Someone stop me if you ever hear me say that I've seen the worst TV health news piece. The bottom keeps dropping.

This piece is a contender for bottom-dweller.

(Note: before you can actually enjoy the piece, you'll have to watch a CBS promo in this clip for all the awards they've won. And you'll see at the end their tagline, "Very Good News." This piece, I warn you, will not win an award and was NOT very good news.)

Watch CBS Videos Online

Let's recap:

A young woman whom the anchorman calls "healthy...gorgeous" but who wants to rid herself of a tiny fat pouch in her belly gets lunchtime liposuction. The surgeon comes on the set with her to chat with the anchorman. But in more than 5 minutes (an eternity in TV news!), they fail to discuss:

• evidence
• how widely the costs vary from the $3,000 the promoting-surgeon cited
• whether insurance pays for it.

Viewers should ask themselves: if this "healthy, gorgeous" young woman wanted to have a little fat pouch removed and if she were in your insurance pool and if insurance covered it, would you want your premiums to go up as a result?

Why don't we have news stories about that?

That would be journalism. This was free advertising: 5 minutes worth!

If there's any doubt about the impact of public relations efforts on news coverage of health products, look at what the PR company Fleishman-Hillard brags about on its website. They describe a campaign for a diarrhea vaccine. From their website:

Don't Leave Home Without It

Fleishman-Hillard launches Dukoral. A three-pronged media relations campaign resulted in 19 million impressions (triple the project goal), physician acceptance and consumer demand for Dukoral.

Dukoral, the first and only oral vaccine for protection against most common causes of Traveller's Diarrhea. For the project spokespeople were identified in key Canadian Markets (Vancouver, Toronto, Montreal-bilingual) willing to speak to the media about Dukoral. The spokespeople represented Dukoral to travel, healthcare and consumer media. All media coverage has had a direct impact on the target audiences. Media coverage incorporated key messages about Travellers' Diarrhea and Dukoral's role in the prevention of this potentially serious illness. Attributed to the extensive media coverage physician have reported to sales team that many patients have asked for Dukoral bringing in articles consumers themselves have read.

Journalists love toilet jokes in their stories. Melody Petersen, in her book, Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, wrote that too many journalists too easily fall into drug company plans to create a market for a drug, such as, in one case, a drug for “overactive bladders.” “Dozens of journalists at newspapers and television stations across the country wrote stories about the disorder said to be destroying the lives of millions of Americans,” she wrote. “Editors and television news directors loved these reports. Silly stories of people running to the toilet brightened the day’s news.”

Dukoral is not yet approved by the FDA.

Thanks for the tip to Alan Cassels, who also points out questions about the vaccine's effectiveness and its cost.

Last year the Kaiser Family Foundation asked me to research and write a report on the state of health journalism in the US. That report will be released and discussed at a news conference in Washington, DC, in three weeks. The announcement was made yesterday:

A collection of recent stories by mid-sized Midwestern newspapers are worthy of special attention.  They all reported on issues of conflict of interest in health care and medical research. 

A series of reports by the Milwaukee Journal Sentinel asked tough questions about financial ties between drug companies and medical school physician faculty members.

* "Doctors Face Pressure To Disclose All Side Pay”

 * "UW Psychiatrist Paid To Speak About Disputed Anti-Smoking Pill"

 * "UW Researcher in Clinical Trial Consults for Medical Firm"

 * "Drug Firms Wine, Dine and Pay Up for Doctors' Speeches"

  * "UW Doctors Speak for Drug Companies: Three Employees' Disclosure Forms Offer Examples of Side Jobs"

An investigative piece by the Minneapolis Star Tribune found that “A professor who is leading the University of Minnesota Medical School's effort to write tougher ethics rules was himself disciplined in 2004 for secretly steering a $501,000 research grant to his own company.”

These are tough issues for newspapers to dig into – especially in these difficult newsroom times.  But it is vital that journalists help the public think about industry influence on health care as these newspapers did. 

Another mid-sized paper, The Oregonian, published a terrific piece that discussed a “widespread problem in the health care system: the tendency to embrace new technology without waiting for proof that it's better than older, cheaper, time-tested solutions.”

It is refreshing to see any journalist try to educate readers that, in US health care, more is not always better and newer is not always better. 

At the other end of the spectrum is a series of dreadful pieces on network TV news. 

