The Times and Anonymous Government Leakers

The anonymous source is one of the most overused crutches in journalism, whose use by a media outlet is usually justified by the public's right to know what its government is doing. So it went this morning when the New York Times's public editor Clark Hoyt explained away the panic caused by a July 10 article that relied on anonymous government sources: "U.S. Weighs Takeover of Two Mortgage Giants" (Fannie Mae and Freddie Mac), the headline read.

Public editor Clark Hoyt backs authors Stephen Labaton and Steven Weisman, who used the usual justification. They told him they relied on anonymous sources because it was necessary to get "information to the public about what government officials are considering doing with the public's tax dollars." And then Hoyt added, "That is what I think too."

Then he goes on to quote bank analyst Richard X. Bove of the brokerage house Ladenburg Thalmann. The story "clearly affected the market, but it was correct."

Er, the article wasn't correct. Subsequent comments by Federal Reserve Bank and Treasury officials said the government never considered taking over Fannie Mae and Freddie Mac. The Wall Street Journal story of the previous day (July 10), which spurred the Times to try to one-up their rival given they were a day late on the story, in fact went to great lengths to explain that the government was primarily concerned about ensuring Fannie and Freddie's continued access to debt markets. If that faltered, it could bring the entire world financial system to its knees.

There is, of course, always contingency planning at the Fed and Treasury for worst case scenarios, just as there is at the Pentagon. But the clear implication of the language of the July 11 Times story was that such plans were being actively considered.

So who is this Bove whom the Times' public editor used to defend the paper's use of anonymous sources that were subsequently proved wrong? Public editor Hoyt also uses him to back the paper's more sensitive coverage of the downfall of San Francisco's IndyMac, whose demise threatened to trigger widespread depositor panic at small banks all across the country. Commenting on a list of banks in trouble that was published on the St. Petersburg Times website, Bove said such lists run the danger of "frightening the public about the soundness of the banking system when it's unnecessary to do so."

So, panic over Fannie and Freddie is okay, but panic over small and medium-sized banks who aren't too big to fail is a sin.

Too bad that Hoyt didn't publish some of Bove's other ideas, which appeared in this Associated Press article over the weekend. Here's what Bove of Ladenburg Thalmann would like to see happen to Fannie and Freddie:

The government (should) create a new agency to buy both Fannie Mae and Freddie Mac, and then distribute their holdings to 12 government-created banks around the country. Those regional banks would be owned by thousands of local lenders, much like the 8,100 member Federal Home Loan Bank system, which also provides money for mortgage lending. The federal government would set standards for loans made under the new system.

This would, of course, wipe out the equity in Fannie and Freddie stock that is held by tens of millions of retirement accounts across the country. It would transfer that equity at no or low cost to small and medium-sized banks, many of which are suffering because they are dependent on lending to their local real estate markets and local builders, whose business has collapsed. Many may also be holding sub-prime mortgages on their books.

So, the only thing I need to know now is whether Ladenburg Thalmann, which acts as a brokerage and investment adviser for wealthy investors, has put many of its clients into the stocks of those regional banks.

Alas, the public editor of the New York Times didn't see fit to report whether his sole source had any conflicts of interest that ought to be taken into account by readers. Perhaps there are none. Perhaps the only statement that was needed, and one that would have bolstered the veracity of his explanation for the paper's earlier use of anonymous government sources, was one that assured readers that Bove's employer has no financial interest in the fate of small- and medium-sized bank stocks across the country, banks whose balance sheets might be bolstered by getting the profitable book of business now held by Fannie Mae and Freddie Mac (you know, the book of business that represents the 98 percent of Americans who are paying their mortgage on time; at last glance, the number of loans in foreclosure has gone from about .75 percent to 1.5 percent in the past year).

But we didn't get such disclosure. Instead, what we have is a public editor -- whose job is to highlight improper journalistic techniques -- using what appears to be conflicted sources to justify the use of anonymous sources.

Perhaps he should look for another line of work.

"What's The Matter With Kansas" Author Rocks

The hallmark of a great columnist is great reporting. Whatever one thinks about Rupert Murdoch taking over the Wall Street Journal, adding Thomas Frank, editor of The Baffler magazine and author of "What's The Matter With Kansas", as leftwing ballast to that paper's usual roster of rightwing crank columnists was inspired. Read today's column on Charlie Black, one of John McCain's top advisers, to see what I mean. Here's a small taste:

During the Reagan years, the Department of Housing and Urban Development allegedly began steering contracts to clients of political favorites; one gang thus favored was Mr. Black's firm, and in particular, Mr. Black's partner, Paul Manafort. The firm took in over $300,000 lobbying HUD for funds, some of it to rehab a New Jersey housing development that, according to the Boston Globe, "New Jersey officials said they did not want and was a waste of taxpayers money." Allegations also flew about Mr. Black's own role in the HUD scandal, but no wrongdoing was ever proven in court. Mr. Manafort, for his part, became a principal in a lobbying firm headed until recently by Rick Davis, John McCain's campaign manager.

There's also some juicy tidbits about Black's early days in Young Americans for Freedom, where, at their 1971 convention, they lifted their voices in unison to sing a fascist Spanish anthem.

Health Wonk Review

A new one is up at Jason Shafrin's Healthcare Economist website. Check it out!

Huffington's Post

I went to hear Arianna Huffington speak Monday evening, shortly before she made news by claiming in an online column that presumptive Republican nominee John McCain told her shortly after the 2000 election that he hadn't voted for George W. Bush. McCain promptly denied the charge. Given his obvious taste for good looking women twenty years his junior, it isn't hard for me to believe both of them are telling the truth.

But I digress. My real purpose in attending a signing event for her new book, "Right Is Wrong," was to talk about journalism. Her three-year-old online site, The Huffington Post, now has over a half million unique visitors daily. It recently surpassed the Drudge Report in traffic, is chock full of ads (and profitable), and recently began hiring real, full-time journalists.

All well and good. I'm all for entrepreneurial success in journalism, especially when the proprietor isn't Rupert Murdoch.

In her talk, Huffington lashed out at the mainstream press, who "act as if there is no such thing as truth and are more interested in cozying up to those in power than in holding them accountable." Though a frequent guest on talking-head TV, she dismissed the limited reach of cable television's endless chatter. "We have our own platform now," she said, pointing to the success of her own site, Talking Points Memo, Daily Kos and other stars of the leftwing blogosphere firmament.

But add it all up and what do you get? There's maybe 200 jobs that have been created by all the online political ferment on the left. Most of her site is made up of blogs like this one, created by people who have other, full-time jobs who get nothing for their effort. She herself is independently wealthy.

Meanwhile, in the real world of MSM (mainstream media), the Bureau of Labor Statistics will report on its annual job survey later this week. It measures the number of people in each job category. The number out Friday will be for May 2007.

Before going over to hear Huffington speak, I looked up the number of "reporters, correspondents and editors" in the U.S. in May 2006. The total came to a shade under 160,000. In May 2001, the total was a shade under 170,000. Given the accelerating job losses of the past two years, I suspect the total reported later this week will be around 150,000 and the actual number now well below that.

The point is: What will happen when there's no one left in the hated MSM to write the primary dispatches (like that wire copy) that tell us news consumers what's actually happening in the world and gives the endless army of pundits fodder for their commentary? It's great that a tabloid-style news outlet like the Huffington Post can blast away day after day about the Bush administration seeding television news shows with former military men still on the Pentagon payroll. But it took a team of investigative reporters at the New York Times a year to unearth and document that story.

Her response was somewhat heartening. A new round of venture capital financing will allow the Huffington Post to expand its reporting staff. They are forging deals with non-profit investigative outlets like the American News Project and angel-investor-funded start-ups like The Washington Independent, a feisty new voice in the nation's capital edited by Los Angeles Times veteran Allison Silver. The non-profit Center for Public Integrity, started by Chuck Lewis and run now by NPR veteran Bill Buzenberg, is still doing its thing and ProPublica run by former Wall Street Journal editor Paul Steiger has been on a hiring spree. It plans to grow to, gulp, 25 full-time journalists. The Kaiser Family Foundation is about to launch its own primary news service to cover health care issues.

