Courier-Journal reporter Darla Carter led off New Year’s Day with a front page article “Health news [is a] prescription for confusion.” I agree with her. Is coffee bad for you of not? Should postmenopausal women take estrogens or not? Should men get a routine PSA test for prostate cancer or not? When and how often should I get a mammogram? Should I get chest x-rays to screen for lung cancer or not? Should my child get immunized or not? Our daily media is full of headlines and stories that address medical scientific issues and their application to medical care. Even if one is not paying attention, it is obvious that the recommendations appearing in these news articles and segments conflict with each other on a regular basis.
It is this article that stimulated me to get off my duff with this blog. For years I have been pulling my hair out about the way medical information is presented to the public. The volume of health and medical information presented to the lay and professional public daily is overwhelming. I don’t know about you, but I can hardly stand to watch television any more because of all the drug ads. The only thing that is worse are the campaign ads, but at least these are with us only part of each year.
We are assaulted by print, broadcast, and electronic media everywhere we go. The nature of the information ranges widely. It ranges from “news,” advocacy sponsored material, through press releases supporting every possible position. The content passes further down the social-value scale through entertainment, snake oil, and outright fraud. The overwhelming volume of health-related material with which we are sandbagged is advertising: somebody is trying to induce us to buy something that will translate into income for them. There is nothing wrong with information: more and better information is badly needed. But we live in a time when food is sold like medicine, and medicine sold like soap powder. Which hospital in my town really has an infection control problem? What is the basis of a claim that a given product or service is the “best,” or even works at all for that matter? Such information is hard to come by– if it is available to the public at all.
I have been an academic physician all my life. I have trained thousands of physicians. I have been a scientist who did basic and clinical medical research. I was on the editorial boards of the major medical journals of my specialty and analyzed the scientific papers that so often form the basis of “news.” I helped teach statistics to medical students. Despite this background, I am generally at a loss about what to believe when I see, read, or hear medical information targeted at the general population, or for that matter the professional one. I am conceited enough to think that if I have trouble sorting through the avalanche of information that is relevant to my own health, the rest of you don’t have a chance.
This topic is too broad to handle in a single post today but I predict that we will be returning to it many times if I can keep this blog going! Since my own attention was peaked by a discussion of the confusion caused by the reporting of apparently legitimate medical research, I will take a moment to give part of my own take on this aspect.
I first became aware more than 20 years ago of the phenomena of scientific research results presented along with regular news items. As regular as clockwork, headlines and teasers would appear on the same day of each week seeming to announce some new scientific breakthrough. At the time, (and without knowing any better, now) I attributed this to the editorial policies of some major medical journals. Legitimate medical journals have a natural desire to protect and enhance their reputation. A fairly standard part of that strategy, and to prevent a prior “undesirable” practice of multiple publication, was to require of potential authors that they not submit their work to another journal or publicize it until the editorial review board had made their decision about acceptance– a process that could take months. Even the scientific papers that were accepted could not be “published” until the publication date of the journal– in another few months. There was always some uncertainty about what counted as prior publication. For example, could the material have been presented in whole or part to other scientists at meetings? Could you talk to your newspaper about your findings? I cannot say that I disagreed with these policies at the time, but it is probably fair to say that some delays in dissemination (of both good and bad) information occurred.
The focus of dissemination on the publication date of the journal set the stage for research findings becoming regular news events. Newspaper reporters were given advance copies of the articles under an embargo not to write about them until the day of publication. This accounted for the regular weekly timing of the news items. In my opinion, the whole spectacle of “pulling back the curtain” overly dramatized the reporting of scientific information. I generally found myself thinking, “Why is this article ready for prime time?” These were generally unconfirmed interim articles that may have been quite valid given the carefully controlled nature of their conduct, but which would apply only to the carefully defined study situation or populations. It was inevitable, however, that the research findings were often overblown. (That includes almost all reporting containing the word “cure.”) Following the teaser headlines, discussion of study limitations were infrequently discussed, and some things like conflicts of interest of the investigators or their institutions were virtually never mentioned. Being in the news does not make a study or recommendation important, relevant, or even correct.
I do not mean to either vilify or denigrate medical reporters as a group. Some are undoubtedly better at it than I could be. However, it seems that anyone can function as a medical reporter nowadays. There are a plethora of daily press releases among which to choose on a slow news day. I do mean to imply that our current model of disseminate medical information conflates the difference between interim science and established fact; and between marketing and reporting. In future postings I hope we can look at some specific examples in more detail.
Is there a fix? Should medical information be made less available? Of course not. Should we let the market decide what is fit to publish? Of course not– the market also sells snake oil. Does the first amendment rule? Can anyone say whatever they want? We at least try to hold drug companies to some standard of accuracy and honesty. Is it let the buyer beware– even the impaired or vulnerable? Even if there should be, can there ever be a judge of what’s fit to print? How can people be held responsible for what they say, especially when it can harm another? I know of nothing in medicine, not even the taking of a history or a physical exam, that does not have the potential for both benefit and harm. Words are not only the most powerful weapons of violence, but also of medical treatment. I do mean to imply that it is quite legitimate to consider the balance of risk and benefit in the way we provide for people to learn about medical information.