January 16, 2015
The Friday file of things I wish I’d addressed earlier
Better late than never, here’s some interesting catch-up reading.
- An Analysis piece in The BMJ by Ronald Koretz, Kenny Lin, John Ioannidis and Jeanne Lenzer, “Is widespread screening for hepatitis C justified?“ The key messages, as summarized in The BMJ:
- The CDC and other major organisations are recommending birth cohort population screening for hepatitis C infection
- Only a minority of patients with chronic hepatitis C infection will ever develop end stage liver disease
- We cannot reliably identify those who will develop end stage liver disease
- Drug trials rely on surrogate markers such as sustained virological response, which is not a cure
- Physicians should resist screening until we have strong evidence that antiviral therapy is clinically effective and the benefits outweigh the harms
Poses’ “…but Who Will Notice?” is a good question. There has been relatively little mainstream news media coverage of The BMJ piece. A couple I’ve seen have some flaws:
- The San Francisco Chronicleused the word “cure” four times in its story.
- The first time: “Widespread screening for hepatitis C — a recommendation that has been aggressively pushed by public health officials, with the advent of new, expensive drugs to cure the viral infection and prevent liver-disease deaths — may be premature, a group of scientists is arguing.”
- Well, The BMJ authors wrote things such as: “sustained response is not a valid surrogate marker for interferon mono therapy….Sustained virological response is not a cure.” This story did get better as you got deeper.
- Bloomberg’s piece hit you over the head with the headline, “Doctors Question Wider Hepatitis C Screening Despite Cures.” Maybe they missed what the authors wrote, as well.
Other noteworthy items:
- On his Forbes blog, Dan Munro wrote, ” ’60 Minutes’ Stumbles On How Health Insurance Works.”
- He concluded: “What we saw Sunday night didn’t serve any purpose ? least of all understanding how basic health insurance works ? how it has worked ? and how it will continue to work under Obamacare. Let’s at least get that right before we take on the monumental task of debating cost.”
- The piece was “reported” by Lesley Stahl. We’ve commented on her reports before in a blog post…and in a systematic story review.
- Yale endocrinologist Kasia Lipska’s opinion piece in the New York Times, “When Diabetes Treatment Goes Too Far.” Excerpt: “The diabetes drug industry has a vested interest in selling its products to as many Americans as it can, and has been incredibly successful at doing so. Sales of diabetes drugs in 2013 were about equal to the combined revenue of the National Football League, Major League Baseball and the National Basketball Association. There is nothing wrong with the industry selling its drugs, but it is the job of the medical profession to guide what treatment patients receive. To do this properly, doctors with financial ties to diabetes drug industry shouldn’t be writing guidelines on how to use these drugs. At present, this is still common. Ultimately, changing current paradigms requires that doctors partner with their patients in making decisions about treatment. Patients need to understand that there are different options, with different risks. The goal is not to get a perfect score on a report card, but to weigh these risks to make a good decision.”