What is most notable about all this activity is that it is non-profit and primarily funded by foundations. Many of these benefactors have agendas. There's nothing wrong with that in and of itself. Most of these new non-profit outlets have gone to great lengths to ensure that there is the same separation between funders and news managers that the MSM always claimed to have between advertisers and its news managers (I say "claimed" because I could tell some hair-raising stories about stories I had spiked because they would have alienated advertisers.)

But will benefactors lose interest? The economics of that model ultimately creates an environment where the primary audience for reporters and editors is their funder, not the public. I have seen this dynamic at work in the non-profit world.

I hope Huffington is economically successful with her online venture and hires a thousand journalists. It will prove that there really is an economy behind the New Economy.

I spent most of my work life in the private sector. In the end, I believe there really is something to be said for creating a product that meets a marketplace test, and that includes the written, broadcast and online word. I suspect the general public will always be somewhat skeptical about journalism that depends on the kindness of strangers.

McCain on Job Training

So this morning I'm listening to NPR and hear a single soundbite from Sen. John McCain amid all the back-and-forth on the Pennsylvania outcome. It was compelling. He wouldn't promise to bring back the steel mills in Pennsylvania, just like he wouldn't promise to bring back the textile mills in South Carolina (I'm paraphrasing here because I didn't have a pen available to write down the exact quote). But he'd make sure that every displaced worker had access to education and training for the jobs of the future, not the jobs of the past.

So honest. So forward-looking. So, dare we say it, compassionate.

Here's John McCain's record on job training:

* In 2002, McCain voted to kill an amendment requiring the Labor Department to establish a pilot program providing low-interest loans to workers in job training or job assistance programs that would enable displaced workers to continue making their mortgage payments.

* In 2007, McCain said "he would reallocate money spent on existing retraining programs to help pay for his proposal" to create a wage insurance system for laid-off workers, according to the Detroit Free Press.

* In March of this year, McCain skipped a vote on a worker training program, which would specifically "improve the training of manufacturing workers." McCain instead attended a $1,000-a-plate fundraiser in Philadelphia.

In 2000, a Republican candidate running for president told the American people he was a "compassionate conservative" while offering private assurances to religious bigots and economic royalists that he was really one of them. Once in office, it was his private assurances, not his public utterances, that really mattered.

Alas, with the help of the press, it looks like it's going to be "fool me once, fool me every time" from the misnamed "straight talk express." It took me five minutes on the Internet to get the counterfactual from the AFL-CIO and Democratic National Campaign Committee websites (admittedly biased sources, but they referenced the specific votes in Congress). And, anyway, isn't it journalists' jobs to get the other side of fact-based questions, and not rely on campaign-style he said/she said?

JAMA May Penalize Authors Who Hide Corporate Ties

Last week, the Journal of the American Medical Association ran two studies that showed the medical publishing industry has been played like a fiddle by the drug industry. The first revealed that Merck had employed ghost-writers on dozens of published Vioxx studies. A second alleged that a company-funded review of studies involving Alzheimer's and dementia patients had manipulated data to hide the drug’s dangers.

In an accompanying editorial, the editors of JAMA called for steeper penalties on authors who fail to disclose conflicts of interest, hide or manipulate data, or claim to have done work actually done by others. The proposed penalties ranged from requiring public letters of apology to a ban on publishing in the journal.

“When integrity in medical science or practice is impugned or threatened—such as by the influence of industry—patients, clinicians, and researchers are all at risk for harm, and public trust in research is jeopardized,” editor-in-chief Catherine DeAngelis and deputy editor Phil Fontanarosa wrote.

That editorial marks a hardening of attitudes by some journal editors toward repeated failures by scientists to reveal their financial ties to industry. In August 2006, DeAngelis rejected a ban on authors who failed to disclose conflicts of interest, claiming authors would simply seek out other journals. “It cleans our house by messing others,” she wrote then. The shift came just a few weeks after JAMA published corrections involving radiologists who failed to disclose their lung cancer screening study had been funded by the tobacco industry.

Notably absent so far from the debate is the New England Journal of Medicine, which got caught in another scandal last week (it also had not disclosed the tobacco-lung cancer screening connection). This one, revealed in the Wall Street Journal, involved an author of an article claiming tanning improved vitamin D uptake who failed to disclose his ties to the tanning industry trade group.

Portions of this item first appeared in Integrity in Science Watch, a publication of the Center for Science in the Public Interest.

Journalists Slam ABC Debate Tactics

The following open letter was posted on The Nation's website this afternoon. I'm a signatory to the letter:

We, the undersigned, deplore the conduct of ABC's George Stephanopoulos and Charles Gibson at the Democratic Presidential debate on April 16. The debate was a revolting descent into tabloid journalism and a gross disservice to Americans concerned about the great issues facing the nation and the world. This is not the first Democratic or Republican presidential debate to emphasize gotcha questions over real discussion. However, it is, so far, the worst.

For 53 minutes, we heard no question about public policy from either moderator. ABC seemed less interested in provoking serious discussion than in trying to generate cheap shot sound-bites for later rebroadcast. The questions asked by Mr. Stephanopoulos and Mr. Gibson were a disgrace, and the subsequent attempts to justify them by claiming that they reflect citizens' interest are an insult to the intelligence of those citizens and ABC's viewers. Many thousands of those viewers have already written to ABC to express their outrage.

The moderators' occasional later forays into substance were nearly as bad. Mr. Gibson's claim that the government can raise revenues by cutting capital gains tax is grossly at odds with what taxation experts believe. Both candidates tried, repeatedly, to bring debate back to the real problems faced by ordinary Americans. Neither moderator allowed them to do this.

We're at a crucial moment in our country's history, facing war, a terrorism threat, recession, and a range of big domestic challenges. Large majorities of our fellow Americans tell pollsters they're deeply worried about the country's direction. In such a context, journalists moderating a debate--who are, after all, entrusted with free public airwaves--have a particular responsibility to push and engage the candidates in serious debate about these matters. Tough, probing questions on these issues clearly serve the public interest. Demands that candidates make pledges about a future no one can predict or excessive emphasis on tangential "character" issues do not. This applies to candidates of both parties.

Neither Mr. Gibson nor Mr. Stephanopoulos lived up to these responsibilities. In the words of Tom Shales of the Washington Post, Mr. Gibson and Mr. Stephanopoulos turned in "shoddy, despicable performances." As Greg Mitchell of Editor and Publisher describes it, the debate was a "travesty." We hope that the public uproar over ABC's miserable showing will encourage a return to serious journalism in debates between the Democratic and Republican nominees this fall. Anything less would be a betrayal of the basic responsibilities that journalists owe to their public.

Spencer Ackerman, The Washington Independent
Eric Alterman, City University of New York
Dean Baker, The American Prospect Online
Steven Benen, The Carpetbagger Report
Julie Bergman Sender, Balcony Films
Ari Berman, The Nation
Brian Beutler, The Media Consortium
Michael Berube, Crooked Timber, the University of Pennsylvania
Joel Bleifuss, In These Times
Sam Boyd, The American Prospect
Lakshmi Chaudry, In These Times
Joe Conason, Journalist and Author
Brad DeLong, Brad DeLong's Semi-Daily Journal and UC Berkeley
Kevin Drum, The Washington Monthly
Henry Farrell, Crooked Timber, George Washington University
James Galbraith, University of Texas at Austin
Todd Gitlin, Columbia University, TPM Cafe
Merrill Goozner (formerly Chicago Tribune)
Ilan Goldenberg, The National Security Network
Robert Greenwald, Brave New Films
Christopher Hayes, The Nation
Don Hazen, Alternet
Michael Kazin, Georgetown University
Ed Kilgore, The Democratic Strategist
Richard Kim, The Nation
Ezra Klein, The American Prospect
Mark Kleiman, UCLA/The Reality Based Community
Scott McLemee, Inside Higher Ed
Ari Melber, The Nation
Rick Perlstein, Campaign for America's Future
Katha Pollitt, The Nation
David Roberts, Grist
Thomas Schaller, Columnist, The Baltimore Sun
Mark Schmitt, The New America Foundation
Adele Stan, The Media Consortium
Jonathan Stein, Mother Jones Magazine
Mark Thoma, The Economist's View
Michael Tomasky, The Guardian
Cenk Uygur, The Young Turks
Tracy Van Slyke, The Media Consortium
Kai Wright, The Root

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Not His Day

From an article in today's Wall Street Journal on the fate of Newsweek, where over 100 editors and journalists (20 percent of staff) just took buyouts:

At a recent speech at Columbia University, (Newsweek editor Jon) Meacham delivered a blistering response after he asked who reads Newsweek and none of the 100-odd students in attendance raised their hands.

