No surprise. Just another terrible example of the one-sided - potentially harmful - information often disseminated on the network TV morning programs. See the latest review of the CBS Early Show on HealthNewsReview.org

It wraps up a very good week for former tennis star John McEnroe. But not so good for men who may have seen him on TV.

* A prime time appearance on CNN's Larry King Live promoting prostate cancer screening
* A CBS Early Show appearance promoting prostate cancer screening

And he was getting paid all the time by a drug company - something clearly noted on the website that McEnroe promoted - but something CBS never disclosed on the air.

GlaxoSmithKline funded and helped develop this campaign, including providing compensation to Mr. McEnroe.

CBS merely turned over the network to this drug company sponsored message - a message that has the support of the American Urological Association but that lacks the support of other respected medical organizations such as the American Cancer Society and the US Preventive Services Task Force.

Shameful in its one-sided, imbalanced, incomplete approach, treating McEnroe's message as gospel.

Dr. Len's Cancer Blog, written by Dr. Len Lichtenfeld, Deputy Chief Medical Officer of the American Cancer Society, offers a terrific example of how to scrutinize confidence intervals in a study.

He commented on a study that got a lot of news coverage - suggesting that women with breast cancer who took tamoxifen had 440% greater chance of developing a more aggressive, hormone insensitive tumor compared to women who did not take the drug. He then jumped in with a lesson:

In statistics, there is something we call the "confidence interval." In simple terms, it means if you kept repeating the same experiment in different populations or with more women in the same population, what is the chance you would come up with the same result? What are the possible other numbers that may show up?

Sitting down?

In this study, the confidence intervals for that 440% number vary from 1.03 (a 3% increased risk) up to 19 (a 1900% risk). In our world, that is what we call "not very tight." That 1.03 number--in reality--just gets you over the line of what we call statistical significance.

He had other problems with the way the news of the study was disseminated. Read his entire thoughtful blog posting.

(Thanks to Ivan Oransky for pointing out Dr. Len's posting.)

His new book, "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," was published this week. But this myth column was published in the Washington Post on Sunday.

Here's the tease of the five myths. Read the full article to see how he backs up each of the five.

1. It's all socialized medicine out there.

2. Overseas, care is rationed through limited choices or long lines.

3. Foreign health-care systems are inefficient, bloated bureaucracies.

4. Cost controls stifle innovation.

5. Health insurance has to be cruel.

Are there any wrinkles left in the U.S. anymore after all of the wrinkle treatments hyped by the TV network morning shows?

The NBC Today Show is the latest that we reviewed on HealthNewsReview.org. Excerpt:

This report once again puts a spotlight on a leading health scourge: wrinkles. At least, it seems that wrinkles rank above many other health issues based on how much time network morning shows devote to the subject.

This time the hook is FDA approval of broader use of an injectable product that stimulates collagen production in the face in order to smooth out wrinkles. The substance had been approved for use in people who had lost facial fat due to HIV.

The taped report and in-studio interview did include a number of strong caveats about problems experienced by some patients and the wisdom of waiting until there is broader experience with the product. However, the only dermatologist featured did work funded by the product's manufacturer and the only patients in the piece gave glowing reviews. Viewers neither heard about special conditions the FDA placed on the manufacturer that requiring larger and longer clinical trials and adverse effect monitoring nor did they get to see or hear from anyone who needed surgical treatment to correct problems caused by the what the field reporter called "latest breakthrough that doesn't freeze time, it helps you grow some of it back."

If, indeed, the segment's advice was "I think you should wait a few years if you're nervous about it" - then one wonders why this was worth several minutes of network TV air time.

Media observer Howard Kurtz threw a big softball to his frequent guest Jeff Jarvis on his CNN "Reliable Sources" program last weekend when he had the author-blogger-prof come on to talk about his recent blogging about his prostate cancer.

Kurtz allowed Jarvis - unchallenged - to say "If just one person gets the PSA test that reveals this in me, that's a good thing."

Is it always a good thing? Can it be a bad thing? The U.S. Preventive Services Task Force reminds men that it can be. They state:

Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient's lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life.

