The Wall Street Journal added to the discussion about cost-effectiveness of cancer drugs reflecting on a commentary in the Journal of the National Cancer Institute estimating that "it would cost $440 billion to extend life by one year for the 550,000 Americans who die annually of cancer."

Important topic. I'm glad the WSJ addressed it.

But one line bothered me. It read:

"Some countries, like the United Kingdom, agree to pay for expensive drugs only if they meet a certain threshold of efficacy, but no such rationing exists in the U.S."

A news story that comes right out and labels a demand for proof of efficacy as rationing?

A semantics purist may say that the term applies in this discussion - like restricting or rationing consumption of meat or electricity during war.

But given that any newsroom must realize how the term is used as a heavy-handed piece of rhetoric by those who oppose evidence-based medicine and who oppose health care reform that calls for such evidence, this seems like editorializing.

Good story - but that one word in that one sentence left a bad taste for me. Semantics, word choice and framing matter if you care about public understanding of complex health policy issues.

Despite my red marks on that one section, read the rest of the article (if it's still available online), which was important enough to be on page one of at least the D section of the printed WSJ, not way back on D4.

It's great to be first. But it's better to be complete, balanced, and helpful with your news.

CBS claimed an "exclusive" with a report on the "first person ever to get an infusion of his own heart stem cells" to try to avoid future problems after a heart attack.

OK, they had the exclusive report that the procedure was done.

But they didn't make clear that:

• There is currently nothing known about the benefits of this approach in people. That simply wasn't emphasized in the story.


• Instead, it was referred to as a "cutting edge" clinical trial. Are there non-cutting-edge clinical trials?


• It was called a "major advance."


• It was called a "trailblazing procedure."


• But the onscreen graphic continuously trumpeted it as a "CBS Evening News Exclusive."

The segment was clear that this treatment is experimental, but the failure to discuss potential risks, potential harms, costs involved, and current treatment options available to patients were huge omissions.

For anyone who really wants to learn about this area of research, the National Institutes of Health has a website describing the current state of the art. It contains questions we wish the CBS segment had explored, such as (excerpt follows):

"What are the implications for extending the research on differentiated growth of replacement tissues for damaged hearts? There are some practical aspects of producing a sufficient number of cells for clinical application. The repair of one damaged human heart would likely require millions of cells. The unique capacity for embryonic stem cells to replicate in culture may give them an advantage over adult stem cells by providing large numbers of replacement cells in tissue culture for transplantation purposes. Given the current state of the science, it is unclear how adult stem cells could be used to generate sufficient heart muscle outside the body to meet patients' demand.

Although there is much excitement because researchers now know that adult and embryonic stem cells can repair damaged heart tissue, many questions remain to be answered before clinical applications can be made. For example, how long will the replacement cells continue to function? Do the rodent research models accurately reflect human heart conditions and transplantation responses? Do these new replacement cardiomyocytes derived from stem cells have the electrical-signal-conducting capabilities of native cardiac muscle cells?"

That quote comes from a Minnesota physician in a Pioneer Press article that includes many good elements:

• Info on disparities in Medicare spending;


• Dartmouth Atlas data and graphic;


• Local angle on Atul Gawande's New Yorker piece .

Kudos to reporter Jeremy Olson.

"This is so ridiculous, it may not be worth blogging on," Marilyn Mann wrote to me.

I thrive on the ridiculous.

Whenever and wherever I see something this absurd, this non-evidence-based, this unhelpful and potentially harmful to health care consumers, I'm going to comment.

The columnist, a certified personal trainer, says she adapted her column from the July/August issue of Men's Health magazine.

She advises men to think about getting

• Cardiac CT angiography

• Bone density scan - She writes: "Uh, oh, fellows. Did you think osteoporosis was just for women? Nope."

• VO2 Max Test. She writes: "For this one, you get on a treadmill or stationary bike and pump up your cardiovascular volume to maximum effort while wearing a mask that measures your every breath.

The VO2 Max Test is the master cardiovascular test that will let you know what you're made of. It's the most accurate measure of your cardiovascular and overall health."

You won't find one evidence-based recommendation that supports any of those recommendations.

This kind of junk journalism feeds the "test, test, test" mentality that fuels the worried well and drives up health care costs.

I hope Philly Daily News readers either didn't read this column or didn't pay any attention to it. But for those that did, now you know the rest of the story.

The subject was a study in the New England Journal of Medicine on PARP inhibitors. It was an early phase I trial - the kind of trial that is not primarily designed to measure effectiveness. That didn't stop the big 3 TV networks from trumpeting "BREAKTHROUGH!"

