We remind you that we tend to focus on communications issues – on messages affecting the public dialogue about health care.  In that spirit, we compiled some of the past posts we’ve published just in the past two years on Komen’s public messages.

July 27, 2011

Website accuses Jennifer Ashton & CBS Early Show of bias on mammography “debate”

 This was actually more of an example of a media ethics issue – but it shows how some journalists have had a love affair with the Komen Foundation that may have led to imbalanced coverage.

Jun 1 2011

A new stink over breast cancer fundraising, lawsuits, and perfume

Northern Minnesota sled-dog race fundraiser gets threatening letter from Komen attorney.  And Komen’s “Promise Me” perfume peddling is criticized by breast cancer bloggers.

Feb 4 2011

Journal editorial: some health organizations are pitchmen for food industry

The journal of the Canadian Medical Association – CMAJ – published an editorial this week, “Partnerships between health organizations and the food industry risk derailing public health nutrition”.  Komen’s finger-lickin’ linkup with Kentucky Fried Chicken was one of them.

January 7, 2011

Komen supporter Colbert parodies “Lawsuits for the Cure”

Comedian Stephen Colbert, who says he is “a huge supporter of the Susan G. Komen for the Cure foundation,” nonetheless took a sarcastic swing at the organization this week “for spending almost a million dollars a year in donor funds to sue… other groups” for using the phrase “for the Cure” in their promotions.

Nov 24 2010

Center for Health Media & Policy finds other losers in “The Biggest Loser”

See the Center for Health Media and Policy blog post about something that bugged them in the “The Biggest Loser” TV program. Excerpt: “What no one missed this week was the constant and prominent placement for Ford and their “Warriors in Pink” promotion, benefiting Susan G. Komen, the breast cancer fundraising juggernaut.”

August 5, 2010

Who owns pink ideas or cure slogans? Welcome to the Charity Brawl

There may be just a few more important things to spend one’s time on in the field of breast cancer. But the Wall Street Journal reports on an ugly dispute, “Charity Brawl: Nonprofits Aren’t So Generous When a Name’s at Stake.” Excerpt quote: “It’s startling to us that Komen thinks they own pink.”

April 20, 2010

Fried chicken goes pink

The “Weighty Matters” blog criticizes Komen’s KFC deal.

January 12, 2010

THIS IS A BLOG.  IT SHOULD NOT BE HELD TO THE SAME STANDARD AS OUR NEWSPAPER PRODUCT.  EVEN THOUGH IT’S DONE BY THE SAME PEOPLE AND APPEARS ON OUR WEBSITE ALONG WITH THE NEWSPAPER PRODUCT.

On our blog’s index page, for example, we post a clear explanation:

Because some journalists have written to us stating that they think it’s unfair to apply the same standards to newspapers’ health care news blog posts as we do to their dead-tree-version of the news. Here are a few of the arguments sent to me (with my quick reactions in red):

• Blogs are the things we try to squeeze in on top of doing a full day’s work.  (If it’s so important, your management should make it a recognized part of your full day’s work.  And if you need help conveying this message to your management, perhaps fostering a more open public discussion about the issue would help.)

• We realize we’re giving readers a taste of something – which we think is better than nothing. (We don’t agree that something is better than nothing.  We think that incomplete, imbalanced health care news can actually be more harmful than helpful.)

• Sometimes we blog when we think something doesn’t warrant a full story.  (Then put a big caveat in your first line:  THIS IS NOT WORTH A FULL STORY SO WE’RE BLOGGING ABOUT IT INSTEAD. This would tell readers that maybe it’s not worth their full attention.)

• The blog post is intended to be short on reporter analysis and long on primary-sourcing–after all, this is why so many of us have been laid off: online readers seem to want to do it themselves! (Where is this intention explained to blog readers?  Where is the evidence that says that’s what they want?)

But as one sign of how confusing this is, here is the explanation given by one journalist recently:

“Usually our blog posts are clearly marked as such – since this blog was reverse-published in print, I think you reviewed the online version of that (which wouldn’t have mentioned the blog, and was actually shorter than the original blog post)”

Huh?  Readers are supposed to sort this out?  How?

To date, no journalist has posted any such comments online for public dialogue.  I just get emails from time to time from journalists we’ve reviewed.

Clearly, the issue is discussed internally in newsrooms.  One journalist wrote me:

It’s an existential issue we think about all the time – are readers best served by fewer reported stories, a whole bunch of blogs (like a ticker of news briefs) or a mix of both? And what’s the real difference between a blog and a story that appears online? To readers, it’s probably very little. But still, some recognition that we as writers aren’t under the mistaken impression that our blog posts are actually comprehensive reported stories would be nice.

