I met yesterday with the World Press Institute's 2008 International Fellows. They came from Argentina, Brazil, Bosnia & Herzegovina, China, Hungary, India, Lithuania, South Africa and Spain.

We reviewed recent examples of U.S. health journalism.

Several of the Fellows expressed amazement at what they saw. Among the comments:

• They couldn't believe that stories promoted drugs without better discussion of evidence.
• They couldn't believe that drug company spokesmen were interviewed in stories.
• They couldn't believe that someone in news organizations didn't say "NO" to some of the stories they saw here.

Welcome to our world.

CNN went "live" yesterday from the operating room where Olympic swimmer Dara Torres was having arthritic shoulder surgery.

Why?

And why have the reporter in the room saying "Hi" to her while the anesthesia is about to take her under?

Over on HealthNewsReview.org, August has been a spotty month for health news quality.

The good news: five stories have been given the site's top five-star score. That's a record for one month. They include stories by the New York Times, the Wall Street Journal, the Washington Post, and the Associated Press (two). All can be found here.

Then there was the crud:

• a one-star story by the Wall Street Journal on a depression drug being tested for chronic pain. At only 189 words, it was still wasted space. It apparently stole a quote from a news release without attribution.

• a one-star story by the CBS Early Show on an "artificial pancreas." CBS called it a "medical miracle." The anchorman gushed, in interviewing a patient:

* "How life-changing was it for you when you tried this thing?"
* "Wow. Wow. How much would you love it if this thing actually came on the market?"

• a zero-star story by the CBS Evening News on a form of 3-D optics to help surgeons. The HealthNewsReview.org summary on this one:

"CBS exaggerates benefits, fails to explain what’s really new, doesn’t mention costs and cites no evidence about whether the machine produces better outcomes or carries any additional risks."

I love Carl Bialik's "Numbers Guy" column in the Wall Street Journal and last week he had another gem, headlined, "Obesity Study Looks Thin." Excerpt:

In 40 years, every single American could be overweight, according to a recent study. Employing that same logic, 13 out of every 10 adult Americans by then won't have landlines.

The phone forecast is impossible, of course, but it's arguably no less solidly grounded than the obesity forecast. The weight projection uses three data points spread out over nearly three decades to estimate a linear trend -- then brazenly draws that line into the future.

The result: 86.3% of American adults will be overweight or obese in 2030, compared with 66.3% by the government's latest estimate. By 2048, the percentage will reach 100%. The study doesn't go beyond that date, but that upward trend would reach logical impossibility the following year.

"Extrapolations are dangerous," says Donald Berry, chairman of the department of biostatistics at the University of Texas M.D. Anderson Cancer Center. "Especially dangerous is to assume that trends are linear. Otherwise we'd conclude that Olympic swimmers will one day have negative times, there will be more Internet users than people, and more people on Earth than molecules in the universe."

The problems with obesity are bad enough and clear enough. They don't need a boost from statistical sensationalism.

The Star Tribune this week published a story under the headline, "A New Heart, A Dark Heart?" (It's interesting that this headline does not appear on the online version today, although search engines still find the original headline.)

The headline is pretty clearly meant to imply that a newly-transplanted heart drove a young man to plan a gruesome murder.

I thought the headline was awful, but I thought, at first, that I may be alone in that judgment.

Then I saw a letter to the editor in today's Star Tribune:

The Aug. 14 headline, "A new heart, a dark heart?" that accompanies the story about the boy from Woodbury who had a heart transplant and is now charged with felonies was so sadly sensationalistic.

Although I am not in the medical field and have no medical expertise, I feel pretty confident that the idea that the heart of an 11-year-old boy, whose grieving parents generously donated to save another boy's life four years ago, could be "dark" is ridiculous. You didn't need that headline for people to read that story. I hope that all families involved in this tragedy were spared from seeing this headline.

Has the decline in circulation led to this much of a decline in standards?

See Maggie Mahar's entry on the HealthBeat blog.

And for a little wisdom of the crowd, here is one online reader reaction to Maggie's post:

"Our local CBS station has a regular feature called "Breakthroughs Everyday" featuring one healthcare network. I've written to the news director at this station requesting, in the interests of fair and impartial journalism, that they also have a regular feature entitled "Failures Everyday" and start reporting on the stories of patients from the same hospital. No reply. ... The hospital PR has disgusted me for years."

