This document summarizes lessons learned from reviewing 1,889 health news stories based on 10 criteria of quality. The most common flaws found were exaggerating effects, failing to provide absolute risk values, using causal language for observational studies, and relying on single sources without independent analysis. Proper risk communication requires stating absolute rather than just relative risk. Framing of health news stories on the same topics can differ dramatically depending on whether independent expert perspectives are included that provide necessary context.
Consumer-centered journalism that promotes patient-centered care could help address issues with how medical news currently impacts health behaviors. Research shows news coverage can influence information-seeking and health actions, yet most coverage fails to fully explain the evidence, costs, risks, and alternatives. By providing more balanced and complete information, consumer-centered journalism could help the public make more informed healthcare decisions that align with their own values and priorities. This may be especially important as new technologies and screening tests are introduced, to avoid harms from unnecessary or poorly-informed actions.
The document discusses limitations of several medical studies and the importance of critically evaluating press releases and media coverage of new research. It provides examples of limitations that should be acknowledged, such as small sample sizes, lack of blinding, potential for bias, and lack of generalizability. The document advocates getting the full text of studies, asking authors questions to understand limitations and implications, considering alternative explanations, and finding perspectives from outside experts rather than just study authors. Reporters are advised to look at relevance, costs, existing alternatives, and other angles beyond initial claims in order to provide accurate context and avoid overstating findings.
How journalists (and other mass media) often promote too much medicineGary Schwitzer
This document summarizes the work of Gary Schwitzer and HealthNewsReview.org in analyzing medical news stories and press releases for accuracy and completeness. Some key points:
- For over 12 years, HealthNewsReview has reviewed over 2,500 news stories and 550 press releases, finding most do not adequately discuss costs, benefits, harms or evidence quality.
- Common flaws include using relative risk instead of absolute, not explaining limitations, relying on anecdotes, and having conflicted sources.
- Examples of misleading stories are provided about new procedures, liquid biopsies, and proton beam therapy that overstate benefits and omit costs/harms.
- The proliferation of health information from various
Covering Medical Studies: How Not to Get It WrongIvan Oransky
This document provides guidance on how to accurately summarize and report on medical studies to avoid misrepresenting results. It emphasizes the importance of reading full studies, asking clarifying questions of authors, considering limitations and biases, disclosing conflicts of interest, and relying on outside experts rather than just study authors when evaluating results. The goal is to help readers make informed health decisions by providing coverage that reflects the evidence objectively and acknowledges uncertainty.
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Int...Gary Schwitzer
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.
This document summarizes Tom Peters' presentation on healthcare excellence in Dubai. The key points are:
1. Peters discusses issues with the current healthcare system, including high rates of medical errors and a focus on treatment over prevention.
2. He advocates shifting to a system focused on wellness, prevention, and evidence-based practices.
3. Peters also discusses the importance of factors like nutrition, exercise, and social support for long term health and reducing chronic diseases.
At least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors.
Experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but “because they were afraid to open up a can of worms they couldn't close.
Consumer-centered journalism that promotes patient-centered care could help address issues with how medical news currently impacts health behaviors. Research shows news coverage can influence information-seeking and health actions, yet most coverage fails to fully explain the evidence, costs, risks, and alternatives. By providing more balanced and complete information, consumer-centered journalism could help the public make more informed healthcare decisions that align with their own values and priorities. This may be especially important as new technologies and screening tests are introduced, to avoid harms from unnecessary or poorly-informed actions.
The document discusses limitations of several medical studies and the importance of critically evaluating press releases and media coverage of new research. It provides examples of limitations that should be acknowledged, such as small sample sizes, lack of blinding, potential for bias, and lack of generalizability. The document advocates getting the full text of studies, asking authors questions to understand limitations and implications, considering alternative explanations, and finding perspectives from outside experts rather than just study authors. Reporters are advised to look at relevance, costs, existing alternatives, and other angles beyond initial claims in order to provide accurate context and avoid overstating findings.
How journalists (and other mass media) often promote too much medicineGary Schwitzer
This document summarizes the work of Gary Schwitzer and HealthNewsReview.org in analyzing medical news stories and press releases for accuracy and completeness. Some key points:
- For over 12 years, HealthNewsReview has reviewed over 2,500 news stories and 550 press releases, finding most do not adequately discuss costs, benefits, harms or evidence quality.
- Common flaws include using relative risk instead of absolute, not explaining limitations, relying on anecdotes, and having conflicted sources.
- Examples of misleading stories are provided about new procedures, liquid biopsies, and proton beam therapy that overstate benefits and omit costs/harms.
- The proliferation of health information from various
Covering Medical Studies: How Not to Get It WrongIvan Oransky
This document provides guidance on how to accurately summarize and report on medical studies to avoid misrepresenting results. It emphasizes the importance of reading full studies, asking clarifying questions of authors, considering limitations and biases, disclosing conflicts of interest, and relying on outside experts rather than just study authors when evaluating results. The goal is to help readers make informed health decisions by providing coverage that reflects the evidence objectively and acknowledges uncertainty.
