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.
- Reuters Health chooses stories based on impact, likelihood of changing practice, strength of evidence, and novelty. They aim to cover stories closely following the HealthNewsReview.org criteria.
- Studies show most health news coverage does not adequately report on benefits, harms, costs or alternatives. Sources with conflicts of interest are often not disclosed.
- Accurate health information is important as many people, especially minorities and those without regular providers, rely on media for health information. Inadequate coverage can negatively impact health behaviors and outcomes.
- Potential interventions include addressing staffing pressures, increasing reporter knowledge, and improving press releases from academic institutions. Targeting coverage at minority audiences may help increase access to care.
When mental health practitioners use methods that are totally lacking in scientific support, particularly when the treatment has been demonstrated to be harmful and evidence-based alternatives are available, they should be liable for malpractice. Organizations like the American Psychological Association claim to support scientific standards but leave loopholes that allow psychologists to practice pseudoscientific nonsense. Several steps must be taken to close the gap between science and practice in mental healthcare, including malpractice reform, improved guidelines based on evidence, consumer education, and a commitment to scientific practice by professional organizations.
Digital communications bring opportunity and risk to the therapeutic relationship. Doctors and other health professionals can learn to collaborate in person and online to protect informed decision making. Modified slightly from a talk August 8 2019 at Brigham & Women's Hospital/Dana-Farber Cancer Institute.
SHARE Presentation: Maximizing Treatment Options -- What to Know When Conside...bkling
Current and former clinical trial participants discuss decision-making from a patient's perspective. What factors should you consider when choosing a clinical trial? What are the potential benefits of participating? What misconceptions might discourage people from seeking clinical trials? When is it best not to participate? Panelists include women living with metastatic breast and ovarian cancers.
This document summarizes challenges in providing preventive care services to older adults in the United States. Fewer than half of those aged 65 and older are up-to-date on recommended preventive services like immunizations and cancer screenings. While some goals have been met, like mammogram rates, the US still falls short of goals for vaccinating older adults against herpes zoster and pneumococcal disease. Barriers include a healthcare system focused on sickness rather than prevention, time constraints in medical visits, lack of awareness among patients and doctors of available preventive services like annual visits and weight loss counseling, and off-putting topics like colon cancer screening that require more discussion.
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.
- Reuters Health chooses stories based on impact, likelihood of changing practice, strength of evidence, and novelty. They aim to cover stories closely following the HealthNewsReview.org criteria.
- Studies show most health news coverage does not adequately report on benefits, harms, costs or alternatives. Sources with conflicts of interest are often not disclosed.
- Accurate health information is important as many people, especially minorities and those without regular providers, rely on media for health information. Inadequate coverage can negatively impact health behaviors and outcomes.
- Potential interventions include addressing staffing pressures, increasing reporter knowledge, and improving press releases from academic institutions. Targeting coverage at minority audiences may help increase access to care.
When mental health practitioners use methods that are totally lacking in scientific support, particularly when the treatment has been demonstrated to be harmful and evidence-based alternatives are available, they should be liable for malpractice. Organizations like the American Psychological Association claim to support scientific standards but leave loopholes that allow psychologists to practice pseudoscientific nonsense. Several steps must be taken to close the gap between science and practice in mental healthcare, including malpractice reform, improved guidelines based on evidence, consumer education, and a commitment to scientific practice by professional organizations.
Digital communications bring opportunity and risk to the therapeutic relationship. Doctors and other health professionals can learn to collaborate in person and online to protect informed decision making. Modified slightly from a talk August 8 2019 at Brigham & Women's Hospital/Dana-Farber Cancer Institute.
SHARE Presentation: Maximizing Treatment Options -- What to Know When Conside...bkling
Current and former clinical trial participants discuss decision-making from a patient's perspective. What factors should you consider when choosing a clinical trial? What are the potential benefits of participating? What misconceptions might discourage people from seeking clinical trials? When is it best not to participate? Panelists include women living with metastatic breast and ovarian cancers.