We recently noted one prediction among the Nieman Journalism Lab’s predictions for journalism for 2012:

“News will increasingly be a conversation rather than a series of stories. In 2012, the divide will grow between journalists who are intently aware of and responsive to the needs of their communities and those who continue to make decisions based on long-ago-learned fortress mentalities. I wish I could say I were optimistic about crumbling fortresses. Instead, I’ll say that I’ll be on the lookout for examples of news presented as an ongoing, topical conversation rather than a series of journalist-driven stories. In an election year, being responsive to users’ actual information needs and being a part of a community’s conversation is more crucial than ever.”

So here’s a call for newspapers to open the dialogue more broadly and more often about how health care news is covered.  How it’s done in the newspaper, how it’s done in the newspaper’s blogs, how it’s done in briefs of fewer than 300 words, how it’s done in business stories as well as consumer health stories  – and how responsive these practices are to the needs of readers, viewers, listeners.

We have also recently been challenged by a network TV representative who wrote under the request – “between you and me – not for posting, please”:

If you are going to cover TV news, it would be very constructive if you could truly rate the various network stories, objectively compare coverage of stories, and call us out when we get it wrong, and when we get it right.  It would also be great if you could work to develop principles for network medical news coverage that recognize the 1:30 minute format. While it is great to have principles to apply to newspapers, it is rather ivory tower to apply the same standards to a different format.

Why must this remain “between you and me” ? Why can’t we have a more open public dialogue about such matters?

Note how, just as with the newspaper blog objections, this TV person is calling for a different standard.  Why?  What would that standard be?  No one ever has ever – ever in 6 years of daily publishing on this site – suggested a different set of criteria.

I am, indeed, honoring this person’s request for anonymity in this case.  But here’s how I responded:

“We did objectively review and compare network TV news stories on our site for 3.5 years and across 228 stories – applying our 10 standardized criteria.  We stopped doing so because it was labor-intensive (I am the only person working on this project fulltime), the scores were poor and not improving, and one of the 3 networks’ main health news contacts told me not to bother anymore because he wasn’t paying any attention to us!  Part of his argument was the same argument you are now making:  that TV news deserves/demands a different set of criteria.  But no one has ever suggested what such a specialized list of criteria would be.  If I had to scale back our list of 10 criteria, 3 that would not change were the 3 for which TV news did the poorest job in our ample 3.5 year, 228-story sample:  covering costs, quantifying benefits and harms.  In other words, giving a sense of the scope of the benefits and harms.  But I don’t agree with scaling back the 10 criteria.  Tell me which of the 10 don’t matter in (your network’s) news stories – and make your answer on the record this time – because I think that (your network’s) viewers should be told that one or several of these don’t matter in all (of your network’s) health new stories:

• What’s the total cost?
• How often do benefits occur?
• How often do harms occur?
• How strong is the evidence?
• Is this condition exaggerated?
• Are there alternative options?
• Is this really a new approach?
• Is it available to me?
• Who’s promoting this?
• Do they have a conflict of interest?

That’s what we’re trying to get at with our criteria.  It is our stake in the ground that these are 10 things that matter.  OK, maybe they’re not all going to be addressed in every story.  But this is our stake in the ground…our guidepost…our discussion starter.

All we review on this site is daily coverage of health care interventions.  How well do journalists cover news about treatments, tests, products and procedures?

The simplest overview answer is:  the average story tends to emphasize benefits and minimize or ignore harms and costs.That’s the average across more than 1,600 stories.

We believe that this becomes a health policy issue – that how journalists help set the agenda for public discussion of harms, benefits, costs, etc., becomes a national health policy issue. The seeds of overtesting and overtreatment and denial of evidence and rhetoric about rationing can become planted and fertilized every day by the way stories about health care interventions are handled.

We’re not going to stop doing what we’re doing – the way we’re doing it – until or unless someone suggests a better way.  There’s too much at stake.

And we welcome and invite a better dialogue.

She reports that results “were discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.”  And we know that other journalists have been reporting other news presumably based on that same tele-conference.  So why haven’t more reported on the proton beam question?

Marchione easily explains the significance of the findings:

Proton therapy is rapidly growing in use — Medicare covers it — even though no rigorous studies have tested whether it is as safe or effective as usual care.

It costs around $48,000 — at least twice as much as other prostate radiation treatments. Hospitals are rushing to build proton centers, and nine are operating now — sites include Boston, Chicago, Houston, Philadelphia, Jacksonville, Fla., and Loma Linda, Calif., east of Los Angeles. Promoters often claim it is less likely to cause complications.

