Ten Grains of Salt For Health Care Reporting

By John Ballard

Health News Review is an outfit watching the intersection of medical news and journalism, an intersection more dangerous to the careless reader than a busy highway intersection with a broken traffic light. 

Independent Expert Reviews of News Stories
Holding Health and Medical Journalism Accountable

Every time is see another flashy, obviously expensive DTC (direct to consumer) advertisement in prime time my first reaction is wondering if and when the generic version will be available. Or more often, whether the "new and better" product is significantly new or better. 

This review site is like Consumer Reports or Snopes for health care journalism. The interested reader is urged to check out the site for bookmarking or subscription. Here is a summary of the ten criteria they use to evaluate "treatments/tests/products/procedures," followed by a current case study regarding Alzheimer's disease as reported in the NY Times.

Criterion #1 The availability of the treatment/test/product/procedure

Criterion #2 Whether/how costs are mentioned in the story

Criterion #3 If there is evidence of disease mongering in the story

Criterion #4 Does the story seem to grasp the quality of the evidence?

Criterion #5 How harms of the treatment/test/product/procedure are covered in the story

Criterion #6 Does the story establish the true novelty of the approach?

Criterion #7 How the benefits of the treatment/test/product/procedure are framed

Criterion #8 Whether the story appeared to rely solely or largely on a news release

Criterion # 9 Is there an independent source and were any possible conflicts of interests of sources disclosed in the article?

Criterion #10 Whether alternative treatment/test/product/procedure options are mentioned

I see no reason to elaborate on these ten items here. Readers are smart enough to do their own homework. As I scanned the list ideas that popped into my mind included

• Availability -- Is this an item apt to be readily available or will political or other considerations keep it out of reach for some time. RU486 comes to mind, the famous "abortion pill" readily available all over the world for years but not available in America thanks to political rather than scientific reasons. Even now the so-called "morning after" pills are a matter of controversy.


• Disease mongering -- the site's description of this scare tactic is worth repeating.



...turning risk factors into diseases (e.g., low bone mineral density becomes osteoporosis); misrepresentation of the natural history and/or severity of a disease (e.g., early-stage low-grade prostate cancer); medicalization of minor or transient variations in function (e.g. temporary erectile dysfunction or female 'sexual dysfunction'); medicalization of normal states [I love this one.] (baldness, wrinkles, shyness, menopause); or exaggeration of the prevalence of a disorder (e.g., using rating scales to 'diagnose' erectile dysfunction). A news story may contain more than one example of mongering. [How do you or your lover rate on the boner scale???]

• Novelty -- Is this really NEW? I can't recall a time when there was not yet another remedy for acid indigestion. Or headaches. Or joint pain. Can the reader? C'mon. how stupid can we be? And it would seem that every male in the country is certain to have trouble getting a boner sooner or later. Shesh! It's like the telephone company selling phone service playing on the fears of abandonment (Remember You're never along with a telephone?)


• Comparative effectiveness. This is a biggie, folks. Look carefully at #7. New drugs and procedures are not telling us whether or not or how much better than they are compared to what is already on the market. If the new product or procedure 65 lives per 100.000 population and what is already available saves 60, is that extra margin of improvement (five one-thousandth of one percent) what you really want to get, especially if it is new and may have as yet undiscovered side effects? As the site says, journalists have a tendency to report benefits as the relative reduction in the frequency of an adverse outcome. For instance a reduction in the risk of hip fracture with treatment from 2% to 1% might be reported as a "halving" or a '50% reduction'.


• 
  Surgical versus non-surgical approaches. There is an old saying that if the only tool you have is a hammer then everything you see looks like a nail. (This applies to professional military types as well, but this post is about medical stuff.)
  ?I have a disease in my left wrist, Kienb�#39;s Disease,which was diagnosed in my twenties. Back then, over forty years ago, they only operated if you had severe pain. I was told they might replace the lunate bone with a synthetic implant, but they were reluctant to do so on someone that young because there was not enough history to predict what could happen with that implant over a lifetime. After a few years of annual visits to orthopedic practices I quit going and forgot about it. I have suffered no ill effects other than a few degrees of lost motion in that wrist and lately some tingling in two fingers on that hand. Otherwise, no problems. Several years ago I consulted with a retired surgeon who asked "Does it bother you? Do you have any pain?" When I told him No he said "Well, if anyone operates, they will be operating on an x-ray, not a patient." I thanked him and continued to do nothing. As long as I continue to be pain free and can use this keyboard I see no reason to do otherwise.

Promise Seen for Detection of Alzheimer�s is a recent example of how Health News Review approaches journalism. And here is a link to the NY Times article being reviewed.
They award three stars out of five, giving the article six out of ten possible good grades.
This is not only a case study of new Alzheimer's disease research, it is also an insight into how easily health news can be either deliberately or inadvertently misunderstood.

I have added the blog to my aggregator, another burden to my already overloaded circuits.