This document summarizes challenges in providing preventive care services to older adults in the United States. Fewer than half of those aged 65 and older are up-to-date on recommended preventive services like immunizations and cancer screenings. While some goals have been met, like mammogram rates, the US still falls short of goals for vaccinating older adults against herpes zoster and pneumococcal disease. Barriers include a healthcare system focused on sickness rather than prevention, time constraints in medical visits, lack of awareness among patients and doctors of available preventive services like annual visits and weight loss counseling, and off-putting topics like colon cancer screening that require more discussion.
This document discusses communicating about sensitive medical topics with different audiences. It provides tips for discussing dementia risk factors and unproven treatments with the general public, people with dementia, the press, and patient organizations. The roles of patient organizations in facilitating informed personal choices about off-label treatments are described. Examples are given of resources like ALSUntangled that provide objective information on alternative treatments. The importance of consent, informing family, and the possibility of body donation rejection are covered in relation to donating one's body to medical science. The challenges of involving the public in clinical research through initiatives like Tissue Access for Patient Benefit are also summarized.
The document discusses overtreatment in healthcare and strategies to address it. It defines overtreatment as medical care where potential harms exceed benefits. The document outlines how overtreatment wastes resources and harms patients. It identifies areas of overuse like unnecessary tests, procedures, and end-of-life treatments. The document proposes reporting quality measures, establishing surgery registries, and engaging the public to curb unwarranted medical services.
This document discusses why costs for treating low back pain have not decreased despite increased understanding and recommendations for more conservative treatment approaches. It argues that one reason is the continued reinforcement of the belief that low back pain has a structural mechanical cause by various "hands-on" health care providers. While large-scale public education programs have attempted to change beliefs, they have had little influence on behaviors or costs. The document suggests more must be done to educate not just doctors but alternative providers about evidence-based best practices to truly reduce the economic burden of low back pain.
This document discusses the challenges of generating, communicating, and disseminating high-quality medical information to physicians, scientists, journalists, patients, and the public. It notes key differences in expectations between these groups. For example, while scientists recognize research is incremental, the public prefers definitive conclusions. The document also outlines methods for strengthening research quality and balancing dissemination of findings with consideration of potential harms. Throughout, it emphasizes that medical knowledge is constantly evolving as new evidence emerges.
Coverage of Clinical Medicine: A Diagnosis and Treatment PlanIvan Oransky
This document provides an overview of challenges in covering clinical medicine and summarizes strategies for improving medical journalism. It discusses issues such as lack of time leading journalists to rely heavily on press releases without sufficient vetting. It also outlines MedPage Today's approach of prioritizing impact, evidence strength, and novelty. Recommendations include curating high-quality sources, specializing in specific topic areas, partnering with other organizations, and getting to know professional groups like the Association of Health Care Journalists. The overall aim is to help journalists overcome barriers and add value through their reporting.
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.
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
This document provides an overview of evidence-based periodontology. It defines evidence-based periodontology as the application of evidence-based healthcare to the field of periodontology. The document discusses the development of evidence-based periodontology and its key components, advantages over traditional periodontology, and terminology used in evidence-based approaches. It also addresses searching for evidence, levels of evidence, systematic reviews, meta-analyses, and evidence-based decision making in periodontal therapy.
Tips for covering conflicts of interestIvan Oransky
This document summarizes tips for reporting on conflicts of interest in research studies and clinical trials. It discusses how funding can influence study results and presents examples of journals facing conflicts of interest from pharmaceutical industry profits. The tips include verifying what "no conflicts of interest" means, asking study authors directly about potential conflicts, having other experts critically review studies, finding examples of journals that refuse industry funding, and properly citing other reports that have uncovered conflicts of interest issues.
This document discusses using patient-reported outcomes to inform off-label drug prescribing. It provides examples of how data from patient communities like PatientsLikeMe can be analyzed:
1. The document analyzes data on amitriptyline use from PatientsLikeMe. It finds amitriptyline is commonly prescribed off-label for purposes like insomnia, pain, and excess saliva in ALS patients.