It's fine for Jarvis, Kurtz, Larry King, Michael Milken, Joe Torre, John McEnroe (the list goes on and on) to make whatever choice they choose to make and we hope they're happy with it.

But it is wrong to use a network television platform to give one-sided advice to an entire population of men without giving balancing information on harms.

At the end of the segment, Kurtz told Jarvis, "You've broken a barrier."

But Kurtz may have also been complicit in breaking journalism's code of ethics (at least the Society of Professional Journalists' code of ethics), which states that journalists should:

-- Examine their own cultural values and avoid imposing those values on others.

-- Support the open exchange of views, even views they find repugnant.

-- Distinguish between advocacy and news reporting. Analysis and commentary should be labeled and not misrepresent fact or context.

If you value PSA screening in your own life, that's fine. But with your network TV platform, support the important exchange of ideas on competing values, not just crusading advocacy.

It is not just a simple blood test. It is not a simple decision. Harms can occur. That should be reported.

(Thanks to Pia Christensen for the tip on this broadcast.)

Larry King Live presented a prostate cancer awareness program Friday night that did a terrific job of informing men about prostate cancer screening and treatment.

Unfortunately, it didn't discuss any of the evidence that would make men think twice about prostate cancer screening or treatment. So it became another celebrity-filled promotion that was woefully lacking in evidence and, thus, was terribly one-sided and incomplete.

It featured former tennis star John McEnroe (whose father had prostate cancer), saying:

"It seems illogical not to have a PSA test. it's hard to imagine there's an argument against it."

That's a demonstration of a classic clash between intuition and evidence.

The U.S. Preventive Services Task Force states "that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years." And they recommend against screening in men age 75 years or older.

What harms could there be? The USPSTF states: "Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient's lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life. Two recent systematic reviews of the comparative effectiveness and harms of therapies for localized prostate cancer concluded that no single therapy is superior to all others in all situations."

But King kept hammering at the screen-screen-screen message.

King: Are we telling every man over 40 to have a PSA test?
McEnroe: I think that's what we are telling them.

King (going to commercial break):

Take the PSA test. Men over 40, it's a simple little blood test. You get your results back in a couple of days. Back after this...

Simple little blood test only if you don't want the full decision-making picture - which Larry King Live failed to present.

Dr. Otis Brawley, chief medical officer of the American Cancer Society was quoted in the New York Times:

The benefits of prostate cancer screening, he said, are "modest at best and with a greater downside than any other cancer we screen for."

And regarding the American Urological Association's call for baseline PSA blood tests in 40-year-old men, Brawley said:
"The truth be told,I was shocked when I read that."

But maybe John McEnroe knows more about prostate cancer than the chief medical officer of the American Cancer Society.

Several guests - Michael Milken, Colin Powell, Joe Torre - mentioned robotic prostatectomy. Powell said "increasingly it's done by robotic surgery." Torre said "they do it robotically now" - almost implying that was the only method.

The US Agency for Healthcare Research & Quality reminds consumers that uncertainty surrounds robotic surgery as well as many other prostate cancer treatments:

"There isn't enough research yet to tell us how well they work compared with other treatments."

But Larry King LIve didn't want to use its one hour of airtime to explore uncertainty. In its incompleteness, in its sense of certainty where certainty doesn't exist, in its imbalance, the program was a dis-service.

Three top-rated five-star stories were reviewed on HealthNewsReview.org late last week - a rare occurence.

Rarer still, two were network TV stories (CBS Evening News and ABC World News)- both on a published study on the HPV vaccine Gardasil's safety. Both stories mentioned aggressive marketing techniques by the manufacturer Merck such as paying medical societies to promote the drug. Such conflicts of interest don't often appear in network TV stories. However, this angle didn't require any digging by the networks; it appeared in a published article.

The third five-star story last week was by the Los Angeles Times and it differed from the other two on topic and approach. But it was similar in that it delivered a message not often found in news stories.

Differences: it was on mammography and it was an enterprise story - something the Times initiated on its own, not merely reflecting what was published in a journal or announced at a news conference.

It did a terrific job explaining the idea that breast cancer screening may be harmful - a point not often discussed in news stories - and a vital issue for consumers to understand.

Congratulations to all three news organizations. We look for more pieces on conflicts of interest in health care and those that question the conventional wisdom.

