raises important questions about the "screener." He writes:

"The campaign points out that "COPD is the 4th leading cause of death in the US" and "an estimated 24 million Americans are affected" and "over half of them don't even know it."

In fact, I didn't know that I MAY have COPD! But thanks to the COPD POPULATION Screener™, which the DRIVE4COPD campaign urges every one to take (see the DRUVE4COPD Web site), I now know it and will talk to my doctor about it, which is the goal of DRIVE4COPD.

You too can find out if you MAY have COPD by taking a simple 5 question test! I had no doubt that I would score high enough to be at risk because:

1. During the past 4 weeks, I DID feel short of breath "a little of the time," like when I had to shovel some snow, and

2. I DID cough up some "stuff," such as mucus or phlegm, but "only with occasional colds or chest infections," and

3. I HAVE smoked at least 100 cigarettes in my ENTIRE LIFE, though I quit smoking about 30 years ago, and

4. I agree (but not STRONGLY agree) that I do less than I used to because of my breathing problems, and

5. I am a man of a certain age (but I won't say how old).

This is not the first time that I have taken such a screening test without any idea who came up with the questions or how the answers determine whether or not you have a medical condition."

I, too, took the "screener," entered the healthiest answers possible, yet still was told by the website:

Don't wait. Call your doctor today to make an appointment if you may be at risk for COPD.

That's ridiculous. But that's what happens with the "Let 's SCREEN for everything" marketing mentality that has sprouted wings (and now NASCAR wheels!) in the good old USA.

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Well, the NBC Today Show's "Inside the O.R." series this week has certainly generated blogger criticism. Earlier we posted Larry Husten's scathing review of the segment on atrial fib ablation. Now Amy Romano on the
Science & Sensibility blog has written about her concerns about the live cesarean section delivery that was part of the series.

NBC execs will probably write off this criticism as coming from a bunch of nobodys - myself included in that bunch of nobodys - but perhaps the suits should pay some attention to the wisdom of the crowds on such matters.

The health spendings projection article in Health Affairs contains this one historic note:

In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent--the largest single-year increase since 1960.

A Los Angeles Times story gets to the heart of the matter:

"There is growing concern that as much as a third of the medical care delivered in this country does not help patients.

"Are we getting value for the dollar? That is the question," said Len Nichols, health policy director at the centrist New America Foundation. "If you believe that so much medical care is unnecessary, as I do, then it is criminal that we are spending so much."

Yet there is gridlock on federal health care reform legislation. Indeed, for all the rhetoric and fear-mongering about "government taking over health care," the latest data shows we're already there.

The Wall Street Journal reports and provides this graphic:

"For the first time, government programs next year will account for more than half of all U.S. health-care spending, federal actuaries predict, as the weak economy sends more people into Medicaid and slows growth of private insurance."

One of the reasons we review news stories about "new stuff" in health care is that we believe news stories may drive up undue demand for unproven, perhaps unsafe, and costly new technologies without giving a balanced picture of the tradeoffs between harms and benefits, without evaluating the quality of evidence behind the new ideas, without looking at conflicts of interest in those promoting the new ideas, etc.

At last check, 70% of the nearly 1,000 stories we've reviewed fail to adequately discuss costs, or quantify harms or benefits. A kid-in-the-candy-store view of US health care.

We believe these are health care reform stories - even though they often aren't presented that way. Just look at what we've written about just in the past week and you see the daily drumbeat of news stories and ads that fill our heads with visions of sugar plums in health care.

• CT and MRI scans

• Robotic surgery

• A weeklong network TV series taking you inside the O.R. for technological wonders

• Misleading drug ads

17.3% of the GDP and rising.

Make sure you see the onslide slideshow accompanying this article about how the FDA is cracking down on drug companies for ads that underplay serious risks.

The slideshow gives you details on the ad or promotional campaign behind the drug and includes copies of the warning letters the FDA sent to the companies responsible for the false promotions. The FDA slaps are for things like omitting or minimizing side effects, implying that the drug could be used for something for which it hasn't been approved, or exaggerating effectiveness claims.