• CBS Early Show, “Heart Score:  New Treatment for Heart Failure.” Our summary:

“The plural of anecdote is not data.  Viewers were told one very positive patient story, but nothing about whether that’s a representative outcome. No independent sources.  Nothing on harms or costs.”

• CBS Early Show, “Breakthrough for MS.”  Our summary:

“Strength: it emphasized this was a small, early study. But it focused exclusively on one patient with an excellent outcome, giving no broader data from the study. No independent sources were quoted.”

• CBS 60 Minutes, “Fountain of Youth in a Wine Rx?”  Our summary:

“The story approach was very similar to 60 Minutes’ coverage of what they called the "Kanzius Cancer Cure" months ago. Cheerleading. Lacking evidence. Failure to interview independent sources.”

•  NBC Today Show, “Lose Weight While You Sleep.”  Our summary:

“NBC gave 5.5 minutes of free publicity to Glamour magazine's pseudo-scientific experiment, then made bold, baseless projections that women would "probably add about 7 years to their life". Amazing.”

• NBC Today Show, “Today’s Matters of the Heart: Dr. Nancy’s Personal Wake-up Call.”   Our summary:

“A 6-minute segment almost completely devoid of evidence and data, riding the single personal anecdote of the network's medical editor. Disease-mongering. Incomplete story on heart CT scans.”

There are journalists – like those we profiled above in Wisconsin, Minnesota and Oregon, who are working hard to educate readers on important health care issues.  But are their efforts being drowned out by the impact of network TV segments like those above - reaching millions with incomplete, non-evidence-based, single source stories that may drive up unrealistic expectations in the worried well? 

There are WMD’s lurking inside your body. And you better find them ASAP.

In its health section today, the Washington Post gives men of all ages screening test advice – much of it not grounded in the best medical evidence or at least not reflecting real controversies in health care.

They do one of those “What To Do In Your 20s, 30s, 40s, 50s…” columns that news organizations find so appealing and that I find so incomplete.

Sanjay Gupta and CNN have done the same thing

So has the Star Tribune and many other news organizations.

Among the questionable advisories from the Post:

• Telling men in their 30s to “sign up for complete physicals”
• Telling men in their 40s to get a complete physical every two years

There was no mention of the controversies surrounding such recommendations - some experts calling it wasteful.

• Telling men in their 40s to start skin cancer screening.

Aren’t they aware that the US Preventive Services Task Force just last week stated :

“ the current evidence is insufficient to assess the balance of
benefits and harms of using a whole-body skin examination by a
primary care clinician or patient skin self-examination for the
early detection of cutaneous melanoma, basal cell cancer, or
squamous cell skin cancer in the adult general population.” ???

They go on to tell men in their 50s to have prostate cancer screening. (They do say the pros and cons should be discussed, but the recommendation for such screening stands nonetheless.)

Again, the USPSTF states: “the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.”

What the Post promotes may be one doctor’s – or some doctors’ - opinion(s). But for a major newspaper to state these as if they were handed to Moses on stone tablets is wrong. There are uncertainties. There is controversy. Screening tests can cause harm - not just benefit. And good journalism should reflect that.

Some of the very disparate views about how health news should be covered in the daily news media were on display recently at a debate, sponsored by the Guardian newspaper, held during a Lancet conference in London. BMJ associate editor Rebecca Coombes wrote about it in last week's journal. Excerpts:

The event exposed the gulf between detail obsessed academics and time poor, space hungry, national newspaper journalists. As doctor, research fellow, and Guardian columnist, Ben Goldacre bemoaned the Daily Mail for its insistence on "dividing all the inanimate objects in the world into those which can cause or cure cancer," the professional journalists became exasperated with him for seeing the media as a monolithic organisation.
...
But journalists could not be straitjacketed into writing like academic researchers (said one journalist who) referred to a "prescriptive and irritating" code of conduct issued by the Royal Society a few years ago, which gave journalists a checklist to use before filing any story. It asked questions such as, is your story scaremongering? If reporting on a clinical study, make sure all conflicts of interests are identified, that independent sources were used, and so on. "All this in a 200 word story, give me a break". There was, he said, a breed of "academics who want journalists to act as a transmission belt for their ideas."

"Scientists expect us to include every counter story, every caveat, but you don’t have that luxury [as a journalist]. And your stories are competing with every other field of human knowledge. The person I have in mind when I write a story is the man or woman on the tube holding on to the bar, or the person online who is only two clicks away from a story about the latest antics of Britney Spears."

I wish I could have been there.

