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

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

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

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

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

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

Jennings writes:

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

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

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

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

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

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

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

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

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

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

I wish the best for him personally.

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

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

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

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

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

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

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

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

Go Pack!

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

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

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

Here's his story on MedPageToday.com.

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

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

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

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

Here's a strength of the story:

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

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

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

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

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

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

But here's a weakness of the story:

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

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

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

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

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

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

Wow.

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

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

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

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

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

• http://www.healthnewsreview.org/blog/2010/08/common-themes-in-the-alzheimers-test-stories-the-cancer-society-screening-ad.html

•
http://www.healthnewsreview.org/blog/2010/08/ucla-md-says-nyt-alzheimers-test-story-was-far-worse-than-our-review-suggested.html

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

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

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

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

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

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

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

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

This is a very important story.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My quick responses as soon as I could respond:

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

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

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

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

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

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

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

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

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

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

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

Addendum on August 27:

I look forward to exchanging ideas with NPF.

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

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

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

I'm late on this, but just want to acknowledge that, yes, I've seen the very clever journalism warning labels pictured and offered on this site. Many good friends and contacts wrote me about this - some urging HealthNewsReview.org to produce its own. And we may.

Out of many great labels offered, this one is perhaps my favorite.

All you have to do is use our search engine on HealthNewsReview.org to search for "Alzheimer's" and you'll get countless returns of stories and claims such as:

• Spinal-Fluid Test Is Found to Predict Alzheimer's

• Drug for Immune Disorders Helps Alzheimer's

• Miracle drug for Alzheimer's patients

• A cocktail to remember? Nutrient elixir shows promise against Alzheimer's

I could go on and on listing a litany of claims about abilities to diagnose Alzheimer's Disease earlier and better, surely leading the way to better treatments. Some stories already make sensational claims about treatments.

Now read Derek Lowe's important blog post, "Lilly's Gamma Secretase Inhibitor for Alzheimer's: Worse Than Nothing." Excerpts:

"Well, well, well. We finally have solid clinical data from a large trial of a gamma-secretase inhibitor for Alzheimer's disease. And it doesn't work.
...
And now we have the results.

Nothing. Worse than nothing - they saw real declines in cognitive function compared to the placebo group. It's not getting as much play in the news this morning, but it also appears - insult to injury - that the drug was associated with a greater risk of skin cancer. Lilly has halted any development, and told all the study centers to stop dosing immediately. All the patients who received it will be monitored to see how they do over the next few months.

This is about as bad a result as could possibly be obtained, and I think it really has to torpedo the idea of gamma secretase as a drug target. Unless someone comes up with a very compelling and intricate argument to explain these results, I don't see how anyone can risk going down this particular road again. What must they be thinking today over at Bristol-Myers Squibb, where they've been developing a direct competitor, BMS708163?

And what does this say about the amyloid hypothesis itself? Nothing good. This is the crucial period for the whole idea, with several different approaches finally yielding late-stage clinical data. And it's starting to look as if the whole idea may have been just a terrible diversion."

This is an example of why we react negatively to stories that mention "new pathways to a cure" after a study of just 3 people - as the NYT piece yesterday on Lou Gehrig's Disease did.

This is why we react negatively to Alzheimer's Disease stories that emphasize what scans can show when we don't fully understand what the images and findings mean.

This is why we react negatively to Alzheimer's stories about treatments that hype results from small, preliminary studies.

We think it's wrong - bordering on malicious - for journalists to sensationalize research findings in an area where sick people are desperate for evidence and for solid information on benefits and harms. Hope has value; sick people have told me that THEY can decide where to invest their hope - they don't need journalists doing it for them. False hope is a harm. And it's a harm that is committed far too often in news coverage of diseases like ALS and Alzheimer's disease.

ADDENDA ON AUGUST 18:

See the Harvard Health Blog post,
"Alzheimer's study on biomarkers generates debate."

See also Robert Langreth's column on Forbes.com,
"The Man Who Predicted Eli Lilly Alzheimer Failure."

This was one time when the headline was OK, but the story that followed had our heads spinning. "Study Says Brain Trauma Can Mimic Lou Gehrig's Disease" is a story that was troubling on a number of fronts. It reported on a study which at the time had not yet been published suggesting that some "athletes and soldiers given a diagnosis of amyotrophic lateral sclerosis...might have been catalyzed by injuries only now becoming understood: concussions and other brain trauma."

