Don't know who nominated this blog for a 2009 Medical Weblog Award - but thanks.

And then, the nomination was elevated to finalist status.

We're kind of a fish out of water in this category, since all the other finalists appear to be doctors - and I'm just an old journalist.

But then again the other finalists write about llamas, cooking and eating (sometimes), and other far-ranging topics you can check out for yourself. And you should check them out - because you'll undoubtedly encounter some new and intriguing blogs and bloggers.

Then vote here: http://medgadget.com/2009bestmedical.html

Blogger Alison Bass jumps on a Journal of Bioethical Inquiry article that says that "while evidence-based medicine is a noble ideal, marketing-based medicine is the current reality."

Bass consistently tracks medicine's conflict of interest issues. Her blog would be a good bookmark for you if you care about these issues. And her book, "Side Effects: A Prosecutor, a Whistleblower, and A Bestselling Antidepressant on Trial," is terrific.

On the MSNBC.com health page at the moment I write this (the site will probably change by the time you visit) is a good story that reports:

"...a bevy of United States breast-feeding advocates may have unleashed a well-meaning but misguided flood of mothers' milk to the earthquake-shattered nation, one that aid workers in Haiti say was not requested -- and is not needed."

The image on the left is how this story appears at the top of the web page.

But lower on that same page, in the "diet and nutrition news" section, is a link to a local California TV story that sings the praises of local breast milk donation efforts - as seen in the image on the right. MSNBC didn't connect the two stories. They could have at least linked from the one story to the other for context and to point out how the story has changed.

I know this can happen on a wide-ranging news website like MSNBC. But somebody needs to keep track of what's been posted better than this.

Why would a local TV station even do this story? A local entrepeneur makes claims about a chewing gum to improve male sexual function.

Why would WTVJ in Miami devote time to this?

Because it's about sex.

It's an easy story.

And what pick up! The same story has now been picked up by the South Florida Sun Sentinel, KING-TV in Seattle, MSNBC.com and many other news organizations across the country.

The entrepeneur couldn't buy the kind of free advertising these "news" stories have just given him.

Visit msnbc.com for breaking news, world news, and news about the economy

Patient advocate Trisha Torrey writes and talks a lot about "participatory medicine." Today she writes:

"While many of us patients truly want to participate in our own care, we're not finding a great deal of cooperation from the others who must participate - our providers.

Some providers get it! In fact, some are very cooperative, offering knowledge, learning materials, assistance, discussion. They are the enlightened ones who realize that two heads -- theirs and their patients (us!) will always be more effective than one."

She has now posted an online poll asking readers:

Think of the specialist you see most frequently. Do you consider him/her to be participatory?

• Yes. My specialist and I decide every aspect of my care together.

• Partially. Sometimes we decide together, other times I just bow to his/her expertise.

• Barely. Once in awhile we discuss options.

• No. I can't get this specialist to discuss options with me at all. It's his/her way or the highway.

Kevin Pho, MD, a primary care physician in Nashua, N.H., who blogs at
KevinMD.com, advises other physicians in his USA Today column:

"Doctors who are not active online risk being marginalized. Facebook and Twitter users, more than half of whom are younger than 34, rely on the Web for most of their information. As this demographic ages, it's conceivable that they will consult social media first to answer their health questions. Already, patients are seeing how social media can improve their care. Hospitals are posting emergency department wait times, as well as updating family members on the status of their loved ones during surgery, on Twitter."

Walt Bogdanich and a team of reporters produced a powerful package entitled, "Radiation Offers New Cures, and Ways to Do Harm."

He profiled two people who died - one who received seven times his prescribed dose and one who absorbed "27 days of radiation overdoses, each three times the prescribed amount." But the story also was built on months of research and examination of thousands of pages of public and private records and dozens of interviews.

What makes this so important is that, as the story explains, Americans receive far more medical radiation than ever before. And some of it comes from technologies about which there is tremendous professional enthusiasm - such as IMRT or intensity-modulated radiation therapy. "Without a doubt," the story states, "radiation saves countless lives and serious accidents are rare. But patients often know little about the harm that can result when safety rules are violated and ever more powerful and technologically complex machines go awry."

I'm not going to post more excerpts here because you should read the entire piece and note the other elements of this rich multimedia package - video, interactive graphics, photos, and information graphics.

Powerful, tragic, important. Terrific journalism.

Physician-blogger Tony Brayer writes, "Why I am so over Dr. Oz." She gives examples of why she thinks he is "embarrassing" the medical profession. Her words:

• "His "Real-Age" website got 27 million people to sign up and take a health quiz. That information was sold to pharmaceutical companies who used the direct emails for marketing.

• He does pieces on "men's health" and tells men to do male breast checks once a month. No research I have read would support this advice.

• On his website he says "By the time women reach their 20th birthday, they are at risk for developing osteoporosis". Really?

• His website deals with topics like "What his erection is telling you" and "Dangerous health secrets men keep". Could what his erection is telling you be a dangerous health secret?"

I've created a "Question Mark TV Health News Hall of Shame" for all of those health stories that are teased, introduced or use graphics with a question mark at the end of a sensational claim. I'm going to keep adding to this list, hoping to reach the tease-writers of tomorrow if today's boffo writers won't change. So far we have:

ABC Good Morning America's: "Can Your Purse Make You Sick? Beware 'bag-teria' "

Ivanhoe Newswire's: "Pomegranates Prevent Breast Cancer?"

ABC World News Tonight's: "Fountain of Youth?"

And now CBS Evening News': "Is Salt Deadly?"

The NPR program "On the Media" did a terrific job turning to several sources (including me) for analysis of the journalism ethics issues involved in TV network MD-reporters becoming part of the story while delivering care in Haiti.