2. Side effects and efficacy ratings are compared for on-label vs off-label uses. Off-label uses are rated as more effective, though dry mouth and sleepiness are common side effects.
3. The analysis demonstrates how patient-reported data can provide evidence about off-label drug uses
The values of clinical practice - Jordi VarelaJordi Varela
Three key principles will guide clinical practice: adding value to patient health, organizing doctors according to clinical processes, and measuring outcomes adjusted for risk and cost. Right care considers benefits and harms, is patient-centered, and evidence-based. Half of surgeries and clinical trials lack evidence to support them. Overdiagnosis leads to unnecessary treatment complications. Fragmented care for chronic patients results in clinical instability, unnecessary tests and costs. Clinical value practices aim to reduce wasteful spending through protocols, teamwork and learning from errors.
This study examined trends in preoperative pulmonary function testing (PFT) in Ontario, Canada before and after 2006 American College of Physicians guidelines. The study found that preoperative PFT rates decreased over the study period and following the 2006 guidelines, while non-operative PFT rates remained stable. By 2013, preoperative PFTs were performed in fewer than 8% of patients with risk factors for pulmonary complications. The decreasing preoperative PFT rates contrast with increases in other perioperative interventions like anesthesia consultations and stress testing.
This document discusses the need for ethically responsible choice architecture in prostate cancer treatment decision making. It notes that while patients are assumed to make autonomous decisions, evidence shows that for prostate cancer many men may not be properly informed of their options, especially active surveillance. Decision making can be influenced by biases and heuristics that favor immediate intervention over active surveillance. The document advocates for clinicians to engage in choice architecture that encourages men to seriously consider the harms of immediate intervention and benefits of active surveillance when deciding on treatment. This could be done through framing options, appealing to social norms, and using patient narratives. The goal is to raise awareness of active surveillance as an appropriate option for eligible men.
The document discusses the attending model of medicine and technologies that can support it. It proposes using medical assistants, medical scribes, health coaches and navigators as a "pit crew" to allow physicians to focus on patients. This team approach aims to improve efficiency and patient satisfaction. Technologies mentioned include electronic health records, secure messaging, telemedicine, wearables and various clinical tools. The attending model seeks to make primary care more scalable and sustainable for solo or small physician groups.
This document summarizes the challenges of communicating risk in prenatal screening tests. It discusses how:
1) Prenatal screening tests have a high rate of false positives, leading many women with healthy pregnancies to undergo invasive follow-up tests that carry risks of miscarriage. For example, a first trimester screening test with a 5% false positive rate could lead to around 50 unnecessary miscarriages among 100,000 screened women.
2) Calculating and understanding the positive predictive value of screening tests, which is needed for informed decision making, requires Bayesian reasoning that most people struggle with. As a result, risks are often underestimated.
3) While research has identified effective ways to communicate Bayesian concepts
1) Cardiac arrest is a leading cause of death worldwide, and survival rates could be improved if more bystanders were trained in cardiopulmonary resuscitation (CPR).
2) Several medical organizations developed a "Kids Save Lives" statement recommending that school children receive 2 hours of CPR training per year starting at age 12 or younger.
3) The World Health Organization endorsed this statement, which could help save thousands of lives by educating more people, especially children, about how to perform CPR.
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.
The magazine uses many typical conventions of real music magazines, such as having a rapper on the front cover, bold writing, and a masthead. However, it challenges conventions by not including pull quotes on the front cover stories. The contents page follows conventions like featuring a main article image and page numbers but could develop the use of different fonts. Double page spreads also use conventions like columns, bold colors, and an introduction, though another image could make the spread more eye catching. The target audience is young music fans.
A União Europeia está enfrentando desafios sem precedentes devido à pandemia de COVID-19 e à invasão russa da Ucrânia. Isso destacou a necessidade de autonomia estratégica da UE em áreas como energia, defesa e tecnologia digital para tornar o bloco menos vulnerável a choques externos. A Comissão Europeia propôs novas iniciativas para fortalecer a resiliência econômica e de segurança da UE nos próximos anos.