To be clear - and please don't anyone miss or miscontrue this point - this is an important and fascinating area of research.

But the story did not exhibit the best of health/medical/science journalism.

1. It was based on a study of 3 people. (The ALS Association says there are up to 30,000 people in the US living with ALS.)

2. It stated, "Lou Gehrig might not have had Lou Gehrig's disease." (No evidence for this was provided. He also may not have been a great left-handed hitter. That may have been an optical illusion.)

3. It said this could "perhaps lead toward new pathways for a cure." (After a suggestive finding in just three people?)

4. The story later says, "The finding's relevance to Gehrig is less clear." (Hedging already after a bold earlier statement in the story.)

5. But just a few paragraphs later, the story says, "The new finding...suggests that Gehrig might not have had (ALS)." (Head spinning yet?)

5. The story dropped lots of big names - Gehrig, Stephen Hawking, Michael J. Fox, former NFL players Wally Hilgenberg and Eric Scoggins, Cal Ripken - in a jumble of claims, associations - or was it just plain name-dropping in order to make the story more appealing?

6. The story brought in "recent epidemiological studies" in soccer players and soldiers without one word about the possible limitations of such studies.

7. It went into detail that a historian or sports nut would love about Gehrig's football concussions or baseball beanings or fights with Ty Cobb. But all of this just fed the theory that was not supported by anything but guesswork and innuendo.

The story ends with a quote from a Gehrig biographer:

"Lou Gehrig wanted to know everything possible about his own illness -- he got to know his doctors, talked with scientists with obscure approaches, and volunteered himself as a guinea pig to find any way to combat the disease. He wouldn't stick in the sand and not want to hear about this. If he were around today, he would continue to have that same curiosity, and that burning desire, to help his situation, or to help others."

As we said earlier, this is important and fascinating research. So we don't think anyone should stick their head in the sand over this research either. But the story also didn't require any hype - the kind it received from the NYT.

Additional thoughts from Dr. Steven Atlas of Massachusetts General Hospital, one of our medical editors:

"This represents a small and interesting case series. The lowest rung on the clinical evidence ladder. It is a pretty big stretch to imply that Lou Gehrig may not have had ALS. To imply that one would need to know how common this is. One line of evidence is that NFL players may be more likely to be diagnosed with ALS than the general public. But it is also possible that given their occupational history, one may look for it more carefully. Another way would be to do a case control study. One could take individuals diagnosed with ALS and maybe age and sex matched controls to see if there is a history of prior brain trauma. For pathologists, one method would be to work to do postmortem exams on more patients with ALS to see if they had the pathological changes of ALS or recurrent brain trauma. One could independently get history of prior brain trauma to see if history and pathology line up. The bottom line as you mention is that this is an intriguing study. It is doubtful that such a study may lead to a "cure" unless one means that we seek to decrease brain trauma in the first place. As the article mentions well into it, we won't know whether Gehrig has ALS or not, but one can't help but surmise that he did have ALS until data shows that much of ALS is in fact a side effect of brain trauma. Finally, even if brain trauma is associated, it is possible that genetic factors that would lead to ALS are present in these individuals with brain trauma. Specifically, is it the severity of the brain trauma that predicts this? Or is it the genetics that dominate and the trauma is the straw that broke the camels back?"

Complexities that, despite the long word count, this story didn't address.

Addendum on August 18:

See Neurocritic blog post:
"Lou Gehrig Probably Died of Lou Gehrig's Disease."

After four years and after publishing more than 1,100 stories on HealthNewsReview.org, we've probably only received a handful (fewer than 10) messages from people who felt we were too soft in our review of a story. But our review of a New York Times story on Alzheimer's Disease was way too soft in the eyes of Dr. Jerome Hoffman, a UCLA emergency medicine specialist, who wrote to me. (This despite the fact that our review stated that the story "was inaccurate...encourages confusion...likely to mislead readers...fails to mention costs...does not alert readers to the possible financial consequences of a test indicating that a person is likely to develop Alzheimer's Disease...perhaps the NYT will pursue this as a next-day folo....discussion of potential harms seems imbalanced....caveats are overshadowed by the strong wording of the headline and lead sentence....fails to note the industry connections of key researchers and the industry funding of the study.")