“There’s no clear evidence that proton therapy is better” for prostate cancer, and the new results suggest it may cause more complications, said Dr. Ronald Chen, a radiation specialist at theUniversity of North Carolina, Chapel Hill.

And from New Jersey comes news of the latest clash between medical evidence and politics:

New Jersey Governor Chris Christie has signed legislation opposing an October 2011 U.S. Preventive Services Task Force (USPSTF) draft recommendation that healthy men should no longer receive PSA tests as part of routine cancer screening.

Is this a first? A state passing a law against draft recommendations intended for primary care doctors?

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Blogger Marilyn Mann has identified what seems to be a very strange set of circumstances surrounding a review article in the journal Reviews in Cardiovascular Medicine (RICM). The article is about a class of drugs called fibrates that are used to treat people with cholesterol problems. What’s unusual is that publication of the article seems to have been paid for by drugmaker Abbott, which also happens to make two fibrate drugs, TriCor and Trilipix.

Marilynn wonders, understandably, “why anyone would want to spend their time reading a medical journal that publishes review articles that have such a high level of involvement from a commercial enterprise with a vested interest in the topic.”

To that I would add this follow-up: Is it wise to trust the judgment of editors who accept consulting and speaking fees from pharmaceutical companies, then write and edit articles that those companies may have an interest in without disclosing the potential conflict to readers?

I am referring here to the medical editors at RICM – Norman Lepor, MD and Peter McCullough, MD.  According to ProPublica’s “Dollars for Docs” database, Dr. Lepor is one of California’s “top earners” when it comes to pharmaceutical company payments, receiving some $187K for speaking, consulting and travel  from Eli Lilly, Glaxo Smithkline, Novartis, and Pfizer since 2009. Some of these pharma ties are acknowledged on a disclosure page (click the RICM tab after the link) on the website of RICM’s publisher, MedReviews, LLC, but other relationships are not. McCullough’s Dollars for Docs listing is also inconsistent with the RICM disclosure page. These discrepancies raise new questions about the objectivity of the writing in RICM.

Consider a commentary (subscription required for full text of many RICM articles) that Lepor and McCullough coauthored in 2011 about the possible overuse of angioplasty procedures. In that piece, they highlighted the limitations of a study which suggested that many angioplasties performed in non-acute settings may be “inappropriate,” and they countered that it would be useful to find out why some patients are being “inappropriately denied” access to angioplasty.

But at the same time that these editors were advocating on behalf of improved access to angioplasty, Eli Lilly, which had paid Lepor about $50K in 2010 and more than $30K in the first quarter of 2011, was heavily marketing its brand new anti-clotting drug called Effient (prasugrel) that is approved specifically for use in patients who undergo angioplasty. More angioplasties might mean more demand for Eli Lilly’s drug that is designed specifically for these patients. But the article does not alert readers to Dr. Lepor’s potential conflict of interest.

A disclosure might also have been helpful in articles (see here and here) that Dr. Lepor wrote about the drug ranolazine. Although Lepor discloses on the MedReviews website that he has been a speaker for CV Therapeutics (acquired by Gilead in 2009), which makes ranolazine, there is no mention of this relationship in the text of the articles (presumably the place one would most expect to find an acknowledgment of this relationship).  The “main points” box in one of the articles mentions only benefits of the drug and offers no caveats.

The editors’ relationships also create the opportunity for less direct, but potentially more insidious commercial bias to be introduced. Was it a coincidence that RICM ran a review article about Eli Lilly’s new cholesterol-lowering drug, pitavastatin, while Lepor was receiving consulting and speaking fees from the company?  Although he didn’t write it, Dr. Lepor presumably had a role in shaping the content and shepherding the article to publication. The article concludes that pitavastatin “has shown favorable clinical efficacy, a positive safety profile, and encouraging clinical experience in Japan and other parts of Asia.”

Keep in mind that Dollars for Docs lists payments only from 12 participating companies since 2009, and so we don’t know to what extent other RICM content may be conflicted by relationships with non-disclosing companies. This is one reason we need the mandatory disclosure requirements that are being introduced as part of the health care reform law.

To be clear, I am not suggesting that industry ties invalidate one’s opinions or make them unworthy of publication. And I’m not suggesting that these conflicts are anything new or even in the same league as some other outrageous conflicts that have been uncovered at medical journals in the recent past. But I do think that there needs to be full disclosure of potential conflicts when they exist, and so it’s troubling that these editors seem to make an extra effort to downplay possible commercial influence rather than getting it out in the open where readers can judge its significance for themselves.