"It's an incredible frustration that I've got some of the most decent, hard-working, honest, passionate, straight-shooting, non-ideological people who just want to tell the damn truth, and how to get this past this image that we're just middlebrow, you know, a magazine that your grandparents get, or something, that's the challenge," Mr. Meacham said. "And I just don't know how to do it, so if you've got any ideas, tell me."

NEJM Confirms Tobacco Industry Funded Study

The New England Journal of Medicine in this morning's edition printed a correction from Drs. Claudia Henschke and David Yankelevitz of Weill-Cornell Medical School that admitted the tobacco giant Liggett & Myers funded their study claiming routine CT scans for smokers can cure 80 percent of lung cancer cases. The original article appeared in NEJM in October 2006 without that information.

In an accompanying editorial, the editors ask authors to reveal who funded their research (the industry funding in this case had been laundered through a non-profit beguilingly named the Foundation for Lung Cancer: Early Detection, Prevention and Treatment.

"As medical journal editors, we believe that it is important that the ultimate source of funding be made clear to the Journal's readers. Second, it is appropriate to ask whether a study on clinical outcomes in lung cancer should be directly underwritten in part by the tobacco industry. Given the enormous burden of smoking-related illness and the ongoing sale of cigarettes and other forms of tobacco, one might question the advisability of research entities accepting funding from tobacco companies except through the American Legacy Foundation, which distributes funds received through the Master Settlement Agreement with U.S. tobacco companies.

"We believe that it is important for our readers and the entire biomedical community to be aware of this situation. Our goal is that readers be fully informed about funding sources. It is the responsibility of authors to disclose fully and appropriately the sources of funding of their studies. We expect that authors will be particularly attentive to transparency in reporting if a funding entity has a vested interest in the outcome. The public's trust in biomedical research depends on it."

Unfortunately, the editors made no mention of another correction from the same article that was also printed in the NEJM this morning. The correction stated that the Henschke-Yankelevitz article should have disclosed their patent on a technique for reading films from CT lung scans, which is held by their university and generates royalties from General Electric.

A few weeks ago, the editors told the Center for Science in the Public Interest and the Cancer Letter that the patent wasn't "relevant" to the original research article and therefore needn't be disclosed. Are they now saying that a patent must be generating royalties before it becomes relevant? Isn't it possible that a scientist holding a patent might want to get something published in the literature that would make some company interested in licensing that patent? Isn't that a conflict of interest that should be disclosed? The editorial's conspicuous silence on this point is disturbing.

"Unnatural Causes" on PBS -- Must See Television

Your local PBS station starting Thursday night and running for the next four weeks will air one of the most significant documentaries on health-related issues to come along in a long time. It's called "Unnatural Causes," and was produced by California Newsreel. Here's the blurb from their website:

UNNATURAL CAUSES sounds the alarm about the extent of our alarming socio-economic and racial inequities in health—and searches for their root causes. But those causes are not what we might expect. While we pour more and more money into drugs, dietary supplements and new medical technologies, UNNATURAL CAUSES crisscrosses the country investigating the findings that are shaking up conventional understanding of what really makes us healthy—or sick.

This is a story that implicates us all. We’re spending $2 trillion a year and rising on health care, more than twice per person than the average industrialized nation. Yet American life expectancy ranks 29th in the world, behind Jordan. Infant mortality? Cypress, Slovenia and Malta do better. One third of Americans are obese. Chronic illness now costs American businesses more than $1 trillion a year in lost productivity.

It turns out there’s much more to our health than bad habits, health care or unlucky genes. The social conditions in which we are born, live and work profoundly affect our well-being and longevity.

The four-hour series will be broadcast by PBS beginning March 27, 2008. It has been conceived as part of an ambitious communications and public engagement campaign conducted with leading public health, policy and community-based organizations. The campaign aims to use the series and companion materials to help reframe the national debate over health. It will suggest a new and hopeful approach to tackling health inequities, one that links our individual aspirations for better health not only to medical interventions but to social and economic justice.

Answer: Send the Editor into Space

This is a multiple-choice question pulled from the MCAT to get into the DeVry School of Newspaper Editing:

You're the page one editor of the world's leading financial newspaper. Your political editor comes to you with three story ideas to illustrate the ideas behind the candidacy of left-wing Cleveland Congressman Dennis Kucinich. You choose:

A) Single-Payer Swan Song. As the only candidate in the race championing a Canadian-style government-run health insurance system, this story uses the Kucinich candidacy to trace the declining fortunes of an idea that once commanded substantial political support within the Democratic Party.

B) Pax Americanus? Kucinich is in good company when he proposes a cabinet-level Peace Department to promote a reduction in global hostilities. Even George Washington thought it was a good idea for the newborn nation. This story looks at how a Peace Department might work.

C) What Kucinich Saw. This story, based on exclusive interviews with Kucinich's companions at Shirley MacLaine's mountain hideaway a quarter century ago where he saw a flying saucer, gives voters a behind-the-scene blow-by-blow account of the wacky Congressman's close encounters of a third kind.

Correct Answer: The wise editor ever attuned to readers' needs would, like the editors of today's Wall Street Journal, choose C.

Health Wonk Review -- Latest Edition

The latest edition of the Health Wonk Review is up at David Harlow's HealthBlawg. Check it out, if for no other reason that to see that he featured my latest musings at the top! But seriously, this biweekly effort by a rotating group of prominent health care bloggers is an excellent way to find new and interesting sources of information on the web.

How the Media Covers Health Care

Reprinted from the Health Beat blog by Maggie Mahar

Sometimes health care reporters remind me of the financial journalists who helped hype the bull market of the 1980s and 1990s. I began my career as a journalist at Money magazine, and I remember sitting in an editorial meeting where we talked about an upcoming cover story: “The Ten Best Mutual Funds NOW.” One intrepid reporter asked: “What if there aren’t ten great mutual funds that you really should invest in right now?”

“Let the fact-checker worry about that,” someone else quipped, referring to the person who would be double-checking the details of the story just before it went to press. Almost everyone sitting around the table laughed.

And Money was generally a pretty responsible magazine that tried to warn investors against the risks of the market. Still, “good news” cover stories sold magazines—just as “breakthrough” medical stories on the local evening news keep viewers from changing the channel.

Gary Schwitzer, an associate professor in the School of Journalism and Mass Communication at the University of Minnesota, recently published a provocative piece about how the media covers health care in the American Editor. Schwitzer begins his piece by asking his reader to “Imagine a reporter filing a story from the Detroit Auto Show. She writes about one car maker’s hot new model as if it is the best thing since the ’57 Corvette. But in the excitement over the chrome and style, she doesn’t mention the cost of the new model, doesn’t compare it with other manufacturers’ offerings in the same class, and doesn’t mention anything about performance (fuel efficiency, handling, braking, safety issues, etc.)

“An editor would certainly raise questions about this kind of puffery.

“But over on the health care beat,” Schwitzer observes, “the majority of stories on new products, procedures, treatments and tests are published without including comparable information. Claims that would never be accepted unchallenged from a politician are accepted unquestioningly from physicians and researchers and company spokespersons.”

Schwitzer, who publishes HealthNewsReview.org, a website that grades health care news stories for accuracy, balance, and completeness, has evidence to back up his claim. Below I’ve re-posted some of his data on some 400 stories from almost 60 major news organizations (available at his website) to demonstrate how many health care stories “provide a kid-in-the-candy-store portrayal of the health care system that leaves readers with the impression that most products or procedures in health care are amazing, harmless and without a price tag”:

Percentage satisfactory for 10 criteria for 400 stories:

Did the story adequately discuss costs? 22%
Did the story quantify the potential benefits? 27%
Did the story quantify the potential harms? 32%
Did the story evaluate the quality of the evidence? 33%
Did the story compare the new idea with existing alternatives? 37%
Did the story have more than one source and look for potential conflicts of interest in sources? 55%
Did the story appear to rely on a news release? 63%
Did the story establish the availability of the test or treatment? 68%
Did the story commit “disease-mongering” – exaggerating the condition or medicalizing a normal state of health? 70%
Did the story establish the true novelty of the idea? 86%

Why aren’t journalists more skeptical when reporting on medical news? Because so many Americans want to believe that there is a cure for everything—and that every new drug, device, or surgical procedure that comes down the pike must be the product of sound scientific evidence. Otherwise, why would doctors recommend it? (Does anyone remember when half of the nation’s children had their tonsils removed?)