The CBS Early Show said "researchers in Britain say they may have found the holy grail of cancer research." They called it "incredibly effective" but gave no evidence to support that.

On NBC, veteran science correspondent Robert Bazell made no mention of the limited scope and duration of the phase I trial or what sort of testing remains to be done. The correspondent presented this treatment as essentially proven, proclaiming "whatever else happens, these drugs look like they will eventually save thousands of lives."

Compared to the NBC News story on treating cancers with PARP inhibitors, ABC News was relatively restrained in its enthusiasm. It offers viewers more information about the underlying concept of synthetic lethality, which is really the core of the news value of this journal article. ABC still called it a breakthrough and still predicted widespread availability within two years - a foolish prediction game to play.

Pick your poison: the offerings of network TV health news.

(Hat tip to Andrew Holtz, who reviewed two of the stories on HealthNewsReview.org. See the full reviews there.)

Paul Scott writes about the documentary, "Depression: Out of the Shadows," which won a Peabody Award.

He criticizes that "its broad survey of the science of the illness included frequent appearances by Charles Nemeroff, M.D., a leading--some say powerful--mood disorders researcher from Emory University. Last fall, Nemeroff also became one of the most prominent psychiatrists to be rebuked for failing to disclose funds earned from the drug industry." ...

The heart of his critique, though, is this:

"That PBS producers either did not know about Nemeroff's drug industry entanglements or did not believe they tainted his discussion of the science of depression is disappointing. Indeed, the science of the illness and antidepressant medications is far less uniformly agreed upon than is depicted in the documentary. Disputes are ongoing over the efficacy, mechanism of action, and "targeted" nature of antidepressants--blockbuster drugs that remain the recipient of favorable press coverage even while now going off patent.

But what made the praise bestowed on this PBS documentary particularly troubling were the erroneous, drug-industry serving statements made by Nemeroff within the film--statements which had the potential to negatively affect public health, and which the documentary left unchallenged."

Read the entire piece.

I have written to the National Press Foundation stating my concern with the fact that they  have accepted funding from the drug company Pfizer to offer journalism fellowships on cancer issues.  

I read about this in an e-newsletter sent by the Society of Professional Journalists (SPJ).  The SPJ newsletter wrote that “Fifteen fellowships will be awarded and they all include lodging, airfare and most meals.”

This is the notice as it appeared in the SPJ newsletter:

I wrote to the SPJ president about my concerns, stating that “I don't think SPJ should be encouraging journalists to take these pharma-funded all-expenses-paid trips by promoting them in the newsletter.”

I remind SPJ that its own code of ethics includes these clauses:

Journalists should:

—Avoid conflicts of interest, real or perceived.

— Remain free of associations and activities that may compromise integrity or damage credibility.

— Refuse gifts, favors, fees, free travel and special treatment, and shun secondary employment, political involvement, public office and service in community organizations if they compromise journalistic integrity.

If taking free airfare, lodging and meals from a drug company whose work you cover isn’t at least a perceived conflict of interest, I don’t know what it is.  And I don’t think SPJ should promote events in its own newsletter that, in my reading, invites journalists to violate the SPJ code. 

More on SPJ in a moment. 

I also wrote to the National Press Foundation and had a long e-mail exchange with its president.  In a nutshell, he defended their acceptance of the drug company money – just as he did when Merrill Goozner wrote about his concerns with NPF’s handling of another drug company-sponsored journalism event last fall.  Or just as he did when Duff Wilson – then of the Seattle Times but now of the New  York Times – wrote about NPF taking pharma money four years ago. 

Now back to SPJ. 

At its national conference in Indianapolis this August, SPJ will offer a tour of the Eli Lilly drug company corporate headquarters and "a professional development session on the reporting of mental health issues.”  SPJ invites journalists on its website, with: "you can participate in a networking reception with Lilly leaders to learn more about Lilly’s history—and future—from the very individuals who are working to shape it."

Lilly makes:

* Cymbalta for depression and "generalized anxiety disorder"
* Prozac
* and Zyprexa for schizophrenia and bipolar disorder

Why don't journalists see any problem with these arrangements? Actually journalists did see problems with such activities– at one time.  The ones who wrote the SPJ code of ethics.  Something about “Refuse gifts, favors, fees, free travel and special treatment….avoid conflicts real or perceived…etc.”