In the sponsored Abbott review, for example, the journal goes out of its way in the disclaimer to say that “no funding was provided to authors.”  The intent seems to be to reassure readers that the content could not possibly be biased—and the wording may be technically accurate. But as both Howard Brody and Pharmalot have pointed out, a portion of Abbott’s payments to MedReviews will most likely end up going to RICM editor and coauthor on the article, Peter A. McCullough, MD, in the form of an editorial stipend.

Similar parsing was done in a 2010 supplement about the use of diagnostic tests in cardiology. McCullough wrote or co-authored several articles that discuss the use of tests made by Alere. The disclosures in those articles say that funding for “technical assistance” was provided to MedReviews, LLC, by Alere, and again that “no funding was provided to authors.”  Some of the articles noted that Dr. McCullough has “no real or apparent conflicts of interest to report.”

But the disclosure (again, click on the “RICM” tab) on the MedReviews website lists McCullough as a speaker and consultant to Alere (the disclosure mentions Biosite, a name the company used up until a merger with Inverness/Alere in June 2010)—relationships which presumably involved some type of funding and at least the appearance of a conflict of interest.  McCullough seems to have had a relationship with the company going back at least to 2002 (see the disclosures mentioned at the end of this article), and he was giving Alere-sponsored talks shortly before and after the supplement’s publication in 2009,  2010 and 2011.

In fact, in that same problematic 2011 issue with the controversial article on fibrates, McCullough also coauthored an article about galectin-3, a diagnostic biomarker for which Alere (previously known as Inverness Medical ) is currently developing a commercial test. The paper also mentions assays that Alere is currently marketing for natriurietic peptides and says they “greatly aid in the diagnosis, prognosis, and management” of heart failure—an assertion that some experts would challenge. McCullough again reported in the article that he had “no real or apparent conflicts of interest” to disclose.

If there are reasonable explanations for these discrepancies, the editors did not take advantage of opportunities offered over the course of several weeks to provide them. Dr. Lepor did not respond to phone and email messages I left for him at his office. And McCullough’s one-sentence emailed response to a query from me was: “I have no conflicts of interest to disclose.”

I fared slightly better in my attempts to get answers from Jeff Arnold, MedReviews’s vice president of sales and marketing, who spoke to me briefly in an initial interview but then didn’t call back with additional details that he said he needed more time to research. I told Arnold that I was concerned because I know that editors at some medical journals receive a royalty based on journal sales or income, and that this can create a hidden financial incentive for them to pursue deals like the Abbott sponsorship (which the editors ultimately benefit from through the publisher’s royalty payment).

Arnold assured me that MedReviews pays McCullough and Lepor a flat editorial fee for their services, and so they would not see a percentage of the Abbott sponsorship in the form of a royalty. He said that Abbott does not advertise in the journal and did not purchase reprints of the article on fibrates. He also said that Abbott did not make changes to the article, and that the only reason they wanted to review the article was to make sure that it contained no off-label claims about the company’s products. (One has to wonder, though, if Abbott would have been so hands-off if the article reflected negatively on their products instead of advocating strongly in favor them.)

“The disclaimer at the end of the article – we’ve had disclaimers like that for 13 years,” Arnold said. “We have disclaimers like that on every single one of our articles in full plain view.”

Notwithstanding the disconnect between these assertions and the reality of RICM’s poor disclosure practices, I do empathize with Arnold. He surely has seen his sales at MedReviews drop in recent years as fewer new drugs are approved and pharmaceutical company promotional budgets are reduced. It’s perhaps understandable that, as a sales professional, he would try to push the envelope regarding commercial involvement.

But if Arnold was not in a position to see the problems with placing sponsored articles next to the journal’s regular content without a bold disclaimer, then surely somebody else at the journal should have been. While there is a long history of sponsored content appearing in supplements to medical journals, the unheralded placement of paid content in the text of a regular issue is unexpected and deceptive. And although some may argue that industry-funded journals like RICM are viewed in the field as not worthy of serious clinical consideration, keep in mind that Abbott’s sponsored content is now indexed and accessible internationally via the National Library of Medicine, whose users may not be aware of the article’s origins in the medical pulp.

Harlan Krumholz, MD, the Yale cardiologist who first tipped off the blogosphere to this situation, described the problem with the Abbott article to me this way: “[RICM] is merely a platform for content paid for by the company – and the information is presented in a way that is far from obvious – and the content leans heavily toward the product – in contrast to a recent AHA statement. It is a promotional piece in a journal that is cited on PubMed – and widely distributed as a scientific journal.” He said RICM’s approach to sponsorship “has no place in a Pubmed journal.”