He gave me permission to quote directly from his email:

Dear Gary,

Let me start off by saying that I love your work -- it is routinely outstanding. So I'm a little embarrassed that I'm only writing now, when I believe you could (and should) have done a better job re: the latest NYT puff piece by Gina Kolata. (I suspect you've seen Vera Sharav's review of same, which I think does a better job of addressing head-on some of the most critical aspects of this.)

I understand that it is best to bend over backward to avoid any remote appearance of stridor, and also acknowledge that you are typically not afraid to be direct and pointedly critical; still, given the real harm surely caused by Ms Kolata's endless hucksterism (backed by the clout of the NYT), I think you missed an opportunity to address not only the outrageous distortions in this particular piece ("100% accurate" -- which is not only on the face of it inaccurate, as you point out, but is surely much worse than she and the researchers claim, given huge methodologic issues re: the "gold" standard, and their confusing how often it's present once disease is clinically evident with how well it predicts later disease, at earlier and earlier pre-clinical times), but larger issues, like failure to mention conflicts of interest or give real credence to contrary views (in an instance where these should be stressed at least as much as usual), conflation of association with cause, creation of disease (hyper-amyloidemia) whose purpose is surely to allow some drug company to develop a blockbuster drug that will be "proven" in some study to "decrease amyloid burden" (even if it has zero effect on any patient-oriented end-point), and a half-dozen other important ones.

You do regularly make big-picture points, but I believe it's particularly important to hold the NYT's foot to the fire. One only has to read the posts about her article to see how effective she (and the companies pushing these, and so many other, tests) are with their use of the combination of fear-mongering and "hope-mongering" (evidence and conflicts of interest be damned). Of course there are also a bunch of thoughtful and critical comments, but there are lots on the order of "it doesn't matter if it's really true, we must try to do something about this terrible disease!"

One other point I feel obliged to make - I believe your comment that "the story is newsworthy" is actually a huge stretch. As one of the more astute readers posted at the NYT website, one could surely find dozens of "promising developments" hailed by the Times each year that we'll never hear of again. Worse, almost all the ones we do later hear about are great successes only in terms of profit (but not health). It's ironic that Kolata compared this test with cholesterol -- since the "best" that's likely to come of it is that it will label zillions of people, and get them to take drugs for years and years ... even if "the amyloid hypothesis" proves as misleading as the cholesterol hypothesis. This story will actually become newsworthy if and only when the years of testing you mention are done, and prove productive, and there is (separately) an actual useful intervention that aborts Alzheimer's Disease progression; even if both of these unlikely events actually happen, it surely won't be for ages and ages -- so running a top of the front-page story in the NYT, now, is vastly counterproductive ... unless the goal is to create desperate expectations, so that when the inevitable anti-amylase drug comes along, it will be impossible for FDA, or Medicare, to say no.

I hope you'll understand that these comments come from someone who greatly admires the excellent work that you routinely do. (I have written you before, simply to praise your work; but it remains unfortunate that people mostly write to complain ... so for that I do apologize.)

Best,

Jerry Hoffman

Reflecting on what we DID say in our review, I believe Dr. Hoffman missed some key points. However, I am very pleased that he wrote and I'm very pleased to post his comments.

One reason we maintain this site - and especially this blog - is to encourage more intelligent discussion of the quality (or lack thereof) in health care news and information disseminated to news consumers and health care consumers.

For now I won't debate any of what Dr. Hoffman wrote. I open this up to other readers.

Please weigh in on this - or on any of our reviews or blog posts - any time.

ADDENDUM ON AUGUST 18:

See the Harvard Health Blog post,
"Alzheimer's study on biomarkers generates debate."

Earlier this week, the NBC Today show brought viewers news of robotic heart surgery - from Australia! Our observations:

• The story went out of its way to name the company making the robotic system - making it feel awfully ad-like. Maybe from a video news release?

• The story said this was "one of only two being used in Australia" but nothing about any US experience. Are viewers in Adelaide, Australia now part of the Today Show's key demo?

• Nothing on cost or evidence.

• Nothing with any context - just more gee-whiz, high-tech drooling - especially because it had ROBOT in the title. Way cool.