Over on the HealthNewsReview.org website, we've reviewed another example of a journalist giving pro-screening test advice that is not supported by medical evidence.

This time it was the CBS Early Show, using physician-"reporter" Dr. Holly Phillips from WCBS-TV in New York to do a followup on actress Christina Applegate's diagnosis of breast cancer.

We said in that review:

The story engages in disease-mongering in its conclusion: "What's most important is to screen. One in eight women nowadays is going to get a breast cancer in her life, so as long as you get in for screening, I'm happy." The 1 in 8 statistic requires explanation. It is a lifetime incidence estimate. Many women misinterpret this to think that they have 1 in 8 chance right now at this time in their life. It is one of the misused and most misunderstood statistics in health care. The National Cancer Institute estimates that a typical 40-year old woman has less than a 2% (1 in 50) chance of developing breast cancer before 50, and less than a 4% (1 in 25) chance of developing it before age 60.

But the story also states, "But generally, we start home breast exam at age 20. I suggest every month, at the same time of the month, examine your breasts at home and get into your doctor for a breast exam at least every three years, earlier if you can." This is not an evidence-based recommendation and involves a physician-reporter giving personal advice and perhaps forgetting that she is now a reporter.

There is little evidence that breast self-examination (BSE) lowers deaths from breast cancer, and SBEs are not recommended by themselves for detecting breast cancer, especially in higher-risk women.

Experts disagree that mammography screening "should begin at 40", especially for women at low to average risk. See: http://www.annals.org/cgi/reprint/146/7/I-20.pdf .

The story had many of the elements of today's TV health stories:

• a young female celebrity angle
• a young female physician-reporter
• fear and promotable content.

Unfortunately, as with many of today's TV health stories, it also lacked details on evidence.

We've posted the following Publisher's Note on HealthNewsReview.org.

Conflicts of interest among sources of health/medical news and information represent an enormous – and growing – problem.

Health care consumers, and news consumers, are often not told of the biases that may exist in medical research, in clinical care, or in health care professionals’ continuing medical education because of financial ties to drug companies and medical device manufacturers.

Journalists, broadcasters, editors, and producers too often rely – wittingly or unwittingly – on drug industry sources. The result: medical news often helps sell drugs to the public, accentuating the positive and minimizing risks, rather than giving readers a balanced, accurate view.

To counter claims that it is impossible to find experts who are not on the payroll of industry, independent journalists Jeanne Lenzer and Shannon Brownlee have compiled a list of more than 100 experts from several nations with expertise across a wide range of disciplines. There are two parts to the list. One part includes experts who have no financial conflicts of interest, or conflicts that are irrelevant to most stories. The second part includes experts with a variety of potential conflicts. Some of these experts have ended their pharma ties – but only within the past five years. Others may have current financial conflicts of interest. These experts, despite their commercial ties, are included in the list because they have provided important insights into the inner workings of industry – effectively biting the hand that fed them in some instances --and/or because their conflicts did not limit their ability to comment in areas unrelated to the conflicts.

The experts include: two former editors of the New England Journal of Medicine, the former editor of the western journal of medicine, current editors of American Family Physician and Public Library of Science-Medicine; former FDA advisors; physician educators; researchers; bioethicists; epidemiologists, methodologists, geneticists, and clinicians from a various specialties; medical whistleblowers; and several medical journalists.

Information about the list appears in the “Journalist Toolkit��? section of the site at: http://www.healthnewsreview.org/independentexperts.php. If you’re a journalist, you’ll be given instructions about how to acquire the list, complete with experts’ contact information. The general public will be able to see the list of names without any contact information.

It’s our hope that this list helps journalists find and use sources who do not have financial conflicts of interest. We hope that the general public understands the gravity of these issues and their impact on the integrity of medical science.

For further information on the list see: Naming Names: Is There an (Unbiased) Doctor in the House? BMJ July 23, 2008.

It is a joy to pass along news like this:

"He no longer has a job directing news, but Glen Mabie now has an ethics award to add to his journalism credits.

The Society of Professional Journalists announced Monday that Mabie, former WEAU TV-13 news director, won the organization's national Ethics in Journalism Award, awarded annually to journalists who act in accordance with the SPJ code of ethics. The award will be given Sept. 6 in Atlanta.