This document discusses communicating about sensitive medical topics with different audiences. It provides tips for discussing dementia risk factors and unproven treatments with the general public, people with dementia, the press, and patient organizations. The roles of patient organizations in facilitating informed personal choices about off-label treatments are described. Examples are given of resources like ALSUntangled that provide objective information on alternative treatments. The importance of consent, informing family, and the possibility of body donation rejection are covered in relation to donating one's body to medical science. The challenges of involving the public in clinical research through initiatives like Tissue Access for Patient Benefit are also summarized.
The document discusses overtreatment in healthcare and strategies to address it. It defines overtreatment as medical care where potential harms exceed benefits. The document outlines how overtreatment wastes resources and harms patients. It identifies areas of overuse like unnecessary tests, procedures, and end-of-life treatments. The document proposes reporting quality measures, establishing surgery registries, and engaging the public to curb unwarranted medical services.
This document discusses why costs for treating low back pain have not decreased despite increased understanding and recommendations for more conservative treatment approaches. It argues that one reason is the continued reinforcement of the belief that low back pain has a structural mechanical cause by various "hands-on" health care providers. While large-scale public education programs have attempted to change beliefs, they have had little influence on behaviors or costs. The document suggests more must be done to educate not just doctors but alternative providers about evidence-based best practices to truly reduce the economic burden of low back pain.
This document discusses the challenges of generating, communicating, and disseminating high-quality medical information to physicians, scientists, journalists, patients, and the public. It notes key differences in expectations between these groups. For example, while scientists recognize research is incremental, the public prefers definitive conclusions. The document also outlines methods for strengthening research quality and balancing dissemination of findings with consideration of potential harms. Throughout, it emphasizes that medical knowledge is constantly evolving as new evidence emerges.
Coverage of Clinical Medicine: A Diagnosis and Treatment PlanIvan Oransky
This document provides an overview of challenges in covering clinical medicine and summarizes strategies for improving medical journalism. It discusses issues such as lack of time leading journalists to rely heavily on press releases without sufficient vetting. It also outlines MedPage Today's approach of prioritizing impact, evidence strength, and novelty. Recommendations include curating high-quality sources, specializing in specific topic areas, partnering with other organizations, and getting to know professional groups like the Association of Health Care Journalists. The overall aim is to help journalists overcome barriers and add value through their reporting.
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.
Pediatric Hospital Medicine Top 10 (ish) 2014rdudas
The article "The survival time of chocolates on hospital wards: covert observational study" studied how long chocolates lasted on hospital wards before being eaten. Researchers covertly placed chocolates in hospital wards and recorded how long they remained. On average, chocolates lasted only 75 minutes before being consumed, with large variations based on ward type and time of day. The study highlights issues around food security and integrity on hospital wards.
This document provides an overview of evidence-based periodontology. It defines evidence-based periodontology as the application of evidence-based healthcare to the field of periodontology. The document discusses the development of evidence-based periodontology and its key components, advantages over traditional periodontology, and terminology used in evidence-based approaches. It also addresses searching for evidence, levels of evidence, systematic reviews, meta-analyses, and evidence-based decision making in periodontal therapy.
Tips for covering conflicts of interestIvan Oransky
This document summarizes tips for reporting on conflicts of interest in research studies and clinical trials. It discusses how funding can influence study results and presents examples of journals facing conflicts of interest from pharmaceutical industry profits. The tips include verifying what "no conflicts of interest" means, asking study authors directly about potential conflicts, having other experts critically review studies, finding examples of journals that refuse industry funding, and properly citing other reports that have uncovered conflicts of interest issues.
This document discusses using patient-reported outcomes to inform off-label drug prescribing. It provides examples of how data from patient communities like PatientsLikeMe can be analyzed:
1. The document analyzes data on amitriptyline use from PatientsLikeMe. It finds amitriptyline is commonly prescribed off-label for purposes like insomnia, pain, and excess saliva in ALS patients.
2. Side effects and efficacy ratings are compared for on-label vs off-label uses. Off-label uses are rated as more effective, though dry mouth and sleepiness are common side effects.
