NCCNFORT LAUDERDALE, FlaOver a billion people worldwide have the potential to view or listen to a CNN program at any given time, Dan Rutz, of the CNN Health and Medical Unit, said at a roundtable on how the media report advances in cancer. The discussion was held at the Fourth Annual Conference of the National Comprehensive Cancer Network (NCCN).
Of course, the number who actually tune in to CNN is smaller but still impressive. Each month, Mr. Rutz said, about 140 million people see a CNN program or at least a part of it. And as viewers of CNN know, a portion of the networks programming is devoted to medical news.
The NCCN panel focused on the medias medical reporting and how physicians can learn to better manage the process of disseminating research results to the public.
Dr. Lundberg on Alternative Medicine
When asked if the media give special treatment to reports on alternative or complementary medicine, Dr. George Lundberg, formerly editor of JAMA and now editor-in-chief of Medscape, replied that there is no alternative medicine; there is only medicine.
There is medicine that has been scientifically tested and found to work, he said. Use it, pay for it. There is medicine that has been scientifically tested and found not to work. Dont use it, dont pay for it. And there is medicine that has not yet been tested appropriately. If there is some kind of rational reason to test it, then test it.
Clifford Goodman, PhD, of The Lewin Group, a health care policy management consultant firm in Fairfax, Virginia, moderated the roundtable. He asked Mr. Rutz how CNN selects which medical reports to cover in its broadcasts.
Its governed many times by competitive pressure, Mr. Rutz replied. If everybody jumps on board with a story, we feel compelled to follow suit for competitive reasons. Mr. Rutz went on to say that such herd reporting is not personally satisfying because reporters would always like to have a scoop. But, in practice, we take a certain comfort in not sticking our necks out too far. We know that if were right, were all going to be right together; if were wrong, the blame can be spread around.
He said that the professional journals are an important source of ideas for stories, really a comforting source, because they are peer-reviewed. Most of the journals have gotten quite good at publicizing their reports, and this fits the model I just discussed. Everybody is going to have the same stories at the same time.
This is one of the downsides of the media embargoes that journals place on data until publication, Mr. Rutz said. The hype surrounding new medical ad-vances is fed by the embargo process, he said. It encourages the mass release of information, allowing stories of perhaps marginal significance to take on a life of their own.
Mr. Rutz added that the rise of the Internet as a source of public information may ultimately lessen reporters reliance on embargoed stories.
Human Interest vs Science
Genevieve Foley, RN, MSN, of St. Jude Childrens Research Hospital and editor-in-chief of Cancer Practice, the American Cancer Societys multidisciplinary journal, said that the media often focus on the human interest aspects of medical advances rather than the science.
She described the Chad Green case some 20 years ago at Mass General, for which she was the primary contact with the media. Chad was a 2-year-old boy with acute lymphocytic leukemia, she said. He was taken off his potentially curative cancer therapy by his parents for nutritional intervention. Mass General went to court for a Care and Protection order, which it was granted. The child remained physically with his parents, but the medical care was under the direction of the hospital. After a period of time, however, the family took the child to Tijuana for laetrile therapy, and Chad died in Mexico.
The media people who came to cover the story were, by and large, feature writers, not science writers, Ms. Foley said. We found ourselves caught between the compelling human interest story and the scientific story. People didnt know the facts about childhood leukemia. They knew so little at that time that they wondered why Mass General was bothering with a child who was doomed to die. And that just simply was not the case.
Dr. Goodman then asked Mr. Rutz if CNN uses specialized medical reporters, to ensure that the facts are presented and interpreted accurately.
He replied that because CNN is so large, it does use specialized reporters. But the human side of medical stories is always stressed, and I applaud that, he said. The anecdote provides a vehicle for explaining the science. It really is a matter of finding a balance and responsibly putting the two aspects together.
Joseph V. Simone, MD, medical director of the Huntsman Cancer Institute at the University of Utah, Salt Lake City, said that initially, as a clinical investigator, my attitude toward the press was suspicion, dread, and fear. But I learned that the press can be good at what it does. I learned that it can become a vehicle for us to convey to the public information that we could not possibly do on our own.
Dr. Simone said that pediatric oncology in particular needed the press in the 1960s, 70s, and into the 80s when rapid advances were being made in childhood leukemia and other cancers, a time when he was affiliated with St. Jude Childrens Research Hospital.
With our help, he said, the journalists who worked on science or medical issues became very knowledgeable. We could call them up and offer to discuss research results with them before the news release came out. So if you develop a good relationship with a reporter, you can get far better reporting.
In this case, Dr. Simone said, the lay medias reporting on advances in treating childhood leukemia may have helped spur its use. At that time, he said, colleagues in the field were criticizing St. Jude for saying that childhood leukemia could be cured. They said we were giving false hope to the public and causing trouble for local physicians because patients had read about the work at St. Jude and wanted information.
Breakthroughs vs Increments
Dr. Goodman next focused on the difference between the way oncology advances are often reported (as breakthroughs that can cure cancer) and how science really works (through incremental advances leading to new treatments).
Peter Angelos, MD, PhD, of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, said that scientists sort of chip away at the truth as they move toward understanding. But thats not generally the way scientific advances are portrayed.
The dilemma, he said, is that scientists want an educated public, but not all the information presented to the public is completely accurate. Patients know a lot more today; they participate in their decision making about care, and thats good. On the other hand, information about medical research is often presented to the public as sound bites that are too short to deal with the studys limitations or the caveats that would be found in the discussion section of a journal article.
George D. Lundberg, MD, former editor of JAMA and now editor-in-chief of Medscape, a leading medical information website, said that at all the conferences weve given at JAMA over the years for public media people, I have always emphasized, dont use the word breakthrough. Its a bad word. Wash out your mouth with soap if you use it because there are no breakthroughs. Mostly there is an incremental wearing away at some research problem.
Science grinds slowly, Dr. Lundberg said, right down to the final steppublication of findings. He noted that JAMA, for example, accepts only about 10% of the 4,000 unsolicited manuscripts it receives each year, and the time lag between acceptance and publication can be weeks or months, during which time the data are embargoed.
However, he cited what he considers a more harmful type of lag timethe lag from the time good research supporting a change in medical practice is published to the time doctors in general actually adopt it. Thats an important problem in terms of quality of care implementation in this country, he said, adding that use of regularly updated guidelines, such as those developed by the NCCN, will help speed implementation of cancer advances.
Mr. Rutz concluded by saying that the mass distribution of information is a messy business, but ultimately the public is best served by the broad distribution of information, even if some of it is inaccurate or poorly presented.