e-patient Dave urged me and convinced me to join the Society for Participatory Medicine, and then he posted a kind note about my joining and about the work we're trying to do on this site.

That work has many overlapping goals with the Society's. Under the masthead of the Society's website it reads:

Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.

And you should know about the Journal of Participatory Medicine, whose mission is to "transform the culture of medicine to be more participatory,"

"Why Big Pharma should buy your doctor lunch sometimes" is the headline of an article on Slate.com that has upset many readers. I'm not terribly upset about it because it just seems too naive and misinformed to get upset about. The final line of the piece tells you all you need to know about the tone of the column:

"Ousting commercial support is creating a huge chasm in medical education, leaving doctors not only hungry but also starved for knowledge."

Some of the online comments posted in reaction to the piece:

• "This columnist is dangerously misinformed."
• "misleading"
• "this article really dropped the ball on any sort of reasonable defense."
• "Whoever wrote this must be a paid shill for the drug companies."
• "I wonder how many pharma paid lunches the author has had?"
• "This post has a naivete to it that is almost breathtaking."
• 'The manufacturer of Remicade has a huge financial incentive to advocate long-term use of Remicade, yet the author of this article doesn't see the inherent conflict of interest."
• (Physician:) "My experience has been that aside from providing info on new meds, what many salesmen (and a high percentage of stunningly attractive saleswomen) do is trash the competition's drug in an effort to get you to write for their own product. A lot of "new" meds being pushed are not really new but merely re-formulations or new combinations of old drugs designed to extend a soon-to-expire patent."
• "This article is both one-sided and under-researched."
• "I'm a bit disappointed about the one-sidedness of this article. First, I have to admit my biases. I am a physician who used to work in an academic medical center. While I was there, I wrote the policy banning pharmaceutical reps from bringing food and gifts to the medical residents, as well as tightening financial disclosure requirements for the faculty."

People are not dumb. Even if - or maybe especially if - news stories don't point out the limitations of observational studies and the fact that they can't establish cause-and-effect, many readers seem to get it.

Here are some of the online user comments in response to a CNN.com story that is headlined, "Coffee may cut risk for some cancers."

* "i love how an article starts with something positive and then slowly becomes a little gloomy. so is it good or not? i'm still where i was with coffee, it's all in moderation, it ain't gonna solve your health woes."

* "The statistics book in a class I'm taking right know uses coffee as an example of statistics run amok. It seems coffee has caused all the cancers and cures them at the same time."

* "Could it be that instead of having mysterious compounds, coffee drinkers just drink more coffee than they drink alcohol or smoke?"

* "I am so f-ing sick of these studies, or more precicesly how these "risk factors" are interpreted as "facts" by newspaper headlines. If you can't explain why something happens other than surmising, stop wasting our time."

* "...correlation IS NOT causation!!!! So people that drink 4 or more cups of coffee have a lower incidence of two certain types of head and neck cancers, and this is supposed to mean that coffee is actually "warding off" these cancers???"

We reviewed the CNN story and a WebMD story - both inaccurate because of the inappropriate use of terms like "benefit...lowers risk...protective effect" - when none of these can be proven by the kind of study they were reporting on.

And in both we referred the journalists and news consumers to a primer on our site, "Does The Language Fit The Evidence? - Association Versus Causation," that explains why it's important to get this right.

E-patient Dave (Dave deBronkart, diagnosed two years ago with stage 4 kidney cancer), blogs today under the headline, "e-Patients and doctors both, wise up. If you haven't already." If you don't know about Dave, you should. He's one of the hottest speakers at health care meetings these days. He begins today's blog:

"I've only been studying healthcare for two years - far less than most people on this blog - and I hesitate to be overly assertive. But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That's always hazardous, and it becomes insidious when it's caused by a blind, unquestioning belief in our institutions."

One of those institutions, he points out, is the peer-review system. He quotes Richard Smith, longtime editor of the British Medical Journal, who wrote in the Journal of Participatory Medicine:

"...evidence on the upside of peer review is sparse, while evidence on the downside is abundant. We struggle to find convincing evidence of its benefit, but we know that it is slow, expensive, largely a lottery, poor at detecting error, ineffective at diagnosing fraud, biased, and prone to abuse. Sadly we also know--from hundreds of systematic reviews of different subjects and from studies of the methodological and statistical standards of published papers--that most of what appears in peer-reviewed journals is scientifically weak."

