Too Much Of The Wrong Kind

Of Health News

Gary SchwitzerPublisher, HealthNewsReview.org

Adjunct Assoc. Prof., School of Public Health, University of Minnesota

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

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

“Good journalism has a subtle feature of reticence. We don’t publish everything we hear. We filter. We curate. The goal of the traditional journalist is to create a reputation for accuracy, fairness, relevance and timeliness, and this requires the willingness to not publish things that are unlikely to be true. … There’s nothing at stake here except the survival of credible journalism.”

- Joel AchenbachWashington Post

Daily Drumbeat of Dreck

After mouse experiment with 5 successful results!

How did this…..

….become this?

And all of this…. 327,000 results on a Google search!

A university news release played a role

2013: The year we “cured” cancer – three times !

“Breaking Through Cancer’s Shield” - Oct 2013

èèè

“Boston Children’s Hospital could be on the verge of curing type 1 diabetes. Seriously. This huge news, which was announced today on their blog.”

JOSH BILLINGS (PEN NAME OF HUMORIST HENRY WHEELER SHAW, 1818 – 1885)

“The trouble with people

is not that they don't know, but

that they know so much that ain't so. …

I honestly believe it is better to know nothing that to know what ain’t so.”

Journal of Incidentalomas

Journal of Experimental EfficacyJournal of Preclinical Self-Importance

Journal of Surrogate Markers Only

September 2012

Positive “spin” was identified in about half of press releases and news stories. The main factor associated with “spin” in press releases was the presence of “spin” in the journal article abstract conclusion.

In other words, a direct link from published study news release news story.

Who thinks about the reader, the consumer, the patient…at the end of this food chain?

Mayo’s Dr. Victor Montori to a journal club:

“Beware spin: composite endpoints, surrogate markers, subgroup analyses, inadequate comparators (too much or too little of an effective alternative or placebo when an effective alternative exists). Above all, avoid the intro/discussion sections which is where most of the interpretational spin is introduced.”

But many journalists – who feed off a steady diet of journal studies in order to meet their story quotas and click rates – have no idea what any of these terms mean.

Dr. Richard Lehman has published reviews of journal articles for 8 years on BMJ website

“I too was once a conclusion-of-the-abstract reader, and was quite smug that I had even got that far. It took me some years to become aware of perhaps the most important principle of critical reading: never believe the stated bottom line without confirming it from the data. And beware of the limitations of the data.”

Dr. Lehman reminds us:

350 years ago the Royal Society of London for Improving Natural Knowledge used as its motto,

Nullius in verba

Rough translation:

“Don’t take anyone’s word for it.”

We still have much to learn from those notable 17th century skeptics.

“Bad science is no excuse for bad journalism.”

Pharma says that for every 5,000 compounds in pre-clinical testing, only 5 make it to human trials. And of those, only 1 will get FDA approval.

But we keep seeing stories like:

– The Toronto Star: “New breast cancer drug heralded as breakthrough” (Phase 2 study)

– CNN: “Stem cell medical breakthrough?” (Phase 1 study)

– Medscape: ‘Truly Remarkable’ Response with Combination for Melanoma (Phase I study – 37 people followed 12 weeks)

Another estimate: only 8% of new drugs in Phase I studies ever get approved

“BREAKTHROUGH” on all 3 main TV networks on a Phase I study

Note that all 3 practice “question mark journalism” – which allows you to say anything, followed by ?

Cover story “breakthrough”

16 words: “moving into the testing phase”

Stenography, not journalism

Reported on Phase 2 breast cancer drug study – directly from a Pfizer news release – which didn’t include any data.

But the story lifted a glowing quote from the company news release:

“The study suggests ‘the potential to transform the standard of care,’ said Mace Rothenberg, Pfizer Oncology's chief medical officer. ‘This is encouraging information for these women.’ “

No data. No independent perspective. Free publicity on results no one will see for two more months when they are presented at a meeting.

But Reuters and AP also reported on the Pfizer news release. Those stories were picked up by Huffington Post, ABC, Charlotte Observer, Boston Herald, Idaho Statesman, Washington Times, Bradenton Herald, Fort Worth Star Telegram, Myrtle Beach Sun News, Philly.com, others

Why does any of this matter?

• Because we are often mired in an ugly, uninformed public dialogue about health care

Message from a researcher who promotes mammography benefit

to a researcher whose work questions benefit

“May the faces of the thousands of women who have died, and will continue to die, prematurely because of you, continue to haunt you in your dreams, and in your nightmares.”

The management of

• The CEO said the US Preventive Services Task Force “condemns tens of thousands of men to die this year and every year going forward…”

• The COO said that Dr. Otis Brawley, chief medical officer of the American Cancer Society “has killed more men by giving them an excuse to not be tested.”

When an FDA advisory committee in 2011 recommended against Avastin for breast cancer

The VP of the National Breast Cancer Coalition - a breast cancer survivor - told the panel the data don’t show that the drug extends the lives of breast cancer patients, but do show it increases risk of harm, especially risk of hemorrhages.• Next, a woman got up to give her public presentation and

started by saying, “I am disgusted to have to speak after that woman.” Her statement was met with applause.

• One woman yelled, “What a patient representative! You better hope your breast cancer doesn’t come back. You’re an embarrassment to all cancer survivors. ”

Respected patient advocate Musa Mayer said:

“As a patient rep for the FDA’s Oncologic Drugs Advisory Committee, I, too have been publicly reviled for making evidence-based decisions that I felt would benefit the larger population of patients. Some of us have had to grow accustomed to receiving hate mail, hurled epithets intended to shame us, and even threats from those who claim to speak on behalf of patients.”

Journalism has an agenda-setting responsibility on issues like this

But the story of the forces behind this wretched public dialogue on screening and on evidence-based medicine is largely untold.

• Are the lobbying forces of special interests so powerful?

• Are journalists afraid, unaware, don’t consider it newsworthy?

• Any one of these possibilities is unacceptable.

Journalists could help people understand

• In health care, newer isn’t always better…more isn’t always better…less can be more.

• Bad things happen when we re-define normal states of health as illness requiring treatment

• There are tradeoffs involved in any health care decision: something you stand to gain but also something you stand to lose.

St. Augustine & Jerry Garcia

“Hope has two beautiful daughters. Their names are anger and courage; anger at the way things are, and courage to see that they do not remain the way they are.”

“Somebody has to do something, and it's just incredibly pathetic that it has to be us.”