In their article, “Who’s Watching the Watchdogs?” in the BMJ on November 19, 2008, Schwartz, Woloshin and Moynihan wrote:

“As watchdogs the media play a vital role in highlighting interconnections between doctors, researchers, and the drug industry. But who watches the watchdogs?

Financial ties between medical journalists and for-profit companies they cover in their reporting have received little attention in the media or from the research community. Such ties warrant scrutiny, not least because many of us first learn about new treatments from the news media, and these reports can affect the way the public uses health care.”

The authors conclude:

“Training and further education of medical journalists should not be funded by the healthcare industries that the journalists cover.”

We urge the National Press Foundation and the Society of Professional Journalists to re-evaluate their policies. 

I have written to the National Press Foundation stating my concern with the fact that they have accepted funding from the drug company Pfizer to offer journalism fellowships on cancer issues.

I read about this in an e-newsletter sent by the Society of Professional Journalists. The SPJ newsletter wrote that "Fifteen fellowships will be awarded and they all include lodging, airfare and most meals."

This is the notice as it appeared in the SPJ newsletter:

I wrote to the SPJ president about my concerns, stating that "I don't think SPJ should be encouraging journalists to take these pharma-funded all-expenses-paid trips by promoting them in the newsletter."

All I got was a "Thanks for your note" response.

As an SPJ member, and as the keynote speaker at a recent SPJ ethics week event, I expected more. As a thank you gesture for my participation in that SPJ event, the national president gave me a plaque with the SPJ code of ethics on it. I remind SPJ that its own code of ethics includes these clauses:

Journalists should:

• Avoid conflicts of interest, real or perceived.



• Remain free of associations and activities that may compromise integrity or damage credibility.



• Refuse gifts, favors, fees, free travel and special treatment, and shun secondary employment, political involvement, public office and service in community organizations if they compromise journalistic integrity.

If taking free airfare, lodging and meals from a drug company whose work you cover isn't at least a perceived conflict of interest, I don't know what it is. And I don't think SPJ should promote events in its own newsletter that, in my reading, invites journalists to violate the SPJ code.

More on SPJ in a moment.

I also wrote to the National Press Foundation and had a long e-mail exchange with its president. In a nutshell, he defended their acceptance of the drug company money - just as he did when Merrill Goozner wrote about his concerns with NPF's handling of another drug company-sponsored journalism event last fall. (See "Jeer to the National Press Foundation")

Now back to SPJ.

At its national conference in Indianapolis this August, SPJ will offer a tour of the Eli Lilly drug company corporate headquarters and "a professional development session on the reporting of mental health issues." SPJ invites journalists on its website, with: "you can participate in a networking reception with Lilly leaders to learn more about Lilly's history--and future--from the very individuals who are working to shape it."

Lilly makes:

• Cymbalta for depression and "generalized anxiety disorder"


• Prozac


• and Zyprexa for schizophrenia and bipolar disorder

Why don't journalists see any problem with these arrangements? Actually journalists did see problems with such activities - at one time. The ones who wrote the SPJ code of ethics. Something about "Refuse gifts, favors, fees, free travel and special treatment....avoid conflicts real or perceived...etc."

In their article, "Who's Watching the Watchdogs?" in the BMJ on November 19, 2008, Schwartz, Woloshin and Moynihan wrote:

"As watchdogs the media play a vital role in highlighting interconnections between doctors, researchers, and the drug industry. But who watches the watchdogs? Financial ties between medical journalists and for-profit companies they cover in their reporting have received little attention in the media or from the research community. Such ties warrant scrutiny, not least because many of us first learn about new treatments from the news media, and these reports can affect the way the public uses health care."

The authors conclude:

"Training and further education of medical journalists should not be funded by the healthcare industries that the journalists cover."

We urge the National Press Foundation and the Society of Professional Journalists to re-evaluate their policies.

The Daily News boasts that today it "begins its ninth year of free prostate screenings at 37 hospitals, medical facilities, recreation centers, churches and office locations across the metro New York area."

The paper states that "Men age 40 and older and those with a family history of prostate cancer are offered the screenings."

Either the paper doesn't realize or doesn't care that:

• The American Cancer Society does not support routine testing for prostate cancer at this time and specifically recommends AGAINST such mass screenings.
• The US Preventive Services Task Force and the American Academy of Family Physicians state that "Current evidence is insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years."
• No major group - except urologists - recommends starting screening as early as this newspaper does - starting at age 40. And that urology group's thinking is the source of major controversy.

The paper reports that in the last 8 years, almost 140,000 men have been screened through the newspaper's efforts.

