Overactive bladder is one of the poster children for disease-mongering. Some have written that it's a "created new disease."

Others have analyzed that its prevalence has been over-estimated.

The folks at WorstPills.org (Best Pills, Worst Pills - a project of the Public Citizen's Health Research Group) write that there are huge questions about the drugs created to treat it:

"All of the drugs currently approved in the U.S. to treat overactive bladder work about the same. The results are all statistically significant, and they are better than nothing, but their effect is minimal (a reduction of about one urination per day compared to a placebo)."

They explain that the six drugs - yep, count 'em: six drugs for overactive bladder - are so-called anticholinergic agents.

"Unfortunately, these anticholinergic effects are both what makes them effective and what makes them potentially harmful. Although for patients with overactive bladder difficulty urinating is the intended effect of the drug, that same difficulty is, in a sense, a side effect of the drug. Taking more of the drug strengthens all of the side effects -- including both the desired effects, such as reduced urination, and the ones you do not want."

Hmm. Did you learn any of that in the TV drug ads?

NOMINATED AS 2009 BEST MEDICAL BLOG - YOU CAN VOTE HERE

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

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

NPR offers an in-depth look at the creation or re-definition of a disease and, as they call it, the "complicated biography of a medication" to treat it. Important story.

Thank God for hospital chaplains - and special thanks for those who are also smart bloggers.

See this chaplain's blog (here and here) for how he evaluated a CNN/Health.com story, "Cholesterol jumps with menopause."

The story included this line:

"A new study shows beyond a doubt that menopause, not the natural aging process, is responsible for a sharp increase in cholesterol levels."

The chaplain wrote:

"So, just when, we asked one another, did menopause cease to be part of the natural aging process for all women? ... In fact they determined that for several measures of cholesterol, menopause was more predictive than age, while for other risk factors age was more predictive. However, in neither case was there any implication that menopause wasn't "natural;" only that in the natural course of things different women experienced it at different ages."

Chaplain, pray for us that we can all learn to scrutinize health care news as well as you do.

The New York Times published a couple of good articles that touched on the theme of disease-mongering this weekend.

One documented how drug companies sold hormone replacement therapy by making menopause into a disease.

The other showed how drug companies are turning premature ejaculation into a disease that requires treatment.

Disease-mongering for men and women. An equal opportunity marketing tactic. Find it in play in a drug ad near you.

Two CNN anchors join the ranks of other journalists (see my blog from just 2 days ago) who have jumped on the "let's screen every American kid's heart" bandwagon.

First, I heard anchor Kyra Phillips say there was an "unprecedented rise in the risk of serious heart problems in children" - calling it "a ticking time bomb."

She and the network provided no evidence about that "unprecedented rise." No numbers. Just hyperbole.

Then Campbell Brown interviewed the Houston doctor who reported screening 100 kids and finding two who needed surgery.

Brown concluded the segment by saying, "With those two children alone it's worth it in my view."

Why does CNN allow its personalities to editorialize like this on complex health policy issues? Ms. Brown seemed to miss her physician-guest's own admission that he can't be sure that his initial screening experience would be duplicated in the next 100 kids he would screen. But it didn't matter. The CNN personality had already declared the screening "worth it."

So there you have it.

CNN, once again, taking a pro-screening advocacy stance that goes well beyond the boundaries of acceptable journalism. And once again, the network makes any meaningful discussion of public health policy and of health care reform just that much more difficult.

For past examples of imbalanced, incomplete CNN stories on screening tests for hearts, breasts, prostates and more, see:
http://www.healthnewsreview.org/blog/2009/11/cnn-takes-advoc.html
or
http://www.healthnewsreview.org/blog/2009/11/fair-and-balanc.html
or
http://www.healthnewsreview.org/blog/2009/08/reliable-source.html
or
http://www.healthnewsreview.org/blog/2009/08/public-dis-serv.html
or
http://www.healthnewsreview.org/blog/2006/06/cnns-questionab.html
or
http://www.healthnewsreview.org/blog/2006/06/cnn-screening-advice-for-women.html

The Wall Street Journal Health Blog published an interesting inside look of - as they put it - "how drug makers can try to lay the groundwork for sales well before a new therapy hits the market."

The topic is premature ejaculation.

Some might call the methods "disease-mongering."

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

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

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

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

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

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

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

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

In one of the worst examples of disease-mongering we've ever seen, the paper let a plastic surgeon get away with saying, “The pain that women with large breasts can have has been compared to when someone gets metastasized cancer of the spine.”

Christopher Lane interviews journalist Philip Dawdy, who has written about the "astonishing" rise in the number of diagnoses of ADHD and bipolar disorder in teens and preschoolers.

There are WMD’s lurking inside your body. And you better find them ASAP.