The ten products promoted in the ads are these:

• Latisse eyelash thickening drug - starring actress Brooke Shields
• Cymbalta - depression and pain drug
• Treximent - migraine
• hormone-releasing IUD Mirena
• Depakote ER for bipolar disorder
• Ertaczo - cream for foot fungus
• Fosrenol - kidney failure drug
• Visipaque - used in heart imaging procedures.
• Dacogen - for certain rare blood cell disorders and blood cancers.
• Kaletra - HIV drug - with ads featuring former NBA star Magic Johnson

Excerpt from the article:

"It's almost impossible for the public to actually parse the ads and come to their own independent conclusions," says Cleveland Clinic cardiologist Steven Nissen, a fierce critic of drug ads.

But Nissen is suspicious of most drugs that are advertised because he thinks that the marketing campaigns distract and mislead consumers. His advice: avoid the most heavily advertised drugs and stick to generics.

How can you avoid getting misled by drug ads? One way is to skip over the glowing patient testimonials and seek hard data about the medication's risks and how it performed in clinical trials. Every drug Web site also includes a link to the drug's official FDA label (the link usually says something like "Full Prescribing Information.") It's heavy reading, and many doctors don't even bother to do it. But it will have definitive, unvarnished information on how effective the drug was in its clinical trials and exactly what all the side effects were.

Great piece. Terrific online slideshow. I don't know how they limited themselves to just ten misleading drug ads.

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This is what I look like after long hours on the Internet. But that does not mean I'm depressed.

And neither does the widely reported study in this week's journal, Psychopathology, prove that long hours on the Web cause depression.

That's because it's an observational study - the kind that can't prove causation - even if it can point to a statistical association. As the excellent UK site, Behind the Headlines, points out:

The study has several limitations and cannot prove that using the internet can lead to depression as reported in several newspapers:

* Cross-sectional studies can only investigate associations between variables because they cannot establish the temporal relationship between them, i.e. which happened first. It is possible that people use the internet more often because they are already depressed and withdrawn, not the other way round.
* The sample was not representative of UK internet users in general. Recruitment took place through social-networking sites, which not all people use, and hence has sampled a predominantly younger population with an average age of 21.
* Although the study used validated questionnaires to examine the outcomes of interest, all were self-completed so there may be some unavoidable inaccuracy. Also, a single questionnaire assessment cannot be taken as a definite diagnosis of either addiction or depression.
* The study has not been able to examine the wider personal, social, professional and health circumstances of the participants, and it is these factors that are likely to be the main influence on an individual's mental health.
* Only 18 people were considered to have internet addiction, so examining associations between other factors in this small number of people is likely to involve some inaccuracy.

So let's not get all depressed over long hours on the Web.

By the way, when did so many journalists (BBC, HealthDay, Reuters, Business Week, NY Daily News, LA Times, etc.) start reporting studies in the journal, Psychopathology?

Journalists have much to learn in the wake of the Lancet's retraction of a study it published 12 years ago making the case that autism could be caused by vaccines. The Wall Street Journal wrote:

"The journal finally issued a full retraction of a study it ran in 1998 linking measles-mumps-rubella vaccines to autism. The paper, with Dr. Andrew Wakefield as lead author, sent British parents fleeing from inoculations and fed U.S. alarm over preservatives in vaccines.

Even in 1998, overwhelming scientific evidence showed vaccines to be safe. Yet the press-savvy Dr. Wakefield had been getting headlines for his research, and the Lancet's publication fed the controversy by giving him an aura of respectability."

And here's the CBS piece on the retraction:

Lessons for journalists and for the public:

• Publication in a peer-reviewed medical journal does NOT mean that the science is sound or that the finding is gospel truth.