• It was 50 seconds of "must miss TV" but we bring it to you anyway.

Visit msnbc.com for breaking news, world news, and news about the economy

Since I posted a note earlier this week about Larry Husten's fine journalism on Cardiobrief.org regarding the SHAPE (Society for Heart Attack Prevention and Eradication) cardiovascular screening guidelines, I'm now posting a link to his followup story. Excerpt:

"Earlier this week we reported that SHAPE was preparing to update its controversial guidelines. It now appears that the guidelines are only the public facade of a larger program designed to encourage the growth of, and take a larger share of, the business of cardiovascular screening. Although conflict-of-interest concerns have previously swirled around SHAPE, new evidence suggests that the non-profit organization has aligned itself with a commercial venture, and presumably stands to benefit from the success of these projects."

If you're interested (as I think you will and should be), please go the link above to read Larry's full story.

And for doing so in the heart of Medtronic country, as the Strib reminds readers:

The state is home to Medtronic Inc., the world's largest maker of devices used in spine surgery, as well as Abbott Northwestern Hospital, which performs more spine fusion surgeries on Medicare patients than any other hospital in the country, according to the industry publication Orthopedic Network News.

We applaud the newspaper for pursuing this story, one that was recommended to them months ago by me and other members of the Minnesota Shared Decision Making Collaborative, including Dr. Craig Christianson, who is quoted in the piece. It's part of an occasional Star Tribune series, "Too much medicine? When less is more in health care."

"The Cost of Dying: End of Life Care" - a CBS 60 Minutes segment originally broadcast last November, was aired again last night. I had forgotten how good it was. And it's a reminder to all of what a good job television can do - indeed any news medium can do - when it devotes time, energy and full attention to a topic. (You're going to have to watch a brief Pfizer ad at the start of this video - unless CBS rotates something else in after I post this.)

Just two days ago I wrote about Dr. Michael Kirsch's excellent blog post "Beware Surrogate Markers." In it he wrote:

"Why do some medical studies, which achieve breaking news status, often fall so short of our expectations? Physicians are cynical about these medical milestones, since they are often short-lived. Today's cure may become tomorrow's disease.
...
The public needs to understand this issue. Think about this the next time you read a news flash that promises a medical miracle. Chances are that the miracle is a mirage."

Need examples? Two days later - just in the course of our limited sweep on HealthNewsReview.org, we've already seen three examples of stories failing to convey the limitations of surrogate markers.

The worst was by WebMD, reporting on "pro-inflammatory markers" to back up anti-aging claims. Read our full story review at the previous link.

Then both USA Today and AP spent varying amounts of time reporting on the surrogate endpoint of higher HDL cholesterol levels in a study of low carb versus low fat diets.

Reviewers wrote in the USA Today story review:

Rather than report simply on this surrogate end point, do we know anything about what these HDL changes mean in terms of their risk of heart attack?

But the AP story chose the HDL angle as a primary focus, and our reviewers commented:

"Americans are already overly obsessed with 'scores.' Emphaszing the HDL difference without adequately explaining its real significance in peoples' lives feels like more scoreboard-watching without knowing the rules of the game."

Ivan Oransky has already launched Embargo Watch and Retraction Watch blogs to track recurring events.

Has it come to this with stories about surrogate markers or intermediate endpoints? Does this topic need its own blog?

Let me be clear that the following is a glimpse of only one story each from two different medium-sized papers. So it should not be construed as systematic overall praise for one nor an indictment of another.

But the examples - the likes of which we see every day in our HealthNewsReview.org work - nonetheless hold some lessons about the struggles squeezed staffs at mid-sized papers face in trying to cover complex health care news. Yet there's a lesson herein about how one can be successful despite the pressures.

The South Florida Sun-Sentinel got a five-star score for its story about an unproven approach to autism coming to the local area. Excerpt of the review:

"A new and unproven approach to autism pops up in a local community. A reporter and his newspaper have several choices:

1. Accept the claims of the promoters at face value
2. Ignore the issue entirely.
3. Dig in, scrutinize the claims, and attempt a public service by evaluating the evidence for local readers.

Thankfully, this reporter and this paper chose #3."

