Usually when something Texan tries to move into Oklahoma, there's a great deal of skepticism. But that's on the sports page.

On the business page of The Oklahoman, a recent health news story was treated like free advertising for a Texas company now bringing its mobile health screening services to Oklahoma. Excerpts:

Austin-based HealthYes! uses the latest equipment and techniques to screen for heart disease, stroke, abdominal aortic aneurysm, peripheral artery disease, diabetes, liver disease and osteoporosis,(said the company president).

"Our goal is to educate people to take a proactive approach to their health care," he said. "So many people don't get these tests because they have no symptoms."

HealthYes! fills a niche in the preventive-care arena, he said. "There's a real need out there."

Another classic example of a business section failing to exercise any tough journalism on a health news story - and of a news organization failing to realize that there can be harms from screening that is done outside the boundaries of evidence.

The story only quoted the company president - who, of course, sees a "real need" and a "niche."

But there isn't one quote with a doctor who could raise questions about what evidence there is to support population-wide, drive-around-screening offerings for "heart disease, stroke, abdominal aortic aneurysm, peripheral artery disease, liver disease and osteoporosis."

If you're scoring at home:

Free advertising 1, Journalism 0

Or

Business Interests 1, Consumers 0

The Associated Press reports on "A look at underused test in efforts to spur millions needing colon cancer checks." Excerpts:

The dreaded colonoscopy may get the most attention but a cheap, old-fashioned stool test works, too -- and when California health care giant Kaiser Permanente started mailing those tests to patients due for a colon check, its screening rates jumped well above the national average.

Now specialists are looking to Kaiser and the Veterans Affairs health system, another program that stresses stool-tests, for clues to what might encourage more people to get screened for a cancer that can be prevented, not just treated, if only early signs of trouble are spotted in time.

"By overselling and overpromising colonoscopies, we've put up barriers for people" to get any type of screening, says Dr. T.R. Levin, Kaiser Permanente's colorectal cancer screening chief in northern California. ...

The $20 stool test -- usually handed over by a doctor, performed at home and then mailed to a lab -- is considered as effective if properly used once a year. But its use has dropped as colonoscopies took center stage.

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

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

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

Other excerpts:

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

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

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

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

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

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

This week the National Institutes of Health convened an "NIH State-of-the-Science Conference on Enhancing Use and Quality of Colorectal Cancer Screening."

The only story I could find on it was in the Columbus Dispatch.

But I've seen no news coverage about what a friend who attended the conference reported to me.

I've now verified with various attendees that there were clear new signs of the turf war between gastroenterologists - keepers of the traditional colonoscopy approach - and radiologists - who are more inclined to favor the new kid "virtual colonoscopy."

More than just "inside baseball" about "inside your colon," this is another war over evidence in health care.

The NIH panel was not charged with judging the relative value of different colon cancer screening methods.

But it sounds like some of the parties who attended had a different expectation and so the conference they got was not the conference they wanted.

I'm told that radiologists were upset - demanding at least more recognition of the benefits of virtual colonoscopy (or CT colonography) if not a downright endorsement. Some stated their disapproval of the U.S. Preventive Services Task Force statement that "the evidence is insufficient to assess the benefits and harms of computed tomographic colonography (ed. note: and fecal DNA testing, for that matter)." And they're upset about the subsequent decision by the Center for Medicare & Medicaid Services not to cover the newer test.

Radiologists wanted more recognition of the large American College of Radiology Imaging Network trial.

I'm told that there were several radiologists who got up and basically screamed at the panel members for being in the "dark ages". They cited the American Cancer Society recommendations that conflict with the USPSTF on the virtual colonoscopy and also evoked what they called the "mammography disaster," referring to the USPSTF mammography recommendations released last November - another time the USPSTF and Cancer Society disagreed.

One of the speakers at the NIH conference said that the Cancer Society does not use a formal process for evaluating the evidence, does not provide details about how they come to their conclusions and includes only sub-specialists on their panel - raising questions about conflict of interest in their recommendations.

