We need more stories like the one in today's New York Times that addresses legitimate questions about mammography now being raised in the UK.

It started with an article in the BMJ about the inadequacy of British informational brochures on mammography. Then a letter to The Times of London entitled, "Breast cancer screening peril: Negative consequences of the breast screening programme."

Legitimate questions - and demands for better information to be given to women.

In the Times story I'm particularly struck by the 75-year old woman diagnosed with DCIS - which creates anxiety and confusion for thousands of women. She says: "You don't know about all the uncertainty until you're one of the unlucky ones."

The story details leading experts' questions about whether mammography has been oversold to American women as well.

Dartmouth's Dr. Lisa Schwartz wraps up the Times article with this:

“You’re not crazy if you don’t get screened, and you’re not crazy if you do get screened. People can make their own decision, and we don’t need to coerce people into doing this. There is a real trade-off of benefits and harms. Women should know that.”

I can already hear the rabidly screen-everybody-all-the-time advocates screaming about this story. But before they scream too loudly, they should walk a mile in that 75-year old woman's shoes.

Jon Palfreman, who has produced some of the smartest health care and science documentaries anyone has ever produced, rolls out his newest tonight.

PBS Frontline. "Sick Around America."

It follows his earlier "Sick Around The World" film.

And it will show once again how you can cover vital health policy issues on TV if you put your mind and creativity to it.

NBC said it "could be the magic bullet for preventing heart disease and strokes." They threw up a "BREAKING NEWS" banner even though they acknowledged that each of the five pills in the "polypill" has been "around for a long time."

The anchor called it "really big." The NBC medical editor called it "very cool." Then the anchor amplified by calling it "very promising."

We call their hyperbole "very premature."

The story contained none of the caveats contained in an AP story, which concluded:

“It won’t be for everybody,” (one expert) said. Some people would be overtreated by getting medicines for conditions they don’t yet have, such as high cholesterol. Others may be undertreated by too-low doses in the combo pill. Several polypills of different strengths may be needed, he said.

“We have to be cautious about assuming that one size fits all,” (another expert) said. “Treating risk factors is a lot like cooking — the ingredients count.”

A devastating indictment. That's what Dr. Daniel Carlat - on his blog - called yesterday's piece in the Milwaukee Journal Sentinel, “Drug firms' cash skews doctor classes: Company-funded UW courses often favor medicine, leave out side effects.”

I'm late in weighing in on this, so I'll just refer you to Carlat's analysis.

But I will add this: somehow that little paper in Milwaukee continues to publish top-notch tough investigative health care journalism and their readers should appreciate what they're getting while they're still getting it. This story was more than 2,500 words of important news - not the usual 300 word drivel trumpeting breakthroughs from the medical journals. Carlat said "Occasionally, a piece of investigative journalism sets into motion processes that strike corrupt business practices at their core. ...it will become required reading for all those involved in health care policy."

Based on my reading of a New York Times story in my local Star Tribune today, I was ready to blast the Times.

I was reading the story out of the American College of Cardiology meeting on the new data suggesting that statins can reduce the risk of venous thromboembolism.

By how much can statins reduce the risk? Depends on which version of the NYT story you read.

The Times reports:

"With the relatively healthy people in the study, the number of clots was small — 94 total — but the placebo group developed 60 of them, compared with 34 for those taking the statin."

But the Star Tribune version of the Times story doesn't include that absolute risk reduction figure and, instead, only lists the more impressive sounding relative risk reduction figure:

"relatively healthy people who took a potent statin were 43 percent less likely than those who took a placebo to get a blood clot known as venous thromboembolism."

The Wall Street Journal's simple language was the most helpful for readers:

"34 participants who were taking Crestor developed VTE compared to 60 who were taking a placebo - a small absolute benefit but a relative risk reduction of 43 percent."

To editors who trim wire stories - or who don't know to look for absolute data - I can't state strongly enough how incomplete your stories are if you don't include absolute risk data.

Borrowing an analogy from Woloshin and Schwartz of Dartmouth, citing relative risk only is like having a coupon for 43 percent off. But you don't know whether it's 43 percent off the cost of a Lexus or off the cost of a lollipop.

GIVE US THE ABSOLUTE DATA OR DON'T GIVE US THE STORY AT ALL!!!

By zero we mean zero stars - our lowest score - on HealthNewsReview.org.

The ABC program's segment last week, "Life Saving Test: How One Minute Can Save Your Life," received one of our rare ZERO scores.