But the San Jose Mercury News got a low two-star score (that one of our reviewers commented was too high) for its story about a new device being used in its area to treat blood clots. Excerpt of our review:

This story baldly misstates the evidence (or lack thereof) supporting the effectiveness of a device used to dissolve certain blood clots. Indeed, a careful reader would not even have to delve into the medical evidence to realize something is amiss. The story calls the Trellis Peripheral Infusion Device "life-saving," effective, and safer and quicker than alternative therapies. However, it notes that only a handful of doctors across the country use the device (even though it has been on the market since 2005) and the clinician quoted in the story says he has used it on only eight patients, even though he sees more than 100 similar patients every year. A reader might well wonder, "If this device is so great, why do so few doctors use it and why do even those who do use it prefer to use different treatments for the overwhelming majority of their patients?" The story ignores that glaring inconsistency.

This story is also an extreme example of disease-mongering. It portrays deep vein thrombosis as a leading killer. However, not only is the death toll figure it uses taken from a misleading statement on a web site sponsored by a pharmaceutical company that sells drugs to treat the condition, the quoted number of deaths is 30 times the estimated toll listed in a recent report from the U.S. Surgeon General.

We wanted to point out this comparison - random and incomplete though it may be. Both reviews were posted the same day. Both stories done by mid-sized papers. One excelled in scrutinizing claims. One failed in our view.

Perhaps one approach could be a model for the other.

We need to help journalists do a better job of healthy skepticism. Otherwise how in the world will their readers ever get the full story?

Journalist Larry Husten, on his CardioBrief blog, describes a "new one on me" in linking to what he calls "an extraordinary document" describing cozy - indeed, invited and paid-for meeting opportunities between medical industry leaders and physicians at a heart valve conference.

Of a long laundry list, one item got special notice from Husten:

"And for $6000 sponsors get to participate in "Meeting of the Minds":

Choose four faculty members for a private one-on-one meeting. Secure your faculty choice early as faculty will be removed from selection list once chosen.

I think the organizers may have missed a big opportunity here. Why only $6000 for 4 faculty? I'm surprised they didn't think of an auction. I'll bet there are some faculty members who could fetch way more than $1500..."

(Photo credit: from Tracy O on flickr)

Ivan Oransky, MD, executive editor of Reuters Health, somehow found time a few months ago to launch his first blog, Embargo Watch - with tagline: "Keeping an eye on how scientific information embargoes affect news coverage."

Now, as evidence he either doesn't sleep or has roots in Transylvania, Oransky the Impaler launches a new blog, Retraction Watch along with partner Adam Marcus. From their first post:

"So why write a blog on retractions?

First, science takes justifiable pride in the fact that it is self-correcting -- most of the time. Usually, that just means more or better data, not fraud or mistakes that would require a retraction. But when a retraction is necessary, how long does that self-correction take? The Wakefield retraction, for example, was issued 12 years after the original study, and six years after serious questions had been raised publicly by journalist Andrew Deer. Retractions are therefore a window into the scientific process.

Second, retractions are not often well-publicized. Sure, there are the high-profile cases... But most retractions live in obscurity in Medline and other databases. That means those who funded the retracted research -- often taxpayers -- aren't particularly likely to find out about them. Nor are investors always likely to hear about retractions on basic science papers whose findings may have formed the basis for companies into which they pour dollars. So we hope this blog will form an informal repository for the retractions we find
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Third, they're often the clues to great stories about fraud or other malfeasance...The reverse can also be true. The Cancer Letter's expose of Potti and his fake Rhodes Scholarship is what led his co-authors to remind The Lancet Oncology of their concerns, and then the editors to issue their expression of concern. And they can even lead to lawsuits for damaged reputations. If highlighting retractions will give journalists more tools to uncover fraud and misuse of funds, we're happy to help. And if those stories are appropriate for our respective news outlets, you'll only read about them on Retraction Watch once we've covered them there.

Finally, we're interested in whether journals are consistent. How long do they wait before printing a retraction? What requires one? How much of a public announcement, if any, do they make? Does a journal with a low rate of retractions have a better peer review and editing process, or is it just sweeping more mistakes under the rug?"

This is going to be fun. Or, if not, I'll issue a retraction and maybe get written up.