So even though that's not what the meeting was about, there was scuffling over screening method vs. screening method, turf wars, and conflict of interest in the setting of guidelines or recommendations.

So this one isn't over.

And it's difficult to understand why this didn't get news coverage. It sure sounded newsworthy to me.

Got your attention with the first two, didn't I? And that's the point behind celebrity spokespeople pushing health campaigns. NASCAR driver and lingerie ad model Danica Patrick is now promoting an online "screener" for COPD or chronic obstructive pulmonary disease.

John Mack gives details on his Pharma Marketing Blog, where he put together this photo montage.

But Mack also raises important questions about the "screener." He writes:

"The campaign points out that "COPD is the 4th leading cause of death in the US" and "an estimated 24 million Americans are affected" and "over half of them don't even know it."

In fact, I didn't know that I MAY have COPD! But thanks to the COPD POPULATION Screener™, which the DRIVE4COPD campaign urges every one to take (see the DRUVE4COPD Web site), I now know it and will talk to my doctor about it, which is the goal of DRIVE4COPD.

You too can find out if you MAY have COPD by taking a simple 5 question test! I had no doubt that I would score high enough to be at risk because:

1. During the past 4 weeks, I DID feel short of breath "a little of the time," like when I had to shovel some snow, and

2. I DID cough up some "stuff," such as mucus or phlegm, but "only with occasional colds or chest infections," and

3. I HAVE smoked at least 100 cigarettes in my ENTIRE LIFE, though I quit smoking about 30 years ago, and

4. I agree (but not STRONGLY agree) that I do less than I used to because of my breathing problems, and

5. I am a man of a certain age (but I won't say how old).

This is not the first time that I have taken such a screening test without any idea who came up with the questions or how the answers determine whether or not you have a medical condition."

I, too, took the "screener," entered the healthiest answers possible, yet still was told by the website:

Don't wait. Call your doctor today to make an appointment if you may be at risk for COPD.

That's ridiculous. But that's what happens with the "Let 's SCREEN for everything" marketing mentality that has sprouted wings (and now NASCAR wheels!) in the good old USA.

Sometimes I just like to share things that I see that Joe Blow and his bride don't see.

Like a web-based news release promoting:

• a "robotic prostatectomy expert" doctor

• the doctor's robotic surgery website

• the fact that the doctor is a contributor to Fox News

• a celebrity's promotion - and the doctor's promotion - of prostate cancer screening that conflicts with that of the US Preventive Services Task Force and the American Cancer Society

Excerpt from the web news release:

"Celebrities are helping to drive the point home for early prostate cancer screening in order to increase chances of survival. Now, with theater big Andrew Lloyd Webber's victory and Dennis Hopper's losing battle with the disease, the spotlight turns to increasing awareness and becoming more proactive with this largely preventable disease."

Our advice to consumers:

• Be wary of celebrity advice.

• Put more stock in evidence than in celebrity anecdotes.

• There's a reason why the US Preventive Services Task Force and the American Cancer Society agree on a more cautious approach to prostate cancer screening and you should learn what that is.

Sharon Begley reports on a study published in the American Journal of Public Health that she says "doesn't inspire confidence that doctors are following evidence-based practices and putting their patients' welfare first." Excerpt:

"In a nutshell: a significant percentage of elderly women with severe dementia are getting screened. Such women have an average life expectancy of only 3.3 years. Yet science-based guidelines from the American Cancer Society and other experts say that women with a life expectancy of less than five years should not be screened (because any cancer that's found will not grow fast enough to cut into her remaining years). Even more disturbing, if an elderly woman with severe dementia is also married and with a net worth of $100,000 or more, she is more than twice as likely to get these inappropriate mammograms as her poorer peers."

