{"id":33,"date":"2011-01-07T16:36:44","date_gmt":"2011-01-07T20:36:44","guid":{"rendered":"http:\/\/www.khpi.org\/wp\/?p=33"},"modified":"2011-07-11T08:21:13","modified_gmt":"2011-07-11T12:21:13","slug":"does-medical-reporting-help-or-hurt","status":"publish","type":"post","link":"http:\/\/www.khpi.org\/blog\/does-medical-reporting-help-or-hurt\/","title":{"rendered":"Does Medical Reporting Help or Hurt?"},"content":{"rendered":"

Courier-Journal reporter Darla Carter led off New Year’s Day with a front page article<\/a> “Health news [is a] prescription for confusion.”\u00a0 I agree with her. \u00a0 Is coffee bad for you of not?\u00a0 Should postmenopausal women take estrogens or not?\u00a0 Should men get a routine PSA test for prostate cancer or not?\u00a0 When and how often should I get a mammogram?\u00a0 Should I get chest x-rays to screen for lung cancer or not? \u00a0 Should my child get immunized or not?\u00a0 Our daily media is full of headlines and stories that address medical scientific issues and their application to medical care.\u00a0 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.<\/p>\n

It is this article that stimulated me to get off my duff with this blog.\u00a0 For years I have been pulling my hair out about the way medical information is presented to the public.\u00a0 The volume of health and medical information presented to the lay and professional public daily is overwhelming.\u00a0 I don’t know about you, but I can hardly stand to watch television any more because of all the drug ads.\u00a0 The only thing that is worse are the campaign ads, but at least these are with us only part of each year.<\/p>\n

We are assaulted by print, broadcast, and electronic media everywhere we go. \u00a0The nature of the information ranges widely.\u00a0 It ranges from “news,”\u00a0 advocacy sponsored material, through press releases supporting every possible position.\u00a0 The content passes further down the social-value scale through entertainment, snake oil, and outright fraud. \u00a0 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.\u00a0 There is nothing wrong with information: more and better information is badly needed.\u00a0 But we live in a time when food is sold like medicine, and medicine sold like soap powder. \u00a0 Which hospital in my town really has an infection control problem?\u00a0 What is the basis of a claim that a given product or service is the “best,” or even works at all for that matter? \u00a0 Such information is hard to come by\u2013 if it is available to the public at all.<\/p>\n

I have been an academic physician all my life.\u00a0 I have trained thousands of physicians.\u00a0 I have been a scientist who did basic and clinical medical research.\u00a0 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.” \u00a0 I helped teach statistics to medical students.\u00a0 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.\u00a0 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.<\/p>\n

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!\u00a0 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.<\/p>\n

I first became aware more than 20 years ago of the phenomena of scientific research results presented along with regular news items.\u00a0 As regular as clockwork, headlines and teasers would appear on the same day of each week seeming to announce some new scientific breakthrough. \u00a0 At the time, (and without knowing any better, now)\u00a0 I attributed this to the editorial policies of some major medical journals. \u00a0 Legitimate medical journals have a natural desire to protect and enhance their reputation.\u00a0 A fairly standard part of that strategy, and to prevent a prior “undesirable” practice of multiple publication,\u00a0 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\u2013 a process that could take months.\u00a0 Even the scientific papers that were accepted could not be “published” until the publication date of the journal\u2013 in another few months.\u00a0 There was always some uncertainty about what counted as prior publication.\u00a0 For example, could the material have been presented in whole or part to other scientists at meetings?\u00a0 Could you talk to your newspaper about your findings? \u00a0 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.<\/p>\n

The focus of dissemination on the publication date of the journal set the stage for\u00a0 research findings becoming regular news events.\u00a0 Newspaper reporters were given advance copies of the articles under an embargo not to write about them until the day of publication.\u00a0 This accounted for the regular weekly timing of the news items.\u00a0 In my opinion, the whole spectacle of “pulling back the curtain” overly dramatized the reporting of scientific information.\u00a0 I generally found myself thinking,\u00a0 “Why is this article ready for prime time?”\u00a0 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. \u00a0 It was inevitable, however, that the research findings were often overblown.\u00a0 (That includes almost all reporting containing the word “cure.”)\u00a0 \u00a0 \u00a0 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.\u00a0 Being in the news does not make a study or recommendation important, relevant, or even correct.<\/p>\n

I do not mean to either vilify or denigrate medical reporters as a group.\u00a0 Some are undoubtedly better at it than I could be.\u00a0 However, it seems that anyone can function as a medical reporter nowadays.\u00a0 There are a plethora of daily press releases among which to choose on a slow news day.\u00a0 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.\u00a0 In future postings I hope we can look at some specific examples in more detail.<\/p>\n

Is there a fix?\u00a0 Should medical information be made less available?\u00a0 Of course not.\u00a0 Should we let the market decide what is fit to publish?\u00a0 Of course not\u2013 the market also sells snake oil.\u00a0 Does the first amendment rule?\u00a0 Can anyone say whatever they want?\u00a0 We at least try to hold drug companies to some standard of accuracy and honesty.\u00a0 Is it let the buyer beware\u2013 even the impaired or vulnerable?\u00a0 Even if there should be, can there ever be a judge of what’s fit to print?\u00a0 How can people be held responsible for what they say, especially when it can harm another? \u00a0 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.\u00a0 Words are not only the most powerful weapons of violence, but also of medical treatment. \u00a0 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.<\/p>\n

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