Dartmouth’s Dr. Jack Wennberg, who has spent nearly three decades researching waste in our medical system, calls this the theory of “Manifest Efficacy: everything we do is effective. And it’s not just doctors--patients want to believe in manifest efficacy, Wennberg adds, because “it places medicine closer to a religion than a science.”

Nevertheless, in recent years, medical reporting in some publications has become increasingly sophisticated. Take a look at Schwitzer’s personal website, Schwitzer health news blog, and you’ll find him spotlighting stories like these:

---CANCER RISK FROM OVERUSE OF CT SCANS

The Wall Street Journal reports on an article in this week's New England Journal of Medicine…
"Doctors are ordering too many unnecessary diagnostic CT scans, exposing their patients to potentially dangerous levels of radiation that could increase their risk of cancer, according to Columbia University researchers . . .

--DEBATE OVER VALUE AND MARKETING OF FERTILITY THERAPIES
The Wall Street Journal reports on questions being raised about genetic screening, egg freezing and other high-tech fertility therapies. Excerpt: "As medical science continues to churn out ever-more-sophisticated methods to treat infertility -- from egg freezing to genetic screening of embryos -- desperate would-be parents rush to embrace the latest techniques. But some fertility experts worry that procedures of limited benefit are unfairly raising patients' hopes.

--TROUBLING PATTERN OF BEHAVIOR BY PHARMACEUTICAL EXECUTIVES"

The Wall Street Journal reports:

"Over a period of several years, drug maker GlaxoSmithKline PLC was so concerned about a prominent physician's negative views of its diabetes drug that it engaged in a concerted effort to intimidate him and stifle his opinion, a report by the U.S. Senate Finance Committee found..."

What’s impressive is that the Wall Street Journal has been particularly brave about exposing what’s going on in our for-profit health care industry. One might expect a financial paper to praise health care companies that are making a killing—but instead, its reporters have honed in on how sometimes, the health care industry’s most touted products may be killing us.

For the Journal understands—perhaps better than other papers—that the health care industry’s for-profit corporations have one goal: to boost earnings. These companies don’t want to hurt their customers, and they certainly don’t want to wind up in court. But making sure that Americans receive the best care possible at the lowest possible price is not their job. That’s why somebody needs to be looking over their shoulder and asking questions. Ideally, that somebody would be the FDA. But if that isn’t happening, skeptical journalists can help. I just hope that new ownership won’t affect how The Wall Street Journal covers medical news.

First Circulation, Then the Ads

The downward spiral of print continues. Two weeks ago, the nation's papers reported a sharp downturn in circulation. Advertises are paying attention. From Dow Jones wires:

Advertising dollars spent on U.S. newspapers and their Web sites declined 7.4% in the third quarter to $11 billion, a further sign of a deteriorating trend in print publishing, the Newspaper Association of America said.

Spending for print ads in newspapers fell 9% from a year earlier to $10.1 billion, more than offsetting a 21% gain in dollars spent on Internet-based ads, the trade organization said. Online advertising now accounts for 7.1% of newspaper ad spending, up from 5.4% a year earlier.

Note to Readers

I added a blogroll to my website this week (see the left hand column) and am considering adding advertising. As many readers of GoozNews know, I spent many years in the news business. For me, it wasn't just a career choice. I am and continue to be a fervent believer in the role that independent news gathering plays in our society. It is crucial to any well-functioning democracy, and I cannot help but think that the decline of the quality of the mainstream press in recent years is in part responsible for the sorry state of our political and economic affairs.

The media's poor performance on issues ranging from Monica-gate to the War in Iraq can't be blamed entirely on its declining economic fortunes. But it sure didn't help. As newsroom budgets shrank, the longer-term, investigative projects that reporters like me used to specialize in were the first to go. Entire walks of life went uncovered, or became just one of three or four beats on beleaguered reporters' plates. Reporters without time or resources to follow a story become easy marks for spinmeisters and propagandists, and far too many fell into the trap of simply regurgitating without evaluation what they were told.

Will the press snap back with a change in administration? The inescapable fact is that the economic model that historically provided employment for the vast majority of reporters is this country is collapsing. Readers are migrating to free websites on the Internet (see this post from last week) in ever greater numbers, yet the jobs are not following them there.

Here's some job statistics I looked up this morning that you may find interesting:

A decade ago, newspapers employed 420,000 people. Today, that's down to 344,000, which includes a loss of 15,000 jobs in the past year alone.

Broadcasting employed 314,000 people in 1997 and employs 337,000 today. But the number of jobs in television and radio is still below its 2001 peak of 345,000.

And the Internet? In 1997 there were just 22,000 jobs in that sector, according to the Bureau of Labor Statistics. Now there are 45,000 jobs. That doubling is good news, but it still makes up for just one in three jobs lost in the newspaper industry, despite the huge profits and stock valuations of aggregators like Google and Yahoo.

As many of you know, for many years I have supplemented my regular jobs as a professor of journalism and, more recently, at the Center for Science in the Public Interest by doing freelance writing, some of which later (when contractual obligations allowed) appeared here. But that kind of work, like full-time work in the field, is getting harder to find. And what is available pays less than before as publishers pare their freelance budgets and/or take advantage of a desperate workforce.

In one sense, I am part of the problem. I don't want to break my arm patting myself on the back, but I like to think that the quality of the writing on this blog and, more importantly, its analysis offers real value to readers. Indeed, I have been pleasantly surprised to watch readership grow month after month almost without fail since I began a few years ago. This site now gets about 15,000 different individuals visiting each month, many of them multiple times. While that's nothing compared to major blogs that cover politics or culture, it is quite respectable for an independent site that focuses largely on health care.

But this is part of the problem. Newspapers, news magazines, and other general circulation periodicals were the aggregators of old. A million circulation newspaper was in reality a composite of audiences: a third of readers liked the news section, a third liked sports, there were sub-audiences for cultural coverage, business, health, and features. Now those sub-audiences have fragmented. They can create a home page or RSS feed that brings in a dozen sites that reflect their interests. Yet none of these aggregators hire journalists -- at least not yet.

Which brings me to a decision point. Unlike many of my competitors with health care-oriented blogs, I do not work for a think tank, work fulltime for a media outlet, or run a consulting business. I will always want to freelance for some publications. But allowing advertising on this site will enable me to devote more of my freelance time and energy to reporting pieces that will appear exclusively on this website. I'm leaning in that direction. What do you think?

Newspaper Circulation in Freefall

While a few newspapers bucked the trend, the downward spiral in newspaper readership continues unabated. This chart in today's New York Times says it all.

A few thoughts: The Wall Street Journal not only lost circulation, but more than half its circulation is now online and those paid subscribers (it's the only newspaper that makes readers buy its content on the web) are included in its total. So most Journal readers now are like me: they read it every day, but they read it only online.

The Los Angeles Times seems to have stopped its slide momentarily. That must be heartening to Jim O'Shea, its new editor, whom I once worked for. I congratuate him, and if it is anything other than blind luck, he ought to share his secrets with the world. Ditto for USA Today (How much of this circulation is real anyway? I'm at a hotel this morning, so I guess I'm included in the totals.).

As readers gravitate to the web, advertising in this medium is just a fraction of the lost advertising at the print editions. And as long as that's the case, the financial support for independent journalism will continue to erode. One of the major issues confronting our democracy in the next few years will be whether an independent, neutral source of news is worth having; and if it is, who will finance it.