One of our reviewers even ran a stopwatch on the "one minute" test.

It took 5 minutes on live TV. Maybe it's the lights.

But how long the test took was a relatively minor issue.

The segment was so bad that a leading gastroenterologist wrote to me asking us to review the story - something that was already underway when he wrote. I know he wrote to an ABC News producer as well. But that producer has told me he doesn't share our reviews with his staff because he doesn't think they are fair.

Maybe he likes the criticism of the letter-writing gastroenterologist better - who used terms like "disservice to the public...distorted...sensationalized...served fear and commercialized interests."

The Argus Leader newspaper of Sioux Falls recently reported that two local hospitals were offering $50 heart screenings to check for excess calcium buildup.

Let me count the ways this story was poor journalism:

1. The headline: "Cost of saving a life: $50." Cost-effectiveness has not been established for this procedure. This is a headline that only an ad agency and a client could love.

2. The story never mentioned that such screenings are not recommended by the American Heart Association nor the American College of Cardiology (despite the praising comments from a South Dakota AHA spokesman who clearly isn't up on the science). It took me about two minutes to find this guideline statement online from AHA and ACC:
"The Committee does not recommend screening of the general population using coronary artery calcium measurement."

3. The story said "Both hospitals say they lose money on the program, that the tests and consultation amount to several hundred dollars worth of services. The gains come in prevention." How naive! Talk about a loss leader! And don't think that somebody somewhere in those hospital systems isn't paying for these scans somewhere in their bill.

4. The newspaper practiced "participatory journalism" and sent its reporter in for a scan. At the end, he abandons all journalistic objectivity and announces in an online video, "I would recommend it if it does what it says it does." This is a clear violation of the Society of Professional Journalists' code of ethics.

The wisdom of the crowd - in some of the online comments following the story are far more skeptical. One says, "Don't confuse science with marketing. What we're seeing here is marketing."

Health care reform is going to be very difficult to achieve in this country if we continue to set unrealistic expectations in the minds of the public, feed the worried well, drive up demand for unproven technologies, and promote technologies outside the boundaries of evidence-based recommendations.

On this scorecard, this story failed Sioux Falls readers horribly.

"Killer Meat" - headlined an LA Times online column.

"Want to Live Longer? Cut Back on Red Meat" - pronounced CNN.com.

"Daily Red Meat Raises Chances Of Dying Early" warned washingtonpost.com.

It all sounds so certain.

But this was an observational study - not an experiment. It was based on responses to a questionnaire.
Such a study CAN NOT - simply CAN NOT - establish cause-and-effect and therefore CAN NOT establish risk.

So any story that said "higher risk" or "chances of dying" was simply wrong.

Stories on such studies are obliged to point out the potential weaknesses in such studies.

Journalists and consumers should read a column we published on HealthNewsReview.org, entitled "Does Your Language Fit the Evidence?"

And stories that gave these kinds of percentage (as the Washington Post did) are obliged to give you more:

Among women, those who ate the most red meat were 36 percent more likely to die for any reason, 20 percent more likely to die of cancer and 50 percent more likely to die of heart disease. Men who ate the most meat were 31 percent more likely to die for any reason, 22 percent more likely to die of cancer and 27 percent more likely to die of heart disease.

35% of what? 20% of what? 50% of what?

That's like having a 50% off coupon and not knowing if it applies to the purchase of a Lexus or the purchase of a lollipop. Give the absolute risk reduction figures.

I gave my undergrad health journalism students about 5 minutes to analyze one such story yesterday. They easily came up with the above flaws and more.

Come on, folks. We have to get smarter about evaluating studies - and news coverage of studies.

Cover story for UMN Alumni Association magazine this month. George Clooney wasn't available.

The new issue of Nieman Reports includes my article,
"Changing the Drumbeat of Typical Health Reporting."

A physician in NY wrote to me today about an article in the New York Times, "After a Stroke, Freeing Muscles With Botox."

The physician wrote because he felt the article didn't explain the exact indications for the approach described in the story, didn't discuss the evidence, and didn't quantify the alleged benefits. He wrote:

I highlight this because I run into this problem all the time and I could see a run on, "doc, I need this."

He's right: none of that information is in the story.

But here is what IS in the story: a projection from one true believer-physician that "only about 5 percent of the stroke patients who could benefit from its use ever get it." The story goes on to disclose that that doc "gets financing from three botulinum toxin producers."

Hmmmm.