Bioethics lecture UMDNJ-RWJ Medical School: "Addressing the Morass at the Int...Gary Schwitzer
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.
This document summarizes Tom Peters' presentation on healthcare excellence in Dubai. The key points are:
1. Peters discusses issues with the current healthcare system, including high rates of medical errors and a focus on treatment over prevention.
2. He advocates shifting to a system focused on wellness, prevention, and evidence-based practices.
3. Peters also discusses the importance of factors like nutrition, exercise, and social support for long term health and reducing chronic diseases.
At least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors.
Experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but “because they were afraid to open up a can of worms they couldn't close.
Risky Business: Risk communicat ion in the provider-patient encounterZackary Berger
Communicating risk is part of nearly every patient-provider encounter. I present some evidence-based strategies to improve patients\' and doctors\' risk perception.
Diagnostic errors are common, accounting for 3.7% of adverse events and 14% of deaths. Most errors stem from cognitive biases and failures of clinical reasoning rather than a lack of knowledge or skills. System-level factors like poor communication, outdated medical records, and lack of alerts also contribute. Improving diagnosis requires addressing cognitive biases through metacognition, encouraging team-based care, and fixing systemic problems like ensuring access to complete patient information.
This study evaluated shock index (SI), defined as heart rate divided by systolic blood pressure, as a predictor of morbidity and mortality in pediatric trauma patients. The study used data from the 2010 National Trauma Data Bank and found that an elevated age-adjusted SI was strongly associated with mortality, need for blood transfusion, ventilation, procedures, and ICU stay. Compared to hypotension alone, elevated SI had improved sensitivity for predicting negative outcomes while maintaining high specificity. The findings support using SI as a simple tool to identify pediatric trauma patients at risk of shock-related complications.
This document discusses several epistemic problems in critical care medicine related to evidence and knowledge. It outlines how the statement "there is evidence for" can obscure a more complex reality. Trials can produce false positives or negatives, and high prior probabilities of the null hypothesis combined with an alpha of 0.05 can lead to many false positive findings. It also discusses how problems like inadequate power from underestimated sample sizes and overestimated treatment effects can undermine trials and produce false negatives. Overall, the document advocates for more rigorous and nuanced interpretations of evidence that consider factors like prior probabilities, replication rates, and the limitations of statistical methods and trial designs.
Is clinician gestalt undervalued in chest pain assessment in EDkellyam18
This presentation discusses the role of clinician gestalt in assessment of emergency department chest pain patients. Is it accurate? How does it compare with risk scores? What are its weaknesses? Can we teach it?
The document discusses key concepts for evaluating diagnostic tests and techniques, including sensitivity, specificity, predictive values, and likelihood ratios. It emphasizes that diagnostic tests need to be evaluated based on their relevance, validity, and ability to help clinicians care for patients. New diagnostic tests should be properly evaluated through clinical studies using gold standard references and accounting for prevalence, blinding, and independent application of the reference standard before being adopted into routine care.
This document summarizes a presentation on using social media tools and metrics to raise awareness of clinical trials and recruit participants. It discusses engaging audiences on social platforms by using interesting, relevant, and motivating messages. The presentation also describes focus groups that identified effective messaging around clinical trials, including normalizing them, emphasizing options and hope, and presenting action steps. Additionally, it summarizes a case study partnering with organizations to increase African Americans' awareness of and participation in a multiple myeloma clinical trial through targeted social media outreach.
This document discusses the uncertainties inherent in medical diagnosis and clinical decision making. It notes that doctors are not perfect diagnosticians, they take risks, and often rely on luck. While a missed or delayed diagnosis could potentially cause harm, multiple unlikely steps would need to occur for significant harm to result. The document advocates that doctors acknowledge uncertainty, use probabilistic reasoning and sound judgment despite risks, and not overestimate the dangers of pursuing diagnoses. Effective problem solving and disclosure of uncertainty are important aspects of the physician/patient relationship.
This document summarizes findings from studies of closed malpractice claims related to anesthesia. Key findings include:
- Respiratory and cardiovascular events are the most common causes of death or brain damage. Monitoring with pulse oximetry and end-tidal CO2 has reduced events related to inadequate ventilation and oxygenation.
- Regional anesthesia claims for obstetric patients have higher payments than non-obstetric claims. Neonatal brain damage is the most common adverse outcome but only 50% are related to anesthesia.
- Studies of peer review found reviewers' judgments of appropriate care were influenced by outcome severity, rating cases with minor injuries as more appropriate than those with disabilities or death.
- Trends show
The document discusses diagnostic error in emergency departments and how emergency physicians think. It outlines that the ED is prone to error due to factors like uncertainty, time pressure, and high cognitive load. It describes a dual-process theory of thinking, with intuitive and analytical approaches, and how understanding this can help mitigate errors. It provides suggestions for EPs to improve their thinking, such as using aids to reduce reliance on memory and practicing metacognition to take a reflective problem-solving approach.