In its health section today, the Washington Post gives men of all ages screening test advice – much of it not grounded in the best medical evidence or at least not reflecting real controversies in health care.

They do one of those “What To Do In Your 20s, 30s, 40s, 50s…” columns that news organizations find so appealing and that I find so incomplete.

Sanjay Gupta and CNN have done the same thing

So has the Star Tribune and many other news organizations.

Among the questionable advisories from the Post:

• Telling men in their 30s to “sign up for complete physicals”
• Telling men in their 40s to get a complete physical every two years

There was no mention of the controversies surrounding such recommendations - some experts calling it wasteful.

• Telling men in their 40s to start skin cancer screening.

Aren’t they aware that the US Preventive Services Task Force just last week stated :

“ the current evidence is insufficient to assess the balance of
benefits and harms of using a whole-body skin examination by a
primary care clinician or patient skin self-examination for the
early detection of cutaneous melanoma, basal cell cancer, or
squamous cell skin cancer in the adult general population.” ???

They go on to tell men in their 50s to have prostate cancer screening. (They do say the pros and cons should be discussed, but the recommendation for such screening stands nonetheless.)

Again, the USPSTF states: “the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.”

What the Post promotes may be one doctor’s – or some doctors’ - opinion(s). But for a major newspaper to state these as if they were handed to Moses on stone tablets is wrong. There are uncertainties. There is controversy. Screening tests can cause harm - not just benefit. And good journalism should reflect that.

Over on the HealthNewsReview.org website, we've reviewed another example of a journalist giving pro-screening test advice that is not supported by medical evidence.

This time it was the CBS Early Show, using physician-"reporter" Dr. Holly Phillips from WCBS-TV in New York to do a followup on actress Christina Applegate's diagnosis of breast cancer.

We said in that review:

The story engages in disease-mongering in its conclusion: "What's most important is to screen. One in eight women nowadays is going to get a breast cancer in her life, so as long as you get in for screening, I'm happy." The 1 in 8 statistic requires explanation. It is a lifetime incidence estimate. Many women misinterpret this to think that they have 1 in 8 chance right now at this time in their life. It is one of the misused and most misunderstood statistics in health care. The National Cancer Institute estimates that a typical 40-year old woman has less than a 2% (1 in 50) chance of developing breast cancer before 50, and less than a 4% (1 in 25) chance of developing it before age 60.

But the story also states, "But generally, we start home breast exam at age 20. I suggest every month, at the same time of the month, examine your breasts at home and get into your doctor for a breast exam at least every three years, earlier if you can." This is not an evidence-based recommendation and involves a physician-reporter giving personal advice and perhaps forgetting that she is now a reporter.

There is little evidence that breast self-examination (BSE) lowers deaths from breast cancer, and SBEs are not recommended by themselves for detecting breast cancer, especially in higher-risk women.

Experts disagree that mammography screening "should begin at 40", especially for women at low to average risk. See: http://www.annals.org/cgi/reprint/146/7/I-20.pdf .

The story had many of the elements of today's TV health stories:

• a young female celebrity angle
• a young female physician-reporter
• fear and promotable content.

Unfortunately, as with many of today's TV health stories, it also lacked details on evidence.

There has been a lot of speculation about what happened to and what could have saved Tim Russert.

Some, like a Wall Street Journal piece, "A Visceral Fear: Unexpected Heart Attacks," bordered on disease-mongering. That story discussed:

"...experts who think wider use of coronary calcium CT scans could help spot more people at risk of soft-plaque blockages. The noninvasive procedure takes about 15 minutes and costs a few hundred dollars. But few insurers cover it because there is scant evidence that treating people on that basis saves lives.

At a minimum, seeing a picture of the calcium lining their arteries can be a wake-up call for patients to take their coronary-artery disease seriously and to be diligent in taking medication, exercising and making other healthy lifestyle changes."

I'm sure there are such experts. But there are many other experts who do not support wider use of such scans. It's not just insurers who are reluctant. The story makes the procedure sound quick and inexpensive. But that is on the individual level. Who should be screened? Everyone over 40? The entire population?

Pictures - even those of the insides of our coronary arteries - don't tell the whole story. And neither did this piece.

Add Women's Health magazine to my list of publications guilty of disease-mongering by advocating tests that are not supported by evidence - recommendations that run counter to those of the U.S. Preventive Services Task Force.

The article, "THE MEDICAL TESTS YOU SHOULD TAKE: Head-to-Toe Tune-Up" is not unlike those I've criticized on CNN, in the Minneapolis Star Tribune, and in a number of other news outlets.

No source is given for the recommendations.

Journalists: when you promote testing and screening in healthy populations in the absence of evidence of benefit and in the presence of known harms you may be causing harm yourselves. And you're certainly stirring up the "worried well" to seek medical attention when they may not need it. We're already devoting 16% of the gross domestic product to health care.