St. Paul Pioneer Press reporters Jeremy Olson and Paul Tosto have been awarded a Frank Premack Public Affairs Journalism Award for their series on the death of Dan Markingson in a clinical trial at the University of Minnesota.

The Premack judges wrote: “Through the eyes of one patient, this story shed considerable light on the complicated and competing interests between the development and path to market of new drugs, funding needs of the University and the integrity of medical research. The judges are hopeful that the new ethics task force implemented at the U of M is resulting in changes in conflict of interest policies.”

Also this week, Professor Carl Elliott of the University of Minnesota Center for Bioethics published an editorial in the Pioneer Press, "Create counterweights to the influence of money on drug studies," regarding the Markingson story. In it he concludes:

"Any serious attempt to clean up industry-sponsored research must do at least two things. First, it must minimize the internal pressure faced by researchers to raise money for their departments. Second, it must eliminate the external financial incentives that lead researchers to recruit patients into studies instead of giving them proven treatment. Unless these conflicts of interests are eliminated, universities will continue to repeat the mistakes that preceded the death of Dan Markingson."

Congratulations to Olson, Tosto, and the Pioneer Press for this terrific investigative piece. Kudos to Professor Elliott for addressing the ongoing ethical issues in clinical trials.

We can't lose this kind of important contribution in daily journalism at the local level.

For much of the past year, I’ve been working with Kaiser Family Foundation support on a report on the state of health journalism in this country.  It was not the intent of the report to do an assessment of the quality of the work as we do here daily on HealthNewsReview.org.  Rather, it was an attempt to capture a snapshot of how changes in the media industry were affecting the development and distribution of health news.

The report, results of a survey of members of the Association of Health Care Journalists, and a podcast and webcast of a Washington, DC briefing at which the report was released are all available online.

The University of Minnesota also videotaped the following interview with me about highlights of the report.

The survey and the journalist interviews I conducted carry a powerful message about the threat to the flow of meaningful health news to the American public.   Here are some of the data that trouble me:

• 94% of survey respondents say the bottom line pressure in media organizations is seriously hurting the quality of news coverage of health care issues;

• 88% of survey respondents think health care coverage leans too much toward short “quick hit” stories, and two-thirds (64%) say the trend toward shorter stories has gotten worse in the past few years.

• A majority of respondents (52%) say there is too much coverage of consumer or lifestyle health, and too little of health policy (70%), health care quality (70%), and health disparities (69%).

• Just under half (44%) of staff journalists participating in the survey say that their organization sometimes (33%) or frequently (10%) bases stories on news releases without substantial additional reporting.

• About one in 10 staff journalists in the survey (11%) say his or her own organization sometimes or frequently allows advertisers, sales staff or sponsors to influence story selection or content and another 21% say this occurs rarely.

I am not at all comforted by this and do not see this as “only” 11%.  In discussing serious ethical breaches, even “rare” events are important.  So I read it as 32% of respondents acknowledging that their news organizations sometimes allow advertisers or sponsors to influence health care news.

That is an amazing admission and perhaps the most troubling finding in the entire survey.

So on the eve of what may be the most important health policy discussion in this country in 15 years, we’re covering these topics less frequently.

Instead, our news organizations often cover cutesy, soft, fluffy, news you can use features.

Or our news organizations often make it seem like every medical journal, every scientific meeting is like Christmas Day with terrific new toys under the tree that have no side effects and no price tag.

The “more is not always better, newer is not always better, screening tests don’t always make sense” evidence-based wisdom of so many of our veteran health care journalists is either not appreciated or it’s being lost to cutbacks, buyouts, layoffs.

Several top health journalists have left their newspaper jobs to work for foundation-supported health journalism jobs, such as the new Kaiser Health News service.  Many will be watching what comes from such efforts.

The improvement in health journalism – in pockets across the country – has been one of the major advances in all of journalism in the past decade. But now it could be one of journalism’s greatest losses.

So while we know that the cutbacks hitting the health beat affect ALL of journalism, the argument could be made that coverage of these topics in these times can least afford setbacks.

I will give the NBC Today Show some credit for trying to address the issue of too much cancer screening and the overtreatment that results.

Matt Lauer acknowledged that the segment would counter much of what the program had told viewers over the past 10 years or so. What he didn't say is that the questions about cancer screening are NOT new and that the Today Show had actually misinformed viewers in many of their earlier messages.

But despite the good effort, today's program was given too little time, was too loosely organized, and probably left viewers horribly confused.

Thank goodness they had one of the best evidence-based minds on the set to address the topic - Dartmouth's Dr. Gil Welch.

