A well-intentioned ad campaign run by the American Cancer Society is too vague, and, therefore, may leave impressions that are imbalanced, incomplete and unsubstantiated - the kind of common tactic seen in many drug company ads.

That's my opinion based on my analysis of the ad and based on my reading of the text.

A Cancer Society news release states:

The American Cancer Society Cancer Action Network (ACS CAN) is launching a new print and online advertising campaign in congressional districts across the country this week, urging lawmakers to fully fund a lifesaving cancer prevention, early detection and diagnostic program that is celebrating 20 years of screening low income, uninsured, and medically underserved women for breast and cervical cancer. The ads also send the message that when it comes to increasing your odds of surviving cancer, access to evidence-based early detection tools is critical.

The ads reference the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which has a track record of reducing deaths from breast and cervical cancer. The program has provided more than 9 million screening exams to more than 3 million women and diagnosed more than 40,000 cases of breast cancer and more than 2,000 cases of cervical cancer since it launched in 1990. But with limited funding, the program is able to serve fewer than 1 in 5 eligible women.

The accomplishments of the CDC NBCCEDP are noteworthy. So this blog entry is no knock on that program.

It's a criticism of the ad.

There is no specific mention of the specific goals of the CDC NBCCEDP. The ad doesn't state what the news release states that this is promoting "20 years of screening low income, uninsured, and medically underserved women for breast and cervical cancer."

Instead, the ad promotes unspecified screening - all screening, one could infer. "We can't fight cancer if we can't see it....When it comes to cancer, screening is seeing...It's time to take the blindfolds off and stop cancer before it starts." Catchy phrases from an ad agency or from someone creative at the Cancer Society. But are we talking about prostate cancer screening? Lung cancer CT scan screening? Ovarian cancer screening? Show me where it does NOT say that. And show me where it DOES say this was about breast & pap smear screening for medically underserved women?

But this is a fund raising and political message: "current funding isn't enough...tell your members of Congress (to) increase funding..."

And when you're raising funds, a little vague fear-mongering can't hurt, right?

Wrong.

One other piece of copy from the ad demands scrutiny: "60% of cancer deaths could be prevented." The implication is that's all from screening because screening is the only prevention method mentioned in the ad. Nothing about stop smoking or other lifestyle changes. If the ad meant to imply that 60% of cancer deaths could be prevented just from screening, it should provide the evidence for that. If the ad did not mean to imply that, but was just misleadingly vague, then I call for the ACS to pull this ad. In either case, I think they have a problem.

That unsubstantiated 60% figure is especially ironic since the ACS news release includes this line: "Access to evidence-based prevention is just one component of the fight to defeat cancer." We needed a little more clear evidence here - evidence that would show that screening is just one part of prevention.

Earlier this summer I criticized a federal agency's vague screening promotion ads. I'll end this note in a fashion similar to the way I ended that note:

I know that the folks at the American Cancer Society (or their ad agency) had their hearts in the right place with this campaign. But their heads have to do a better job of learning how to communicate about screening. Or else they'll be guilty of the same disease-mongering techniques that are so prevalent in so many other messages in general circulation these days. The worried well are constantly whipped into a frenzy over the supposed weapons of mass destruction inside all of us. As a physician-colleague reminded me: "All screening tests cause harm; some may do good as well."

You'd never know it from the ACS ad. But then again, it's "only" a fundraising ad, right?

Today must be psych day on the blog. There's a noteworthy column in Psychiatric Times, "Normality Is an Endangered Species: Psychiatric Fads and Overdiagnosis," by Allen Frances, MD. He was chair of the task force that worked on the Diagnostic & Statistical Manual - DSM-IV - one edition of the "bible of psychiatry." He is professor emeritus of psychiatry at Duke University School of Medicine. There's a lot of common ground between what Dr. Frances writes and what Dr. Daniel Carlat (subject of my earlier blog posting today) writes about. Dr. Frances is concerned about the directions that might be taken in the authoring of DSM-V - now underway.

