As we pointed out in some separate examples just last week, the answer might be in whom you decide to interview, and in whether you hear from independent expert perspectives in your news stories.
On the one hand
The Cleveland Plain Dealer reported, “New FDA-approved device helps doctors detect deadly melanoma skin cancer.” The story only interviewed a couple of doctors who are true believers and users of the system. No skeptics, no truly independent perspectives. And there were no questions raised about possible limitations in the use of the technology.
But on the other hand
The New York Times reported , “Dissent Over a Device to Help Find Melanoma.” Excerpts:
“This technology should still be considered to be in the developmental stage,” said Dr. Roberta Lucas, an instructor of clinical dermatology at the Northwestern University Feinberg School of Medicine in Chicago. “We are better off when the system supports doctors who are thorough and unhurried; who examine and listen carefully and who empower patients to practice good surveillance and sun protection.”
In fact, some members of an expert medical panel asked to review MelaFind a few years ago for the Food and Drug Administration warned that the device had the potential to give doctors and patients a false sense of security. While MelaFind can analyze small pigmented spots identified by dermatologists as having signs of melanoma, it is not designed to evaluate other problems: large melanomas, colorless melanomas or two other types of skin cancer — basal and squamous cell carcinoma.
Dr. Amy E. Newburger, a dermatologist in Scarsdale, N.Y., who was a member of that F.D.A. panel, told me that she was concerned that a doctor could inadvertently use MelaFind on a non-melanoma skin cancer, receive a score indicating that the spot was not irregular, and erroneously decide not to biopsy it. She voted against recommending the device for F.D.A. approval.
Some biostatisticians are also critical of MelaFind, saying the device can recognize a high percentage of melanomas correctly because it also falsely scores as positive so many non-melanomas — potentially prompting doctors to perform unnecessary biopsies.
To help me visualize that issue, Jason Connor, a biostatistician at Berry Consultants, a biostatistics consulting firm, compared the accuracy of MelaFind in distinguishing non-melanomas to a hypothetical pregnancy test which, used on 100 nonpregnant women, would mistakenly conclude that 90 of them were pregnant.
“My concern with MelaFind is that it just says everything is positive,” Mr. Connor said. A member of the F.D.A. panel, he abstained on a vote about whether the device’s intended uses outweighed the risks.
“I don’t think this helps an aggressive doctor,” Mr. Connor told me, “and unaggressive doctors could do just as well if they were more diligent without the device.”
The Cleveland paper wasn’t alone in failing to raise some of the tough questions.
A Cleveland TV station, WKYC, reported on the device with nothing but praise.
KDVR-TV, Denver allowed a doctor to call it the biggest advance in melanoma in his 26-year career – without raising any questions about that.
KVUE in Austin, Texas also failed to present an independent perspective in its story, even interviewing the device manufacturer’s CEO.
WTVF in Nashville was one of the stations using a syndicated news service’s story that claimed “The Cleveland Clinic has named the device one of its top medical innovations of 2013.” So did KFSN in Fresno.
Isn’t that special, how news of medical technology races across the US, unchallenged, unquestioning? Kudos for the New York Times effort to dig a little deeper.
By the way, Congressional Quarterly’s HealthBeat newsletter last week reported on a particular concern with dermatologists overtesting and overtreating when all the services are provided under their roof – standing to profit from all of that care:
“The number of times doctors order biopsies when they have a financial stake in the testing is increasing dramatically, with the nonpartisan Government Accountability Office estimating that in 2010, Medicare paid $69 million it could have saved had the number of self-referrals not been so high.” Yesterday, “a bipartisan group of lawmakers – Senate Finance Committee Chairman Max Baucus, R-Mont., ranking member Charles E. Grassley, R-Iowa; House Ways and Means Committee ranking member Sander M. Levin, D-Mich.; and House Energy and Commerce ranking member Henry A. Waxman, D-Calif….berated physicians for over-ordering such procedures.” The GAO report indicated that “three specialties – dermatology, gastroenterology and urology – accounted for 90 percent of self-referred anatomic pathology services in 2010.”
When a nonpartisan report draws bipartisan attention, maybe it should get your attention, too.
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