McGovern Award Lecture - American Medical Writers AssociationGary Schwitzer
The McGovern Award is given by the American Medical Writers Association for "preeminent contributions to medical communications." It was presented at the AMWA annual conference, in Memphis, October 9, 2014.
Knight Science Journalism Fellowships at MIT Medical Evidence Boot Camp 2013Gary Schwitzer
This was, I believe, the fifth time I've been asked to speak at this event in Cambridge. Other speakers: Drs. Steven Woloshin and Lisa Schwartz of Dartmouth, Dr. Barry Kramer of NCI, and Dr. Marty Makary of Johns Hopkins.
My talk to National Breast Cancer Coalition Project LEAD® workshop 2014Gary Schwitzer
Delivered in Washington, DC, on November 16, 2014. These slides also became the basis for a talk I gave via Skype to Doug Starr's class in the graduate Program in Science and Medical Journalism at Boston University on November 19.
Role of the media in preventing or promoting overdiagnosisGary Schwitzer
Seminar presentation at Preventing Overdiagnosis 2015 conference in Washington DC 9/1/15 by Gary Schwitzer, Publisher, HealthNewsReview.org & Adjunct Associate Professor, University of Minnesota School of Public Health
Covering Cancer News - Lessons from HealthNewsReview.orgGary Schwitzer
This is 1 of 2 presentations I made at the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 7, 2011
Evaluating medical evidence for journalistsIvan Oransky
This document provides tips for journalists on evaluating medical evidence from studies. It discusses issues like the reliability of peer review and publication bias. It also covers challenges like overreliance on embargoed studies, how often studies are later found to be wrong, and the rise in retractions. The document provides advice on getting studies, assessing study quality, considering benefits and harms, and maintaining objectivity. It emphasizes the importance of reading full studies rather than just press releases or abstracts. Overall, the document aims to help journalists critically evaluate medical studies and provide accurate reporting to readers.
My talk to University of Wisconsin event, "Science Writing in Age of Denial"Gary Schwitzer
This is an amended version to reduce file size to allow it to fit on SlideShare.
My main theme was news coverage of screening tests that emphasized only benefits while denying/ignoring/minimizing evidence of potential harms.
HOW TO SAVE MONEY ON YOUR HEALTHCARE: An Integrative Medicine ApproachLouis Cady, MD
In this webinar, the fourth in a series of five from Dr. Louis Cady and the Cady Wellness Institute, we focus on the actual dollars and cents of health care expenditures, and the societal and PERSONAL costs of poor health maintenance behavior. We examine the essentially passive US medical system, that would rather drug a symptom than fix the underlying problem.
Great attention is paid on not shaming the patient or the doctors as they exist in the current system. Both groups "do not know what they do not know." Confirmation bias is rampant.
This webinar points the way to living a more vital, energetic life, with a minimum of cost, grief, and misery.
Lessons to improve our reporting on evidence - analysis of 1,600 stories over...Gary Schwitzer
This document summarizes lessons from analyzing 1,600 health news stories over 6 years. It finds that most stories fail to adequately discuss costs, quantify benefits and harms, evaluate evidence quality, and compare new options to existing ones. There is also a tendency to emphasize benefits and minimize harms. Screening stories in particular are often one-sided and promote false certainty. Overall, health journalism could be improved by providing more balanced and evidence-based reporting.
Risky Business: Risk communicat ion in the provider-patient encounterZackary Berger
Communicating risk is part of nearly every patient-provider encounter. I present some evidence-based strategies to improve patients\' and doctors\' risk perception.
Diagnostic errors are common, accounting for 3.7% of adverse events and 14% of deaths. Most errors stem from cognitive biases and failures of clinical reasoning rather than a lack of knowledge or skills. System-level factors like poor communication, outdated medical records, and lack of alerts also contribute. Improving diagnosis requires addressing cognitive biases through metacognition, encouraging team-based care, and fixing systemic problems like ensuring access to complete patient information.
This study evaluated shock index (SI), defined as heart rate divided by systolic blood pressure, as a predictor of morbidity and mortality in pediatric trauma patients. The study used data from the 2010 National Trauma Data Bank and found that an elevated age-adjusted SI was strongly associated with mortality, need for blood transfusion, ventilation, procedures, and ICU stay. Compared to hypotension alone, elevated SI had improved sensitivity for predicting negative outcomes while maintaining high specificity. The findings support using SI as a simple tool to identify pediatric trauma patients at risk of shock-related complications.
This document discusses several epistemic problems in critical care medicine related to evidence and knowledge. It outlines how the statement "there is evidence for" can obscure a more complex reality. Trials can produce false positives or negatives, and high prior probabilities of the null hypothesis combined with an alpha of 0.05 can lead to many false positive findings. It also discusses how problems like inadequate power from underestimated sample sizes and overestimated treatment effects can undermine trials and produce false negatives. Overall, the document advocates for more rigorous and nuanced interpretations of evidence that consider factors like prior probabilities, replication rates, and the limitations of statistical methods and trial designs.
