April 23-24, 2012

Madison, WI

"Irrationally held truths may be more harmful than reasoned errors." -Thomas Huxley

Cheerleading, shibboleths and uncertainty

Consumer healthcare news may leave you wondering—where is my ticking time bomb? In a lump in my breast, colon or lung? And if you haven’t found anything yet, you may conclude it’s just a matter of not looking hard enough. Gary Schwitzer likens our fixation on cancer screening to a search for weapons of mass destruction, a fixation he diagnoses as a symptom of poor consumer healthcare coverage.

Schwitzer has more than 40 years of healthcare reporting experience to reflect on and for the last six years has taken healthcare journalists to task as publisher of HealthNewsReview.org. In his conference talk, “Cheerleading, Shibboleths and Uncertainty,” Schwitzer said journalists covering consumer healthcare have largely become cheerleaders, often advocating the aggressive use of expensive and new healthcare tests and technology, while ignoring or denying costs and harms.

“We’re giving people a kid in the candy store view of U.S. healthcare,” he said. “Seventy percent of the time, making things look terrific, risk free, without a price tag.”

In the last six years, HealthNewsReview.org has reviewed more than 1,700 consumer healthcare news stories that include a claim of efficacy or safety for a healthcare intervention. The organization rates stories based on ten criteria and the report card doesn’t look pretty. About 70 percent of the stories reviewed, for example, fail to address the intervention’s costs, quantify the benefits and harms or evaluate the quality of evidence presented in support of its use.

As an example of the “worst episode of public discussion of healthcare” he has seen, Schwitzer discussed the visceral media response to the U.S. Preventative Services Task Force’s 2009 revision of breast cancer screening. Revisions reducing the recommendations for screening were criticized as gender genocide.

“Throwing women under the bus, that’s what we heard,” he said.

Meanwhile, the potential costs and harms of aggressive screening were largely ignored. Schwitzer says many healthcare consumers incur unnecessary costs, anxieties and medical procedures due to aggressive cancer screening. Out of 1,000 women screened every year or two, for example, an estimated 50 to 200 experience at least one false alarm requiring a biopsy. The reduced risk, on the other hand, can be quite small and particularly for women under 50. Regular screening reduces the risk of dying from breast cancer from 3.5 to 3 out of 1,000 for a woman under 50.

Schwitzer argued that we shouldn’t tell anyone to be screened or not to be screened, but give them the facts and let them plug their own values into the decision.

“A hell of a lot of consumers believe that more is always better, that newer is always better, that screening tests always make sense for everybody,” he said.

He said too few stories are told of the people who received screening and then wished they had not. And too few consumers realize that in addition to finding a potential harm, screening can also raise unnecessary anxiety. While a blood screening test might seem like a harmless precaution against prostate cancer, for example, Schwitzer cautioned that it is unwise to take such a test without considering the downstream consequences.

“Once you kick off that cascade of events of a score, that’s a little high, you may wish that you could roll the carpet back again,” he said.

Schwitzer encourages journalists to ask questions like—how often do we need to screen? How long do we need to screen? And take an evidence-based consideration of both harms and benefits.

“To cherry pick and to deny the harms, and to only tell the state on benefits is an imbalanced presentation that harms people,” he said. “I would submit that we will never effect meaningful healthcare reform in this country, if we don’t improve the public dialogue about screening tests.”

By Patrice Kohl

2 thoughts on “Cheerleading, shibboleths and uncertainty

  • Gary Schwitzer says:

    Patrice,

    Good summary.

    One correction: we’ve “only” reviewed 1700 stories, not 17,000 – even though many days it feels like 17,000!

    Gary Schwitzer
    Publisher
    HealthNewsReview.org

  • simis says:

    Thanks for your comment, Gary. Correction made!

    Molly Simis
    Project Asstistant
    University Communication
    UW-Madison

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