• As the WSJ wrote, "The Lancet episode shows how even reputable publications can become conduits for junk science when political causes run hot. Especially amid the scandal over politically motivated climate science, the public needs professional journals to be scrupulous about their standards and honest about the science."

• Journalists must learn to scrutinize evidence. They must see that the weight of evidence means something.

• Journalists and the public must learn from this example how much harm can be done by premature and imbalanced coverage of scientific claims.

• Finally, a good news story about journalism. Gutsy investigative journalism can make a difference. Some journalists - most notably Brian Deer - did the digging that exposed Wakefield and his flawed claims.

Blogger Larry Husten found plenty wrong. Let him count the ways. Excerpts:

"NBC Medical correspondent Dr Nancy Snyderman substituted schmaltz for substance and presented the "heartwarming" story of the patient, a great-grandmother, accompanied by stirring music and sentimental images. ...

Just in case anyone hadn't somehow caught the positive message, Snyderman told her viewers that the patient's life (even before the procedure was finished) now "has new promise thanks to a dedicated physician, a world-class medical center, and extraordinary medical advances..."

Didn't anyone at NBC think about the ethics of broadcasting a live medical procedure? Suppose something had gone drastically wrong during the live broadcast? I think there are legitimate questions worth raising about the public display of any medical procedure, but a live broadcast on a major television network is indefensible, in my opinion. (In my previous job as the editor of heartwire we investigated the issue of live case demonstrations at medical meetings, though in those circumstances there was always at least a plausible case for medical education in a professional setting.) Now we have live operations for public consumption or, even worse, the spectacle of physician-reporters reporting on their own medical efforts in Haiti.

Even if you believe it is ethical to broadcast a live procedure, it's unethical and irresponsible to report it with this kind of relentless, upbeat mindlessness. Let's be clear: there is no evidence in the literature to support the statement of an 85-90% success rate for catheter ablation of AF (a rate cited in the segment). To present this kind of statistic to the general public, many of whom may have AF, or may know someone who has AF, is completely irresponsible. Catheter ablation is emerging as an important therapeutic option for some patients with AF, and it is indeed an impressive medical advance, but it comes with a lot of caveats. ...

The shoddiness of the reporting becomes even more apparent when Snyderman declared the procedure a success, and the patient cured, before the actual ablation had even started, and without the long-term followup that can provide the only real measure of success. You would never know from the report that last year AF ablation received a mixed review from a Medicare advisory committee and was the subject of a critical AHRQ review. Further, it is typical of reporting like this that a genuine issue of concern like radiation is only mentioned in the context of saying "the radiation risk is minimal."

An anecdote is not evidence. By focusing exclusively and obsessively on single stories with happy endings, reporting like this has raised viewers expectations to such a degree that they will inevitably be disappointed and give up on the very real but more modest and unmiraculous aspects of modern medicine."

This was the first of a weeklong series on NBC's Today Show taking viewers "inside the O.R." I had commented more broadly about the series yesterday. Husten's specific examination of the first of the series is important. I am encouraged to see smart observers like him weigh in on some of the health news misinformation that network TV delivers that can so mislead the American viewing public - dwindling though those numbers may be.

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Ounce for ounce, vitamin D may be the most covered (over-covered?) health news topic in American news media.

Look at what we've seen just within the past week.

A New York Times column, "The Miracle of Vitamin D: Sound Science or Hype?" Excerpts:

"Imagine a treatment that could build bones, strengthen the immune system and lower the risks of illnesses like diabetes, heart and kidney disease, high blood pressure and cancer.

Some research suggests that such a wonder treatment already exists. It's vitamin D, a nutrient that the body makes from sunlight and that is also found in fish and fortified milk.
...
But don't start gobbling down vitamin D supplements just yet. The excitement about their health potential is still far ahead of the science."

The Dallas Morning News had a headline, "Heart health: Is vitamin D the new superhero?"

And the Los Angeles Times blog proposed in its headline, "Let's put Vitamin D in the water."

