Addressing the Ethical Morass at the Intersection ofMedia, Medicine and Public HealthGary SchwitzerPublisher16th Annual Ma...
1974: I wanted to do sports
1984: an epiphanyAIDSArtificial HeartAlzheimer’s
“The limits of what doctors can do to human beings inthe name of science are a matter for public decisionand public accoun...
April 1984 news conferenceat which HHS secretaryMargaret Heckler namedAmerican Robert Gallo asdiscoverer of the AIDS virus...
Jay Winsten in Health Affairs:“Alzheimer’s disease became a hot story in the fall of1984. Five weeks before the presidenti...
• The medical center held a news conference at which apatient was made available. ABC, CBS, CNN, NBC, PBS andnewspapers an...
30 years later
April 1, 2013Critic Seth Mnookin:“The result of this succession ofgrandiose promises is similar to thatof the boy who crie...
And within the pages of that TIME coverstory are 9 mentions of MD AndersonCancer Center, including mention of their“Moon S...
TIME Warner owns CNN7 months earlier, CNN had a “breaking news exclusive”on the MD Anderson Moon Shots program
What CNN didn’t report…• Resignations, questions about conflicts ofinterest and fraud probes of the program inquestion.• N...
Gupta attempted to defend the live coverage. “We didn’t know what theywere going to say,” he explained. “They didn’t tell ...
Alzheimer’s today?NBC: “For the first time ever an experimental drug is showing great promise of slowing theprogression of...
Lots of excitement – not much evidence- about expensive new technologies
We review storiesthat include claimsabout…• Medical treatments• Tests• Products• Procedures
Our criteria: Does the story explain…• What’s the total cost?• How often do benefits occur?• How often do harms occur?• Ho...
After 1,900 storiesover 7 years60-70% of stories fail to:✔ Discuss costs✔Quantify potential benefits✔ Quantify potential h...
News stories often paint akid-in-candy-store pictureof U.S. health careTerrificRisk-freeWithout a price tag
Drowning from a firehose of infoxication
Common flaws: too much stenography – notindependent vetting of studies in journalsGlorifying big names/big journals - Publ...
Failure to evaluate inherently weak scienceIdolatry of the surrogate – Not understanding or simply notreporting that surro...
IgnoreorMinimizePotential Harms
“Mosttroublesometrend” awardTHE WINNER IS:SCREENING TESTS(often involving this gland)Award for best supporting roles:• Bre...
“All screening programmes do harm;some do good as well.”- Dr. Muir Gray False positives suggest a problem that’s really n...
Prizes for Prostates
I am not anti-screening• I do oppose imbalanced, incomplete messageson screening tests• I do oppose messages that emphasiz...
Crossing line from journalism to advocacy
A physician wrote to me after seeing this:"Could a political reporter sayVote for Obama?!"
“The 5-year survival rates for breast cancer diagnosed early is 98percent…and this is largely due to screening and early d...
Can you imagine a TV politicalreporter wearing a button saying,“Vote for Romney” ?
JOSH BILLINGS (PEN NAME OF HUMORISTHENRY WHEELER SHAW, 1818 – 1885)“I honestly believe it is better toknow nothing than to...
Cheerleading“The press, on its own, if it chooses, can make thetransition from cheerleaders of science to independentobser...
We should strive to be independent from the agendas and timetables ofjournals, advocates, industry and government agencies...
Every second spent reporting on“new stuff” in health care is asecond not spent on helpingpeople understand:• The social de...
Health journalism ethics issues• National Press Fdn. offers Pfizer-pfunded all expense paid trips toworkshops on issues af...
Read John Ioannidis to learn pitfallsof a steady diet of journal storiesPLoS Med 2005; 2(8): e124
Journals complicit in miscommunication• Editors of the HEART Group journals recentlystated that “inappropriate word choice...
Annals of Oncology: “Bias in reporting of endpoints of efficacy and toxicity in randomized,clinical trials for women with ...
What the authors point out:• “Investigators go overboard to make theirstudies look positive.”• In 2/3 of studies, that mea...
September 2012Positive “spin” was identified in about half of press releases andnews stories. The main factor associated w...