Host Bob Garfield used these phrases and terms in describing the reporting in question:

• Gimmick
• Obscures and trivializes the news
• Obliterates any measure of objectivity
• Exploiting patients

You can listen to the entire segment here:

His ending:

"Or maybe the prime canon of medicine just needs an update: Do no harm. But first, roll the tape."

It is surprising how much momentum this discussion gathered as the week wore on. Last night there was an explosion of activity on Twitter after CUNY prof and interactive media expert Jeff Jarvis posted a heated and simplistic series of rants against the Society of Professional Journalists, which had issued a statement urging Haiti reporters to remove themselves from their stories. Blogger Tyler Dukes captured Jarvis' tirade and described it as "hyperbole and distortion," continuing: "These are not the tools of a responsible journalist, but of a blowhard with an axe to grind."

After a week of mounting criticism of the practice of network TV physician-reporters reporting on themselves delivering care in Haiti, today the Society of Professional Journalists - in a rare move - issued a news release using strong language to chastise the networks and reporters. Excerpt:

"I think it's important for journalists to be cognizant of their roles in disaster coverage," SPJ President Kevin Smith said. "Advocacy, self promotion, offering favors for news and interviews, injecting oneself into the story or creating news events for coverage is not objective reporting, and it ultimately calls into question the ability of a journalist to be independent, which can damage credibility."

Undoubtedly, journalists walk a fine line to balance their professional responsibilities with their humanity when covering disasters. SPJ does not nor would it ever criticize or downplay the humane acts journalists are performing in Haiti. But news organizations must use caution to avoid blurring the lines between being a participant and being an objective observer.

"No one wants to see human suffering, and reporting on these events can certainly take on a personal dimension. But participating in events, even with the intention of dramatizing the humanity of the situation, takes news reporting in a different direction and places journalists in a situation they should not be in, and that is one of forgoing their roles as informants," Smith said.

The SPJ says it is "the nation's most broad-based journalism organization, dedicated to encouraging the free practice of journalism and stimulating high standards of ethical behavior. Founded in 1909 as Sigma Delta Chi, SPJ promotes the free flow of information vital to a well-informed citizenry through the daily work of its nearly 10,000 members; works to inspire and educate current and future journalists through professional development; and protects First Amendment guarantees of freedom of speech and press through its advocacy efforts."

The SPJ statement clearly signals that the ethical criticism of the past week's TV reporting practices is significant and broad-based.

The CBC radio program "As It Happens" began its discussion of this issue with this introduction:

"It is a dramatic image: a reporter who is also a qualified medical doctor springing into action to perform first aid on someone hurt in the Haiti earthquake -- and in some cases, going as far as to perform surgery. All of it during a news report.

And while a physician correspondent giving medical assistance to those injured in a natural disaster is commendable, it does raise some ethical issues about the role of journalists."

They then interviewed me for more than 8 minutes. You can listen to it by downloading this file.

There have been countless articles on this topic this week - many missing the journalism ethics point that many concerned journalists have raised. As I have consistently tried to point out, an ethical middle ground would appear to be this: Physician-reporters should render care if they are so moved but they should not report on themselves doing so.

Broadcasting & Cable is an industry magazine. On their website appeared these comments from TV network executives:

"Steve Capus, president of NBC News, expressed outrage that ethicists would question the judgment of medical reporters who have a unique capacity to help in the face of so much human suffering.

"I'd love for (Poynter Institute Journalism Values Scholar & DePauw University Professor) Bob Steele to have to pick up the phone and [lecture] Nancy Snyderman on the journalistic ethics of driving past a kid who can't walk anymore because he has a crushed leg," says Capus.

"Where would you draw the line? How does one remain absolutely 100 percent objective and say, I'm not going to go near that child who can't walk any further? You don't need to be objective about human suffering. If someone is trained as a medical doctor and they help, good for them. That's the right thing to do."

Frankly, I'd love to hear Bob Steele (who has been quoted this week with concerns about what he's seen) do that as well. But, first, he wouldn't "lecture" in the heavy-handed manner that Capus' quote suggests. He would guide Snyderman through the complex decision-making about exactly the questions Capus raises about where to draw the line and how one alternative path is to simply provide care without promoting yourself and your network in the process. This is something that Steele has done with hundreds of journalists in past years.

The online B&C quotes continued:

Paul Friedman, executive VP at CBS News, says news executives asked themselves all the right questions before letting their medical correspondents practice participatory journalism.

"We always need to ask ourselves is a reporters involvement in the story appropriate and does it in any way impinge on accuracy, fairness and so on," he says. "I just think in this case it is so innocent and the benefit is so obvious to the people who are in need of care that it's not a difficult call to make."

(CBS' Dr. Jennifer) Ashton told CBS News executives that she wanted to go to Haiti first as a doctor. And the network has followed her as she has become a participant in medical efforts there.

"We've felt a little bit guilty about taking her away, for even short periods of time, from what she was doing that was really important compared with reporting," adds Friedman.

Indeed, that's one of the points I made in my CBC interview and one that another journalist made earlier on this blog, when he wrote:

"How do they justify leaving the scene to go do their live shot or writing or other tasks? Does the urgent need magically disappear when the show open rolls?

Just think how many more people these physicians could help if they took a leave of absence from their network jobs in order to provide care full-time... and left the reporting to journalists."

If you haven't had your fill, there wlll be more radio discussion on these issues this weekend on the NPR program, "On the Media," whose hosts also interviewed me.

When a study appeared in JAMA earlier this week pointing to an association between circulating levels of omega-3 fatty acids with a change in telomere length 5 years later (if you really care about this stuff, you can look up the study), many news organizations jumped on it. Another omega-3 fatty acid story!!!