Excerpts:

"Fads in psychiatric diagnosis come and go and have been with us as long as there has been psychiatry. The fads meet a deeply felt need to explain, or at least to label, what would otherwise be unexplainable human suffering and deviance. In recent years the pace has picked up and false "epidemics" have come in bunches involving an ever-increasing proportion of the population. We are now in the midst of at least 3 such epidemics--of autism, attention deficit, and childhood bipolar disorder. And unless it comes to its senses, DSM5 threatens to provoke several more (hypersexuality, binge eating, mixed anxiety depression, minor neurocognitive, and others).

Fads punctuate what has become a basic background of overdiagnosis. Normality is an endangered species. The National Institute of Mental Health estimates that, in any given year, 25 percent of the population (that's almost 60 million people) has a diagnosable mental disorder. A prospective study found that, by age thirty-two, 50 percent of the general population had qualified for an anxiety disorder, 40 percent for depression, and 30 percent for alcohol abuse or dependence. Imagine what the rates will be like by the time these people hit fifty, or sixty-five, or eighty. In this brave new world of psychiatric overdiagnosis, will anyone get through life without a mental disorder?
....
The "epidemics" in psychiatry are caused by changing diagnostic fashions--the people don't change, the labels do. There are no objective tests in psychiatry--no X-ray, laboratory, or exam that says definitively that someone does or does not have a mental disorder. What is diagnosed as mental disorder is very sensitive to professional and social contextual forces. Rates of disorder rise easily because mental disorder has such fluid boundaries with normality.
....
The media feeds off and feeds the public interest in mental disorders. This happens in two ways. Periodically, the media becomes obsessed with one or another celebrity whose public meltdown seems related to a real or imagined mental disorder. The mental disorder is then endlessly commented on and dissected by the media. The latest example is the Tiger Woods media frenzy which will likely lead to an "epidemic" of "sexual addiction."
...
There is no objective way to determine what should be the proper rate of mental disorder in the general population. My view is that DSM-IV is almost certainly overinclusive, but I would not recommend tightening the criteria until we have clear evidence this would do more good than harm. The DSM-5 bias to thrust open the diagnostic floodgates is supported only by flimsy evidence that does not come close to warranting its great risks of harmful unintended consequences. It is too bad that there is no advocacy group for normality that could effectively push back against all the forces aligned to expand the reach of mental disorders."

Nice job by Jeremy Cox in the Florida Times-Union (Jacksonville) highlighting overlapping issues of disease-mongering, medicalization and health care costs.

Excerpts:

If Americans would stop thinking of certain problems in a medical context, experts argue, it might chip away at the more than $2 trillion the nation spends annually on health care. Furthermore, people would be healthier because they would avoid some of the problems caused by too much health care, such as hospital-acquired infections and bad drug interactions.
...
A provocative new study for the first time puts a dollar figure to all the treatments, pills and procedures Americans seek to cure their formerly non-medical ills: $77.1 billion, in 2005 dollars.

That total represents less than 4 percent of the annual medical spending tab, but it's more than the country spends on heart disease, cancer and public-health campaigns, Peter Conrad, a sociologist at Brandeis University and the lead author of the study, which was published in the journal Social Science and Medicine, said in an e-mail.

Kudos to Cox and his paper for making time and space for this. Newspapers could have a daily column on this topic. And I'd bet it'd be good for circulation!

The hosts of this international conference on disease-mongering have asked my help in spreading the word. I'll be attending. Some of you may be interested as well.

Details are available online.

From the conference site:

The conference is designed for everyone with an interest in pharmaceutical information and promotion including: health professionals, policy makers, staff of government health and regulatory departments, inspectors, staff of pharmaceutical, advertising and public relations companies, staff of NGOs and journalists. The host is Healthy Skepticism (Netherlands) assisted by the Dutch Institute for Rational Use of Medicine and Healthy Skepticism (International).

The AP reports:

"...members of the Food and Drug Administration's reproductive drugs panel voted 11-0 that the drug's benefits did not outweigh side effects, including fatigue, depression and fainting spells.