These stories have become - and believe me, we've seen enough to back this up - formulaic and predictable. Headlines that scream MIRACLE...SUPERHERO. Followed by some caveats.

Most of what we've commented on before were network TV news stories including some that committed fear-mongering and disease-mongering.

But this week's examples all came from newspapers. Is it in the water?

The NBC Today Show is traveling around the country this week taking viewers "inside the operating room" to see various procedures.

Monday it was Cleveland and a heart arrhythmia procedure. Very high tech stuff.

Tuesday it was Boston and a baby born by C-section. Absolutely no news. Just drama and cute fat baby video.

An "Inside the Operating Room" series, of course, is going to make surgery and high-tech interventions seem dramatic.

I only wish we'd see a week-long series on primary care - doctors and nurse practitioners and RNs and others dealing with patients in shared decision-making encounters. Last week, at the Foundation for Informed Medical Decision Making's annual research and policy forum, I talked with two health care consumers who truly exemplified the ideal of informed and shared decision-making. Mary Bianchi of Northern California talked about her breast cancer decision-making and Larry Forsberg of Minnesota talked about his BPH decision-making. I wish more Americans could hear more often (in news stories and elsewhere) from smart, informed patients and consumers like these two.

They may not involve high-tech interventions, but primary care encounters are where a lot of the rubber-meets-the-road health care happens - and where true health care reform might take place.

I'm not holding my breath to see that weeklong TV series, though.

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Sometimes I just like to share things that I see that Joe Blow and his bride don't see.

Like a web-based news release promoting:

• a "robotic prostatectomy expert" doctor

• the doctor's robotic surgery website

• the fact that the doctor is a contributor to Fox News

• a celebrity's promotion - and the doctor's promotion - of prostate cancer screening that conflicts with that of the US Preventive Services Task Force and the American Cancer Society

Excerpt from the web news release:

"Celebrities are helping to drive the point home for early prostate cancer screening in order to increase chances of survival. Now, with theater big Andrew Lloyd Webber's victory and Dennis Hopper's losing battle with the disease, the spotlight turns to increasing awareness and becoming more proactive with this largely preventable disease."

Our advice to consumers:

• Be wary of celebrity advice.

• Put more stock in evidence than in celebrity anecdotes.

• There's a reason why the US Preventive Services Task Force and the American Cancer Society agree on a more cautious approach to prostate cancer screening and you should learn what that is.

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The New York Times reports:

"...the Food and Drug Administration has cracked down on one of the most widely quoted cosmetic doctors, sending shudders through the ranks of opinion leaders in fashion publishing and vanity medicine.

The F.D.A. recently sent a warning letter to Dr. Leslie Baumann, a well-known dermatologist and clinical researcher in Miami Beach, citing the doctor for expressing premature enthusiasm in the media about Dysport, an injectable antiwrinkle drug the agency had not yet approved.

Dr. Baumann's comments in the media in 2007 violated restrictions on drug promotion, according to the letter; the agency asked Dr. Baumann to explain how she intended to prevent similar violations in the future.

... this is believed to be the first time the agency has warned an individual investigator -- a medical researcher who oversees a clinical trial -- for apparently promoting an unapproved drug.

...(The magazine) Allure has been particularly reliant on Dr. Baumann's expertise. The monthly magazine quoted her in 10 articles last year and mentioned her in another, according to a Nexis search."

While we're on the topic of celebrity MDs, many journalists received a news release last week under the heading, "Celebrity MDs Learn From Hollywood & Washington." Excerpt:

"Celebrity doctors like Dr. Oz or Sanjay Gupta aren't born polished and mediagenic; they build visible and compelling personal brands. Would your audience enjoy learning how it's done and how they can attract high-value patients with some powerful branding of their own?

A new book (title deleted - I'm not going to shill for it) reports that physicians who achieve most-notable status are as adept at publicity and personal branding as any Hollywood hero or rock star politician.

If your audience would like a behind-the-scenes look at the celebrity publicity, branding, and promotion strategies high-visibility doctors use to land book deals, CNN expert spots, and earn a tenfold multiple of the norm, let's set up an interview."