Michael Kirsch, M.D, who blogs as MD Whistleblower, offers an educational insight about surrogate markers - especially helpful if you don't know much about these. And, in his estimation, many news stories don't seem to reflect much knowledge on the topic. Excerpt:

Why do some medical studies, which achieve breaking news status, often fall so short of our expectations? Physicians are cynical about these medical milestones, since they are often short-lived. Today's cure may become tomorrow's disease.

A common practice and serious flaw in medical research is to rely upon a surrogate marker when studying a disease. Let me explain. If you endure the following few paragraphs of literary driftwood, you will understand press reporting of medical studies on a deeper level. This could directly affect your medical care and generate some interesting conversations during your next doctor visit.

The impact on medical care from misunderstanding surrogate markers could be profound. Here's his definition:

A surrogate marker is an event or a laboratory value that researchers hope can serve as a reliable substitute for an actual disease. A common example of this is blood cholesterol levels. These levels are surrogates, or substitutes, for heart disease. If a medical study demonstrates that a medication can lower cholesterol level 10%, then we assume that this will also lower the risk of cardiovascular disease. Why doesn't this same study determine if an anti-cholesterol drug decreases heart attack rates directly? After all, most folks would rather be spared a heart attack than have a silent decrease in their blood cholesterol levels.
...
Surrogates often take on a life of their own, far removed from the actual disease they represent. Patients shouldn't care if their 'surrogates' are improving; their objective should be to prevent disease, feel better and live longer. Yet, we physicians have often convinced our patients that surrogate improvement means better health. Monitoring cancer blood tests called tumor markers illustrates this point well.

"Great news Mrs. Bedridden. Your cancer blood test improved 10 points!"

"Thank you doctor, but I still can't walk."

As a gastroenterologist, Kirsch also frames colon polyps as a surrogate marker.

Polyps are not diseases. They are surrogates for colon cancer. We hope and believe that when we remove pre-cancerous polyps that we are reducing your risk of colon cancer. Interestingly, there is no double-blind placebo controlled trial (the gold standard of medical research) that establishes that colonoscopy reduces colon cancer. Just because it sounds logical, doesn't mean that it's true.
...
The public needs to understand this issue. Think about this the next time you read a news flash that promises a medical miracle. Chances are that the miracle is a mirage.

Amen. Everytime I've written recently about what we don't know about colonoscopy, someone always rises up defending the test from the perspective of intuition, not science. It's good to hear this honest assessment from a gastroenterologist.

Read his entire piece at the link above. It's good for journalists, consumers and physicians.

Since we stumbled onto colonoscopy a bit with the above, I want to draw attention to a commentary, "Colonoscopy vs. Sigmoidoscopy Screening: Getting It Right," in the Journal of the American Medical Association last week, raising more questions about colonoscopy. Excerpt:

"From a public health and policy perspective, these apparent limitations of colonoscopy can no longer be ignored. The accumulating evidence has not established the long-held belief that colonoscopy carries greater benefits than sigmoidoscopy. How should the medical establishment advise the public given this conflict between widespread belief and current evidence?

And, from earlier in the piece, this excerpt:

A third approved screening mode for colorectal cancer is the fecal occult blood test (FOBT), which has had efficacy proven in randomized trials. ...Whether sigmoidoscopy plus FOBT is a superior screeningstrategy vs sigmoidoscopy alone remains a question.

I can't leave this issue alone. We should discuss more openly, more often, what we know and what we don't know about all screening tests. This should include the difference between what we know and what we want to believe.

Medical errors, safety and quality issues are highlighted in several new health journalism efforts.

The St. Louis Post-Dispatch has a "Who Protects the Patients?" series underway. The latest story profiles a teenager who died after being suffocated at a hospital that had been warned that its restraint policies weren't safe.

A sidebar to the latest story contrasts reporting policies in Missouri with those from at least one case in Minnesota.

It's a nice job of team reporting by the Post-Dispatch.

Meantime, the Boston Globe today reports on "Mistakes that matter: 2 biopsy errors result in an unnecessary surgery and delayed treatment."

An important story, well told by the Tribune and veteran writer Judith Graham. Excerpts:

"Families have reason to be alert to risks associated with diagnostic tests such as CT scans. Kids' changing bodies and brains are especially sensitive to ionizing radiation from X-rays used in the exams. And because children have longer to live than adults, they're more likely to experience delayed effects of radiation exposure, notably a small potential increased risk of cancer.