Flibanserin failed to increase sexual desire, as recorded by women in daily journals, in two company studies.

The FDA will make its own decision on the drug in coming months, though it generally follows the panel's advise."

When will we learn to put evidence before hype?

To wait until all the evidence is in before promoting something as "the female viagra" - as "the pink pill" that women have been waiting for?

Shame on the journalists who hyped this story leading up to the FDA panel's vote. It resembled free advertising, free marketing, free buildup of demand for an unproven product.

And pity the poor consumers who heard about this every day and bought the hype.

When will we learn to be better evaluators of the evidence?

Addendum two hours after original post: many more good details in this story from MedPageToday.com.

The crescendo of news in anticipation of an FDA advisory committee's consideration of the drug flibanserin for hypoactive sexual desire disorder or HSDD is crazy.

And few stories question the oft-cited estimate that up to 40% of women may have this problem. Why don't they cite the source? Why don't they explain how flimsy the evidence is for that market-boosting projection?

NBC's chief medical editor, Dr. Nancy Snyderman, didn't challenge it in her nightly news story last night.

And while she did include a sound bite with a gynecologist skeptical about the drug, Dr. Nancy concluded:
"All eyes are on FDA on Friday as to whether women will have to continue to wait."

Well, let's slow down a bit. Not all eyes are unblinkingly fixated on their computer screens awaiting that FDA advisory panel's recommendation. First, their vote doesn't determine the FDA's final decision. So there will be at least one more wave of news about this drug. And many of the eyes that are so trained on the news have been whipped into a frenzy by the news itself.

But the phrase "whether women will have to continue to wait" is really loaded. How many are really waiting for a drug to improve their sex life? How many are tired of having yet another antidepressant prescribed for a "female problem"? Many alleged problems of women all end up in the same place: with an antidepressant prescription.

CNN.com published a story that didn't challenge a sexual medicine doc's statements that: "HSDD is a horrible tragedy in women" and that this drug would be "the beginning of an era" for women, and that having a safe and effective drugs is a "unique and historic opportunity for women in the U.S. and for the FDA."

Horrible tragedy?
Beginning of an era?
Unique and historic opportunity?

CNN didn't challenge any of those statements.

Let's step outside the realm of crazy American hype and peek at what Australian journalist Ray Moynihan wrote:

"In trials on women in the US, compared to placebo, flibanserin offered women an extra 0.7 "satisfying sexual events" per month. In the trials on European women, flibanserin simply failed to beat the dummy pill. With data like that, the drug is going to need all the marketing help it can get."

That's data, not drama. Journalism, not disease-mongering promotion of a drug.

Moynihan is co-author of a forthcoming book, "Sex, Lies and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction."

I predict: if and when the FDA rejects this drug, there will be many stories talking about how unfairly women are being treated and how this is rationing.

I, too, may then take an antidepressant. Consider the evidence.

Addendum: As another sign of how unquestioning some news organizations are, on Twitter, @MSNBC_health retweeted this:

RT @SexBrainBody: 3 times as many women are aware of erectile dysfunction (66%) than they are of female sexual dysfunction (20%) http://znl.me/BYH-Q6 #SXBB

FYI: @SexBrainBody, and the URL have "content developed with the support of a sponsorship from Boehringer Ingelheim Pharmaceuticals, Inc." - which is the maker of flibanserin. Gee, could the rest of us get free advertising from MSNBC that easily?

This week the FDA will vote on flibanserin, the much-talked-about drug for women with the condition called hypoactive sexual desire disorder or - because everything in sexual health needs an acronym like ED or PE - HSDD.

On the eve of the FDA vote, CBS last week ran still another story about flibanserin. This drug has received so much news coverage, you'd think it cures cancer.

And CBS did little more than promote the hype even more, saying FDA approval "could translate into a $2 billion market in this country alone" and then failing to challenge the disease-mongering estimate of "10 percent to 30 percent of women" with this condition. It all just goes along with the drug company's efforts to build a demand before the drug is even approved.

