Stories about Elizabeth Edwards’ breast cancer and Tony Snow’s colon cancer have led some news organizations to offer recommendations about cancer screening. Unfortunately, some of the recommendations are simply not based on evidence.

On the NBC Today show on March 28, Matt Lauer said the Edwards and Snow cases put “a huge spotlight on the importance of early detection.”  Did they?  The Edwards and Snow cases were not about early detection; they were recurrences.  Theirs were not stories about cancer screening in the general population of people without symptoms.  They were stories about follow up testing and recurrence in people who already had been treated for cancer.  That’s an important distinction, glossed over in the kind of introduction Lauer used.   

And to use the Edwards and Snow cases to stir up enthusiasm for early detection in ways that fall outside the boundaries of the best evidence is troubling. 

Lauer brought on NBC News chief medical editor Dr. Nancy Snyderman and the two of them reviewed recommendations for screening tests for breast cancer, colon cancer, lung cancer and prostate cancer.  But the discussion weaved in and out of the boundaries of evidence. 

In discussing colon cancer screening, Snyderman explained that because she has a family history, she started having colonoscopies at age 40 in two to three year intervals. She says now that she’s over 50 she gets one every year. “And I get one more than my doctors really recommend because I just get a little nervous about it,” Snyderman said.

It’s fine for her to choose whatever path makes sense to her.  But it is troublesome to use a national TV platform to leave even the perception that this is an evidence-based course.  The frequency of her screening is far more aggressive than the intervals described by the U.S. Preventive Services Task force for most people in the viewing audience.

Annual FOBT (fecal occult blood testing) offers greater reductions in mortality rates than biennial screening but produces more false-positive results. A 10-year interval has been recommended for colonoscopy on the basis of evidence regarding the natural history of adenomatous polyps. Shorter intervals (5 years) have been recommended for flexible sigmoidoscopy and double-contrast barium enema because of their lower sensitivity, but there is no direct evidence with which to determine the optimal interval for tests other than FOBT. Case-control studies have suggested that sigmoidoscopy every 10 years may be as effective as sigmoidoscopy performed at shorter intervals.

http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm

It is unclear whether the increased accuracy of colonoscopy compared with alternative screening methods (for example, the identification of lesions that FOBT and flexible sigmoidoscopy would not detect) offsets the procedure's additional complications, inconvenience, and costs.

The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).

http://www.ahrq.gov/clinic/uspstf/uspsprca.htm

We have written about the one-sided, pro-screening enthusiasm exhibited on some network TV newscasts before.

    (• Two CNN reports in February and May, 2006.

     • NBC’s Mike Taibbi getting a lung scan and endorsing such scans.)

Journalists should not be advocates, especially if their advocacy is based on personal opinion, not evidence or fact. 

A good source for an evidence-based assessment of these issues:  “Should I Be Tested For Cancer?  Maybe Not and Here’s Why,” by H. Gilbert Welch, M.D., MPH.  (University of California Press, ISBN 0-520-23976-8).

A Wall Street Journal story today looks at an important question in science, in policy-making, and in journalism: "What do the results of animal studies really tell us about humans? That question still puzzles researchers even though guinea pigs, lab rats and their brethren have long been part of experiments."

Two examples from the story:

Many times, however, subtle results in animals are unclear and scientists just don't know what to make of them. In the case of the new Novartis drug Galvus, James Shannon, the company's global head of pharmaceutical development, told investors that Novartis researchers "do not understand -- do not know -- the mechanism of the skin findings" in monkeys. They do know that "humans appear to react to Galvus in a very different way."

Another example of the confusing disparities that can arise in testing is the case of the popular sleep drug Lunesta. It won FDA approval despite the fact that tumors appeared when rats and mice took huge doses of a closely related chemical cousin of the medication. Some FDA reviewers were concerned enough initially to recommend rejection of Lunesta. After further analyses, however, agency officials concluded the data from human testing didn't suggest a signal for cancer in people. But you won't see the issue highlighted in the company's ubiquitous green-moth commercials for the drug.

Journalists who report on preliminary findings from animal research without strongly emphasizing the inherent weaknesses in trying to interpret such findings are not serving the public.

Earlier this week, I pointed out how - on one day - the Wall Street Journal appeared to favor positive drug news out of the American College of Cardiology meeting more than negative drug news. But day in and day out, the WSJ is one of the few news organizations to put negative drug news on page one. And today they should be praised for the spot they gave the story headlined, " 'Miracle' Obesity Pill Looks Less Miraculous." It begins:

"When Sanofi-Aventis SA reported data on a new obesity pill at a medical conference in March 2004, it generated instant buzz.

Hundreds of newspaper and television reports around the world the next day referred to the drug, Acomplia, as a "super pill" and a "miracle drug." With a new approach to obesity, Acomplia promised not only to help people shed pounds but also to raise good cholesterol and cut diabetes risk. It even showed signs of working as an antismoking aid.

