Business Week has an interesting special report on "blurring the lines between objective science and financial gain. "

The magazine profiles a New York heart specialist who is chairman of the Cardiovascular Research Foundation in New York. Excerpt: "The foundation uses donations and fees from medical device companies to stage (an) annual conference, called Transcatheter Cardiovascular Therapeutics (TCT). A professor of medicine at Columbia University, he has helped start a handful of cardiac device companies through a corporate "incubator" he co-founded. He also has served as a paid scientific adviser for several other startups. Over the years, companies to which he has had close ties have been featured prominently at TCT, creating at minimum a perception that the companies' products are favored for reasons other than medical merit. ... Beyond the danger that conflicts may distort individual clinical decisions, some TCT observers worry that the event engenders a general excess of enthusiasm for complicated device-based procedures. From 1986 to 2003 the number of nonsurgical cardiac procedures, such as propping open arteries with wire-mesh stents, rose twelvefold, according to the American Heart Assn. Such procedures "are uncomfortable, relatively expensive, and might be taking the focus away" from less invasive, equally effective treatments, such as taking medicine, says Dr. David D. Waters, chief of cardiology at San Francisco General Hospital."

Read the entire report. It paints a picture that is now being seen more often in medical research - a tangled web of conflicts of interest with big dollars at stake. And where, in all of this, are consumer interests represented?

Sometimes you see a letter to the editor of a newspaper that you just want to frame. One such note appeared in today's Star Tribune.

The letter stated:

"Why not a more accurate headline for your Oct. 23 Business article "Massage that offers a healing message"? I suggest "St. Thomas prof sees business opportunity in quack remedy."

As an Asperger's parent, I'm tired of being treated as a sucker and cash cow for unproven remedies. When looking at possible medical treatments, businesspeople, writers, editors and "experts" owe the public the truth. If the "evidence" for effectiveness is just someone's personal story and there is no scientific rationale, it may be all right to study the treatment, but it is evil to commercialize it."

I recall reading the story in question (but was unable to find it now in the Star Tribune archives), and I recall my reaction was not far from this woman's reaction. But, as I've stated before, newspapers seem to have a different set of guidelines - and perhaps a different standard of ethics - for the Business section. There seems to be a lower standard of evidence if the story promotes any local product or company.

My friend Andrew Holtz asked journalists on the Association of Health Care Journalists' listserv, "Why did this week's Cochrane review examining the balance of risks and benefits of mammography get widespread coverage in the UK, but almost no mention in the US news media? Of the two dozen stories picked up in a Google News search, almost all were from the UK, Australia and other Commonwealth nations, but there were no U.S. news stories found. The story hasn't appeared on NYTimes.com, Washingtonpost.com or LATimes.com. CNN.com mentioned it only in its international section as part of a world news digest. So the BBC and others had headlines like: "Breast Screening Concerns Raised" and "Researchers question benefits of breast cancer screening." Meanwhile, US news outlets ran story after story on breast cancer that never mentioned the potential downsides of mammography... with rah-rah leads such as "Mammograms are good" and "No more excuses for not getting mammograms." It seems British and Australian editors have a different view from those in the US about what sort of info is relevant to their readers and viewers."

You can read the BBC story as an example of what you didn't get here. Excerpts:

"They found that for every 2,000 women screened over a decade, one will have her life prolonged, but 10 will have to undergo unnecessary treatment."

"...The scientists found mammograms did reduce the number of women dying from the disease. But they also discovered it was diagnosing woman with breast cancer who would have survived without treatment, meaning they were undergoing unnecessary chemotherapy, radiotherapy or mastectomies. About a fifth of cancers picked up by screening are in the milk ducts of the breast. Some of these cancers will progress while others will not - but there is no way of predicting what will happen. This means women and doctors have to decide whether or not to risk doing nothing, or go ahead with treatment which might be unnecessary. They also revealed a further 200 women out of every 2,000 experienced distress and anxiety because of false positives - a result that indicated a cancer was present but was later found to be wrong."