Mabie was recognized for the award after resigning from his news director position in January when he objected to an agreement between the TV station and Sacred Heart Hospital in which TV-13 would run medical stories featuring Sacred Heart employees and not those of other Chippewa Valley hospitals or clinics.

Broadcasting programming featuring Sacred Heart content exclusively didn't sit well with Mabie, who noted the resulting conflict of interest that called the newsroom's objectivity into question.

Mabie and other TV-13 newsroom staff protested the agreement but were initially unable to convince management to cancel the deal. Mabie subsequently resigned, and the TV station's management canceled the deal with Sacred Heart.

Mabie said he is humbled by the award and credited his former TV-13 news colleagues with their protest of the agreement.

"Many of the people in that newsroom deserve this honor just as much as I do," he said. "To see those people stand up for those ethical guidelines was really neat."

Just four days ago, in response to an NBC News story in which reporter George Lewis recommended that all men over age 50 get annual prostate exams including the PSA blood test, I cited the statement of the U.S. Preventive Services Task Force to show that Lewis' advice was not based in evidence:

The 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). Although the Task Force found evidence that screening can find prostate cancer early and that some cancers benefit from treatment, the Task Force is uncertain whether the potential benefits of prostate cancer screening justify the potential harms.

The potential harms of prostate cancer screening include fairly frequent false-positive results from PSA screening, which may lead to unnecessary anxiety and biopsies. In addition, early detection and treatment may result in complications from treating some cancers that may never have affected a patient's health.

Yesterday the USPSTF updated its recommendation and it makes Lewis’ on-the-air statement to all of NBC’s viewers all the more problematic in its crusading advocacy that is not supported by evidence:

In men younger than age 75 years, the USPSTF found inadequate evidence to determine whether treatment for prostate cancer detected by screening improves health outcomes compared with treatment after clinical detection.

In men age 75 years or older, the USPSTF found adequate evidence that the incremental benefits of treatment for prostate cancer detected by screening are small to none.

The USPSTF found convincing evidence that treatment for prostate cancer detected by screening causes moderate-to-substantial harms, such as erectile dysfunction, urinary incontinence, bowel dysfunction, and death. These harms are especially important because some men with prostate cancer who are treated would never have developed symptoms related to cancer during their lifetime.

There is also adequate evidence that the screening process produces at least small harms, including pain and discomfort associated with prostate biopsy and psychological effects of false-positive test results.

The USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined.

For men 75 years or older, there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits.

Older men, African-American men, and men with a family history of prostate cancer are at increased risk for diagnosis of and death from prostate cancer.1 Unfortunately, the previously described gaps in the evidence regarding potential benefits of screening also apply to these men.

The yield of screening in terms of cancer cases detected declines rapidly with repeated annual testing. If screening were to reduce deaths, PSA screening as infrequently as every 4 years could yield as much of a benefit as annual screening.

Journalism is supposed to be about evidence and facts, not crusading advocacy.

"We don’t have any studies that show prostate cancer screening saves lives," explains Dr. Otis Brawley, chief medical officer for the American Cancer Society.

The Cancer Letter (subscription required) does its usual excellent job in reporting on the latest network TV free-for-all on cell phones and cancer. Excerpts:

"A teaser for the Larry King Live news show July 29 got to the quintessence of the scientific controversy over cell phones:

“A prominent cancer researcher says, ‘Put down that phone right now, if you want to reduce the risk of cancer!’�

The researcher in the spotlight was none other than Ronald Herberman, a respected immunologist and founding director of the University of Pittsburgh Cancer Institute.

A week earlier, Herberman stunned his colleagues by sending out an e-mail blast to his cancer center’s 3,000 employees, urging them to limit their exposure to cell phones. This exploded into an international story: director of an NCI-designated cancer center sounds alarm over dangerous occupational exposure.

Meanwhile, Herberman’s peers—including current and former directors of comprehensive cancer centers—say privately that they are watching with considerable surprise as the formerly cautious, conservative immunologist is staking his well-deserved, hard-earned prestige on a cause where data have been weak and findings cherry-picked.

