On a trip to NYC last week, I visited Ivan Oransky at Scientific American. This week he announced he is leaving SciAm to become executive editor of Reuters Health.

I also visited Diana Mason, editor of the American Journal of Nursing. She announced that yesterday was her last day on that job.

Diana will have an endowed chair at the Hunter–Bellevue School of Nursing at the City University of New York. She will launch a center for health media and policy.

Ivan and Diana are two good friends, and two terrific journalists, both headed to exciting new opportunities. We wish them both the best.

Interesting look at international coverage of the H1N1 flu story in a new analysis by the Project for Excellence in Journalism.

They studied 12 days of front-page newspaper coverage in seven countries around the world.

Key points from their summary:

• The three major U.S. papers studied offered some of the broadest coverage of the outbreak of any country studied, and all stories were staff-generated, as opposed to wire copy. Despite complaints in some quarters of excessive media hype, the level of coverage was relatively moderate when matched up against the number of confirmed U.S. cases.

• The number of cases of swine flu in a given country had little to do with the volume of coverage around the world. China, for example, had the fewest confirmed cases of any of the countries studied (1), but the paper studied, People’s Daily, offered about as much front-page coverage as the average paper in the U.S., which had over 2000 cases.

• In Mexico, extensive coverage by El Universal (20 front-page stories over the 12 days) cut across a broad range of issues, from the impact on businesses to the history of the virus. But the Mexican paper largely skipped any close assessment of its own government’s response.

• The French paper Le Figaro was more restrained but also controversial in its coverage. The paper ran just two stories on the front pages, but sparked an outcry by terming the outbreak “the Mexican flu.”

• In the Spanish-language papers in the U.S., one of the most striking findings was a heavy reliance by two of the three—El Diario and El Nuevo Herald—on U.S. wire service copy to fill their pages.

I meant to post this on Memorial Day.

But, in keeping with the theme, better late than never.

One of our health journalism grad students, Dr. Kay Schwebke, had a terrific article in the American Journal of Nursing in May, "The Vietnam Women's Memorial: Better Late Than Never." The article was based on her capstone project in our graduate program.

There are also podcasts related to the article online.

More recently, Schwebke had an important article posted on MinnPost.com, "As recession bites, Minnesota hospitals struggle with unpaid bills." It profiles some of the "hundreds of Minnesota hospital and clinic employees laid off within the past eight months, largely because of rising costs of uncompensated care."

Kay is a role model for new physician-journalists - diligent, health-policy-minded, inquisitive, able to think like a journalist writing for her audience - not just like a doctor.

This is a troubling trend. HealthNewsReview.org has now reviewed four stories based on abstracts for the American Society for Clinical Oncology meeting that won't even be held until next week.

Woloshin & Schwartz wrote the excellent paper pointing out the flaws of drawing conclusions from presentations at scientific meetings, but this stuff hasn't even been presented yet!

An ASCO "presscast" on May 14 drew special attention to just seven of the more than 4,000 abstracts released by ASCO two weeks in advance of the meeting. The four stories we've reviewed on HealthNewsReview.org covered three of those seven highlighted abstracts.

So if you think that all this news coverage is driven by independent vetting by journalists - think again.

The most troubling example is the following - because of the quality reputation of the newspaper and the reporter involved and because of the influence of this paper.

A Wall Street Journal story wasn't critical enough of a genetic test for colon cancer, according to HealthNewsReview.org reviewers, including former Washington Post health section editor Craig Stoltz, who wrote a clear and powerful review. He noted that a few hours after the not-critical-enough WSJ print story appeared, the WSJ health blog posted this:

Genomic Health was trading higher on data suggesting its test for early-stage colon cancer may help patients and doctors decide whether they needed chemotherapy after their tumors are removed with surgery. Read the WSJ story on the colon-cancer test here. (referring readers back to the print story.)

If, as was claimed in another WSJ story, this early release of ASCO news releases was supposed to prevent "past problems that resulted in trading on market-moving information before it was released to the general public," we wonder how well this policy is working.

We do know that the ASCO publicity machine worked.

We've also reviewed two other non-ASCO stories recently that let companies get away with making claims about research progress but without having all the data in hand. The message was sort of, "Trust us, this is really solid data, but we can't give it to you now because it's going to be presented in a month."

One was by the New York Times on the prostate cancer drug Provenge.

One was another Wall Street Journal story on the anti-clotting drug Brilinta.

Readers beware: what you're getting in these jump-the-gun stories may not be the whole story, may not have all the data, and may not scrutinize the quality of the evidence. Look for independent, non-conflicted voices in such stories but even then it may be difficult for other experts to comment because they haven't seen all the data.

This is a troubling journalistic trend - for all the reasons given.

