Covering Screening Tests: Do No Harm (As A Reporter)
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Covering Screening Tests: Do No Harm (As A Reporter)

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One of two talks I gave at Cancer Research in the Media: The NCI’s 2nd Annual Inter-American Workshop for Scientific Journalism

One of two talks I gave at Cancer Research in the Media: The NCI’s 2nd Annual Inter-American Workshop for Scientific Journalism

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Covering Screening Tests: Do No Harm (As A Reporter) Covering Screening Tests: Do No Harm (As A Reporter) Presentation Transcript

  • Covering Screening Tests: Do No Harm (as a Reporter) Ivan Oransky, MD Executive Editor, Reuters Health Cancer Research in the Media Inter-American Workshop for Scientific Journalism Guadalajara, Mexico November 7, 2011
  • What’s Not Worth Covering
  • What’s Worth Covering?
    • Focus on evidence, not opinion, advocacy, or anecdote
    • Criteria: Peer-reviewed?
    • Most journals are
    • Most conferences aren’t
  • What’s Worth Covering?
  • What’s Worth Covering?
    • Conferences select presenters based on < 1000 words
    • Urologists at U of Florida & Indiana U studied 126 randomized controlled trials presented in 2002-2003
  • What’s Worth Covering?
    • RCTs are the “gold standard” of medical evidence
    • But the quality of that evidence wasn’t pretty
    • No abstract said how trial subjects were randomly assigned to different treatments or placebos
    • None told how the study ensured that neither the researchers nor their doctors knew which they got
    • Only about a quarter said how long researchers followed the subjects in the trial
  • What’s Worth Covering?
    • Published?
      • In what kind of journal?
      • How highly ranked (e.g., what impact factor)?
      • Just because it’s in a journal doesn’t mean it’s the highest-level of evidence
  • From Covering Medical Research , Schwitzer/AHCJ
  • Journals: What to Keep in Mind
    • Positive publication bias:
      • Publish a trial that will bring US$100,000 of profit or meet the end-of-year budget by firing an editor. -- Former BMJ editor Richard Smith
    • Over-reliance on embargoed studies
    • How often it turns out to be wrong
  • Journals: What to Keep in Mind Ioannidis JPA. PLoS Med 2005; 2(8): e124
  • Journals: What to Keep in Mind
  • Always Read the Study
    • Writing about a study after reading just a press release or an abstract – without reading the entire paper – is journalistic malpractice
  • How to Get Studies
    • www.EurekAlert.org for embargoed material
    • Join the Association of Health Care Journalists – membership includes access to Cochrane Library, Health Affairs, JAMA, and many other journals www.healthjournalism.org
    • ScienceDirect (Elsevier) gives reporters free access to hundreds of journals www.sciencedirect.com
    • Open access journals (e.g., Public Library of Science www.plos.org )
    • Ask press officers, or the authors
  • A Dirty Little Secret
    • Keep a biostatistician in your back pocket
    Photo by Peyri Herrera, on Flickr
  • How to Cover Screening
    • Early detection is only worthwhile if two conditions are met:
      • the disease tends to kill people (not all do)
      • there are effective treatments that people are willing to have
    • Keep lead time bias in mind
    • Be wary of “pre-cancerous” conditions
    • Remember: Screening tests have harms
  • Testing vs Screening
    • If someone is part of a risk group, that’s testing, not screening
    • Screening refers to testing large populations without any clear increased risk
  • Are There Alternatives?
    • Colonoscopy vs. sigmoidoscopy vs. fecal occult blood testing
    • Digital mammography vs. film mammography
    Brownlee S, Lenzer J. The New York Times, 10/5/2011
  • What If You Test Positive?
    • Is there a good treatment?
    • What are side effects and costs of treatment?
  • What Do Guidelines Say?
    • USPSTF http://www.uspreventiveservicestaskforce.org
  • What Do Guidelines Say?
    • Cochrane Library http://www.cochrane.org/
  • What Do Guidelines Say?
    • Cochrane Library http://www.cochrane.org/
    • Scientific and medical societies
  • Who Gains from Promoting Screening?
    • Doctors, hospitals
    • Drug and device manufacturers
    • Advocacy groups
      • More worry, more funding
    • Are you engaging in disease mongering?
  • Number Needed to Screen
    • An elegant way to help decide whether something is worthwhile
    • Example:
    • To find one dangerous breast cancer, you’d need to screen 1,900 women between 40 and 50, compared to 1,300 women over 50.
    • So how many false positives, biopsies, overdiagnosed/overtreated women would result?
  • Number Needed to Screen
    • “ Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed.”
  • Acknowledgement/Contact
    • Nancy Lapid, Reuters Health
    • [email_address]
    • Twitter: @ivanoransky