One friend referred to this as "making a biological mountain out of a mole hill."

Oh, you mean, like ABC and Diane Sawyer leading into the story with one of Jon Stewart's least favorite TV ploys - the question mark graphic or tease.

Fountain of youth? You'd have to stay tuned to learn that the answer is "no."

John Mack, on his terrific Pharma Marketing Blog, gives us a pharma marketing perspective on the creation of an Omega-3 fatty acid prescription drug. Excerpt:

"The pharmaceutical industry is often criticized for developing new Rx drugs having little value over current medications. Such drugs are called 'me-too' drugs because of their similarity to existing Rx drugs. Glaxo has now taken this to a completely NEW level: developing an Rx drug that is a 'me-too' of existing over-the-counter dietary supplements. I am talking about LOVAZA, aka omega-3-acid esters approved by the FDA for the treatment of high triglycerides."

Mack goes on to do a cost and ingredient comparison, and explores what might be the clinical reality of the introduction of this new prescription drug. Read his entire blog entry.

Here's an ad for LOVAZA, which Mack cut out of this week's Newsweek Magazine:

A team of reporters from KHN delivers this thoughtful piece. Excerpts:

"There's nothing in (the proposals) the average person could understand about why your costs would be lower," says Robert Blendon, professor of health policy at Harvard's School of Public Health. "They don't even have good illustrations about how it would be cheaper. They did not find a way to save money for people with job-based insurance." ...

Many of the taxes have been dropped or scaled back. Others have been designed to pressure the health care system to operate more efficiently. But the laundry list of levies has fueled concerns that Americans, struggling with the severest economic slump in decades, would have to pony up more for the tax man.

"The final bill will not have all those taxes in it," says Blendon, "but people hear about the tax on insurers, the tax on pharmaceuticals, the income tax - and they can't segregate it in their minds." Opposition to taxes was a key part of (newly-elected Massachusetts Senator Scott ) Brown's campaign.

"People don't like taxes," says Leslie Norwalk, who was acting director of the Centers for Medicare and Medicaid during the administration of President George W. Bush. "The electorate is trying to decide what it thinks about this health care stuff, sees the economy is in trouble and a lot of discussion about taxes, but isn't all that unhappy about their own healthcare. Weighing those two things can be difficult."

Sharon Begley reports on a study published in the American Journal of Public Health that she says "doesn't inspire confidence that doctors are following evidence-based practices and putting their patients' welfare first." Excerpt:

"In a nutshell: a significant percentage of elderly women with severe dementia are getting screened. Such women have an average life expectancy of only 3.3 years. Yet science-based guidelines from the American Cancer Society and other experts say that women with a life expectancy of less than five years should not be screened (because any cancer that's found will not grow fast enough to cut into her remaining years). Even more disturbing, if an elderly woman with severe dementia is also married and with a net worth of $100,000 or more, she is more than twice as likely to get these inappropriate mammograms as her poorer peers."

When the journal of Occupational and Environmental Medicine published a paper, "Maternal occupation and the risk of birth defects: an overview from the National Birth Defects Prevention Study," Reuters Health was ready to report on it.

But when the published study stated, for example, that "The results of this study indicate that women working as janitors have a significantly increased risk of giving birth to a child with (certain birth defects)," Reuters Health understandably and appropriately asked the authors to provide the absolute numbers.

Reuters Health executive editor Ivan Oransky told me: "I even went as far as doing my own calculations based on some of the tables (in the published study), and having the reporter run it by them to make sure I was getting it right." Oransky said the author responded: "We do not express our results in these terms. ...We do not feel it is prudent to publish the sentence below based on these results." (The researcher is referring to a sentence that Reuters drafted including the absolute risk calculations that Reuters did on its own.)

So Oransky decided it wasn't prudent to publish a story on the study.

Good for Reuters Health. This little episode raises several important points in my mind:

• Researchers love to get publicity for their work. If they don't take the time to answer basic statistical questions about their work, then their work shouldn't be publicized.

• Journals should take some responsibility as well. This particular journal published a bold sidebar box labeled, "What This Paper Adds." The "significantly increased risk" language appears in that box. The journal chose to highlight that finding. Why didn't the journal demand the absolute numbers? Will that journal do anything about a published author refusing to provide data to a reputable news organization?

I know that some people may not see any ethical conflict in physician-reporters like CNN's Sanjay Gupta, CBS' Jennifer Ashton and ABC's Richard Besser reporting on their own delivery of health care in Haiti.

But people who think a lot about these issues DO have concerns.

Media ethics guru Bob Steele of the Poynter Institute and DePauw University told the Los Angeles Times: "It clouds the lens in terms of the independent observation and reporting." Given that Gupta's story involved a child who - in the end had a cut but no head injury - Steele said, "Frankly, it isn't much of a story. You can't help but look at this and worry there is a marketing element in it." Los Angeles Times media columnist James Rainey referred to it as "self-promotion." That's from a journalism ethics perspective.

Physician-ethicist Steve Miles, MD, of the University of Minnesota Center for Bioethics wrote to me:

"The reporters who have been practicing well-televised drive-by medical care in Haiti are demonstrating an appalling abuse of medical and journalistic ethics." He feels the decisions on what to broadcast are based on what presents itself as a "telegenic case."

Miles served as medical director for the American Refugee Committee for 25 years, including service as chief medical officer for 45,000 refugees on the Thai‑Cambodian border and projects in Sudan, Croatia, Bosnia-Herzogovina, Indonesia, and the Thai-Burmese border. He is on the Board of the Center for Victims of Torture. He wrote:

"They justify this form of self-aggrandizement by its effect in mobilizing response for the larger disaster. The added value of their self promotion largely goes unchallenged."

