5-Star Friday: The obvious and the obscure

The 5-star writing we feature below highlights an interesting contrast: the obvious and the obscure.

5-Star FridayOn the one hand, I’m guessing it’s fairly obvious to many of us that some physicians have ties to industry money; but on the other hand, is it widely known that some doctors and medical journals are blatantly refusing to disclose such ties?

And what about HIV, which seemed to be on everyone’s radar for years, and lately much less so. Now there’s a preventive medicine that, obviously, would be a good thing … or is it?

Then there’s the promise of robotic surgery for cancer patients. Newer and less invasive must be better right? Or is there something less obvious and maybe more important to consider?

Finally, your doctor – if you’re lucky enough to have one you call your own. Seems obvious that the longer that relationship lasts, the better. But is it really that simple?

This 5-Star Friday serves as an important reminder that good reporting thrives on this contrast, and explores not just the obscure, but challenges the obvious.

Gary Schwitzer | Publisher & founder
Prominent Doctors Aren’t Disclosing Their Industry Ties in Medical Journal Studies. And Journals Are Doing Little to Enforce Their Rules  • by Charles Ornstein & Katie Thomas • ProPublica & New York Times

Gary Schwitzer

Often in these 5-Star Friday features we have celebrated high-quality investigative health care journalism efforts. And the ProPublica-New York Times team of Charles Ornstein and Katie Thomas is leading the way very often, as they did earlier this week with another in their occasional series on conflicts of interest. In their sights have been big names: the chief medical officer of Memorial Sloan Kettering Cancer Center in New York; the dean of the Yale School of Medicine; the president-elect of the American Society of Clinical Oncology, and others.

Now they’ve shifted their focus to what leading medical journals are not doing to ensure proper disclosure by authors of manuscripts in their journals. About the editor-in-chief of the Journal of the American Medical Association, they wrote that he said that verifying each author’s disclosures would not be worth the time or effort. They cited studies recently published by the New England Journal of Medicine that omitted disclosures.

They concluded this story with a quote from Dr. Bernard Lo, the chairman of the 2009 Institute of Medicine panel on how conflicts of interest should be reported.  Lo said, “(Journals are) certainly not out in front trying to be trailblazers, let me just say it that way. The fact that it hasn’t been done means that nobody has it on their priority list.”

Kudos to Ornstein and Thomas for putting it on their priority list, and thereby, on their readers’ radar screens.

Jill U. Adams | Associate Editor
The unexpected effects of the HIV prevention pill • by Bryn Nelson • Mosaic

Jill U. Adams

This Mosaic story about the rise of the HIV-prevention medication Truvada, also known as PrEP (pre-exposure prophylaxis), takes the reader from San Francisco’s Castro Street to a London health clinic that caters to gay men.

The piece is deeply reported, which allows writer Bryn Nelson to address the nuanced and sometimes contradictory data and the wide range of interpretations of that evidence. Nelson covers an assortment of opinions and predictions by various activists and doctors; he also dips back in history to show how moral judgments of casual sex hampered AIDS treatment in the 1980s, and how they might do the same today.

For instance, one worry with PrEP is that men who have sex with men will forego other protective measures, such as condoms, putting them at greater risk of other sexually transmitted diseases. Nelson asks: “What if this common narrative isn’t quite right?”

This is the driving question of the article and makes for a rich and informative read.

Michael Joyce | Writer-Producer
Long-term Physician-Patient Relationships — Persevering in a Practice • by Adam Cifu • JAMA

From the article:

“I am a better physician when I care for a patient I know well than when I care for a patient I have only just met.”

Michael Joyce

You may be tempted to file this under “obvious,” but you’d also be justified filing it under “obviously not the norm.” And that’s revealing.

Cifu, an internist and regular contributor to our site, beautifully describes how an organically grown, long-term alliance between patient and doctor fosters much more than just familiarity. He also speculates about improved job (and patient) satisfaction, better outcomes, and improved efficiency.

And he sees disadvantages too, which are much less obvious, but no less compelling. Granted, it’s an opinion piece, but it’s proof that good health care writing does find its way into medical journals.

We’d love to see more articles like this reach the general public.

Joy Victory | Deputy Managing Editor
As surgeons tout robot-assisted breast cancer surgeries, safety remains a question • by Marie McCullough • Philadelphia Inquirer

Joy Victory

As we pointed out earlier this year, too often news outlets have a poor track record when it comes to producing high-quality journalism about robot-assisted surgery. Instead, puff pieces get published (or aired) that never examine the claims being made. That means potential patients come away thinking machines like the da Vinci robot are unquestionably the latest and greatest in modern medicine.

The reality is a lot more muddled, especially for breast cancer patients needing tumor removal, according to the Philadelphia Inquirer. The core problem? “Rigorous clinical trials have not been done to compare the safety of robotic approaches with conventional methods,” reporter Marie McCullough explains.

What we do know, she points out, is that for other types of cancers, evidence reveals that minimally invasive surgery, including robot-assisted surgery, may not be more effective and in some cases may actually be less safe. The article also explores the lack of certainty around using these types of surgeries for prophylactic breast removal or cosmetic reconstruction, the latter of which the University of Pennsylvania medical school recently touted as the “world’s first.”

Instead of merely rehashing Penn’s talking points, McCullough dug deep, surfacing a far richer–and more valuable–story.

Please Note: These stories have not been subject to our rigorous, 10-criteria systematic review for accuracy, balance, and completeness. Rather, they represent pieces of health care journalism and opinion writing that members of our staff found compelling and wanted to share with others.

However, our reviewers did award 5 stars to this HealthDay story: Incontinence Drug May Cut Hot Flashes in Breast Cancer Survivors

Our reviewers noted:

“This story from HealthDay does many things right — it covers costs, side effects, study limitations, and more. This earned it five stars from us. However, we do think the story would have been even stronger if it had better emphasized a key fact: The overall reduction in hot flashes was roughly 28 to 23 in the drug group and 28 to 25 in the placebo group. That’s not much, and raises eyebrows in light of a physician in the story calling it “game-changing.”

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Comments (1)

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Shannon Horst

December 17, 2018 at 5:03 pm

I am so sad to see your work come to an end. If I had sufficient $, I would fund you to continue. Thank you for the work you’ve done for past number of years and blessings to all of you.