To be fair, at first glance, it did sound like a huge story.<\/p>\n
\u201cMetastatic Prostate Cancer Cases Skyrocket,\u201d proclaimed the press-release headline in July of 2016. New cases of an incurable form of prostate cancer rose a whopping 72 percent from 2004 to 2013, according to a study from the prestigious Northwestern University.<\/p>\n
The news headlines came fast and furious:<\/p>\n
\u201cMost Aggressive Form of Prostate Cancer on the Rise\u201d<\/p>\n
\u2014Newsweek<\/em><\/p>\n \u201cAdvanced Prostate Cancer Cases Soar\u201d<\/p>\n \u2014AARP<\/p>\n \u201cAdvanced Prostate Cancer on the Rise, Screening at Age 50 Key to Detection\u201d<\/p>\n \u2014Huffington Post<\/em><\/p>\n The shocking increase could be due to \u201clax\u201d screenings, the press release suggested. In recent years, various organizations, including the respected US Preventive Services Task Force (USPSTF), had relaxed their prostate-cancer screening guidelines, to some controversy. Was that the reason for the increase? Or perhaps prostate cancer, a disease that mostly affects men 50 and older, had become more aggressive.<\/p>\n Actually, what few reporters seemed to recognize was that there was a strong chance that neither factor was to blame\u2014because there may have been no cancer increase at all.<\/p>\n This prostate-cancer frenzy was the perfect storm that experts in health and science journalism warn of. From the press release to the articles, it was a meld of sensationalism, misunderstanding and lack of due diligence.<\/p>\n But it wasn\u2019t an anomaly. After all, news about research these days has become a running joke. Anything could kill you. Anything could be good for you. Think coffee is unhealthy? Just wait till tomorrow.<\/p>\n It\u2019s funny, until it isn\u2019t. Research on issues related to aging, in particular, helps shape our world. It affects medical guidelines, policy debates, social programs, even personal wellness decisions. To be accurately informed, people need to understand what the research really shows.<\/p>\n I\u2019ve worked as a health journalist for over a decade, with a specialty in aging for much of that time. I started out with an unusual educational leg up: my father, James Hubbard, a family doctor and writer, taught me key points about understanding studies. Yet I still struggled at first. Research papers were gobbledygook\u2014supposedly in English but impossible to make sense of.<\/p>\n Over the years, the studies haven\u2019t gotten simpler, but I\u2019ve gotten savvier\u2014not only as a journalist but as a research news consumer. You can too. After all, in the midst of all that sensationalism, sometimes studies do come out that you\u2019d actually benefit from knowing about. Deciphering which ones are likely worth a look just takes a little jargon know-how\u2014and a deeper understanding of how research and journalism really work.<\/p>\n From Misled to Misleading<\/strong><\/p>\n In the midst of the prostate-cancer frenzy, none other than Otis W. Brawley, MD, the American Cancer Society\u2019s chief medical officer, stepped in to stem the tide.<\/p>\n It\u2019s the rate that matters, not the raw numbers, he reminded the media through a statement on the ACS Pressroom Blog<\/em>. \u201cA rising number of cases can be due simply to a growing and aging population among other factors,\u201d his statement read. If the number of new cases per 100,000 men ages 50 to 69<\/em> had risen by 72 percent, that would have been news. \u201cIn addition, in this study, the rise [the researchers] detected began before USPSTF guidelines for screening changed,\u201d he wrote. <\/p>\n Brawley continued:<\/p>\n The issue of whether and how screening may affect deaths from prostate cancer in the US is an incredibly important one. This study and its promotion get us no closer to the answer, and in fact cloud the waters. We hope reporters understand that and use this study to ask another important question: can we allow ourselves to be seriously misled by active promotion of flawed data on important health matters?\u201d<\/p>\n His stinging question isn\u2019t new. The problem has been discussed\u2014by both researchers and journalists\u2014for decades. There are remedies. But in many ways, society has only gotten further from them. <\/p>\n Behind the Scenes in a Newsroom<\/strong><\/p>\n The quality of research reporting varies. Some is fantastic. Some is abysmal. But here\u2019s how such reporting is ideally done in my field, health journalism: a reporter reads the full study, paying particular attention to its limitations and weaknesses. She conducts interviews, including at least one with a researcher who isn\u2019t affiliated with the study and who provides objective opinion and overall context. If part of her job is to suggest headlines for her stories, she writes one that\u2019s not sensational or misleading.<\/p>\n But journalism doesn\u2019t live in an ideal world. So here\u2019s how health reporting is often done instead: the reporter interviews one of the lead researchers (maybe). She writes a compelling article based on that interview, the press release and the study abstract (summary). A click-worthy headline is added\u2014either by her or an editor\u2014and then it\u2019s on to the next story.<\/p>\n What happened? No time, no education in reading studies and lots of pressure to drive clicks.<\/p>\n \u201cThe people who are dedicated health reporters at a lot of the major media outlets have really been dramatically cut. Where there used to be 10, 20 people, now there are two,\u201d says Lisa Schwartz, MD, codirector of the Medicine in the Media program at the Dartmouth Institute for Health Policy and Clinical Practice.