The LA Times Booster Shots Blog was one of the handful of news organizations that wrote anything about the Journal of the National Cancer Institute articles this week on DCIS or ductal carcinoma in situ.

The Times wrote:

"The issue is important because 25% of all breast cancers diagnosed in the United States are DCIS. DCIS is defined as an abnormal collection of cells in the milk ducts of the breast. It can be life-threatening in some cases. But most of the time DCIS is a low-grade tumor that is best described as something between normal breast tissue and breast cancer. In this country, women diagnosed with DCIS have surgery to remove the tumor, and survival rates are 98%."

I've interviewed dozens of women who've been diagnosed with DCIS and they told me stories of their anxiety and confusion over what they were variously told was "precancerous...premalignant...a benign cancer" yet were told - in some cases - to consider bilateral prophylatic mastectomy to treat it.

The JNCI articles summarized last Fall's National Institutes of Health state-of-the-science conference on ductal carcinoma in situ.

There is such a disconnect in journalists' relative lack of attention to DCIS at the same time many of them whip up uproars over the US Preventive Services Task Force's recommendations on mammography. Because it is this same DCIS condition that so often turns up when mammograms are done in younger women - one of the key issues the USPSTF tried to address.

Indeed, after the Fall NIH conference, a debate began about whether to change the name of DCIS. The Journal then reported that there was talk of dropping "carcinoma" from the name because some thought it was an "anxiety-producing term." Gee, the same anxiety that so many USPSTF critics minimized? Excerpt from an earlier JNCI article:

"Otis Brawley, M.D., chief medical officer of ACS and an oncologist who is in favor of the name change, argues that the medical community can take better care of patients both emotionally and medically if there is a better name. "I think there is a huge amount of confusion," he said. "I'm much more concerned that we are scaring a whole host of people that have ductal carcinoma in situ who make rash decisions because it's called 'carcinoma'--decisions that they wouldn't make if it was more adequately described for what it truly is." ...

Barbara Brenner, director of Breast Cancer Action, an advocacy group, said it doesn't make a difference if it's called "neoplasia," "carcinoma," or even "the bad disease." Conversations about treatment have to happen regardless of what the disease is named, she argues. "I know there is a great deal of anxiety with DCIS, but I don't think the anxiety would be lessened by calling it something else, because at the end of the day you still have to talk to someone about what to do about it," said Brenner. She said it's the treatment that's scaring women, not the name. In Brenner's view, the medical community should allocate any resources being spent on the name change to improving risk stratification of patients because the real issue is not knowing whom to treat.
"It's a nonpriority," said Brenner, who said she would attend the name-change meeting if the opportunity presented itself. "This is a silly discussion. I understand why doctors want to have it, but it's not going to help women one iota."

One way or another, it's unfathomable to me that journalists would cover USPSTF controversies and fail to report in more depth about DCIS.

That's a line from a commentary entitled, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," published in the Journal of the American Medical Association this week by Dartmouth's Steve Woloshin and Lisa Schwartz.

Blogger Merrill Goozner did a good job summarizing the piece. So far he's the only journalist I've seen who's written about the article as I go to post this.

As the authors wrote:

"...people need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries (and they provide a table of some) about the benefits and harms of testing would help foster good decision making."

That's something journalists struggle with every day in telling health care stories - as we've shown over and over on HealthNewsReview.org.

Alicia Mundy of the Wall Street Journal reports: "The final health-care bill is likely to require coverage for more mammograms than the new guidelines recommend after women's groups, doctors and imaging-equipment makers stepped up pressure on lawmakers -- one of many threads of the bill negotiated behind the scenes."

Less than 24 hours after we blogged about USA Today's story about some of the problems with celebrities' health advice, the Associated Press reports that 71-year old Teresa Heinz, wife of Senator John Kerry of Massachusetts, "says she is being treated for breast cancer discovered through mammography and argues that younger women should continue undergoing the tests despite a federal panel's recent recommendation to reduce their frequency."