Is clinician gestalt undervalued in chest pain assessment in EDkellyam18
This presentation discusses the role of clinician gestalt in assessment of emergency department chest pain patients. Is it accurate? How does it compare with risk scores? What are its weaknesses? Can we teach it?
The document discusses key concepts for evaluating diagnostic tests and techniques, including sensitivity, specificity, predictive values, and likelihood ratios. It emphasizes that diagnostic tests need to be evaluated based on their relevance, validity, and ability to help clinicians care for patients. New diagnostic tests should be properly evaluated through clinical studies using gold standard references and accounting for prevalence, blinding, and independent application of the reference standard before being adopted into routine care.
This document summarizes a presentation on using social media tools and metrics to raise awareness of clinical trials and recruit participants. It discusses engaging audiences on social platforms by using interesting, relevant, and motivating messages. The presentation also describes focus groups that identified effective messaging around clinical trials, including normalizing them, emphasizing options and hope, and presenting action steps. Additionally, it summarizes a case study partnering with organizations to increase African Americans' awareness of and participation in a multiple myeloma clinical trial through targeted social media outreach.
This document discusses the uncertainties inherent in medical diagnosis and clinical decision making. It notes that doctors are not perfect diagnosticians, they take risks, and often rely on luck. While a missed or delayed diagnosis could potentially cause harm, multiple unlikely steps would need to occur for significant harm to result. The document advocates that doctors acknowledge uncertainty, use probabilistic reasoning and sound judgment despite risks, and not overestimate the dangers of pursuing diagnoses. Effective problem solving and disclosure of uncertainty are important aspects of the physician/patient relationship.
This document summarizes findings from studies of closed malpractice claims related to anesthesia. Key findings include:
- Respiratory and cardiovascular events are the most common causes of death or brain damage. Monitoring with pulse oximetry and end-tidal CO2 has reduced events related to inadequate ventilation and oxygenation.
- Regional anesthesia claims for obstetric patients have higher payments than non-obstetric claims. Neonatal brain damage is the most common adverse outcome but only 50% are related to anesthesia.
- Studies of peer review found reviewers' judgments of appropriate care were influenced by outcome severity, rating cases with minor injuries as more appropriate than those with disabilities or death.
- Trends show
The document discusses diagnostic error in emergency departments and how emergency physicians think. It outlines that the ED is prone to error due to factors like uncertainty, time pressure, and high cognitive load. It describes a dual-process theory of thinking, with intuitive and analytical approaches, and how understanding this can help mitigate errors. It provides suggestions for EPs to improve their thinking, such as using aids to reduce reliance on memory and practicing metacognition to take a reflective problem-solving approach.
McGovern Award Lecture - American Medical Writers AssociationGary Schwitzer
The McGovern Award is given by the American Medical Writers Association for "preeminent contributions to medical communications." It was presented at the AMWA annual conference, in Memphis, October 9, 2014.
Knight Science Journalism Fellowships at MIT Medical Evidence Boot Camp 2013Gary Schwitzer
This was, I believe, the fifth time I've been asked to speak at this event in Cambridge. Other speakers: Drs. Steven Woloshin and Lisa Schwartz of Dartmouth, Dr. Barry Kramer of NCI, and Dr. Marty Makary of Johns Hopkins.
My talk to National Breast Cancer Coalition Project LEAD® workshop 2014Gary Schwitzer
Delivered in Washington, DC, on November 16, 2014. These slides also became the basis for a talk I gave via Skype to Doug Starr's class in the graduate Program in Science and Medical Journalism at Boston University on November 19.
Role of the media in preventing or promoting overdiagnosisGary Schwitzer
Seminar presentation at Preventing Overdiagnosis 2015 conference in Washington DC 9/1/15 by Gary Schwitzer, Publisher, HealthNewsReview.org & Adjunct Associate Professor, University of Minnesota School of Public Health
Covering Cancer News - Lessons from HealthNewsReview.orgGary Schwitzer
This is 1 of 2 presentations I made at the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 7, 2011
Evaluating medical evidence for journalistsIvan Oransky
This document provides tips for journalists on evaluating medical evidence from studies. It discusses issues like the reliability of peer review and publication bias. It also covers challenges like overreliance on embargoed studies, how often studies are later found to be wrong, and the rise in retractions. The document provides advice on getting studies, assessing study quality, considering benefits and harms, and maintaining objectivity. It emphasizes the importance of reading full studies rather than just press releases or abstracts. Overall, the document aims to help journalists critically evaluate medical studies and provide accurate reporting to readers.
My talk to University of Wisconsin event, "Science Writing in Age of Denial"Gary Schwitzer
This is an amended version to reduce file size to allow it to fit on SlideShare.
My main theme was news coverage of screening tests that emphasized only benefits while denying/ignoring/minimizing evidence of potential harms.
HOW TO SAVE MONEY ON YOUR HEALTHCARE: An Integrative Medicine ApproachLouis Cady, MD
In this webinar, the fourth in a series of five from Dr. Louis Cady and the Cady Wellness Institute, we focus on the actual dollars and cents of health care expenditures, and the societal and PERSONAL costs of poor health maintenance behavior. We examine the essentially passive US medical system, that would rather drug a symptom than fix the underlying problem.
