Tuesday, October 27, 2009

American Cancer Society vs. The New York Times

This article also appears in odwyerpr.com.

Feud Adds to Public Confusion Over Cancer Screening
As if there isn’t already enough conflicting information about cancer screening, a tiff between The New York Times and the American Cancer Society – two trusted sources of information – have the public scratching its collective head. It’s another example of how the current state-of-the-art in diagnostics, conflicting medical points of view, and the way in which healthcare news is communicated can cause people to either run to or away from their physician.

Veteran healthcare reporter Gina Kolata reported that the ACS “is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.” Dr. Len Lichtenfeld, Deputy Chief Medical Officer of the ACS, writing in his blog, counters that it’s not true. He wrote, “The American Cancer Society is not working on any stealth project to change commentary on our website to emphasize the shortcomings and risks of screening.”

With a tone of exasperation, Dr. Lichtenfeld went on to write, “And here is another news bulletin for the press and the rest of the media: developing and accurately promoting guidelines are complex processes that don’t lend themselves to sound bite messaging.” So true. Cancer is incredibly complex and the screening tools are far from perfect. Yet, it was Dr. Lichtenfeld’s boss, Dr. Otis Brawley, who was quoted in the Times article. He said, “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages of screening have been exaggerated.”

What’s really going on here?

1. We have a gender gap. Much of the controversy boils down to the fact that prostate screening is less effective than breast cancer screening. It’s a message not very many men want to hear.

2. Cancer diagnostics are not created equally. In addition to some screening tests having greater predictive powers than others, they do not differentiate between tumor types that may be more or less aggressive. This has a big impact on which cancers to treat or just to observe.

3. The ACS needs to harmonize its message. A third ACS executive, CEO Dr. John Seffrin, has now weighed in on this story. He said, “we have long acknowledged that cancer screening isn’t perfect. Sometimes cancers get overlooked. Sometimes cancers get misdiagnosed. Sometimes aggressive cancers can appear even after a clear screening test. It is important to acknowledge these limitations, understand them, discuss them with your doctor, and decide what is right for you.”

4. Physicians need to find the right language. The pros and cons, the risks and benefits, if and when to treat – they all must be discussed. It takes time, and it takes some skill to understand their patient and their ability to understand and deal with the facts.

5. The public needs improved health literacy. A corollary to number 4 above is that the public simply does not have a good enough grasp of the scientific concepts or the ability to assess the risks or benefits. If The New York Times and the American Cancer Society can’t agree or somehow misunderstand each other, then what hope should the average citizen have of making heads or tails of all the possible screening and treatment options?

Let’s hope we can get back on the same page and deliver timely, accurate and understandable information on what is literally life and death information.

Between blog posts, you can follow me on Twitter.

Monday, October 19, 2009

A Healthcare Answer For Some But Not All

The Internet Is Another Health Disparity That Must Be Addressed If you ask your friends, relatives and colleagues if they’ve used the Internet to find healthcare information, I’d be willing to bet the answer would be yes. There’s no question that the Internet is an ever more important healthcare tool. The ability to capture and consolidate information into electronic medical records; search and share health and wellness resources, and enhance communications between professionals and patients are among the many benefits of the web. It’s OK to cheer but just not too loudly.

The problem is that our friends, relatives and colleagues aren’t everyone – not by a long shot. According to Neilsen Online, there’s a whopping 277,636,000 Internet users in the U.S. The flip side of this seemingly good news is that it leaves about 30 million Americans disconnected from the world wide web and, thus, unable to access important healthcare tools and information.

The web is no panacea, of course. You may have read some of my previous articles where I pointed out the problems of web-based healthcare information. Because there’s so much junk science reported and repeated in cyberspace, it can be a case of information doing more harm than good. Still, there’s a growing list of important applications that will not be available to all who could benefit from them.

Take Keas, for example, the new company that boasts Google Health and Microsoft HealthVault as partners. Keas seeks to marry personal data and health information to produce personalized health plans for individuals. Delivered right to your desktop or smart phone might be diet and exercise advice, an explanation of lab results, different treatment options or reminders to take a medication.