As our review on HealthNewsReview.org said...

The story noted that people should make vaccination decisions with good information. Unfortunately it didn't provide much. A confusing jumble lacking appropriate context.

Start lining up the awards for the series on conflict of interest published by the Milwaukee Journal-Sentinel this year.

Excerpts of the latest:

"As fears were growing about the link between hormone therapy and breast cancer, a drug company paid the University of Wisconsin to sponsor ghostwritten medical education articles that downplayed the risks, records obtained by the Journal Sentinel show.

The five articles were funded by Wyeth, the company that made the top-selling hormone therapy products. The articles, published in 2001, appeared under the names of doctors who specialized in diseases common to menopausal women, but actually were written by professional writers paid by the company.

The articles came shortly before a long-term $1.5 million arrangement between Wyeth and UW to educate doctors and patients around the country about hormone therapy. The initiative promoted the benefits and softened the risks of drugs that produced sales of more than $1 billion a year."

The article also showed two faces of health care on this issue. Excerpt:

"The company's ultimate goal is to sell more drugs, said Steven Miles, a physician and professor at the Center for Bioethics at the University of Minnesota Medical School.

"These ghostwritten articles are advertising masquerading as scientific reviews," he said. "It's dishonest."

One of the listed authors, Leon Speroff, then a professor of obstetrics and gynecology at Oregon Health Sciences University...said the practice of ghostwriting remains commonplace, and he defended it.

"There is nothing dishonest about it," he said.

He laughed at the idea that someone might be offended by the lack of transparency.

"If you don't like the way it works, that's your business," Speroff said."

Registered dietitian Rebecca Scritchfield blogs about "The Price of Misinformation in the Media."

She writes:

Bottom line: ANYONE can call themselves a nutritionist. You can. Your grandma can. President Obama can.

When a person calls themselves a nutritionist with no formal or accredited training and spreads misinformation on television, everybody loses.

She also gives a nice plug to our HealthNewsReview.org project.

"Smoking Memo - or Bad Journalism" - that's the title of Maggie Mahar's blog post on the alleged Obama-PhRMA deal. Excerpt:

Yesterday, it seemed that the Huffington Post's Ryan Grim had a scoop. He reported that Huffington has obtained a memo that "confirms" that the White House and the pharmaceutical lobby secretly made a deal--the deal that I wrote about a few days ago in a post titled "What Was Billy Tauzin Thinking?" According to the memo, the White House supposedly pledged to oppose any Congressional efforts to let Medicare negotiate for discounts on drugs, or to import drugs from Canada.

The memo in question turns out to be typed--and unsigned. How does the reporter know that it is authentic? "A knowledgeable health care lobbyist" told him so. According to the lobbyist the memo "was prepared by a person directly involved in the negotiations [and it] lists exactly what the White House gave up, and what it got in return.

Wait a minute. As PhRMA senior vice president Ken Johnson points out later in the story: "Anyone could have written it. Unless it comes from our board of directors, it's not worth the paper it's written on. . . ."

And who is the "knowledgeable lobbyist" who gave the memo to Huffington? His name is not disclosed.

What we have then, is a story based on what one unnamed source says--and a typed memo that probably is untraceable.

She goes on to quote me about whether this is acceptable journalism.

"Smoking Memo - or Bad Journalism" - that's the title of Maggie Mahar's blog post on the alleged Obama-PhRMA deal. Excerpt:

Yesterday, it seemed that the Huffington Post's Ryan Grim had a scoop. He reported that Huffington has obtained a memo that "confirms" that the White House and the pharmaceutical lobby secretly made a deal--the deal that I wrote about a few days ago in a post titled "What Was Billy Tauzin Thinking?" According to the memo, the White House supposedly pledged to oppose any Congressional efforts to let Medicare negotiate for discounts on drugs, or to import drugs from Canada.

The memo in question turns out to be typed--and unsigned. How does the reporter know that it is authentic? "A knowledgeable health care lobbyist" told him so. According to the lobbyist the memo "was prepared by a person directly involved in the negotiations [and it] lists exactly what the White House gave up, and what it got in return.

