Gary Schwitzer's HealthNewsReview Blog

March madness means marketing for urologists

2010-03-09T16:00:41Z

Ahhh, spring! When a young man's thoughts turn to:

• urinating at baseball Spring training
• getting a vasectomy during basketball March Madness.

Am I right?

I am if I do marketing for urologists.

American Medical News reports that some urologists are trying to get men's attention by marketing March Madness as a great time to get a vasectomy. Excerpt :

"After all, men, if you're going to do something that requires you to sit around in a bathrobe, doing nothing for two days, why not do it when there's wall-to-wall basketball on TV?

For a growing number of urology practices, tournament time has become key to marketing a procedure that many men put off or avoid out of -- shall we say -- sensitivity. And because many men meet a urologist for the first time through a vasectomy, the practices find it a great way to get their names out to new patients."

They market under the labels "Rip City" or "Snip City" or with "I Got Chopped at the Urology Team" T-shirts. You can see the gory details at the link above.

But as basketball season winds to a dramatic close, baseball season fires up again.

Indefatigable Yankees fan Ivan Oransky followed his Bombers to Florida for Spring training last week, presumably imbibed, presumably relieved, and found this urinal screen in the process:

My wife made me block out the urologist's name and phone number. She said, "You're not going to give that guy any more free publicity."

I can't imagine anyone at a urinal writing down the urologist's name and number. I can only imagine Ivan taking out his cell phone and taking a picture. I know he feared ending up on a post office wall for this. He may still.

Imagine the urologist deciding on the need for a marketing campaign and going to the
PeePeeFace.com site and choosing his personalized urinal screen.

Now that's a fan. Or a urologist desperate for customers.

(Correction: Ivan Oransky advises that he saw the Cards play the Marlins. Not a Bronx Bomber in sight.)

Kudos to ABC for story on leg fracture risks from osteoporosis drugs

2010-03-09T15:26:28Z

Dr. Richard Besser reports - as summarized on the ABCNews.com website - "Fosamax, one in a class of drugs called bisphosphonates, is supposed to make bones stronger, and for many women, it is safe and effective. But now there's mounting evidence that, for some women, taking these medications for more than five years could cause spontaneous fractures."

Journal editor troubled by Obama's CT scan for coronary calcium & virtual colonoscopy

2010-03-08T22:32:02Z

Archives of Internal Medicie editor Rita Redberg writes:

"I was troubled to read that the President's physical examination included an electron beam computed tomographic (CT) scan for coronary calcium. This screening test likely exposed Mr Obama to significant radiation unnecessarily, increasing his risk of future cancer. ...In light of this radiation risk, and the lack of proven benefit in low-risk persons, the US Preventive Services Task Force (USPSTF) recommends against this test in men such as Mr Obama. In addition, the leading professional cardiology societies do not recommend coronary calcium screening for such men. ...According to news reports, Mr Obama also underwent colon cancer screening, even though this screening is not recommended in his age group. Moreover, even when he reaches age 50 next year, the recommended colon cancer screening tests are either fecal occult blood test or colonoscopy. The USPSTF does not recommend virtual colonoscopy for screening, as performed on Mr Obama, owing to the lack of supporting evidence. This CT colonography test, like the electron beam CT scan, increased his radiation exposure and subsequent cancer risk.

Inadvertently, but perhaps fittingly, the reports of Mr Obama's physical examination reflect some of the key challenges facing health care reform today--Mr Obama appears to have been administered 2 cutting edge, expensive diagnostic tests that exposed him to a radiation risk while likely providing no benefit to his care. Some might defend these tests on the grounds that the President, of all people, deserves the very best our health care system can provide, but that would miss the point: more care is not necessarily better care. If the tests have no proven benefit for patients like Mr Obama, then they have no benefit for Mr Obama himself. Worse, evidence shows that the performance of unnecessary tests is not limited to Mr Obama or some select few patients. On the contrary, Mr Obama's case is multiplied many times over at extraordinary cumulative financial cost to society and personal cost to the individuals who receive tests with known adverse effects and potential harms but without benefits.