In fairness, the story did call it "a rather vague diagnosis" and did say that some "critics say creating a pharmaceutical solution is driven by greed. "

But then it flip flopped by offering only a single patient anecdote, a woman who didn't want to be identified, who was "desperate" after "losing her sex drive completely" and who now says she is "definitely improved" after being in a trial of the drug.

Meantime, this weekend I got an e-mail from a group calling itself "The New View Campaign" which opposes FDA approval of the drug. They've posted an online petition.

This group says the drug:

1. offers only TRIVIAL benefits to women's sexual lives, as shown in the company's clinical trials.
2. might have serious ADVERSE EFFECTS when marketed to a large population.
3. comes with an AGGRESSIVE MARKETING campaign to convince women that sexuality is located in the brain, and that low sexual desire suggests chemical imbalances in the brain.
4. contributes to UNDERMINING and CONCEALING social and cultural issues that lead to women's problems with sexual desire.
5. tends to pathologize normal sexual diversity and therefore NARROWS the 'cultural ideal' around female sexuality.
6. represents a classic case of the pursuit of PROFIT rather than women's sexual pleasure and scientific knowledge.

A few issues that CBS didn't touch on.

A few weeks ago, Medscape quoted Gail E. Wyatt, PhD, a sex therapist, psychologist, and professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles:

"There are sometimes good reasons why women have no sexual desire. They may be in a relationship that's unhealthy or where there's physical or sexual violence. ...This drug is not going to be a panacea for sexual problems, because often sexual problems are complex and happen for a good reason. My concern is that by prescribing patients a drug like flibanserin, we are medicalizing sexual function, rather than understanding the problem."

Finally, blogger Merrill Goozner writes:

"I have a much more prosaic concern. Because I write often about prescription drugs, I get inundated with email spam from robots selling male sexual dysfunction drugs (I don't want to use their names because it only adds to the volume). Approval of flibanserin will double that volume. So in the name of God, I beg the FDA committee: Stop spam! Vote no on flibanserin."

Ads have led John Mack, of the Pharma Marketing Blog, to think that his chances are pretty good that he has ED and Low T. That's erectile dysfunction and low testosterone for those of you not up on pharma's alphabet soup of marketing.

Mack writes:

"Symptom quizzes designed by pharmaceutical marketers in cahoots with sponsored patient advocacy groups are dishonest, IMHO. I do not believe they represent "honest dialogues with the public" nor do I believe that they are in "the best interest of patient health," two principles recently espoused by Bob Perkins, Vice President, Public Policy, AstraZeneca. In fact, they are just the opposite: dishonest and in the best interest of the pharmaceutical company!"

But he also links to a hilarious post on male hormone replacement on the blog, "Is Something Not Quite Right With Stan." Excerpt:

"Big Pharma wants you to believe their aggressive promotion of 'T' disease is growing at epidemic proportions throughout America with millions upon millions of aging men being Low T ripe consumers for their much needed Testosterone-Gel treatment."

Meantime a story by Reuters Health says that Low T ointment ads have been running during the NBA playoffs. I must have missed those while focusing on double dribbles and three seconds in the paint. But Reuters reports:

"According to a review in the June issue of the Drug and Therapeutics Bulletin, testosterone replacement therapy is questionable because it has risks, its efficacy is uncertain, and there's no strong agreement about whether low testosterone is really a disease in older age.
...
"We're skeptical about this," Dr. Ike Iheanacho, the journal's editor, told Reuters Health. "You may have men who have symptoms who have low testosterone levels, but in our view it doesn't add up convincingly to an undoubted medical condition."

Reuters quotes another doc saying a European doctor "would look at you blankly" if you asked about Low T. Oh, those behind-the-times Europeans! Don't they wish they could do disease-mongering like we do in the good old USA.

The flying nun got grounded by this hilarious drug ad parody on Saturday Night Live. Another SNL smackdown of drug ad disease-mongering. Fave lines:

• "All women are inherently weak and very fragile."

