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Applying
HealthNewsReview.org
       criteria


            Gary Schwitzer
   Publisher, HealthNewsReview.org
Availability
• Sometimes stories seem to suggest that something is
  imminently available, when, in fact, it may be years
  away. There may be a lot of marketing hype involved.
• Whenever you hear a prediction about something
  “expected to be approved” in a certain time period, ask
  what is the basis for that prediction? There needs to be
  some sense of history of the thousands of exciting ideas
  that never panned out. Does the person making this
  prediction stand to benefit in some way?
• With devices/procedures, did you consider the
  availability of trained personnel to deliver the approach?
  The learning curve? These are important issues that may
  severely limit availability/adoption. You can address it
  in just a few more words.
• Finally, when you hear about new approaches – new
  devices or new operations – you should ask how
  widespread is the approach. No one wants to be the first
  patient treated with a new device or a new operation.
Costs
• It’s not sufficient to write, "The cost is much lower.” What
  is that cost? How much lower?
• It may be difficult to estimate costs of an experimental
  approach that is very early in its development. But can
  you at least cite costs of existing alternatives? Is the new
  approach comparable to other approaches whose costs
  you can cite? We believe: If it's not too early to talk
  about how well something might work, then it’s not too
  early to start discussing what it may cost.
• A recent study reported “Perhaps as many as one in five
  people don't take drugs a doctor has prescribed
  because they can't pay for them.” This is why cost
  information is vital information. Yet 70% of the 1,600
  stories we’ve reviewed get unsatisfactory grades on the
  cost issue.
Disease-mongering
• Question prevalence estimates. Scrutinize statistics.
  Where did they come from?
• Are you using interviews with “worst-case” scenario
  patients, holding such patients up as examples as if
  they were representative of all with this condition?
• Have you framed surrogate markers or intermediate
  endpoints (test scores, blood values, etc.) as if they
  were the outcomes that people should really care
  about to establish improved quality of life and
  longevity?
Evaluating the evidence
• Confusing causation and association – failing to explain
  limitations of observational studies.
• Failure to emphasize limitations of small, short-term
  studies.
• Failure to include study dropout rate. Why did they drop
  out?
• Presenting findings from an animal or lab experiment
  without cautioning about the possibly limited
  applicability for human health
• Not explaining that abstracts presented at conferences
  undergo only limited peer review and should be
  scrutinized very carefully
• Presenting anecdotes as evidence of a treatment’s
  harms or benefits – rather than as a single illustration of
  its use.
Harms
• It’s not sufficient to report on “common side effects.”
  How common? 40-50% of patients? Important to
  quantify.
• Don’t accept promoters’ claims that “minimally invasive”
  automatically means safer. Demand the data.
  Compare with existing alternative options. Seek
  independent perspectives.
• Failing to account for “minor” side effects that could
  have a significant impact on a person’s life.
• Screening tests cause harm. It is a common journalistic
  pitfall to overlook this fact. Don’t minimize anxiety from
  false positives. Though a blood test may have little
  risk, future consequences that have real risks are rarely
  considered (for example, complications from surgical
  biopsy following prostate cancer blood test).
True novelty of the idea
• In health care, newer isn’t always better. In
  fact, sometimes it really isn’t even “newer”
• Many “new” treatments, tests, products or procedures
  are not really novel. A “new” drug may be another
  member of a well-established class of drugs.
• Even if a drug is the first in a new class of drugs it may
  offer no more than the drugs that are widely available.
• Drug companies are very good at promoting their new
  drugs as “novel” in order to increase initial sales.
• The website ClinicalTrials.gov is a good source of
  information about other studies that are underway about
  a specific treatment or for a particular condition. It can
  help you judge whether something is truly innovative.
• Another good resource for assessing novelty is
  PubMed.gov. You can enter a key word and soon
  establish whether something is unique and if not – how
  long it’s been around and studied.
Benefits
• Risk reduction benefits should usually be reported in
  absolute, not just relative terms.
• Insufficient to write “significantly increased.” What does
  that mean? How was it measured? Avoid vague terms.
• Statistical significance may not equal clinical
  significance. What difference did it make in peoples’
  lives?
• The plural of anecdote is not data. Patient stories are not
  data. Personal stories may overwhelm readers’ critical
  thinking.
• Reporting only surrogate markers or intermediate
  endpoints. For example, changes in blood test
  scores, may not be a true benefit – may not influence
  individual health outcomes. What difference did the
  intervention make in peoples’ lives?
Did the story rely on a
       news release?
• News releases can be valid sources of some information.
  But journalism is charged with independently vetting
  claims. So it is unacceptable to rely on a news release
  as the sole source of information.
• There are many vested interests in health care trying to
  influence consumer choices. We expect journalism to
  use independent verification – not to rely on news
  releases or company spokesmen.
• Again, industry isn’t the only guilty party. Dartmouth
  Medical School researchers concluded in a study: “Press
  releases from academic medical centers often promote
  research that has uncertain relevance to human health
  and do not provide key facts or acknowledge important
  limitations.”
Story sources
• Who’s promoting this? Do they have a conflict of interest?

