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Can You Trust What You Read In (Scientific and News)papers?
Ivan Oransky, MDExecutive Editor, Reuters HealthCo-Founder, Retraction Watch
@ivanoransky
University of Alabama, BirminghamJune 14, 2013
Put Down That Coffee!
Put Down That Coffee!
“Although the statistical association does not prove that coffee causes cancer, Dr. Brian MacMahon of Harvard, leader of the research group, said he stopped drinking coffee a few months ago when the results of the study became clear. In a telephone interview, he said that he would not presume to advise others.”
STUDY LINKS COFFEE USE TO PANCREAS CANCERNew York Times, March 12, 1981
Or Get A Refill
Or Get A Refill
''This otherwise excellent paper may be flawed in one critical way,'' said a letter from Dr. Steven Shedlofsky of the Veterans Administration Hospital in White River Junction, Vt. He questioned the comparison of pancreatic cancer patients with persons hospitalized for noncancerous diseases of the digestive system.
CRITICS SAY COFFEE STUDY WAS FLAWEDNew York Times, June 30, 1981
Or Get A Refill
“Such patients, he noted, might be expected to give up coffee drinking because of their illness. This, he argued, would tilt the proportion of coffee drinkers away from the ''control'' group who were being compared with the cancer patients. Amplifying the letter in an interview, Dr. Shedlofsky said many patients with digestive diseases give up coffee because they believe it aggravates their discomfort, and others do so because their doctors have advised them to.
CRITICS SAY COFFEE STUDY WAS FLAWEDNew York Times, June 30, 1981
We Cured Cancer 15 Years Ago
We Cured Cancer 15 Years Ago
“Within a year, if all goes well, the first cancer patient will be injected with two new drugs that can eradicate any type of cancer, with no obvious side effects and no drug resistance -- in mice.”
…
''Judah is going to cure cancer in two years,'' said Dr. James D. Watson, a Nobel laureate who directs the Cold Spring Harbor Laboratory, a cancer research center on Long Island. Dr. Watson said Dr. Folkman would be remembered along with scientists like Charles Darwin as someone who permanently altered civilization.”
The New York Times, May 3, 1998
Or Maybe We Didn’t. Here’s Why.The New York Times,February 11, 2013
Or Maybe We Didn’t. Here’s Why.
“The study’s findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.”
The New York Times, February 11, 2013
How Are The Media Doing?
How Are The Media Doing?
Schwitzer G. How do U.S. journalists cover treatments, tests, products, and procedures? An evaluation of 500 stories. PLoS Medicine 2008 doi:10.1371/journal.pmed.0050095
207 stories• 83 (40%) did not report benefits quantitatively
• 124 did, but- 103 (83%) reported relative benefits only, - 3 (2%) absolute benefits only, - 18 (15%) both absolute and relative benefits
• 98 (47%) mentioned potential harm to patients
• 63 (30%) mentioned costs
• 170 stories cited an expert or a scientific study- 85 (50%) cited at least one source with disclosed financial ties- 33 (39%) disclosed these ties
Moynihan R et al. Coverage by the news media of the benefits and risks of medications. N Engl J Med 2000; 342:1645-1650
How Are The Media Doing?
193 articles reporting at least one benefit or harm of a drug 100% mentioned at least one benefit 132 (68%) did not mention side effects or harms 119 (62%) did not quantify benefits or harms – Of 510 mentions of benefits and harms, only 120 (24%) gave quantitative
information– In 26% (31/120) the magnitude was presented in relative terms
37 (19%) articles reported only surrogate benefits 7 (4%) mentioned contraindications
61 (32%) mentioned drug costs, 89 (46%) mentioned drug alternatives30 (16%) mentioned nondrug options (such as exercise or diet)
Cassels A. Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ, April 29, 2003; 168 (9)
How Are The Media Doing?
193 articles reporting at least one benefit or harm of a drug
120 (62%) quoted at least one interviewee.