Public Misunderstanding of Cancer Risk• Studies have consistently shown peopleoverestimate their own risk of cancer• Other...
“Unrealistic Optimism in Early-Phase OncologyTrials”People tended to overestimate the benefits ofthe trial they were enrol...
Many cooks in this stew…Editors wrote:“Schwitzers alarming report card of the trouble with medical newsstories is thus a w...
We hold up a mirror to all who communicate about health care• Are you guilty of infoxication?• Are you helping peoplenavig...
First, do no harmIncluding in the messages we convey
We must help people understand anddeal with the clash between:• Science• Evidence• Data• Recommendations forentire populat...
Will this be our legacy as well?
Gary@HealthNewsReview.orgThank you
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"
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Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"

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I began the talk by expressing my thanks and humility for being invited to speak in a lecture series that had previously hosted George Annas, Art Caplan, Robert Veatch, Linda and Zeke Emmanuel, Daniel Callahan and many others whose work I have followed and admired. I expressed my appreciation for being the first journalist to speak in the series and hoped that I would not be the last.

I noted that one previous speaker in the series had said, ”In the last 30 years, our entire ethical sensitivity has increased substantially.” I began by wondering if the same could be said about increased ethical sensitivity in media messages about health care. And then I launched into my own 30 year retrospective.

I cited a few examples from the epiphany I had in 1984 as a reporter whose eyes were opened to the hype/misinformation disseminated on AIDS, Artificial Heart, Alzheimer's. And then I transitioned to a reflection on how the same or similar issues are covered today. I offered only a few examples; it would have been a 5-hour talk if I'd made the list more complete. CNN, not coincidentally, is cited in many of the examples, some of them from my own first-hand experience. From the ‘80s, the network insisting on hourly live reports of artificial heart patient updates, and the hyping of a trial in 4 Alzheimer’s patients. In ’90, the hype of an AIDS patient (or was he?) claiming cure from a hyperthermia experiment. Then in the current era, CNN lending credence to cloning claims by a UFO-obsessed sect, and claiming an “exclusive” and “breakthrough” on a hospital news release claiming a cancer cure was within reach. The talk emphasized shared responsibilities on the part of all who communicate about medical research and health care claims. It touched on the imbalance in many media messages about screening tests, with journalists sometimes crossing the line from independent vetting into non-evidence-based advocacy. I cited the Statement of Principles of the Association of Health Care Journalists (which I wrote). It pointed to how medical journals can be complicit in the miscommunication of findings, but how many articles are now being published in journals raising questions about “spin” and bias and interpretation and word choice.

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  • That’s me on the right. Mustaches were hot then. It looks like they even tried to paint one on my female colleague. Of course today this wouldn’t be unusual during the Movember prostate cancer awareness campaign. But there was too much high quality competition at my station in the sports department. But news director tapped me on shoulder one day and asked if I wanted to do a new medical news beat – that no one else wanted!
  • Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Intersection of Media, Medicine & Public Health"

    1. 1. Addressing the Ethical Morass at the Intersection ofMedia, Medicine and Public HealthGary SchwitzerPublisher16th Annual Mates David and Hinna Stahl Memorial Lecture in BioethicsRobert Wood Johnson Medical School, UMDNJ
    2. 2. 1974: I wanted to do sports
    3. 3. 1984: an epiphanyAIDSArtificial HeartAlzheimer’s
    4. 4. “The limits of what doctors can do to human beings inthe name of science are a matter for public decisionand public accountability.”- George Annas, NYT op-ed, 2001
    5. 5. April 1984 news conferenceat which HHS secretaryMargaret Heckler namedAmerican Robert Gallo asdiscoverer of the AIDS viruswith no mention of thework of Frenchman LucMontagnier (who wasawarded 2008 Nobel Prizefor discovery of HIV). Worse, she announced that avaccine would be readywithin two years.