Wait a minute. As PhRMA senior vice president Ken Johnson points out later in the story: "Anyone could have written it. Unless it comes from our board of directors, it's not worth the paper it's written on. . . ."

And who is the "knowledgeable lobbyist" who gave the memo to Huffington? His name is not disclosed.

What we have then, is a story based on what one unnamed source says--and a typed memo that probably is untraceable.

She goes on to quote me about whether this is acceptable journalism.

(See correction in the post above this one)

See the HealthNewsReview.org review of the CBS Evening News story, and of the USA Today story. Both 3 stars out of five. Both used the more impressive relative risk reduction figures rather than the more helpful absolute risk reduction stats. Neither explained the long history of research into aspirin and colon cancer - thereby again hyping the research as "revolutionary" - in USA Today's words.

Thanks to Andrew Holtz for having a hand in both reviews.

In another fine example of its dedication to important health care journalism, the Milwaukee Journal-Sentinel published a piece, "Debate on MRI payments just one hurdle for reform."

Gems in this piece include:

• Information on the Access to Medical Imaging Coalition, a group backed by the major manufacturers of imaging equipment, including GE Healthcare. The paper reports: "That industry backing goes unmentioned by the innocuously named group. The Access to Medical Imaging Coalition, which includes cardiologists and radiologists, is just one of the myriad special interest groups that often oppose cuts in what Medicare pays for medical services."

• "The reality is the status quo puts a lot of money in a lot of people's pockets," said Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change, a policy research organization in Washington, D.C.

  Another reality is groups such as the Access to Medical Imaging Coalition often succeed in persuading Congress to protect their interests.

Read the entire piece. It includes local angles on local industry affected and about Wisconsin legislators' activities in this area. A fine example of local journalism on a national issue.

A story on an implanted pacemaker to control previously uncontrolled high blood pressure called it a "breakthrough," a "game-changer," and said it has "proven highly effective" and could help millions.

HealthNewsReview.org analyzed the NBC effort as follows:

Strip away the hyperbole and the story failed to:

* Give any evidence - any data - on how well it worked;

* Include any independent expert perspective (the only interviews were with sources with a vested interest);

* Include any cost estimate.

The medical editor who reviewed this piece for us said it was one of the worst he's reviewed in three years.

In response to my recent criticism of the schlock on their show, an ABC spokeswoman told the NY Post that:

"Good Morning America" is "committed to providing the most timely and relevant medical reporting. Led by Dr. Tim Johnson, our medical unit is the best in the business and strives to make sense of the complicated health issues on the nation's agenda."

Well, it wasn't me, but CJRDaily.org that ripped them a new one this time. Excerpt:

ABC News's constructive contribution to health care reportage this morning on Good Morning America, above the unintentionally(?) maddening chyron "THE GREAT DEBATE: Is this the way to reform health care?":

GMA's CHRIS CUOMO: By anybody's reckoning, this is certainly a battle between messages, really. So let's bring in two masters of political messages to join us this morning. We have Ann Coulter, author of Guilty, Liberal Victims and Their Assault on America, and in Washington, GMA contributor, Democratic strategist, Mr. James Carville.....

Why, GMA, why? Laziness? A throwing-up-of-the-hands? Desperate ratings bait? (Or, maybe health care reform really isn't a "journalism-friendly story," to the extent one regards morning news shows as involving "journalism.")

And the Carville-and-Coulter-on-Health-Care-Reform segment proceeded just about how you might imagine, with Cuomo kicking things off by asking, "With what we see with these [town hall] demonstrations, is this proof that the president has lost control of this debate?...And he's spinning out of control?" (and then later complaining that Carville "isn't dealing with the issue on the table, isn't talking about health care," as if that were what Cuomo asked about, let alone what a segment involving two "masters of political messages" would ever hope to achieve). And, Coulter compared what "Obama is saying" about health care reform to a "chocolate cake" "diet plan."

Marketplace on NPR has begun an occasional series called "The Cure." The lead-in to the first segment said:

"Up first, the inner workings of a typical medical practice. Did you ever wonder, for instance, what all those people on the other side of the counter are actually doing? And why there are so many of them? We sent Marketplace's Tamara Keith to find out."

