I began the talk by expressing my thanks and humility for being invited to speak in a lecture series that had previously hosted George Annas, Art Caplan, Robert Veatch, Linda and Zeke Emmanuel, Daniel Callahan and many others whose work I have followed and admired. I expressed my appreciation for being the first journalist to speak in the series and hoped that I would not be the last. I noted that one previous speaker in the series had said, ”In the last 30 years, our entire ethical sensitivity has increased substantially.” I began by wondering if the same could be said about increased ethical sensitivity in media messages about health care. And then I launched into my own 30 year retrospective. I cited a few examples from the epiphany I had in 1984 as a reporter whose eyes were opened to the hype/misinformation disseminated on AIDS, Artificial Heart, Alzheimer's. And then I transitioned to a reflection on how the same or similar issues are covered today. I offered only a few examples; it would have been a 5-hour talk if I'd made the list more complete. CNN, not coincidentally, is cited in many of the examples, some of them from my own first-hand experience. From the ‘80s, the network insisting on hourly live reports of artificial heart patient updates, and the hyping of a trial in 4 Alzheimer’s patients. In ’90, the hype of an AIDS patient (or was he?) claiming cure from a hyperthermia experiment. Then in the current era, CNN lending credence to cloning claims by a UFO-obsessed sect, and claiming an “exclusive” and “breakthrough” on a hospital news release claiming a cancer cure was within reach. The talk emphasized shared responsibilities on the part of all who communicate about medical research and health care claims. It touched on the imbalance in many media messages about screening tests, with journalists sometimes crossing the line from independent vetting into non-evidence-based advocacy. I cited the Statement of Principles of the Association of Health Care Journalists (which I wrote). It pointed to how medical journals can be complicit in the miscommunication of findings, but how many articles are now being published in journals raising questions about “spin” and bias and interpretation and word choice.

1. Addressing the Ethical Morass at the Intersection of
Media, Medicine and Public Health
Gary Schwitzer
Publisher
16th Annual Mates David and Hinna Stahl Memorial Lecture in Bioethics
Robert Wood Johnson Medical School, UMDNJ

2. 1974: I wanted to do sports

3. 1984: an epiphany
AIDS
Artificial Heart
Alzheimer’s

4. “The limits of what doctors can do to human beings in
the name of science are a matter for public decision
and public accountability.”
- George Annas, NYT op-ed, 2001

6. April 1984 news conference
at which HHS secretary
Margaret Heckler named
American Robert Gallo as
discoverer of the AIDS virus
with no mention of the
work of Frenchman Luc
Montagnier (who was
awarded 2008 Nobel Prize
for discovery of HIV). Worse, she announced that a
vaccine would be ready
within two years.

11. Jay Winsten in Health Affairs:
“Alzheimer’s disease became a hot story in the fall of
1984. Five weeks before the presidential election, HHS
Secretary Heckler announced five new federal grants
creating centers for research on the disease. The NY
Times carried page-one stories on new developments in
Alzheimer’s research.”
It was in this climate that researchers published the
results of a feasibility study of a potential therapy in the
journal Neurosurgery.
• 4 patients
• Relied on patients’ families’ subjective assessment of
improvement.
• The authors wrote that “results must be interpreted
cautiously” but that “We have had repeated reports
of decreased confusion, increased initiative and
improvement in activities of daily living.”
December 3, 1984

12. • The medical center held a news conference at which a
patient was made available. ABC, CBS, CNN, NBC, PBS and
newspapers and magazines across the country covered it.
• Print headlines:
– Alzheimer’s Treatment Found Successful
– Scientists Find First Breakthrough Against Alzheimer’s
– Researchers Believe Treatment for Alzheimer’s Disease is Near
– Researchers describe possible Alzheimer’s cure

14. 30 years later

16. April 1, 2013
Critic Seth Mnookin:
“The result of this succession of
grandiose promises is similar to that
of the boy who cried wolf:
Eventually, it becomes hard to take
even realistic claims seriously. …the
real problem with Time’s headline,
which is not that it’s wrong…is that
in the context of a fatal disease with
excruciatingly painful treatment
options, it’s simply cruel.”

17. And within the pages of that TIME cover
story are 9 mentions of MD Anderson
Cancer Center, including mention of their
“Moon Shots” program to cure cancer…
and this full-page ad insert.
Paul Raeburn of the Knight Science
Journalism Tracker points out that this
violates The American Society of Magazine
Editors guidelines that state:
“Editors and publishers should avoid
positioning advertisements near editorial
pages that discuss or show the same or
similar products sold by the advertiser (a
rule of thumb used by many magazines is,
the reader must turn the page at least
twice between related ad and edit).”

18. TIME Warner owns CNN
7 months earlier, CNN had a “breaking news exclusive”
on the MD Anderson Moon Shots program

19. What CNN didn’t report…
• Resignations, questions about conflicts of
interest and fraud probes of the program in
question.
• Not likely to be the kinds of angles and issues
one pursues when there are “exclusive”
reporting arrangements between a news
organization and a medical center.