The "prescriptive and irritating code of conduct" and the "checklist" sounds very much like our HealthNewsReview.org approach - although I would never refer to it as a code of conduct. But, yes, some US journalists might call it prescriptive and irritating.

Most that we've heard from don't, though.

We actually have two surveys out in the field right now:

1. Of all members of the Association of Health Care Journalists;
2. Of all journalists whose work we've ever reviewed on HealthNewsReview.org

The response rate has been abysmal. I know that health journalists feel they have been surveyed to death. Nonetheless, here are some responses:

• I love it. There's so much awful health reporting out there in very respected publications. It is important to train reporters and to make the public aware of what to look for in stories. Keep up the great work.
• Wish we'd known about it sooner.
• You're doing good work and maybe I just need to be reminded more to use it.
• The web site is helpful in forcing me to improve the quality of my work.

And then this:

You live in a bubble. Newspapers are imploding, we are struggling to deal with virtually no resources and increased demand for content and you offer no insight into how to produce quality stories under the circumstances. In a perfect world, we would all gladly embrace your guidelines, but it's far from a perfect world and you're obviously not acknowledging that.

This is why we need a conversation. Our ten criteria are our attempt to give insight into how to produce quality stories under the current circumstances. And I don't live in a bubble. Next month the Kaiser Family Foundation will release a report I wrote based, in part, on interviews with about 50 health journalists.

Our ten criteria are not an academic exercise. They are not an attempt to turn news into a medical journal. They are key questions we think any consumer should ask about any claim made by anyone about new health care treatments, tests, products or procedures.

I always ask journalists: if not our criteria, what criteria do you employ in choosing health news stories and in deciding how to write about them?

That tends to be a very short discussion, because there usually isn't a comeback.

Because too often health news is treated as if it is only two clicks away from Britney Spears news in the paper. And maybe readers don't want that. And maybe that's why you're losing them.

Newer is not always better. Evidence is important. Simple themes, oft forgotten in health journalism.

Back in October, an Atlanta Journal-Constitution story talked of the wonders of virtual colonoscopy, saying it replaced the dreaded colonoscope and lessened patient risk. It used these words to refer to the technology: "science fiction, Star Wars, video game, Disney World."

Also in October, the Wall Street Journal promoted the growing popularity of virtual colonoscopies.

Neither story mentioned the fact that the U.S. Preventive Services Task Force had stated that same month that "The evidence is insufficient to assess the benefits and harms of computed tomographic colonography as a screening modality for colorectal cancer."

Last week's announcement that Medicare may stop paying for virtual colonoscopies also got little news attention. At least the New York Times reported it. Excerpts:

The Centers for Medicare and Medicaid Services said in a decision posted on its Web site that there was "insufficient evidence" to conclude that virtual colonoscopy "improves outcomes in Medicare beneficiaries."

...the United States Preventive Services Task Force, which advises the government on prevention, said last year that there was insufficient evidence to assess the benefits and harms of the CT technique. Some private insurers pay for the tests; others do not.
...
In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare's older population.

For instance, older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater. That would make the CT scan less cost-effective.

"The specter of the government coming between doctor and patient raised its head again," Trudy Lieberman writes, about a CNN segment that she says "ranks among the most irresponsible health stories I’ve seen over the past year."

Which reminds me: what's the update on the Surgeon General choice?

Do you think Daschle's conflict of interest issues may have given the President second thoughts?

Kudos to Chen May Yee and the Star Tribune for a front-page story on how screening tests offered by for-profit companies may cause more harm than good and may be a waste of money.

I slammed the Strib almost exactly one year ago for a non evidence-based article promoting screening tests.

So let this blog posting be further evidence that I'm not out to bash all health care news - just the schlock.

Today's Strib story - by a smart, dedicated journalist - showed enterprise, depth, and a concern for how readers may be misled and hurt by profit-driven screening promotions.

WASHINGTON, Feb. 5 --The Milwaukee Journal Sentinel is the first news organization to receive an award for Excellence in Health Journalism from the Boston-based Foundation for Informed Medical Decision Making. The Foundation, which presented the award yesterday at its Research and Policy Forum in Washington DC, chose the Milwaukee newspaper because of its consistently high ratings by HealthNewsReview.org. That web-based project, funded by the Foundation, is the only organization of its kind in the US that reviews the quality of health news reporting nationwide each day.

