Gary Schwitzer's HealthNewsReview Blog

Prevention Magazine: we said we'd be watching you and we are!

2010-09-01T18:54:50Z

The September issue of Prevention magazine inaccurately headlines a story, "4 Ways Coffee Cures." There's no solid proof that coffee cures anything - unless some of you cure bacon with java, which I don't want to know about.

What the story (below) did was to try to present a cute little graphic summary of observational studies that show a statistical association between increasing coffee consumption and fewer early deaths, fewer deaths from heart attack, fewer cases of dementia and fewer cases of type 2 diabetes.

But such observational studies (they actually never cite the source - I'm just giving them the benefit of the doubt that they're citing observational studies) can NOT establish cause and effect therefore it is inaccurate for the story to use terms like "cure...protective...lowers (or reduces or slashes) your risk." Besides being inaccurate, such stories fail to educate readers. They mislead.

We ask the editors of Prevention to read and understand our guide, "Does the Language Fit the Evidence? Association versus Causation."

NYT prostate cancer patient/writer reviews "Invasion of Prostate Snatchers"

2010-08-31T18:07:28Z

New York Times writer Dana Jennings, who's been publicly sharing his own story of prostate cancer, writes about a new book about someone else's prostate cancer story.

It's "Invasion of the Prostate Snatchers," by Ralph H. Blum and Dr. Mark Scholz.

Jennings writes:

"(The book) is a provocative and frank look at the bewildering world of prostate cancer, from the current state of the multibillion-dollar industry to the range of available treatments.

About 200,000 cases of prostate cancer are diagnosed each year in the United States, and the authors say nearly all of them are overtreated. Most men, they persuasively argue, would be better served having their cancer managed as a chronic condition.

Why? Because most prostate cancers are lackadaisical -- the fourth-class mail of their kind. The authors say "active surveillance" is an effective initial treatment for most men.

They add that only about 1 in 7 men with newly diagnosed prostate cancer are at risk for a serious form of the disease. "Out of 50,000 radical prostatectomies performed every year in the United States alone," Dr. Scholz writes, "more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality

Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48.

And surgery, of course, is most often recommended by surgeons and urologists -- who are also surgeons. Mr. Blum writes: "As one seasoned observer of the prostate cancer industry told me, 'Your prostate is worth what Ted Turner would call serious cash money.' " As for patients, their rational thinking has been short-circuited by the word "cancer." Scared, frantic and vulnerable -- relying on a doctor's insight -- they are ripe to being sold on surgery as their best option. Just get it out.

Every urologist I met with after my diagnosis recommended surgery, even though it was believed then that I had a low-risk Stage 1 cancer. The best advice came from my personal urologist, who declined to do my operation because it was beyond him: "Avoid the community hospital guys who do a volume business in prostates."

I did, but I'm still maimed. In my experience, doctors play down punishing side effects like incontinence, impotence and shrinking of the penis. Those are just words when you hear them, but beyond language when you go through them."

Read Jennings' full column. And you may want to pick up your own copy of "Invasion of the Prostate Snatchers." I'm getting mine.

Fanning the flames of Favre's ankle health news - without educating anyone

2010-08-31T16:13:22Z

First, let me disclose to anyone who doesn't know me that if you cut me open, I bleed green and gold and cheese for the Green Bay Packers. Because of this, and not despite this, I have remained one of Brett Favre's biggest fans through the good times and the bad, and through his years with the Pack, the Jets (one year) and now the Vikings (will he make it through a second year?). I didn't know anything about him when he started with the Falcons.

I wish the best for him personally.

But news coverage of his ankle has gone from the silly to the ridiculous - with stories including nothing but meaningless terminology that doesn't inform anyone.

The latest: Peter King of Sports Illustrated posted an article claiming that Favre is "already taking injections in his wounded ankle." (Picture at left is from SI website.) Samples of the junk journalism:

• Favre "got an injection of lubricant in the left ankle that has three times been operated on to remove loose bodies. "Like a grease fitting,'' he said.

• Lubricant? What is that lubricant? WD-40? Or, given Brett's age and advertising popularity, is it a new product called BF-40? Grease?

• King writes: "Noted orthopedist Dr. James Andrews did the most recent surgery May 22, with an interested party in the operating theater: Deanna Favre. "They took out a cup full of stuff -- bone and all these other loose bodies.''

• Really? A cup full of stuff? That's what Deanna said. What did Dr. Andrews say? Or wouldn't he be quoted because he cares about patient privacy issues?!?