Shannon Brownlee on disease-mongering.

If you survived the last TV ratings period and DIDN’T see a story about the horrible epidemic of bedbugs right in your town - maybe right in your own bed - then just stay tuned until the next sweeps period.

David Segal of the Washington Post was on NPR’s “On the Media��? program talking about the hyperbolic news coverage of the bedbug panic.

A physician who teaches evidence-based medicine, and who is also a freelance health journalist, has been reading my thoughts about journalists advocating screening tests in the absence of evidence.

She wrote me: "Here's one of the more annoying recent examples, one that I actually used in class to illustrate the issue of patients coming in and requesting specific tests based on what they read in the newspaper."

So I'm adding Parade Magazine to my list of offenders.

Don't let the special interest campaign catch you napping!

Dozens upon dozens of stories about Americans lacking sleep are popping up from news organizations all over the country this week, driven by another of the National Sleep Awareness Week campaigns of the National Sleep Foundation.

Few - if any - of these stories will tell you that it is industry special interests - sleeping pill makers, sleep labs, mattress makers - who are paying for this campaign. They do it every year. And news organizations fall into line like sheep and report the "new" findings every year.

Examples:

USA Today reports:

U.S. workers are silently suffering from a dramatic lack of sleep, costing companies billions of dollars in lost productivity, says a study out Monday.

Nearly three in 10 workers have become very sleepy, or even fallen asleep, at work in the past month, according to a first-ever study on sleep and the workplace by the non-profit National Sleep Foundation. The late-2007 survey was based on a random sample of 1,000 workers.

AP reports:

Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.

CNN, WebMD, UPI, the St. Louis Post-Dispatch and many, many more news organizations are reporting the same stuff - handed to them by the industry-funded campaign.

Yawn.

Wake me when the next disease-mongering campaign comes around.

Last week the NBC Today Show presented a series it called “Mini Medical Miracles.�

Were you waiting for news on cancer? Heart disease? Diabetes? Infectious diseases?

Sorry. What you got was baldness, insomnia, dandruff and wrinkles.

But NBC called the approaches “miracles� and “breakthroughs.� Man, that’s what we need is a good miracle for dandruff and wrinkles.

Anchor Matt Lauer led into the wrinkles story by asking “Could having a new laser treatment in your forties or fifties prevent you from ever needing a facelift?�

Who says that anyone needs a facelift? Facelifts are a matter of want, not need.

47-million uninsured is a matter of need.

Lauer and NBC medical editor Dr. Nancy Snyderman could barely contain their enthusiasm for the laser “treatment.�

(Snyderman:) “This is going to be in your doctor’s office soon.�

(Lauer:) “It’s interesting. And anything that keeps people away from the knife. I mean, that’s major surgery.�

(Snyderman:) “I think you can say to people, this is a preemptive strike and it’s taking care of your skin and you can avoid a real operation. There will be a lot of people, men and women, who will be interested.�

There was no discussion of evidence, no quantification of benefits or harms, no discussion of how long the approach has been tested nor in how many people.

On HealthNewsReview.org the story is one of only 10 of the first 500 stories reviewed that got a score of 0.

Oh, for the good ol’ Today Show days of Dave Garroway and J. Fred Muggs, the chimp.

Dr. Sanjay Gupta’s HouseCall program on CNN today featured a story on anxiety disorders, and offered one of those handy self-assessments that allows you to diagnose yourself with almost anything under the sun.

Gupta said only one in five people with anxiety disorders get help. Then he offered a self-assessment from the Anxiety Disorders Association of America (ADAA). Gupta listed:

Do you have a (sic) anxiety problem?
• Excessive worry, occurring more days than not, for a least six months?
• Unreasonable worry about a number of events or activities, such as work or school and/or health?
• The inability to control the worry?

He said if you answered yes to any of these, you could seek help from your doctor or from ADAA.
He did not mention that the ADAA’s corporate advisory council is made up of drug companies Eli Lilly & Company, Forest Laboratories, Pfizer, Inc. and Wyeth.

I worry a lot about how commercial, how unquestioning, and how cheerleading much of CNN’s medical news is. It makes me very anxious and I am unable to control that worry. It only gets worse.

I just finished reading an important new book, "Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients," by Ray Moynihan and Alan Cassels.

It documents disease-mongering, how drug companies foster the creation of medical conditions to create markets for their pills, the marketing of fear, the "medicalization" of normal states of health, the hidden agendas of "disease-awareness campaigns," problems with drug company relationships with celebrity spokespersons and patient advocacy groups, and other issues about which most consumers don't have a clue.

As one skeptic says in the book, "We're changing the experience of what it means to be human."

It also points to numerous instances of what the authors call "sycophantic media coverage" and an "indictment of the flaccid culture of much medical reporting."

I highly recommend the book.