3. The analysis demonstrates how patient-reported data can provide evidence about off-label drug uses
The values of clinical practice - Jordi VarelaJordi Varela
Three key principles will guide clinical practice: adding value to patient health, organizing doctors according to clinical processes, and measuring outcomes adjusted for risk and cost. Right care considers benefits and harms, is patient-centered, and evidence-based. Half of surgeries and clinical trials lack evidence to support them. Overdiagnosis leads to unnecessary treatment complications. Fragmented care for chronic patients results in clinical instability, unnecessary tests and costs. Clinical value practices aim to reduce wasteful spending through protocols, teamwork and learning from errors.
This study examined trends in preoperative pulmonary function testing (PFT) in Ontario, Canada before and after 2006 American College of Physicians guidelines. The study found that preoperative PFT rates decreased over the study period and following the 2006 guidelines, while non-operative PFT rates remained stable. By 2013, preoperative PFTs were performed in fewer than 8% of patients with risk factors for pulmonary complications. The decreasing preoperative PFT rates contrast with increases in other perioperative interventions like anesthesia consultations and stress testing.
This document discusses the need for ethically responsible choice architecture in prostate cancer treatment decision making. It notes that while patients are assumed to make autonomous decisions, evidence shows that for prostate cancer many men may not be properly informed of their options, especially active surveillance. Decision making can be influenced by biases and heuristics that favor immediate intervention over active surveillance. The document advocates for clinicians to engage in choice architecture that encourages men to seriously consider the harms of immediate intervention and benefits of active surveillance when deciding on treatment. This could be done through framing options, appealing to social norms, and using patient narratives. The goal is to raise awareness of active surveillance as an appropriate option for eligible men.
The document discusses the attending model of medicine and technologies that can support it. It proposes using medical assistants, medical scribes, health coaches and navigators as a "pit crew" to allow physicians to focus on patients. This team approach aims to improve efficiency and patient satisfaction. Technologies mentioned include electronic health records, secure messaging, telemedicine, wearables and various clinical tools. The attending model seeks to make primary care more scalable and sustainable for solo or small physician groups.
This document summarizes the challenges of communicating risk in prenatal screening tests. It discusses how:
1) Prenatal screening tests have a high rate of false positives, leading many women with healthy pregnancies to undergo invasive follow-up tests that carry risks of miscarriage. For example, a first trimester screening test with a 5% false positive rate could lead to around 50 unnecessary miscarriages among 100,000 screened women.
2) Calculating and understanding the positive predictive value of screening tests, which is needed for informed decision making, requires Bayesian reasoning that most people struggle with. As a result, risks are often underestimated.
3) While research has identified effective ways to communicate Bayesian concepts
1) Cardiac arrest is a leading cause of death worldwide, and survival rates could be improved if more bystanders were trained in cardiopulmonary resuscitation (CPR).
2) Several medical organizations developed a "Kids Save Lives" statement recommending that school children receive 2 hours of CPR training per year starting at age 12 or younger.
3) The World Health Organization endorsed this statement, which could help save thousands of lives by educating more people, especially children, about how to perform CPR.
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.
The magazine uses many typical conventions of real music magazines, such as having a rapper on the front cover, bold writing, and a masthead. However, it challenges conventions by not including pull quotes on the front cover stories. The contents page follows conventions like featuring a main article image and page numbers but could develop the use of different fonts. Double page spreads also use conventions like columns, bold colors, and an introduction, though another image could make the spread more eye catching. The target audience is young music fans.
A União Europeia está enfrentando desafios sem precedentes devido à pandemia de COVID-19 e à invasão russa da Ucrânia. Isso destacou a necessidade de autonomia estratégica da UE em áreas como energia, defesa e tecnologia digital para tornar o bloco menos vulnerável a choques externos. A Comissão Europeia propôs novas iniciativas para fortalecer a resiliência econômica e de segurança da UE nos próximos anos.