21. Gupta attempted to defend the live coverage. “We didn’t know what they
were going to say,” he explained. “They didn’t tell us. We didn’t know
whether they were going to have any proof. We didn’t think they were.”
Yet they chose to carry it live.
Unverifiable claims were broadcast to a worldwide audience, leaving
viewers to figure out whether the claim had any meaning or not.
Gupta also defended five interviews CNN had aired with two leaders of
Raelian group, in one of which Connie Chung addressed one of the leaders
as “Your Holiness.”
Holy sh-- !!!

22. Alzheimer’s today?
NBC: “For the first time ever an experimental drug is showing great promise of slowing the
progression of Alzheimer’s disease.”
First time ever?
In 5-minute web search, we found 6 different approaches reported to slow the progression
of Alzheimer’s disease in just the past 4 years:
July 17, 2012: New Alzheimer’s Drug Slowing Progression of the Disease (CBS)
March 8, 2012: Alzheimer’s treatment in late stages of disease does slow progression
(The Independent)
October 20, 2011: Antiviral Drugs May Slow Alzheimer’s Progression (Science Daily)
May 11, 2009: Can New Drug Slow Progress of Alzheimer’s? (ThirdAge.com)
August 3, 2008: Drugs May Slow Progress Of Alzheimer’s (NPR on two drugs)

23. Lots of excitement – not much evidence
- about expensive new technologies

26. We review stories
that include claims
about…
• Medical treatments
• Tests
• Products
• Procedures

27. 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?

28. After 1,900 stories
over 7 years
60-70% of stories fail to:
✔ Discuss costs
✔Quantify potential benefits
✔ Quantify potential harms
✔ Evaluate the quality of the evidence

29. News stories often paint a
kid-in-candy-store picture
of U.S. health care
Terrific
Risk-free
Without a price tag

30. Drowning from a firehose of infoxication

31. Common flaws: too much stenography – not
independent vetting of studies in journals
Glorifying big names/big journals - Publication in a medical
journal does not guarantee the findings are true (or even
important).
Not ready for prime time – journals meant for conversation
among scientists
Never intended to be sources of daily news. So if you’re going to
use them that way, you simply must be aware of the
landscape:
• retractions, research fraud, fabrication, falsification of
data
• unpublished data (BMJ special edition on “the extent,
causes and consequences of unpublished evidence”)
• ghostwriting of journal articles (The Public Library of
Science hosts a “Ghostwriting Collection” on its website.)

32. Failure to evaluate inherently weak science
Idolatry of the surrogate – Not understanding or simply not
reporting that surrogate outcomes (like tumor shrinkage) may not
translate into clinically meaningful outcomes (longer life).
Reckless extrapolation - Predicting what may happen in humans –
and soon - based on very preliminary animal / lab science.
Lack of awareness of conflicts of interest & other ethical issues
Going soft on business stories or on local stories
Common flaws

33. Ignore
or
Minimize
Potential Harms

34. “Most
troublesome
trend” award
THE WINNER IS:
SCREENING TESTS
(often involving this gland)
Award for best supporting roles:
• Breasts
• Lungs
• Arteries

35. “All screening programmes do harm;
some do good as well.”
- Dr. Muir Gray
 False positives suggest a problem that’s really not there.
 Requires more testing, some of it more invasive carrying its own harms (biopsies)
 Incidentalomas – finding things you didn’t need to/want to find
 Emory radiologist after his virtual colonoscopy found suspicious spots:
“I awoke in the recovery room after 5 hours, with chest tube, Foley catheter,
subclavian central venous catheter, nasal oxygen catheter, epidural catheter,
arterial catheter, subcutaneously administered heparin, constant infusion of
prophylactic antibiotics, and patient-controlled analgesia with intravenously
administered narcotics. Excruciating pain.” Cost: > $50,000. All incidentalomas.
 Anxiety. Labeling. You are now “a patient.” You “have something.”
 Cost

36. Prizes for Prostates

38. I am not anti-screening
• I do oppose imbalanced, incomplete messages
on screening tests
• I do oppose messages that emphasize benefits
and minimize or ignore harms
• I do oppose messages that only tell anecdotes
of those who claim their life was saved by
screening – something that can never be
proven.

39. Crossing line from journalism to advocacy

40. A physician wrote to me after seeing this:
"Could a political reporter say
'Vote for Obama?'!"

41. “The 5-year survival rates for breast cancer diagnosed early is 98
percent…and this is largely due to screening and early diagnosis.”
Crusading advocacy on CBS News
Left CBS, left “journalism,” recently joined ABC

42. Can you imagine a TV political
reporter wearing a button saying,
“Vote for Romney” ?

43. JOSH BILLINGS (PEN NAME OF HUMORIST
HENRY WHEELER SHAW, 1818 – 1885)
“I honestly believe it is better to
know nothing than to know what
ain’t so.”