I could go on but won't. But King's Sports Illustrated stuff has been picked up by all sorts of other news organizations, especially local Twin Cities media. Stories like this don't educate anyone very much or vey well about bone spurs or ankle problems in elite athletes. But they do fan the flames of Favre fever. And I know this is only sports, but this is a missed opportunity to educate people who never get beyond the sports section.

But these are some of the same sportswriters who write about "successful surgery" within minutes after the surgical wound is closed. How do we measure "success" so quickly? Did we learn nothing from the old joke about "The operation was a success, but the patient died?"

Go Pack!

Radio program on HealthNewsReview.org & health journalism

2010-08-30T16:33:16Z

The Recovery Room radio program out of North Carolina has a half hour program on HealthNewsReview.org and on the challenges of health journalism. The program features interviews with me and with Scott Hensley, of NPR's health blog, "Shots."

Story of Medtronic's Infuse product - from revolutionary advance to public health alert

2010-08-30T14:53:22Z

There are many stories journalists could report about conflicts of interest and questions about evidence in the treatment of low back pain, perhaps especially with spinal fusion. We talked about many of these with journalists from the American Society of News Editors in a workshop at the Foundation for Informed Medical Decision Making in Boston in May.

John Fauber of the Milwaukee Journal-Sentinel hammers one of these issues, looking at how Medtronic's Infuse product "went from revolutionary advance to public health alert."

Here's his story on MedPageToday.com.

His entire "Side Effects: Money, Medicine and Patients" series is indexed on the Milwaukee Journal-Sentinel website.

The image below is from the Journal-Sentinel's online story.

Where was the hospital competition/expansion angle in story of hospital job cuts?

2010-08-27T13:58:07Z

This week, the Twin Cities' two major newspapers reported - in varying but incomplete ways - an announcement from Children's Hospitals and Clinics of Minnesota that it planned to cut up to 250 jobs by mid November.

The Pioneer Press beat its larger crosstown competitor, the Star Tribune, by at least doing some original reporting on the story.

Here's a strength of the story:

"The changes announced this week, (a hospital spokesman) said, stem from more fundamental, long-term challenges facing the hospital. First and foremost, he said, is diminished revenue from the state-federal Medicaid health insurance program.

"We've seen a significant increase in the number of kids relying on Medicaid, and at the same time huge cuts in Medicaid reimbursement," (a hospital spokesman) said.

In the past year, the share of patients at Children's covered by Medicaid has grown from 38 percent to 44 percent.

Hospitals have had a long-standing concern that Medicaid pays too little for hospital services, said Schindler of the Minnesota Hospital Association. The issue hits especially hard at Children's because it has such a large number of Medicaid patients -- the health insurance program typically covers only about 9 percent to 10 percent of patients at most other hospitals in the state, Schindler said.

Medicaid reimbursement rates have been declining each of the past several years, he said, although recent cuts haven't been dramatic."

That's a very important issue - one that is probably under-reported about pressures facing children's hospitals across the country.

But here's a weakness of the story:

"The hospital said a one-day strike by nurses in June, the planned but averted nursing strike in July and the slow economy were factors.

"The net result was a 2.3 percent decline in total revenue equal to $3.2 million," the hospital reported. "The decline in revenue coupled with increased operating expenses and expenses related to the nursing work stoppage resulted in an operating loss of $7.3 million."

Lucas, the hospital spokesman, stressed that one-time factors related to the labor dispute with nurses aren't driving the changes announced this week. The decline in admissions during the quarter was one such event, he said, adding that the hospital had to "ramp down our volumes in anticipation to be sure we were adequately staffed to meet patient needs."

Well, wait a minute: How much of a factor was the nursing issue? The story never explains and, in our view, only confuses the issue.

The story also never commented on the hospital's expensive expansion, arguably the clearest manifestation of its competition with Fairview University medical center, which has also built a new children's facility (pictured at left in a photo taken last summer). We've written about this before, and how the Twin Cities may lead the nation in the number of different, separately-operated, competing children's hospitals it now has.

But the limited Pioneer Press story nonetheless still showed up the state's #1 newspaper, the Star Tribune, which only managed to rewrite and republish an Associated Press story, which ran only 123 words and was put in a little corner of page B4 in the Metro section.

Wow.

Local citizens deserve much more scrutiny of the local hospital industry than that.