They report that 7% "were urged to follow up with a visit to their physician or hospital."

That's almost 10,000 men.

That's a huge public responsibility for a newspaper to take on - especially when it conflicts with medical evidence.

Before being screened, what did the newspaper inform men about the tradeoff of harms and benefits? On the American Cancer Society website, its president, Dr. Otis Brawley says:

"There are some proven harms associated with screening. Screening, for example, leads to unnecessary treatment in some men who are diagnosed with localized disease.

It is difficult to comprehend, but there are prostate cancers that are confined to the prostate and never destined to metastasize (spread to other parts of the body). Screening diagnoses a large number of men who would never be bothered by the disease. In one clinical trial, more than 12% of average risk men were diagnosed through screening over 7 years. This group of men is estimated to have a lifetime risk of death of less than 4%. This study suggests that 2 out every 3 men in this study did not need to be diagnosed nor treated. While this study suggests that the proportion of men in the overall population who are diagnosed with cancers that do not need therapy is as high as 67% of men with localized disease, others estimate it to be as low as 30%. We have very poor ways of predicting who needs treatment because their prostate cancer might kill them, and who does not need therapy because their tumor is of no threat to them."

You do the math: how many of the 10,000 men the Daily News urged to have followup fell into these categories?

It's not just a simple blood test, as it is so often promoted. That's why Dr. Brawley says:

"Many health care provider organizations and many well-meaning community groups encourage prostate cancer screening and offer mass screening at health fairs and other activities. The American Cancer Society is concerned that so many do not understand that the benefits of screening are still undetermined. The ACS recommends against such mass screening activities because one cannot be assured that the patient has the opportunity to hear a balanced explanation of screening in an environment in which he can feel comfortable to ask questions and make an informed decision."

A CBS Early Show segment on "three heart tests all women should know about" actually claimed that heart CT scans involved no radiation! And this involved a physician-correspondent!

Excerpts of the story review on HealthNewsReview.org:

This was classic morning show health news garbage.

"Three heart tests that all women should know about"? "All" suggests that even women without symptoms should be thinking about these tests. But the segment later says that the tests are only for women with symptoms, but then never gives a detailed description of these symptoms.

So viewers are left with another high-tech showcase: stress echocardiograms, screening ultrasounds, and CT scans looking for calcium in the coronary arteries - the menu for the morning news-viewing woman.

Does CBS and its physician-correspondent realize that the term "screening" (which they used in reference to ultrasounds) does not apply to those with symptoms?

So which women - precisely - should think about or pursue these tests? Those with symptoms - or those without symptoms?

On top of everything else, the segment included a glaring, unforgivable error. It said that the three tests involved no radiation - implying that they are harm-free. But a cardiac CT scan has an average radiation dose equivalent to 600 chest x-rays!!! In addition, according to a 2007 study in JAMA, there is an increased risk of breast cancer in women having the test due to the radiation dose. And this segment was all about women having these tests.

Who is responsible for this content?

Is this news? Is this public education? Or is it just another meaningless medical marvel morning show segment that fails to quantify benefits or talk about harms or acknowledge costs?

The Oklahoman is another newspaper that must love new, expensive, unproven medical technologies.

The story, "Tulsa company hopes device can ease cancer screenings," may just as well have been headlined, "Tulsa company can't write a better promotional news release than this."

It's a local business story, cheerleading for local business, and to hell with the evidence. And for that matter, the story thumbs its nose at women who need better information than this about breast cancer screening.

Former Washington Post health section editor Craig Stoltz wrote this summary on HealthNewsReview.org:

"This story on a new ultrasound imaging device stands out from other zero-star stories we've reviewed. This piece doesn't merely fail to be accurate, balanced and complete. It fails to even try.

* It draws on only one source, a company executive whose job it is to sell machines
* It doesn't present any data to justify the source's claims of efficacy and superiority
* It doesn't provide any context about similar devices and other diagnostic techniques
* By implying the device can detect cancers mammograms cannot, it could provoke unjustified fear
* It fails to distinguish between screening and diagnosis

Looking over the story, it's not clear the reporter even asked a question. It is not mean or hyperbolic to say that most press releases are more informative."

Consider the impact on consumers of this kind of daily drumbeat of such stories by news organizations all across the country while you listen to all of the mounting opposition to health care reform proposals in Washington. (Today I've blogged about just two - albeit egregious - examples in South Dakota and Oklahoma.)

Until we educate health care consumers better than this, health care reform is going to be a really tough sell.