Dr. Carl Elliott, also on the faculty of the UMN Center for Bioethics, wrote to me:

"It's worse than self-promotion. It's exploiting the suffering of Haitians for the PR goals of their employers. They should not be reporting on their own work. That's a classic PR tactic: using humanitarian aid as a public relations device, in order to drive up ratings for their network."

It's only a coincidence that my last blog was about Stephen Colbert's "Cheating Death" segment and today's is about Dr. Sanjay Gupta's "Cheating Death" book.

Marshall Scott, man of the cloth, publisher of the Episcopal Chaplain at the Bedside blog, critiques Gupta's book.

His critique is especially relevant given the media ethics situation unfolding where Gupta reported on his own involvement in health care in Haiti. (This has now become a real trend, with CBS' Dr. Jennifer Ashton and ABC's Dr. Richard Besser reporting on their own involvement in health care episodes in Haiti. I'll address this more fully in a future post.)

Reverend Scott writes:

"...that Dr. Gupta the reporter has overcome Dr. Gupta the physician in his effort to tell the story. ...

This is an interesting and readable book. Unfortunately, for all the qualifications of Dr. Gupta the doctor, this book from Dr. Gupta the reporter shows all the shortcomings of health journalism. It brings out possibilities well before they're going to be generally accepted, much less available. It highlights the successes without making clear the limitations, and especially the limitations in how many patients might actually be appropriate recipients of the therapies. Finally, while it uses research to support the story, it does so poorly, relying primarily on anecdotal reports and using published research imprecisely. Yeah, it's an interesting read. Unfortunately, it might just create more problems than it solves."

Read Rev. Scott's entire blog entry. As a hospital chaplain, he's a smart observer of health care and of health care journalism.

On his "Cheating Death" segment this week, Colbert reports: "Did you know that for microseconds every day you go blind? It's a treatable condition called blinking. But now there's a way to treat your restless eyelid syndrome." See full details on this Comedy Central clip. How close to reality his parodies hit!

Prevention magazine wrote about "9 remarkable innovations that promise to revolutionize how doctors prevent, diagnose, and treat common conditions and diseases." The NBC Today Show chopped the list from 9 down to 6 and then put it on the air and on their website, labeling it as "6 breakthroughs that could change medicine: Prevention magazine shares some game-changing new developments." NBC even further blessed the list by having its medical correspondent Dr. Nancy Snyderman go on the air to talk about each one. The anchorwoman said Snyderman would explain "how they could affect all of us."

Well, we asked one of our medical editors, Dr. Steve Atlas of the Massachusetts General Hospital, to critique the story. To begin with, Dr. Atlas says:

"Catchy title, too bad it's not true. Most clinicians know that true 'game changers' in medicine are real but uncommon."

1. Vaguely described as "breakthrough that could stave off cancer naturally." They were talking about exercise and the fact that the American College of Sports Medicine is now certifying "cancer exercise trainers."

Dr. Atlas says:

"Of course exercise is a good thing for everyone, including those with cancer. Is this a breakthrough? Hardly. How does the cancer exercise trainer compare to someone who just provides support and no exercise to the cancer patient or compared to a recommendation to walk for 3 hours a week?"

2. "A new drug called dabigatran prevents more strokes with less bleeding than warfarin." Dr. Atlas says:

"Dabigatran may be a game changer, but there is one thing the story didn't mention. The group that got Dabigatran had more heart attacks than those who got coumadin. Oops! This could be the real game changer from the FDA's perspective. Note it's still under review there."

3. Research that offers new hope for an HIV vaccine. Dr. Atlas says:

"Good news, but it will be years before additional research leads to a vaccine. And the results weren't spectacular by any means. Just better than the dismal prior attempts."

4. "Omega-3 fatty acids have been upgraded from nutritional supplement to bona fide heart medicine: Lovaza, a prescription medication." Dr.Atlas says:

"There hasn't been a large randomized trial comparing (the cholesterol-lowering drug) Lipitor alone to Lipitor plus omega-3 fatty acid. That's the breakthrough study I'm waiting for! Data so far is hopeful. What's the bang for the buck? No clue."

5. Device to predict heart attack or stroke risk. Dr. Atlas says:

"This is hardly worth mentioning. Every year there are 10 new predictors. The Framingham prediction rule is still going strong after many, many years."

6. Breakthrough that could lead to a cure for Alzheimer's. This was about a test and also a drug - a drug that doesn't even go into clinical trials until this year. Dr. Atlas says:

"This one's cruel. Desperate families with Alzheimer's patients can have no hope that this drug will be available outside of studies for 3-5 years. Who knows if it will help?"

Breakthroughs? That could affect all of us?

Just look at the simple, cautious, common-sense, evidence-based approach Dr. Atlas applied to each of the claims. That's something any of could start to do better. And THAT would be a breakthrough!

This is a media ethics issue. So don't read anything into this about medicine.

Physician-reporter Sanjay Gupta today reported on himself treating an injured baby in Haiti - in a video segment that got a lot of airtime and a lot of prime real estate on CNN's website.

The Los Angeles Times reports:

"This wasn't the first time Gupta has brought his medical skills to bear on assignment. In 2003, while embedded with the U.S. Navy's "Devil Docs" medical unit in Iraq, he performed brain surgery five times.

His actions trouble some media ethicists, who said it's problematic for Gupta to be toggling between the roles of reporter and a doctor.