Keith spent the day at a doctor's practice, seeing firsthand why there were more administrative staff than health care professionals in this particular practice. They're dealing with health insurance - and different flavors of insurance from different health insurance companies. It's the American way. It's the marketplace at work that anti-health care reform forces want to preserve.

Listen to it. It's good radio journalism.

But you should also read the comments section following the text story on the Marketplace website. One guy wrote:

"I worked for Ingenix, a subsidiary of UnitedHealth group, for three years as a software developer. I worked on a crack team of Java developers who used cutting edge technology to build two huge software systems: ContractManager and iCES.

ContractManager cost $150,000 a seat. It sat in the offices of large physician practices and analyzed the doctor's rejected claims and figure out ways to bleed more money from insurance companies.

iCES sat in the office of insurance companies and analyzed claims using high technology with the intent of finding ways of paying doctors less.

Our shorthand internal way of describing what we did: "Selling guns to the Hatfields and the McCoys."

Having worked for several insurance companies, I must point out that the single payer, public option is the way to go. Right now, providers and payers are having an arms race and you and I are paying for both sides."

A physician friend of mine in Los Angeles told me her office deals with 94 different insurance plans. 94 DIFFERENT INSURANCE PLANS! And none of the people who push that paper do anything directly to benefit your health. Amazing.

In another in a continuing series of stories about doctors, drug companies and conflicts of interest, John Fauber of the Milwaukee Journal-Sentinel writes about the disease-mongering promotion of low testosterone or "Low T." Excerpts:

"A rash of television commercials in recent months have told millions of middle-age men that their diminished sex life and somber mood may be the result of low levels of testosterone.

Setting the stage for the ads was a series of medical journal articles that first appeared four years ago. The articles, which were sponsored by the University of Wisconsin School of Medicine and Public Health, read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.

While the TV commercials were intended for consumers, the medical articles were written for thousands of doctors who could earn continuing medical education credit by reading them. Presumably, they also would write more testosterone prescriptions.

Both the ads and the articles were paid for by Solvay Pharmaceuticals, the company that dominates the testosterone therapy field and which allegedly conspired to pay off generic drug makers to keep their testosterone products off the market.

The campaign seems to have paid off.

Over the last few years, prescriptions for testosterone, especially Solvay's AndroGel, have boomed despite concerns that it may increase the risk of prostate cancer and cardiovascular disease. Aside from the potential health risks, there is a lack of science that the expensive drugs provide real benefit for middle-age and older men whose testosterone levels are declining as a result of normal aging. ...

UW was an active participant in the testosterone surge. Solvay paid about $1 million to fund UW-sponsored doctor education in 2005, 2006 and 2007 such as dinner meetings around the country and newsletters designed to reach more than 50,000 physicians. UW directly received about $115,000 of that amount."

Read the full article.

Here's how Solvay bought space on WebMD to promote AndroGel in an ad that is meant to look like normal editorial content.

A rare four-star score for a TV story on HealthNewReview.org.

Read the full review to see how we think the story could have been even better.

There's been some media attention given to my HealthNewsReview.org Publisher's Note, "Network TV morning health news segments may be harmful to your health."

Journalist Alison Bass blogged about it, asking "Is the financial meltdown of the media becoming a public health threat?"

As noted earlier, Susan Perry, in her MinnPost.com column, called HealthNewsReview.org "indispensable for health consumers as well as health journalists" -

On the most-read journalism blog - Romenesko Media News - the link read "Morning news shows get an 'F' for health coverage."

The Association of Health Care Journalists' "Covering Health" blog headlined it: "Morning shows' health news called dangerous."

And I did interviews with the New York Post and with KSTP radio, Minneapolis-St. Paul.

In the KSTP interview I described feeling a bit like Howard Beale, crazed anchor on the movie, "Network." Like him, when I think about the schlock that appears on the networks' morning TV health shows, I just want to say:

"I want all of you to get up out of your chairs. I want you to get up right now and go to the window. Open it, and stick your head out, and yell: I'M AS MAD AS HELL, AND I'M NOT GOING TO TAKE THIS ANYMORE."

And another zero-star review by HealthNewsReview.org for a morning health news segment.