<\/p>\n Today\u2019s reporters\u2014on any beat\u2014are notoriously overworked. In addition, \u201ca lot of places have laid off staff like copy editors,\u201d says Liz Seegert, a freelance health journalist who\u2019s written for the Silver Century Foundation and is the topic leader on aging with the Association of Health Care Journalists. \u201cSo the checks and balances that used to be there have in many instances disappeared. In the rush to get published, you\u2019ve got to be your own fact-checker, you\u2019ve got to be your own editor.\u201d<\/p>\n Yet reporters are often not even trained to do their main job. Specialty training for the health beat isn\u2019t a big part of many university journalism programs, says Schwartz, who\u2019s also a professor of medicine at the Dartmouth Institute. And because of the shrinking newsrooms, these reporters often don\u2019t have so much as a mentor who\u2019s been there longer to help them along, she points out.<\/p>\n Therefore, many health journalists have had no training that would, for example, help them read that prostate cancer article\u2014whose second paragraph, by the way, begins as follows:<\/p>\n From the National Cancer Data Base (NCDB), all men diagnosed with adenocarcinoma of the prostate (International Classification of Diseases for Oncology histology codes 8550 and 8140) from 2004 through 2013 were included. Only patients with data available to risk stratify based on National Comprehensive Cancer Network (NCCN) guidelines were included (low risk: cT1cT2a, PSA <10\u2009ng\u2009ml\u22121<\/sup> and Gleason score <<\/u> 6; intermediate risk: cT2b\u2013T2c, PSA 10\u201320\u2009ng\u2009ml\u22121<\/sup> and Gleason score 7; high risk: cT3\u20134, PSA <<\/u> 20\u2009ng\u2009ml\u22121<\/sup> and Gleason score 8\u201310; metastatic cN1 or cM1).5<\/sup> <\/p>\n A press release is a lot easier to get through. So that\u2019s often what journalists depend on (perhaps along with the study abstract, a brief summary of the study that\u2019s published along with it). And some press releases do explain studies fairly. But many others exaggerate, misrepresent or worse. After all, publicists\u2014not to mention researchers and universities\u2014want those media hits.<\/p>\n \u201cThere are lots of self-interests that are served by getting great media coverage,\u201d Schwartz says. \u201cThat\u2019s part of how researchers advance their careers\u2014by showing that their research is important. It\u2019s also how institutions raise money. And part of that is to write a really exciting press release.\u201d<\/p>\n Add to all this the intense pressure on the reporter to draw an audience.<\/p>\n \u201cJournalists sometimes feel the need to play carnival barkers, hyping a story to draw attention to it,\u201d health policy journalist Susan Dentzer wrote in 2009 in an article for the New England Journal of Medicine <\/em>about the pitfalls of health care journalism. \u201cThis leads them to frame a story as new or different\u2014depicting study results as counterintuitive or a break from the past\u2014if they want it to be featured prominently or even accepted by an editor at all.\u201d<\/p>\n Not all reporters fall into these traps. Paula Span, who writes the New York Times<\/em> column The New Old Age, reads the studies even though she doesn\u2019t have a science background. She calls the researchers for help translating.<\/p>\n \u201cI find that most researchers are extremely glad to help out,\u201d she says. \u201cThey want their information to get a broader audience.\u201d If she\u2019s reporting on a controversial issue, she\u2019ll get opinions from researchers who weren\u2019t involved in the study, as well.<\/p>\n Span also does something that many media watchers wish journalists would do more often: she reports on studies that have negative results\u2014those that find no benefit to a treatment or supplement, for example.<\/p>\n Span, who\u2019s also the author of When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions<\/em> (2009), believes that studies with negative findings should be covered more often. \u201cWe are coming to learn how much overtesting and overtreatment there is of older people and how detrimental this can be to them. I\u2019ve written about a number of different studies that show no benefit to doing something.\u201d<\/p>\n How to Analyze Research Stories<\/strong><\/p>\n As the journalism, research and marketing worlds continue to sort all this out, the public still needs reliable information. So here\u2019s how to get it: learn to be research-media savvy. The first step is to watch for three telling things in a story: association, size and risk.<\/p>\n First: association.<\/strong> One of the most common problems in research reporting is that the difference between association and causation is not made clear, says James Hubbard, MD, my father, who, full disclosure, publishes a website I edit, TheSurvivalDoctor.com<\/a>.<\/p>\n For example, when an article says a particular fruit is \u201cassociated with\u201d or \u201clinked to\u201d a reduced risk of developing some disease, that does not necessarily mean the fruit caused the reduced risk.<\/p>\n Usually, for association studies like this, \u201cresearchers take a big group of people and ask some questions and then try to associate different illnesses with the people\u2019s habits,\u201d Hubbard says. \u201cThis gives the investigators something to be suspicious of. Then more specific studies that are much more accurate and precise are done.\u201d<\/p>\n For example, if a study finds that women who sip a nightly glass of red wine are less likely to get osteoporosis, maybe the wine reduced the risk. Or maybe the wine drinkers also tended to do yoga or eat dairy or do something else that was the true risk reducer. Further studies would be needed to find that out. Some studies that show association pan out; many don\u2019t.