Too Much Medicine: A small medical conference with a big impact

The Too Much Medicine (TMM) conference is small, but has a potentially huge impact. 

We cover plenty of medical conferences about heart disease, cancer, and dementia (to name a few) that trigger tsunamis of media coverage because they –quite obviously and understandably — affect millions of people and involve grave outcomes.

But the TMM conference, wrapping up Friday in Helsinki, gets just a whisper of coverage even though — less obviously and much harder to fathom —  it also affects millions of people and involves grave outcomes.

I realize this is comparing apples and oranges. And there may be plenty of reasons this symposium flies under the radar of most journalists including: the (unsexy?) nature of the topic, the lack of big industry backing and promotion, or the outwardly counterintuitive notion that less can be more when it comes to health care. 

But understanding how too much healthcare can affect the health of millions, cause serious harm, and even threaten the financial and scientific integrity of healthcare worldwide, is precisely why we think the big message of this small conference needs a larger audience.

So we’ve opted to bring some aspects of the conference to you. We’ve chosen some slides presented at the conference that got quite a bit of social media attention. We’ve included recent examples of our own work that illustrate the real-world impact of the important themes highlighted in these slides, and suggest why these themes matter.

The branding & marketing of  ‘diseases’

Theme One:  “The focus of healthcare has shifted from the sick to the well” (aka the potential patient). These are often the “pre”-diseases or the medicalization of variations on normal.

Real World Examples:

• Your manhood and womanhood at stake – here’s some of our coverage on “Hypoactive Sexual Desire Disorder” (HSDD),  and “Low T” (testosterone). A source quoted in the testosterone story said: ““This is a very classic example of the ready, shoot, aim approach to medicine we take in the US; implementing widespread use of a therapy that has not been adequately tested for benefits and harms.”
• You could be pre-sick – imagine the police handing out tickets for ‘pre-speeding’ if you’re 5 miles under the speed limit. The number of potential speeders would skyrocket, as would the government’s income from tickets. You get the picture. Over the past 12 years we’ve written extensively on ‘pre-diseases’ and here’s some of our more recent coverage of: osteopenia (‘pre-osteoporosis’), pre-diabetes, and pre-Alzheimer’s disease.
• “A need for treatment and action” — here’s a good example of taking a drug company’s quiz to see if you have the disease that can be treated by their new drug. We’ve written over 200 articles on disease mongering, but here are a few ‘diseases’ you don’t want to miss: ‘Resting bitch face,’ Marisa Tomei’s “Chronic Dry Eye,” and Allergan’s funding of the “The White Dress Project” to ““help build awareness of the fibroid patient journey.”

Why This Matters: It boils down to who does it help and who does it hurt? Manufacturing diseases to boost sales undoubtedly affects newly minted patients (increasing risk for harms, and emotional and financial stress), the healthcare system (shifting resources away from more legitimate/pressing needs), as well as the public trust in journalism (when reporting lacks scrutiny) and in biomedical companies (who may profit while potentially misleading and harming their customers).

Seek and ye shall find … and then what?

Theme Two: “If you’re not sick you just haven’t had enough tests.” (aka “Screen for More, Find More”)

Real World Examples: I doubt a week goes by at HealthNewsReview.org that we don’t come across a news release or news story that perpetuates these clichés in framing their narrative: screening saves lives, better safe than sorry, and newer or more is better. A very recent and very short list includes:

• Atrial fibrillation — here’s our story on a wearable EKG sensor. The company marketing the product claims it will “redefine the way cardiac arrhythmias are clinically diagnosed.” But the doctors we interviewed were more concerned about the lack of evidence that increased detection would impact outcomes at all, and that it could lead to a landslide of unnecessary blood thinner prescriptions and huge costs.
• Waking up hypertensive – last fall the American Heart Association and American College of Cardiology — in reaction to very preliminary findings from a study called SPRINT — recommended lowering the threshold for high blood pressure (‘hypertension’) from 140/90 to 130/80.  The new guidelines would mean that almost half of the adults in the United States would now qualify as having hypertension. Tens of millions of people woke up with a ‘disease’ they didn’t know they had, and now qualified for further tests, treatments, and very real downstream consequences. We found that reporters focused on the millions of new hypertensives, but neglected to explore the potential risks/harms of the lower threshold, and did not seek out alternative studies or alternative views of doctors regarding the implications of “how low is too low?”
• “Lung cancer screening could save your life” — check out these 3 stories from just the past 12 months: Using anecdote to urge action (not educate), marketing screening while downplaying harms, and the implications of the world’s largest cancer meeting pumping up a one-sided view of screening that’s passed along to the public by several uncritical reporters.

Why This Matters: The very notion that screening may NOT save lives, and may do more harm than good is counter-intuitive for many people. Challenging this thinking calls for nothing short of a paradigm shift. The ideal place for this to occur would be the doctor-patient relationship. But before that can happen more medical journals (kudos to BMJ’s ‘Too Much Medicine’ and JAMA’s ‘Less is More’), more medical meetings, more medical schools and centers, and certainly more medical journalists need to become more aware of the evidence-based scholarship on screening.

Our stream of health news and information is polluted

Theme Three: How can we expect the public to differentiate too much vs. too little health care if their sources of information are incomplete or misleading or toxic.

Real World Examples: This is our bread and butter at HealthNewsReview.org. After 12 years, >5,000 articles, and 46 podcasts we’ve documented sources of pollution at numerous points in the flow of health care information from its source to the public. Here’s a very abbreviated list of some of those polluted sources:

• Universities — check out these 3 misleading university news releases on Parkinson’s, HIV, and mental illness.
• Government — here’s what we wrote about some worrisome conflicts of interest at the CDC involving: concussions and the NFL, and their support of Tamiflu based on dodgy data.
• Patient Advocacy Groups —  They aren’t always what they seem and their sources of funding deserve special scrutiny.
• Medical journals — even the most reputable can make mistakes (and correct them).  And conflicts of interest and lack of transparency pose major problems.
• Medical Meetings — cancer meetings are closely followed by journalists so we closely follow the biggest cancer meeting: ASCO. Our extensive coverage is revealing.
• Pharma & Device Companies — there’s not enough room! But start here: our toolkit regarding medical devices and “Fact-checking Pharma: 5 cancer drug myths busted“

Why This Matters: What’s above is just a partial list. When you consider that medical media — broadly defined — would include advertising, talk shows, op-ed writing, network news, and social media (to name just a few), you can begin to appreciate the dizzying number of opportunities that exist for contamination of our health care discussions. It requires vigilance and scrutiny — our modus operandi — if we’re going to achieve our goal of improving the public’s critical thinking about health care. We see the roughly 200 participants of this year’s Too Much Medicine symposium as important allies in helping the public separate the sense from the nonsense in our dysfunctional medical industrial complex.

Editor’s note: Our publisher, Gary Schwitzer, spoke at the symposium in a session titled: How journalists often promote too much medicine: >3,000 lessons from HealthNewsReview.org. Tweets about his presentation and other information from the conference can be found at #TooMuchMedicine and #TMM.

My hero @garyschwitzer at Too Much Medicine Conference.
His @HealthNewsRevu exposes how crap media hype fails to report:
1)Costs
2)Harms
3)Scope of benefits
4)Quality of evidence
5)Alternate options
Media PR has contributed to overtreatment.
Only media truth can cure it.#TMM pic.twitter.com/nrgEyZ8mY8

— Allen Frances (@AllenFrancesMD) August 15, 2018