That's the title of an editorial in this week's Annals of Internal Medicine (subscription required - even though the article is marked as "free" on the Annals home page.)

It's a reflection on the US Preventive Service Task Force's recommendations on breast cancer screening from last fall. The Annals editors remind readers:

"Although some subspecialty organizations advocate more aggressive routine breast cancer screening, the update actually aligned the USPSTF recommendations more closely with guidelines from the American College of Physicians, the World Health Organization, and the United Kingdom's National Health Service."

Other excerpts:

"Annals posted a survey on our Web site to solicit readers' impressions. The responses suggest that clinicians are more inclined to change what they do in light of the new recommendations than are members of the general public. ...

Clinicians who offer advice compatible with the new USPSTF recommendations are likely to meet resistance. Most women who responded to the survey resolved to continue as routine the practices that the USPSTF advises against being routine. ...

The Task Force's charge is to provide evidence-based, population-level guidance. Only rarely does evidence unequivocally support a single, definite "one-size-fits-all" recommendation. As the breast cancer recommendations so vividly illustrate, clinicians must often invoke the art of medicine to apply available evidence to an individual patient. Before these most recent guidelines, many clinical encounters about breast cancer screening probably involved little more than the physician handing the patient a mammography referral. Going forward, these interactions will surely involve more discussion about risks, harms, benefits, and preference. The Task Force's intent was to motivate such rational discussion, not to ration care. ...

Because the USPSTF issued recommendations that were politically unpopular among some constituents, there have been calls to curtail this independent body's work. If the USPSTF sinks in turbulent waters whipped up by emotion, anecdotes, and politics, Americans should mourn its loss."

Finally, the Annals editors referred to "a media cacophony" - a phrase I've used in reference to coverage of this episode. They wrote that "the media and politicians presented the breast cancer screening recommendations as a major departure from existing guidelines that heralded an age of rationed care in the United States. Confusion, politics, conflicted experts, anecdote, and emotion ruled front pages, airwaves, the Internet, and dinner-table conversations."

This episode was - and still can be - a golden opportunity for informing people about evidence - and for shared decision-making. This won't be last collision between evidence and anedote/politics/emotion. Will we be any smarter next time?

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.

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."

Natasha Singer's story looks at ads for cancer centers that tout high cure rates and low risk but no evidence to back that up. Testimonials rule the message. She writes:

"In medical science, such anecdotal data would not be considered statistically valid. But ads for nonprofit medical centers are not held to scientific standards of evidence.

....If a drug maker ran an ad for a cancer medicine, Food and Drug Administration regulations would require the company to be able to support any superiority claims with substantial evidence from rigorous clinical studies.

But federal agencies cannot limit the ad claims made by nonprofit medical centers about their ability to cure people of diseases like cancer, according to the government's main ad regulator, the Federal Trade Commission.

Cancer experts interviewed for this article say there are no comprehensive statistics showing that any one elite medical center has better overall cancer success rates than its competitors. "

It's an important story. Read the whole thing at the link above. And don't miss the great use of multimedia - with radio, TV and print ads included in the online story in the left margin.

It's noteworthy when news stories look closely at the decision-making approaches that patients employ.

Case in point: a New York Times column on a study of 632 women whose five-year breast cancer risk projections might seem to make them leading candidates to take the drug tamoxifen.

Excerpt:

"Virtually every woman in the study said she would be unlikely to take the drug. Just 6 percent said they would consider it after talking to their doctors, and only 1 percent reported actually filling a prescription for it. Fully 80 percent cited worries about side effects.

"When the numbers were laid out for them in a way they could clearly understand, they weren't interested in taking tamoxifen," said Angela Fagerlin, associate professor of internal medicine at the University of Michigan and the lead author of the study, published in the journal Breast Cancer Research and Treatment. "They didn't think the benefits of tamoxifen outweighed the risks."

The column suggests that these reactions surprise and concern some doctors and researchers.

But look at how the story itself was framed in the opening lines:

"If someone invented a pill to cut a cancer risk in half, would you take it? Who wouldn't? Apparently the answer is millions of women."

If these women were fully informed about benefits and harms of tamoxifen, then they learned that "cut in half" is a relative risk reduction figure. Half of what? According to the story, it's a reduction from 19 breast cancer cases over 5 years in 1,000 women down to 10 cases. Or an absolute risk reduction from about 2 percent down to 1 percent.