I would have to agree. Even my free local weekly—festooned with advertising as it is—alerts readers across the top of each page when articles are part of a paid advertising section. And the text is in a different font than the rest of the issue to make sure there is no confusion.

So the conflicts are right out front when it comes to cleaning ladies, roofers, and restaurants. Is it too much to expect the same level of transparency when the topic is as important as our medical care?

“problems confront anyone trying to navigate all the medical procedures, operations, prescription medications, vitamins, supplements, herbs, alternative treatments, over-the-counter products, and home devices that confront them. The key to the problem is an empowered, knowledgeable patient, but, as we shall see, extra information need not lead to empowerment. Whether information is pushed to consumers (by the news media or by direct-to-consumer advertising) or pulled out of the system by consumers themselves (by, for example, visiting Google Scholar or a social-networking site developed for sufferers of a particular disease), if a consumer can’t make the best, most intelligent use of it, all sorts of trouble can unfold.”

There’s a review in the Boston Globe of the new book, “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America,” by Dr. Otis Brawley of the American Cancer Society and Paul Goldberg of The Cancer Letter. Excerpt:

“Brawley’s sense of outrage is palpable, and he makes clear what his purpose was in writing this book: “I am not especially concerned about the rationing of health care. I am more concerned about something else entirely: rational use of health care.’’ He continues: “Poor Americans consume too little health care, especially preventive health care. Other Americans – often rich Americans – consume too much health care, often unwisely, and sometimes to their detriment.’’ And elsewhere: “[M]y hope [is] that a genuine popular movement will form to make medicine accessible, driven by science, and trustworthy . . . nothing short of another civil rights movement will do . . . [civil] rights are important, but the right to equality in health care is no less important, and it has been left behind.’’

Brawley also focuses attention on the quality of care delivered to Americans fortunate to have health insurance and finds it lacking. One example involves recommendations for aggressive screening for early forms of cancer that lead not only to huge expense, but also to excessive and unnecessary radiation exposure and surgery in patients who would have died with, and not of, their disease.

I came away from this book sharing Brawley’s frustration and agreeing with much of his basic outlook on how medicine should be practiced. He reminds the reader that “[o]ne of the greatest honors a human being can bestow upon another is to say, ‘Can you help me?’ ’’; and that doing just that while first doing no harm continue to be at the core of good medical practice.”

This is an important contribution to our understanding of the food chain of the dissemination of research news to the American public:  medical journals feed journalists who feed the American public what they get out of journals – sometimes driven largely by what’s in journal news releases.  If the information at the source is complete and high quality, the flow of information from journalists to the public is more likely to be complete and high quality as well.  But this analysis also suggests that “low quality press releases might make (associated newspaper stories) worse.”

Excerpts:

Higher quality press releases issued by medical journals were associated with higher quality reporting in subsequent newspaper stories. In fact, the influence of press releases on subsequent newspaper stories was generally stronger than that of journal abstracts. Fundamental information such as absolute risks, harms, and limitations was more likely to be reported in newspaper stories when this information appeared in a medical journal press release than when it was missing from the press release or if no press release was issued. Furthermore, our data suggest that poor quality press releases were worse than no press release being issued: fundamental information was less likely to be reported in newspaper stories when it was missing from the press release than where no press release was issued at all (although the findings were generally not statistically significant).

…

Reporting on medical research is challenging: newspapers need to reach readers who vary widely in, for example, statistical literacy and reading levels. But these issues are not unique to medical news. Journalists constantly report quantitative information. Imagine the sports section without scores, player statistics, or team standing tables; or political polls without numbers. Although further work is needed to improve public understanding of medical research, a first step is to ensure that people have access to the fundamental information—basic study facts, quantified results, important study limitations—information they need to understand the findings and to decide whether to believe them. Our results suggest that press releases of high quality increase the chance that readers will receive this information.

High quality abstracts might improve newspaper coverage. But our observations suggest that well written press releases issued by medical journals could do even more to improve the communication of medical news to the public. Our observation that press releases have more influence than journal abstracts on reporting is unsurprising. Abstracts are dense, technical, and written mainly for a professional audience. Press releases are written in a non-technical narrative format that explicitly targets journalists, many of whom have limited scientific training.

High quality press releases are a simple way for medical journals to increase the chance of newspapers receiving key information. We hope our observations encourage medical journals to issue high quality press releases. Press officers could use a checklist to remind them to include the basic facts, numbers, and cautions. A more ambitious approach would be to develop a standardised press release that would help journalists find key information, perhaps by including structured tables quantifying benefits and harms. Some small journals, however, simply lack the necessary staff to produce high quality press releases, emphasising the need for editors to ensure that the relevant information is easily accessible in the journal abstract.