<\/p>\n With association studies, there\u2019s also often the question of which came first. For example, if older people with a positive attitude<\/a> tend to be healthier, perhaps positivity improved their health. On the other hand, maybe they feel positive because they\u2019re healthier.<\/p>\n Second: size.<\/strong> In general, bigger studies are better; smaller studies are preliminary. This is especially true of association studies, Hubbard says.<\/p>\n Stronger types of studies don\u2019t have to be as large to be impactful. One of the strongest types is the randomized, double-blind, placebo-controlled study. All those terms are good to know:<\/p>\n Third: risk.<\/strong> When a study finds that the risk for something has increased or decreased, consider what your risk was to begin with. The book Know Your Chances <\/em>(2008), available for free<\/a> at the PubMed Health website, which Schwartz co-wrote, explains it this way:<\/p>\n When someone tells you something like this\u2014\u201c42 percent fewer deaths\u201d\u2014the most important question to ask is \u201c42 percent fewer than what?\u201d Unless you know what number is being lowered by 42 percent, it\u2019s impossible to judge how big the change is.<\/p>\n Thinking about risk reduction is like deciding when to use a coupon at a store. Imagine that you have a coupon for 50 percent off any one purchase. You go to the store to buy a pack of gum, which costs 50 cents, and a large Thanksgiving turkey, which costs $35.00. Will you use the coupon for the gum or for the turkey? Most people would use the coupon for the turkey.<\/p>\n So far, you\u2019re watching out for association, size and risk. But there are a few other important things to consider:<\/p>\n These are some of the main points experts want you to understand when you\u2019re reading news stories about medical research. But if you want to delve deeper, check out the review criteria<\/a> from HealthNewsReview.org, which publishes critiques of health-news articles. They point out, for example, that the cost and possible harms of medical interventions are important to consider, not just the exciting positive possibilities.<\/p>\n HealthNewsReview.org also recommends a few websites to check out for reliable medical news<\/a>, including a couple of my favorites, MedPageToday<\/em><\/a>, which is written for health care professionals, and Kaiser Health News<\/em><\/a>.<\/p>\n Overall, health news tends to be hit-and-miss, according to the experts I spoke with. No one outlet was mentioned by everyone as a go-to for great medical news. Schwartz believes newspapers with health sections and with reporters dedicated to those sections tend to do a better job. Both Hubbard and Seegert say that even when you find a good source, you shouldn\u2019t trust them implicitly. \u201cEven the best stories and the best done studies can be skewed,\u201d Seegert says, \u201cso look at multiple sources.\u201d<\/p>\n Positively Percolating<\/strong><\/p>\n Despite all the problems in research-related journalism, there are some positive signs for older people concerned about health.<\/p>\n For one thing, even though the aging beat is \u201cnot seen as a magnet for advertising or political or market support from the editorial suites upstairs, it has stayed alive because it percolates up from the bottom of the newsroom,\u201d says Paul Kleyman, director of the Ethnic Elders Newsbeat at New America Media. Though corporate may not be pushing for stories on issues related to aging, reporters, editors and television producers continually encounter such issues in their own lives. \u201cI\u2019ve always felt that, like \u2018all politics are local,\u2019 \u2018all journalism is personal,\u2019\u201d Kleyman says.<\/p>\n Also, these days, a number of fellowship and training programs support journalism that\u2019s focused on aging or health. The Silver Century Foundation cosponsors one of them through a yearly grant to the Journalists in Aging Fellows Program, run by the Gerontological Society of America and New America Media. Seegert, the topic leader on aging with the Association of Health Care Journalists, was a fellow in 2015.<\/p>\n One of the most important things journalists learn from educational courses is when not to cover a study, says Schwartz, whose Medicine in the Media training program is, incidentally, on hold due to a halt in federal funding for it.<\/p>\n \u201cThere are lots of studies that help science to move forward but that are not ready for the public,\u201d she says. Sometimes, she\u2019ll get an email from a journalist who\u2019s proud to have fought to keep a study out of the news. \u201cThat prostate cancer study is a great example,\u201d she says, noting that, though many big outlets bit, a number of others didn\u2019t. \u201cWhen journalists take a stronger line about things that they feel aren\u2019t in the public\u2019s interest\u2014and argue to get those things out of the news\u2014they\u2019re doing an incredible public service.\u201d<\/p>\n When they don\u2019t, though, the public needn\u2019t be fooled. There are usually red flags galore; people just need to know how to recognize them.<\/p>\n","protected":false},"excerpt":{"rendered":" To be fair, at first glance, it did sound like a huge story.<\/p>\n \u201cMetastatic Prostate Cancer Cases Skyrocket,\u201d proclaimed the press-release headline in July of 2016. New cases of an incurable form of prostate cancer rose a whopping 72 percent from 2004 to 2013…<\/p>\n\n
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