    6. 6. Jay Winsten in Health Affairs:“Alzheimer’s disease became a hot story in the fall of1984. Five weeks before the presidential election, HHSSecretary Heckler announced five new federal grantscreating centers for research on the disease. The NYTimes carried page-one stories on new developments inAlzheimer’s research.”It was in this climate that researchers published theresults of a feasibility study of a potential therapy in thejournal Neurosurgery.• 4 patients• Relied on patients’ families’ subjective assessment ofimprovement.• The authors wrote that “results must be interpretedcautiously” but that “We have had repeated reportsof decreased confusion, increased initiative andimprovement in activities of daily living.”December 3, 1984
    7. 7. • The medical center held a news conference at which apatient was made available. ABC, CBS, CNN, NBC, PBS andnewspapers and magazines across the country covered it.• Print headlines:– Alzheimer’s Treatment Found Successful– Scientists Find First Breakthrough Against Alzheimer’s– Researchers Believe Treatment for Alzheimer’s Disease is Near– Researchers describe possible Alzheimer’s cure
    8. 8. 30 years later
    9. 9. April 1, 2013Critic Seth Mnookin:“The result of this succession ofgrandiose promises is similar to thatof the boy who cried wolf:Eventually, it becomes hard to takeeven realistic claims seriously. …thereal problem with Time’s headline,which is not that it’s wrong…is thatin the context of a fatal disease withexcruciatingly painful treatmentoptions, it’s simply cruel.”
    10. 10. And within the pages of that TIME coverstory are 9 mentions of MD AndersonCancer Center, including mention of their“Moon Shots” program to cure cancer…and this full-page ad insert.Paul Raeburn of the Knight ScienceJournalism Tracker points out that thisviolates The American Society of MagazineEditors guidelines that state:“Editors and publishers should avoidpositioning advertisements near editorialpages that discuss or show the same orsimilar products sold by the advertiser (arule of thumb used by many magazines is,the reader must turn the page at leasttwice between related ad and edit).”
    11. 11. TIME Warner owns CNN7 months earlier, CNN had a “breaking news exclusive”on the MD Anderson Moon Shots program
    12. 12. What CNN didn’t report…• Resignations, questions about conflicts ofinterest and fraud probes of the program inquestion.• Not likely to be the kinds of angles and issuesone pursues when there are “exclusive”reporting arrangements between a newsorganization and a medical center.
    13. 13. Gupta attempted to defend the live coverage. “We didn’t know what theywere going to say,” he explained. “They didn’t tell us. We didn’t knowwhether they were going to have any proof. We didn’t think they were.”Yet they chose to carry it live.Unverifiable claims were broadcast to a worldwide audience, leavingviewers to figure out whether the claim had any meaning or not.Gupta also defended five interviews CNN had aired with two leaders ofRaelian group, in one of which Connie Chung addressed one of the leadersas “Your Holiness.”Holy sh-- !!!
    14. 14. Alzheimer’s today?NBC: “For the first time ever an experimental drug is showing great promise of slowing theprogression of Alzheimer’s disease.”First time ever?In 5-minute web search, we found 6 different approaches reported to slow the progressionof Alzheimer’s disease in just the past 4 years:July 17, 2012: New Alzheimer’s Drug Slowing Progression of the Disease (CBS)March 8, 2012: Alzheimer’s treatment in late stages of disease does slow progression(The Independent)October 20, 2011: Antiviral Drugs May Slow Alzheimer’s Progression (Science Daily)May 11, 2009: Can New Drug Slow Progress of Alzheimer’s? (ThirdAge.com)August 3, 2008: Drugs May Slow Progress Of Alzheimer’s (NPR on two drugs)
    15. 15. Lots of excitement – not much evidence- about expensive new technologies
    16. 16. We review storiesthat include claimsabout…• Medical treatments• Tests• Products• Procedures
    17. 17. Our criteria: Does the story explain…• What’s the total cost?• How often do benefits occur?• How often do harms occur?• How strong is the evidence?• Is the condition exaggerated?• Is this really a new approach?• Is it available?• Are there alternative choices?• Who’s promoting this?• Do they have a financial conflict of interest?