Great attention is paid on not shaming the patient or the doctors as they exist in the current system. Both groups "do not know what they do not know." Confirmation bias is rampant.
This webinar points the way to living a more vital, energetic life, with a minimum of cost, grief, and misery.
Lessons to improve our reporting on evidence - analysis of 1,600 stories over...Gary Schwitzer
This document summarizes lessons from analyzing 1,600 health news stories over 6 years. It finds that most stories fail to adequately discuss costs, quantify benefits and harms, evaluate evidence quality, and compare new options to existing ones. There is also a tendency to emphasize benefits and minimize harms. Screening stories in particular are often one-sided and promote false certainty. Overall, health journalism could be improved by providing more balanced and evidence-based reporting.
This document discusses evidence-based guidelines for diabetes treatment. It notes that guidelines aim to streamline care but are not mandatory. While guidelines can help optimize care, they also assert authority and can extend disease boundaries. The document questions whether guidelines are judged on scientific quality or the status of the issuing organization. It argues guidelines may aspire to therapeutic futility by treating very minor risks and ignoring individual patient needs and risks. Overall, the document presents a skeptical view of clinical guidelines and their limitations.
This is the presentation I made to the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 8, 2011. It is step-by-step advice about things to consider about each of the 10 criteria we apply to the review of health care news stories about treatments, tests, products & procedures.
Health & wealth agenda of the provincial federation of ABCsArnulfo Laniba
This document outlines the agenda of the Provincial Federation of ABCs to combat poor health and wealth issues. It discusses the current dismal state of disease, death, poverty, and bankruptcy, and identifies the medical-pharmaceutical system as failing and as the number one cause of death in America. Alternative approaches focusing on preventive medicine using natural remedies are presented. The wellness industry and networking are proposed as the main strategies to tackle these problems.
This document summarizes several ways in which modern medicine has failed patients by promoting treatments that are not evidence-based or proven effective. It argues that doctors often rely on historical practices rather than evidence, and presents several examples of commonly prescribed treatments, like prostate biopsies and statin drugs, that have been shown to do more harm than good or have natural alternatives that are safer and more effective. The document promotes the work of Dr. Jonathan Wright, who it says has warned about these issues for 30 years and offers natural solutions to health problems.
Here is Gabe Whitley's response to my defamation lawsuit for him calling me a rapist and perjurer in court documents.
You have to read it to believe it, but after you read it, you won't believe it. And I included eight examples of defamatory statements/
El Puerto de Algeciras continúa un año más como el más eficiente del continente europeo y vuelve a situarse en el “top ten” mundial, según el informe The Container Port Performance Index 2023 (CPPI), elaborado por el Banco Mundial y la consultora S&P Global.
El informe CPPI utiliza dos enfoques metodológicos diferentes para calcular la clasificación del índice: uno administrativo o técnico y otro estadístico, basado en análisis factorial (FA). Según los autores, esta dualidad pretende asegurar una clasificación que refleje con precisión el rendimiento real del puerto, a la vez que sea estadísticamente sólida. En esta edición del informe CPPI 2023, se han empleado los mismos enfoques metodológicos y se ha aplicado un método de agregación de clasificaciones para combinar los resultados de ambos enfoques y obtener una clasificación agregada.
Essential Tools for Modern PR Business .pptxPragencyuk
Discover the essential tools and strategies for modern PR business success. Learn how to craft compelling news releases, leverage press release sites and news wires, stay updated with PR news, and integrate effective PR practices to enhance your brand's visibility and credibility. Elevate your PR efforts with our comprehensive guide.
Acolyte Episodes review (TV series) The Acolyte. Learn about the influence of the program on the Star Wars world, as well as new characters and story twists.
An astonishing, first-of-its-kind, report by the NYT assessing damage in Ukraine. Even if the war ends tomorrow, in many places there will be nothing to go back to.
2. 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?
• Are there alternative choices?
• Is the condition exaggerated?
• Is this really a new approach?
• Is it available?
• Who’s promoting this?
• Do they have a financial conflict of interest?
69%
66%
65%
61%
57%
Percent
unsatisfactory
after 1,889
story reviews –
7 years
4. Most common flaws
• Conveying a certainty that doesn’t exist
– Exaggerating effect size
– Using causal language to describe observational
studies
– Failing to explain limitations of surrogate
markers/endpoints
– Single source stories with no independent
perspective
– Failing to independently analyze quality of evidence
6. Exaggerating effect size –
Absolute vs. Relative Risk
• Two ways of saying the same thing
• One way – relative risk reduction – makes effect size seem
larger.
– Risk of something happening in one group relative to risk in another.
• Other way – absolute risk reduction – makes effect size seem
smaller.
– The chance that something will happen to someone – a ratio of
number of people who have an event divided by all of the people
who could have the event.
• We absolutely think you should use the absolute figures.