I don't think so.

Don't know who nominated this blog for a 2009 Medical Weblog Award - but thanks.

And then, the nomination was elevated to finalist status.

We're kind of a fish out of water in this category, since all the other finalists appear to be doctors - and I'm just an old journalist.

But then again the other finalists write about llamas, cooking and eating (sometimes), and other far-ranging topics you can check out for yourself. And you should check them out - because you'll undoubtedly encounter some new and intriguing blogs and bloggers.

Then vote here: http://medgadget.com/2009bestmedical.html

Blogger Alison Bass jumps on a Journal of Bioethical Inquiry article that says that "while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality."

Bass consistently tracks medicine's conflict of interest issues. Her blog would be a good bookmark for you if you care about these issues. And her book, "Side Effects: A Prosecutor, a Whistleblower, and A Bestselling Antidepressant on Trial," is terrific.

On the MSNBC.com health page at the moment I write this (the site will probably change by the time you visit) is a good story that reports:

"...a bevy of United States breast-feeding advocates may have unleashed a well-meaning but misguided flood of mothers' milk to the earthquake-shattered nation, one that aid workers in Haiti say was not requested -- and is not needed."

The image on the left is how this story appears at the top of the web page.

But lower on that same page, in the "diet and nutrition news" section, is a link to a local California TV story that sings the praises of local breast milk donation efforts - as seen in the image on the right. MSNBC didn't connect the two stories. They could have at least linked from the one story to the other for context and to point out how the story has changed.

I know this can happen on a wide-ranging news website like MSNBC. But somebody needs to keep track of what's been posted better than this.

Why would a local TV station even do this story? A local entrepeneur makes claims about a chewing gum to improve male sexual function.

Why would WTVJ in Miami devote time to this?

Because it's about sex.

It's an easy story.

And what pick up! The same story has now been picked up by the South Florida Sun Sentinel, KING-TV in Seattle, MSNBC.com and many other news organizations across the country.

The entrepeneur couldn't buy the kind of free advertising these "news" stories have just given him.

Visit msnbc.com for breaking news, world news, and news about the economy

Patient advocate Trisha Torrey writes and talks a lot about "participatory medicine." Today she writes:

"While many of us patients truly want to participate in our own care, we're not finding a great deal of cooperation from the others who must participate - our providers.

Some providers get it! In fact, some are very cooperative, offering knowledge, learning materials, assistance, discussion. They are the enlightened ones who realize that two heads -- theirs and their patients (us!) will always be more effective than one."

She has now posted an online poll asking readers:

Think of the specialist you see most frequently. Do you consider him/her to be participatory?

• Yes. My specialist and I decide every aspect of my care together.

• Partially. Sometimes we decide together, other times I just bow to his/her expertise.

• Barely. Once in awhile we discuss options.

• No. I can't get this specialist to discuss options with me at all. It's his/her way or the highway.

Kevin Pho, MD, a primary care physician in Nashua, N.H., who blogs at
KevinMD.com, advises other physicians in his USA Today column:

"Doctors who are not active online risk being marginalized. Facebook and Twitter users, more than half of whom are younger than 34, rely on the Web for most of their information. As this demographic ages, it's conceivable that they will consult social media first to answer their health questions. Already, patients are seeing how social media can improve their care. Hospitals are posting emergency department wait times, as well as updating family members on the status of their loved ones during surgery, on Twitter."

Walt Bogdanich and a team of reporters produced a powerful package entitled, "Radiation Offers New Cures, and Ways to Do Harm."

He profiled two people who died - one who received seven times his prescribed dose and one who absorbed "27 days of radiation overdoses, each three times the prescribed amount." But the story also was built on months of research and examination of thousands of pages of public and private records and dozens of interviews.