That's not a cause to shun the tests, medical experts agree. Medical imaging is an extraordinary tool that allows doctors to make diagnoses, select optimal treatments and save lives, they say.

But it does warrant caution, and medical professionals have been adopting measures to reduce children's radiation exposure. These include adjusting CT scanner settings for smaller bodies, imaging only those areas under medical investigation and using other tests, such as ultrasounds and MRIs, whenever possible.

Yet problems remain. Some hospitals and freestanding imaging centers continue to administer adult-size doses of radiation to children, experts report. Facilities also sometimes scan children repeatedly without cause or expose children's breasts, eyes, thyroids and genitals to unnecessary radiation by scanning too broadly or failing to use protective shields.

"We still have a way to go in terms of optimizing these examinations," said Dr. Donald Frush, chief of pediatric radiology at Duke University Hospital, acknowledging the shortcomings in the medical field.

About 7 million CT scans are administered to children every year; the number is expanding nearly 10 percent annually, according to a 2008 review of radiation risks associated with CT scans for kids in Current Opinion in Pediatrics. Almost one-third of the tests are given to children in their first decade of life."

The ending of a story is often the take-home impression for readers. This one ends with the story of an 11-year old girl with Ewing's sarcoma who has had 10 CT scans in addition to X-rays and a positron emissions tomography scan, or PET scan.

"Too many, in my book," said her mother, Susanne Eyles, of Mount Prospect.

At this point, the benefits from the tests -- monitoring the progress of the girl's cancer and its response to treatment -- are far more important than any risks, said a pediatric oncologist.

"Unfortunately, we really don't have the data to say whether the number of scans we're doing are optimal," he added.

As long as Lindsey's doctors say imaging tests are medically necessary, "then we'll say yes, go ahead," her mom said. But "as a parent, I plan to keep on asking how many of these does she really need."

It's also a nice touch to include in a story a patient/consumer anecdote that models how informed, shared decision-making can take place. Great use of the Tribune's time and energy.

In an unusual move, a journal has actually gone in and changed a previously-stated conclusion of a previously-published paper. This follows a Reuters Health story that raised questions about the study. Today Reuters reports:

"A journal editor has scrubbed a line supporting the use of a L'Oreal-Nestle tanning pill from the conclusion of a company-sponsored study.

The edits come days after a Reuters Health story about serious shortcomings in the report.

Dr. Tanya Bleiker, editor of the British Journal of Dermatology, which published the study, told Reuters Health this week by e-mail she had changed the conclusion of the report, with the permission of the authors, and added the researchers' financial conflicts.

Half of them were employees of Laboratoires Inneov, a joint venture between L'Oreal and Nestle that makes the tanning pill, called Inneov Sun Sensitivity. However, the original version of the study did not include a conflict of interest statement, Bleiker said last week, because "the authors stated very clearly that there was no conflict of interest."
...
On the first page of the report, the researchers concluded that their "results support the use of this nutritional supplement."

That sentence has now been removed. But the new version of the report now available online still says the tanning pill increases the threshold for sunburns and "represents a complementary strategy to sun avoidance and sunscreen use for a global approach to photoprotection."

An independent dermatologist who reviewed the results for Reuters Health disputed those claims last week.

Referring to whether the pill would protect women against the sun's harmful UV rays, Dr. Peter Schalock, a dermatologist at Massachusetts General Hospital in Boston, said he had "hard time seeing that statistically or scientifically (the researchers) have proven it."

Journalists and the general public can learn from this example. Journals aren't perfect. Publication - even in a top-notch journal - doesn't make a study bullet-proof. Peer review has flaws. Conflict of interest disclosure policies are variable and have holes in them.

A radical thought - but one I harbor quite often: Maybe we just spend too much news time, space and attention on journal articles.

But kudos to Reuters for pulling some of the covers off of this one.

We do a lot of colonoscopies in this country, looking for colon cancer. And that's a good thing.

But do people realize that the only screening test for colon cancer shown by randomized controlled trials to decrease colon cancer mortality and incidence is fecal occult blood testing (FOBT)? It's an inexpensive (about $20) at-home test kit that often seems to get lost in the enthusiasm for in-office higher-tech procedures like standard colonoscopy - or its new sibling, virtual colonoscopy.