Profile of HealthNewsReview.org on Journal of Participatory Medicine

2010-08-26T14:37:27Z

e-patient Dave DeBronkart published a review/profile of our project on the website of the JOPM. Excerpts:

"Why would someone interested in participatory medicine want to know about this? Learning to decode news articles about health and health care is essential to being a responsible driver of one's health. It is impossible to act responsibly without good information. Too often the health stories we read have been poorly analyzed and reported on by today's time-pressured reporters, as Schwitzer's reviews make clear. The reviews and methodology presented on this site can help patients bring better quality information to the care relationship with their clinicians, and help all parties make better informed decisions.

Careful scrutiny of health news can be a potent enabler of participatory medicine because of the radical differences in focus between the patient, who must care for only their own illnesses and conditions, and the clinician, who must know about and manage many.
...
We consumers can help physicians stay informed about our health concerns by scouting or digging for relevant articles. Chances are we are not going to search first in the scientific literature, but rather in the news media. For us, this is where quality matters. We depend on accurate representation of new scientific findings by journalists: Is the finding new? How robust is it? At what point in the development process is the drug or treatment approach? Schwitzer's team encourages better health news reporting by publicly critiquing the work of specific journalists while at the same time demonstrating to the public the criteria that each of us should apply in our own reading of the news. Because their criteria are presented in lay terms, they enable consumer participation in health decision making."

Thanks to Dave and to the Journal for their interest in and support of our project and its goals.

How would you feel about your surgical team Tweeting during your operation?

2010-08-25T20:21:02Z

And why are so many stories so unquestioning about these runaway surgical Twitter practices? Just look at this frame grab from a Google search showing all the stories (so far) on one hospital team's surgical Twitter exploits. One story stated:

"Senior hand fellows...when not actively involved in the surgery, sat at a laptop just outside the operating suite and tweeted real-time updates during the procedure, according to a hospital press release. According to the Twitter feed, expert teams of hand surgeons rotated in and out of the operating room throughout the surgery."

Oh, phew, their hands were tweeting when their hands were not operating! I might rather that my surgeons - even when not actively involved in the operation and when rotating out of the OR - would just rest their digits and not flex them digitally. But what an old-fashioned guy I am.

NYT's new public editor settles in with criticism of paper's Alzheimer's test story

2010-08-25T14:00:28Z

The New York Times' new public editor (or ombudsman), Arthur S. Brisbane, writes that his blog "opens with an entry in the field of science, something my mama told me never to do." Actually, we hope to see much of this.

His opening target: the paper's own front-page story of Aug. 10 by science reporter Gina Kolata, headlined "In Spinal Test, Early Warning on Alzheimer's," with a subhead that said "100% Accuracy Found in Study Results."

He acknowledges that "The piece drew dissenting comments from a number of readers, including some with PhD appended to their names."

We were among the critics, with our systematic story review (that called it misleading) and our blog posts:

• http://www.healthnewsreview.org/blog/2010/08/common-themes-in-the-alzheimers-test-stories-the-cancer-society-screening-ad.html
•
http://www.healthnewsreview.org/blog/2010/08/ucla-md-says-nyt-alzheimers-test-story-was-far-worse-than-our-review-suggested.html

• http://www.healthnewsreview.org/blog/2010/08/hope-vs-false-hopeharm-in-news-stories-about-alzheimers-als.html

Brisbane writes that the subhead and the lead to the story "create the clear impression that here is a test that will enable you to walk into your doctor's office and find out with 100% accuracy whether you will get Alzheimer's. In fact, the study said something much narrower than that." And more:

"My take is that danger awaits stories that venture into the land of 100% -- or any other absolute, for that matter. Stories that report on something that is a "first," a "biggest," an "only"; stories that employ "never," and stories that predict with absolute certainty are often headed for trouble. Yes, sometimes an absolute is absolutely right, but many, many times there is a crack of imperfection there.

A better approach in this case would have been to offer either a narrower claim for the 100% connection among factors or a broader description, less the absolute, of a promising new study of Alzheimer's."

Read his entire column and note the comments left online by some smart readers as well.

On Twitter, Paul Raeburn wrote - in an apparent assessment of Brisbane's assessment: "OK, I guess, but superficial." Raeburn was among the early critics of the original Kolata story in his contribution to the Knight Science Journalism Tracker.

But the Times' public editor did write: "I could go on making further distinctions about the study, its structure and findings but the risk of saying something inaccurate grows, so I will stop and ask the question: What went wrong here and what should the story have said instead?"

I applaud Brisbane's scrutiny of the story, limited though it may be. There is so much good done by the New York Times. But there is so much that could be so much better. Maybe his columns will help the paper look in the mirror and achieve that goal.

An important shared decision-making message in NYT story on breast imaging radiation risks

2010-08-24T17:54:23Z

This is a very important story.

