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FDA Risk Communication guideLast week, the Food and Drug Administration's Risk Communication Advisory Committee, of which I'm a member, published, "Communicating Risks and Benefits: An Evidence-Based User's Guide."  The book was written by members of the committee.  I think it's a terrific resource for students of health communication and journalism, public health and medical school students.  And, since it's available online free as a pdf file, faculty in these disciplines can easily adopt the guide in their curricula. It is also relevant for medical journal and health agency staff, for news release writers from academic medical centers, and for many others who communicate about risks and benefits of interventions. Australian journalist Melissa Sweet is one of the first to write a review. I wrote Chapter 18 - on what journalists can do to improve their reporting on the tradeoffs involved between benefits and harms in health care decisions. 

And the need was never more clear than in what we saw last week in several stories about screening tests - not for cancer, as we usually see - but in stories about heart screening tests.
  • CNN touted the benefits of certain screening tests for heart disease, giving the megaphone to a doctor who "invented one of the imaging tests" to make over-the-top claims of the benefits of screening. The story also includes, without rebuttal, this sensationalistic and fear-mongering comment from the doctor: "Unless you do the imaging, you are really playing Russian roulette with your life."       
  • NBC News chief medical editor Dr. Nancy Snyderman told women, "If you're over Nancy Snydermanthe age of 40, this is the time to have a conversation with your doctor about this very simple (C-reactive protein or CRP) blood test that's covered by most insurance." This was one of several examples we saw this week that should remind news consumers: anytime you hear about a "simple" test,  be very, very wary.  These "simple" tests can be a lot more complicated than their promoters suggest, as we explain.   

Both the ABC and NBC stories urged action on the part of viewers: "this is the time to have a conversation....and....I want you to ask your doctor."  They advocated and promoted a certain approach.  The leading organization that promotes health care news standards - the Association of Health Care Journalists - in its Statement of Principles states that journalists should:    

 

"Distinguish between advocacy and reporting. There are many sides in a health care story. It is not the job of the journalist to take sides, but to present an accurate, balanced and complete report."

These stories did not make that distinction. And the topics in question are not without controversy.  It's not like saying,"This is the time to have a conversation about how to stop smoking." For example, the ABC TV story didn't even include what ABC's own website reported:

"Calcium scanning is one of the worst examples of medicine gone wild," said Dr. Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic. "It's taken on a 'cultlike' following."

 

These were not doctor advice columns.  It wasn't Dr. Oz or Dear Abby. They were news broadcasts.  Imagine if a New York Times business reporter - not a columnist or editorial writer but a reporter - wrote, "I want you to talk with your broker about investing in Pfizer."  Or if ABC's political reporter advised viewers on the air, "This is the time to have a conversation with your friends about joining the Tea Party movement."

Here's my opinion - clearly-labeled and passionately held. I urge physician-journalists - and the news organizations that put them in these positions - to stop giving health care opinions and advice within news programming. 

In a response on Twitter, Dr. Besser admitted:

 

"It is my job to synthesize complex med info and have an opinion. Very different from straight journalist."

 

That's my point: this belongs in an op-ed segment, not in a newscast. Viewers aren't told this segment is "different from straight journalism." Dr. Besser also tweeted:

 

"I practice public health from my perch at ABC News."

 

So he doesn't view his job as straight journalism, but, instead, as "the practice of public health" via network TV news. But, since not all would agree with the public health advice given by TV docs  - e.g.,  the US Preventive Services Task Force states that the evidence is too uncertain on either of the tests these TV docs promoted - why isn't that evidence-based perspective reflected on the nation's airwaves?  

 

30 or so years ago, network TV newscasts included regular clearly-labeled opinion pieces by the likes of John Chancellor or David Brinkley or Howard K. Smith.  If network news execs today want to use some of the 22 minutes of nightly news time for doctors' opinions, they should be obliged to call it what it is:  opinion, not news. 

 

But news consumers who care about the evidence behind health care claims should remember: because of the potential for bias, opinion resides at the very bottom of the hierarchy of evidence.

Hierarchy of evidence

 

Links to all of the week's story reviews and blog posts appear below.  

Story Reviews from the Past Week
Doctors screen for cervical cancer too often: study
Reuters Health
Score: 5 out of 5 stars
A lack of clarity may mislead readers about the screening recommendation - marring an otherwise high-scoring story on an important topic for women's health.
Ultrasound of Neck Arteries May Help Gauge Stroke Risk
Health Day
Score: 3 out of 5 stars
 An interesting story on an important topic.  Independent perspectives contributed a great deal.
Dogs Sniff Out Lung Cancer in Humans
WebMD
Score: 4 out of 5 stars
The story ends with an appropriate quote: ""The dogs show that it can be done. We need to find out what the dogs are sniffing so we can do it in a more scientific manner."
Will you have a heart attack? These tests might tell
CNN Health
Score: 1 out of 5 stars
Severely flawed story.  Includes simply unbelievable claims from a conflicted source, who is allowed to make non-evidence-backed promotions of various screening approaches.
Blood injections may help chronic "tennis elbow"
Reuters Health
Score: 3 out of 5 stars
This short story about a small study doesn't offer readers much of the necessary context to judge the significance of this potentially new treatment for tennis elbow.
Chinese Herbs Equal to Tamiflu in Reducing H1N1 Fever: Study
Health Day
Score: 3 out of 5 stars
Common shortcomings seen in this story:  failure to address costs, to adequately quantify benefits and to provide independent perspectives.
A breast cancer breakthrough?
Boston Globe
Score: 3 out of 5 stars
Two evidence-trained breast cancer advocates (Christine Norton and Suzanne Hicks) reviewed this piece and make constructive criticism comments from a patient's perspective.

 

Blog posts from the past week  
The dangerous duality of the TV MD-"journalist" - 2 examples in 2 nights on network TV news

NBC urges women >40 to ask about CRP test - something not supported by evidence

Physician blogger blasts NYT obese mice drug story

How to & how not to report on imaging/screening tests

The Menopause Industrial Complex

FDA publishes "Communicating Risks & Benefits: An Evidence-Based User's Guide"

Newsweek cover story on tests & procedures that may do more harm than good

One week in the wide & wild variations in quality of health care journalism
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Grandpa Gary & EmmaYou can send feedback to:  

 

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Finally, the photo at right is of my beautiful new granddaughter Emma Michele.  One of these days I'll hang up this work and just be a fulltime Grandpa. 

 

Thanks for your interest.

 

Gary Schwitzer
Publisher
HealthNewsReview.org

Logo: Foundation for Informed Medical Decision Making

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