Prime example - ABC's story this week on red yeast rice to lower cholesterol.

HealthNewsReview.org reviewers said:

"Like so many news reports, this one treats elevated cholesterol as a disease, not just a marker of coronary artery disease risk. Indeed, nowhere does the story even mention coronary artery disease or heart disease of any kind; lowering measurements of blood cholesterol levels are treated as the ultimate goal. This confusion of a lab test result with an actual health outcome then leads the story to proclaim that red yeast rice "just might be the answer," without ever making clear that this study was neither long enough nor large enough to provide any answers about whether people taking red yeast rice live longer or healthier. ...

In the journal article abstract, the authors caution that, "The study was small, was single-site, was of short duration, and focused on laboratory measures." Then in the discussion they write, "A larger, multicenter trial with longer follow-up is needed to determine whether red yeast rice offers a safe and effective solution for this unmet medical need and to evaluate its effects on cardiovascular outcomes." Viewers heard neither of these important caveats."

There was also no mention of an editorial accompanying the published study that read, in part, "The U.S. Food and Drug Administration continues to warn against inconsistent and possibly toxic formulations of red yeast rice, and we should not prescribe it until it has been standardized and tested further."

Why weren't these caveats included?

Weekly e-mail digests available at: http://www.healthnewsreview.org/get_e-mail_updates.php

New York Times, 5-star score
Doubts on Ovarian Cancer Relapse Test
Good job describing the current study and how it relates to current clinical thinking. Adds to the "more is not always better" knowledgebase that is growing in health care.

ABC World News with Charles Gibson, 0-star score
Personalized Cancer Care
This story is a marketing coup for a hospital, but its relevance to most cancer patients is unclear. This story failed on costs and on context, cheerleading for an approach that lacks evidence.

ABC's Good Morning America, 2-star score
Cutting the fat--without incisions: New weight-loss surgery
Breathless enthusiasm - not backed by facts about new incision-free approach to weight loss surgery. Story calls it "remarkable" and "exciting" but that results aren't as good as gastric bypass.

ABC World News with Charles Gibson, 2-star score
Diabetes Test: Simple Diagnosis
ABC missed the whole point of the news - calling an old test "new" but that it's "already widely available." It never explained what it's used for now and what the change would be. Weak. Unhelpful.

Washington Post, 5-star score
Peanuts, Anyone? Researchers Expose Kids to Risky Foods In Order to Cure Them
Nice job on a story about desensitization for milk and peanut allergies. Emphasized that the work has been done in small studies so far, and that it's far from ready for widespread use.

CBS The Early Show, 1-star score
Erasing Age Lines: New Wrinkle in Anti-Aging Devices
Gertrude Stein said of Oakland, "when you get there, there isn't any there there." With its lack of useful information about a wrinkles laser, the same could be said of this story that isn't a story.

USA Today, 2-star score
Here's a twist to managing back pain: Push your muscles
Story didn't emphasize the findings haven't been peer-reviewed, didn't explain absolute benefit to patients, and didn't include independent perspectives.

Last week I praised the CBS Evening News for a piece on overuse of angioplasty.

Tonight I must criticize them for junk journalism on the McAllen, TX story.

They went to McAllen, admitting that they were simply following the Atul Gawande article, "Cost Conundrum" in The New Yorker.

But then they added nothing to the story, in fact, detracting from the original piece with this exchange:

"We need to think about reforming the payment system to start rewarding providers for providing better value not just for doing more services," says Dr. Elliott Fischer.

Back in McAllen, Ruben Ramirez, who sees four different doctors per month, says he should have all the care he needs for his bad back, diabetes and erratic blood pressure.

He told (the CBS reporter) he wants more care, not less.

"That's what I would like," he says.

A total non-sequitur. Is the value and are the services discussed by Fisher (yes, it's Fisher, not Fischer as CBS incorrectly put on its website) the services Ramirez needs?
We don't know. That would require journalism.

If you want to deconstruct the Gawande piece, there are many ways to do it. Lord knows, many have tried to do so in the past two weeks. But this wasn't one that contributed anything meaningful to the public discussion.

It simply showed, "Oh, yeah, we read The New Yorker, too!"

This is how NOT to cover health care news. It is one more example in a long list of major media in this country promoting screening tests in the absence of evidence.

Dr. Holly Phillips of WCBS-TV in NY reports about a van that ...

..."travels around New York City and offers free MRI brain scans to virtually anyone. Neurosurgeon Dr. Patrick Kelly spearheaded the campaign and believes catching brain tumors early will save lives.