"There definitely are cases where a journalist who is qualified can and should provide medical assistance when the need is immediate and profound," said Bob Steele, journalism values scholar at The Poynter Institute and journalism professor at DePauw University. "The problem in Dr. Gupta's case is that he has done this on a number of occasions in Iraq and now in Haiti. If it's imperative that he intervene and help medically, then take him out of his journalistic role and do that. But don't have him covering the same stories in which he's a participant. It muddles the journalistic reporting. It clouds the lens in terms of the independent observation and reporting."

Steele also questioned the prominence CNN gave the piece, which got significant play on the network and online. "Frankly, it isn't much of a story," Steele said. "You can't help but look at this and worry there is a marketing element in it."

Bob Steele has thought longer and harder about news media ethics issues than anyone I know. I agree with him 100% on this issue. And it raises a question for ABC, CBS, NBC, CNN, Fox or any other network or any local TV station that loves to put doctors on the air as reporters. Who gives them a primer in media ethics?

(Addendum: On January 15, LA Times media columnist James Rainey wrote: "No matter how much CNN succeeded in delivering the story, it will never make me stomach the self-promotion that it and other outlets insist on weaving throughout their coverage. Can we please get through an hour without heaping praise on our correspondents' valor (however real it may be)? Maybe Gupta can't be stopped from playing both reporter and doctor (he is a neurosurgeon, after all), but how many times are we going to have to watch that video of the good doctor bandaging the head of a 15-day-old girl?")

(Second addendum - January 18: Now both CBS' Dr. Jennifer Ashton and ABC's Dr. Richard Besser have also reported on themselves delivering health care in Haiti.)

The LA Times Booster Shots Blog was one of the handful of news organizations that wrote anything about the Journal of the National Cancer Institute articles this week on DCIS or ductal carcinoma in situ.

The Times wrote:

"The issue is important because 25% of all breast cancers diagnosed in the United States are DCIS. DCIS is defined as an abnormal collection of cells in the milk ducts of the breast. It can be life-threatening in some cases. But most of the time DCIS is a low-grade tumor that is best described as something between normal breast tissue and breast cancer. In this country, women diagnosed with DCIS have surgery to remove the tumor, and survival rates are 98%."

I've interviewed dozens of women who've been diagnosed with DCIS and they told me stories of their anxiety and confusion over what they were variously told was "precancerous...premalignant...a benign cancer" yet were told - in some cases - to consider bilateral prophylatic mastectomy to treat it.

The JNCI articles summarized last Fall's National Institutes of Health state-of-the-science conference on ductal carcinoma in situ.

There is such a disconnect in journalists' relative lack of attention to DCIS at the same time many of them whip up uproars over the US Preventive Services Task Force's recommendations on mammography. Because it is this same DCIS condition that so often turns up when mammograms are done in younger women - one of the key issues the USPSTF tried to address.

Indeed, after the Fall NIH conference, a debate began about whether to change the name of DCIS. The Journal then reported that there was talk of dropping "carcinoma" from the name because some thought it was an "anxiety-producing term." Gee, the same anxiety that so many USPSTF critics minimized? Excerpt from an earlier JNCI article:

"Otis Brawley, M.D., chief medical officer of ACS and an oncologist who is in favor of the name change, argues that the medical community can take better care of patients both emotionally and medically if there is a better name. "I think there is a huge amount of confusion," he said. "I'm much more concerned that we are scaring a whole host of people that have ductal carcinoma in situ who make rash decisions because it's called 'carcinoma'--decisions that they wouldn't make if it was more adequately described for what it truly is." ...

Barbara Brenner, director of Breast Cancer Action, an advocacy group, said it doesn't make a difference if it's called "neoplasia," "carcinoma," or even "the bad disease." Conversations about treatment have to happen regardless of what the disease is named, she argues. "I know there is a great deal of anxiety with DCIS, but I don't think the anxiety would be lessened by calling it something else, because at the end of the day you still have to talk to someone about what to do about it," said Brenner. She said it's the treatment that's scaring women, not the name. In Brenner's view, the medical community should allocate any resources being spent on the name change to improving risk stratification of patients because the real issue is not knowing whom to treat.
"It's a nonpriority," said Brenner, who said she would attend the name-change meeting if the opportunity presented itself. "This is a silly discussion. I understand why doctors want to have it, but it's not going to help women one iota."

One way or another, it's unfathomable to me that journalists would cover USPSTF controversies and fail to report in more depth about DCIS.

Got an email from a PR company the other day - same PR company I'd asked to take me off their mailing list last year. This important note proclaimed that:

"2010 is the year of the Pomegranate. On January 5, Reuters posted an article stating that Pomegranate helps reduce the risk of breast cancers. It is increasingly important for women to do all they can to continue fighting this ugly disease. Incorporating pomegranate into your foods and recipes is an easy way to get the appropriate doses to fight off many diseases and illness - including breast cancer."

What the news release didn't tell you was what else was in the Reuters story:

• This quote: "It's not clear that these levels could be achieved in animals or in humans because the (compounds) are not well absorbed into blood when provided in the diet," said Gary Stoner of Ohio State University.

Wait. What's that? The research WASN'T in humans? Not even in animals? Only in a lab dish? Hmmm. The news release didn't say that either.

But it DID tell women that adding a teaspoon of the product it was promoting - handsomely captured in the photos provided - would "aid in the fight of breast cancer."

The PR person offered to send me samples of the product. I won't ask for those.

She also said she looked forward to my feedback. i've just delivered it.

As long as they keep me on their mailing list, I'll continue to point out the completely unfounded claims they make. The leap between what's seen in the lab and what may happen in mice or in women should not be minimized in the attempt to pitch products.

A journalist sent this to me with the one word subject line: "Seriously?" There was a link to a story on CNN's website about people being depressed - even suicidal - after watching the movie, "Avatar."