8. Chance of breast cancer over 6 yrs.
Women on placebo – 3.3%
Women on tamoxifen – 1.7%
50% relative risk reduction
1.6% absolute risk reduction
OR – if 100 women took tamoxifen instead of placebo for
6 years, there would be 2 fewer cases of breast cancer.
9. Oh, by the way….
Tamoxifen users were >2 times more likely to develop
uterine cancer or blood clots in lungs/legs.
In relative risk terms, that’s 210% greater risk!
(Absolute risk increased from 0.5% up to 1.1%)
Net effect for every 1,000 women on tamoxifen:
• 16 fewer breast cancers
• 5 more serious blood clots
• 6 more uterine cancers
10. Risk reduction must be stated in
absolute, not just relative, terms
• NBC News reported, “In women, aspirin reduces the rate of stroke
blood clots in the brain, the most common type, by 24% but had
little effect on heart attack risk. In men, the daily aspirin cuts heart
attack risk by 32 percent but had little effect on stroke risk.”
– HealthNewsReview.org comment: “24 percent of what? And 32
percent of what? The journal article upon which the story is
based did state the absolute values for both benefits and risks.
Over 6.5 years:
Daily aspirin is predicted to result in:
- 2 fewer strokes and 2.5 more major bleeds per 1000 women
- 8 fewer heart attacks and 3 more major bleeds per 1000 men.
To many viewers, those numbers will mean more than 32% or 24%.”
11. Last example: absolute vs. relative
3rd graf of NYT story:
“About 8 percent of 2- to 5-year-olds were
obese in 2012, down from 14 percent in
2004.”
From the published study:
“Overall, there have been no significant
changes in obesity prevalence in youth or
adults between 2003-2004 and 2011-2012.”
12. • Results suggest a systematic bias of major
newspapers preferentially covering medical
research with weaker methodology.
• More likely to cover observational studies & less
likely to cover randomized clinical trials
• When they cover observational studies, they
select those of inferior quality.
13. Observational study vs.
randomized clinical trial
• Observational study: observing what happens to people
under exposure conditions that have been self-selected
or determined by influences outside the control of the
researcher. The researcher can choose what exposures
to study, but does not influence them. (Susceptible to
bias and confounding factors)
• Randomized clinical trial: A true experiment. The
researcher controls the exposure and assigns people
randomly to experimental or control group.
14. Using causal language to describe
observational studies
• Observational studies cannot prove cause and
effect so it is inaccurate to use terms like
“benefits…protects…reduces risk”
• These studies can only show a statistical
association, so all you can say is that. We
offer a primer, “Does The Language Fit The
Evidence? – Association Versus Causation.”
16. Stories on:
• Alcohol can make men smarter – CBS
• Eating greater variety of fruit reduces risk of Type 2 diabetes – NYT
• Small reduction in sodium in American diet could save half a million lives/yr. – NYT
• Coffee may protect against heart failure – ABC, CBS, HealthDay, CNN
• The St. Louis Post Dispatch reminded readers:
Researchers caution, however, that they can’t be sure whether these
associations mean that drinking coffee actually makes people live longer.
• Coffee can kill you – Atlanta magazine
• Coffee may cut risk for some cancers – CNN
• Reader comments:
• “I am so f—ing sick of these studies. Stop wasting our time.”
• “Correlation IS NOT causation!!!!”
• “The statistics book in a class I’m taking uses coffee as an example of
statistics run amok.”
17. Surrogate markers/endpoints
• Measuring an outcome, such as a lab test, that substitutes
for measuring an important life event – but may not be an
important finding in itself.
• “A difference to be a difference must make a difference”
– Drug may reduce cholesterol but not prevent MI/death
– Drug may increase bone density but not reduce hip fractures
– Cardiac Arrhythima Suppression Trial (CAST) – drugs to reduce
premature ventricular contractions. Study stopped early
because drugs led to higher death rate and nonfatal problems
than placebo.
– Avastin for breast cancer - drug may extend progression-free
survival but not impact overall
18. Failure to explain limits of surrogate
markers
• USA Today: “New drug ‘may turn back the clock on heart disease.’ ”
– HealthNewsReview.org analysis: “The story focuses excessively on the
‘unprecedented’ changes in cholesterol achieved with the drug. …
these are surrogate markers that may not reflect any real benefit on
the outcomes that matter to patients.”
• WebMD: “Beet Juice Good for Brain: Drinking Beet Juice Increases
Blood Flow to Brain and May Fight Dementia.”
– HealthNewsReview.org analysis: “Surrogate endpoints do not
necessarily reflect on overall health outcomes. And especially not
from a study of 14 people over four days. And from this we get the
headline that ‘drinking beet juice may fight dementia’ ???”
• HealthNewsReview.org linked to 10 stories that framed a tiny short-
term study of a biochemical marker of bone turnover as if it were
definitive advice to women that, for example, “Two glasses of wine
a day ends menopause misery.”
19.
20. Whom to believe? Framing matters.
• Dueling news stories on new prostate cancer
radiation therapy: Breakthrough?
Or not a home run?
– Medical News Today: “breakthrough…extends lives”
vs.