"We were very surprised and pleased by this recognition," said Becky Lang, the Journal Sentinel's health and science editor. "In the current media environment of instant Internet coverage and reduced staffing in credible news outlets, the pressure is on for us to keep the standards high. It is even more important than ever for us to provide health stories that are meaningful, accurate, reader friendly and that delve deeper than the surface. We welcome this kind of oversight."

"The Journal Sentinel has been reviewed a dozen times and nine of those stories received high marks with four- or five-star reviews, more than any other newspaper of this size in our experience so far, " says Gary Schwitzer, associate professor of the University of Minnesota School of Journalism and Mass Communication and publisher of HealthNewsReview.org. Schwitzer began the website with the support of the Foundation because of his belief that health reporting can, if not balanced, have a profound, often negative, impact on the public's ability to make medical decisions.

Since the launch of HealthNewsReview.org in 2006, Schwitzer and his team have reviewed more than 700 articles and stories, and published an analysis of the first 500 in the April 2008 edition of the journal PLoS Medicine.

At the Foundation's Research and Policy Forum yesterday, Schwitzer described the evaluation process and what he and his team have learned about the current state of health news reporting in the US.

During the HealthNewsReview.org review process, each story is ranked on 10 criteria, including whether the story adequately discussed the costs of the idea being reported, and whether it quantified potential benefits and harms. (See evaluation instrument at http://www.healthnewsreview.org/ratings_info.php)

"In our analysis of the first 500 stories, we found that most journalists usually failed to discuss costs and the absolute magnitude of potential benefits and harms," said Schwitzer. "That leaves a 'kid-in-the-candy-store' view of US health care, wherein everything looks terrific, risk-free and without a price tag."

On the other hand, he said that reporters have been very receptive to feedback from HealthNewsReview.org, which comes in the form of an email linking the reporter back to a review of his or her story on the website. He hopes the website will help stimulate more interest on the part of editors, who are a crucial part of the process of change. He also believes that addressing the issues of time (required to research and write), space (in publications and broadcasts), and training of journalists can provide solutions to many of the journalistic shortcomings identified by the project.

The Excellence in Health in Journalism Award, which is a certificate and a cash prize, is one way of acknowledging hard work and motivating best practices, said Jack Fowler, PhD, president of the Foundation for Informed Medical Decision Making, who presented the award.

For the complete PLoS Medicine study, go to http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050095&ct=1&SESSID=65729af539d28a09f944a407b81a7d30

To see the Milwaukee Journal Sentinel reviews and articles, go to http://www.healthnewsreview.org/review/by_org.php?type=Media+Source

To learn more about HealthNewsReview.org, go to the home page at http://www.healthnewsreview.org/

For more information about the Foundation for Informed Medical Decision making, go to http://www.informedmedicaldecisions.org/

The Foundation for Informed Medical Decision Making's mission is to assure that people understand their choices and have the information they need to make sound decisions affecting their health and well being. The Foundation organizes and frames medical evidence in an unbiased manner to help people evaluate their options, particularly in instances where differences in individual preferences and perspectives are likely to affect personal choice. For more information, visit www.informedmedicaldecisions.org/.

SOURCE Foundation for Informed Medical Decision Making

That paper was honored yesterday by the Foundation for Informed Medical Decision Making with an award for Excellence in Health Journalism. The Foundation, which presented the award yesterday at its Research and Policy Forum in Washington DC, chose the Milwaukee newspaper because of its consistently high ratings by HealthNewsReview.org- the only organization of its kind in the US that reviews the quality of health news reporting nationwide each day.

"We were very surprised and pleased by this recognition," said Becky Lang, the Journal Sentinel's health and science editor. "In the current media environment of instant Internet coverage and reduced staffing in credible news outlets, the pressure is on for us to keep the standards high. It is even more important than ever for us to provide health stories that are meaningful, accurate, reader friendly and that delve deeper than the surface. We welcome this kind of oversight."

HealthNewsReview.org reviewed a dozen Journal-Sentinel stories and nine of them received high marks with four- or five-star reviews, more than any other newspaper of this size in our experience so far.

I’m always amazed that my little blog gets any traffic or draws any links or whatever drives the various ranking services. I usually do this stuff at 6:30 in the morning after one cup of coffee at home - like now. So I'm amazed that my blog has achieved a top 20 health blog ranking from the folks at Wikio. If you visit their site today, you’ll still see a #25 blog ranking for this site. They tell me the #20 ranking will be posted onThursday.