Our study shows that there is substantial room for improving press releases. Medical journals should use press releases not simply to make medical news—but also to make news reporting better.

• NPR interview with author of The Information Diet making the case for “conscious consumption of news and information.”  We certainly make that case for health news and information – which often floods a thirsty public with a firehose of information when all they want and need is a sip of balanced, unbiased, complete information.  Excerpt:

“The question is, can we make enough people go: ‘Hey, you know what? I’m done. I’m done with the sensationalism of media. I’m done being taken advantage of by media companies so that I can have ads sold to me.’ … If we want to make media better, then we’ve got to start consuming better media.”

• The surgeon-blogger known only as the Skeptical Scalpel tries to educate readers (he aims it at journalists but this is good for consumers as well) about the medical journal peer review process. In an earlier post, he wondered about whether he had more influence with published journal articles or with his current blogging and tweeting. I know I answered that for myself in my own career, resigning a tenured faculty position to work on this website fulltime because of the same question which was easy for me to answer.

• I’ve cut way back on my speaking commitments for 2012 because I need to stay home and write more this year.  One that I look forward to is a University of Wisconsin event, “Science Writing in the Age of Denial,” April 23-24 in Madison.

• This is really getting old since we’re a month deep into 2012, but among the Nieman Journalism Lab’s predictions for journalism for 2012  was this one:
  • “News will increasingly be a conversation rather than a series of stories. In 2012, the divide will grow between journalists who are intently aware of and responsive to the needs of their communities and those who continue to make decisions based on long-ago-learned fortress mentalities. I wish I could say I were optimistic about crumbling fortresses. Instead, I’ll say that I’ll be on the lookout for examples of news presented as an ongoing, topical conversation rather than a series of journalist-driven stories. In an election year, being responsive to users’ actual information needs and being a part of a community’s conversation is more crucial than ever.”

  I have often said that many news organizations are out of touch with the communities they are supposed to serve on health care issues – out of touch with what readers/consumers really need from health care news stories.  We base our 10 story review criteria on things we think consumers need from stories.

That’s a wrap.

See you back here on the blog in a week or so with sand still between our toes.

Now Croakey has a new project called The Naked Doctor. The site says:

Naked Doctor aims to encourage discussion and awareness of the opportunities to do more for health by doing less. It is a compilation of articles, books and other works that highlight overdiagnosis and overtreatment.

It is a project of Dr Justin Coleman, a GP who works in Aboriginal and Torres Strait Islander health in Brisbane. He holds a Masters in Public Health, and is President of the Australasian Medical Writers Association.

In an initial post, he writes:

The modern doctor seems to have an intervention for every occasion. He or she wears a magician’s coat of surprises, each more incredible than the last. Hidden pockets contain pills, scalpels and lasers, with sophisticated medical tests providing the performance instructions.

At its finest, the medical method is impeccable; type I diabetes was a rapid death sentence prior to insulin and accurate blood sugar tests. Sometimes, though, the heavy clothing creates it own problems. Tests point to the wrong diagnosis, treatments cause harm and the promised magic fails.

Some failures are a consequence of bad luck and random variation. But the closer we study these problem areas—applying the scientific method—the more we find predictable patterns emerging. Many tests and interventions fail because they should never have been used in the first place.

The Naked Doctor probes the places in medicine that would be better stripped bare. Places where the correct option is to do nothing. The ‘doctor’s bag’ accompanying a home visit before the second world war contained no medication which would be considered of any use today, and quite a few dangerous poisons. The physician would have been of more use turning up empty handed—or, given the lack of latex gloves and infection control, perhaps not turning up at all. The modern example of cancer screening via whole-body CT scanning offers as much protection as the emperor’s new clothes, and the guileless emperor would be better off naked.

Naked Doctor’s old anatomy professor Norm Eisenberg used to claim ‘only half of the stuff we teach you in this medical course is true. The problem is, we don’t know which half!’

Luckily, various health professionals and journalists around the globe dedicate themselves to steadily peeling back the covers. Naked Doctor exposes their disrobing of over investigation and overtreatment. We invite you to watch, and to contribute.

In his initial list of articles on the topic, he cites one of our recent articles and asks, “could Gary himself be a closet Naked Doctor?”

We have data to point out which news organizations are more likely to report from news releases.  We have data to point out which news organizations are more likely to offer critical analysis and scrutinize claims.