"We've scanned over 1,300 people and we have found some astounding things," he told CBS 2.

Nearly a million Americans are walking around with a brain tumor and don't even know it. About 25,000 of them are in New York City alone, and by the time brain tumors cause symptoms, often times it's too late for treatment."

This, on the other hand, is how you practice quality health care journalism:

The Cancer Letter (subscription or day pass required) did the same story, but reported that "Skeptics say these folks should have their heads examined. Screening experts ... say there's no evidence to support brain scans for asymptomatic people."

One of those skeptical experts said, "“The question is what is the best use of resources to deal with the brain tumor population? The incidence of brain tumors in a population per year is in the range of 6 to 10 per 100,000 population. So what you would have to do is perform MR scans on 100,000 people to find somewhere between 6 and 10 brain tumors, and of those 6 to 10, about half of those lesions would be benign. It wouldn’t seem to be a reasonable expenditure of resources.”

Things to think about as you compare the two stories:

• The first was done by a physician who has been put on the air as a journalist.
• What is her training in journalism?
• Does she think first like a journalist, or like a doctor?
• If the latter, then her inclination, from her medical training, is probably to test, test, test.

• The Cancer Letter is written by serious journalists.
• They think about evidence, harms along with benefits, and costs.

The latter type of journalism prepares us to think about health care reform.

The former exacerbates the mess we're in.

So the President goes to Green Bay for a town hall forum on health care reform, and two of the three TV networks (ABC and NBC; I didn't see CBS) reported NOTHING about the health care discussion - showing instead only the cute little clip of Obama signing a "please excuse" note for the little girl who skipped school to attend.

Cute.

But where's the beef?

As usual, not on the evening news.

Except that it was the lead story on The NewsHour with Jim Lehrer.

We want to praise several recent journalistic efforts to address health care reform issues. Most notable, given the terrible track record of network TV news on these topics, was a two-part series by CBS News and Jon LaPook on questions about angioplasty, addressing the medical arms race and the need for true informed consent about harms and benefits.

Monday June 8 clip here.
Tuesday June 9 clip here.

The first (at least) was done in partnership with BusinessWeek, which published its own piece. (Disclosure: The BusinessWeek piece interviewed Jack Fowler, president of the Foundation for Informed Medical Decision Making, which supports this site.)

We wish and hope that CBS - and the other TV networks - would pursue more stories more often that raise such vital questions about evidence, overuse, costs, and quality in health care. Instead of a regular diet of stories that convey that "more is better, newer is better" - this type of story is much more meaningful for health care consumers.

For examples of some of the continued TV news drivel, see:

http://www.healthnewsreview.org/review/review.php?rid=2051 http://www.healthnewsreview.org/review/review.php?rid=2047 http://www.healthnewsreview.org/review/review.php?rid=2043 http://www.healthnewsreview.org/review/review.php?rid=2002 http://www.healthnewsreview.org/review/review.php?rid=1994 http://www.healthnewsreview.org/review/review.php?rid=1972 http://www.healthnewsreview.org/review/review.php?rid=1966

For now, though, we simply want to tip our hat to this week's efforts by CBS.

We also want to add to the litany of praise for Atul Gawande's piece, "The Cost Conundrum," in The New Yorker. About that piece, the Kaiser Health News service writes:

"The ... article is now being called one of the most influential health care stories in recent memory. The New York Times reported that President Obama made it required reading for his staff and cited it at a meeting with Democratic senators last week. His budget chief, Peter Orszag, has written two blog posts about the article. Health and Human Services Secretary Kathleen Sebelius referred to it in a speech at the John F. Kennedy School of Government last week. Lawmakers on the Hill also are discussing it. Congressman Jim Cooper, D-Tenn., for instance, says the article has "shifted perceptions on the health care industry."

By the way, if you want to learn about health policy and if you haven't been following the recently-launched Kaiser Health News Service, you should be.

But critics of the Gawande piece, and of the Dartmouth Atlas data upon which it's largely based, have come out of the woodwork. And Maggie Mahar, in her excellent Health Beat Blog, addresses many of those criticisms. The debate is warming up. And journalism needs to do better than just report on the horse race - the "he said/she said" political wrangling that has helped kill almost every embryonic health care reform effort with a death of a thousand cuts. In these times, journalism needs to guide, to interpret, to help consumers navigate. Some of the examples I've just highlighted do a terrific job of that.

They said the A1C test was new, but then said it's already widely available. Huh?