• "There doesn't have to be anything wrong with you to take Preniva. You just have to be scared - which you should be."

• "Preniva: your weakness is our strength."

Hat tip to e-patient Dave for sending this to us.

Somebody at NBC must be obsessed with baldness. About three years ago, their Nightly News devoted more than two minutes to questionable hype of a "laser hair comb breakthrough."

Last night anchor Brian Williams whipped the worried well into a frenzy with his lead in, saying:

"Now to the relationship between humans and their hair. It ranges between frustration, obsession and desperation....We're talking about people who would pay any price, bear any burden to keep it, grow it, put it back."

That was his set-up for an announcement of what he called a "big development" - the discovery of what they called a "human hair control gene" that NBC said may lead to a baldness treatment.

Interesting science. But the piece had more comedy clips from Seinfeld and Larry David and man-on-the-street interviews than it did evidence. And in showing the full-head-of-hair researcher who once had alopecia areata but then was "cured" by doctors, the network misleads because that's not the condition the current research addressed.

We found these headlines around the globe this morning:

• Uncovered at last, the gene that may herald a cure for baldness
• Hair Loss Gene Identified - Male Pattern Baldness Cure Around the Corner?
• Bald gene may help find cure

HealthDay was among the more calm and reasoned voices when it reported:

"The finding won't immediately lead to a better treatment or cure... it's just a tiny little piece of the puzzle."

Jamie Kopf Hirsh, who does the Consumer Reports AdWatch series, gets personal in revealing that she urinates often - at least 10 times a day on average. So does she have overactive bladder? No, and she doesn't fall prey to the overactive marketing of OAB drugs. (Yep, it has its own acronym now - just like ED for erectile dysfunction or PE for premature ejaculation.) On the CR website, she writes:

"I asked my doctor about these drugs, just like the ads suggested. And she asked me a few things back. Did I have any problems with my urination other than the frequency--like having accidents, feeling like I couldn't get to the bathroom on time, or leaking urine inadvertently? Well, no. Did I drink coffee? Yep, every day. Alcohol? A bit, yeah. Water? Yeah, lots. She said the amount I was urinating made sense given how much liquid I drank and the fact that, given my petite stature and family history of constant pit stops, chances were I had a pretty small bladder. She could prescribe one of the drugs, she said, which work by powerfully suppressing the urge to urinate. But I probably didn't need it."

It's an example of disease-mongering, she explains, in the latest drug AdWatch video.

Ray Moynihan, who has written quite a bit about the disease-mongering of female sexual dysfunction, now writes in the BMJ (subscription required for full access):

"The definitions of female sexual dysfunction and its disorders of desire, arousal, orgasm, and pain are facing a major overhaul as part of the current revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM).

A working group for the American Psychiatric Association, which produces the manual, has proposed new definitions that give greater acknowledgment to the relationship context of women's sexual difficulties and new criteria to raise the threshold for diagnosis."

Further excerpts:

"The group has proposed abandoning the two existing disorders of desire and arousal and merging them into a new entity potentially labelled "sexual arousability disorder." Under its proposals, symptoms may have to be of a certain severity and to present for more than six months before a woman qualifies for a diagnosis.

It is unclear how the proposal to move away from the label "hypoactive sexual desire disorder" will affect drug companies--including Boehringer Ingelheim--that are currently testing products to treat the condition. Boehringer Ingelheim recently released abstracts suggesting that its drug flibanserin could offer woman an extra 0.7 "satisfying sexual events" per month, over and above the effects of a placebo.

For more than a decade some researchers have claimed that the condition called female sexual dysfunction affects 43% of women, though others believe the true prevalence is far less."

The American Psychiatric Association has now posted all the proposed revisions online.

The Wall Street Journal had a good overall look at the DSM draft revisions.

So did the Los Angeles Times.

ABC had a piece that at least raised the question, "Are We Over-Diagnosing Mental Disorders?"

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?

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.