Lauer half-promised there would be more segments in the future on this topic. I hope they live up to that.

Podcast, webcast, survey of Association of Health Care Journalist members and my report on the state of health journalism are all available online.

The University of Minnesota News Service videotaped the following interview with me about the higlights of the report.

Personally, the 50 hours or so of indepth interviews I conducted with health care journalists for this report was a buzz kill. I spent a lot of time with smart, dedicated, hard-working people who didn’t feel they were able to do their best work anymore. Coast to coast, all media types, all market sizes, all experience levels.

But from a public policy – public discussion perspective, this report should be the strongest of warnings to managers of news organizations and to policy makers.

• Ninety-four percent of survey respondents say the bottom line pressure in media organizations is seriously hurting the quality of news coverage of health care issues;

• 88% of survey respondents think health care coverage leans too much toward short “quick hit” stories, and two-thirds (64%) say the trend toward shorter stories has gotten worse in the past few years.

• A majority of respondents (52%) say there is too much coverage of consumer or lifestyle health, and too little of health policy (70%), health care quality (70%), and health disparities (69%).

• Just under half (44%) of staff journalists participating in the survey say that their organization sometimes (33%) or frequently (10%) bases stories on news releases without substantial additional reporting.

• About one in 10 staff journalists in the survey (11%) say his or her own organization sometimes or frequently allows advertisers, sales staff or sponsors to influence story selection or content and more than a quarter of respondents (28%) say they personally get story ideas from public relations firms or marketing outreach somewhat or very often.

So on the eve of what may be the most important health policy discussion in this country in 15 years, we’re covering these topics less frequently.

Instead, our news organizations often cover cutesy, soft, fluffy, news you can use.

Or our news organizations often make it seem like every medical journal, every scientific meeting is like Christmas Day with terrific new toys under the tree that have no side effects and no price tag.

The “more is not always better, newer is not always better, screening tests don’t always make sense” evidence-based wisdom of so many of our veteran health care journalists is either not appreciated or it’s being lost to cutbacks, buyouts, layoffs.

The improvement in health journalism – in pockets across the country – has been one of the major advances in all of journalism in the past decade. And it could be one of journalism’s greatest losses.

So while we know that the cutbacks hitting the health beat affect ALL of journalism, the argument could be made that these topics in these times can least afford setbacks.

Get out and buy the April issue of RD and frame it.

RD has a history of proclaiming more cures than a ham processor. Two examples:

But “the little magazine that could” finally did publish an evidence-based health journalism piece.

Shannon Brownlee’s thoughtful “What’s Wrong with Cancer Tests” piece will be good bathroom reading for thousands, we hope.

Sorry I can’t offer a link. RD doesn’t offer them.

Longtime Poynter Institute ethics guru Bob Steele - now a professor at DePauw University - published a column, "Dr. Sanjay Gupta Covers Obama's Health Care Policies with Competing Loyalties." Excerpts:

"My heightened concern focuses on the erosion of Gupta's journalistic independence given his two-plus months of discussions with the Obama administration about becoming surgeon general. ...

Gupta's withdrawal from consideration deserved scrutiny it did not receive on CNN Thursday night. Larry King had a buddy-buddy chat with Gupta that elicited little insight. But King's show is more entertainment than journalism.

However, on "Anderson Cooper 360," which is a news program, Cooper said how happy he was Gupta was going to stay at CNN and lobbed a few simple questions his way. There was no serious attempt to probe why Gupta had stayed in contention for over two months only to withdraw now. No effort to report on what his pulling out might mean to an Obama administration that has lost a number of appointees. No references to concerns about Gupta voiced by some politicians. ...

It was ironic that CNN used a breaking news label for the interview, imparting the event with that sense of importance, then treated Gupta's interviews like soft news. ...

It sure appears to me that CNN and Gupta are on a collision course filled with competing values and competing loyalties, one that could affect future coverage. In his wrap-up of the interview, Cooper teased Gupta's upcoming coverage of the administration. ...

For a couple of months we've had Sanjay Gupta in the running to be one of Obama's trusted allies. As surgeon general he would have had a key voice in the President's health care policy. While Gupta was, in essence, interviewing for the surgeon general's position, he was likely interviewing the President as well, not as a reporter but as a potential team player. He was bound to learn some insider information.

That's where the ethical challenges surface. To whom does Dr. Gupta owe loyalty? Can he serve the public with comprehensive reporting uninfluenced by his White House connections? Can he fairly report on an administration he almost joined? Can he fairly report on critics of Obama's health care plans?"