And we know that this week’s ABC hype of reporter Bill Weir’s heart scan is not an isolated case for that network. (But it was extraordinary; a leading cardiologist wrote to us that the piece was the worst he’s ever seen.)

• In June of 2011, the network aired what one of our expert editors called “an amazingly unbalanced report” on lung cancer screening – a piece so bad that ABC apparently pulled the video off its website within hours after posting it.
• In August of 2011, ABC News’ senior health and medical editor, Dr. Richard Besser, said this on the air: “Before you go on a cholesterol medication, I want you to ask your doctor about this: A coronary artery calcium test.” Re-read our critical analysis of Bill Weir’s story if you need a primer on what’s missing or incomplete in that recommendation. And, by the way, since when do “Senior health and medical editors” – that means “journalist” – give advice to viewers/readers?
• In November of 2010, in our review of 8 stories on a lung cancer screening study, ABC News had the least balanced report. Its lead-in graphic called this a “breakthrough.” Contrast that with the NPR expert interviewee who said it’s too early to know if this is ready for prime time. And ABC used the tired “Holy Grail” line. It featured conflicted CT scan advocate Dr. Claudia Henschke crying over the news. It used the word “cure” and featured a man it said was “one of the lives she (Henschke) saved.”
• In May of 2010, ABC’s George Stephanopoulos, with excitement in his voice, announced a “brand new technology approved just 3 weeks ago by the FDA.” It was a story about a tiny camera inside the coronary arteries. ABC called it a new “cutting edge device.” and a “new technology that could save your life.” One expert wrote that the “new” technology was at least 8 years old and that “the million dollar question is not if it makes pretty pictures, but rather what does it add to the cost of the procedure and will it improve outcomes?”
• In September of 2009 we reported how ABC’s on-air opinion and rhetoric  on prostate cancer screening clashed with the recommendations of major scientific and medical organizations.
• Also in September of 2009, ABC’s Good Morning America failed to challenge former President Bill Clinton’s wild statement that because of what’s now known about breast cancer genetic variations – females “should be tested as soon as possible after they’re born – young girls, for example, for breast cancer.” Clinton went on to predict that someday we would go in for our annual checkup and “stand in a cone and our bodies will be scanned and now submicroscopic tumors will be picked up.” No actual medical expert appeared to address that.  Of course, Clinton’s prediction is very much in line with ABC’s prediction this week about “6 Devices That Could Change the Standards of Medical Care.” So the consistency in ABC’s editorial handling of new screening technologies is not surprising.
• In March of 2009, ABC’s Good Morning America anointed another “life-saving test” – promoting it as “How one minute can save your life.”  Our reviewers said the story failed to make the case that the approach can increase early detection or that early detection will lead to reduced mortality. A leading gastroenterologist wrote to us about the ABC story, describing it as “disservice to the public…distorted…sensationalized…served fear and commercialized interests.”
• In October, 2006, ABC’s Dr. Timothy Johnson, while reporting on a lung cancer screening trial, offered his own opinion on the air, declaring that he “would probably get a scan” if he were at high risk for lung cancer.

We’ve seen similar examples on CBS, NBC and CNN.  But the clear, consistent recurring theme of ABC’s coverage raises questions about whether there is, indeed, an editorial bias for promoting screening tests. And if one exists, what is the source or what are the sources?  There are very smart people working at ABC News.  How can one explain such a clear pattern unless it is deliberate?

The examples above touch on screening for breast, prostate, and lung cancers – and for heart disease.  So the topic range affected is broad.

The individuals involved in these cited stories include the ABC World News Tonight and Good Morning America – cutting across editorial units and day parts.

Those individuals include general assignment reporters, physician-medical editors, and anchors – broad-based representation.  We have no idea what’s going on with assignment editors, producers, writers and behind-the-scenes people.

All we know is what we see on the air.  And it’s not a balanced picture.  And it’s not one that supports or promotes fully informed, shared decision-making on screening issues.  That’s not only not good journalism; it’s not in the public’s best interest. It’s potentially harmful. It does not reflect a concern for health policy issues or health care costs.  So it is not informing the public debate.  It is advocacy for more testing and newer technologies – at a time when evidence increasingly shows that Americans should be educated that in health care “more is not always better and newer is not always better.”

As a way to illustrate the kind of technology he uses, Agus put me through a battery of various tests, including a full-body CT scan. It was all very fun and interesting right until the moment he showed me a picture of the calcification in my heart and told me that if I didn’t make some changes, I’d drop dead within five years.

…

So it was a $1,300 ride through that radiation doughnut that probably saved my life — a test most insurance company would probably reject and some doctors would resist, for fear of “false-positives.” This is one the main things Agus is trying to change.