"That is amazing. People are going to want this drug today, I'm sure," effused an anchor on ABC's "Good Morning America."

Three years later, Acomplia is looking less like a miracle. The drug still hasn't hit the market in the U.S. The Food and Drug Administration has asked for more data and repeatedly put off approval for the drug as an obesity treatment, while rejecting it for smoking cessation. Side effects associated with Acomplia -- including depression and anxiety -- are likely giving the FDA particular cause for concern, analysts and doctors say."

This episode is repeated many times each year: journalists trumpeting preliminary unproven claims made by drug companies or pharma-funded researchers without exercising appropriate skepticism and caution.

Thanks to the WSJ for not only pointing this out, for doing so in its prominent page one position.

Very preliminary findings from stem cell research got a lot of news coverage this week. Probably because there were local researchers involved, the Star Tribune put the story on the front page of Monday's paper. They reported:

An experimental treatment using adult stem cells was able to limit heart damage and improve the quality of life of patients suffering their first heart attack, according to a study of patients in Minneapolis and several other cities.

First, I balk at calling an experiment a treatment. It’s an experiment. Health lawyers have a term for this – “therapeutic misconception.� That means leading people to think there’s a certain therapeutic benefit from what is really an unknown undergoing experimentation.

The Star Tribune quoted four sources – which is usually good. But all four were connected with the research in some way, with a vested interest in reporting positive findings.

Especially since the work had only been presented at a scientific conference, which means that it had not yet been peer-reviewed, the story should have included independent perspectives.

Remember, questions have been raised about other stem cell research at the UMN – questions that are likely to come to the fore after peer review.

And ABC News recently reported on the drug Tykerb for metastatic breast cancer. But the story failed to mention that the drug is approved only for use with another drug (Xeloda) and that the combined cost of the drugs is $4,400 per month. It also failed to discuss potential harms of the two drugs.

It is hard to understand why/how such key components are so consistently left out of health news stories.

You're seeing lots of cardiovascular news this week because the annual meeting of the American College of Cardiology is going on in New Orleans.

I applaud the health news coverage of the Wall Street Journal, but even their coverage shows a bias toward the positive and against negative findings.

In today's WSJ, the front page of the "Marketplace" section, page B1, has a story on the "blockbuster drug plavix" and a pack of new rivals on the horizon.

But negative findings on two other drug studies are relegated to pages B6 and B7, deep in the paper and deeper in that section.

Stories headlined "Crestor Fails to Clear A Bar in Arterial Study" and "Two Heart-Failure Drugs Fail to Reduce Death, Admissions" were important, but got neither the quality nor quantity of space given to the generally positive Plavix (and rivals) story.

American consumers need to be reminded that not all drugs are blockbusters, and that hopes at the beginning of trials are often dashed at the end. Page 1 placement would drive that point home.
(But at least the WSJ reports on the negative findings somewhere - don't get me wrong.)

Gardiner Harris of the New York Times is all over issues about drug company influence on doctors and on the FDA this week. Today he writes:

Expert advisers to the government who receive money from a drug or device maker would be barred for the first time from voting on whether to approve that company’s products under new rules announced Wednesday for the F.D.A.’s powerful advisory committees.

Indeed, such doctors who receive more than $50,000 from a company or a competitor whose product is being discussed would no longer be allowed to serve on the committees, though those who receive less than that amount in the prior year can join a committee and participate in its discussions.

A “significant number��? of the agency’s present advisers would be affected by the new policy, said the F.D.A. acting deputy commissioner, Randall W. Lutter, though he would not say how many.

Yesterday, Harris' story on "Doctors' Ties to Drug Makers Are Put on Close View" simply blew away the competition - better by far than any other story I saw on the subject in many media across the country - including right here in Minneapolis. He and Janet Robert reported on records in Minnesota, where drug makers are required to disclose payments to doctors.

The Minnesota records are a window on the widespread financial ties between pharmaceutical companies and the doctors who prescribe and recommend their products. Patient advocacy groups and many doctors themselves have long complained that drug companies exert undue influence on doctors, but the extent of such payments has been hard to quantify.

The Minnesota records begin in 1997. From then through 2005, drug makers paid more than 5,500 doctors, nurses and other health care workers in the state at least $57 million. Another $40 million went to clinics, research centers and other organizations. More than 20 percent of the state’s licensed physicians received money. The median payment per consultant was $1,000; more than 100 people received more than $100,000.

The reporting on this latter story was complete and comprehensive, with many examples of Minnesota physicians receiving surprising amounts of money from drug companies; ten doctors and one dentist received more than $500,000. You should read the entire story. But be ready to take an anti-anxiety pill when you're done.

