This article is about a panel at Health Journalism 2008.
Presentation:
Cancer Screening: The Clash between Intuition and Science, by Barnett Kramer, M.D., director, Office of Disease Prevention, National Institutes of Health
Panelists:
• Barnett Kramer, M.D., director, Office of Disease Prevention, National Institutes of Health
• Jeanne Lenzer, independent journalist, Kingston, N.Y.
• Moderator: Shannon Brownlee, Schwartz Senior Fellow, New America Foundation
By Joan Aragone
Independent Journalist
Unless they understand the context and technical language of the medical research they report on, journalists can misinterpret the data and get the story wrong.
That was the cautionary message from panelists Barnett S. Kramer M.D., director, Office of Disease Prevention, NIH, and independent journalist Jeanne Lenzer at the Saturday workshop "Lies, Damned Lies and Medical Statistics."
Kramer focused on the complexities of cancer screening. Lenzer examined "M'English," which she defined as "a phrase that has one meaning in plain language and an entirely different meaning to researchers, leading to utter confusion."
For Kramer, the notion that "early detection (cancer screening) saves lives" sometimes clashes with scientific evidence. "Cancer screening represents a clash between intuition and science," he said.
Confusion occurs because screening success is often reported in terms of survival rates. But "survival is not the same thing as mortality," Kramer said. "Survival means nothing if a screening is involved." He urged journalists to distinguish between survival and mortality.
When populations who are screened for cancer are compared with those who are not screened, the mortality rate may rise but mortality rates usually remain the same.
To understand what Kramer calls this "brain teaser," journalists need to consider biases that affect screening, such as selection of patients, leadtime and length of screening. Also important is comparison with a control group.
Dangers associated with screening include overdiagnosis and false positives, with consequent possible unnecessary treatment and costs to patients.
During the question and answer session, Kramer said that among widely used screenings, occult/blood, Pap smears for cervical cancer and mammograms for women age 50 and above are valuable.
For reference, Kramer recommended "PubMed," www.AHRQ.gov and www.Cancer.gov. (Click on "physicians data" under cancer topics.)
He is the author of "The Logic of Cancer Screening: The Clash of Medical Science and Intuition." AMWA Journal, Vol. 16, No. 4, 2001.
Lenzer cited a 2002 BMJ article on a treatment for stroke that led journalists to report that the treatment saved lives. Actually, she said, the treatment was potentially life-threatening, but the study was written in language she called confusing, leading to inaccurate reporting by journalists.
Among potentially misleading words or patterns she encouraged journalists to watch for are:
- "And," which can mean "and/or."
- "Endpoints," which may be combined or which may be overlooked in favor of less important ones.
- "May, " which could also mean ‘may not.'"
- "No problem, Bob," which occurs when researchers miss a problem because they were not looking for it.
She also urged reporters to check for funding sources for research.
Lenzer recommended www.HealthNewsReview.org for guidance on news reporting.
Panelists release list of independent medical experts
During Saturday's "Lies, damned lies and medical statistics: How to interpret the evidence," moderator Shannon Brownlee, Schwartz Senior Fellow at the New America Foundation, and independent journalist Jeanne Lenzer announced a new list of medical experts who have pledged that they are not receiving industry funding.
The 75 experts from eight nations have expertise across a wide range of disciplines. Each has pledged that he or she is not receiving industry funding or considerations – nor have they for at least the past five years.
The experts include: two former editors of the New England Journal of Medicine, the former editor of the Western Journal of Medicine, current editors of American Family Physician and Public Library of Science-Medicine; former FDA advisors; physician educators; researchers; bioethicists; epidemiologists, methodologists, geneticists, and clinicians from a various specialties; medical whistleblowers; and several medical journalists.
Brownlee and Lenzer released brief biographical sketches of some experts and promised to update the list on a quarterly basis to be released to journalists on request.
Contacts: Shannon Brownlee 443.994.6142 shannon.brownlee@comcast.net
Jeanne Lenzer, 845.207.3020 jeanne.lenzer@gmail.com