“Reimbursement for preventive medicine’s always difficult in our country,” he told me. “You know, the problem is most people change health plans all the time. So if you’re that health plan, why should you spend money on something that’s not going to affect a person until a decade from now? And so one of things we really have to change is we have to push prevention… a heart attack costs hundreds of thousands of dollars. A couple hundred dollar tests along with a drug can prevent it. Obviously it’s cost effective as a return on investment.”

As for the fears that CT scans could both scare and bankrupt a person by showing a scary speck that turns out to be nothing, Agus argues that is no reason to reject them entirely.

“There are false positives or false negatives with any technology,” he said. “It matters who does it and where it’s done. And so, like with anything, any person can pick up a camera and take a picture. But very few people are a Cartier-Bresson, one of the great photographers. It’s the same thing here.”

Rather than frightening the worried well with this one reporter’s anecdote, the piece could have explained what evidence-based recommendations state.  They could have explained different risk categories.

“The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors (including coronary calcium scans) to screen asymptomatic men and women with no history of coronary heart disease to prevent coronary heart disease events.”

ABC itself, in the past, posted this independent expert’s quote:

“Calcium scanning is one of the worst examples of medicine gone wild,” said Dr. Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic. “It’s taken on a ‘cultlike’ following.”

The American Heart Association and American College of Cardiology’s guideline on this screening is this:

The body of evidence supports measuring coronary calcium score in asymptomatic adults at intermediate cardiovascular risk or low to intermediate risk, but not in low-risk individuals.

Dr. Michael Pignone of the University of North Carolina is one of our HealthNewsReview.org medical editors.  He wrote to me:

There are a number of problems with the story:

1) getting information about coronary calcium may change one’s predicted risk somewhat, but it is not clear that it affects how they should be managed (we are actually studying this right now)

2) the change in risk is usually modest (making the language used in the article over the top)

3) the advice given about treatment is no different than what is recommended without the calcium results (so how has it helped?)

4) no discussion of the adverse effects of getting the information (anxiety, both for the “patient” and his family)

5) no discussion of adverse effects (radiation, incidental findings)

A more realistic scenario might be:

• A man is “on the fence” about whether to start a statin based on a low-intermediate risk (7% chance of heart attack over 10 years)
• The man gets a calcium scan
• If the scan is negative, he continues to work on exercise and healthy eating
• If the scan is positive, he continues to work on exercise and healthy eating, and also takes statin

This is not quite as dramatic, but is more realistic. Whether it is cost-effective depends on the cost of the scan (has to be low) and the cost of the statin (has to be relatively high or otherwise it’s just better to treat without doing the scan.)

Of course, the flip side to the reporter-involvement angle was this piece by ProPublica’s Marshall Allen: “Body Imaging Business Pushes Scans Many Don’t Need – Including Me.”

But that wasn’t the only high-tech promotion ABC engaged in related to its promotion of Agus’ book.

In the midst of the ABC online story about Weir, there’s a link to a piece, “6 Devices That Could Change the Standards of Medical Care.“  It’s another promotion of Agus’ beliefs and statements, including:

Dr. Agus offers a timeline for when he suggests these devices and tests will likely be standard in medicine – some even in your homes – in the next decade.

His timeline predicts 2012 – this year – as the year that full body positron emission tomography (PET) scans will become the standard of care.  But the story doesn’t explain:  standard of care for what? “To detect disease early on” – as the piece suggests?  I don’t think ABC or Agus will have many join them in that prediction of 2012 – or the foreseeable future.

Agus’ ABC timeline also projects 2014 as the year his own DNA test will become a standard of care.

The Navigenics Test, developed by Dr. Agus, analyzes your DNA for genetic risk markers associated with 40 different types of diseases and the reaction your body might have to certain medications used in treatment of those diseases.

No independent perspectives appear.  This is nothing but promotion.

Let me emphasize:  Perhaps it is good for him that Weir got his scan.  We’re happy for him that he’s pleased with his discovery.  We’re not given enough details in the story to be able to critically evaluate the doctor’s warning that he’d “drop dead within five years.”  But it is not good journalism to present this one anecdote in isolation while waving off false positives as happening with any technology – without including an independent (and easy to find, dissenting) opinion. That’s not sound journalism. We cited several evidence-based perspectives.  The story should have as well.

ADDENDUM ON JANUARY 19:  We have added a new blog post tracking the clear pattern of imbalanced stories on screening tests by ABC News – 10 examples.  But as we note in the new post, one leading cardiologist wrote to us that the Bill Weir story was the worst he’d ever seen.