Many serious health journalists struggle with how to handle research stories in animals. Last night, KSTP-TV in MInneapolis-St. Paul presented a story that showed little attempt to put mouse research findings into a meaningful context.

It was on Rett Syndrome, which KSTP reported was "a disorder similar to autism." They said, "Doctors, who are testing mice, were able to reverse the symptoms of Rett Syndrome, an advancement beyond what many had even hoped for. ... The discovery is so monumental because it could lead not only to a cure for Rett Syndrome, but it could also help doctors working to cure autism. This is still in the research stage, a cure is at least ten years out. In the meantime, the Evert family and thousands of others are excited about a Rett Syndrome clinic set to open at Gillett (sic) Childrens' Hospital in Saint Paul."

First, the finding is not new; it is more than a month old.

Second, the story made little of the leap required from mice to humans. How can one even discuss "cure" with something that has not yet been tried in humans? How good an animal model is the mouse for this syndrome? What are the hurdles that lie ahead? We heard none of this. Yet we heard "cure" three times within seconds.

Finally, the story seemed to fall prey to a news release from a local hospital creating a clinic for Rett Syndrome patients, without any regard for the fact that such patients may receive specialized treatment at other area hospitals as well.

But, as evidenced from a listing of stories on the research on the Rett Syndrome Research Foundation website, KSTP was not alone. Many other news organizations used the word "cure" in describing this perhaps promising but certainly preliminary finding.

I would not dissuade people from finding hope wherever they choose to invest it. But I would dissuade journalists from promoting what may be false hope laden with more emotion than evidence.

The magazine TV Week this week profiles my efforts with the HealthNewsReview.org website.

On Friday, I’ll present data at the Association of Health Care Journalists annual conference in Los Angeles on our findings from the reviews of the first 300 stories in our first 11 months of experience with the site. It’s not a pretty story.

Stay tuned.

In the February issue of Columbia Journalism Review (CJR), Trudy Lieberman writes about TV news stations accepting pre-packaged new stories created by health care behemoths such as the Cleveland Clinic or the Mayo Clinic, creating stories that are "a hybrid of news and marketing, the likes of which has spread to local TV newsrooms all across the country in a variety of forms, almost like an epidemic. It’s the product of a marriage of the hospitals’ desperate need to compete for lucrative lines of business in our current health system and of TV’s hunger for cheap and easy stories. In some cases the hospitals pay for airtime, a sponsorship, and in others, they don’t but still provide expertise and story ideas. Either way, the result is that too often the hospitals control the story. Viewers who think they are getting news are really getting a form of advertising. And critical stories—hospital infection rates, for example, or medical mistakes or poor care—tend not to be covered in such a cozy atmosphere. The public, which could use real health reporting these days, gets something far less than quality, arms-length journalism."

Some recent network TV segments point to an unquestioning – almost cheerleading – approach to health news coverage.

On March 10, Dr. Sanjay Gupta’s HouseCall program on CNN featured a story on anxiety disorders, and offered one of those handy self-assessments that allows you to diagnose yourself with almost anything under the sun. Gupta said only one in five people with anxiety disorders get help. Then he offered a self-assessment from the Anxiety Disorders Association of America (ADAA). He said if you answered yes to any of the questions, you could seek help from your doctor or from ADAA.

He did not mention that the ADAA’s corporate advisory council is made up of drug companies Eli Lilly & Company, Forest Laboratories, Pfizer, Inc. and Wyeth.

On February 6, CNN reported on "ArteFill, billed as the first permanent filler." CNN said "known side effects are minimal."

But it's easy to find the following on the FDA website:

Side effects of ArteFill® include:
* Lumpiness at injection area more than one month after injection
* Persistent swelling or redness
* Increased sensitivity
* Rash, itching more than 48 hours after injection

Let's let consumers decide if those sound "minimal" or not. The story never mentioned that one of the conditions of FDA approval last fall was that a five-year study for safety be done after approval, a clear sign that reviewers were not convinced that all the evidence on safety was yet in.

And NBC hit the trifecta with three recent stories:

• NBC’s Mike Taibbi getting his lungs scanned for cancer, then personally endorsing the scans. (The benefits of such scans were questioned in a study in JAMA in March.)
  
• NBC’s Josh Mankiewicz reporting on the “benefits” from GlaxoSmithKline ads for a restless leg syndrome drug – ads they featured during the NBC Nightly News.
• NBC using some of its tight 22-minutes of airtime to report on a “laser hair comb” showing a graphic - “Hair breakthrough?”.

Lieberman concludes her CJR article: “…stories about profitable, high-tech, yet often unproven procedures stimulate demand for them, fueling ever-rising health care costs. Local TV health journalism doesn’t often discuss those big issues, or even often take on the smaller stories that together weave a tale of a health care system in trouble.”