I was very fortunate this week to meet - in total - with more than 100 very smart people who are dedicated to quality improvement in health journalism.

My visit to New York included:

• a talk to the NY chapter of the Association of Health Care Journalists at the CUNY Graduate School of Journalism. Twitter accounts of this presentation can be found using the #ahcjnyc hashtag.

• two days of meetings with various editorial and other folks at Consumer Reports. For years health care consumer advocates have said, "There's no Consumer Reports for health." Well there is now and there actually has been for some time. It may be under-appreciated that there are some very smart people at CR thinking very hard and long every day about how to educate consumers on vital health care and health care reform issues.

• a chance to talk with editorial folks at the American Journal of Nursing - again a very savvy group whose work may be under-appreciated. Think about the dominance of physician-dominated journals promoting a medical model of health care and you'll see why it's important to consider the perspectives and issues of other key health care providers like nurses - and why this Journal is important. Thanks to the AJN blog for a plug about our work and about our visit earlier today.

I think I contributed a little to these groups in my meetings in NYC this week, but I took away a lot - including new inspiration about how much quality journalistic work is being done in many different venues on vital health care and health care reform topics.

The Science News Cycle depicted on PhD Comics.

Thanks to my student Stephanie for the tip.

Read David Williams' blog posting about the USA Today story, "In patients' hunt for care, doctor database 'a place to start'".

This may be a trend. And if so, it's a troubling one.

On HealthNewsReview.org, we've just posted a review of a Wall Street Journal story that we characterize as
"Another story that lets a drug company get away with making superiority claims without releasing data."

Many news orgs let the makers of Provenge get away with this just a few days ago.

Stock manipulation anyone?

Is it going to kill anyone to wait until the data is actually released when independent expert opinion can be sought?

We don't like this practice one bit.

Read how the the European Court of Justice views journalism that it equates with advertising.

Dr. Jennifer Ashton, CBS news medical correspondent, in an interview on the Columbia j-school site, says:

"The people who are really at the forefront of medical media and medical correspondents - they are physicians."

I couldn't disagree more. Hundreds of non-physician journalists have toiled on this complex beat far longer, with more dedicated fulltime effort, and with a track record that in many cases surpasses that of most, if not all, physician journalists. Physician journalists often tend to bring their "member of the gang" medical mentality with them as they approach news topics. They are still more physician than journalist. Some give advice, not balanced news. Some promote the "medical model" - not a "public health model." Some tend to talk about medicine's terrific new toys without ever discussing costs, quality, access, disparities.

Some - not all.

I don't want to be guilty of the same stereotyping that Ashton used in blanketing all physician journalists - but her boast that her type is in the forefront of medical journalism is not supported by fact.

Case in point:

The CBS Early Show - where her segments often appear - has been reviewed six times so far in 2009.
Of the ten criteria we apply to the review of all stories, those segments have been judged satisfactory between 10-20% of the time. On important little things like cost, evidence, scope of the potential benefits and of the potential harms. Things consumers need to know in order to evaluate claims being made about new treatments, tests, products and procedures.

Here are reviews of three of her recent segments:

• http://www.healthnewsreview.org/review/review.php?rid=1975

•http://www.healthnewsreview.org/review/review.php?rid=1972

•http://www.healthnewsreview.org/review/review.php?rid=1966

Physician-reporter segments on the other networks have received similar poor grades. Give me an ink-stained wretch who applies basic healthy skepticism and journalistic fundamentals to these topics any day.

A healthy online discussion has begun over the Woloshin-Schwartz paper, published in last week's Annals of Internal Medicine, that concluded: “Press releases from academic medical centers often promote research that has uncertain relevance to human health and do not provide key facts or acknowledge important limitations.”

On the Columbia Journalism Review website, Earle Holland - assistant vice president for research communications at Ohio State University - scrutinizes that paper and news coverage thereof. And, in a followup comment, he gives a plug for our work, writing:

"The lamentation that news "releases are distributed directly to the public via the web, and the news spreads without any independent assessment" is easily fixed, if it is a concern at all. Journalists need to do a better job of evaluating the studies. A bit of time spent at Gary Schwitzer's great website, HealthNewsReview.org offers a great primer on what's good and bad about ongoing medical/biomedical reporting."

Read all of Holland's article. This is an important topic for discussion by those who care about the dissemination of health, medical and research news.

Reviewers gave a zero-star score to a story on a device to screen for melanoma. Excerpts:

"This story abounds in pretty pictures and a tale of tragic loss, but it lacks any context or facts that would allow viewers to understand what is new or relevant about a device to screen for melanoma skin cancer. ...In the end, viewers are given hope and amazement, but no useful information."