Some journalists responded on the listserv that the Cochrane Library review was just that - a review of past studies - and therefore, not news. Others responded with emotion - not evidence - about a woman's "need" to, or "right" to, have regular mammograms. (These were supposedly even-handed journalists, mind you.)

Holtz's observation about British and Australian editors having a different view from those in the US about what sort of info is relevant to their readers and viewers is interesting, and it may reflect an American cultural bias toward more screening and more aggressive treatment, regardless the evidence.

Journalists already know this, but many news consumers may not. What you read in your local newspaper or its website may be a considerably-shortened version of a story that was written by someone in another city who put a lot more work into the original than what you see. Here's an example of what can happen and how readers of health news may not be well served by the practice.

We recently reviewed a story published by the Pittsburgh Post-Gazette about a new drug for macular degeneration. But the story was a version of a story written by a reporter for the Charlotte Observer.

The story did not get a favorable review; it was rated unsatisfactory on nine criteria with a score of "not applicable" on a tenth criteria. So it got a score of zero stars.

We always send e-mails to reporters whose stories are reviewed, so we wrote to the Charlotte reporter. She claimed that what we reviewed was a very short version of her original story. She said that many of the things we said were missing in the Pittsburgh story were available in the original story.

We checked and, indeed, the Charlotte paper originally ran two stories on macular degeneration on September 17 - one on the front page and one on page 20. The two stories totaled more than 1,500 words. But the Pittsburgh Post-Gazette published a version that only ran about 500 words, about a third of the material in the original version.

What do you lose when you chop 1,500 words down to 500? In this case, the shorter story didn't contain information the longer story had on:

• Cost. The drug costs about $2,000 per monthly dose.
• Other options. "What if an off-label drug, Avastin, could do the same thing for $50 per dose?" (a question raised in the original story)
• Whether the drug is approved by the FDA (It is.)
• How big is the potential benefit? ("The drug halted vision loss in 95 percent of patients.")
• How is it administered? (The drug is not taken orally; it is injected into the eyeball - something prospective patients would want to know.)

These are all things we look for as we review stories. And they weren't there in the version that readers of the Pittsburgh Post-Gazette got. And for many Americans, a local newspaper is their main source of news. I doubt that many people in Pittsburgh read the Charlotte paper.

The Pittsburgh paper was one that we happened to be reviewing on that particular day. We review the top 50 papers each week, but only 10 each day on a rotating basis. On that day, Pittsburgh was in our rotation, not Charlotte.

Many newsrooms talk a great deal about transparency these days. Perhaps because of many recent journalism ethics disasters, and perhaps because of declining circulation in many cities, many news organizations feel they have to do a better job of explaining their decision-making processes to the public.

As part of that transparency, perhaps newsrooms need to do a better job of explaining how they lift material off wire services and often don't include all of the original material. That is why we listed the Pittsburgh paper as the source of the story we reviewed, not the Charlotte paper. An independent judgment was made in the Pittsburgh newsroom about what to run, how much to run, and what to leave out.

In tough economic times, many newsrooms may be investigating and reporting fewer local enterprise stories while filling the news hole with more pickups from wire services and from other, less journalistically-sound sources (industry news releases, for example). In many newsrooms, staffs are being cut so fewer people are being asked to do more with less.

Shortcuts may save in the short-term but cost dearly in the long run, especially when accuracy, balance and completeness are at stake.

Another one of my web efforts, HealthNewsReview.org, was named Cool Site of the Day by The Kim Komando Show one week ago today. Komando says she “hosts the largest talk radio show about computers and the Internet.� The program is heard on over 450 stations throughout the United States. One thing is known: traffic to HealthNewsReview.org soared. This week, the site registered more than 1.3 million hits and had more than 30,000 unique visits. Almost 400 of those visitors became registered users.

After just six months of operation, we have reviewed 208 health news stories on the site.

The editor of Milwaukee Magazine writes: "Perhaps the most under-covered issue in the Milwaukee metro area is the cost of healthcare. Medical costs are killing this community in both public and private sectors.

I don’t claim to have any solutions to this crisis. But it’s a safe bet nothing will happen until more attention is paid to the issue. And the media can help make that happen." (my emphasis added)