Bancroft Family Folds

Murdoch Wins Bid For
Biggest Business
Broadsheet
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Remembering
'Rabbi Caught in
Sex-Slavery Ring'
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Editorial Page
Vows to Stay
Right Wing

The editorial pages are still the first thing I read in my morning Wall Street Journal. It gives us lesser mortals a portal for viewing the unvarnished id of America's ownership class.

For those of us who follow the drug and biotech industries, it's crucial. Those industries' executives and their think tank toadies have an unfettered pathway onto its pages. Today, for instance, an oncologist who made millions with one successful anti-cancer drug complains that the Food and Drug Administration has gotten too tough on new ones because it didn't give fast-track approval to a traditional chemo agent for prostate cancer -- a drug that couldn't win a single vote from a panel of independent outside experts last week.

Is there actually someone out there who thinks the 76-year-old Rupert Murdoch, creator and owner of Fox News and employer of Roger Ailes, would try to change that outlook? L. Gordon Crovitz, the Dow Jones publisher, assures us this morning that their readers and contributors can count on the paper remaining a bastion of anti-regulatory zealotry:

The nastiest attacks have come from our friends on the political left. They can't decide whose views they hate most -- ours, or Mr. Murdoch's. We're especially amused by those who say Mr. Murdoch might tug us to the political left. Don't count on it.

Contrary to the fears of many journalists in the paper's newsroom, I also don't think you'll see many changes in news coverage. If anything, he'll beef up political coverage in Washington, which, given the Journal's business focus, should increase the amount of news flowing from the nation's woefully undercovered regulatory agencies. That's a good thing.

Murdoch has learned a few things since he briefly owned the Chicago Sun-Times in the mid-1980s, which was his first foray into U.S. publishing. Columnist Mike Royko immediately quit and joined the Tribune, giving that newspaper, with its long history of right-wing conservatism and anti-unionism, an undeserved centrist image.

A few weeks into Murdoch's Sun-Times proprietorship, an ambitious editor inserted a wire story headlined "Rabbi caught in sex-slavery ring" deep inside the paper. Thousands of subscribers in the heavily Jewish north shore suburbs cancelled their subscriptions, starting that once great newspaper's long-term slide into irrelevance. Conrad Black merely finished what Murdoch started.

A few years later, Murdoch bought the struggling New York Post and transformed it into a right-wing rag. But it was a shell of a newspaper at the time, and his willingness to pour money into the project kept tabloid journalism alive in the one city in America that appears to have the stomach for it. I've always liked tabloid journalism myself -- in the 1950s we had two papers come into the house; my dad read the New York Times and my mom read the Daily News. Great sports. Great cheesecake. And Dick Tracy. What else could a young boy want?

But don't look for any tabloid-like transformations at the Journal, or even political meddling. The man is spending $5 billion. This is the journalistic equivalent of buying a trophy wife. Screw around too much with the merchandise and she'll leave you broke and broken-hearted.

He may end up broke anyway. This deal reminds me of the Tribune Co.'s decision to purchase Times-Mirror in 2000 -- also at the peak of a business cycle and at a hefty premium to then already-inflated stock market price. The only ones who made out on the deal were the ones who got out. The Tribune has taken a lot of heat for journalistic mismanagement, but that is merely a proxy complaint for the company's loyalty to the bottom line, which dictates layoffs and shrinkage to cope with declining advertising revenue.

Will Murdoch's Journal be able to escape a similar fate? Today's New York Times leads with a story suggesting that the advertising sales people who work for Murdoch are among the most aggressive in the business. The story had the smell of fear about it. Yet, while a broadsheet newspaper war would be fun to watch, the sad fact is that the two papers are fighting over a shrinking market. Ultimately, no one wins such a battle.

For me, the most interesting business question is whether Murdoch will follow through on his public musing about making the paper's website freely available. Right now, it is the most successful pay news site on the web. I am one of 900,000 people ponying up nearly $100 a year for the right to get web access to Journal coverage. Do the math: that's nearly $100 million. It's making money. Yet Murdoch thinks he can do better by getting "more eyeballs" via free circulation and selling advertising.

I think that would be a big mistake. Advertisers have always placed a higher value on paid circulation over freebies thrown up on peoples' lawns. It shows that readers place a value on the product. Why is the web any different?

The biggest strategic mistake newspapers made a decade ago was giving away their content for free. Now, aggregators like Google and Yahoo reap the advertising revenue by repackaging a product produced by someone else. What's going to happen when newspapers can no longer afford to produce that product? The aggregators will either have to repackage undigested public relations or get into the news business themselves. And, as was always true with freely-circulated papers, the incentives are all toward choosing the p.r. model.

As long as the Journal keeps its website a part of paid circulation, it is living proof that serious news journalism (as distinct from opinion) will survive the transition to the era of internet information distribution. Serious journalists needn't fear Murdoch's politics or his opinions. They should fear his business model.

Newspaper Industry Death Watch

As some of my readers know, I spent a quarter century in the news business (more if you include the time I spent throwing newspapers up on lawns as a kid). I started at age 19 in the composing room (when newspapers still had them) and had the privilege of working among some of the best in the profession while serving as a foreign and Washington-based correspondent. I care deeply about newspapers, and still read three or four every day.

So I couldn't help but notice the bad news on the business page today. Profits at the New York Times Co. and the Tribune Co. were down again. The Times is planning to triple its cost-cutting in the next two years, the report said. At the Tribune, according to the Wall Street Journal, publishing revenue dropped 9% to $920 million. Ad revenue fell 11%. Online revenue rose 17% to $66 million. Circulation revenue fell 6%."

Allow me to deconstruct those numbers a bit. The decline in ALL revenue was greater than ALL internet revenue combined. In other words, for every $8 decline in print revenue, the company picked up $1 in internet revenue.

We're at the peak of a business cycle (with many recessionary winds blowing, but that is another story). Advertising has always been a coincident indicator, in other words, it rises and falls in tandem with the overall economy. Advertising dollars are migrating away from print to the internet, broadcasting and other sources like direct mail. Companies like Google and Yahoo are rolling in cash.

But they hire very few journalists (if any). And those they do hire have very few standards. I had lunch yesterday with a former reporter trying to raise a little money to catch on at a univeresity (apparently the people who get teaching jobs now are the ones who can raise their own salaries, and pay a 50 percent kickback to the university).

She had done a bit of freelancing for a mainstream newspaper and an internet outlet. The former paid about 40 cents a word; the latter paid about 10 cents a word. I can remember earlier in this decade (when I was doing much more freelancing than I am now) that I could get $2 a word from some outlets, and $1 from unprofitable (usually non-profit political mags) ones. It appears that internet economy is collapsing payscales, too.

Which brings me to my final complaint of the morning. I get something called the Alternet in my in-box every day. It is a bunch of stories from a progressive point of view, many of them from well known names like Amy Goodman or Barbara Ehrenreich. But it also has a lot of young journalistic talent who are getting their initial training in the field by publishing on this site. All well and good.

But today's banner headline involved a shriek about how hedge-fund short-selling could lead to a great crash like 1929. With today's stock market acting kind of wobbly, and, as I mentioned earlier, a lot of signs that the economy may be heading south soon, I was intrigued. So I read it. The reporter quoted a few investors who had been burned by short-sellers (they operate their own websites, which disclosed that fact even though the reporter did not). He never called the Securities and Exchange Commission to get its comments on the systemic risk posed by hedge fund activities. He never called the Federal Reserve, which closely monitors and regulates capital markets for systemic risk threats, about its analysis of the situation. In short, no real reporting.

It is often said that our democracy cannot survive without a free press. But when the only information the new economy's free press provides is ill- or uninformed opinion, what kind of democracy will we have?

Cohn, LA Times on Moore

The New Republic's Jon Cohn reviews Michael Moore's "Sicko" here. Definitely worth reading, as are the dozens of comments, many from France that is a major point of comparison both in the film and the review. If nothing else, we're going to learn a lot about alternative health care delivery systems as the debate over health care insurance reform unfolds.

Meanwhile, a news story yesterday in the Los Angeles Times highlights the tension between the plans offered by leading Democratic Party presidential contenders and Moore's call for a single-payer national health insurance system. This story highlights another issue raised in the Cohn review: If Moore's film turns the debate over the failures of our own system into another endless argument over long lines in Canada or Cuba, we'll never get beyond the insurance debate to the really serious issue confronting America: the deteriorating condition of our children's health and the likelihood that for the first time in American history, the next generation may live shorter lives than the previous generation. A new study that comes out next week (still embargoed so I can't talk about it) will reveal some startling data along those lines.

