Conflict of interest: ABC allows Ob-Gyn/”journalist” to report her opinion on pelvic exam recommendations

From MedPageToday:

Average-risk, asymptomatic women do not benefit from pelvic exams as part of routine care and face potential harms from false-positive results, according to a new clinical guideline.

When screening for cervical cancer, clinicians should limit the physical examination to visual inspection of the cervix and use of cervical swabs for cancer or human papillomavirus, said a panel of clinical specialists convened by the American College of Physicians (ACP).

A review of more than 60 years’ worth of medical literature did not produce compelling evidence that the benefits of routine pelvic exams outweigh the potential harms, the panel concluded in a statement published online in Annals of Internal Medicine. Instead, the authors of the guideline found that screening pelvic exams have a low diagnostic accuracy for both cancer and infections.

“Our guidelines really have to do with women who do not have symptoms, who do not have a discharge or bleeding or pain,” guideline panelist Russell Harris, MD, of the University of North Carolina in Chapel Hill, told MedPage Today. “Those women clearly need a pelvic examination, and that’s fine.”

“Our guidelines talk about screening of asymptomatic women who are not pregnant. Those women simply don’t need the exam. It’s not something that is useful for them.”

There was a great deal of news coverage of the Annals publication. But the commentary by one “journalist” caught my attention.

Here is ABC News Senior Medical Contributor Dr. Jennifer Ashton, an ob-gyn on ABC’s Good Morning America.

ABC News needs to think about what they’ve done by putting an Ob-Gyn front and center as the “reporter” on this study, and without an independent perspective as part of the story.

It is perhaps unavoidable that there would be controversy and debate over such recommendations, but does that mean your network’s only voice in the debate is one that is firmly entrenched on one side of the debate?

Would the network allow a drug rep to double as a journalist and then give opinions about the benefits of certain drugs that he/she promotes?

Would the network allow a politician to double as a journalist and then give opinions about legislation that he/she introduced?

There is an inherent conflict of interest here, and it comes out in some of what Dr. Ashton said on the air:

  • “it’s important to see an ob-gyn every year”
  • “These (recommendations) came from internists not ob-gyns”

So internists are chopped liver?  They’re not capable of evaluating evidence?

On ABC World News Tonight, the anchorman asked her, “What are you telling your patients tonight?”   Did they ask the political reporter, “Which candidate are you supporting?” What makes her opinion – and what she tells her patients – more important than what any other source would say on this topic?  ABC: This is a problem.

On Twitter, Dr. Ashton seemed to scoff at the description of tests causing anxiety as a potential harm.  She wrote:

“I agree with the ‘first do no harm’ premise of medicine. I have a problem with the paternalistic view that tests cause “anxiety” in women….”

Paternalistic?  It could be argued that it’s paternalistic to scoff at anxiety as a harm.

The Annals paper authors cited data from their research:

“…limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety, or embarrassment in about one third of women and can lead to unnecessary, invasive, and potentially harmful diagnostic procedures.”

Those numbers would suggest it’s an issue.  I’ve talked with women who’ve had a false positive and who describe the anxiety they experienced as a very real harm.

ABC’s website picked up an AP story that included an independent perspective that Ashton’s reporting did not:

Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, said the new guideline “gets rid of an unnecessary practice” that takes up valuable time that could be put to better use.

“Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it. Many of us have stopped doing them for a long time,” said Mishori, who wasn’t involved with the recommendations. …

…editorial coauthors Drs. George Sawaya and Vanessa Jacoby of the University of California, San Francisco, said that whether the new guideline changes doctors’ practice or not, it could lead to better evaluation of what “has become more of a ritual than an evidence-based practice.”

“Clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow,” they wrote.

I’ve written many times about concerns about MD-journalists.  But the inherent conflicts came out quite clearly in this latest example.  And it’s another example of the screening test bias that exists in much of health care journalism.

Addendum:   When a mammography debate was stirring 3 years ago, Dr. Ashton publicly displayed her advocacy for the Komen Foundation on the air.  She was with CBS at the time. The networks who hire physicians to act as journalists should consider providing at least a crash course in journalism ethics.


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Comments (17)

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jessica c corbes

July 1, 2014 at 10:55 am

I dread to take the pelvic exam. The 1st one I had was not completed because I could not take the pain any more. My primary physician is encouraging me. But I could not take the severe discomfort or pain that I go through.
I’m 45 yo not married, not sexually active, no vaginal discharges, pelvic pain or vaginal bleeding.
I would like to take this side that if a woman is not symptomatic then she shouldn’t be subjected to such horrible exam. I would love to see one day there is another way of doing screening for cervical cancer. less painful.

S. Fitzgerald

July 1, 2014 at 11:18 am

Yo, Gary, your post made the Google News cut in the Health section! Here’s hoping lots of people see it, and come back to visit you.

Thanks for calling this out. I learned about this years ago when my health insurance would cover only a set amount for annual physical. My doctor said, well, you don’t need the pelvic exam every year if you havent had any problems. THIS despite having given me one every year until the (insurance) money ran out. So, I guess I know what the motivation was there. I have a different doctor now. And ask a lot more questions.

Finley Austin

July 1, 2014 at 11:28 am

Kudos for calling this out on two points. First, this is a clear example (one of many) that shows why we have a bloated, inefficient, overly costly health system in the US. A practice started as well meaning has no health value but it makes money for the practitioner and the patient thinks they are doing the best for their health. It gets entrenched without study to support its validity. Over time – this took 60 years – the utility is called into question and the data clearly shows the practice has no value. However, for those earning a living off of it and for those who have internalized the routine there is great reluctance to change, but change we must if we want better healthcare.

Second, shame on ABC for allowing an “expert” with a financial conflict of interest to editorialize. Next time ABC wants to do a piece on the high cost of healthcare instead of going after the pharmaceutical companies they should take a look at physicians who continue to advise patients to undergo proven useless procedures. They have an in-house expert.

Tazia K. Stagg

July 1, 2014 at 6:41 pm

CBS This Morning did about the same. (Invited the wrong guest, then didn’t ask the right questions.)
NPR’s Shots blog presented the recommendation as controversial; some commenters caught on.

I don’t think the average journalist, the general public, or medical specialists themselves understand how professional bias works. It’s not only about character…

Ashton is a joke. In one of her appearances on The Dr. Oz Show, she stated that abstinence doesn’t prevent HPV infection, and that women need a pelvic exam every year. I asked her for an explanation last year; still waiting for a response. She deserves more scrutiny and less attention.

Ranit Mishori

July 3, 2014 at 3:03 pm

In response to Dr. Streicher….expert opinion (EBM 101) is the lowest grade and level of evidence. Here’s a quick reminder:
Unfortunately, this is very confusing to the the word ‘expert’ has a certain cache.

A Woodward

July 7, 2014 at 1:53 pm

What does one do when you do not have another primary care phasiscian but your OBGYN refuses to see you even though your issues you are experiencing a related to female things. My doctors nurse told me to go to the emergency room even though I am not in need of emergent attention. Going the emergency room would cost me a great deal of money which I do not have where as going to my OB would cost a small amount for an initial check up. I called back to ask for a referral to a doctor who would be willing to treat me and have not received a call back.

Is there a number for nurses or someone with a medical background that someone could call to get direction and help?