The story was about facelifts and migraines, and as you can see in the picture above, ABC had to use the tired "Cure?" reference to get our attention.

They got our attention, as we summarized in our review:

Story suggests there may be a cure for migraines - a cure that didn't eliminate migraines in 43% of people and resulted in complications in 35% of those for whom it did. Is that your kind of cure?

Read the full review to find out much more about what was missing in the story.

We salute the Philadelphia Inquirer and reporter Stacey Burling for a terrific piece, "Debate surrounds new prostate cancer treatment."

It got a rare five-star (top score) rating on HealthNewsReview.org. Excerpts of the review:

This was an excellent, provocative exploration of some of the critical issues involving the tension between treatment options, payment responsibility, patient choice, and evidence on risks and benefits. There are a great number of uncertainties about prostate cancer itself, whether active treatment is called for and if so, which is the most appropriate choice for individual patients. Combining this with financial interests of those providing treatment adds another layer of difficulty in making good individual choices.

High marks for a terrific enterprise piece that helps readers understand an important health policy and health care reform topic.

One standout quote from a physician in the story:

"There's a lot of politics involved in this. There's a lot of self-interest. There's a lot of greed."

You tell me if this sounds like a cure. CNN.com posted a Health.com story on face lift surgery "curing" migraines. Excerpt:

In the year after the procedure, 57 percent of those who had the actual surgery reported the complete elimination of migraine headaches, compared with just 4 percent in the sham surgery group. In addition, 84 percent of those who had the surgery reported at least a 50 percent reduction in migraine pain compared with just 58 percent in the sham group.

However, nearly 60 percent of the people who had the sham procedure reported some migraine relief too. ...

Overall, there was a 92 percent success rate, notes (the researcher).

Cure?

A 57% rate of complete elimination is a cure?

It's not a cure for the other 43%, is it?

And 60% of people who got a fake treatment improved!

And then where does the 92 percent success rate come from? And couldn't another headline just as accurately read that there's a 60% success rate from fake treatments for migraines?

Then, in a story sent to me by one of my blog followers because she was bothered by it, CNN reported that:

People as young as 40 with borderline or high cholesterol levels are at increased risk for developing Alzheimer's disease or vascular dementia, said a Kaiser Permanente study released Tuesday.

But it took them until the second last line of the story to add an important caveat:

Although the Kaiser study does not show proof that lowering cholesterol definitively lowers the risk for Alzheimer's disease as well, many doctors agree that nothing adverse can come of reducing high cholesterol levels.

Wait a minute: the lead says they "ARE AT INCREASED RISK" but the end of the story says there's no proof "THAT LOWERING CHOLESTEROL DEFINITIVELY LOWERS THE RISK."

That's because this was an observational study and the story never addressed the limitations of drawing conclusions from observational studies. It confused association (which is all an observational study can show) with causation (which an observational study can't show). But it didn't stop them from DEFINITIVELY scaring the hell out of cheeseburger-eating-40-year-olds in the lead. Be very afraid: you're at risk and there may be nothing you can do about it! Amazing.

These two stories exhibit two subtle (sometimes not so subtle), but significant, and recurring flaws in health care stories:

1. Cures are around every corner.
2. We all should be afraid and should seek cures for the unknown dangers that lurk inside all of us.

There was a lot of disease-mongering and fear-mongering wrapped into the ABC, CBS and NBC stories on vitamin D in kids this week. All three tried to link insufficiency with disease. This is simplistic, inaccurate, and may cause undue fear in viewers.

Here's a story-by-story breakdown, with all three complete reviews available on the HealthNewsReview.org site.

ABC World News Tonight

Excerpt of our review:

Blurs the line between vitamin D deficiency & insufficiency, which is clearly defined in the research being reported. Assuming that insufficiency equals disease is incorrect, and is disease mongering....Of the three TV network stories we reviewed on this same topic, ABC was the only one to include independent voices.

NBC Nightly News

Excerpt of our review:

It fell short because it:

* Committed disease-mongering, linking vitamin D to other conditions which are common and can be caused by many other things.

* Failed to point out the limitations of such observational studies. You can't prove causation from an observational study. The story should have at least nodded in this direction.

* Didn't evaluate the study or the quality of the evidence in any way. It just took the researchers' work at face value.