"Unfortunately," as a Mayo Clinic physician says in the story, "this is something that isn't well understood, not just by the public - but by physicians who order the tests."

Special focus was placed on the nuclear technologies of breast-specific gamma imaging and positron emission mammography. The story says a single exam with one of these tests "exposes patients to a risk of radiation-induced cancer that is comparable to the risk from an entire lifetime of yearly mammograms starting at 40."

And the story goes on to discuss a concern that these tests will "become more widespread and casual...now being considered and even being used in some cases as screening tests, and this is not appropriate" - according to the Mayo physician quoted.

KSTP-TV proclaims petri dish research may be HIV cure: Shame on them

2010-08-24T14:38:31Z

Predictably, local media in Minneapolis-St. Paul are all over a news release from the University of Minnesota about lab experiments - we're talking petri dishes not people - that showed a two drug combo impacted HIV.

But KSTP-TV - the ABC station in the city - headlined this on its website as "U of M Researchers May Have HIV Cure."

Shame on them. This is a classic example of local cheerleading for local research - note the University flag photo in the story. And it's a classic example of how bad not only some local TV news is on the air, but on station websites. Inaccurate, imbalanced, incomplete, sensational, insensitive to viewer/patient needs.

What a horrible piece of hype, undoubtedly causing some excitement among people affected by HIV - until they read the details.

To be clear: this is an interesting and important area of research.

But it does harm - not good - for a news organization to report that this may be a cure when it hasn't even been tested in one person yet.

Addendum on August 24: KSTP's crosstown competitor, KARE (NBC) tonight got around to the story a day later than KSTP but didn't put the extra time it took to file to much better use. It wasn't until 135 words deep in a 195 word story that the story even mentioned that this hadn't even been tested in people yet, and then almost as an afterthought:

"Plenty more research needs to be done, including clinical trials in humans, which are still a ways off. But researchers have already tested the drugs in mice and found positive results."

Do we really have to remind anyone that you could line up from here to the moon and back things that looked good in the test tube and in mice but didn't pan out in people? Perhaps especially with HIV? But there wasn't much analysis here - just more hometown cheerleading.

I ask news directors of KSTP and KARE: What are the chances you would have even aired a 10-second reader if this research had come out of neighboring Madison or Iowa?

Here we go again with Pfizer-funded cancer seminar for journalists

2010-08-23T19:42:52Z

I knew about it. But I wasn't going to write about it because I did last year and my criticism apparently went nowhere.

But then a former journalism student, Emma Carew, now at the Star Tribune, tweeted me this morning about the latest round of Pfizer-funded cancer seminars at the National Press Foundation in Washington, D.C.:

@garyschwitzer your thoughts? JOURNOS: Attend a 4-day seminar on cancer issues in DC. All expenses paid. http://j.mp/cgJ8eH. about 5 hours ago (from @emmacarew)

My quick responses as soon as I could respond:

Wouldn't want on my c-v! I criticized these Pfizer-pfunded seminars to NPF & SPJ which helped promote it last year. Deaf ears. http://bit.ly/9gHkyK. about 3 hours ago

The link goes to a blog post I wrote one year ago when the National Press Foundation was promoting its Pfizer-pfunded cancer seminar last summer.

Maybe it's a good thing this issue did get dusted off again. It's clear that others are upset about it, because the online Twitter conversation continued:

@garyschwitzer part of the multi level marketing campaign - it's not enough 2 use direct 2 consumer/doctor advertising - need the press also about 3 hours ago via web (from @WriteWithStan)

Just a (choke) whiff of conflict-of-interest RT @garyschwitzer: @emmacarew All expenses paid (by Pfizer) cancer seminar. http://j.mp/cgJ8eH about 3 hours ago via HootSuite (from @MedicalBillDog)

Journalism organizations too cozy with drug industry... http://bit.ly/bh8uaZ Gary Schwitzer's HealthNewsReview #UMN about 3 hours ago via bitly (from @wbgleason)

RT @wbgleason: Journalism organizations too cozy with drug industry... http://bit.ly/bh8uaZ Gary Schwitzer's HealthNewsReview #UMN about 3 hours ago via HootSuite (from Michael Caputo, Minnesota Public Radio)

I wish more journalists like Caputo would report on this. Journalists have been terribly quiet. I know at least one news organization plans to report on this soon because I've been asked for a reaction by a reporter via email this afternoon.

This one shouldn't be swept under the rug because it's questioning a "news foundation."