We have much to learn about how people process risk reduction figures. But one thing journalists must learn is that absolute risk reduction figures are far more helpful to readers and patients and consumers than the more impressive-sounding relative risk reduction figures.

See our primer on this topic.

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

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

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

Huh?

It got worse, as he wrote:.

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

Stop the foolishness.

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

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

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

It got worse. Much worse. As he continued:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

John Crewdson in The Atlantic:

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

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

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

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

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

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

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

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

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

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

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

1. This is all about saving money.

2. This is about rationing.

3. Early detection saves lives.

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

5. The shifting recommendations prove that scientists are clueless.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A quote in a New York Times story yesterday:

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

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

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

And now it's happening again.

From the LA Times:

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

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

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

In the Washington Post:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It's a TV sweeps ratings period, and it's also breast cancer awareness month, so any boob could see this coming.

The Washington Post makes a big deal of the fact that DC station WJLA is making an even bigger deal about:

"...breaking TV's unspoken taboo by showing two women fully exposed on its late-afternoon and evening newscasts."

...

WJLA acknowledges, however, that the timing of its stories may raise some eyebrows: The reports will air on the first two days of TV's traditional "sweeps" month, a period in which stations air their most eye-catching stories to boost ratings that are used to set advertising rates.

WJLA general manager Bill Lord said he had no qualms about the timing of the reports, or in promoting them beforehand. "People will say we're doing it just for ratings," he said. "But we're a commercial television station -- we're trying to get people to watch us. Yes, this is an attention-getting story, but it's also an important story."

Tell me that even this dramatic viewer warning about their online video isn't meant to titillate:

But the Post story buries the real story, only deep in the story getting to the question of how newsworthy this really is:

"The effectiveness of self-exams as an early cancer-detection method, however, has been questioned in recent years. The National Breast Cancer Coalition says medical studies suggest that the exams are not useful and can lead to "elevated anxiety, more frequent physician visits and unnecessary biopsies of benign lumps."

The American Cancer Society says self-exams play only "a small role" in finding breast cancer. On its Web site, the society says "it's okay not to do [a self examination] or not to do it on a fixed schedule."

At least the Post touched on these issues. The WJLA report never did.

But good luck telling that to a TV news director in the middle of a ratings period.

And good luck trying to talk about evidence (or lack thereof) when a naked breast can give you the bump in the ratings you need so badly.

Now, will they do the same thing for testicular cancer?

Excerpt from Dr. Len Lichtenfeld's blog posting, criticizing both the JAMA article and the NYT article this week that raised questions about screening.

"This was an opinion piece, not original research. It reiterated arguments that have been made before, and are certainly valid. But they represent the thoughts of several respected scientists, but not all who are involved in trying to reduce the burden of cancer in this country and throughout the world.

And while we may agree with the comments about prostate cancer, we do not agree with the negativistic comments about breast cancer. As noted in the New York Times article, when the public gets a mixed message it takes that as a reason not to move forward with the most effective breast cancer screening modality we have available today. ...

The sad part is that the women in this country may only read the New York Times, and leave it at that. They will miss the nuances of the experts' arguments. They will not read the conclusions of the JAMA study, and if they do they probably won't have the working knowledge that would put it in context.

Hopefully they won't miss the nuances that could impact their lives. That would be a tragedy. But such is the risk of living in a sound bite world."

Gina Kolata had her article in the Times - subject of my blog earlier today (below).

Later, the American Cancer Society issued this news release (Is it a retraction? Is it a correction? Is it 'we wish we hadn't said that to the NYT?' Is it "Gina Kolata got it wrong?' What is it?).

CBS 60 Minutes once again devoted a big chunk of prime time last night to an unproven idea - which is fine, if you're going to devote your show to such explorations of basic science all the time. But they don't. And it shows.

The subject was the pie-plates-and-radiowaves cancer experiment of inventor John Kanzius - which CBS has now profiled three different times - in April 2008, in July 2008, and now on October 18, 2009.

Correspondent Lesley Stahl exhibited some of the same breathless awe that she showed in previous segments, saying at one point, "we don't want to be in a position to hype this."

Too late, Lesley, you already have - with three segments in 18 months for something that isn't even in human trials.

I can only wonder what all the other cancer researchers watching think when they see such cheerleading for such little evidence.

Presidents have said some whacky stuff - even on network TV.

But journalism organizations - rather than treating such appearances as "open mike" night - have an obligation to listen, to react, to ask tough questions.