* Only included the perspectives of one of the researchers, but sought no independent voice.

* May have caused unnecessary fear.

CBS Evening News (the worst of the three)

Excerpt of our review:

"It would be good for them to turn off the TV and send their kids outside." That's the advice one study author gave another news organization (www.livescience.com) about what to do about children who aren't getting enough vitamin D. It's tempting to recommend that same action to viewers who saw the CBS Evening News promote reliance on supplement pills.

The story combined information taken from studies on both vitamin D levels and fish oil recommendations in two different medical journals. The story did not include any independent experts, despite the fact that many experts and organizations are skeptical about the conclusions of the authors of these studies. The story also left out cautionary statements in the studies about the need to do randomized controlled experiments before recommending vitamin D supplements for children.

Perhaps the worst offense was the misuse of graphics. It is a tenet of television that when the pictures and the words send conflicting messages, the pictures always win. Yet as the CBS doctor talked about eating more fish, viewers saw pictures of fish oil supplement capsules. During the studio lead, as the anchor talked about 7 out of 10 children "not getting enough" vitamin D, the graphic behind her said "Vitamin D Deficiency," even though the study reported that fewer than 1 in 10 children was actually deficient.

One of the best plugs we've received: Susan Perry calls HealthNewsReview.org "indispensable for health consumers as well as health journalists."

By reviewing health news coverage every day, we are able to see big pictures of clear patterns unfolding that the casual day-to-day news consumer may miss.

One picture is quite clear. The morning health news segments on ABC, CBS and NBC do the following regularly:

• Unquestioningly promote new drugs and new technologies

• Feed the "worried well" by raising unrealistic expectations of unproven technologies that may produce more harm than good

• Fail to ask tough questions

• Make any discussion of health care reform that much more difficult

Here is just some of what we've observed, broken down by topics. You can look up any of these on the HealthNewsReview.org website. Probably the easiest way is to go to "Find Reviews" > "By News Organization", then use the pulldown menu to select the news source.

We apologize for the length of this note, but we thought it was important for you to see the full pattern of what we see unfolding. We give you the "headline" of the story, the date it aired, the star score it received after our review, and a brief excerpt of our review comments.

By reviewing health news coverage every day, we are able to see big pictures of clear patterns unfolding that the casual day-to-day news consumer may miss.

One picture is quite clear.  The morning health news segments on ABC, CBS and NBC do the following regularly:

• Unquestioningly promote new drugs and new technologies
• Feed the “worried well” by raising unrealistic expectations of unproven technologies that may produce more harm than good
• Fail to ask tough questions
• Make any discussion of health care reform that much more difficult

Here is just some of what we’ve observed, broken down by topics. You can look up any of these on the HealthNewsReview.org website.  Probably the easiest way is to go to “Find Reviews” > “By News Organization”, then use the pulldown menu to select the news source. http://www.healthnewsreview.org/review/by_org.php?type=Media+Source

We apologize for the length of this note, but we thought it was important for you to see the full pattern of what we see unfolding.  We give you the “headline” of the story, the date it aired, the star score it received after our review, and a brief excerpt of our review comments. 

Obesity & weight loss & thinning

ABC’s Good Morning America

Breakthrough obesity drug
July 21, 2009
Rating: (2 stars out of a possible 5)

Miscasts an experimental obesity Rx as potential "silver bullet" for people wanting to drop a few pounds. Oddly refers to interviewee's potential conflicts of interest as evidence of expertise. Huh?...

Super shot? Can it cut weight by 25%?
July 14, 2009
Rating: (2 stars out of a possible 5)

Woefully inadequate reporting on animal research on a weight loss drug. Makes the unfounded leap that this is a "promising new drug that could ultimately impact how to control obesity and diabetes."

Cutting the fat--without incisions: New weight-loss surgery
June 3, 2009
Rating: (2 stars out of a possible 5)

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....

Blasting Inches Off Without Surgery: New Technique to Lose The Fat
January 5, 2009
Rating: (2 stars out of a possible 5)

This story medicalizes a normal state of health - a few additional pounds or inches. The story lacked evidence and data from the alleged 50,000 who've had it - an astoundingly poor use of air time....