Addendum on August 24: For more, read Christopher Weaver's piece on the NPR Shots health blog.

And my followup to what was said in that piece, even if National Press Foundation staff choose the speakers and set the agenda, even if the Pfizer "guy never even showed up" last year, even if one reporter doesn't recall Pfizer even being mentioned once at last year's session, one fact remains. Some journalists will have taken Pfizer money to attend this session. Journalists are taught to avoid even the perception of conflict. Or are they taught that anymore?

Addendum on August 25: Other key perspectives just posted by Merrill Goozner on his blog.

Addendum on August 27:

Just today, the National Press Foundation invited me to speak at this year's Pfizer-funded session. From NPF: "You may speak on any topic you like related to journalism or cancer coverage, including matters relating to the current online discussion of this program."

That was a gracious, proactive and open-minded move by NPF and I thank them for it and applaud them for it.

Unfortunately I cannot attend because of a longstanding prior commitment. I have communicated this to NPF and also stated my desire to meet with them to discuss these issues in the future.

The debate on this issue has been healthy, although, at times a bit acrid. I regret if any of my comments contributed to that tone or were interpreted in the wrong way. My passion runs deep on this issue, as I know it does in those who have voiced differing opinions.

I've devoted my entire career to the improvement of health journalism. I wrote the Statement of Principles of the Association of Health Care Journalists and just wrote an AHCJ guide on how to report on research. I'm traveling >70K miles/yr. - all devoted to health journalism improvement.

I look forward to exchanging ideas with NPF.

NPR: more evidence that newer isn't always better - this time with birth control pills

2010-08-23T13:42:53Z

Very important and very well done story by Richard Knox of NPR. It's enterprise reporting - not something he did in response to a news release coming across his desk. He evaluated evidence. He found troubling patient stories in young women - not the glowing, happy faces and balloons the drugmaker provides in ads and testimonials. He interviewed several expert sources.

This is a must read - you can read the text online.

Or a must-listen, which you can do here:

TMI on health for young women? Or too much of wrong kind?

2010-08-20T15:17:33Z

Interesting piece by Elizabeth Cooney in the Boston Globe, "TMI! - Too much information? Chat rooms, infomercials, tweeting: Young women face new challenges in search for solid answers about their health."

Interesting sidebar:

Top 10 questions from young women

Dr. Hope Ricciotti, gynecologist-obstetrician, says these are among the most frequent queries she gets from her youngest patients:

1. How can I get rid of PMS?
2. Does what I eat really make any difference?
3. I'm thin, so I don't have to exercise, right?
4. Do I have to exercise?
5. How can I have better sex?
6. Do I really have to tell you everything?
7. Can a Pap test detect sexually transmitted infections?
8. Can my underwire bra cause breast cancer?
9. Is a manicure good or bad for my health?
10. What does that vaginal discharge mean?

The story quotes one young woman with an interesting perspective: "I usually go to the Internet, but it can be troublesome. I make sure I look at the credentials of whatever I'm looking at. On WebMD, it can be nerve-wracking when you list several symptoms and it may make you seem like you have a bigger problem than you actually do.''

And the story lists resources for young men as well.

"Hazards of market-driven research" - look back at ethical quagmire at University of Minnesota

2010-08-20T14:06:48Z

On MinnPost.com, Susan Perry previews a piece in next month's Mother Jones magazine by Dr. Carl Elliott of the University of Minnesota about the suicide of a young man who was enrolled at the time in a University of Minnesota industry-funded clinical trial of the antipsychotic drug Seroquel (quetiapine). Perry writes:

"It's a disturbing tale (the unsuccessful efforts of (patient Dan) Markingson's mother to get her son released from the trial and into other treatment are particularly heartbreaking) and one that, as Elliott acknowledges, was first told in the Pioneer Press by Jeremy Olson and Paul Tosto.

But Elliott's purpose in writing the article wasn't only to revisit the tragic details of Markingson's story. "[T]he more I examined the medical and court records, the more I became convinced that the problem was worse than the Pioneer Press had reported," he writes. "The danger lies not just in the particular circumstances that led to Dan's death, but in a system of clinical research that has been thoroughly co-opted by market forces, so that many studies have become little more than covert instruments for promoting drugs. The study in which Dan died starkly illustrates the hazards of market-driven research and the inadequacy of our current oversight system to detect them."

The story is a sorry chapter in a checkered history of U of Minnesota medical school research ethics practices.

Perry advises that "The Mother Jones article reaches subscribers' mailboxes today. Everybody else will have to wait until it hits the newsstands on Aug. 31."