Provide names of other journalists involved.
n/a
List date(s) this work was published or aired.
20-Apr-12
Provide a brief synopsis of the story or stories, including any significant findings.
My story parses the marketing campaign of a prominent New York doctor who wants everyone over 50 to have their gullets screened for cancer, though there’s no evidence that doing so saves people from a deadly malignancy. As the nation struggles to rein in its bloated healthcare bill, the risks and benefits of cancer screening have become a hot topic. More importantly, perhaps, it’s becoming clear that early detection is not always better — and may in fact be harmful, as we’ve seen with prostate cancer screening. While esophageal cancer screening isn’t routine at this point, the new campaign looked very much like a blueprint for the next prostate cancer debacle. Thanks to a procedure called transnasal esophagoscopy, or TNE, the screening test is now a cinch. One of the main driving forces behind the new campaign, Dr. Jonathan Aviv, told Reuters he believes he has saved a life every time he finds precancerous cells in a patient’s gullet. What he and his practice don’t advertise is that there are no data showing the test saves lives, that experts in the field believe routine screening for gullet cancer will cause significant harm and drive up healthcare costs, and that Aviv has massive conflicts of interest: He owns several thousand shares in the company whose screening technology he is touting and he has been a paid consultant to other companies that make or sell related equipment. Each time he screens a patient, a procedure that takes a couple minutes, his practice makes a few hundred dollars. That information deserves to be in the public domain before consumers are hit with what Aviv’s practice, ENT and Allergy Associates’, calls a “remarkable direct-to-consumer advertising campaign.” And before Aviv’s onetime colleague, Dr. Jamie Koufman, opens the doors to the 26 screening clinics she plans to set up across the US.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
This story started with a press release that sounded too good to be true. To get the science right, I went through guidelines from major medical societies as well as a lot of primary literature on the topic. I used Pubmed/MEDLINE to find relevant articles about the technology and esophageal cancer screening in general. I found some conflicts of interest for Dr. Aviv listed in scientific articles, but some only surfaced when I pressed him on his financial ties to manufacturers.
Explain types of human sources used.
The first thing I did after getting the press release was to contact a source at the U.S. Preventive Services Task Force. From there I interviewed doctors from various specialties, including Dr. Aviv and his partners, as well as PR people and companies involved in the marketing of the new technology. To understand what it’s like to be diagnosed with “precancerous cell changes,” I contacted a few patient support groups (the Association of Gastrointestinal Motility Disorders was particularly helpful). The people I talked to all told me pretty much the same story: It’s like having a ticking time bomb in your throat. That’s why some choose to have expensive preemptive treatments, such as burning off the lining of the esophagus.
Results:
I’m not aware of any concrete results of the report.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
None.
Advice to other journalists planning a similar story or project.
In a fee-for-service system, health providers don’t only think about their patients. They also think about money. Consider the question, cui bono? Does a given treatment or procedure benefit the patient, the doctor, the hospital? Conflicts of interest are common in medicine. While some are obvious, you might have to dig a little to find others. Arm yourself with the best, unbiased science you can find and ask tough questions, even when you’re talking to an expert in a topic you know little about. And never, ever trust a press release without fact checking it and getting at least one independent perspective first.