I would ignore this except that it's in the Washington Post and despite the fact that they're closing bureaus in Chicago, Los Angeles and New York, what's in what remains of the paper is still influential.

So I feel compelled to address Dana Milbank's column in the Post about the US Preventive Services Task Force breast cancer screening recommendations.

He characterized the USPSTF recommendations as a "cruel and clumsy blow" that "wiped out much of the progress" in breast cancer detection.

Huh?

It got worse, as he wrote:.

"With a drumbeat of recommendations raising doubts about various cancer screenings, the public could easily get the mistaken impression that all cancer screening is a waste of time and money."

Stop the foolishness.

The USPSTF said nothing about any cancer screening being a waste of time and money. In fact, it recommends biennial screening mammography for women aged 50 to 74 years. It recommended against routine screening mammography in women aged 40 to 49 years, stating "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

How "cruel" to try to ensure that women are fully informed about benefits and harms, and to state that this should be an individual decision based on individual values.

If the public can get the impression that all cancer screening is a waste of time and money from those statements, then Milbank might better spend his time educating the public on how to read.

It got worse. Much worse. As he continued:

"Luckily, Congress has a simpler solution at hand: It can abolish the task force and turn it into a group that is more accountable to the public. Under the House version of health-care legislation, the task force, whose members need not subject themselves or their opinions to public comment or public hearings, would be reorganized as a federal advisory committee subject to oversight. Their scientific judgments would stay independent, but the group would no longer be able to go rogue with surprise recommendations."

Oh, that would be a grand idea. Make science accountable to the public? Let's make science ignore the evidence and tell us fairy tales that we want to hear. That everything is terrific, risk-free and without a price tag? And let's make the independent task force subject to federal government oversight. Then we can make science ignore the evidence and only spew out what is politically popular at the moment.

Milbank believes his ideas mean that the task force would no longer be able to "go rogue with surprise recommendations." Read your own paper, Dana.

Dan Eggen and Rob Stein reported that "The findings underscore a decades-long debate in the medical community about the benefits and risks of routine breast cancer screening for younger women." So this is not "rogue" and not "surprising" to anyone who has made any attempt to follow the issue.

Why did he choose to give only Nancy Brinker's side of the story? His own paper reported this praise for the USPSTF recommendations:

"It's about time," said Fran Visco, president of the National Breast Cancer Coalition, a Washington-based patient advocacy group. "Women deserve the truth -- and the truth is the evidence says this is not always helpful and can be harmful."

But it's really sick when a columnist suggests that task force members be sent to Gitmo and that they be sent "to the Death Panel for a humane end."

If he thought this was humorous, it wasn't. If he thought his column clarified anything, it didn't. Confusion and rhetoric will reign as long as we continue to get one-sided, vacuous, inaccurate columns like this. If, indeed, anyone is reading it.

A Bloomberg story reminds us that 6 years ago journalist Ray Moynihan in the British Medical Journal called female sexual dysfunction (FSD) "the freshest, clearest example we have" of a disease created by pharmaceutical companies to make healthy people think they need medicine.

Now that the Boehringer Ingelheim drug company has announced results of a trial of its female libido drug, flibanserin, the disease-mongering is in full bloom again.

Some journalists injected some skepticism - like Susan Perry of MinnPost.com in her article:

"The bitter irony of the FSD controversy, says the Guardian's Ottery, is "the disempowering message that women who are having sexual problems are all ill."

For women, one of the primary causes of loss of sexual desire is "relationship issues," she says, "so feeling empowered to communicate what you want could be crucial in resolving this. Nevertheless, some women will want a magic bullet solution to their sex life problems. It is a tempting idea in our time-poor lives to pop a pill and not take the time to work out the root cause of issues and address them."

As I said, get ready for more annoying commercials."