And, as you can see, sometimes network TV news isn't much better. This is a growing concern, one we will continue to analyze on this site.

On the listserv of the Association of Health Care Journalists, a journalist raises an important issue that we don't hear enough about. That journalist wrote:

"May I suggest that while Washington is obsessing about Walter Reed, the rest of us should be paying attention to what’s happening in our back yards in the run-up to the deadline for switching Medicare Advantage plans? In many areas, plans have contracted with independent brokers/agents to make a last push to persuade beneficiaries to switch plans. Many broker/agents who signed beneficiaries up for one plan in the fall (to begin Jan. 1) are now urging them to switch before the deadline; that way, they collect commissions twice. There’s a lot of misinformation being spread, a lot of dirty tricks. By the time we get around to reporting on it, the March 31 deadline will have passed and the misinformation campaigns will have been successful."

Have you heard anything about this from your news organizations in your market?

Merrill Goozner suggests that the FDA announcement late last Friday afternoon, issuing an official warning against giving cancer patients erythropoietin drugs (Epogen, Procrit, Aranesp) for anemia, was timed to minimize bad news or embarrassment. Goozner writes:

"What struck me most about yesterday's announcement was its timing. It has long been a hallmark of White House public relations staff that the best time to release bad news was late on Friday afternoons. That way, the least number of people will hear about it through traditional news media sources. It's too late to make the Friday evening newscasts; and the print stories usually wind up inside the Saturday papers, which are the least read of the week. (The New York Times story, at least, got mentioned on the front page.)

This late Friday afternoon release shows as much as anything how the culture of the agency has been transformed in recent years from industry watchdog to industry lapdog."

Dr. Sanjay Gupta’s HouseCall program on CNN today featured a story on anxiety disorders, and offered one of those handy self-assessments that allows you to diagnose yourself with almost anything under the sun.

Gupta said only one in five people with anxiety disorders get help. Then he offered a self-assessment from the Anxiety Disorders Association of America (ADAA). Gupta listed:

Do you have a (sic) anxiety problem?
• Excessive worry, occurring more days than not, for a least six months?
• Unreasonable worry about a number of events or activities, such as work or school and/or health?
• The inability to control the worry?

He said if you answered yes to any of these, you could seek help from your doctor or from ADAA.
He did not mention that the ADAA’s corporate advisory council is made up of drug companies Eli Lilly & Company, Forest Laboratories, Pfizer, Inc. and Wyeth.

I worry a lot about how commercial, how unquestioning, and how cheerleading much of CNN’s medical news is. It makes me very anxious and I am unable to control that worry. It only gets worse.

Sometimes my own critics have said that I am unfair to those who practice television health news. They imply that because I once worked in that field I am bitter in my criticisms.

Well, veteran journalist Trudy Lieberman never worked in TV news, but you must read her comprehensive indictment of current TV health news practices in the current issue of the Columbia Journalism Review.

She writes about news stations accepting pre-packaged new stories created by health care behemoths such as the Cleveland Clinic or the Mayo Clinic, creating stories that are "a hybrid of news and marketing, the likes of which has spread to local TV newsrooms all across the country in a variety of forms, almost like an epidemic. It’s the product of a marriage of the hospitals’ desperate need to compete for lucrative lines of business in our current health system and of TV’s hunger for cheap and easy stories. In some cases the hospitals pay for airtime, a sponsorship, and in others, they don’t but still provide expertise and story ideas. Either way, the result is that too often the hospitals control the story. Viewers who think they are getting news are really getting a form of advertising. And critical stories—hospital infection rates, for example, or medical mistakes or poor care—tend not to be covered in such a cozy atmosphere. The public, which could use real health reporting these days, gets something far less than quality, arms-length journalism."

Read the full story. Then you'll see that it's not just me who thinks that much of TV health news is in critical condition, possibly creating more harm than good.

The screen-at-all-costs mentality takes an intellectual hit with the publication of a new study in the Journal of the American Medical Association. The conclusions of those authors: "Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks."

Back in October, another study claimed quite the opposite, and many journalists failed to report with balance on those findings. (See summary on 8 stories on HealthNewsReview.org.) One journalist on the listserv of the Association of Health Care Journalists (AHCJ) has already pointed out this morning that some news organizations will have difficulty explaining the apparent flip-flopping findings today - if they did a naive job in October. Mike Taibbi of NBC News even went on the air in the fall reporting on his own CT scan after a life of smoking, and ended with a personal endorsement of the procedure. No spots on his lungs but now egg on his face.

One who wouldn't have a tough time explaining the latest study is former Miami Herald reporter Jacob Goldstein, who was recognized on HealthNewsReview.org for his excellent story in October. We've just learned that his excellence led the Wall Street Journal to lure him away as their first health news blogger.