This is 1 of 2 presentations I made at the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 7, 2011

1. Covering Cancer News –
Lessons from
HealthNewsReview.org
Gary Schwitzer
Publisher, HealthNewsReview.org

5. 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?
 Is the condition exaggerated?
 Is this really a new approach?
 Is it available?
 Are there alternative choices?
 Who’s promoting this?
 Do they have a financial conflict of interest?

6. After 5 years and 1,500 stories
 72% fail to adequately discuss costs.
 68% fail to quantify benefit - often how small is
potential benefit
 66% fail to quantify harm - often how large is
potential harm
 65% fail to evaluate the quality of the evidence
 58% fail to compare new idea with existing options

7. Kid-in-candy-store picture
of U.S. health care
 70% of ideas are terrific
 70% are risk-free
 70% - cost not an issue

8. A clear pattern
 News stories tend to emphasize or
exaggerate the benefits of
treatments, tests, products and
procedures.
 And they tend to minimize or
ignore the harms.

9. Is all
published
health care
news actually
newsworthy?
Or are we
drowning from
firehose of
information?

10. Concerns about cumulative effect of health messages
 Daily drumbeat of news
 Steady diet of news from journals - disregard for
publication bias for positive findings
 Advertising (US allows prescription drug advertising)
 Web health info
 News releases from industry, academic medical
centers, even from journals
 Misleading Twitter messages

15. Actual newspaper headlines on
DaVinci Robotic Surgery
 Cancer survivors meet lifesaving surgical robot
 Da Vinci puts magical touch on the prostate
 Robotic surgeon's hands never tremble
 Da Vinci is code for faster recovery
 Hospital hopes robot surgery will lure patients
 WHAT’S THE HARM OF THIS?

16. Stories about wonderful health care
gifts are NOT what they appear to be.

17. What’s the harm?
 British Journal of Urology – June – found that “massive
media coverage” of robotic prostatectomy was “a major
contributor” to rise in consumer interest in it.
 Journal for Healthcare Quality – May – found hospital
websites hype robotics, ignore harms, are influenced by
manufacturers.
 Author: “This is a really scary trend. We're allowing
industry to speak on behalf of hospitals and make
unsubstantiated claims….violation of public trust.”

18. “Robotics blamed for spike in prostate surgery.”
• American urology conference this summer
 “There is other evidence to suggest that radiation
therapy use also is increasing. I think there is pretty
good evidence that (we are treating more prostate
cancer). Why is that, in an era when the incidence
is going down and there is no reason to believe that
the disease is a lot more dangerous than it used to
be?”
James Montie, MD
Urologist
University of Michigan

19. June: Tufts University study
 Review of the available literature on radiation and
prostate cancer, including 10 randomized controlled
trials and 65 observational studies.
 They concluded there was "insufficient evidence" to
say with certainty whether radiation treatment
compared to watchful waiting is more likely to save
lives.
 Yet expensive new technologies like proton beam
therapy and intensity-modulated and proton beam
radiation therapy are proliferating.

20. What’s the harm?
 Stories whip the“worried well” into a frenzy
 Raise unrealistic expectations of health care system
 Promote undue demand of costly, unproven technologies
that may produce more harm than good.
 Communication of these issues - itself - is a major health
policy issue.
 Leading U.S. health economist Uwe Reinhardt asks:
“Where has civic education failed?”

21. News coverage & poor public discussion of screening
tests should be most concerning.
Worst, most biased coverage I’ve seen in 37 years

22. 10 claims that many stories didn’t challenge
1. This is all about saving money.
2. This is about rationing.
3. It’s the first sign of Obamacare.
4. Government is deciding some lives don’t matter.
5. Early detection always saves lives.
6. The fact that I or someone I know was saved by a mammogram proves
that more testing is better.
7. The shifting recommendations prove that scientists are clueless.
8. This was surprising and came out of nowhere.
9. The task force members must be uninformed idiots - especially since
none was an oncologist or radiologist.
10. American Cancer Society disagrees so the task force must be wrong.

23. What the Task Force actually wrote:
“The decision to start regular, biennial screening
mammography before the age of 50 years
should be an individual one and take patient
context into account, including the patient's
values regarding specific benefits and harms.”

24. Annals of Internal Medicine editors
called it a “media cacophony”
 “Confusion, politics, conflicted
experts, anecdote, and emotion ruled
front pages, airwaves, the Internet,
and dinner-table conversations.”

25. The Public's Response to the U.S. Preventive
Services Task Force's 2009 Recommendations
on Mammography Screening
233 newspaper articles, blogs & tweets coded
“These results are consistent with previous
studies that suggest a media bias in favor of
mammography screening."