44. Cheerleading
“The press, on its own, if it chooses, can make the
transition from cheerleaders of science to independent
observers. The journalistic trumpeting of medical cures,
even though accompanied by sober cautions against
optimism, deserves to be severely throttled back in
recognition of an unfortunate reality: though news is
sold around the clock, major advances in medicine come
along infrequently.”
-- Daniel Greenberg: Science, Money, and Politics, 2001

45. We should strive to be independent from the agendas and timetables of
journals, advocates, industry and government agencies. We should nourish
and encourage original and analytical reporting that provides
audiences/readers with context. Given that thousands of journal articles
and conference presentations appear each year, and that relatively few are
immediately relevant to our audiences/readers, health journalists have a
responsibility to be selective so that significant news is not overwhelmed
by a blizzard of trivial reports. We are the eyes and ears of our
audiences/readers; we must not be mere mouthpieces for industry,
government agencies, researchers or health care providers.
- Am J Bioeth, 2004 Fall;4(4):W9-13.
A statement of principles for health care journalists
- Website of Assoc. of Health Care Journalists

46. Every second spent reporting on
“new stuff” in health care is a
second not spent on helping
people understand:
• The social determinants of
health
• Affordable Care Organizations
• Medical homes
• Concepts they need to navigate
the health care system of this
era.

47. Health journalism ethics issues
• National Press Fdn. offers Pfizer-pfunded all expense paid trips to
workshops on issues affecting Pfizer’s product line.
• Retired S. Carolina newspaper columnist got his column back, now
sponsored by his new employer, local medical center.
• Many local TV stations air gee-whiz medical news that is actually
produced and written by the very hospital being touted.
• TV MD-“journalists” who report on themselves delivering care.
• Many radio news anchors solicit advertising and then read ads for
health care advertisers they solicited.
• Many magazine writers have told me they are ordered to avoid
certain topics or go soft on others so as not to offend advertisers.
Often in women’s magazines.

48. Read John Ioannidis to learn pitfalls
of a steady diet of journal stories
PLoS Med 2005; 2(8): e124

49. Journals complicit in miscommunication
• Editors of the HEART Group journals recently
stated that “inappropriate word choice to describe
results can lead to scientific inaccuracy.”
– J AM COLL CARDIOL, Vol. 60, No. 23, 2012
• “Are we making a mountain out of a mole hill? A
call to appropriate interpretation of clinical trials
and population-based studies”
– Am J Obstet Gynecol, published online 11/29/12
• “Spin and Boasting in Research Articles.”
- Commentary in Arch Pediatr Adolesc Med:
[published online October 2012]

50. Annals of Oncology: “Bias in reporting of end
points of efficacy and toxicity in randomized,
clinical trials for women with breast cancer”
(published online January 9, 2013)
Reuters: “Doctors relying on studies published in
top journals for guidance about how to treat
women with breast cancer may not be getting
the most accurate information.”

51. What the authors point out:
• “Investigators go overboard to make their
studies look positive.”
• In 2/3 of studies, that meant not listing
serious side effects in the abstract – which is
all many may read
• In 1/3 of studies, if the treatment didn’t work
as hoped, researchers reported results the
study was not designed to test – “secondary
endpoints”

52. September 2012
Positive “spin” was identified in about half of press releases and
news stories. The main factor associated with “spin” in press
releases was the presence of “spin” in the journal article abstract
conclusion.
In other words, a direct link from
published study news release news story
Readers/consumers/patients left behind in this food chain

53. Public Misunderstanding of Cancer Risk
• Studies have consistently shown people
overestimate their own risk of cancer
• Other studies show people overestimate risk
factors that have not been proven and
underestimate risk factors that are well-
established

54. “Unrealistic Optimism in Early-Phase Oncology
Trials”
People tended to overestimate the benefits of
the trial they were enrolled in and
underestimate its risks.
-- IRB: Ethics & Human Research 2011

55. Many cooks in this stew…
Editors wrote:
“Schwitzer's alarming report card of the trouble with medical news
stories is thus a wake-up call for all of us involved in disseminating
health research—researchers, academic institutions, journal
editors, reporters, and media organizations—to work
collaboratively to improve the standards of health reporting.”

56. We hold up a mirror to all who communicate about health care
• Are you guilty of infoxication?
• Are you helping people
navigate this confusing
system?
• Are you fostering an
environment of shared
decision-making between
patients and doctors?
• What kind of grades would
you get on our 10 criteria?
• If you don’t accept or agree
with our 10 criteria, what
criteria do you use?

57. First, do no harm
Including in the messages we convey

58. We must help people understand and
deal with the clash between:
• Science
• Evidence
• Data
• Recommendations for
entire population
• What we can prove
• Grasping uncertainty and
helping people apply
critical thinking to
decision-making issues
 Intuition
 Emotion
 Anecdote
 Decision-making by an
individual
 What we believe, wish, or hope
 Promoting false certainty
where it does not exist

59. Will this be our legacy as well?

60. Gary@HealthNewsReview.org
Thank you