The document provides information about various environment, health and safety awards organized by different organizations in India. It discusses the CII's Leadership and Excellence Award in Environment, Health and Safety which recognizes best practices in EHS. It also mentions the D.L. Shah Trust/ASSE Safety India Award that recognizes individuals making significant contributions in occupational safety, environment and sustainability. Finally, it lists eligibility criteria and assessment parameters for the 16th Greentech Environment Awards and 5th Greentech CSR Awards that honor commitment to environment management and CSR.
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.
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.
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.
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
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.
Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Ca...Ivan Oransky
The document summarizes research on the quality of health news coverage and discusses why improving coverage matters and what doctors can do to help. Key findings include:
- Many news stories do not adequately report on the benefits and risks of medical treatments, tests, and drugs or mention costs.
- For many groups, media and doctors are the top sources of health information, so inaccurate coverage can influence health behaviors.
- Doctors can help by developing relationships with reporters, answering questions, reviewing press releases, and providing context on new studies through their own blogs or comments to reporters.
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
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.
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
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.
4 Ways for Doctors to Avoid Inappropriate TestingBest Doctors
The document discusses 4 ways for doctors to avoid inappropriate medical tests by educating students and colleagues, advocating for administrative changes, engaging patients in treatment decisions, and building collaboration among peers to question unnecessary tests in order to address the large costs and risks associated with overtesting. Inappropriate testing wastes healthcare dollars, can delay accurate diagnoses, and potentially causes patient harm.
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.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Expanded version of a short panel presentation on the subject of mHealth. My point was that mHealth has meaning only in the larger context of an important reality: the best quality care depends on having the best information, so THAT is what we need to be thinking about.
This document summarizes the history and influence of public relations (PR) in the healthcare industry based on the speaker's organization's reviews of health care news stories and PR releases. Some key points:
- Edward Bernays popularized modern PR in the 1920s including promoting smoking and hyping breakfast foods.
- Modern healthcare PR aims to promote new tests, drugs and treatments but often exaggerates benefits and ignores costs and harms based on the organization's reviews.
- PR campaigns have influenced journalists and the public by promoting ideas like "simple tests" that overstate what tests can determine and fuel overdiagnosis.
- The organization aims to provide more balanced reviews of PR releases to counter hype and better inform journalists
This document discusses using patient-reported outcomes to inform off-label drug prescribing. It provides examples of how data from patient communities like PatientsLikeMe can be analyzed:
1. The document analyzes data on amitriptyline use from PatientsLikeMe. It finds amitriptyline is commonly prescribed off-label for purposes like insomnia, pain, and excess saliva in ALS patients.
2. Side effects and efficacy ratings are compared for on-label vs off-label uses. Off-label uses are rated as more effective, though dry mouth and sleepiness are common side effects.
3. The analysis demonstrates how patient-reported data can provide evidence about off-label drug uses
Similar to Schwitzer keynote to ISDM 2013 Lima, Peru (20)
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. Index of Scientific Quality for Health Reports in the Lay Press
- Andy Oxman, Gordon Guyatt et al, J Clin Epidemiol, 1993
“Medical news reports may increase or diminish
the willingness of individuals to present
themselves for care or for clinical trials, may
raise expectations (sometimes falsely), may dash
hopes or may provoke alarm (sometimes
unnecessarily.”
3. A Prompt to the Web: The Media & Health Information
Seeking Behavior
- PLoS One 2012
“longstanding concerns about quality of info in traditional media and
growing concern about quality of info available on internet and newer
social media.”
------------------------------------
Behavioral Consequences of Conflict-Oriented Health News
Coverage: 2009 Mammography Guideline Controversy & Online
Information Seeking
- Health Comm 2011
“compelling evidence that news coverage can impact people’s health
information-seeking behavior, which may be the first step toward actual
health behavior.”
4.
5. We review stories
that include claims
about…
• Medical treatments
• Tests
• Products
• Procedures
6. 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 1,900
story reviews –
7 years
7. News stories often paint a
kid-in-candy-store picture
of U.S. health care
Terrific
Risk-free
Without a price tag
8. “75% of Americans pay at least a moderate amount of
attention to medical/health news, but only half say they
get the right amount to keep them well informed.”