CBS Early Show

The Real Skinny: Liposlim During Lunch?
February 16, 2009
Rating: (0 stars out of possible 5)

What the anchorman calls a "healthy, gorgeous" young woman gets lunchtime lipo with no discussion of evidence or whether insurance covers it. If your premiums went up because she was in your insurance pool, would you be happy?...

NBC Today show

Lose weight while you sleep?
February 9, 2009
Rating: (0 stars out of possible 5)

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....

Paralysis & spinal cord injury

ABC’s Good Morning America

In Christopher Reeve's footsteps: Young man beats the odds
July 16, 2009
Rating: (2 stars out of a possible 5)

Story focused on one person's experience but failed to reference any research or provide quantitative data on benefits. No independent expert, no discussion of cost, harms, alternatives or outcomes.

CBS Early Show

Blue Breakthrough? Blue Food Dye Could Help Prevent Spinal Cord Injury
July 28, 2009
Rating: (2 stars out of possible 5)

A story about spinal cord injury with no certain human application that implied just the opposite. The fact that the study was done on rats does not appear until 2 minutes into a 3-minute segment. ...

Walk on: New device helps paraplegics walk again
July 22, 2009
Rating: (2 stars out of possible 5)

This segment puts a check next to nearly every item on a list of Health Journalism Worst Practices. It calls the device new, revolutionary, miracle. The device is none of these. Terribly misleading.

New medical technologies

ABC’s Good Morning America

The Cutting Edge: Robotic Surgery, Today!
May 5, 2009
Rating: (1 star out of a possible 5)

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....

The Cutting Edge: Amazing Journey Inside the Brain
May 4, 2009
Rating: (2 stars out of a possible 5)

Another gee-whiz Good Morning America segment that fits their apparent formula: no discussion of costs, no quantification of benefits or harms, and no independent source....

Cutting edge nail cure
April 9, 2009
Rating: (0 stars out of a possible 5)

The advantages were unsubstantiated, the harms unstated and the effectiveness exaggerated. Network TV promoting an off-label use. Disease mongering at its worst. A new low. Stay tuned for lower....

Life-Saving Test: How One Minute Can Save Your Life
March 25, 2009
Rating: (0 stars out of a possible 5)

The story overstated the risk of esophageal cancer and the value of a new approach for direct visualization and biopsy of the esophagus and was a free ad for a local hospital and a manufacturer. Wow....

America’s leading killer  - cardiovascular diseases

ABC’s Good Morning America

Medical Breakthrough: Amazing New Heart Valve Procedure
January 7, 2009
Rating: (2 stars out of a possible 5)

One week into 2009,  calls this "one of the big medical stories of 2009, "groundbreaking," and "the biggest thing since the heart transplant." Unfortunately no data are given to support that....

Heart Health: New Treatments For America's #1 Killer
March 30, 2009
Rating: (1 star out of a possible 5)

Story on coronary calcium test fails to discuss evidence, cost, or problems with false positive tests. But it hypes the test and disease mongers - telling us it's a wakeup call we all need. Not so....

CBS Early Show

Three Heart Tests Every Woman Should Know About
June 18, 2009
Rating: (0 stars out of possible 5)

Classic morning show health news garbage - confusing screening and diagnostic tests and confusing viewers. And a glaring error on the CBS website claims that heart CT scans had no radiation! On which planet?...

Heart Score: New Treatment for Heart Failure
February 16, 2009
Rating: (1 star out of possible 5)

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

NBC Today show

Today's Matters of the Heart: Dr. Nancy's Personal Wake-Up Call
February 4, 2009
Rating: (1 star out of possible 5)

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....

 This is a dangerous pattern.  Such stories do more harm than good to public understanding of health care.  This must change. 

We continue to offer our help to any news organization that wants it.  We have loads of good story ideas to take the place of this pablum – stories that affect individuals’ health, finances and decision-making – all the makings of good news stories. 

This is the transcript of an actual exchange on the NBC Today Show among anchor Ann Curry, medical editor Dr. Nancy Snyderman and ob-gyn guest Suzanne Gilberg-Lenz. I like the term cacophony. I think this is the definition of cacophony.