That's how unhelpful the ABC News story was on the proposed broader use of the A1C diabetes test.

They never once stated that this is a proposed new application of an old test - proposed by an international committee of diabetes experts.

One print story we read had no problem summarizing the news succinctly when it led:

"A blood test physicians use regularly to check blood sugar levels in people with diabetes is now being recommended as a tool to diagnose the disease."

Was that so difficult? Would that gobble up too much precious TV airtime?

Instead, much of the airtime was wasted on meaningless people-on-the-street interviews - a hackneyed technique that doesn't employ much in the way of sound journalism. Asking people whether they knew if they had diabetes is not directly related to the news about the expanded use of the A1C test - UNLESS those people had been tested in conventional ways and were left uncertain.

But the story also:

• failed to compare the A1C with existing plasma glucose or glucose tolerance tests;
• failed to describe the sensitivity or specificity of the test;
• failed to describe the cost implications of this proposed broader use.

So, all in all, this story didn't help viewer understanding very much. It just fed the "newer is better, more is better" mentality without scrutinizing - or even apparently understanding - what was before them.

I'm honored to be included in a list of commenters recruited by the Kaiser Health News Service to react to Atul Gawande's New Yorker piece on "The Cost Conundrum."

KHN writes:

"The ... article is now being called one of the most influential health care stories in recent memory. The New York Times reported that President Obama made it required reading for his staff and cited it at a meeting with Democratic senators last week. His budget chief, Peter Orszag, has written two blog posts about the article. Health and Human Services Secretary Kathleen Sebelius referred to it in a speech at the John F. Kennedy School of Government last week. Lawmakers on the Hill also are discussing it. Congressman Jim Cooper, D-Tenn., for instance, says the article has "shifted perceptions on the health care industry."

Then they asked the following to comment - an interesting range of perspectives:

• Robert Blendon, Professor of Health Policy and Political Analysis, Harvard School of Public Health and John F. Kennedy School of Government

• Greg Scandlen, Senior Fellow, Heartland Institute

• Joseph W. Stubbs, President, American College of Physicians

• E. Linda Villarreal, Past President of the Hidalgo-Starr County Medical Society, Internist in Edinburg, Texas

• and me.

By the way, if you want to learn about health policy and if you haven't been following the recently-launched Kaiser Health News Service, you should be.

CBS News has aired two pieces the last two nights that raise questions about the overuse of angioplasty, about the medical arms race, and about informing patients with true informed consent about harms and benefits.

Monday June 8 clip here.

Tuesday June 9 clip here.

The first (at least) was done in partnership with Business Week.

We wish that CBS - and the other TV networks - would pursue more stories more often that raise such vital questions about evidence, overuse, costs, and quality in health care. Instead of a regular diet of stories that convey that "more is better, newer is better" - this type of story is much more meaningful for health care consumers.

For now, though, we simply want to tip our hat to this week's efforts.

William Heisel, who’s done some terrific health journalism at the LA Times and elsewhere, interviewed me for the “Reporting on Health” blog of the California Endowment Health Journalism Fellowship website.

He asked good questions, making it easy for me to give substantive (I hope) answers.

And he also elicited a couple of my analogies about health news coverage:

• Broccoli and hot fudge sundaes in health care news
(To my students: you’re not the only ones who get this line from me);

• O.J. and the white Bronco;

• Thirsty people trying to get a drink from a firehose.

You’ll have to read the article to get the context.

(Photo credit: Peppysis on Flickr)

That way, each week you can get summaries of the past week's news reviews sent to you by e-mail. such as:

ABC's Good Morning America, 2-star score

Homegrown Cure: Can Breast Milk Heal Adults?
Story on the potential for "harnessing the curative effects (of human breast milk) to fight terminal cancer." But it left viewers' heads spinning over what - if anything - is known.

ABC World News with Charles Gibson, 2-star score

A New Voice
High drama about one opera singer's struggle with and treatment for recurrent respiratory papillomatosis. But the story lacks info on costs, evidence, and harms. And it quotes only one expert.

Associated Press wire service, 4-star score

Immune System Taught to Fight Deadly Skin Cancer
A well written, balanced story about a trial which created a buzz at a national meeting of oncologists. It was clear, hopeful without hyping the new treatment, and included expert comment.

Los Angeles Times, 4-star score

Study finds antidepressant doesn't help autistic children
Story about the failure of Celexa to control repetitive behaviors in autistic kids does a solid job explaining why the study matters and its conclusions can be trusted. But read about 3 key flaws.