After exclusion of industry and government spokespeople, potential financial conflicts of interest were reported for only 5 of 164 interviewees (3%)
Of 57 articles covering studies, only 15 (26%) included information on study funding
Cassels A. Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ, April 29, 2003; 168 (9)
How Are The Media Doing?
Wells: “Newspapers over-represent support for screening mammography for ages 40 to 49”
Reports would have been improved by • Identification of all sources for information cited • Less reliance on relatively few sources • Discussion of benefits in absolute terms
Medical journalism may need standards similar to those used for reporting medical research
Wells J. Newspaper reporting of screening mammography. Ann Intern Med 2001;35:1029-1037.
How Are The Media Doing?
FDA message: Use of pediatric antidepressants is linked to a risk of suicidality (as opposed to suicide itself)
• Reported correctly in the vast majority of news stories, BUT• Other key health messages in FDA warning often missing• News stories more likely to include anecdotes of children harmed
versus children helped by antidepressants• Quoted experts more likely to emphasize benefits over risks
Coverage grew increasingly neutral over time, conveying neither the impression that the risks outweighed the benefits nor that benefits
outweighed the risks
Barry CL, Busch SH. News coverage of FDA warnings on pediatric antidepressant use and suicidality. Pediatrics 2010; 125:88-95.
How Are The Media Doing?
Why Is It So Bad?
In a national survey of U.S. health and medical journalists: • Nearly 70% had at least a bachelor’s degree• 19% reported having a master’s degree; • 4.5% had a doctorate; about 3% were M.D.s • Almost half had a degree in journalism• 13% had a degree in communications • 8% were ‘‘life sciences’’ majors
Viswanath K et al: Occupational practices and the making of health news: A national survey of U.S. health and medical science journalists. Journal of Health Communication 2008; 13:759–777.
Why Is It So Bad?
The ProblemFewer reporters are doing more stories, broadcasts, and blog posts
• Sites chasing a smaller number of advertising dollars
• Pressure to cover more and more, which places heavy reliance on journals and meetings
The Problem
Many health reporters feel it’s hard to find independent experts willing to assist journalists
They think editors need education in critical appraisal of medical news
Larrson A. Medical messages in the media--barriers and solutions to improving medical journalism. Health Expectations 2003;6:323-31.
The ProblemBarriers to improving medical journalism
• Lack of time, space and knowledge (the most common obstacles)
• Competition for space and audience
• Difficulties with terminology
• Problems finding and using sources
• Problems with editors and commercialism
Larrson A. Medical messages in the media--barriers and solutions to improving medical journalism. Health Expectations 2003;6:323-31.
But It’s Not Just JournalistsAcademic medical centers issue a mean of 49 press releases/year
Among 200 randomly selected releases
– 87 (44%) promoted animal or laboratory research, of which 64 (74%) explicitly claimed relevance to human health
– Among 95 releases about clinical research, 22 (23%) omitted study size and 32 (34%) failed to quantify results
– 113 releases promoted human research
• 17% promoted randomized trials or meta-analyses
• 40% reported on uncontrolled interventions, small samples (<30 participants), surrogate primary outcomes, or unpublished data—yet 58% lacked the relevant cautions
Woloshin S et al. Press releases by academic medical centers: not so academic? Ann Intern Med 2009;150:613-618
How Often Are Studies Wrong?
Retractions on the Rise
-The Wall Street Journal
How Often Are Medical Studies Wrong?
Positive Publication Bias
Positive Publication Bias
“The overall frequency of positive supports has grown by over 22% between 1990 and 2007, with significant differences between disciplines and countries.”
“…the strongest increase in positive results was observed in disciplines—like Clinical Medicine, Pharmacology & Toxicology, Molecular Biology”
Fanelli, Scientometrics 2012.
How Often Are Studies Wrong?
Ioannidis JPA. PLoS Med 2005; 2(8): e124
Let’s Work to Avoid This
