Covering Cancer News - Lessons from HealthNewsReview.org
Covering Cancer News –Lessons fromHealthNewsReview.org Gary Schwitzer Publisher, HealthNewsReview.org
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?
After 5 years and 1,500 stories 72% fail to adequately discuss costs. 68% fail to quantify benefit - often how small is potential benefit 66% fail to quantify harm - often how large is potential harm 65% fail to evaluate the quality of the evidence 58% fail to compare new idea with existing options
Kid-in-candy-store picture of U.S. health care 70% of ideas are terrific 70% are risk-free 70% - cost not an issue
A clear pattern News stories tend to emphasize or exaggerate the benefits of treatments, tests, products and procedures. And they tend to minimize or ignore the harms.
Is allpublishedhealth carenews actuallynewsworthy?Or are wedrowning fromfirehose ofinformation?
Concerns about cumulative effect of health messages Daily drumbeat of news Steady diet of news from journals - disregard for publication bias for positive findings Advertising (US allows prescription drug advertising) Web health info News releases from industry, academic medical centers, even from journals Misleading Twitter messages
Actual newspaper headlines on DaVinci Robotic Surgery Cancer survivors meet lifesaving surgical robot Da Vinci puts magical touch on the prostate Robotic surgeons hands never tremble Da Vinci is code for faster recovery Hospital hopes robot surgery will lure patients WHAT’S THE HARM OF THIS?
Stories about wonderful health caregifts are NOT what they appear to be.
What’s the harm? British Journal of Urology – June – found that “massive media coverage” of robotic prostatectomy was “a major contributor” to rise in consumer interest in it. Journal for Healthcare Quality – May – found hospital websites hype robotics, ignore harms, are influenced by manufacturers. Author: “This is a really scary trend. Were allowing industry to speak on behalf of hospitals and make unsubstantiated claims….violation of public trust.”
“Robotics blamed for spike in prostate surgery.” • American urology conference this summer “There is other evidence to suggest that radiation therapy use also is increasing. I think there is pretty good evidence that (we are treating more prostate cancer). Why is that, in an era when the incidence is going down and there is no reason to believe that the disease is a lot more dangerous than it used to be?” James Montie, MD Urologist University of Michigan
June: Tufts University study Review of the available literature on radiation and prostate cancer, including 10 randomized controlled trials and 65 observational studies. They concluded there was "insufficient evidence" to say with certainty whether radiation treatment compared to watchful waiting is more likely to save lives. Yet expensive new technologies like proton beam therapy and intensity-modulated and proton beam radiation therapy are proliferating.
What’s the harm? Stories whip the“worried well” into a frenzy Raise unrealistic expectations of health care system Promote undue demand of costly, unproven technologies that may produce more harm than good. Communication of these issues - itself - is a major health policy issue. Leading U.S. health economist Uwe Reinhardt asks: “Where has civic education failed?”
News coverage & poor public discussion of screeningtests should be most concerning.Worst, most biased coverage I’ve seen in 37 years
10 claims that many stories didn’t challenge1. This is all about saving money.2. This is about rationing.3. It’s the first sign of Obamacare.4. Government is deciding some lives don’t matter.5. Early detection always saves lives.6. The fact that I or someone I know was saved by a mammogram provesthat more testing is better.7. The shifting recommendations prove that scientists are clueless.8. This was surprising and came out of nowhere.9. The task force members must be uninformed idiots - especially sincenone was an oncologist or radiologist.10. American Cancer Society disagrees so the task force must be wrong.
What the Task Force actually wrote:“The decision to start regular, biennial screeningmammography before the age of 50 yearsshould be an individual one and take patientcontext into account, including the patientsvalues regarding specific benefits and harms.”
Annals of Internal Medicine editors called it a “media cacophony” “Confusion, politics, conflicted experts, anecdote, and emotion ruled front pages, airwaves, the Internet, and dinner-table conversations.”
The Publics Response to the U.S. PreventiveServices Task Forces 2009 Recommendationson Mammography Screening233 newspaper articles, blogs & tweets coded“These results are consistent with previousstudies that suggest a media bias in favor ofmammography screening."