Let's revisit this oft-violated tenet of scientific communication.

Just because an association is established, it doesn't mean a causal link has been established.

The latest botching of this message was two weeks ago when the Journal of the National Cancer Institute published a study looking at women, how much alcohol they drank and how often they got cancer.

The study's lead author told The Guardian, "Given that this is the largest study in the world to look at this, it’s clear that even at low levels of alcohol consumption, there does seem to be a very significant increase in cancer risk, and most women are probably not aware of that."

Several friends wrote to me about news coverage of this study.

It was page one news in the Washington Post, for example, where the headline incorrectly states: "A Drink A Day Raises Women's Risk of Cancer."

One Post reader wrote the following to me:

It is a good example of what confuses the public. The Post article overflows with causal language, using phrases such as "increases the risk," and "may cut the risk" multiple times. The writing is naïve and I am doubtful that he understands the hierarchy of evidence, or the difference between observational and experimental. Unfortunately, the investigators are complicit here, as well. The reporter quotes the investigator saying "increasing your risk," which is consistent with her language, "Low to moderate alcohol consumption in women increases the risk of certain cancers..." in the abstract of the paper itself.

(The journal article) uses associative language quite a bit as well and I'll bet the authors understand the difference. Why they slip into causal language, I don't know. I guess it sounds better and varies the syntax. Or it sells better. I have observed a lot of this in the scientific literature---in JAMA, the NEJM, JNCI and others. This is frustrating because it leads the journalists down that path, wittingly or not. Makes it harder to educate the journalist, if you are having to instruct them that the investigators are sometimes wrong and may mislead them.

Another friend sent me a link to an online article by Patrick Basham and John Luik, " Women, keep drinking: Why was a flimsy study apparently showing a link between booze and breast cancer so uncritically accepted?" Excerpts:

Allen (the lead author) came across with even scarier news for Americans, telling the Washington Post that the ‘take-home message’ was this: ‘If you are regularly drinking even one drink per day, that’s increasing your risk for cancer [since] there doesn’t seem to be a threshold at which alcohol consumption is safe.’

One can’t help but wonder just what Allen herself has been drinking... After all, her public pronouncements, her recommendations to government, and the reports about her study in the media are certainly not supported by her results.

First, Allen’s study is an observational one, based on data from the UK’s Million Women Study, which is a study about the association between Hormone Replacement Therapy and cancer and heart disease. Allen’s study comes from self-reports about the drinking habits of women in that study.

This means that the study, as an observational study – the weakest kind of epidemiological endeavour and certainly nothing close to the gold standard of a randomised controlled trial – is inherently unable to draw any causal conclusions about a link between drinking and cancer.

Second, the study fails to meet even the most basic requirement of science – that is, being able to validate its measurements – since it is entirely based on the women’s self-reports of their recollection of their drinking. None of these reports was checked and the authors can make no claim about how reliable they are. No one knows how much or how little these women really drank since no one bothered to measure it.

This makes any conclusions based on such ‘evidence’ just a tad dicey. At its foundation, therefore, the study can’t warrant that any of its data about the key fact – the drinking habits of its subjects – is accurate.

Basham and Luik went on to point out that "teetotallers had a higher population incidence of cancer than those consuming up to 14 drinks a week!" And that "of the cancer-drinking correlations examined, virtually none was statistically significant."

Their conclusion:

What is the real take-home message of this study? Perhaps it should be to avoid drinking policy advice produced by Oxford epidemiologists.

Front page. More than 2,000 words. The kind of story Americans need to understand. We're fortunate to have the WSJ on days like this with stories like this. - "FDA Backs Knee Device After Long Lobby Effort."

I'm just amazed.

The headline is WRONG. It DIDN'T block HIV. The H in HIV stands for "Human." This was research on SIV - S is for Simian - so we're talking about a virus in monkeys.

I am not anti-science. And I'm certainly all in favor of educating people about advances in research. But there is a weight and an emphasis given to this kind of placement. And so, even though the story has caveats, they are overwhelmed by the enthusiasm, the pull quote, the breakthrough language.

5 monkeys followed for two weeks, one of whom did, indeed, become infected when you follow it out for five months.

Interesting? Yes.

Important? Yes.

Page one breakthrough? Not in my book.

And let's go down the boulevard of broken dreams of hope that didn't pan out - a headline one year ago - "Anti-AIDS gel disappoints, researchers say."

The leap from animal research to human efficacy is huge. It can't be stated often enough.