As is typical with such stories, the celebrity was provided a platform for her views and there was no countering comment from any evidence-based supporter of the US Preventive Services Task Force's recommendations.

Someone suggested that we comment on a CBS segment from two weeks ago. We reviewed it and found it to be the most confusing jumbling of breast cancer screening information we've seen from a major news organization.

The anchor began by saying, "Now it seems like we're getting new recommendations every week and it's confusing."

Every week? Only if you make it seem that way.

Then the anchor and physician-correspondent began discussing "the latest study" showing that "mammograms in younger women could increase their risk of cancer." They discussed an unspecified study in high-risk women, some of whom had mammograms before the age of 20.

Huh? If this was supposed to follow up the US Preventive Services Task Force recommendations for women in their 40s, why were they suddenly talking about mammograms in high-risk women including teenagers? And when you look for breast cancer in high risk women it is no longer accurate to refer to this as "screening." Screening refers to looking for disease in broad populations of apparently healthy people with unknown risk.

The semantics are important. Or else you're confusing people even more.

The physician-correspondent immediately followed this discussion by saying that the American Cancer Society stands by its recommendations that the benefits of screening far outweigh the risks.

Again, huh? In the teenagers the segment had just discussed? That's ludicrous.

Then the segment, which was labeled as being about alternatives to mammograms, discussed only one - ultrasound - calling it "our most important test." That, dear readers, is a completely unfounded statement.

The anchor quickly shut off the discussion. No other "alternatives" were discussed and the segment whizzed by anyone who was watching in a whirlwind of misinformation that ran one minute and 43 seconds.

Let's hope most viewers were instead brushing their teeth or getting their first cup of coffee at the time. Better yet, that they had the TV turned off.

TV loves screening stories. They love big scanners. And they love to have their reporters wear hospital gowns and get down and get scanned. The trifecta of TV health news stories.

A few weeks ago, KOVR-TV in Sacramento reported on a local scanning center's promotion of whole body CT scans "to catch disease before you have symptoms."

While the story did talk about radiation risks and did include one skeptic who said such scanning was "pointless and could lead to more unnecessary testing," it did fall into the trap of allowing the reporter to get screened. Why do they do that? Why should any of us relate to her story - which may not be and probably isn't anything like our own?

But they also ended the segment with the scanning center's name and phone number on the screen for a full 30 seconds. Great free advertising!

The 5 pm story only teased us that the results of the reporter's scan would be on the 10 pm news. I couldn't find that followup anywhere on the station website.

In an issue of the Archives of Internal Medicine that published several studies pointing out the risk of cancer associated with overuse of popular CT scans, there is also a strongly worded editorial about CT scan screening for coronary artery calcium - something some journalists seem to have fallen in love with.

Dr. Patrick G. O'Malley of the Uniformed Services University of the Health Sciences wrote the editorial. Excerpts:

"Any screening for coronary artery calcification (CAC) for primary prevention of cardiovascular disease (CVD) is still an unproven strategy to improve health outcomes. ... there is ample reason to be wary of screening for CAC. First, we do not know whether it results in improved outcomes. ... There are members of our own profession who are not only endorsing this practice but also profiting from it. In short, screening coronary CT, as currently implemented, is a costly practice with unclear benefit and theoretical potential net harm....

Since it seems that the medical community is unwilling to self-regulate in this probably enormously wasteful endeavor, it will require policy makers to be more forceful in reining in the madness, whether it be the Food and Drug Administration or financiers of health care. To be fair, there are strong logic, rationale, and even promise for this technology, but any further resources invested in this area should first go to large randomized clinical trials to prove its clinical impact. Those trials that use change in calcification scores as a marker for atherosclerosis progression should clearly be using longer intervals than 1 year (likely at least 3 years) for repeated measurements."

We have seen many stories - especially on TV news - that have glamorized these scans - sometimes by having reporters undergo the scans themselves as part of the story. It will be interesting to see how much attention this editorial and these new studies get.