ABC World News with Charles Gibson, 0-star score

Personalized Cancer Care
This story is a marketing coup for a hospital, but its relevance to most cancer patients is unclear. This story failed on costs and on context, cheerleading for an approach that lacks evidence.

New York Post, 0-star score

Tomato Scoop
The best thing that can be said about this story is that it was short. For anyone thinking of lycopene supplements, this story failed to deliver the information they would need to make an informed choice.

New York Daily News, 3-star score

For many women, breast reduction means less pain and more activity
The story conveys the impression that the surgery is effective without providing any credible information to verify this. No mention of risks or costs. Egregious disease-mongering example.

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This story is a marketing coup for a hospital, but its relevance to most cancer patients is unclear. This story failed on costs and on context, cheerleading for an approach that lacks evidence.

Andrew Holtz, former CNN-er, and past president of the Association of Health Care Journalists, was one of the reviewers of this piece. He recently joined the HealthNewsReview.org team of reviewers. I mention this because sometimes readers may wonder if the story reviewers have journalism - and, in this case, TV journalism experience. Between Andrew and me, we have more years (30+) of such experience than we may care to remember.

This doesn't happen very often: a Minnesota researcher and a Minnesota journalist questioning the wisdom of the kinds of "executive physicals" performed so often at the Mayo Clinic.

"Unnecessary testing may cause more harm than good, owing to false positive findings, unwarranted follow-up visits and costs, needless worry, and harmful side effects of the tests themselves," wrote Dr. Brian Rank of HealthPartners about the practice.

Mother Mayo doesn't like to be questioned in this way - especially within its own home state.

Science blogger Andrew Maynard - who says he's not a journalist but a "social media commentator" - posts some interesting thoughts in an article, "To tweet or not to tweet - social media and the scientific meeting." Excerpt:

"Once upon a time, scientific conferences were predominantly about exchanging and examining new information with your peers - at least, they were in my field of research. Reporters just weren’t a part of the equation. Now, major conferences tend to be a media-fest - with the scientific community clamoring to have their messages and stories heard by all and sundry. There’s tremendous pressure to “sell” studies to the media - to work out what might appeal to a broad readership, then dress it up so it’s as attractive as possible. If you don’t believe me, just take a look at the press releases and media coverage surrounding something like an American Chemical Society meeting.

As a result there is a tendency - at some conferences at least - for presentations to be less about peer to peer review and discussion, and more about broad dissemination and promotion. In this context, people want their work to be communicated in the media - but on their terms. In other words, they love the media when they feel they are on control, but get antsy if they feel that control slipping."

How about tweeting from a meeting where non-peer-reviewed-data is being presented? Maynard writes:

If the aim of the meeting is to seriously assess and discuss someone’s unpublished research, I would hesitate to live tweet. I might blog - but only if it seemed appropriate given the state and significance of the research.

Journalists should be as transparent as this "social media commentator" is about how they're going to use social media to cover health, medicine, science. Will there be different criteria? Different codes of ethics? Thanks to Maynard for his contribution to the discussion.

In one of the worst examples of disease-mongering we've ever seen, the paper let a plastic surgeon get away with saying, “The pain that women with large breasts can have has been compared to when someone gets metastasized cancer of the spine.”

That's the sub-head of an article in the UC-Berkeley alumni magazine by David Tuller, who teaches health reporting at the University of California-Berkeley Graduate School of Journalism and who is helping to build a new master's program in public health and journalism there. He interviewed me for the article and reflected on my recent report to the Kaiser Family Foundation on the state of health journalism.

Last week, ABC aired a story looking at the potential for "harnessing the curative effects (of human breast milk) to fight terminal cancer." Excerpt from HealthNewsReview.org:

The segment:

* failed to adequately document any evidence of the benefits of this approach in adults;

* failed to explain that breast milk has been shown to transmit viruses such HIV, hepatitis, and meningitis – an important point when discussing its use in immunosuppressed cancer patients who are especially vulnerable to infection;

* failed to include interviews with any oncologists, gastroenterologists, immunologists or lactation specialists.

It was described as “a highly alternative treatment.” What does that mean?

What did any of this mean to viewers? It went from saying there was "promising research that would indicate that in the future, the solutions for not only preventing cancer, but even treating and curing cancer might be within human milk" – to saying "there's no research that says...human breast milk will benefit a man, such as this man suffering from cancer."

Yet the network gave lots of airtime to the suggestion of potential benefits.

Such a “yes it can, no it can’t” use of network TV airtime is not a public service.