ASNE seminar: Bad reporting contributes to broken health-care system
Eight editors convened in Boston last week for an ASNE seminar on health-care coverage sponsored by the Foundation for Informed Medical Decision Making. FIMDM's presenters argued that the U.S. health-care system “medicalizes” commonplace conditions and promotes the use of expensive treatments and new technology without regard to their cost or efficacy, and that the media shares blame for this broken system. (Their PowerPoint presentations are embedded as pdfs within this report.)
By Richard Karpel, ASNE executive director
The health-care system in the U.S. “medicalizes” commonplace conditions and promotes the use of expensive treatments and new technology without regard to their cost or efficacy. And policymakers, the health-care industry, and the news media share fault for this broken system.
That was the message heard by eight editors who convened in downtown Boston last week for a one-day seminar on health-care coverage organized by ASNE and the Foundation for Informed Medical Decision Making. FIMDM, a non-profit organization dedicated to ensuring that health-care decisions are made with the active participation of fully informed patients, sponsored the event and paid attendees' travel expenses.
According to FIMDM's presenters, the media is culpable because it reports too many stories focused on “breakthroughs” and “miracle cures,” indulges too often in light, feel-good, news-you-can-use features, and frequently publishes inaccurate, unbalanced stories that fail to ask the right questions or seek verification from independent sources.
The program began last Wednesday evening with a dinner and introductory presentation by FIMDM President Dr. Michael Barry, medical director of the John D. Stoeckle Center for Primary Care Innovation at the Massachusetts General Hospital, and professor of medicine at Harvard Medical School. Dr. Barry discussed the foundation's principles and history and identified some of the powerful forces at work with strong vested interests in prescribing specific treatment choices regardless of patients' needs.
The following day's program began with a presentation by Gary Schwitzer, publisher of HealthNewsReview.org a website funded by FIMDM that is devoted to improving the accuracy of news coverage of medical treatments, tests, products and procedures. Schwitzer, who worked in TV health/medical news for 15 years and taught health journalism and media ethics for nine years at the University of Minnesota, was one of the original organizers of the seminar, along with Milwaukee Journal Sentinel editor and ASNE past president Marty Kaiser. Schwitzer mounted a broad critique of health-news coverage and cited the media storm last year over the U.S. Preventative Services Task Force's recommendations regarding breast-cancer screening as the “worst, most biased coverage (he) has seen in 35 years” in the business. (Schwitzer also noted that HealthNewsReview.org no longer reviews TV health-care coverage because their work wasn't leading to any improvement.)
The remaining presenters each provided specific examples demonstrating how patients' interests weren't being served by the modern health-care system, and how the subversion was abetted by poor media coverage.
Dr. Barry returned to the podium to raise questions about whether men are truly informed about prostrate cancer screening and treatment decisions, and he noted evidence showing that such treatment often leads to poor outcomes for patients who were in little danger of dying from prostate cancer. He also described the conditions -- including recent news coverage -- that explain why the daVinci robotic procedure now accounts for approximately 80 percent of all prostate surgeries despite its increased expense and a lack of evidence that it works better than laparoscopic or other previously existing procedures.
Dr. Karen Carlson, director of Women's Health Associates at Mass General Hospital and assistant professor in medicine and deputy director of the Center of Excellence in Women's Health at Harvard Medical School, focused on disease-mongering in women's health issues. Dr. Carlson contended that pregnancy and menopause have been unnecessarily medicalized, and that news stories have reinforced the trend. Dr. Carlson also showed how MRI screenings for breast cancer produce too many “false positives,” which lead to unnecessary biopsies. She suggested that when reporting on the efficacy of specific treatments, journalists should always consider “the number of people that needed to be treated to save one life.”
Dr. Steven Atlas, assistant professor of medicine at Harvard Medical School, made a powerful presentation on the damage done by the medical community in the treatment of lower-back pain. According to Dr. Atlas, lower-back care is a field in which patients' expectations are high but doctors ability to cure the condition is limited -- an environment that begs for informed decision-making by patients but instead has led to widespread over-medicalization, which he demonstrated by citing the following.
- There are wide regional variations in the rates of spine fusion operations, the use of which are on the rise despite studies that show outcomes that are no better than nonsurgical treatments.
- Lower-back MRIs increased five-fold during a recent 10-year period despite a lack of evidence that they lead to better treatment.
- The use of narcotics to treat lower back pain doubled between 1997 and 2004 despite studies showing no benefit from their use.
- The incidence of vertobloplasty surgery is exploding even though there is no evidence that it works.
- Epidural steroid injections and facet injections recently increased over 500 percent, despite no evidence of long-term improvement from epidurals and strong evidence that facet injection doesn't work.
Studies also show that the incidence of chronic back pain has increased significantly in recent years, which Dr. Atlas believes has probably been caused by this litany of over-treatment.
Harold DeMonaco, the director of Innovation Support Center at Mass General, trained his sites on the explosion in the use of pharmaceuticals. According to Mr. DeMonaco, the number of drug prescriptions was up 50 percent in a recent 10-year period, while direct-to-consumer marketing is up four-fold. Meanwhile, prices have doubled at the same time that out-of-pocket costs are going down, indicating that health-care consumers are becoming economically disenfranchised from the decisions that are feeding the exponential growth in the use of pharmaceuticals. Dr. DeMonaco urged journalists covering the health-care system to move from hyperbole to understatement; to add context by framing medical studies and reports in light of longer-term developments; and to practice the same skepticism in their health-care reporting that they bring to bear in their coverage of other issues.
The editors in attendance -- four editors-in-chief and four section editors responsible for their news organizations' health-care coverage -- uniformly agreed that the seminar was a valuable and eye-opening experience, and that ASNE and FIMDM should look for other opportunities to work together in the future.