And get ready for more annoying news stories. The Newark Star-Ledger bombed on the story, in our reviewers' opinions:

• No cost data was provided for flibanserin. But an estimate of the potential U.S. market, up to $100 million in sales, was given. Those sales estimates had to be based on some price assumptions. What where they? It doesn't seem that you should provide the one number without providing the other.
• This story misses the mark by failing to address the larger issue of whether acquired hypoactive sexual desire disorder in pre-menopausal women is a condition being promoted by pharmaceutical manufacturers to create a market for a new drug and to sell more drugs.
• This article cites very little medical or scientific evidence. The story should have noted that more reliable information would have come from more rigorous research published in peer-reviewed scientific journals.
• No adverse effects of the drug were reported in the story. Safety data reported indicates that potential side effects include dizziness, nausea, fatigue, somnolence, and insomnia.
• Most of the benefits reported in the story were described in general, lay terms: having more sex, wanting more sex and experiencing less distress related to lack of desire. The story should have placed any benefits in context and noted that while results were statistically significant the medical or individual significance appears to be quite small. For example, the story should have noted that women taking flibanserin had an average increase of 1.7 "sexually satisfying events" over the course of 6 months compared to an average increase of 1 event in women taking placebo.

The disconnect between the facts and women's beliefs about breast cancer was shown again in a USA Today story. Excerpts:

"A vast majority of American women plan to ignore controversial new recommendations about mammograms, a USA TODAY/Gallup Poll shows. The poll also shows that most women sharply overestimate their risk of developing the disease. ...

Forty percent of women estimate that a 40-year-old's chance of developing breast cancer over the next decade is 20% to 50%. The real risk is 1.4%, according to the National Cancer Institute."

Is it any wonder that women say they'll ignore the USPSTF recommendations when they over-estimate their own risk by such a huge degree! And such over-estimation of risk is not new - having been reported consistently through the years.

The story includes this chart, with figures that get lost in the rhetoric.

Paul Scott has an opinion piece in the Rochester Post-Bulletin in which he criticizes what he calls the Mayo Clinic's "vague and surprisingly unprepared" response to the US Preventive Services Task Force's mammography recommendations.

"Taking unspecified issue with "the modeling data used in the analysis," it stated "a substantial number of women who receive biopsies because of a screening mammogram are found to have cancer." Mayo's Dr. Sandhya Pruthi added "there are many stories about younger women who have found cancer early as a result of screening."

I'm not sure why she made mention of stories. Dr. Pruthi is surely a talented clinician, but in supporting mammograms for women in their 40s here she is citing anecdotes, not data. It would have been better for her to acknowledge that when it comes to population-wide recommendations about screening and illness, medicine always eventually draws a line in the sand somewhere. People invariably will fall on either side of that line wrongly, but if we don't draw a line somewhere, you have to screen everybody for everything, and screening sets in motion the potential for new harms."

It seems that anyone who opposes the USPSTF recommendations trots out personal anecdotes to bolster their argument. Scott countered and concluded with an anecdote of his own:

"I would like nothing more than for our society to prevent the incidence of breast cancer. It took the life of my mom, who identified a tumor on her own at 37, was treated surgically at Mayo in the mid 1970s, and who then lived another 26 years. But my mom believed in science, and in trusting science, and in this case, the science says what it says. I hope that Mayo can do the same, even when doing so runs against that which is popular."

The first online comment posted in response to Scott's opinion piece stated that "there isn't one single oncologist on the US Preventive Services Task Force." I've heard that curious argument before. Evidence is evidence - regardless of whether you're a primary care doc, an oncologist, an epidemiologist, an ob-gyn or a breast surgeon. Evidence-based medicine should be guided by the best evidence, not by the personal experiences or preferences of any specialty group.

Many of us might rather move on and end all of the discussion about the US Preventive Task Force's mammography recommendations last week. But I think it's essential that we reflect on ten things that stand out from last week:

1. Many in the general public (most of those quoted in news stories) are not prepared for evidence to be used in making health care recommendations. They haven't been prepared by the health care industry, by their physicians, or by the news media.

2. Many in health care (many of those quoted in news stories) are too invested in their own preferences to allow evidence to make a difference in their practices.

3. There is an undeniable and clear bias in many news stories, reporters and news organizations for promoting screening - evidence be damned. I've reported on this before and last week provided overwhelming new evidence. (Mind you - I said "many", not "all.")

4. The USPSTF, which is a collection of independent experts, has no public relations arm. They simply review the evidence and publish their recommendations.

5. The public relations machinery of the American Cancer Society, the American College of Obstetrics and Gynecology - and other groups that opposed the USPSTF recommendations - helped the anti-USPSTF message rule the media all of last week.