37-year Chicago Tribune & NYTimes veteran John Crewdson wrote: “There are multiple reasons women are ill- informed about breast cancer. The fault lies primarily with their physicians, the cancer establishment, and the news media--especially the news media. Until coverage of breast cancer rises above the level of scary warnings mixed with heartwarming stories of cancer survivors, women are likely to go on being perplexed."
A national poll suggests lingering impact of imbalanced news• 11 percent of women surveyed said theybelieve mammograms should start in the 20s,even for women with no risk factors • 29 percent believe mammograms should start in their 30s.• 45 percent said the guidelines were anattempt to reduce health-care costs
Other examples: Chicago Sun-Times Wall Street Journal Washington Post New York Daily News Minneapolis Star Tribune All TV networks
The inkisn’t even dry on studies beforemarketing begins
On Twitter Men’s Health magazine: If youre a smoker, you NEED to get a CT scan. Body of story: “But dont run out and ask for one.” (as it discusses issues of costs and false positive test results) American Association of Retired Persons: Are you a smoker? CT scan those lungs Body of story: 371 words of caveats.
HealthDay wire service didn’t challengeresearcher promoting universal pancreaticcancer screening for everyone over 50. After study of tissue from 7 people!
Why don’t we deliver this message? “All screening tests cause harm; some may do good.”But much health journalism consistently emphasizesbenefits & minimizes harms
And that’s the message I think we’re missing That there’s a harm behind screening promotions that are not based on evidence That there’s a harm in selling sickness…in selling the search for weapons of mass destruction inside all of us Communication of the evidence about tradeoffs – about harms - is a key health policy issue
Prevention - Myth vs. Truth(slide borrowed from Harvard breast surgeon) Myth - we can prevent breast cancer Truth- we can reduce the risk of some breast cancers But it is the hormone receptor positive, better prognosis cancers we have decreased No difference in mortality has been shown And many women will suffer adverse events from the medications and get no benefit We need: Better ways to determine risk Risk reduction or prevention of high risk breast cancers Risk reduction methods that are not life threatening and do not decrease the quality of life
Breast Self Exam 2 randomized controlled trials have shown no benefit from breast self exam in decreasing mortality Breast self exam does lead to the discovery of more benign masses
2007 Cochrane Review of randomized clinical trials of screened versus not screened –only small benefits from screening mammography
Screening - Myth and Truth Myth: if women go for their recommended screening, their breast cancer will be caught early when it is 98% curable Truth: Many breast cancers are not picked up on screening Screening decreases the risk of dying of breast cancer by only 15-30% Screening best finds the slower growing less aggressive cancers with better prognosis Faster growing, more aggressive tumors (biology!) are more likely to be found between screens and higher numbers have metastasized prior to diagnosis
A leading US breast cancer advocacy group talks about “changing the conversation” Measure real progress, not by measuring how many women have been screened or what the five-year survival rates are but by seeing significant reductions in incidence and mortality rates.
In health communication, we see a clash between… Science Intuition Evidence Emotion Data Anecdote Recommendations for Decision-making by an entire population individual Grasping uncertainty Promoting false certainty What we can prove What we believe, wish, or hope
“I honestly believe it is better to know nothingthat to know what ain’t so.” Josh Billings (pen name of humorist Henry Wheeler Shaw, 1818 – 1885)
Health Affairs paper:“Evidence That Consumers Are SkepticalAbout Evidence-Based Health Care.”“The beliefs that surfaced in both the qualitativeresearch and the survey—more is better, newer isbetter, you get what you pay for, guidelines limit mydoctor’s ability to provide me with the care I need anddeserve—are deeply rooted and widespread.” Carman KL, et al. Health Affairs 29, No.7 (2010)
Even in 300 words journalists can explain that… More is not always better Newer is not always better Screening doesn’t always make sense. Journalists could help consumers be smarter, healthier skeptics Or we could & actually do cause harm.
Summary of health news flaws Failure to quantify harms, benefits, costs Failure to evaluate the evidence Emphasizing benefits while minimizing or ignoring harms Using questionable story sources Failure to get independent perspectives Ruining balance with “tyranny of the anecdote” Glowingly positive patient stories not balanced by stories of treatment failures, trial dropouts, dissatisfied, or those who decline aggressive testing or treatment
From the American movie, “Network” –“I’m mad as hell & I’m not going to take it anymore” Thank you