We're Number 81!

eDrugSearch.com's HealthCare100.com ranks GoozNews number 81 among the world's top blogs on health and medicine. It's a fine site for finding all the health care comment you would ever want or need. For my money, the Cheerful Oncologist takes the prize for best-laugh-in-a-name blog.

Who's Number One? The musings of a London-based emergency medical technician, who writes daily about his ambulance runs. Fascinating reading at Random Acts of Reality.

My thanks to Jane Hiebert-White at the the Health Affairs Blog for pointing out the listing and the website!

Unspiked But Defanged

This is a jaw dropper. The latest issue of the New England Journal of Medicine includes a version of the Robert Steinbrook article on the overuse of Amgen's erythropoietin. Last week, the Wall Street Journal reported that the original story had been spiked. Steinbrook, who is a national correspondent for the NEJM, then submitted the original piece to the Lancet, which ran it on December 23.

Is it possible that the editors of NEJM were so ashamed by the Journal article that they decided to run the story? If so, they haven't done themselves any favors. I won't be the only reader who will compare the two versions. Every mention of corporate conflicts of interest, which was the major subtext of the Lancet article, is missing from the NEJM version. Specifically, this information about the relationship between the drug companies and the National Kidney Foundation, which issued the guidelines leading to greater use of Amgen's drug (and is responsible for higher mortality from increased heart attacks and strokes) is gone:

The National Kidney Foundation guidelines . . . have been questioned for their reliance on expert opinion and because of the close relations between the Foundation, the Kidney Disease Outcomes Quality Initiative (KDOQI) that formulates its recommendations, and the drug industry. In fiscal year 2005, according to its annual report, the Foundation received $19·7 million—57% of its total support—from various “corporate and organizational partners”. In calendar year 2005, it received $4·1 million from Amgen and $3·6 million from Ortho Biotech, a subsidiary of Johnson & Johnson, the current marketers of epoetin products in the USA. Amgen supported the development of the anaemia guidelines and is acknowledged as “the founding and principal sponsor of KDOQI”. Of the 18 members of the workgroup, two-thirds disclosed financial associations with Amgen or other epoetin manufacturers or marketers.

Are the financial relationships between the drug industry and physician-led, industry-dominated "patient advocacy" groups like NKF now subject non-grata at the NEJM?

NEJM Spiked Story Exposing NKF

We're take a break from our holiday break (I'm still reading the papers, of course; my thirst for a daily fix remains as strong today as when I took up the habit 45 years ago when I was 11 and began my first paper route) to point out an interesting story in today's Wall Street Journal. David Armstrong, who is turning the corporate takeover of medicine into an interesting beat, reports that the New England Journal of Medicine had originally commissioned Robert Steinbrook's story exposing Amgen's control of the National Kidney Foundation guidelines on anemia management.

You can see the Journal story here.

You can see my coverage of this story in real time (as the original stories appeared in NEJM and the Lancet, where Steinbrook's story eventually appeared, here, here, here and here.

Hope everyone is having a happy holidays. Back to the papers.

Robert Wilson and Breast Cancer

An interesting side note to today's big story in the New York Times, which reports that the sharp seven percent decline in breast cancer rates reported in 2003 was probably due to declining use of hormone replacement therapy. Robert Wilson, author of the book that stoked the movement to stay Forever Feminine, was receiving substantial financial assistance from Wyeth, the maker of the estrogen pills, while promoting his book and the drug's use.

Gina Kolata mentioned Wilson in her story this morning in the Times. But she didn't mention his well-documented background. That's unfortunate, because it would have educated the millions of women who will avidly read that story about a phenomenon that is still with us. If you read about a drug that is too good to be true, it probably is; and not only that, the guy touting it is probably on the take.

Upton Sinclair Speaks

Three alert readers sent me the reference to Upton Sinclair's original quote, which came from his memoir, "I, Candidate for Governor, and How I Got Licked," p. 109. University of California Press; New Ed edition (December 16, 1994). Hopefully, this photocopy of the page where the original quote appears will enlighten web readers for generations to come. The exact quote states: "It is difficult to get a man to understand something, when his salary depends on his not understanding it." . . .View image

Why Today's JAMA Editorial Doesn't Go Far Enough

The Journal of the American Medical Association has been making news lately, and not always for its publication of pathbreaking medical studies. After learning from readers about several incidents of failures by authors to disclose conflicts of interest, editor-in-chief Catherine DeAngelis tightened the journals disclosure rules and asked deans at the offending researchers’ institutions – including the famed Mayo Clinic College of Medicine – to beef up their ethics training.

Conflict-of-interest disclosure isn’t the only area where the editors at JAMA have felt compelled to tighten their oversight of researchers who work for for-profit firms. The editors also now require industry-funded studies to hire an independent outside data analyst to give its peer reviewers an extra layer of comfort with the presentation of information contained in articles submitted for publication.

In today’s issue of JAMA, Dr. DeAngelis offered a sober editorial summing up and defending her responses to the past year’s events (it was published online while I was on vacation). The “The Influence of Money on Medical Science,” contains some fascinating new revelations. Without naming names, she reported that some companies are insisting that their academic researchers avoid submitting studies to JAMA because of the rules requiring independent data analysis. One set of authors even withdrew their study and submitted it to another (unnamed) journal, which promptly published it and won “much media coverage” for its contents.

I’d like to know what study that was and where it appeared. Did those media reports reveal that it had been withdrawn from JAMA because its authors did not want to submit its data to independent analysis? Alas, she did not say.

DeAngelis also revealed that the dean of the Harvard Medical School, Joseph B. Martin, has informed her that he will send the 8,000 faculty members at that prestigious institution copies of JAMA’s new disclosure rules, as well as those from the New England Journal of Medicine. The three incidents of failures to disclose conflicts of interest to JAMA that made national headlines this year all involved HMS faculty.

But the editorial stopped short of breaking new ground. She once again rejected advice I offered two years ago, when a study I conducted for the Center for Science in the Public Interest pointed out that JAMA, like the three other journals studied, had a small but persistent pattern of authors failing to disclose their financial ties to firms with a stake in the outcome of the studies being published. That study recommended that journal editors ban authors from publishing for at least three years when such incidents are brought to their attention, as they often are, by readers. Here’s her latest response:

Leveling sanctions against an author who fails to disclose financial interests by banning publication of his or her articles for some time period would only encourage that author to send his or her articles to another journal; it cleans our house by messing others. So what about all editors, or at least a group, such as the International Committee of Medical Journal Editors, agreeing to share the information and jointly to ban the offending authors? Those who suggest this approach have not considered the risk of an antitrust suit.

This antitrust argument repeats comments she made to a reporter a few weeks ago. It's a red herring. I wrote a letter to the Times, which they chose not to publish. Here’s the argument.

If full disclosure of potential conflicts of interest is crucial to “ensuring that physicians and patients can properly interpret and more important trust, what they read” in journals, then isn’t failure to disclose conflicts of interest a form of scientific fraud? And don’t editors have a right to collectively protect themselves against fraud?

She says that getting academic deans to “intervene” with mandatory ethics training is a more effective method of sensitizing industry-paid researchers to their ethical responsibilities than sanctions that might violate some lawyer’s notion of antitrust law. If newspaper editors had the same attitude, then Jayson Blair would still be working – after his mandatory ethics training, of course.

No Drug Ads in Medical Journals?

If a medical journal refuses to take advertising from drug companies, it that an unconstitutional limit on freedom of speech? Pharmaceutical Research and Manufacturers Association (PhRMA) chief Billy Tauzin, the former Congressman, went so far as to complain of "human rights abuses" when George University professor Adrienne Fugh-Berman suggested (in an article in PLoS Medicine) that medical journals adopt such policies.

After receiving a lot of flack (including being charged with hypocrisy since at least one drug company official sits on its board), the open-source journal fired back in a hard-hitting editorial, which you can read here.