6. Politicians chimed in - sometimes distorting the evidence beyond all recognition. The clash between politics and science at such times is predictable and disgusting.

7. The rhetoric used to oppose the USPSTF recommendations was the ugliest and most ill-founded I can remember.

8. There was some excellent journalism done on the issue last week, but it was overwhelmed by and drowned out by the drumbeat of dreck shoveled out by many news organizations - including in much (not all) of what was provided on network TV.

9. The week may have caused harm to the nation's discussion of health care reform.

10. The week was certainly a setback for the nation's understanding of science, of evaluation of evidence, of the potential harms of screening tests.

Kirsten Boyd Goldberg writes in this week's Cancer Letter:

"In the past three decades, attempts to develop rational, evidence-based screening guidelines for breast cancer in the U.S. have always generated intense controversy.

What happened this week with the new U.S. Preventive Services Task Force recommendation has happened many times before:

An independent panel of experts is assigned to rationally assess the data and evaluate the level of evidence for screening in order to minimize the role of commercial and political interests in promoting a test that might or might not reduce cancer mortality.

The moment the panel's document is released, political combat ensues. The result is a cacophony. The resulting cacophony angers politicians who don't understand why "the experts" can't agree on "one simple message."

The anger of politicians frightens federal health officials who want to protect their budgets and their ability to run programs without meddling from Congress.

The federal health officials bob and weave and distance from the expert panel's recommendations.

The expert panel becomes the focal point of the anger. Commercial and political interests make accusations about the panel's composition, experience, and potential conflicts of interest. The panel must have been politically influenced, critics charge. The specter of "rationing" health care is raised.

The beleaguered panel members either defend their recommendation or say nothing.
Rational assessment has always had a tough road to travel in the U.S., starting with the dawn of randomized clinical trials, when doctors didn't accept trial results as being valid. But that's another story."

She's absolutely correct. Those who don't learn from the past are doomed to repeat it.

John Crewdson in The Atlantic:

"The current controversy over the task force's report owes much to the media's confusing coverage, some of which has been misinformed, including by TV doctors who ought to know better.

The confusion has been abetted by the American Cancer Society, whose position appeared to have softened, then hardened again, in recent weeks.

There are multiple reasons women are ill-informed about breast cancer. The fault lies primarily with their physicians, the cancer establishment, and the news media--especially the news media. Until coverage of breast cancer rises above the level of scary warnings mixed with heartwarming stories of cancer survivors, women are likely to go on being perplexed."

Washington Post media columnist Howard Kurtz strayed beyond media observations and injected his own comments about the US Preventive Services Task Force breast screening recommendations.

He calls the task force recommendation a "don't-worry-be-happy-till-you're-50 finding."

He defines "the essential problem with such studies" as "in the end it's a very personal decision."

Exactly. And that was the entire point of the USPSTF recommendation - that women need to weigh the harms and benefits in consultation with their doctors. But Kurtz must not have read that far.

And then he goes on to cite a list of journalists who wrote about their own personal opposition to the recommendations.

But he didn't quote even one person who wrote in a more balanced way about the evidence behind the recommendations. So, while his column was headlined, "A battle over breasts," he didn't present much about "the other side" in this battle.

Then again, Kurtz has exhibited an advocacy stance for the screen-screen-screen mentality in the past in his handling of a friend's promotion of prostate cancer screening.

My friend Robert Davis writes about five popular falsehoods he's seen this week in the "the widespread confusion, consternation, and even anger that the new (US Preventive Services Task Force mammography) guidelines have unleashed." His five:

1. This is all about saving money.

2. This is about rationing.

3. Early detection saves lives.

4. The fact that I or someone I know was saved by a mammogram proves that more testing is better.

5. The shifting recommendations prove that scientists are clueless.

Read his entire column. He's a smart guy and his summary is insightful.

I am a frequent critic of TV health news - and especially of much of this week's TV coverage of the US Preventive Services Task Force mammography recommendations. So I want to make special note this week of some of the fine work by Dr. Nancy Snyderman on this issue. I've seen several examples where she offered more explanation and context than her network TV competitors.

Case in point: this clip on yesterday's NBC Today Show.