During the healthcare reform debates, we heard repeatedly that a key to lowering costs is to have a healthier nation and that this goal will only be possible if individuals take more responsibility for their health. While we could achieve a lot if plain old common sense was applied more often, tools like those being developed by Keas could play an important role in both learning about and managing one’s health.

If experts are telling us that things like electronic medical records, on-line health information and personalized health plans are important to healthcare reform efforts and our own personal well being then we need to be thinking about two kinds of health disparities: insurance coverage and Internet access. Creative, cost-effective ways to distribute computers and expand broadband access must take on new urgency. The benefits would be manifold.

And, access should include more than the ability to go on-line. Access is meaningless if one can’t interpret what one has found. Even for those with Internet connections, there’s an enormous deficit in health literacy that threatens the public health, such as sensationalized claims that lead people to take potentially dangerous alternative medicines or parents to refuse vaccinations for their children other than for legitimate medical reasons. If there’s any hope in increasing coverage and quality while containing (or even lowering) costs, more attention must be placed on expanding access to and understanding of healthcare information.

Between blog posts, you can follow me on Twitter.

Friday, October 9, 2009

Informed Dissent

H1N1 Vaccine is Here With Too Few Takers
Parents want the best for their children – happiness, success and good health. But nearly two-thirds plan on delaying or denying vaccinations against the H1N1 flu to their kids. It’s more than ironic to me, especially when so many complain about the lack of access to preventative care in this country.

Two similar polls just came out – one from the Associated Press-GfK and the other from Consumer Reports – that demonstrate that only about half of the U.S. population will be vaccinated. It’s not big news, though. This sort of result has been the unfortunate norm.

Why haven’t the numbers improved? Why are people so wary? Why are there so many who actively oppose vaccination? Is this just a case of people not being adequately informed? And, is this the government’s fault? The report published by the AP said that “The survey raises questions about government efforts to stem illnesses already spreading widely across the country.” I’m not quite sure what this statement is based on but my view is that the public-private partnership that has made millions of doses available is an impressive achievement.

So, allow me to briefly address some of the suspicions and concerns:

Flu isn’t all that serious. Influenza and pneumonia are the eighth leading cause of death in the U.S. (over 56 thousand annually).

It may be safe but I worry about side effects. Everything we do carries a risk. One must weigh the risk of injection site swelling and pain against contracting the flu with its potentially serious sequelae.

The vaccine hasn’t been adequately tested. Again, nothing is fool-proof, nothing is risk-free. FDA’s requirements for safety and effectiveness, however, are demanding. Moreover, the methodology for manufacturing the H1N1 vaccine is no different from other flu vaccines – vaccines that have an excellent safety record.

Vaccines can cause autism and other diseases. We may never know with 100 percent certainty but every credible study and review thus far (the most recent having been conducted by the Institute of Medicine) has concluded that there is no causative link.

I don’t think I/my children will get the flu. Sure, you might get lucky but why count on this wishful thinking? It has already been reported in 37 states – a much more rapid spread than in previous years.

I don’t trust it if the government is behind it. Fine, have a healthy skepticism but please don’t take it too far. Don’t undermine your health or the health of your family by listening to the fringe opinions of people like Rush Limbaugh who recently said that “All of this is designed to get people to respond to government orders, not to do things or to do things. It is designed to expand the role and power of governments and schools, and the media, of course, just falls right in line here with amplifying the nature of the crisis.” It's too bad there's no vaccine for paranoia.

If there are such good responses to these concerns, why aren’t people listening? Why aren’t people better informed?

My sense is that people are listening. They listen to and are informed by people that make sense to them. The CDC and NIAID have been all over the news with compelling information. About half of the country will act on what they heard. The other half will not be convinced. The message from anyone employed by or connected to these sources will not be trusted.

This is a barrier that will probably take a long time to breach. The ongoing outreach and education must continue while new efforts must be established to address the reasons why health messages bounce off of so many. Politics and conspiracy theories aside, elevating the public’s health and science literacy may give everyone a common ground from which to make their healthcare choices.
Between blog posts, you can follow me on Twitter.