The core of their response concludes:

This is nonsense. Drug advertising is often misleading, and it can potentially distort clinical practice. The need to prevent another Vioxx tragedy, in which the “drug marketing got well ahead of the science, ” requires us all to think carefully about the net effect upon society of drug adverts. Public health must always come before industry's unfettered “rights.”

FAIR on Tom Friedman

I had lunch the other day with a friend who expressed amazement that I had not read Tom Friedman's book, "The World is Flat." I replied that I found most of his columns facile when they weren't boring, especially when dealing with the Middle East, which is supposedly his area of expertise. The Fairness and Accuracy in Reporting website has just documented his conventional wisdom on the war in Iraq, providing me with additional ammunition for combating those million-plus Friedman fans, which includes, alas, a number of my acquaintances and friends. Here is their analysis:

Tom Friedman's Flexible Deadlines Iraq's 'decisive' six months have lasted three and a half years

5/16/06

New York Times foreign affairs columnist Tom Friedman is considered by many of his media colleagues to be one of the wisest observers of international affairs. "You have a global brain, my friend," MSNBC host Chris Matthews once told Friedman (4/21/05). "You're amazing. You amaze me every time you write a book."

Such praise is not uncommon. Friedman's appeal seems to rest on his ability to discuss complex issues in the simplest possible terms. On a recent episode of MSNBC's Hardball (5/11/06), for example, Friedman boiled down the intricacies of the Iraq situation into a make-or-break deadline: "Well, I think that we're going to find out, Chris, in the next year to six months—probably sooner—whether a decent outcome is possible there, and I think we're going to have to just let this play out."

That confident prediction would seem a lot more insightful, however, if Friedman hadn't been making essentially the same forecast almost since the beginning of the Iraq War. A review of Friedman's punditry reveals a long series of similar do-or-die dates that never seem to get any closer.

"The next six months in Iraq—which will determine the prospects for democracy-building there—are the most important six months in U.S. foreign policy in a long, long time."
(New York Times, 11/30/03)

"What I absolutely don't understand is just at the moment when we finally have a UN-approved Iraqi-caretaker government made up of—I know a lot of these guys—reasonably decent people and more than reasonably decent people, everyone wants to declare it's over. I don't get it. It might be over in a week, it might be over in a month, it might be over in six months, but what's the rush? Can we let this play out, please?"
(NPR's Fresh Air, 6/3/04)

"What we're gonna find out, Bob, in the next six to nine months is whether we have liberated a country or uncorked a civil war."
(CBS's Face the Nation, 10/3/04)

"Improv time is over. This is crunch time. Iraq will be won or lost in the next few months. But it won't be won with high rhetoric. It will be won on the ground in a war over the last mile."
(New York Times, 11/28/04)

"I think we're in the end game now…. I think we're in a six-month window here where it's going to become very clear and this is all going to pre-empt I think the next congressional election—that's my own feeling— let alone the presidential one."
(NBC's Meet the Press, 9/25/05)

"Maybe the cynical Europeans were right. Maybe this neighborhood is just beyond transformation. That will become clear in the next few months as we see just what kind of minority the Sunnis in Iraq intend to be. If they come around, a decent outcome in Iraq is still possible, and we should stay to help build it. If they won't, then we are wasting our time."
(New York Times, 9/28/05)

"We've teed up this situation for Iraqis, and I think the next six months really are going to determine whether this country is going to collapse into three parts or more or whether it's going to come together."
(CBS's Face the Nation, 12/18/05)

"We're at the beginning of I think the decisive I would say six months in Iraq, OK, because I feel like this election—you know, I felt from the beginning Iraq was going to be ultimately, Charlie, what Iraqis make of it."
(PBS's Charlie Rose Show, 12/20/05)

"The only thing I am certain of is that in the wake of this election, Iraq will be what Iraqis make of it—and the next six months will tell us a lot. I remain guardedly hopeful."
(New York Times, 12/21/05)

"I think that we're going to know after six to nine months whether this project has any chance of succeeding. In which case, I think the American people as a whole will want to play it out or whether it really is a fool's errand."
(Oprah Winfrey Show, 1/23/06)

"I think we're in the end game there, in the next three to six months, Bob. We've got for the first time an Iraqi government elected on the basis of an Iraqi constitution. Either they're going to produce the kind of inclusive consensual government that we aspire to in the near term, in which case America will stick with it, or they're not, in which case I think the bottom's going to fall out."
(CBS, 1/31/06)

"I think we are in the end game. The next six to nine months are going to tell whether we can produce a decent outcome in Iraq."
(NBC's Today, 3/2/06)

"Can Iraqis get this government together? If they do, I think the American public will continue to want to support the effort there to try to produce a decent, stable Iraq. But if they don't, then I think the bottom is going to fall out of public support here for the whole Iraq endeavor. So one way or another, I think we're in the end game in the sense it's going to be decided in the next weeks or months whether there's an Iraq there worth investing in. And that is something only Iraqis can tell us."
(CNN, 4/23/06)

"Well, I think that we're going to find out, Chris, in the next year to six months—probably sooner—whether a decent outcome is possible there, and I think we're going to have to just let this play out."
(MSNBC's Hardball, 5/11/06).

The Lies That Keep On Running

Late last week, Merck unveiled the results of a study that purported to show that a one-year follow-up of the patients in the Vioxx trial that led to the drug being pulled from the market did not suffer from an increased risk of heart attacks and strokes after they stopped using the drug. Within 24 hours, the story had completely turned around: It turns out this was only true if you excluded some late arriving data, which added a number of strokes to the total and suggested that people who took Vioxx will remain at increased risk years after they've stopped taking the pill.

Then, this morning's Wall Street Journal carried a damning piece on the role of the New England Journal of Medicine in covering up its own role in failing to correct its original 2000 science article touting the virtues of Vioxx. It turns out last fall's "expression of concern," the first time the prestigious journal corrected the original article, was part of a public relations strategy to deflect attention from the fact that NEJM editors had been made aware that Merck scientists hid data in that original article, data that was submitted a few months later to the Food and Drug Administration and almost immediately brought to the attention of NEJM editors, who chose to ignore it.

Clearly, the courtroom drama surrounding Vioxx is spilling over into a recriminations battle among experts over who knew what and when. I highly recommend you go to the original sources if you're interested, and today's Wall Street Journal has all the links (pay the buck if you don't have an online subscription).

I have one major quibble with the article. It prominently quoted Dr. Gurkirpal Singh as a critic of Merck. When Singh last appeared in the press, he was working for Pfizer. And if you go back into the late 1990s, this minor academic was working for Merck and more than any other person was responsible for the myth that there was a major gastrointestinal side effect problem with traditional pain relievers that needed to be addressed by Cox-2 inhibitors like Vioxx and Celebrex. I wrote about this in my book, and I wrote about it again last year (see this GoozNews). But it seems that Dr. Singh's chameleon-like role in the long-running Vioxx saga is like the lie that travels a thousand miles before the truth even wakes up. He's still running strong. I keep waiting for an enterprising reporter to conduct a thorough post-mortem on his role in the Vioxx/Cox-2 affair.

Giving Credit Where Credit Is Due on Breast Cancer Coverage

When a reporter gets it right, they should be complimented. I didn't get around to reading the New York Times' Science section until tonight. But I was pleasantly surprised by Denise Grady's hardnosed story on drugs like tamoxifen and raloxifene (Evista) that reduce the risk of breast cancer. She carefully laid out the relatively low absolute risks most women face, which put these preventive pharmaceutical strategies in their proper context. We armchair journalism critics are quick to blame and don't often praise reporters when they get it right. She did. And it's a good read, too.

Breast Cancer and the Press

I spoke Sunday morning before the National Breast Cancer Coalition's annual advocacy conference in Washington, DC. Here's a truncated version of my remarks:

A few years ago, the Journal of the National Cancer Institute published a study about the role of the press in spreading misinformation about breast cancer. The authors surveyed all the articles that appeared in popular magazines over a year's time. They found that fully 84 percent of the women portrayed in the articles were younger than 50, and nearly half were under 40. Yet just 16 percent of breast cancer cases occur among women under 50, and just 3.6 percent under 40.

There's a reason why writers and editors run such coverage.

Young, attractive women with breast cancer and preferably small children at home make a much more compelling story. But, as the study pointed out, they create an entirely unrealistic fear in many women's minds about their actual risks for contracting and dying of breast cancer.