• 15% say they get so much such news that they have trouble
sorting through all of it.
• 58% say they have changed their behavior or taken some action
as a result of health care news stories
• 76% of them say they “took the advice offered in the news
stories”
Americans Talk About Science and Medical News: The National Health Council Report
Roper Starch survey of 2,256 adults – December 1997
9. “More than half of the public says that
national, local, or cable news is their most
important source of health information.”
- Kaiser Family Foundation
Harvard School of Public Health, 2001
10. Agenda Building, Source Selection &
Health News at Local Television Stations
- Science Communication 2004
• > half the local TV health reporters surveyed said they receive most of
their ideas from a PR person or press release.
• > half said their health reports were sponsored
• 13% said the sponsor affected their decision to cover a story but
qualitative research suggests some feel obligated to ue the story ideas
pitched by their sponsor or use sources only from the sponsor.
11. If significant % of consumers believe everything they
hear in the news, what impact may that have on SDM?
• Use of statins for primary prevention in low-risk people?
• Choice of robotic surgery for you-name-it?
• Screening tests for you-name-it?
• Use of coronary calcium scans?
• Faith in vaccines?
• Attitudes about imaging for low back pain?
• Diets?
• Advance directives, end-of-life issues?
• “Cures..breakthroughs…dramatic…promising” interventions
12. How many of you have had patients
come in asking about such things
they heard in the news?
13. Common flaws: too much stenography – not
independent vetting of studies in journals
Not ready for prime time – journals meant for
conversation among scientists
Never intended to be sources of daily news. So if
journalists are going to use them that way, they
must be aware of the landscape:
• retractions, research
fraud, fabrication, falsification of data
• unpublished data, ghostwriting
14. Learn from John Ioannidis about
pitfalls of steady diet of journal stories
PLoS Med 2005; 2(8): e124
15. Journals complicit in miscommunication
• Editors of the HEART Group journals stated that
“inappropriate word choice to describe results can
lead to scientific inaccuracy.”
– J AM COLL CARDIOL, Vol. 60, No. 23, 2012
• “Are we making a mountain out of a mole hill? A
call to appropriate interpretation of clinical trials
and 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]
16. Reporting on papers presented at scientific meetings
- Even more problematic than reporting on journals
Idolatry of the surrogate – Not understanding or
simply not reporting that surrogate outcomes (like
tumor shrinkage) may not translate into clinically
meaningful outcomes (longer life).
Tyranny of the anecdote – telling success stories but
rarely profiling dropouts, dissatisfied, those who
choose conservative route or lifestyle change instead
of treatment
Common flaws
19. “All screening programs do harm;
some do good as well.”
- Dr. Muir Gray
All screening stories would be better if they simply stated:
20. Anecdotes of
those who make
a rational choice
not to be
screened – or
those who were
screened and
regret it
The tyranny of the anecdote
in screening news stories:
Whom do we model?
23. What is the quality of
the shared decision-
making encounter…
…as mammograms
are promoted with
wine, cheese, fondue,
chocolate
fountains, pink
treats, pink
lemonade, massages,
facials, manicures/ped
icures, paraffin hand
treatments, beauty
consultations, etc. ?
24. Sharon Begley reported for Newsweek
magazine:
“Dr. Rita Redberg, professor of medicine at
the University of California, San
Francisco, and editor of the prestigious
Archives of Internal Medicine, has no
intention of having a screening
mammogram even though her 50th
birthday has come and gone. That’s the
age at which women are advised to get
one. But, says Redberg, they detect too
many false positives (suspicious spots that
turn out, upon biopsy, to be nothing) and
tumors that might regress on their
own, and there is little if any evidence that
they save lives.”
25.
26. • Reported on woman with DCIS – ductal carcinoma in situ
• Reported on her choice to pursue active surveillance rather
than immediate aggressive intervention such as bilateral
prophylactic mastectomy
• Reported on the shared decision-making program at UCSF that
helped her understand the tradeoffs.
THAT IS GOOD JOURNALISM
27.