• We believe that you always need second opinions from
  independent experts who have no vested interest in the research.

• Over-enthusiastic claims are not made solely by drug companies or
  medical device manufacturers. Academic medical centers are
  often just as guilty.

• Frequent examples of potential conflicts of interest in people
  making claims about new treatments, tests, products or procedures
  include:
   o A trial paid for by the drug manufacturer.
   o Researchers employed by or getting fees from a drug company.
   o A spokesman for a device manufacturer.
   o Doctors who are early adapters & true believers in a new idea.
   o An inventor.

• All of these people want their product or their idea to look as good
  as it can.
Alternative options
• Did you discuss the harms/benefits of a new idea
  compared with harms/benefits of existing approaches?
• Did you provide some sense of the inevitably larger
  evidence base for existing approaches than for the new
  approach?
• A story should not focus on a surgical approach while
  never mentioning nonsurgical options or prevention.
• Stories should always consider the option of doing
  nothing – of “watchful waiting” – of “active surveillance”
  only
• Stories about screening tests should mention other
  screening options, including the option of not being
  screened.

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Applying HealthNewsReview.org criteria

  • 1. Applying HealthNewsReview.org criteria Gary Schwitzer Publisher, HealthNewsReview.org
  • 2. Availability • Sometimes stories seem to suggest that something is imminently available, when, in fact, it may be years away. There may be a lot of marketing hype involved. • Whenever you hear a prediction about something “expected to be approved” in a certain time period, ask what is the basis for that prediction? There needs to be some sense of history of the thousands of exciting ideas that never panned out. Does the person making this prediction stand to benefit in some way? • With devices/procedures, did you consider the availability of trained personnel to deliver the approach? The learning curve? These are important issues that may severely limit availability/adoption. You can address it in just a few more words. • Finally, when you hear about new approaches – new devices or new operations – you should ask how widespread is the approach. No one wants to be the first patient treated with a new device or a new operation.
  • 3. Costs • It’s not sufficient to write, "The cost is much lower.” What is that cost? How much lower? • It may be difficult to estimate costs of an experimental approach that is very early in its development. But can you at least cite costs of existing alternatives? Is the new approach comparable to other approaches whose costs you can cite? We believe: If it's not too early to talk about how well something might work, then it’s not too early to start discussing what it may cost. • A recent study reported “Perhaps as many as one in five people don't take drugs a doctor has prescribed because they can't pay for them.” This is why cost information is vital information. Yet 70% of the 1,600 stories we’ve reviewed get unsatisfactory grades on the cost issue.
  • 4. Disease-mongering • Question prevalence estimates. Scrutinize statistics. Where did they come from? • Are you using interviews with “worst-case” scenario patients, holding such patients up as examples as if they were representative of all with this condition? • Have you framed surrogate markers or intermediate endpoints (test scores, blood values, etc.) as if they were the outcomes that people should really care about to establish improved quality of life and longevity?
  • 5. Evaluating the evidence • Confusing causation and association – failing to explain limitations of observational studies. • Failure to emphasize limitations of small, short-term studies. • Failure to include study dropout rate. Why did they drop out? • Presenting findings from an animal or lab experiment without cautioning about the possibly limited applicability for human health • Not explaining that abstracts presented at conferences undergo only limited peer review and should be scrutinized very carefully • Presenting anecdotes as evidence of a treatment’s harms or benefits – rather than as a single illustration of its use.