In it, Snyderman said: "What we as a population were unwilling to accept - which has become very apparent in the last 48 hours - is that we didn't like the message." Yet she emphasized that the message was what the science shows.

She said HHS secretary Sebelius threw the task force under the bus and oversimplified the message by telling women "keep doing what you're doing."

She said "emotion, anecdote, lobbying, advocacy groups, doctors and patients" led to a political reversal.

She said "This is the role of scientists to take the emotion out of the science. That was their charge - look at the hard numbers and give recommendations back."

While she editorialized on Sebelius, her even-handed comments on the work of the task force stood in sharp contrast to some of what was broadcast on ABC, CBS, CNN and Fox.

As I've written earlier, the reaction from some people that this week's US Preventive Services Task Force recommendations were "surprising" or "coming out of nowhere" are themselves surprising. Anyone - certainly any informed health care consumer and certainly any journalist- should have known that the uncertainties surrounding mammography have been debated for decades.

There's a nice summary of the history by Charles Bankhead of MedPageToday.com.

For a long time, I've urged health care journalists to refer to the recommendations of the US Preventive Services Task Force and to educate readers/viewers about how the group operates.

Perhaps one of the reasons the task force's recommendations this week caught so many people by surprise is that journalism hasn't done a good enough job of:

• explaining the uncertainties that still exist and always have existed about mammography
• explaining the work of the USPSTF

Gina Kolata of the NYT offers somewhat of a backgrounder/explainer today.

All of their work - how they do it - what they base their recommendations on -who they are - is available online - and has been.

Since they're an independent group of experts from across the country, they have no PR machine like the American Cancer Society does. So it's easy for the ACS to rule the airwaves and the columns when they disagree with something the USPSTF states.

But I think journalists have failed badly in explaining this work. And the harm done to evidence-based medicine this week may be lasting.

More on the reactions to the US Preventive Services Task Force mammography recommendations. Susan Perry writes on MinnPost.com about:

"... the rampant, breathless fear-mongering rhetoric that has framed much of the media's response to the recommendations. ...

On ABC's daytime talk show "The View," co-host Elisabeth Hasselbeck made the stunning claim that the recommendations were "gender genocide."

I can't tell you how many times I've used that line in interviews recently.

So it was refreshing to see someone else - Steven Pearlstein - use it today in the Washington Post. (* Actually, either he or the copy desk butchered the quote, leaving out the "not." Surely they meant well, but the quote and the point makes no sense without it, and indeed, is NOT what the standard line is. I've added it in the following excerpt with a * and hope the Post corrects this soon.)

"I should acknowledge that I have no idea who should and should not get routine mammograms. But I know enough about statistics to say that the issue is not settled just because you know of someone in her 40s whose breast cancer was detected by a mammogram and cured. As economists and medical researchers are fond of saying, the plural of anecdote is *(not) data. ...

As is often the case in such matters, those raising the most fuss were those with greatest financial interest in mammography (the radiologists and the makers of mammography machines) and the disease groups (in this case, the American Cancer Society), which tend to resist recognizing limits on how much time, money and attention is devoted to their cause.

"How many mothers, sisters, aunts, grandmothers, daughters and friends are we willing to lose to breast cancer while the debate goes on about the limitations of mammography?" Otis Brawley, chief medical officer of the American Cancer Society, asked in an op-ed article in Thursday's Washington Post. Dr. Brawley cleverly didn't answer his own question, but the clear implication of his question was that the only acceptable number should be zero. And it is that very attitude, applied across the board to every patient and every disease, which goes a long way in explaining why ours is the most expensive, and one of the least effective, health-care systems in the industrialized world."

Not only did Dr. Sanjay Gupta of CNN show his imbalanced perspective on the US Preventive Services Task Force breast screening recommendation. But CNN's non-physician medical correspondent, Elizabeth Cohen, also offered her opinion on the air.

She said:

"This task force is the only big group that is saying this. There are lots of groups that disagree with this. So for me, a woman in her 40s who has to make this decision, I look at it this way. I say, alright, government task force says I don't necessarily need a mammogram. On the other hand, the American College of Obstetrics and Gynecologists says I should get one. The American Society for Clinical Oncology says I should get one. The American Cancer Society (a chuckle and smirk now appear in her voice and on her voice) say I should get one. I think you can see how that decision - how that weighs out."