As if there hasn't been enough hype about this movie, now CNN stirs the pot by reporting:

"James Cameron's completely immersive spectacle "Avatar" may have been a little too real for some fans who say they have experienced depression and suicidal thoughts after seeing the film because they long to enjoy the beauty of the alien world Pandora."

That kind of flip discussion of depression and suicide shows no appreciation for concerns over media portrayal of suicide and the phenomenon of copycat suicides. If this, indeed, is such a newsworthy phenomenon, shouldn't the story have mentioned at least one mental health resource for troubled readers or moviegoers?

And all of it was based on posts to an online chat forum.

Well, online chatters responded to the CNN story itself, writing:

• "Geez, I thought this was a joke the first time I read it! What annoys me here is abuse of the word "depression." Depression is a clinical mental illness that has to be ongoing and significant to be actual depression. It isn't the same as being a little bummed that a silly movie isn't real."

• "This is far and away the stupidest article I've ever read."

• "Wait, this isn't theonion.com? Serious journalism indeed."

For some time many news organizations have trumpeted, as ABC's Good Morning America did, the "cutting-edge" healing powers of platelet-rich plasma therapy or PRP. As is often the case in stories about wonderful new therapies, evidence is cast aside in favor of sparkling anecdotes such as that of pro football player Hines Ward.

Well today evidence gets its turn. Stories by the Wall Street Journal and by the New York Times point out, as the Times put it, "the first rigorous study asking whether the platelet injections actually work finds they are no more effective than saltwater."

This study was in people with injured Achilles tendons. But as the Times explains, PRP has already been extended to so many uses - "treating muscle sprains and tendon pulls and tears, arthritis, bone fractures and surgical wounds -- that Dr. Bruce Reider, editor of The American Journal of Sports Medicine, said in a recent editorial that perhaps it should be called "platelet-rich panacea."

The lead investigator was even quoted saying, "We are sorry for the patients"

Supposedly a forthcoming study will tout PRP's benefits in elbow problems, but the Times reports that:

"Dr. Freddie H. Fu, an orthopedist at the University of Pittsburgh Medical Center, said the study stacked the deck in favor of platelet injections. ...

Although 73 percent of patients given platelet injections improved after a year, compared with 54 percent for steroid injections, Dr. Fu said that was not much success. "Any time you touch a patient, you get 70 percent success," he said, adding that even placebos give that rate over time.

... Fu said he was keeping an open mind but still did not offer platelet injections. "I just do not have the heart to ask patients to pay for an unproven therapy," he said.

Guarantee: this won't be the last you hear of PRP as it is being looked at to treat injured shoulders, knees, elbows, heels - you name it. The old medical maxim applies - to a man with a new hammer, everything looks like a nail.

That's a line from a commentary entitled, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," published in the Journal of the American Medical Association this week by Dartmouth's Steve Woloshin and Lisa Schwartz.

Blogger Merrill Goozner did a good job summarizing the piece. So far he's the only journalist I've seen who's written about the article as I go to post this.

As the authors wrote:

"...people need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries (and they provide a table of some) about the benefits and harms of testing would help foster good decision making."

That's something journalists struggle with every day in telling health care stories - as we've shown over and over on HealthNewsReview.org.

Glad to see Naomi Freundlich on Maggie Mahar's Health Beat Blog address a column that the New York Times published last month, "Not All Drugs Are The Same."

Freundlich points out, appropriately, that:

"The "controversy" over generic drugs is really less than meets the eye. There have been scattered concerns--some based on patient or doctor reports, others from proprietary drug makers--about generics not being biologically close enough (bioequivalent) to name brand meds. But the issue is mired in complexity and misinformation. For example, many doctors accept significant payment from drug companies to promote their name brand drugs--especially cardiologists and psychiatrists. It can be hard to remain unbiased when a pharmaceutical company is paying the tab on research."

She quotes Aaron Kesselheim, an instructor in medicine at Harvard Medical School who has authored studies comparing generic and name-brand drugs saying the NYT column was "pretty irresponsible" because it doesn't reflect the body of evidence supporting the use of generics. "For the vast, vast, majority of pills and the vast, vast majority of patients there is no evidence of problems substituting generics for brand name drugs," he said.

I heard similar complaints about the column from Larry Sasich, consultant to the Public Citizen Health Research Group and co-author of "Worst Pills, Best Pills" --- and from Dr. Stephen Schondelmeyer of the University of Minnesota College of Pharmacy. Sasich wrote me: "The journalist covered the science but then used the experience of a patient and a physician as rebuttal to the evidence that there has been no credible evidence that generic drugs harm patients. This seems counter to good scientific journalism as uncontrolled observations were evidence that generics can cause harm." Schondelmeyer has told me for years that he continues to be perplexed by people who continue to breathe life into the "generics aren't safe or aren't equal" arguments.

Alicia Mundy of the Wall Street Journal reports: "The final health-care bill is likely to require coverage for more mammograms than the new guidelines recommend after women's groups, doctors and imaging-equipment makers stepped up pressure on lawmakers -- one of many threads of the bill negotiated behind the scenes."

The Columbia Journalism Review looks at what are at least temporary suspensions of two health journalism graduate programs - at City University of New York and at the University of Minnesota (where I've taught for 8 years).

CJR frames this as the irony it is - that institutional/student interest is "Flatlining Despite Healthcare Overhaul" - as the headline reads. So at a time when the need for quality health care journalism is being seen greater than ever, these cutbacks are curious.

The article concludes:

"Whatever the solution may be, one hopes that universities will find it soon. Programs of this sort may disappear, but the need for quality health and medical reporting will not go away."