It is unlikely that Mr Obama will have a dispute with his insurance company over the costs of the tests performed at his physical examination, whether or not they were necessary, but it is a certainty that we all will have great disputes over the spiraling costs of health care for the rest of us."

The high-tech prostate treatment train has left the station...before the evidence is in

2010-03-08T21:43:32Z

MedPageToday.com reports some staggering numbers that show how "expensive prostate cancer treatments are winning out over the old standards, driving up the cost of treatment before there's clear evidence that they improve outcomes." For example:

Robotic and laparoscopic procedures jumped from 1.5% to 28.7% of radical prostatectomies in the Medicare population between 2002 and 2005. MedPageToday reports:

This exponential growth appears to have run ahead of the evidence, which includes a prior analysis by a Brigham and Women's team showing that minimally invasive prostate surgery doubles risk of genitourinary complications despite shorter hospital stays, and another study suggesting neither benefit nor harm.

Among external beam radiation treatments, intensity-modulated radiation therapy jumped from 28.7% in 2002 to 81.7% in 2005 and perhaps 100% by now.

Within brachytherapy, the addition of intensity-modulated radiation therapy jumped from 8.5% to 31.1% over the same period.

Any evidence of benefit is only coming in now after the fact. But the high-tech train has already left the station. It's not known how much these technologies are costing Medicare.

And the prediction is that proton beam therapy will dwarf all of these technologies in cost.

Syracuse professor hired to rid health insurance system of conflicts brings conflict of her own

2010-03-08T15:33:29Z

Syracuse reporter James Mulder cracked this story.

As with the Chicago Tribune story cited earlier today, this story ends with a powerhouse quote from one observer:

"You may not think you are being biased, but if you make 10 minor decisions in a row that are all slightly biased, all those little biases add up in the end. It's an unhealthy situation."

Hat tip to Pia Christensen for the tip on this.

Kudos to Chicago Tribune front page story on "perfect storm" of CT radiation risks

2010-03-08T14:50:29Z

Headline: "CT scans may pose cancer risk, new research indicates: Doctors, patients should weigh risks vs. rewards of medical imaging." Good infographics in the paper and online (see below). And a sober ending:

"And some doctors who own scanning equipment have a financial stake in diagnostic imaging. Research shows that doctors who own machines perform two to seven times more imaging tests than those who don't, said Dr. Vijay Rao, chair of radiology at Thomas Jefferson University Hospital in Philadelphia.

Moreover, "the physicians who own this equipment and order the tests have generally had no training in radiology and little understanding of the complexities of radiation dosing" and its attendant health risks, Rao said. "For patients, this is absolutely the perfect storm."

Science & chronic fatigue syndrome: criticism of journal reviewing

2010-03-05T17:23:51Z

There's a very important "Observations" article in this week's BMJ (subscription req'd for full access). University of Edinburgh scientist Cathie Sudlow writes about a paper in Science that reported an association between a retrovirus and chronic fatigue syndrome. Excerpts:

"... after reading and rereading the article and its online supplement I could find little description of the epidemiological methods. Where were the details of the characteristics and selection procedures for the cases and controls or of blinding of researchers to the case-control status of the samples? Where was the discussion of the potential roles of bias and confounding?
...
Concerned about the lack of basic methodological information in the Science report, some colleagues and I sent an e-letter response, a week after the initial online publication of the paper. E-letters are described on Science's website as "online-only, 400-word contributions for rapid, timely discussion." But no e-letter responses to the paper appeared--and indeed still have not. In early January this year, nearly three months later, a Science editor emailed to explain that they had received a number of responses to the paper and had decided to consider our submission and others as refereed "technical comments," which appear in Science Online with a response from the authors of the commented paper. By early February we had received referees' largely enthusiastic comments and an invitation to resubmit an appropriately revised version of our comment, which will hopefully be published soon.

In the meantime three published studies that used samples from the United Kingdom and the Netherlands have found no association between (the retrovirus) and chronic fatigue syndrome.