– NY Times Well blog (quoting independent expert): “I
think this is a big deal. It’s not a home run, but it’s a
nice advance.”
21. Whom to believe? Framing matters.
• Dueling news stories on brain wave scan for ADHD.
Important tool? Or waste of money?
– NJ Star-Ledger, Fox News, NY Daily News, Bloomberg – all gushing praise such
as “this should be an important tool” quote from MD in the study
vs.
– NY Times quoted independent expert “skeptical about the test”
– LA Times quoted independent expert “The current scientific research really
doesn’t support (this) as a diagnostic tool. I would caution people.”
– ABC News quoting independent expert: “I don’t know that this going to
help...it’s going to make people spend money needlessly. They can charge for
it and it gives you a pseudo-scientific basis for diagnosis.”
22. Whom to believe? Framing matters.
Dueling news stories on melanoma detection device.
Helping doctors? Or causing dissent/polarizing the field?
• Cleveland Plain Dealer: “helps doctors detect deadly cancer”
• WTVF Nashville & KFSN Fresno – among the stations using a syndicated news
service’s story that claimed “the Cleveland Clinic named the device one of its top
medical innovations of 2013.”
• KDVR Denver allowed a doctor to call it the biggest advance in melanoma in his
26-year career
vs.
• NY Times quoted 3 independent experts:
1. “This should still be considered to be in the developmental stage.”
2. A dermatologist on the FDA panel who voted against approval
3. Biostatistician: “(The test) just says everything is positive. I don’t think it
helps an aggressive doctor and unaggressive doctors could do just as well if
they were more diligent without the device.”
23. Whom to believe? Framing matters.
• Dueling news stories on meds for mild-moderate depression.
Give pause about prescribing? Or no reason to avoid meds?
– HealthDay: “Severely depressed gain most from antidepressants: But
that’s no reason to avoid meds for moderate cases.”
vs.
– LA Times: “Study finds medication of little help to patients with mild,
moderate depression”
– USA Today (quoting independent expert): Such findings “demonstrate
a failure in the system: These drugs were not thoroughly tested in mild
to moderate depression prior to their approval.”
24. Whom to believe? Framing matters.
• Dueling news stories on Alzheimer’s drug. BY
THE SAME NEWS SOURCE! Reverses disease in
mice? Or a flop?
– MedicalDaily.com: “Cancer drug may help reverse
Alzheimer’s.”
AND
– “Targretin a flop: Potential Alzheimer’s drug fails
retrial.”
25. Whom to believe? Framing matters.
• Dueling news stories on limitations of colonoscopy.
Miss many cancers? Or concerns overblown?
– NY Times: “Colonoscopies miss many cancers, study finds.”
VS.
– ABC News: “The Case for Keeping Colonoscopy: Cancer Experts
Say Concerns Over Colonoscopy Effectiveness May Be
Overblown.”
– CBS News’ Katie Couric: “Don’t use this study as an excuse not
to get screened.”
26. Whom to believe? Framing matters.
• Dueling news stories on prostate cancer screening study.
Reduces deaths? Or isn’t saving lives/value questioned?
– MSNBC: “Regular prostate screening reduces deaths”
– HealthDay: “PSA testing cuts cancer death risk”
– Bloomberg: “PSA screening reduces deaths”
vs.
– Associated Press: “prostate cancer screening isn’t saving lives,
study finds”
– CNN.com: “Value of mass prostate cancer screenings
questioned.”
27. The final line of the NEJM article:
More information on the balance of
benefits and adverse effects, as well as
the cost-effectiveness, of prostate-
cancer screening is needed before
general recommendations can be made.
Maybe that should have received a little
more attention.
28. Framing
• Star Tribune: “Boy, 12, dies after historic
transplant to treat HIV, leukemia.”
– “He was in line to become the second person in
the world to be cured of both deadly illnesses by
the extraordinary type of bone marrow transplant,
doctors said.”
– Maybe. But in fact he was in line to die from a
transplant that was not historic because it did not
treat his HIV & leukemia.
29. The tyranny of the anecdote
• Stories may use only positive, glowing patient
anecdotes but fail to capture trial dropouts,
compliance problems, patient dissatisfaction or
the choice to pursue less aggressive options.
• In one example, four major US news sources all
used the same “breakthrough” patient anecdote
of one man’s reported improvement from a heart
failure stem cell experiment.
– This suggests another common problem: public
relations people spoon-feed journalists the patient
anecdotes that put an intervention in the most
positive light.
30. Single source stories & journalism via
news release are unacceptable
• ABC’s Good Morning America asked, “Could a cure for obesity be just a pill away?”
HealthNewsReview.org analyzed the sourcing in this story:
– “In a bizarre twist, the reporter used the potential conflicts of interest of the doctor he
interviewed in the studio as evidence of his expertise. He noted that the doctor is a
consultant to the manufacturer of the pill and then said, “You’re the right man to talk
to.” Really? In a recent journal publication, this researcher listed financial ties to 17 drug
and device makers, including the maker of the (pill in question)… viewers were not
clearly told that all of the results reported in the story came from a trial controlled by
the company that has not been independently reviewed.”