What makes this so important is that, as the story explains, Americans receive far more medical radiation than ever before. And some of it comes from technologies about which there is tremendous professional enthusiasm - such as IMRT or intensity-modulated radiation therapy. "Without a doubt," the story states, "radiation saves countless lives and serious accidents are rare. But patients often know little about the harm that can result when safety rules are violated and ever more powerful and technologically complex machines go awry."

I'm not going to post more excerpts here because you should read the entire piece and note the other elements of this rich multimedia package - video, interactive graphics, photos, and information graphics.

Powerful, tragic, important. Terrific journalism.

Physician-blogger Tony Brayer writes, "Why I am so over Dr. Oz." She gives examples of why she thinks he is "embarrassing" the medical profession. Her words:

• "His "Real-Age" website got 27 million people to sign up and take a health quiz. That information was sold to pharmaceutical companies who used the direct emails for marketing.

• He does pieces on "men's health" and tells men to do male breast checks once a month. No research I have read would support this advice.

• On his website he says "By the time women reach their 20th birthday, they are at risk for developing osteoporosis". Really?

• His website deals with topics like "What his erection is telling you" and "Dangerous health secrets men keep". Could what his erection is telling you be a dangerous health secret?"

I've created a "Question Mark TV Health News Hall of Shame" for all of those health stories that are teased, introduced or use graphics with a question mark at the end of a sensational claim. I'm going to keep adding to this list, hoping to reach the tease-writers of tomorrow if today's boffo writers won't change. So far we have:

ABC Good Morning America's: "Can Your Purse Make You Sick? Beware 'bag-teria' "

Ivanhoe Newswire's: "Pomegranates Prevent Breast Cancer?"

ABC World News Tonight's: "Fountain of Youth?"

And now CBS Evening News': "Is Salt Deadly?"

The NPR program "On the Media" did a terrific job turning to several sources (including me) for analysis of the journalism ethics issues involved in TV network MD-reporters becoming part of the story while delivering care in Haiti.

Host Bob Garfield used these phrases and terms in describing the reporting in question:

• Gimmick
• Obscures and trivializes the news
• Obliterates any measure of objectivity
• Exploiting patients

You can listen to the entire segment here:

His ending:

"Or maybe the prime canon of medicine just needs an update: Do no harm. But first, roll the tape."

It is surprising how much momentum this discussion gathered as the week wore on. Last night there was an explosion of activity on Twitter after CUNY prof and interactive media expert Jeff Jarvis posted a heated and simplistic series of rants against the Society of Professional Journalists, which had issued a statement urging Haiti reporters to remove themselves from their stories. Blogger Tyler Dukes captured Jarvis' tirade and described it as "hyperbole and distortion," continuing: "These are not the tools of a responsible journalist, but of a blowhard with an axe to grind."

After a week of mounting criticism of the practice of network TV physician-reporters reporting on themselves delivering care in Haiti, today the Society of Professional Journalists - in a rare move - issued a news release using strong language to chastise the networks and reporters. Excerpt:

"I think it's important for journalists to be cognizant of their roles in disaster coverage," SPJ President Kevin Smith said. "Advocacy, self promotion, offering favors for news and interviews, injecting oneself into the story or creating news events for coverage is not objective reporting, and it ultimately calls into question the ability of a journalist to be independent, which can damage credibility."

Undoubtedly, journalists walk a fine line to balance their professional responsibilities with their humanity when covering disasters. SPJ does not nor would it ever criticize or downplay the humane acts journalists are performing in Haiti. But news organizations must use caution to avoid blurring the lines between being a participant and being an objective observer.

"No one wants to see human suffering, and reporting on these events can certainly take on a personal dimension. But participating in events, even with the intention of dramatizing the humanity of the situation, takes news reporting in a different direction and places journalists in a situation they should not be in, and that is one of forgoing their roles as informants," Smith said.