This week, a study in Health Affairs reminds us about the relative benefits of FOBT. And it's about time. Kaiser Permanente in California thinks highly enough about FOBT that it mails test kits to subscribers to use at home. From a public health perspective - trying to reach as many people as possible with a cost-effective approach - it sure seems to make sense.

Katie Hobson writes about this study on the Wall Street Journal health blog and includes links to the Health Affairs study and to a MedPageToday.com story, "Virtual Colonoscopy Misses Mark on Cost." See Katie's story and visit those links if you're interested in learning more.

Meantime, one message for journalists is to include a discussion of FOBT whenever discussing colon cancer screening. It seems incomplete and imbalanced not to do so.

And a possible message for consumers (although we don't give medical advice on this blog), ask your physician about FOBT whenever other colon cancer screening methods (e.g., colonoscopy, flexible sigmoidoscopy) are brought up.

Why NOT talk about the evidence for (or against) FOBT?

Another excellent piece by John Fauber of the Milwaukee Journal-Sentinel, "Drug that could stop stroke isn't always used." This story also includes good graphics and reminders for readers on warning signs of a stroke, how to be prepared for a stroke emergency and what to do in such an emergency.

And, in that newspaper's partnership with MedPageToday.com, a version of the story appears on that site as well under the headline, "Do Certified Stroke Centers Deliver Speedy Treatment?"

Kudos to Christopher Snowbeck and the Pioneer Press for digging into new Medicare data to report that the state the newspaper serves is out of whack with the rest of the country in how many expensive MRI scans are done on Minnesotans' bad backs.

Snowbeck artfully captures the predictable rationalization and defensive responses coming from locals who don't like what the data suggest. Because what they suggest is overuse leading to overtreatment. So here's one attempt a provider makes to deflect the data:

"The Medicare billing/claims data, which this report is generated from, would not capture conversations between a patient and provider that may have addressed alternative therapies for lower back pain," said Robert Prevost, a spokesman for North Memorial Health Care. "It's important to recognize the limitations of this data."

No, data don't capture conversations. But wouldn't it be fascinating to be a fly on the wall during those many patient-physician encounters that led to an MRI to see what level of truly informed shared decision-making (if any) took place?

The story includes other excuses from local providers along the lines of "the data are outdated...we've changed...we're better now...that can't be right...it's not us!" When have you ever seen a story on health care data that didn't have these predictable reactions? It reminds me of The Tobacco Institute continually rejecting any new finding that showed new harms from smoking. When you don't like the data, damn the data. For most of the history of medicine we had no outcomes data to show patterns of practice or what happens to people over time. Now that we're starting to collect some such data, vested interests find that information is a menacing thing.

Instead, we can learn from it, even if it is a little surprising or embarrassing.

The story captured a key question about "what's the right rate of MRIs?" Excerpt:

" (a) spokeswoman for the Minnesota Hospital Association (said) "It is impossible to make judgments from the data ... on whether or not clinicians ordered too many, too few or just the right number of imaging tests."

Bingo. And that's why the data are important whether you live in a high-use or low-use area. As Dartmouth's Jack Wennberg has been saying for decades, we don't know the right rate of utilization of many medical interventions. But the variations across the country show that patients may not be fully informed, may not be told about the tradeoffs of benefits and harms, and may not be provided a truly shared decision-making encounter. Until true reform occurs in these patient-physician encounters, you can forget about getting overuse, overtreatment and health care spending under control.

Snowbeck and the Pioneer Press did a good job of digging and finding an important local story.

And where was the much larger, much better-staffed Star Tribune on this story? The same paper that just stole away Snowbeck's colleague Jeremy Olson who used to cover health care for the Pioneer Press? Deafeningly silent. I had actually written to a key staffer at the Star Tribune recently asking when/if the state's biggest paper was going to mine the data from the new Medicare database to see if there were any important local findings. I got no response. I've not seen a story in the paper on it. And I couldn't find one after I did an online search. Maybe I missed it. But regardless, thank goodness for a little remaining competition between two newspapers in a metropolitan area. And on this one - apparently - the little guy won the day big time.