A reminder: three different reviewers evaluate each story reviewed on HealthNewsReview.org. So this isn't just one person's opinion of quality, or lack thereof.

Several people have asked me to comment on the news that Nancy Snyderman, M.D., chief medical editor for NBC News, will anchor a one-hour daily show about health news and issues that will air on MSNBC beginning June 29.

I can't comment on a program that hasn't begun to air yet.

I can only point toward past reviews of Dr. Snyderman's work.

Birth Control for Men: May 5, 2009

Excerpt of review: “In almost every way, this story overstates the benefits and essentially ignores the risks and limitations of testosterone injections for male contraceptive use.”

Can you recover from autism? April 17, 2009

Excerpt of review: “This story dangles hope of recovery in front of parents of children diagnosed with autism. Indeed, the word "hope" is invoked four times. However, the story provides neither evidence that the therapy program is responsible for the improvement in the featured patient nor any details of how this intervention differs from standard therapies used to manage the symptoms of autism.”

Lose weight while you sleep? February 9, 2009

Excerpt of review: “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.”

Today’s Matters of the Heart: Dr. Nancy’s Personal Wake-up Call; February 4, 2009

Excerpt of review: “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.”

Nothing but miracles, breakthroughs, rainbows and unicorns for Today Show; February 5, 2008

Networks' pro-screening enthusiasm; March 30, 2007

These were all short segments.

Imagine what they can do with a full hour!

Local TV Now is a weekly podcast covering the business of local television. One of the hosts interviewed me last week.

Last week's event, "Fever Pitch: Does health news reporting leave consumers out in the cold?", co-hosted by the Minnesota chapter of the Society of Professional Journalists, the Minnesota News Council and the Silha Center for the Study of Media Ethics and Law, is now available for viewing online.

The full event is broken up online into three video clips. The introductions, and my talk, are in the following video:

The event offered a chance for an open dialogue about issues confronting those trying to cover health care issues. This photo shows me locking in on a point made by Jeremy Olson of the St. Paul Pioneer Press while Dave Hage of the Star Tribune listens.

Bad week on network TV.

Stories on...

• a male contraceptive

• robotic surgery

• a new MRI device

* and a new skin cancer detection device

all failed to discuss costs, to quantify benefits and harms, or to give independent perspectives.

Viewers of these programs got one-sided, incomplete, imbalanced portrayals of health care treatments, tests, products and procedures.

See HealthNewsReview.org review of Good Morning America's latest medical technology cheerleading story. Excerpt:

A few minutes of techno-tainment with inexcusable, almost inconceivable lapses in journalistic hygiene. No discussion of cost, of evidence for benefits or harms, and no independent insight.

This story has barely been touched by local Twin Cities news organizations. But a student journalist, Emma Carew, reported on it as her last story at the Minnesota Daily before graduating and before going to work for the Washington Post this summer.

As you'll see, the story touches on issues of duplication of services, increased costs, competition and the medical arms race.

A 1,200-word story by a student journalist on an important topic for local discussion.

In the inquisitiveness and determination of young journalists, there is hope for health care journalism. This is one shining example.

The Radio-Television News Directors Association website posted an article by RTNDA chairman Stacey Woelfel, reflecting on the high school class clown who did an oinking and squealing routine whenever anyone mentioned swine flu back in 1976. He doesn't hear oinking today but, rather, "the sound of hundreds of reporters beating this story to death."

Woelfel writes:

"The rampant coverage stems from the fact we’re in a good, old-fashioned arms race. That’s right, an arms race just like the ones the U. S. and the Soviet Union were having back when Gerald Ford was getting his swine flu shot. But the current arms race doesn’t have anything to do with out-nuking each other. It has to do with the escalating competition between media outlets to grab an ever-shrinking audience for our product. I must give credit to Robert Frank and his terrific book The Economic Naturalist for opening my mind to the current arms race scenario. Frank describes the race in economic terms, focusing on why businesses do what they do—even it seems illogical. That illogic is, I believe, at the heart of our swine flu crisis. We fight to do more and more on this mostly-trivial disease because we fear our competitor will have more than we do. But what we miss is that our audiences are laughing at us every bit as hard as I did when Ken Kosciulek (his old class clown classmate) started his pig noises.

Should we end all swine flu coverage? No. But our goal should not be to have the most coverage—just the best. And best may include not covering it at all when there’s nothing new to report. At least put the current news in context. I’ll risk mentioning another book all news directors should read. Pick up a copy of Barry Glassner’s The Culture of Fear: Why Americans are Afraid of the Wrong Things. Even though the book’s now ten years old, it still speaks to our role in frightening the American public for no good reason. Again, I’m not saying we shouldn’t cover stories that might be a little scary. But we should put those scares in the context of the odds—the odds of catching swine flu, the odds of dying from it, the odds you’ll even know you have it. That gives the audience a fighting chance to decide just how important the story is and to make an intelligent decision to tune elsewhere when they tire of it."

