Evidence?  Harms? Why don't journalists report the full story on screening tests?
Created 10/30/08

My thanks to The Daily Beast for publishing my commentary this week.
The following is a modified version.

This week the Wall Street Journal published a big splash, "CT Scans Gain Favor as Option for Colonoscopy." But in this 1,300-word article, there isn't one mention of the recent statement by the U.S. Preventive Services Task Force

"that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography”

and that

"there is potential for both benefit and harm. Potential harms arise from additional diagnostic testing and procedures for lesions found incidentally, which may have no clinical significance. This additional testing also has the potential to burden the patient and adversely impact the health system."

The USPSTF is often considered the “gold standard” on preventive health recommendations.

Its new statement on colon cancer screening was issued just 3 weeks ago, so it isn't like it gathered dust or is outdated.

And it's written by independent experts from various fields with no skin in the game - not by radiologists or gastroenterologists or by any interest group.

Insufficient evidence. Harms may occur. Newer isn't always better. Why isn't that part of the story?

Yet it keeps happening.

On this site, we recently reviewed another similarly cheerleading one-sided story in the Atlanta Journal-Constitution.

Earlier this month, the CBS Early Show let actress-singer Olivia Newton-John appear on their program to promote a commercial product without a balanced review of the evidence.

In fact, the anchor led in to the relevant part of the interview by prompting the celebrity, “Tell us about your crusade.”

(Newton-John:) “I’d like to introduce the Liv Aid, which is a Breast Self Examination kit to encourage women to do regular breast self-examination, because early detection is key.”

Newton-John went on to remind viewers that she found a lump during breast self-exam 16 years ago. She said she was working with the Curves chain to try to get these LivAid kits to one million women.

But a recent review of the scientific literature by the Cochrane Collaboration stated:

"Data from two large trials do not suggest a beneficial effect of screening by breast self-examination but do suggest increased harm in terms of increased numbers of benign lesions identified and an increased number of biopsies performed. At present, screening by breast self-examination or physical examination cannot be recommended."

There was never a mention of this in the CBS program - only free airtime for a "crusade" - and a commercial one at that.

The month before that, the same CBS program gave an incomplete view of breast self-exam using physician-"reporter" Dr. Holly Phillips from WCBS-TV in New York to do a followup on actress Christina Applegate's diagnosis of breast cancer.

Last month all three big TV networks and their anchors loaned their support for an advocacy cause in the StandUpToCancer telethon.

On the telethon, "Everybody Loves Raymond" star Brad Garrett - in a highly promoted move - appeared to fake having a digital rectal exam on the air. Meantime, the program pronounced that every man over age 50 should have an annual prostate exam. The program urged viewers to "Push Your Dad To Get a Prostate Exam," and used this cartoon on its
website.

The U.S. Preventive Services Task Force states:

 "The USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined."

We've tracked incomplete stories on screening on NBC, on CNN, in the New York Daily News, the Chicago Sun-Times, the Minneapolis Star Tribune and in other news outlets.

You want to talk about health policy and health care reform? This is not a bad place to start. It doesn’t require wonkish jargon. A few simple reminders could guide journalists and the public:

• Newer isn’t always better.
• More isn’t always better.
• Screening doesn’t make sense for everyone.
• Many screening tests do good; many also do harm.

Such stories stoke the fears of the “worried well.” They raise undue demand for unproven technologies. They raise unrealistic expectations of what screening – and health care – can achieve.

And they overlook evidence, harms and costs.

Trudy Lieberman wrote a column for the Columbia Journalism Review asking if journalists deserve some of the blame for the high cost of health care when they write stories like this.

We spend more on health care than any other country on the globe, yet we have outcomes for some conditions that are worse than in developing countries. And we still have more than 40-million neighbors who are uninsured.

That might be a better reference point for a discussion on health care reform and health policy than what we get from stories that make us all think that we should be screened because we all have
something silent lurking inside us that should be found and treated.

Gary Schwitzer
Publisher

HealthNewsReview.org