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

Last week, several news stories across the country reported that a Houston sports cardiologist was calling for widespread heart screening of sixth-graders after he found seven with undiagnosed heart conditions -- two of which required surgery.

The Houston Chronicle reported the story, but the only comment about concerns was one of cost:

"Such an endeavor, however, would be costly.

A $150 exam similar to the HEARTS screening is offered monthly at the Memorial Hermann Sports Medicine Institute.

The preventive EKGs and cardiac ultrasounds are usually not covered by insurance."

CNN reported the story and managed to explain that there are "downsides to screening." They mentioned how expensive it would be to screen all those kids for "relatively unusual heart problems." And they mentioned false positives, with some parents being told their child has a heart problem when indeed they don't. In this case, it was good to see CNN learn and disseminate the message: "With all screening, it's important to ask what benefits are you getting but what are the downsides?"

The CBS Early Show did not deliver the caveats that CNN did. First, the main story was delivered by a general assignment reporter from the Dallas bureau. His report included the disease-mongering anecdote of a girl who died from sudden cardiac arrest. But, of course, they didn't mention that there's no evidence that any screening would have prevented that death. And the reporter did not challenge the doctor's statement that this could lead to routine heart exams for all sixth graders in America. At the end of the segment, CBS had Dr. Jennifer Ashton come on the set but gave her all of 30 seconds. I don't think I've ever heard anyone talk so fast. I believe I heard her briefly mention costs, but, no fault of hers, I don't think anyone can do this justice talking that fast in 30 seconds.

ABC's website was far more complete in its report. Excerpt:

"...the price of a nationwide pediatric heart screening program would be considerable. Some doctors say it may not be the best use of health care dollars.

"We are not good enough at screening to make this routine," said Dr. Brian Olshansky, director of Cardiac Electrophysiology at the University of Iowa. He says that screening will cause some kids to be identified as needing treatment -- even though any heart abnormalities they have may be harmless.

In these cases, "an intervention would actually create more harm than good," he said.

Dr. Barry Love, assistant professor of pediatric surgery at Mount Sinai, agreed, saying, "finding the very small number of children who would have died suddenly...has the unintended consequence of excluding a large number of children from healthy sports participation."

"We already have an epidemic of obesity and sedentary lifestyle in this country. Screening would make this worse," Love said.

Dr. Steve Nissen, chair of cardiovascular medicine at the Cleveland Clinic, doesn't feel that Higgins' screening would be wise to apply widely."

Nonethless, how you end a story often shows how a reporter feels about a story and the ABC story, like many, ended with the pro-screening personal anecdote of a parent:

"It's a great thing that we have this technology and we are able to screen kids. It's such a blessing that we were able to catch this."

Finally, one of our HealthNewsReview.org medical editors, Dr. Michael Pignone of the University of North Carolina gave me his opinion of the stories. He wrote:

"These are pretty extreme claims based on limited data. What is not clear is the incremental benefit of doing their procedure-oriented exam (with EKG and echocardiogram) above and beyond a good history and physical exam by one's primary care doctor (including an assessment of blood pressure, review of any symptoms like shortness of breath, and screening family history for red flags (early sudden death or coronary artery disease) It is likely that a basic assessment would be nearly as effective (with fewer opportunities for false positives) at a lower cost."

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

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

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

Huh?

It got worse, as he wrote:.

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

Stop the foolishness.

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

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

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

It got worse. Much worse. As he continued:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Many of us might rather move on and end all of the discussion about the US Preventive Task Force's mammography recommendations last week. But I think it's essential that we reflect on ten things that stand out from last week:

1. Many in the general public (most of those quoted in news stories) are not prepared for evidence to be used in making health care recommendations. They haven't been prepared by the health care industry, by their physicians, or by the news media.

2. Many in health care (many of those quoted in news stories) are too invested in their own preferences to allow evidence to make a difference in their practices.