If only RTNDA and its chairman and its website and its terrific code of ethics seemed to make any difference with its members! Sadly, that often doesn't seem to be the case on journalism ethics issues - and certainly not regarding shoddy coverage of health news stories.

There's considerable discussion on the listserv of the Association of Health Care Journalists about this UPI story - with the above headline - being the worst yet on flu coverage.

Among the comments journalists posted:

• The paragraphs about HIV looks like someone stuck it in there, as it bears little resemblance to the rest of the story.

• It says "Health authorities are particularly worried that the capability to mutate already exhibited by the virus could eventually let it combine with the human immunodeficiency virus, which causes AIDS." Then it gives a sentence comparing that to the Spanish flu, and that's the end of the possible "mixing" with HIV. No sources on this at all, only the very ambiguous "health authorities."

• It throws out completely unsubstantiated data with no source. There is also no background info on that--even in the absence of resources, it gives no background on why anyone would think that it could combine with HIV, or how that could even happen. Or what makes this flu strain so special that it would have a special affinity for HIV.

• Reuters uses some pretty loose language too. I think they're both overinterpreting the WHO statement, which discusses the comorbidity of the two infections, not some apocalyptic biological combination.

• There is no scientific basis for such speculation, or evidence that it has occurred in the decades that both viruses have been around.

• The speculation makes about as much sense as saying that because dogs and cats are both pets, some day they might combine to produce a dat or cog.

Great paper by Woloshin & Schwartz (and others) in the current Annals of Internal Medicine, "Press Releases by Academic Medical Centers: Not So Academic?"

Excerpts from the Discussion section of their paper:

Press releases issued by 20 academic medical centers frequently promoted preliminary research or inherently limited human studies without providing basic details or cautions needed to judge the meaning, relevance, or validity of the science. Our findings are consistent with those of other analyses of pharmaceutical industry and medical journal press releases, which also revealed a tendency to overstate the importance and downplay (or ignore) the limitations of research.
…
The quickest strategy for improvement would be for centers to issue fewer releases about preliminary research, especially unpublished scientific meeting presentations, because findings often change substantially—or fail to hold up—as studies mature. Forty percent of meeting abstracts and 25% of abstracts that garner media attention are never subsequently published as full reports in medical journals. Similarly, centers should limit releases about animal or laboratory research. Although such research is important, institutions should not imply clinical benefit when it does not exist (and may not for years, if ever): Two thirds of even highly cited animal studies fail to translate into successful human treatments.

When press releases are issued, they should include basic study facts and explicit cautions. For example, press releases should remind journalists that strong inferences cannot be drawn from uncontrolled studies, or that surrogate outcomes do not always translate into clinical outcomes. Although good press releases will probably help, quality reporting also requires good critical evaluation skills. Fortunately, journalists have opportunities to acquire these skills, through such programs as the Association of Health Care Journalists seminars; the Knight Science Journalism Medical Evidence Boot Camp at MIT; and "Medicine in the Media: The Challenge of Reporting on Medical Research," a workshop sponsored by the National Institutes of Health, the Dartmouth Institute for Health Policy and Clinical Practice, and the Department of Veterans Affairs.

Investigators can also do better. They could forgo requesting releases for studies with obvious limitations and review releases before dissemination, taking care to temper their tone (particularly their own quotes, which we often found overly enthusiastic).

By issuing fewer but better press releases, academic centers could help reduce the chance that journalists and the public are misled about the importance or implications of medical research. Centers might get less press coverage, but they would better serve their mission: to improve the health of their communities and the larger society in which they reside.

NPR's media correspondent interviewed me for this segment on "How Well Have Media Covered the Flu Outbreak?"

Why doesn't this kind of cost analysis make it into stories?

An AP story last week on Avodart being tried for prostate cancer DID give the NNT or number needed to treat, but didn't project the cost analysis behind that NNT.

The story said that "to prevent a single case of cancer, 71 men would have to take finasteride [a similar drug] for 7 years." But it didn't then do the math. The story says Avodart is $3 per pill, so---

71 men x 365 days/yr. x 7 yrs. x $3/pill = $544,215 to prevent a single case of prostate cancer.

How can these kinds of numbers be left out of stories?

Intro to Hospital Public Relations: How to learn from bad examples.

James Rainey of the LA Times writes that some news organizations "seem to have a congenital inability to tell this story with precision or proportion."

This story being the flu story.

I have stuck to my diet: I've still not watched one second of TV news coverage of the flu. The healthiest diet I've ever pursued.