I am pleased that our concerns about potential shortcomings in the methods of the original Science report of this association are likely to be formally published. But the story has led me to reflect on how the whole process of scientific discovery is communicated. What can be done to avoid the false hope that follows an initial report of a breakthrough, which will often later be shown to be a false positive finding or an overestimate of the truth? (my emphasis added) Does a system of genuinely rapid responses to journal articles help, or is a slower and more selective approach such as that taken by Science a better way of reflecting the subsequent scientific debate? I am uncertain, although a forum for such debate must surely be offered by scientific and medical journals.

More importantly, though, I believe that scientists, journal editors, and reviewers must all take more responsibility for ensuring that the published scientific record contains all the information needed to judge the accuracy and reliability of the reported results. Scientists and journals must be careful that the excitement of novel findings and the draw of the impact factor do not lead to important details being overlooked."

Dimebon for Alzheimer's: in journalism, from "miracle" to "flop" in 20 months

2010-03-04T15:47:08Z

It was just 20 months ago that ABC News called the drug dimebon a "miracle for Alzheimer's Disease."

They weren't alone in singing the drug's praises after a preliminary trial. WebMD proclaimed, "Dimebon Shines as Alzheimer's Therapy."

Yesterday, MedPageToday.com reported, "Novel Alzheimer's Drug Flops." Excerpts of their story:

The investigational Alzheimer's disease drug dimebon failed in the pivotal CONNECTION trial of patients with mild-to-moderate disease, the drug's makers announced today. Latrepirdine did not result in significant gains on any of the five efficacy endpoints versus placebo after six months of treatment, according to Medivation and Pfizer, who have a partnership to develop the drug.
...
Peter Davies, PhD, an Alzheimer's disease expert at Albert Einstein College of Medicine in New York City, said in an e-mail, "I am personally disappointed, but not surprised."

"The results from the (earlier widely reported) study were too good to be true."

There's a reason why words like "miracle...breakthrough...promising...hope" can be troublesome in medical research stories. This is another example.

(My thanks to Andrew Holtz for his inspiration on this post.)

Fox News contributor has conflict of interest on prostate CA screening discussion

2010-03-03T21:09:31Z

Here's another problem with the practice of TV networks using physician "contributors" to comment on health care news. They may have a clear conflict of interest that is not addressed.

When the American Cancer Society released its updated guidelines on prostate cancer screening today, Fox News reported:

"Dr. David Samadi, a Fox News contributor and chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City, said he thinks the new guidelines could cause unnecessary deaths.

"In my practice, we find men in their 30s and 40s that are at high-risk and develop prostate cancer," Samadi said.

"Knowing your PSA is power, it is educational; you follow it all the time. You can find a silent prostate cancer that will not affect you, and there is a possibility to over-diagnose, but that's a risk the patient needs to take. You could also find cancer that could lead to death."

The number of prostate cancer deaths continues to decline because of regular screening, Samadi added.

"I really recommend (the age) of 40 as a baseline age," Samadi said."

Doesn't Fox see that he has a blatant conflict of interest on this topic as one who runs a robotic surgery center? There are countless ways to counter these short quotes from Dr. Samadi, but I'm not going to run through them here. Read the Cancer Society report and you'll find all of them there - in dispassionate, non-conflicted, evidence-based depth.

Look at how Katie Hobson of US News & World Report included an expert urologist's input, and one with a much more open-minded and balanced perspective.

"... the gist of all this is a firm end to the notion, still held by some clinicians, that screening for prostate cancer is "the same as colorectal cancer screening or cholesterol screening," says Durado Brooks, director of prostate and colorectal cancers for the ACS and coauthor of the report.

"There has to be a conversation," says John Davis, assistant professor in the department of urology at the M. D. Anderson Cancer Center in Houston. "And these guidelines give some very nice bulleted points and Web links you could build into an information sheet and give to patients."

"Against backdrop of uncertainty and controversy" ACS updates prostate screening guidelines

2010-03-03T15:00:03Z

The American Cancer Society has just released updated guidelines on prostate cancer screening.