So when former President Bill Clinton was interviewed on ABC's Good Morning America today, shouldn't we have expected some kind of challenge to his wild statement that - because of what's now known about breast cancer genetic variations - females "should be tested as soon as possible after they're born - young girls, for example, for breast cancer" - ???

And then Clinton went on to predict that someday we would go in for our annual checkup and "stand in a cone and our bodies will be scanned and now submicroscopic tumors will be picked up."

It is the identification of submicroscopic are-they-tumors-or-are-they-something-else abnormalities that already create confusion for patients and their physicians in screening of the prostate, breast, cervix and more.

I guess it was expecting too much to have Good Morning America reflect on any of this.

The South Dakota resident who sent me this clip wrote, simply, "Just...wow."

Keloland News Healthbeat reporter Kelli Grant is taking you to an appointment every man over 50 should schedule with their doctor.

That's an editorial/advocacy stance not backed up by evidence-based guidelines from many major medical and heatlh care organizations. And news stories aren't supposed to do that.

TV news prostate cancer awareness month promotions apparently try to do good.

But they miss the mark when they fail to tell men that The American Cancer Society, for example, does not support routine testing for prostate cancer at this time.

The "every man should" message discourages complete, balanced, informed decision-making. There shouldn't be an "every man should" message just as there shouldn't be an "every man shouldn't" message.

If TV can't take the time to explain these issues more completely, they shouldn't cover them at all.

On the very day that we announced that HealthNewsReview.org would no longer systematically review network TV health news stories, we were provided two fresh examples - both on ABC - of the sorry state of many network TV health news efforts.

Reporting on the two studies in the Journal of the National Cancer Institute that raised important questions about both prostate cancer screening and breast cancer screening (at least the role of clinical breast exams), ABC still managed to end up with strong statements of endorsement - DESPITE the evidence on which they just reported.

On ABC's World News Tonight, reporter Dan Harris turned to a New York urologist for his only expert interview on the prostate issue. He didn't interview the authors of the study. Nor Dr. Otis Brawley of the American Cancer Society who wrote a powerful accompanying editorial. He only turned to a urologist, who makes his living off of diagnosing and treating prostate cancer.

Harris asked the urologist: "Seeing this study, one is tempted to conclude that you should stay away from early screening. Is that the right conclusion to reach?"

The urologist responded: "That's absolutely the wrong conclusion to reach. ...You should be screened because if you had cancer you'd want to know about it."

Harris' conclusion: "Bottomline: doctors we spoke with today said you should still go for early screening but you should know that these tests are not foolproof."

Harris said they spoke with "doctors" (plural). Viewers should ask: which doctors? Who were they? Were they all urologists? Why didn't you have the authors appear (one of whom is a urologist)? We only heard from one urologist.

Then, on ABC's Good Morning America this morning, medical contributor Dr. Marie Savard reviewed the two studies. Savard wrapped up her discussion with anchor Diane Sawyer by emphasizing that the digital rectal exam (one prostate screening option) "is still important."

Savard: "Men you still need to appear every year and get checked."

Diane Sawyer "You'd rather have a false positive than something missed."

Savard's opinion and Sawyer's rhetoric clash with the recommendations of major scientific and medical organizations, which don't differentiate between PSA tests and digital rectal exams.

On the American Cancer Society website are these statements:

Neither the PSA test nor the DRE is 100% accurate. Abnormal results of these tests don't always mean that cancer is present, and normal results don't always mean that there is no cancer. Uncertain or false test results could cause confusion and anxiety. Some men might have a prostate biopsy (which carries its own small risks, along with discomfort) when cancer is not present, while others might get a false sense of security from normal test results when cancer is actually present.

No major scientific or medical organizations, including the American Cancer Society (ACS), American Urological Association (AUA), US Preventive Services Task Force (USPSTF), American College of Physicians (ACP), National Cancer Institute (NCI), American Academy of Family Physicians (AAFP), and American College of Preventive Medicine (ACPM) support routine testing for prostate cancer at this time.

Over and over and over I have written about how many news organizations stick to the pro-screening message despite the best and latest evidence.

ABC News has done it again - twice - in different programs.

There were opportunities here to drive home the importance of shared decision-making, to explain the uncertainties, to show how there isn't one best choice for all people. But despite the fact that they reported on the studies - mostly accurately - they still left viewers with strong screening endorsements at the end of both programs.

That's advocacy, not journalism.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

King (going to commercial break):

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

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

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

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

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

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

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

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

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

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