28. Men who didn’t have
SDM prostate screening
experience:
Tim Glynn, lawyer, age 47
when his doctor “decided I’d
have a PSA test without
consulting me…..Men should be
aware of the truly terrible
consequences. As a screening
tool, you could do as well by
throwing dice on a table.”
Profiled by
Shannon Brownlee
in New York Times
magazine piece,
“Can Cancer Ever
Be Ignored?”
29. Sharon Begley in Newsweek:
“Dr. Stephen Smith, Professor emeritus of
family medicine at Brown University
School of Medicine, tells his physician not
to order a PSA blood test for prostate
cancer or an annual electrocardiogram to
screen for heart irregularities, since
neither test has been shown to save
lives. Rather, both tests frequently find
innocuous quirks that can lead to a
dangerous odyssey of tests and
procedures.”
30. The marketing of screening
In 2010 after the National Lung Screening Trial
results were released, the American Cancer
Society said:
"It's only been a few days since researchers
released preliminary results… our greatest fear
was that forces with an economic interest in the
test would sidestep the scientific process and use
the release of the data to start promoting CT
scans. Frankly, even we are surprised how
quickly that has happened."
31. Interviewed Otis Brawley:
“We really need to weigh the harms associated with
screening. The scientific community still needs to digest
this…A lot of people run out when there is a new
announcement and get the new test. We’re very
frightened some people are going to be harmed
because of this.”
32.
33. • Began with virtual colonoscopy – after routine physical.
• But scan also showed something on kidney, liver, and lungs.
• Kidney and liver issues benign after liver biopsy, PET scan and more CT scans. But lung
questions led to major lung surgery
“I awoke in the recovery room after 5 hours, with a chest tube, a Foley catheter, a
subclavian central venous catheter, a nasal oxygen catheter, an epidural catheter, an
arterial catheter, subcutaneously administered heparin, a constant infusion of
prophylactic antibiotics, and patient-controlled analgesia with intravenously
administered narcotics…..Excruciating pain.”
• No malignant disease – all “incidentalomas”
• Total cost > $50,000
• All precipitated by a screening test
34.
35. If we don’t improve discussion on screening, we may
never improve public dialogue on expensive new
technologies – “Gizmo Idolatry”
36.
37. JOSH BILLINGS (PEN NAME OF HUMORIST
HENRY WHEELER SHAW, 1818 – 1885)
Why?
Because there are harms in making people more
hopeful or more frightened than evidence and
rational thinking would warrant.
38. Consumers believe more health care = better care.
“Clearly, consumers will revolt if evidence-based
efforts are perceived as rationing or as a way to
deny them needed treatment. … A necessary
condition for effective communication, after all, is
to start where your audience is—even if that is not
where you hoped or expected it to be.”
Evidence that consumers are skeptical about evidence-based health care.
Carman KL et al. Health Affairs 2010
39. Consumer-centered journalism –
like patient-centered care – can help people
understand and deal with the clash between:
• Science
• Evidence
• Data
• Recommendations for
entire population
• What we can prove
• Grasping uncertainty and
helping people apply
critical thinking to
decision-making issues
Intuition
Emotion
Anecdote
Decision-making by an
individual
What we believe, wish, or hope
Promoting false certainty
where it does not exist
We’ve been talking about this for a long time. Gordon Guyatt, another of our conference keynote speakers, along with Andy Oxman and others, wrote 20 years ago
Fast forward to today and the internet and social media present new challenges. This David Henry piece in PLoS One looked at news stories driving people to the web – perhaps for more harm. This Health Communication piece looked at confusing news coverage driving people to the web – again with the potential for Good or Harm.
16 years ago this Roper survey
Ask for show of hands
We have an increasing number of media organizations actually partnering with screening advocates for non-evidence-based promotions. State Fairs big in MN where Victor and I come from…Not sure if this last photo depicts anything about the screening process itself
Sometimes if the “Just Say NO” story is going to be told, you have to tell it yourself, as nurse practitioner Veneta Masson did in several media formats
The NYT and USNWR were two of the only news orgs to tell this story