Perfect smile, perfect skin, perfect hair - that's what the headlines promote on the CBS Early Show website today. So if you have fine lines, wrinkles, eye dark circles, acne, age spots - CBS tells you that "All can be easily treated to enhance your overall look in the new year, prevent signs of aging for the long-term, and increase your self-esteem."

It's ironic that lower on the same page is a video story on "Costs of Healthcare: Five Tips To Save You Money." One of those tips could have been: don't fall prey to all the CBS Early Show stories that would make you think you're imperfect, abnormal and NEED expensive treatment for things that are actually normal variations of life and health.

Some news organizations are going to give top priority to a little study in this month's International Journal of Food Microbiology that found bacteria in soda fountain machines.

The CBS Early Show trotted out one of its physician-reporters, Dr. Alanna Levine, to talk about the study. It's almost difficult to hear her over the noise of the soda fountain next to her. Sound contamination as well?

But there was none of the context that appeared on ABCNews.com, for example. Excerpt:

"Wherever man is there will be representation of feces," said Philip Tierno, director of Clinical Microbiology and Immunology at New York University Langone Medical Center.

"We're basically bathed in feces as a society," he said.

Charles Gerba, a microbiologist at the University of Arizona was "not too surprised" to learn coliform bacteria were found in soda fountain machines either.

"We've seen it with drinking water dispensing machines where customers fill up jugs of water," said Gerba. "You see it anytime you have something where people can touch the dispenser."

Based on some of the online comments I've read, some people are sick of these "you're going to get sick" stories. Here is some of the wisdom of the crowds in comments following the story on one site:

• "I am so sick of hearing these 'breaking stories' about how such-and-such product has - GASP - bacteria in it. There was even something on TV the other day about how your shower head has bacteria in it, so you shouldn't put your face directly under it. EVERYTHING has bacteria in it/on it/around it, including our bodies. We've become such a wimpy Purell-dependent society and it makes me angry! Our immune systems are equipped to handle 99.9999% of the stuff we throw at them, because we've evolved with bacteria around us since the beginning of life!"

• "Study: the human mouth has millions of bacteria in it.

Study: run for cover, THE SKY IS FALLING, THE SKY IS FALLING."

• "Where are all the sick/dead soda drinkers?"

And do you think that CBS and other news organizations will now start reporting studies from the International Journal of Food Microbiology each month? There were other interesting-sounding articles in this same issue, such as:

• A contribution to the alternative method to preserve foods without using chemical preservatives

• Farm-to-fork characterization of Escherichia coli associated with feedlot cattle with a known history of antimicrobial use

But I guess it's hard to beat poop in your soda on network morning TV! Put it right alongside TV sweeps period pieces on hotel cleanliness (bed bugs, air conditioning bacteria, stains on bed cover, drinking glass sanitization, etc.)

Jon Stewart of the Daily Show has talked about how journalists must feel they can get away with saying anything in headlines or teases, as long as they follow it with a question mark. Example: ABC Good Morning America's story "Can Your Purse Make You Sick?"

That routine came to mind when a journalist wrote, asking me to comment on an Ivanhoe Newswire story headlined, "Pomegranates Prevent Breast Cancer?" The journalist wrote to me that this was a misleading headline and "a pretty poor piece of health journalism."

Should women go out and start popping pomegranates however and whenever they can?

Not so fast. This is one case where a news release did a better job than a "news story."

An American Association for Cancer Research news release quoted an expert saying:

"This is an in vitro study ...It's not clear that these levels could be achieved in animals or in humans because the ellagitannins are not well absorbed into blood when provided in the diet."

Hmmm. Ivanhoe, which has a product called "Medical Breakthroughs," never told us this was only in the lab - not in human research.

That makes the ? in the headline loom pretty large.

And if you were interested enough to look up the journal article, Ivanhoe tells us it's in the February issue of the American Journal of Preventive Medicine. I couldn't find it on that journal's website. I called the Journal office and the associate editor said it didn't sound familiar.

Maybe it's not in that journal.

But a study on the same topic by the same authors was published on January 5 in the journal Cancer Prevention Research. The Ivanhoe story was published January 6.

Sheesh!!!

One website called the Ab Circle Pro product "one of the top-selling fitness products in the US." Consumer Reports investigated company claims that you can get washboard abs in just minutes a day.

CR had two women and two men use the device, and had nine women and four men do the DVD workout. Their bottom line:

"Three minutes a day? That won't cause much weight loss. The device engages core muscles but burns no more calories than brisk walking. The nutrition plan is strict, so most people could lose weight on that alone. Just three of our 13 panelists said they'd consider buying the device."

CR has learned how to use video very effectively. Other traditional media could learn from them.

"Ranking 37th -- Measuring the Performance of the U.S. Health Care System" is an article posted online by the New England Journal of Medicine. Excerpt:

Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

What an important question for US journalists to tackle more deeply more often.

A study published in JAMA this week drew markedly different news coverage. The LA Times headline read: "Study finds medication of little help to patients with mild, moderate depression."

But the HealthDay wire service, whose story appeared on the websites of BusinessWeek, MSN, Yahoo News, and ABCNews.com among others, had a glaringly different headline and framing perspective that read: "Severely depressed gain most from antidepressants."

The HealthDay story went on to state:

But the findings are not actually that surprising, said one expert, and don't necessarily mean that people with mild-to-moderate depression should not try antidepressants.

"I'm not sure this is a finding that's counter to giving medication to people with mild-to-moderate depression," said Dr. Gregory Asnis, director of the anxiety and depression program at Montefiore Medical Center in New York City.

Why they conducted this interview but didn't quote any of the study authors is odd.