Finally, Dave plugged our project, which he calls a "wise-up tool."

Read his entire column. I've only given you a few points from it.

Last Sunday I spoke at the National Breast Cancer Coalition Foundation annual conference. There were about 800 people in the audience, so it's understandable if I didn't meet (or don't remember meeting) breast cancer advocate Sandra Spivey who was in the crowd.

She got back home from the meeting and did what I told all 800 attendees to do: if you see something inaccurate, incomplete, imbalanced in local health news coverage, let the editor/producer/reporter/news director know about it or you'll continue to get what you deserve for not speaking out.

So she did.

She saw a story on NBC4- KNBC in Los Angeles talking about "cures" with a "major breakthrough" of a "groundbreaking" tumor freezing technique. But she didn't see any of our ten criteria from HealthNewsReview.org addressed in the story.

So look what she did: she posted a comment on the KNBC website (seen at left), calling the story "false hope" and posting our ten HealthNewsReview.org criteria right on the KNBC website! She was clearly listening when I told the multitude at the meeting in DC: imagine what would happen if all of you and all of your breast cancer advocate colleagues back home did this!

Just like Howard Beale in the movie, "Network," she got out of her chair, went over to the window (her computer in this case) and yelled, "I'm mad as hell and I'm not going to take it anymore!"

God love you, Sandra. I wish there were thousands more like you. And I know there are. I hope the National Breast Cancer Coalition tells this story to all of its members. It's the wisdom of the crowds, and it reflects what NBCC president and founder Fran Visco told her members on Sunday, "We need to do more, to do it better, and to do it all differently. We're not here to be popular or well-liked."

Well, the NBC Today Show's "Inside the O.R." series this week has certainly generated blogger criticism. Earlier we posted Larry Husten's scathing review of the segment on atrial fib ablation. Now Amy Romano on the
Science & Sensibility blog has written about her concerns about the live cesarean section delivery that was part of the series.

NBC execs will probably write off this criticism as coming from a bunch of nobodys - myself included in that bunch of nobodys - but perhaps the suits should pay some attention to the wisdom of the crowds on such matters.

Patient advocate Trisha Torrey writes and talks a lot about "participatory medicine." Today she writes:

"While many of us patients truly want to participate in our own care, we're not finding a great deal of cooperation from the others who must participate - our providers.

Some providers get it! In fact, some are very cooperative, offering knowledge, learning materials, assistance, discussion. They are the enlightened ones who realize that two heads -- theirs and their patients (us!) will always be more effective than one."

She has now posted an online poll asking readers:

Think of the specialist you see most frequently. Do you consider him/her to be participatory?

• Yes. My specialist and I decide every aspect of my care together.

• Partially. Sometimes we decide together, other times I just bow to his/her expertise.

• Barely. Once in awhile we discuss options.

• No. I can't get this specialist to discuss options with me at all. It's his/her way or the highway.

A news story - it's not labeled as an editorial or as an advertisement - on a New Jersey news website bemoaned how "doctors will soon be forced to scale back or discontinue medical imaging services, due to the major reimbursement cuts recently released in the Centers for Medicare & Medicaid Services' (CMS) 2010 Physician Fee Schedule."

The story went on to quote four sources who promoted the need for imaging support - but it quoted no one who talked about questions of overuse of, and overspending on, medical imaging.

So a reader weighed in on the online comment section, writing:

"Is this a press release or a news story? Are you paid by the imaging lobby?

The part about "stifling innovation" and "delivering better outcomes with less radiation" is downright disturbing, particularly in light of a a recent National Cancer Institute report that said 29,000 cancers - and 14,500 deaths - related to radiation exposure from CT tests will occur in people who were scanned just in the year 2007.

You should know your reporting could be hurting people. How about an article detailing the risks of CT scans to provide some balance to your readers? Imaging can help but medical researchers are quickly discovering it's vastly overused, particularly for heart disease and musculoskeletal disorders. Not only can the radiation harm you, it can lead people to get unnecessary surgeries that carry the risk of harming them for life."

Thank goodness the "news website" posts comments. In this case, it made the page look smarter and more balanced.

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

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

The story included this line:

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

The chaplain wrote:

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

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