• The Wall Street Journal reported, “Depression treatment Cymbalta effective as pain reliever,
Lilly says.” HealthNewsReview.org wrote:
– “This 189-word story failed on almost every count:
– no independent perspective;
– a quote apparently lifted from a company news release;
– The company news release actually did a better job of explaining the study than did this
news story.”
31.
32. Stories about screening tests
• Sir Muir Gray: “All screening programmes do
harm; some do good as well.”
• All screening stories should explain the
tradeoffs of potential benefits and potential
harms
35. Movember misinformation in Chicago Sun-Times from
star of “In the Bedroom with Dr. Laura Berman”
• She wrote that “men aren’t aware of the warning signs of prostate cancer” and
went on to list some, including “frequent lower back pain” and “swelling of the
legs and feet and weight gain.” But there are no warning signs that are specific for
prostate cancer. Her message could create unnecessary anxiety and lead to
unnecessary testing.
• She mentioned an industry-funded survey suggesting that men “greatly
underestimate their risk of prostate cancer.” She did not provide a reference for
that survey. But peer-reviewed published work has shown that men vastly
overestimated such risk.
• She also wrote as a statement of fact that “more frequent ejaculation could help
men to lower their risk of prostate cancer.” At best, the research on this point is
inconclusive, with other studies suggesting that men who have more ejaculations
are more likely to develop prostate cancer.
• She may know something about ejaculation but she’s shooting blanks on this one.
36. Fawning coverage of new technologies
(proton beam therapy & robotic surgery)
• KERA public radio in Dallas reported on both
technologies in its “Battlefield Breakthrough” series.
– Headline: “Zapping Cancer With A Ray-Gun.” We wrote:
“The story presents not one word of caveats, concerns or
limitations. There was no independent source, no data
about efficacy.” Instead, there was fascination: “looks like
something out of Star Wars.”
– Headline: “Robots Slice Time Under The Knife.”
We wrote: “Star Wars was a theme in that one as well. In fact, the
formula was the same as for part one with proton – more battlefield
breakthroughs. … Maybe we need to wait a bit to see how this arms
race plays out with evidence and data before proclaiming battlefield
breakthroughs just yet.”
37. Going easy on health business stories
• Reuters
– Headline: Medtronic tests stents for erectile dysfunction. Our comment: “An initial feasibility study
in 30 men is worthy of news coverage? With a company-sponsored investigator as the only source?
Not in our view.”
• Chicago Tribune
– Headline: Area firm’s pneumonia treatment passes test. Our comment: “It features the company
president’s positive assessment of the study results but does not seek independent comment. … It
fails to make clear that the results of the trial have not been peer-reviewed or published and that
results of a related trial have not been released at all.” 56
• New York Times
– Headline: “Test of Eye Drug Is Said To Show Success in Elderly.” Our comment: “The piece …
should’ve slapped a bigger warning label on this cocktail of leaked summaries of secret results,
speculation, and an inadequate dash of independent evaluation.”
• Wall Street Journal
– Headline: “AstraZeneca Says Brilinta Beats Plavix in Clinical Trial.” Our comment: “… lets a drug
company get away with making superiority claims without releasing data. … All information in the
story appears to come from company sources.”
• Los Angeles Times
– Headline: “Drug for menstrual cramps in the works.” Our comment: “This story reports that data
were presented at a scientific meeting. But it didn’t tell readers what the data showed. But it did
allow a company VP – the only person quoted – to say this could be a ‘breakthrough.’ Wow.”
• Minneapolis Star Tribune
– HealthNewsReview.org found four stories within six weeks in which the Star Tribune established a
clear pattern of writing nice things about local medical device industries, but did not lead in
reporting negative stories (e.g., on troubling Medtronic stories in their own back yard, often scooped
by Milwaukee Journal-Sentinel – in another state, a smaller paper.)
38. Blog roll:
• Dr. Richard Lehman’s weekly journal review on
a BMJ blog.
– Funny. Hard-nosed. A treasure.
• Retraction Watch/Embargo Watch.
• Knight Science Journalism Tracker
• Skeptical Scalpel blog.
• Not Running A Hospital blog.
39. 1. Not all studies are equal. All have flaws. You
and your audience should appreciate the
limitations inherent in any study design.
2. If you rely on medical journals as a main source
of your news, you are getting and giving an
imbalanced view of new treatments, tests,
products and procedures.
3. Both industry interests and journal policies
tend to promote positive findings.
4. If you rely on presentations at scientific
meetings as a main source of your news, you may
be promoting claims that have not been validated
by any independent expert sources.
5. There are a growing number of resources that
can help you evaluate claims and evaluate the
underlying science in journal articles,
presentations at scientific meetings, news
releases and interviews with experts.
40. “Good journalism has a subtle feature of
reticence. We don’t publish everything we hear.
We filter. We curate…and this requires the
willingness to not publish things that are
unlikely to be true.”
Joel Achenbach, Washington Post
“The Shroud of Turin, pseudoscience and journalism”