  • 6. Harms • It’s not sufficient to report on “common side effects.” How common? 40-50% of patients? Important to quantify. • Don’t accept promoters’ claims that “minimally invasive” automatically means safer. Demand the data. Compare with existing alternative options. Seek independent perspectives. • Failing to account for “minor” side effects that could have a significant impact on a person’s life. • Screening tests cause harm. It is a common journalistic pitfall to overlook this fact. Don’t minimize anxiety from false positives. Though a blood test may have little risk, future consequences that have real risks are rarely considered (for example, complications from surgical biopsy following prostate cancer blood test).
  • 7. True novelty of the idea • In health care, newer isn’t always better. In fact, sometimes it really isn’t even “newer” • Many “new” treatments, tests, products or procedures are not really novel. A “new” drug may be another member of a well-established class of drugs. • Even if a drug is the first in a new class of drugs it may offer no more than the drugs that are widely available. • Drug companies are very good at promoting their new drugs as “novel” in order to increase initial sales. • The website ClinicalTrials.gov is a good source of information about other studies that are underway about a specific treatment or for a particular condition. It can help you judge whether something is truly innovative. • Another good resource for assessing novelty is PubMed.gov. You can enter a key word and soon establish whether something is unique and if not – how long it’s been around and studied.
  • 8. Benefits • Risk reduction benefits should usually be reported in absolute, not just relative terms. • Insufficient to write “significantly increased.” What does that mean? How was it measured? Avoid vague terms. • Statistical significance may not equal clinical significance. What difference did it make in peoples’ lives? • The plural of anecdote is not data. Patient stories are not data. Personal stories may overwhelm readers’ critical thinking. • Reporting only surrogate markers or intermediate endpoints. For example, changes in blood test scores, may not be a true benefit – may not influence individual health outcomes. What difference did the intervention make in peoples’ lives?
  • 9. Did the story rely on a news release? • News releases can be valid sources of some information. But journalism is charged with independently vetting claims. So it is unacceptable to rely on a news release as the sole source of information. • There are many vested interests in health care trying to influence consumer choices. We expect journalism to use independent verification – not to rely on news releases or company spokesmen. • Again, industry isn’t the only guilty party. Dartmouth Medical School researchers concluded in a study: “Press releases from academic medical centers often promote research that has uncertain relevance to human health and do not provide key facts or acknowledge important limitations.”
  • 10. Story sources • Who’s promoting this? Do they have a conflict of interest? • We believe that you always need second opinions from independent experts who have no vested interest in the research. • Over-enthusiastic claims are not made solely by drug companies or medical device manufacturers. Academic medical centers are often just as guilty. • Frequent examples of potential conflicts of interest in people making claims about new treatments, tests, products or procedures include: o A trial paid for by the drug manufacturer. o Researchers employed by or getting fees from a drug company. o A spokesman for a device manufacturer. o Doctors who are early adapters & true believers in a new idea. o An inventor. • All of these people want their product or their idea to look as good as it can.
  • 11. Alternative options • Did you discuss the harms/benefits of a new idea compared with harms/benefits of existing approaches? • Did you provide some sense of the inevitably larger evidence base for existing approaches than for the new approach? • A story should not focus on a surgical approach while never mentioning nonsurgical options or prevention. • Stories should always consider the option of doing nothing – of “watchful waiting” – of “active surveillance” only • Stories about screening tests should mention other screening options, including the option of not being screened.