No, Elizabeth, I don't see from what you cited how that decision should play out.

Because you haven't explained any evidence to me.

You haven't explained the need for shared decision-making between informed patients and their health care providers.

You've merely drawn a red state/blue state map for me - except that your map was incomplete. What do you mean by "big group"? Do you mean the organizations with big PR machines that usually spin their stories through you?

Because the National Breast Cancer Coalition, Breast Cancer Action, and the National Women's Health Network are among the "little groups" - as you must define them - who support the US Preventive Services Task Force recommendations.

CNN, what have you done to educate viewers on this issue?

What have you done to explain the data?

And why should I care about what Elizabeth Cohen decides?

Why should I care any more about her decision than about the story of women who regret that they ever were screened? (A story she chose not to tell.)

You can hear what Cohen said and how she said it in the clip below from Newsy.com.

You'll also see the comments from Fox News' "Dr. Manny." Perhaps CNN has achieved its goal. In an attempt to catch Fox News in the ratings, it has become just like Fox News.

Was it Bill O'Reilly I was hearing? Sean Hannity?

No, it was CNN's Dr. Sanjay Gupta, badgering Lucy Marion, PhD, RN, a member of the US Preventive Services Task Force in what felt like a paternalistic, heavy-handed, show-how-tough-you-can-be style.

His line of questioning:

"Are you comfortable with what you're saying?

You're a nurse....What you're saying is that some lives are not worth it - that's why we're changing these recommendations.

That's an incredibly frightening thing to hear from someone like yourself. Is that what you're saying?"

The "you're a nurse" comment could be interpreted many ways. One of them could be, "I'm a doctor and you're only a nurse...." That was certainly the tone of the interview.

This segment was brought to my attention by a reader of this blog - who wrote:

"She was basically made to defend a position (that Dr. Gupta asserted as fact) that she thinks increased deaths due to reduced screening are okay. It was a pretty crappy tactic.

...It's a shame that a physician would use his credibility to bolster the tactics of hit-and-run media, but that's about what this amounts to. ...

I hope physicians-that-are-also-journalists start realizing that by (ab)using their positions of trust as doctors to lend credibility to hit-and-run stories, they cheapen both medicine and journalism."

Slate republishes a five-year old piece that does two things:

• a good job of explaining the potential harms of screening
• re-establishes the fact that this is NOT a new debate (by the very fact that it's 5 years old and could have just as easily been 15 years old).

In the stories reported by major news organizations all across the US, there have been countless quotes that make wild, unsubstantiated charges about the motivation behind the US Preventive Services Task Force's breast screening recommendations.

A quote in a New York Times story yesterday:

"Why all of a sudden this change?" said Karen Sun, 41, who was loading her groceries into her car here in Los Angeles. "It feels out of nowhere."

As the Washington Post led with in their story, this has been a decades-long debate. What we have seen in the past 3 days is akin to what happened with the uproar 12 years ago after a NIH Consensus Conference on this issue made a concluding statement that many women - and their politicians - disagreed with.

In an ugly clash between science and politics, confusion reigned.

And now it's happening again.

From the LA Times:

Some Republicans jumped on the report as the kind of government intervention in medical decisions that Obama's healthcare plan would bring.

"This is really the first step toward that business of rationing care based on cost," said Rep. Phil Gingrey (R-Ga.), a physician.

Where is the evidence for that? That is fear-mongering rhetoric.

In the Washington Post:

"We can't allow the insurance industry to continue to drive health-care decisions," said Rep. Debbie Wasserman Schultz (D-Fla.), who said earlier this year that she had undergone treatment for breast cancer.

Wasserman-Schultz, whose legislation promoting breast cancer education in young women was widely criticized by evidence-based experts, should be forced to produce evidence for her claim as well.

And on ABC last night, a physician was allowed to say - unchallenged - that mammograms pick up early cancers when they need less treatment. If anecdotes are going to rule the day, then that physician should have to counter the anecdotes I've heard from women whose early DCIS or ductal carcinoma in situ - often called "pre-malignant" or "pre-cancerous" - was picked up by mammograms. And the range of treatment options then thrown at them - as aggressive as prophylatic bilateral mastectomy - left the DCIS-diagnosed to wish that they had actually received a diagnosis of invasive cancer because the choices were easier and more clear cut. These are real stories I heard from real women. The story - the discussion - isn't complete without taking into account the experiences of women like that.

