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    Sunday, September 13, 2009

    Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.

    Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.

    On April 26, 2007, ABC World News, the American Broadcasting Corporation's flagship television news program, aired a “good news” story about a new test for prostate cancer. Against a background of a dramatic graphic showing that 1.6 million American men undergo prostate biopsy each year, the presenter announced: “Researchers at Johns Hopkins say they have developed a more accurate blood screening test.” The story was based on a new study examining the performance of early prostate cancer antigen-2 as a serum marker for prostate cancer. Unfortunately, ABC failed to disclose one crucial fact: the principal investigator of this study receives a share of the royalty sales of the test and is a paid consultant to the test's manufacturer. There was no discussion, for example, of the scientific evidence showing that the test was “more accurate” than existing screening tests or of the uncertain benefits and proven harms of prostate cancer screening

    This failure was one of a litany of weaknesses in medical stories and poor health reporting.

    I encourage all to check an online project called ( that evaluates and grades media stories about new health interventions, notifying journalists of their grades. The project builds on other initiatives that monitor the quality of health reporting, such as the Australian Media Doctor Web site ( and the United Kingdom's Behind the Headlines project ( ). uses a 10-point grading scale. The rating criteria include whether a story adequately quantifies the benefits of an intervention, appraises the supporting evidence, and gives information on the sources of a story and the sources' competing interests. On this scale, the ABC story received a grade of just two. Based on the ratings of 500 stories from the highest circulation newspapers and news magazines, the most widely used wire service (Associated Press), and the three most popular US television networks, the report card from is grim.

    Most stories (62%–77%) failed to adequately address costs, harms, benefits, the quality of evidence, and the existence of other treatment options. The trouble with distorted journalistic reports, is that they can generate false hopes and unwarranted fears. Accurate, balanced, and complete health reporting is crucial, so that “health care consumers are properly informed and ready to participate in decision making about their health care.”

    When it comes to the quality of health reporting, why is the bar set so low?

    One problem is that today's health reporters may have been covering crime last week and politics the week before. They have rarely been trained to understand the complexities of health research. For example, in her survey of 165 reporters in the US (response rate 69.6%), Melinda Voss found that 83% (96/115) had received no training in interpreting health statistics, and a third said that understanding key health issues was “often” or “nearly always” difficult.

    While there are certainly studies in specialist medical journals that will be difficult for many people to grasp, nevertheless there may be some value in establishing a core set of scientific competencies for all health reporters. Indeed, the Association of Health Care Journalists' Statement of Principles states that health reporters should “understand the process of medical research in order to report accurately” ( ).

    When a health story gets hyped, it is all too easy for medical journal editors to deny any responsibility. The reality, of course, is that journal editors themselves are the third party in the “complicit collaboration”—the journal's press release is the usual mechanism for linking the researcher to the journalist. Medical journals issue press releases about their upcoming studies partly because media publicity drives readers to the journal and builds brand recognition. A bland press release may be less likely to get your journal and the study noticed. Not surprisingly, a content analysis of journal press releases by Steven Woloshin and Lisa Schwartz found that these releases were themselves prone to exaggeration; press releases from research institutions and funding agencies may be equally as prone. Woloshin and Schwartz argue that all journal press releases should include:

    (1) a section putting results into context,
    (2) a section for the study's limitations,
    (3) a statement of the study authors' competing interests, and
    (4) a summary of the quantitative results expressed using absolute rather than just relative measures.

    COMMENT: In this column or blog of my medical articles I assure all that I try to use all 4 criteria in the story. Wherever possible we attempt to gauge the evidence pro and con with these levels of evidence prior to writing the article.

    LEVEL OF EVIDENCE for the medical articles we publish on this website.
    Level Definition
    A High-quality randomized controlled trial (RCT)
    High-quality meta-analysis (quantitative systematic review)
    B Nonrandomized clinical trial
    Nonquantitative systematic review
    Lower quality RCT
    Clinical cohort study
    Case-control study
    Historical control
    Epidemiologic study
    C Consensus
    Expert opinion
    D Anecdotal evidence
    In vitro or animal study
    Adapted from Siwek J, et al. How to write an evidence-based clinical review article. Am Fam Physician 2002;65:251-8.
    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Can you believe Medical New Stories: The Trouble with the Medical News Stories you read every day.

    Deepen your understanding of "medical malpractice"...

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