The Times reported:

Hundreds of studies have attested to the benefits of antidepressants over placebos, (senior author Robert J. DeRubeis) said. But many studies involve only participants with severe depression. Confusion arises, he said, "because there is a tendency to generalize the findings to mean that all depressed people benefit from medications."

That seems to be an important point.

Meantime, USA Today reported other important perspectives from the author and from another source:

"The health establishment needs to take stock and ask about costs and benefits" of antidepressants, DeRubeis says. Meanwhile, he says, his study "should give one pause" about prescribing antidepressants to mildly, moderately or even severely depressed patients. Instead, he says, doctors might want to consider non-drug options, such as exercise or psychotherapy.

Such findings "demonstrate a failure in the system: These drugs were not thoroughly tested in mild to moderate depression prior to their approval," says Thomas Moore, a senior scientist at the Institute for Safe Medication Practices in Horsham, Pa., and co-author of the 2008 paper. "Any new antidepressants should be."

So which is it?

• The study should give pause about prescribing antidepressants? or

• This is no reason to avoid meds?

Looks like it depends on which story you read.

(Addendum: Just moments after I posted this, I saw that MedPageToday.com posted its story on this study. It offers a very reasonable and wide-ranging look at the study, the questions it raises, and the possible limitations of the research.)

Liz Szabo reports that experts worry that recent outbreaks of Hib, or Haemophilus influenzae type b, mumps and measles "represent cracks in the country's protection against terrifying childhood diseases that were once virtually eradicated."

She reports:

A study published Monday in the Archives of Pediatrics & Adolescent Medicine found that unvaccinated children are nine times as likely as others to contract chickenpox -- which killed 100 children and hospitalized 10,000 a year before a vaccine became available in 1995. The same authors found that unvaccinated kids are 23 times as likely to develop whooping cough.

And the story includes this chart from the Journal of the American Medical Association.

There are strong multimedia elements - photos and video - as well.

One suggestion - for USA Today or any newspaper expanding its video efforts. Think twice about using the maudlin music on your videos. It's as if you feel you need to tell readers/viewers how to feel. On this topic, with an already powerful and clear message, you don't need to add the music. It's formulaic, an approach borrowed from TV news, and
I hope websites don't adopt it.

Regina McCombs of the Poynter Institute has compiled several news organizations' policies on the use of music in video in a column, "Music in Multimedia: Add Sparingly, Not as a Crutch."

David Whelan of Forbes blogs about how ABC News turned to Jenny McCarthy as its one "expert" source on an autism story yesterday.

Excerpt of his blog:

"When the medical journal Pediatrics released a consensus report yesterday by a large panel of experts saying that autistic children do not benefit from special diets, ABC News' Diane Sawyer knew just which expert to consult. Jenny McCarthy, former MTV game show host, nude model, and now mother of an autistic son Evan, got the call and enthusiastically denounced the study. "Until doctors start listening to our anecdotal evidence, which is it's working, it's going to take so many more years for these kids to get better," she said. ...Is this responsible science journalism on ABC's part?"

Surprise! The CBS Early Show offered another diet segment.

Surprise! It was another free promotion for a book - this one on "The O2 Diet." Or, as they headlined it on their website, "Eating Antioxidants for a Better You."

Claims made on the air:

• 4-day cleanse in which you can lose up to 5 pounds

• you'll feel good

• you'll have better energy

• your skin looks better

• as a byproduct of feeling great, you lose weight

• even the smell of cinnamon may relieve stress

Evidence given on the air to back up anything of those claims:

• NONE

Think of what a better use could be made of that air time. And remember: if you get too stressed thinking about it, just sniff some cinnamon.

Did it come from a study? Or straight out of the Wall Street Journal? Last week the CBS early show brought on another physician-correspondent to talk about the benefits of coffee drinking. Anchor Harry Smith referred to "this new study." What new study? None was referenced.

What the segment was apparently based on was a Wall Street Journal story that same day that had ALL of the same information. No attribution was given.

Watch CBS News Videos Online

Smith laughed in talking about "the study" showing that 6 cups a day of coffee lowered a man's risk of advanced prostate cancer. He chuckled, "I don't know how you get a control group for that or how this works..." Clearly he doesn't know. Because "the study" in question didn't have a control group and wasn't a true experiment. It was an observational study.

When I was a kid, there was a Sunday morning TV show in which the host read the comics straight from the newspaper.

Maybe the CBS Early Show should just read us the health news straight out of the paper.
It could only be an improvement.

The NBC Today program offered an inane segment labeled "Eat This, Cure That."

It was formulaic and overly simplistic. The anchor and a guest walked behind tables of food displays and quickly told viewers about the wonders of the various items on display.

What's wrong with that approach? The segment provided no time get into details about the quality of the evidence behind the claims - so, instead, viewers were told about foods that - broadly - can "cure and even prevent illness." But not one shred of evidence was provided.

The segment stated that eating one cup of black beans can help ease migraine pain. Viewers should be given some data to back that up.

They were told that eating sunflower seeds can lower the risk of cold or flu by 20%. Again, evidence please. What studies? In how many people?

And people who were about to give a big speech were told to eat red peppers. How many red peppers? How far in advance before speaking? Where's the evidence for this stuff?

All of these claims may have some scientific basis, but the certainty of the language - "cure...prevent...lower risk...ease pain...help soothe" - is too certain and too sweeping for a 3-minute TV segment.

TV doesn't educate anyone when it rushes through such topics, dumbing down any scientific evidence that does exist and misleading viewers about the true quality of the evidence.

Whenever I talk to journalism groups, I always give out our mousepad with reminders of our review criteria for HealthNewsReview.org.

Today, German blogger and freelance science journalist Marcus Anhäuser wrote about our work and our mousepad.

I met Marcus in Bremen in November. Danke schoen!