    18. 18. After 1,900 storiesover 7 years60-70% of stories fail to:✔ Discuss costs✔Quantify potential benefits✔ Quantify potential harms✔ Evaluate the quality of the evidence
    19. 19. News stories often paint akid-in-candy-store pictureof U.S. health careTerrificRisk-freeWithout a price tag
    20. 20. Drowning from a firehose of infoxication
    21. 21. Common flaws: too much stenography – notindependent vetting of studies in journalsGlorifying big names/big journals - Publication in a medicaljournal does not guarantee the findings are true (or evenimportant).Not ready for prime time – journals meant for conversationamong scientistsNever intended to be sources of daily news. So if you’re going touse them that way, you simply must be aware of thelandscape:• retractions, research fraud, fabrication, falsification ofdata• unpublished data (BMJ special edition on “the extent,causes and consequences of unpublished evidence”)• ghostwriting of journal articles (The Public Library ofScience hosts a “Ghostwriting Collection” on its website.)
    22. 22. Failure to evaluate inherently weak scienceIdolatry of the surrogate – Not understanding or simply notreporting that surrogate outcomes (like tumor shrinkage) may nottranslate into clinically meaningful outcomes (longer life).Reckless extrapolation - Predicting what may happen in humans –and soon - based on very preliminary animal / lab science.Lack of awareness of conflicts of interest & other ethical issuesGoing soft on business stories or on local storiesCommon flaws
    23. 23. IgnoreorMinimizePotential Harms
    24. 24. “Mosttroublesometrend” awardTHE WINNER IS:SCREENING TESTS(often involving this gland)Award for best supporting roles:• Breasts• Lungs• Arteries
    25. 25. “All screening programmes do harm;some do good as well.”- Dr. Muir Gray False positives suggest a problem that’s really not there. Requires more testing, some of it more invasive carrying its own harms (biopsies) Incidentalomas – finding things you didn’t need to/want to find Emory radiologist after his virtual colonoscopy found suspicious spots:“I awoke in the recovery room after 5 hours, with chest tube, Foley catheter,subclavian central venous catheter, nasal oxygen catheter, epidural catheter,arterial catheter, subcutaneously administered heparin, constant infusion ofprophylactic antibiotics, and patient-controlled analgesia with intravenouslyadministered narcotics. Excruciating pain.” Cost: > $50,000. All incidentalomas. Anxiety. Labeling. You are now “a patient.” You “have something.” Cost
    26. 26. Prizes for Prostates
    27. 27. I am not anti-screening• I do oppose imbalanced, incomplete messageson screening tests• I do oppose messages that emphasize benefitsand minimize or ignore harms• I do oppose messages that only tell anecdotesof those who claim their life was saved byscreening – something that can never beproven.
    28. 28. Crossing line from journalism to advocacy
    29. 29. A physician wrote to me after seeing this:"Could a political reporter sayVote for Obama?!"
    30. 30. “The 5-year survival rates for breast cancer diagnosed early is 98percent…and this is largely due to screening and early diagnosis.”Crusading advocacy on CBS NewsLeft CBS, left “journalism,” recently joined ABC
    31. 31. Can you imagine a TV politicalreporter wearing a button saying,“Vote for Romney” ?
    32. 32. JOSH BILLINGS (PEN NAME OF HUMORISTHENRY WHEELER SHAW, 1818 – 1885)“I honestly believe it is better toknow nothing than to know whatain’t so.”
    33. 33. Cheerleading“The press, on its own, if it chooses, can make thetransition from cheerleaders of science to independentobservers. The journalistic trumpeting of medical cures,even though accompanied by sober cautions againstoptimism, deserves to be severely throttled back inrecognition of an unfortunate reality: though news issold around the clock, major advances in medicine comealong infrequently.”-- Daniel Greenberg: Science, Money, and Politics, 2001
    34. 34. We should strive to be independent from the agendas and timetables ofjournals, advocates, industry and government agencies. We should nourishand encourage original and analytical reporting that providesaudiences/readers with context. Given that thousands of journal articlesand conference presentations appear each year, and that relatively few areimmediately relevant to our audiences/readers, health journalists have aresponsibility to be selective so that significant news is not overwhelmedby a blizzard of trivial reports. We are the eyes and ears of ouraudiences/readers; we must not be mere mouthpieces for industry,government agencies, researchers or health care providers.- Am J Bioeth, 2004 Fall;4(4):W9-13.A statement of principles for health care journalists- Website of Assoc. of Health Care Journalists
    35. 35. Every second spent reporting on“new stuff” in health care is asecond not spent on helpingpeople understand:• The social determinants ofhealth• Affordable Care Organizations• Medical homes• Concepts they need to navigatethe health care system of thisera.