Can local TV news do more than scratch the surface on important health news? My former student Jeff Baillon (There - the disclosure is out of the way) shows once again how well it can be done. He reported this week on the widely-prescribed proton pump inhibitor drugs for heartburn. But his angle was not one of breathless awe. Rather, he reported that "there's scientific evidence that these medicines might also cause the problem they're designed to cure."

I watched all three TV networks' lead stories from last night's newscasts - all three on the US Preventive Services Task Force's new breast cancer screening recommendations. Lots of talk about "anger, confusion, concern, fear, outright revolt, disturbing, shocking" reactions from women and doctors all across the country.

First, I'll note a reasonably well-balanced job by CBS' Dr. Jon LaPook and by NBC's Dr. Nancy Snyderman. LaPook included a woman who had experienced a false positive mammogram. Snyderman talked about data versus personal anecdotes.

But ABC's Dr. Timothy Johnson gave a personal recommendation - perhaps only because he was asked to by anchor Charles Gibson - and recommended "sticking with the current guidelines." He said he understood concerns about costs and quality. But that misses the underpinning of much of the USPSTF's recommendation and rationale. It implies that the USPSTF considered costs, which they have repeatedly reiterated they did not. He never addressed false positives and the harms thereof. So his summary was misleading and incomplete.

And CBS again allowed Dr. Jennifer Ashton to give her own personal medical opinion, saying "I am not telling (women) to deviate from their screening practices."

I have a lot of problems with the networks giving airtime to the opinions of their physician-correspondents. Do they ask political reporters about their voting habits? Do they ask economics reporters what their investments are? Do they ask the White House correspondent if they personally like the President or support his stances?

I don't personally care what Timothy Johnson or Jennifer Ashton recommend - and I don't think there's any reason for anyone in the viewing audience to care. In this venue, they are supposed to be journalists. Not recommenders. Not opinion-promoters.

Instead of promoting their celebrity docs, the networks should use that precious air time to educate people on the evidence behind the USPSTF recommendations.

All three networks - and many other news organizations - are treating this issue as if it's new. There never has been certainty about mammography recommendations for women in their 40s. And it was just 12 years ago that an NIH Consensus Conference on this issue resulted in a great uproar - what one editorialist described as "what took place seemed more akin to the Queen's order in Alice's Adventures in Wonderland: "Off with her head!" Thus began the latest round in the debate over recommendations for breast-cancer screening."

Journalism has to take responsibility for conveying far too much certainty about screening issues. And at times like this, when evidence-based bodies speak up, journalists - and the public they serve - act as if their worlds have been shaken. But, in fact, their world on this issue never was cast in concrete. Anyone who spends anytime following this issue would know that.

In the face of the confusion, journalists can fuel the flames by interviewing endless women about their personal anecdotes. Or they can explain, give context, history, guide readers and viewers through the confusion.

NBC's Dateline segment on new diet pills for weight loss was ripped on this blog:

"While this story naturally paints a rosy picture of weight-loss drugs, there are always potential problems. For instance, none of these drugs have yet been approved by the Food and Drug Administration, so there's no telling when or if they will hit the market. The drugmakers report no serious side effects, but further study may pick something up.

The story only highlights people who had success with the drug, but such drugs never work dramatically for everyone. And, as is noted in the story, it's possible that once someone is on one of these drugs, they'll need to keep taking them for the long-term, perhaps even for life, to be able to keep the weight off. And at this point no one knows what effect that would have on the health of a patient.

So while it's great to consider the possibilities of a weight-loss drug that makes it easy to lose however much excess weight you need to, it's important to remember the reality isn't always so rosy as the news stories would have you believe."

