G A R Y S C H W I T Z E RP U B L I S H E R , H E A L T H N E W S R E V I E W . O R G

STRIVING FOR BALANCE IN CANCER SCREENING NEWS

The editors of the Annals of Internal Medicine referred to a “media cacophony”:

“Confusion, politics, conflicted experts, anecdote, and emotion ruled front pages, airwaves, the Internet, and dinner-table conversations.”

Dana Milbank, Wa Post “Send Task Force to the Death Panel”

Elisabeth Hasselbeck on “The View” called it “gender genocide.”

Elizabeth Cohen, CNN: "This task force is the only big group that is saying this.”

Dr. Manny, Fox News: “Mammograms should be done because they save lives. Period.”

ABC’s Dr. Tim Johnson: “I recommend sticking with the current guidelines.”

CBS’ Dr. Jennifer Ashton: "I am not telling women to deviate from their screening practices."

AP quoted one breast cancer advocacy group that opposed the recommendations, but didn't include the perspectives of two much larger national advocacy groups that support the recommendations - the National Breast Cancer Coalition and Breast Cancer Action.

Veteran science journalist John Crewdson wrote in the Atlantic:

"The current controversy over the task force's report owes much to the media's confusing coverage, some of which has been misinformed, including by TV doctors who ought to know better.”

"Are you comfortable with what you're saying? You're a nurse. What you're saying is that some lives are not worth it - that's why we're changing these recommendations. That's an incredibly frightening thing to hear from someone like yourself. Is that what you're saying?"

A viewer who is a breast cancer survivor wrote to me:

"She was basically made to defend a position that Dr. Gupta asserted as fact. It was a pretty crappy tactic.

… I hope physicians-that-are-also-journalists start realizing that by (ab)using their positions of trust as doctors to lend credibility to hit-and-run stories, they cheapen both medicine and journalism."

Fox News website, March 3, 2010

Headline: “Cancer Society Casts Doubt on Value of Prostate Cancer Test.”

Excerpt: "Dr. David Samadi, a Fox News contributor and chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in NY, said he thinks the new guidelines could cause unnecessary deaths. "In my practice, we find men in their 30s and 40s that are at high-risk and develop prostate cancer.”

In 2010, the American Cancer Society aggressively addressed journalistic - and public - misperceptions about screening tests. Dr. Len Lichtenfeld asked on his blog, "Does PSA Testing Really Reduce The Risk of Prostate Cancer Recurrence?”

Excerpt:”Headlines are suggesting that the study demonstrates that even though PSA tests don't necessarily save lives, they do lead to a reduction in cancer recurrence, and therefore are valuable. I am of the opinion that no such conclusion can be drawn from this research. ... In my personal opinion, promoting this study in the press does a disservice to the men in this country who are faced with a dilemma of trying to decide whether or not PSA screening is right for them."

“There's a lot of publicity out there - some of it by people who want to make money by recruiting patients - that oversimplifies this - that says that 'prostate cancer screening clearly saves lives.' That is a lie. We don't know that for sure…

...We're very concerned about a number of clinics that are offering mass screening where informed decision making - where a man gets told the truth about screening and is allowed without pressure to make a decision - that's not happening. Many of these free screening things, by the way, are designed more to get patients for hospitals and clinics and doctors than they are to benefit the patients. That's a huge ethical issue that needs to be addressed.

We're not against prostate cancer screening. We're against a man being duped and deceived into getting prostate cancer screening."

The Cancer Society started a series of YouTube chats with chief medical officer Otis Brawley. In one, he tackled controversies in prostate cancer screening:

Duped & Deceived?

Tim is a 60-year old lawyer.

When he was 47, he had a physical because he was tired. The doctor ran a blood profile and included a PSA test without telling Tim.

In Nov., after the National Lung Screening Trial results were released, the ACS posted on its blog:

"It's only been a few days since researchers released preliminary results of a major trial of early detection of lung cancer in heavy smokers using CT scans. At the time, the American Cancer Society and others (including the authors themselves) expressed cautious optimism, with emphasis on the cautious, saying that although enormously promising, the data was not enough to call for routine use of this screening test, even in heavy smokers. ...But 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."

Interviewed Dr. Peter Bach of Sloan-Kettering:

“Bach says the risk that this test will give a false positive result is about 100 times higher than the chance that it will keep someone from dying of lung cancer.”

Amidst general weak journalism, NPR stood out:

And Dartmouth’s Bill Black:

“How long do we screen these people for? How often do we screen them? How exactly do we interpret all the findings? What do we do about people who are little bit older or a little bit younger? There's tons of questions that have to be answered.”

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.”

Evidence that consumers are skeptical about evidence-based health care. Carman KL et al. Health Affairs 2010

“Clearly, consumers will revolt if evidence-based efforts are perceived as rationing or as a way to deny them

needed treatment. Policy makers, employers, health plans, providers, and researchers will thus need to translate evidence-based health care into accessible concepts and concrete activities that support and motivate consumers. 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.”

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Our two patient examples, Tim and Veneta, reflected on the hurdles that individuals face when they want act on their own preferences, and on the dilemma for caregivers trying to implement shared decision-making on screening test issues.

OUR CHALLENGE• WHAT VOICE COULD ANY OF YOU HAVE IN THIS? • CAN YOU HELP QUIET THE CACOPHONY & CALM

THE CONFUSION?• PROMOTE EFFORTS OF BRAWLEY, LICHTENFELD,

WELCH, MASSON, JOURNALISTS WHO HAVE INFORMED WITH BALANCE & EVIDENCE• WHAT ARE THE FORUMS THAT HAVE NOT BEEN USED

TO HELP PEOPLE UNDERSTAND? • WHAT HAVE YOU OR YOUR ORGANIZATION DONE TO

PUBLICLY ADDRESS THESE ISSUES? HOW CLEAR, HOW STRONG HAS THE VOICE OF REASON BEEN?