“This whole thing makes no sense to me,� said one prominent researcher. “What was the urgency?� asked another peer. Scientists who know Herberman only by his publications were equally surprised. “I can’t help but wonder just what on earth Dr. Herberman was smoking when he decided to issue this warning,� David Gorski, a surgical oncologist at Barbara Ann Karmanos Cancer Institute, wrote on a quackbusters’ blog called Science-Based Medicine. “Scaring the nation based on ‘early unpublished data’ that can’t be examined by the entire medical and scientific community is generally not a good idea. That’s why I’ve been asking over the last few days: Why on earth did Dr. Herberman do it?�

Otis Brawley, chief medical officer for the American Cancer Society, was similarly surprised. “I am afraid that if we pull the fire alarm, scaring people unnecessarily, and actually diverting their attention from things that they should be doing, then when we do pull the fire alarm for a public health emergency, we won’t have the credibility for them to listen to us,� Brawley said on the CNN show."

First, we send our sincere best wishes to NBC reporter George Lewis, who this week reported on his diagnosis and treatment for prostate cancer. I have respected his work throughout his career.

But the standards of sound journalism are not suspended when a reporter chooses to report on himself. Indeed, concern for balance should be heightened when a reporter chooses to report on himself. In this story he talked about his choice of proton beam therapy. But he never mentioned questions about the evidence for/against this therapy, the tremendous cost of the therapy (can be more than $50,000 per patient), or the fact that there are only a handful of centers in the U.S. where this is done.

The New York Times, on the other hand, recently had no problem exploring these issues. It found a Harvard radiation oncologist who said "that while protons were vital in treating certain rare tumors, they were little better than the latest X-ray technology in dealing with prostate cancer, the common disease that many proton centers are counting on for business.

“You can scarcely tell the difference between them except in price,� he said. Medicare pays about $50,000 to treat prostate cancer with protons, almost twice as much as with X-rays. …

“There are no solid clinical data that protons are better,� the chairman of radiation oncology at the University of Michigan told the Times. “If you are going to spend a lot more money, you want to make sure the patient can detect an improvement, not just a theoretical improvement.�

The Times also mentioned an economic analysis by researchers at Fox Chase Cancer Center in Philadelphia that found that proton treatment would be cost effective for only a small subset of prostate cancer patients.

Why didn't NBC include any of that information? Maybe because NBC was more interested in emotion than evidence.

But the flaws in the NBC story didn't end with the proton beam coverage. The network allowed its reporter to become an advocate and a crusader when Lewis said, "Every guy over 50, doctors say sometimes every guy over 45, should get tested annually for prostate cancer. There’s a simple blood test called a PSA and a digital rectal exam where the doctor feels for lumps in the prostate. Early detection is the key." That is not an evidence-based recommendation.

The U.S. Preventive Services Task Force states:

The 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). Although the Task Force found evidence that screening can find prostate cancer early and that some cancers benefit from treatment, the Task Force is uncertain whether the potential benefits of prostate cancer screening justify the potential harms.

The potential harms of prostate cancer screening include fairly frequent false-positive results from PSA screening, which may lead to unnecessary anxiety and biopsies. In addition, early detection and treatment may result in complications from treating some cancers that may never have affected a patient's health.

We have commented on such stories before. NBC Nightly News had already done something similar to this - when reporter Mike Taibbi advocated lung cancer screening after he was scanned in a story. Such stories violate the Society of Professional Journalists' code of ethics which states that journalists should "distinguish between advocacy and news reporting. Analysis and commentary should be labeled and not misrepresent fact or context."

But that was only one episode in NBC's week of medical news mis-steps.

Last night they aired a piece (as so many media did) on mouse research on a pill for exercise. What was stunning about the NBC piece was the following:

• It devoted more than 2 minutes out of its total of 22 minutes or so of news time to this story. We are at war. The economy is in the tank. No one can afford gas in the tank. But 2 minutes was given to this mouse research.

• About a quarter of that time was spent explaining why this wasn't a story for people yet - ample caveats, indeed. But why, then, did they devote so much time to the story?

• They used some of the air time to explain that this was a Schering-Plough drug - even putting the company's name and logo onscreen. Why? With limited airtime, why was that an important nugget? Unless one's goal is to make drug company sponsors happy.

From these two stories, the big scorecard in the sky reads:

Medical industry interests 2, NBC viewers 0.