Because of the uncertainties of benefits vs. harms of such screening, the ACS puts a new emphasis on shared decision-making and on the use of patient decision aids to help men.

Excerpts from ACS statements released today:

"As it has since 1997, the American Cancer Society advises against a general recommendation for men to undergo screening, instead saying testing should only occur when a man is provided the opportunity to learn about the limitations and potential benefits of screening and treatment.

...The guidelines now outline the uncertainties regarding the balance of benefits and harms associated with screening. They clearly state that every man should be told of the uncertainties, risks and potential benefits of screening, and that no man should be tested without receiving this information."

On the problems with big community screening events:

"The American Cancer Society discourages participation in community-based prostate cancer screening programs unless those can adequately provide for an informed decision-making process and appropriate follow-up. For men who have limited or no access to other sources of care, community-based screening programs may provide the only opportunity to make an informed decision about testing. Men who are contemplating screening through these programs should first receive high-quality objective informed decision-making, either through interaction with trained personnel, or through the use of validated, high-quality decision aids, appropriate to the target population. Since virtually all men age 65 years and older have health insurance through Medicare, they should be discouraged from participating in community-based screening programs, and should be referred to a primary care provider."

The Foundation for Informed Medical Decision Making (disclosure: they support this HealthNewsReview.org project) posted a video clip with its president, Dr. Michael Barry, reinforcing the shared decision-making message.

For now, the Foundation's shared decision-making program on prostate cancer screening can be seen online. Check it out.

Does Vitamin D lower heart risk? Depends on which news story you read!

2010-03-02T19:07:00Z

WebMD headline: "Vitamin D linked to lower heart risk."

Reuters headline: "Calcium, Vitamin D pills don't help heart."

Same study. Quite different stories.

Look at how the evidence was analyzed differently.

WebMD:

"Researchers found six studies (five of which involved people on dialysis and one which included the general population) showed a consistent reduction in heart-related deaths among people who took vitamin D supplements. But four studies of initially healthy individuals found no differences in development of heart disease between those who received calcium supplements and those who did not.

A second analysis of eight studies showed a slight, but statistically insignificant 10% reduction in heart disease risk among those who took moderate to high doses of vitamin D supplements."

Reuters:

"Some studies did show that vitamin D supplements cut the risk of dying from heart disease and stroke. However, most of these involved patients with severe kidney disease who were on dialysis, a vast difference from healthy individuals, (the senior author) noted.

The remaining studies failed to show any meaningful benefits of vitamin D, calcium, or a combination of the two."

The WebMD piece seemed to keep trying to make the case for there being some heart benefit from vitamin D when that isn't what the results they presented indicate. No matter how you cut it, the evidence in favor of vitamin D having heart benefit is not robust, so how did they decide on the definitive headline, "Vitamin D linked to lower heart risk"?

The Reuters story helped people understand that more vitamins isn't necessarily better - with the editorial writer's quote, "We've learned in the past that things can go really, really wrong" when people start taking vitamin pills.

Connecting the dots between online self-screening-tests and pharma funding

2010-03-01T21:22:39Z

Psychiatrist Daniel Carlat, on his terrific blog, raises questions - just as Senator Chuck Grassley is doing - about a WebMD TV commercial that leads viewers to take an online depression screening test. The test was funded by Eli Lilly--information that was apparently omitted from the TV commercial.

Carlat says the WebMD test takes the DSM-4 list of nine possible symptoms of depression, but adds a tenth:

"I'm having frequent headaches, stomach problems, muscle pain, or back problems.Yes or No"

Carlat believes that happens, as he writes:

"Because Lilly markets Cymbalta as the "go to" antidepressant for patients who have both depression and physical pain. This is not really a "depression screening test" at all. Instead, it is a "Cymbalta-requester" screening test.

WebMD is telling the public a big lie. The say that "this content is selected and controlled by WebMD's editorial staff" when in fact the crucial aches and pains questions was selected by Eli Lilly's marketing team to encourage patients to ask their doctors for Cymbalta."