Headlines from around the world today read:

'Female Viagra' may boost sex drive

Boehringer's Desire Drug Boosts Lust, Improves Sex

New drug could boost women's libido

Desire Drug May Prove Sex Really Is All in Her Head

Anti-depressant can revive a woman's libido

Coming soon! A 'viagra' for women

Meet Your New Experimental Sex Drug

But John Mack of the Pharma Marketing Blog reacted this way to a Bloomberg story:

"So, compared to placebo, women taking BI's "desire drug," flibanserin, experienced 0.8 more "satisfying sex acts" per month than did women taking a placebo. That's about 0.2 more per week.

By the way, a "satisfying sex act" can include ... wait for it ... masturbation! ...

"The U.S. market for medicines to rekindle female desire could exceed $3.5 billion a year," said the Bloomberg article. Isn't that more than the current US sales of Viagra, Cialis, and Levitra combined? That seems like a lot of money to pay for 10 or so yearly masturbatory sexual acts in patients who take these "desire pills."

Boy, I wish I could see the clinical trial data. I am sure it's all very scientifically valid...NOT! I mean, how do they measure a "satisfying sexual act?" I'm pretty sure they do not hook women subjects up to some kind of gizmo as Pfizer has done to measure erections in men who take Viagra (see "Pfizer's Erection Hardness Meter").

...God help us if FDA approves this snake oil product! If you thought the Viagra ads were inappropriate, wait until you see Congress's reaction to ads showing women experiencing increased sexual libido. Whichever ad agency wins that account will have a lot of interesting issues to deal with."

For example, an AP story that had 6 voices of people criticizing the new recommendations and only 4 who supported them.

Within that story there was more troubling imbalance and even inaccuracy. It allowed one woman to say "I don't know how the US government or a panel of government officials can think they know better than the American Cancer Society."

That statement went unchallenged.

The US Preventive Services Task Force is NOT "the US government or a panel of government officials." The task force is made up of independent primary care doctors and others whose stated interests include: decision modeling and evaluation; effectiveness in clinical preventive medicine; clinical epidemiology; the prevention of high-risk behaviors in adolescents; geriatrics; and the prevention of disability in the elderly.

The AP story also included the perspective of one Chicago-based breast cancer advocacy group that opposed the recommendations, but didn't include the perspectives of two much larger national advocacy groups that support the recommendations - the National Breast Cancer Coalition and Breast Cancer Action.

One of my local TV stations - KMSP Fox 9 in Minneapolis - had a story with a single patient anecdote: a woman who said her life was saved by a mammogram in her 40s.

Why weren't there any anecdotes like the one I wrote about recently - from the Sunday Times of the UK - a story about harms and regrets from breast cancer screening.

And I already wrote last night about CBS' physician-"correspondent" Dr. Jennifer Ashton concluding her story about the USPSTF recommendations by telling viewers she'd have a hard time accepting them and sharing them with patients.

This is not journalism. This is not how journalists can lead a discussion about evidence-based medicine. Rather, this is how journalism gets swept away by the one-sided rhetoric of rationing.

Already - once again - I see online commenters referring to the independent panel's recommendations as signs of what's to come with "Obamacare." If we can't elevate the discussion about evidence-based medicine any higher than that, we are doomed.

Looks like all 3 TV networks led with the story about the US Preventive Services Task Force changing its recommendations on breast cancer screening.

I couldn't watch all 3 simultaneously so I watched the CBS Evening News, which had Dr. Jennifer Ashton report the story.

At the conclusion of the taped segment, she told the CBS viewers that she, as a doctor, would have a difficult time accepting the new recommendations and sharing them with women.

She's entitled to her opinion. But not on a program called the "CBS Evening News." If they want to change it to the "CBS Evening Physicians' Opinion Show" then have at it.

But what she did isn't journalism. It's advocacy and opinion.

Someone at CBS News is responsible for failing to insist that their TV docs aren't told what their role is: take your pick - journalism or medicine.

USC Annenberg prof Marty Kaplan blasts CNN coverage of claims that "there is a bra in fact that will soon be on the market, and the claim is that it can help women fight breast cancer."

The program looks at cyberchondria and at the plethora of health awareness weeks "to satisfy even the choosiest of hypochondriacs."

And they produced a segment with me - and CBS' Dr. Jon LaPook - about the quality of network TV health news.

Take a look at the graphic below. Does it look like a pig's breast or like a human breast form? Because it was a centerpiece of a CBS Early Show story about research to grow breast tissue - and it's only been done in pigs.