The SPJ says it is "the nation's most broad-based journalism organization, dedicated to encouraging the free practice of journalism and stimulating high standards of ethical behavior. Founded in 1909 as Sigma Delta Chi, SPJ promotes the free flow of information vital to a well-informed citizenry through the daily work of its nearly 10,000 members; works to inspire and educate current and future journalists through professional development; and protects First Amendment guarantees of freedom of speech and press through its advocacy efforts."

The SPJ statement clearly signals that the ethical criticism of the past week's TV reporting practices is significant and broad-based.

The CBC radio program "As It Happens" began its discussion of this issue with this introduction:

"It is a dramatic image: a reporter who is also a qualified medical doctor springing into action to perform first aid on someone hurt in the Haiti earthquake -- and in some cases, going as far as to perform surgery. All of it during a news report.

And while a physician correspondent giving medical assistance to those injured in a natural disaster is commendable, it does raise some ethical issues about the role of journalists."

They then interviewed me for more than 8 minutes. You can listen to it by downloading this file.

There have been countless articles on this topic this week - many missing the journalism ethics point that many concerned journalists have raised. As I have consistently tried to point out, an ethical middle ground would appear to be this: Physician-reporters should render care if they are so moved but they should not report on themselves doing so.

Broadcasting & Cable is an industry magazine. On their website appeared these comments from TV network executives:

"Steve Capus, president of NBC News, expressed outrage that ethicists would question the judgment of medical reporters who have a unique capacity to help in the face of so much human suffering.

"I'd love for (Poynter Institute Journalism Values Scholar & DePauw University Professor) Bob Steele to have to pick up the phone and [lecture] Nancy Snyderman on the journalistic ethics of driving past a kid who can't walk anymore because he has a crushed leg," says Capus.

"Where would you draw the line? How does one remain absolutely 100 percent objective and say, I'm not going to go near that child who can't walk any further? You don't need to be objective about human suffering. If someone is trained as a medical doctor and they help, good for them. That's the right thing to do."

Frankly, I'd love to hear Bob Steele (who has been quoted this week with concerns about what he's seen) do that as well. But, first, he wouldn't "lecture" in the heavy-handed manner that Capus' quote suggests. He would guide Snyderman through the complex decision-making about exactly the questions Capus raises about where to draw the line and how one alternative path is to simply provide care without promoting yourself and your network in the process. This is something that Steele has done with hundreds of journalists in past years.

The online B&C quotes continued:

Paul Friedman, executive VP at CBS News, says news executives asked themselves all the right questions before letting their medical correspondents practice participatory journalism.

"We always need to ask ourselves is a reporters involvement in the story appropriate and does it in any way impinge on accuracy, fairness and so on," he says. "I just think in this case it is so innocent and the benefit is so obvious to the people who are in need of care that it's not a difficult call to make."

(CBS' Dr. Jennifer) Ashton told CBS News executives that she wanted to go to Haiti first as a doctor. And the network has followed her as she has become a participant in medical efforts there.

"We've felt a little bit guilty about taking her away, for even short periods of time, from what she was doing that was really important compared with reporting," adds Friedman.

Indeed, that's one of the points I made in my CBC interview and one that another journalist made earlier on this blog, when he wrote:

"How do they justify leaving the scene to go do their live shot or writing or other tasks? Does the urgent need magically disappear when the show open rolls?

Just think how many more people these physicians could help if they took a leave of absence from their network jobs in order to provide care full-time... and left the reporting to journalists."

If you haven't had your fill, there wlll be more radio discussion on these issues this weekend on the NPR program, "On the Media," whose hosts also interviewed me.

When a study appeared in JAMA earlier this week pointing to an association between circulating levels of omega-3 fatty acids with a change in telomere length 5 years later (if you really care about this stuff, you can look up the study), many news organizations jumped on it. Another omega-3 fatty acid story!!!

One friend referred to this as "making a biological mountain out of a mole hill."

Oh, you mean, like ABC and Diane Sawyer leading into the story with one of Jon Stewart's least favorite TV ploys - the question mark graphic or tease.

Fountain of youth? You'd have to stay tuned to learn that the answer is "no."