    36. 36. Health journalism ethics issues• National Press Fdn. offers Pfizer-pfunded all expense paid trips toworkshops on issues affecting Pfizer’s product line.• Retired S. Carolina newspaper columnist got his column back, nowsponsored by his new employer, local medical center.• Many local TV stations air gee-whiz medical news that is actuallyproduced and written by the very hospital being touted.• TV MD-“journalists” who report on themselves delivering care.• Many radio news anchors solicit advertising and then read ads forhealth care advertisers they solicited.• Many magazine writers have told me they are ordered to avoidcertain topics or go soft on others so as not to offend advertisers.Often in women’s magazines.
    37. 37. Read John Ioannidis to learn pitfallsof a steady diet of journal storiesPLoS Med 2005; 2(8): e124
    38. 38. Journals complicit in miscommunication• Editors of the HEART Group journals recentlystated that “inappropriate word choice to describeresults can lead to scientific inaccuracy.”– J AM COLL CARDIOL, Vol. 60, No. 23, 2012• “Are we making a mountain out of a mole hill? Acall to appropriate interpretation of clinical trialsand population-based studies”– Am J Obstet Gynecol, published online 11/29/12• “Spin and Boasting in Research Articles.”- Commentary in Arch Pediatr Adolesc Med:[published online October 2012]
    39. 39. Annals of Oncology: “Bias in reporting of endpoints of efficacy and toxicity in randomized,clinical trials for women with breast cancer”(published online January 9, 2013)Reuters: “Doctors relying on studies published intop journals for guidance about how to treatwomen with breast cancer may not be gettingthe most accurate information.”
    40. 40. What the authors point out:• “Investigators go overboard to make theirstudies look positive.”• In 2/3 of studies, that meant not listingserious side effects in the abstract – which isall many may read• In 1/3 of studies, if the treatment didn’t workas hoped, researchers reported results thestudy was not designed to test – “secondaryendpoints”
    41. 41. September 2012Positive “spin” was identified in about half of press releases andnews stories. The main factor associated with “spin” in pressreleases was the presence of “spin” in the journal article abstractconclusion.In other words, a direct link frompublished study news release news storyReaders/consumers/patients left behind in this food chain
    42. 42. Public Misunderstanding of Cancer Risk• Studies have consistently shown peopleoverestimate their own risk of cancer• Other studies show people overestimate riskfactors that have not been proven andunderestimate risk factors that are well-established
    43. 43. “Unrealistic Optimism in Early-Phase OncologyTrials”People tended to overestimate the benefits ofthe trial they were enrolled in andunderestimate its risks.-- IRB: Ethics & Human Research 2011
    44. 44. Many cooks in this stew…Editors wrote:“Schwitzers alarming report card of the trouble with medical newsstories is thus a wake-up call for all of us involved in disseminatinghealth research—researchers, academic institutions, journaleditors, reporters, and media organizations—to workcollaboratively to improve the standards of health reporting.”
    45. 45. We hold up a mirror to all who communicate about health care• Are you guilty of infoxication?• Are you helping peoplenavigate this confusingsystem?• Are you fostering anenvironment of shareddecision-making betweenpatients and doctors?• What kind of grades wouldyou get on our 10 criteria?• If you don’t accept or agreewith our 10 criteria, whatcriteria do you use?
    46. 46. First, do no harmIncluding in the messages we convey
    47. 47. We must help people understand anddeal with the clash between:• Science• Evidence• Data• Recommendations forentire population• What we can prove• Grasping uncertainty andhelping people applycritical thinking todecision-making issues Intuition Emotion Anecdote Decision-making by anindividual What we believe, wish, or hope Promoting false certaintywhere it does not exist
    48. 48. Will this be our legacy as well?
    49. 49. Gary@HealthNewsReview.orgThank you

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