3. There is an undeniable and clear bias in many news stories, reporters and news organizations for promoting screening - evidence be damned. I've reported on this before and last week provided overwhelming new evidence. (Mind you - I said "many", not "all.")

4. The USPSTF, which is a collection of independent experts, has no public relations arm. They simply review the evidence and publish their recommendations.

5. The public relations machinery of the American Cancer Society, the American College of Obstetrics and Gynecology - and other groups that opposed the USPSTF recommendations - helped the anti-USPSTF message rule the media all of last week.

6. Politicians chimed in - sometimes distorting the evidence beyond all recognition. The clash between politics and science at such times is predictable and disgusting.

7. The rhetoric used to oppose the USPSTF recommendations was the ugliest and most ill-founded I can remember.

8. There was some excellent journalism done on the issue last week, but it was overwhelmed by and drowned out by the drumbeat of dreck shoveled out by many news organizations - including in much (not all) of what was provided on network TV.

9. The week may have caused harm to the nation's discussion of health care reform.

10. The week was certainly a setback for the nation's understanding of science, of evaluation of evidence, of the potential harms of screening tests.

Kirsten Boyd Goldberg writes in this week's Cancer Letter:

"In the past three decades, attempts to develop rational, evidence-based screening guidelines for breast cancer in the U.S. have always generated intense controversy.

What happened this week with the new U.S. Preventive Services Task Force recommendation has happened many times before:

An independent panel of experts is assigned to rationally assess the data and evaluate the level of evidence for screening in order to minimize the role of commercial and political interests in promoting a test that might or might not reduce cancer mortality.

The moment the panel's document is released, political combat ensues. The result is a cacophony. The resulting cacophony angers politicians who don't understand why "the experts" can't agree on "one simple message."

The anger of politicians frightens federal health officials who want to protect their budgets and their ability to run programs without meddling from Congress.

The federal health officials bob and weave and distance from the expert panel's recommendations.

The expert panel becomes the focal point of the anger. Commercial and political interests make accusations about the panel's composition, experience, and potential conflicts of interest. The panel must have been politically influenced, critics charge. The specter of "rationing" health care is raised.

The beleaguered panel members either defend their recommendation or say nothing.
Rational assessment has always had a tough road to travel in the U.S., starting with the dawn of randomized clinical trials, when doctors didn't accept trial results as being valid. But that's another story."

She's absolutely correct. Those who don't learn from the past are doomed to repeat it.

John Crewdson in The Atlantic:

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

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

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

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

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

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

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

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

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

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

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

1. This is all about saving money.

2. This is about rationing.

3. Early detection saves lives.

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

5. The shifting recommendations prove that scientists are clueless.

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

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

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

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

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

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

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

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

As I've written earlier, the reaction from some people that this week's US Preventive Services Task Force recommendations were "surprising" or "coming out of nowhere" are themselves surprising. Anyone - certainly any informed health care consumer and certainly any journalist- should have known that the uncertainties surrounding mammography have been debated for decades.

There's a nice summary of the history by Charles Bankhead of MedPageToday.com.

For a long time, I've urged health care journalists to refer to the recommendations of the US Preventive Services Task Force and to educate readers/viewers about how the group operates.

Perhaps one of the reasons the task force's recommendations this week caught so many people by surprise is that journalism hasn't done a good enough job of:

• explaining the uncertainties that still exist and always have existed about mammography
• explaining the work of the USPSTF

Gina Kolata of the NYT offers somewhat of a backgrounder/explainer today.

All of their work - how they do it - what they base their recommendations on -who they are - is available online - and has been.

Since they're an independent group of experts from across the country, they have no PR machine like the American Cancer Society does. So it's easy for the ACS to rule the airwaves and the columns when they disagree with something the USPSTF states.

But I think journalists have failed badly in explaining this work. And the harm done to evidence-based medicine this week may be lasting.

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

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

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