But that didn't stop CBS' Dr. Jennifer Ashton from calling it a breakthrough with "potentially huge implications." Somehow, without any explanation, she was able to project that this might be used in women in 3 years - even though human trials have not yet begun. Wow, what a fantastic crystal ball TV docs possess!

Pertinent facts:

1. It's only been done in pigs.
2. It hasn't been done in one woman yet.
3. There are far more failures than successes in any research that makes the leap from animals to humans.
4. Anything that has "potentially huge implications" also has the potential for no implication.

That's why we favor a rational discussion of evidence - not breathless hyperbole. And that's why we don't work in TV news anymore.

Here's a glaring, classic example of how health care industry public relations is taking advantage of a weakened news media to get its story - and only its story - across.

For free.

As if it were independently vetted news.

Which it isn't.

German science journalists gather in Bremen, Germany next week for the annual Wissenswerte conference. I'll speak on a panel there on Monday.

I've also been asked to consult with a group there that is hoping to launch a German version of HealthNewsReview.org.

I was also recently approached by an Italian journalist who is interested in the concept for his country. This idea has certainly taken off - from the pioneering efforts in Australia, to Canada, the US, Hong Kong, and now potential for more countries to begin reviewing the quality of health/medical/science news coverage.

The UK also has a "Behind the Headlines" project with a somewhat different approach.

I've told my students that covering health care conflicts of interest could be a fulltime beat - and you still wouldn't keep up.

The NY Times today reports:

In the first half of this year, the drug giant Eli Lilly paid 3,971 doctors and other medical professionals an average of about $11,230 each. The payments were for participating in an average of 12 speaking or consulting engagements during those six months, according to a company spokeswoman.

Dr. Manoj V. Waikar, for example, a physician among the top five earners this year, received $74,850 for consulting and speaking at 51 events, according to Lilly's on-line faculty registry. The company caps payments at $75,000 for each health care provider in any calendar year.

He's an adjunct instructor at Stanford. Stanford's ban on regular faculty members participating in drug company speakers' bureaus doesn't apply to adjuncts - as long as they're not using the Stanford name.

As blogger Merrill Goozner writes:

Waikar gave 51 talks last year to earn that $75,000. That's one a week, week after week, all year at $1,500 a pop. Think about it. Same slides, same talk. Just show up for two hours and the check is in the mail. Do that for three companies and you're earning over $200,000 annually. And you were wondering how the man earns a living on an adjunct faculty's salary.

Meantime, it doesn't take the NY Times to dig into conflict of interest issues. A student journalist with the Minnesota Daily points out how medical students receive free textbooks from drug companies promoting their products. Case in point: an otolaryngology text given out by a company making an ear infection drug - with the company's logo on it, and with the beginning of each chapter crediting the drug company.

The student journalist also pointed out that the University of Minnesota has no policy to ban such practices.

It's good that this student journalist starts looking at conflict of interest issues now. If she stays on this beat, she's going to be busy on COI stories for a long time.

Amidst the flood of stories that only reflect the benefits of cancer screening, here's a story from the UK - and the Sunday Times - that delivers the perspective of the harms of screening that we seldom hear. It begins:

Jane Flanders was not aware of the risks involved in being screened for breast cancer when she received her invitation from the National Health Service four years ago.

After being diagnosed with cancer and undergoing extensive surgery, the mother of two now wishes she had not attended. She believes she was the victim of over-diagnosis.

The 56-year-old maths teacher from Basingstoke, Hampshire, was diagnosed with ductal carcinoma in situ, a dormant cancer which was not spreading and may never have caused problems.

Doctors advised her to have radical treatment -- including a mastectomy -- in case it might spread.

"Screening has caused me considerable and lasting harm. It has certainly not saved or prolonged my life," she said.

"The reality of this diagnosis has been two wide excisions, one partial mutilation (sorry, mastectomy), one reconstruction, five weeks' radiotherapy, chronic infection, four bouts of cellulitis (a bacterial infection), several general anaesthetics and more than a year off work."

Flanders believes it is "outrageous" that the NHS has withheld information on the risks. The government has been forced to rewrite its advice to include warnings about potential harm caused by the screening process.