26. 37-year Chicago Tribune & NY
Times veteran John Crewdson wrote:
 “There are multiple reasons women are ill-
informed about breast cancer. The fault lies
primarily with their physicians, the cancer
establishment, and the news media--especially the
news media. Until coverage of breast cancer rises
above the level of scary warnings mixed with
heartwarming stories of cancer survivors, women
are likely to go on being perplexed."

27. A national poll suggests lingering
impact of imbalanced news
• 11 percent of women surveyed said they
believe mammograms should start in the 20s,
even for women with no risk factors
• 29 percent believe mammograms should
start in their 30s.
• 45 percent said the guidelines were an
attempt to reduce health-care costs

28. Other examples:
 Chicago Sun-Times
 Wall Street Journal
 Washington Post
 New York Daily News
 Minneapolis Star Tribune
 All TV networks

29. The ink
isn’t even
dry on
studies
before
marketing
begins

30. On Twitter
 Men’s Health magazine:
If you're a smoker, you NEED to get a CT scan.
Body of story: “But don't run out and ask for one.” (as it
discusses issues of costs and false positive test results)
 American Association of Retired Persons:
Are you a smoker? CT scan those lungs
Body of story: 371 words of caveats.

31. HealthDay wire service didn’t challenge
researcher promoting universal pancreatic
cancer screening for everyone over 50.
 After study of tissue from 7 people!

32. Journalists’ Screening Bias
 Crusading
 one-sided
 advocacy

33. Why don’t we deliver this message?
“All screening tests
cause harm;
some may do good.”
But much health journalism consistently emphasizes
benefits & minimizes harms

34. And that’s the message I
think we’re missing
 That there’s a harm behind screening promotions that
are not based on evidence
 That there’s a harm in selling sickness…in selling the
search for weapons of mass destruction inside all of
us
 Communication of the evidence about tradeoffs –
about harms - is a key health policy issue

35. Prevention - Myth vs. Truth
(slide borrowed from Harvard breast surgeon)
 Myth - we can prevent breast cancer
 Truth- we can reduce the risk of some breast cancers
 But it is the hormone receptor positive, better prognosis
cancers we have decreased
 No difference in mortality has been shown
 And many women will suffer adverse events from the
medications and get no benefit
 We need:
 Better ways to determine risk
 Risk reduction or prevention of high risk breast cancers
 Risk reduction methods that are not life threatening and do
not decrease the quality of life

36. What pinkwashing leaves out

37. Breast Self Exam
 2 randomized controlled trials have
shown no benefit from breast self exam
in decreasing mortality
 Breast self exam does lead to the
discovery of more benign masses

38. 2007 Cochrane Review of
randomized clinical trials of
screened versus not screened –
only small benefits from screening
mammography

39. Screening - Myth and Truth
 Myth: if women go for their recommended
screening, their breast cancer will be caught early
when it is 98% curable
 Truth:
 Many breast cancers are not picked up on screening
 Screening decreases the risk of dying of breast cancer
by only 15-30%
 Screening best finds the slower growing less aggressive
cancers with better prognosis
 Faster growing, more aggressive tumors (biology!) are
more likely to be found between screens and higher
numbers have metastasized prior to diagnosis

40. A leading US breast cancer advocacy group
talks about “changing the conversation”
 Measure real progress, not by measuring how
many women have been screened or what the
five-year survival rates are but by seeing
significant reductions in incidence and
mortality rates.

41. In health communication,
we see a clash between…
 Science  Intuition
 Evidence  Emotion
 Data  Anecdote
 Recommendations for  Decision-making by an
entire population individual
 Grasping uncertainty  Promoting false certainty
 What we can prove  What we believe, wish, or
hope

42. “I honestly believe it is better to know nothing
that to know what ain’t so.”
Josh Billings (pen name of humorist
Henry Wheeler Shaw, 1818 – 1885)

43. Health Affairs paper:
“Evidence That Consumers Are Skeptical
About Evidence-Based Health Care.”
“The beliefs that surfaced in both the qualitative
research and the survey—more is better, newer is
better, you get what you pay for, guidelines limit my
doctor’s ability to provide me with the care I need and
deserve—are deeply rooted and widespread.”
 Carman KL, et al. Health Affairs 29, No.7 (2010)

44. Even in 300 words journalists
can explain that…
 More is not always better
 Newer is not always better
 Screening doesn’t always make sense.
 Journalists could help consumers be smarter,
healthier skeptics
 Or we could & actually do cause harm.

45. Summary of health news flaws
 Failure to quantify harms, benefits, costs
 Failure to evaluate the evidence
 Emphasizing benefits while minimizing or ignoring harms
 Using questionable story sources
 Failure to get independent perspectives
 Ruining balance with “tyranny of the anecdote”
 Glowingly positive patient stories not balanced by stories of
treatment failures, trial dropouts, dissatisfied, or those who
decline aggressive testing or treatment

46. From the American movie, “Network” –
“I’m mad as hell & I’m not going to take it anymore”
Thank you