Niche blog tracks embargo issues

2010-03-01T17:19:13Z

What a great idea for a blog - with a focus solely on the practice of embargoes in the management of the flow of health/medical/science news and information.

Reuters Health executive editor Ivan Oransky just launched his Embargo Watch blog last week but already has a faithful following. It's evidence, I think, of what a sore subject embargoes are and have been with so many who have toiled in these fields for so (too?) long.

In his initial post, Oransky wrote:

"You've probably noticed that every major news organization -- including mine, Reuters -- seems to publish stories on particular studies all at once. Embargoes are why.

A lot of journals, using services such as Eurekalert.org, release material to journalists before it's officially published. Reporters agree not to publish anything based on those studies until that date, and in return they get more time to read the studies and obtain comments.

That would seem to be a good thing for science and health journalism, much of which is reliant on journals for news because it's peer-reviewed -- in other words, it's not just a researcher shouting from a mountaintop -- and punctuates the scientific process with "news events."

Vincent Kiernan doesn't agree. In his book, Embargoed Science, Kiernan argues that embargoes make journalists lazy, always chasing that week's big studies. They become addicted to the journal hit, afraid to divert their attention to more original and enterprising reporting because their editors will give them grief for not covering that study everyone else seems to have covered.

But even if embargoes are a necessary evil, they're not uniform, and how each organization deals with them provides case studies in some of the chinks in embargoes' armor."

Ironically (or was this a test case?), Reuters itself lost its advance notice "privileges" from the American Heart Association last week for jumping an embargo by a whopping 43 minutes. (Correction added 12:21 pm Central time, March 1: They jumped the embargo by 1 hour and 43 minutes. A bit more whopping.)

The Embargo Watch blog is a great concept. It becomes a repository for embargo-related issues. It provides a social media platform for all parties involved in the dissemination of health/medical/science (and other) news and information to weigh in on the issue. Who knows? It may even lead to a better system.

The news love affair with robotic surgery - even simulators

2010-02-26T20:58:34Z

We've written before about some of the headlines praising robotic surgery:

• Robot doctor - surgery of tomorrow

• Da Vinci puts magical touch on the prostate

• Cancer survivors meet lifesaving surgical robot

• Robotic surgeon's hands never tremble

• Da Vinci is code for faster recovery

• Surgical Maestro

• DA VINCI ROBOT IS SURGERY WORK OF ART

Now even the news that a company is testing a couple of robotic-surgery-training-simulators "and expects the units to go on sale for about $100,000 by early 2011" makes news.

The AP reported it (this is their photo at left of the news conference) and the story was picked up by ABC News.com, CNBC, the Los Angeles Times and elsewhere.

Granted, a simulator that might help train docs in what seems to be the inevitable spread of this technology might be an important quality/safety improvement.

But the AP story that spread across the country didn't mention any concerns about the medical arms race involving robotic devices, nor any questions about evidence.

• Hold news conference.

• Demonstrate gizmo.

• Get nationwide news.

How easy it can be to get free publicity, without ever having people focus on some of the important policy questions at stake. But after this week, who cares about health care policy, anyway?

Is the subject of this story going to kill you or cure you?

2010-02-26T15:20:05Z

There's now a website that actually tracks The Daily Mail of London to categorize its stories as either "kill or cure" stories. The site quotes British physician-author Ben Goldacre: "The Daily Mail, as you know, is engaged in a philosophical project of mythic proportions: for many years now it has diligently been sifting through all the inanimate objects in the world, soberly dividing them into the ones which either cause - or cure - cancer."

Visitors to the site can vote on the stories.

So far, the following things cause cancer: age, air pollution, air travel, aluminum, artificial flavors, artificial light.... You get the picture. That's only in the A alphabetical listing.

So far, the following things prevent cancer: bananas, Brazil nuts, breakfast, etc. Beer, it should be noted, both causes and prevents cancer!

Hmmm. I may have just received inspiration for a new health news review project in this country!