When it comes to breast cancer, misleading coverage in the rule, not the exception. Here's a lead from a recent news story in the New York Times. "Two important studies being published today challenge conventional thoughts about treating and avoiding breast cancer."

The first study and the one covered more extensively in the article suggested taking estrogen-blocking drugs might obviate the need for chemotherapy in breast cancers that feed off estrogen. But as one read deeper and deeper into the article, the reader learned that doctors don't have an effective way of determining which tumors feed off estrogen. Even the doctor who conducted the study told the reporter that chemotherapy was still needed for all cancers above a certain size. "Period. End of story," he said.

So how does this challenge conventional thoughts about treating breast cancer, which was the lead?

Which brings me to hormone therapy wars. Can it really be just six years ago that Lauren Hutton was on the cover of Parade Magazine offering the beauty tips of the stars. Her number one beauty secret was estrogen-based hormone therapy. There had already been stories in the medical literature warning that the powerful drugs might increase the risk of heart attacks and strokes in healthy women, but the landmark Women's Health Initiative, which proved that connection, was still two years away. What might have tipped off that reporter or Parade's editors that this wasn't the best idea in the world -- encouraging women to take estrogen? If they knew Ms. Hutton was a paid spokesperson for Wyeth-Ayerst, the drug's maker, perhaps they might have foregone that cover. But either they didn't ask, or decided not to tell their readers.

Indeed, as recently as January of this year, the Times carried a story about women still on hormone replacement therapy. The gist of the story was that researchers are exploring the theory that early initiation of hormone replacement therapy -- at the average age of menopause of 51 rather than the average of 64 for women in the Women's Health Initiative -- might in fact be cardioprotective. They quoted one Mary Jane Minkin, a professor at Yale Medical School. "Personally, in my heart of hearts, I think there is a benefit," she said. "However, I'm politically incorrect if I say that." Two paragraphs later, readers were informed she was a paid speaker for "companies that make the estrogen products she prescribes."

I first learned about the hype and hope associated with breast cancer research stories when writing my book, "The $800 Million Pill." I read Michael Waldholz's "Curing Cancer" and Robert Bozell's "Her-2." The former covers the story of Mary Claire King's discovery of the genes linked to some breast cancers. The latter told the story of the discovery of Herceptin, the targeted drug that attacks a specific mutation. What both books, just like the extensive coverage of Herceptin over the years, only briefly mentioned was the fact that only 15 to 20 percent of breast tumors occur in women who carry such genes or have that mutation.

So far, I've emphasized the misleading nature of much coverage about breast cancer issues. But what doesn't get covered. In March of this year, the British Medical Journal ran an important analysis of one of the more comprehensive tests of mammography on breast cancer incidence. It showed that routine mammography probably increases the incidence rate by about 10 percent more than is actually the case -- in other words, at least 10 percent of the cancers found by mammograms do not really exist or were benign lumps that would never have turned into a virulent cancer. This story received not one mention in the U.S. that I could find, even though it was extensively covered by the European press.

What should reporters do to improve their coverage of this important issue?

First, they must pay more attention to the conflicts of interest of the physicians who have conducted the studies they're reporting on. A 2000 study by Ray Moynihan and colleagues that appeared in the Journal of the American Medical Association found that just one-third of ties between doctors and drug companies got reported in the press when those doctors' studies were quoted. Today, I suspect the percentage is a bit higher. The organization I work for, The Center for Science in the Public Interest, has lobbied news organizations to improve their policies. Last year, the New York Times adopted a policy of routinely reporting such conflicts. But that policy is sometimes honored in the breach and many other organizations still have not followed suit. They should.

Second, disclosure doesn't go far enough. When reporters report on a study funded by a drug company, they have an obligation to probe the data with a healthy skepticism. Too often, preliminary results presented at a scientific meeting that will never appear in a peer-reviewed medical journal gets splashed across the front pages of leading newspapers. Women need more critical coverage than that.

Another important point is presenting the real risks women face and the real benefits women might receive from a therapeutic alternative. Yes, there were 40,000 deaths from breast cancer last year, making it the second leading cause of cancer death among women after lung cancer. But half those deaths occured in women who were in 69 years of age older. It reminds me of the old joke: "Look at me, I'm 85, never smoked, never drank, and I'm lying in bed, dying of nothing." To the extent cancer is a disease of aging, reporters and the public need to disaggregate the data and present the real risks women face.

The government's long-standing war on cancer, and the anti-cancer establishment it created, is partially to blame for this. The National Cancer Institute routinely talks about women's one in eight risk of getting breast cancer in their lifetimes. That's a pretty scary number. But in women under age 40, the odds are only 1 in 229; even for women ages 60 to 69, the risk is 1 in 26. The 1 in 8 chance of getting breast cancer is first and foremost an artifact of aging, not a growing epidemic.

Finally, it is incumbent on reporters to cover the risks as well as benefits that come from a particular therapy. Last May, a report at the American Society of Clinical Oncology meeting that received widespread coverage showed that taking statins lowered the risk of breast cancer. "Half as likely" said every lead. Sounds pretty dramatic. But elsewhere in the story, it was reported that only 12 percent of the 40,000 women in the study were taking statins; and only 1.4 percent of the group contracted cancer (it was a multi-year study). You had to do a lot of finagling with the numbers to discover that it would require putting 700 women on statins for five years to eliminate just one case of diagnosed cancer -- a case, by the way, that had a one in five chance of being fatal.

At the same time, the story never mentioned the liver problems or muscle-wasting problems associated with prolonged statin use. Indeed, simply by checking the FDA label, a reporter could discover that Lipitor, the most widely prescribed statin, has a 1 in 500 chance of causing liver problems at the lowest doses, and a 1 in 50 chance at the highest doses of causing liver problems. Are we encouraging women to substitute one disease for another when we mindlessly report the findings of the latest industry-funded study?

Finally, it is time for reporters to begin inserting cost-benefit analysis into their coverage. Yes, cost-benefit analysis has gotten a bad name, largely because insurance companies used it as justification for arbitrarily cutting off their HMO patients from needed coverage in the 1990s. But with the Baby Boom entering their high cost years, figuring out what new products Medicare should pay for is going to become a huge social issue.

Let's use the previous example: Patented statins cost about $1,000 a year. Given that 700 women would need to take these drugs for five years to eliminate one case of cancer, which probably wouldn't be fatal if treated, the cost of that preventive measure would be $3.5 million. Is that worth it? Or more importantly, could that $3.5 million be spent in other ways that might prevent far more cancer cases -- like intensive screening in communities where the women are most at risk, like in the black community, which has a far higher breast cancer mortality rate than the white community?

Breast cancer is a serious problem, as are the more than 200 other forms of cancer. And advocacy groups like yours have played an important role in raising many of the questions I am raising this morning. But you have to figure out a way to make your criticisms (and mine) the main point of the story, rather than the one-paragraph caveat buried deep on the jump page.

Thank you.

Lebron Walked

Folks who followed Michael Jordan's rise to basketball prominence have no trouble recalling his breakthrough moment: It was his sideways-moving jump shot from the top of the key over Craig Ehlo that sank the Cleveland Cavaliers in game 5 of a first round NBA playoff series in 1987. This poster shot has taken on iconic status.

Tonight, Lebron James danced through the key to hit the winning shot in game 3 -- always the crucial game in a 7-game set tied 1-1 -- to lift the visiting Cleveland Cavaliers over the Washington Wizards. It was his 40th and 41st points of the night, the most ever by a visiting player in his first NBA playoff game on the road.

But I doubt you will ever see it on television, the way we see Jordan's shot over and over again. Why? James walked.

Measuring Health Care Coverage

As many of you know, I spent a quarter century in the ink-on-paper news business, mostly covering business and economic issues, before being relegated to minor league status on the Internet. Unlike many bloggers, I try to do my own reporting before I go on at length about one thing or another, a trait that is sadly lacking in most of cyberspace. That's why I am more sanguine about the fate of so-called mainstream media than many of my former colleagues in the press (not to mention the know-it-alls on the web). Hard-working reporters cannot be replaced by opinion-mongers who think reporting is reading the headlines in the morning paper and starting to type before they get to the jump page.

That said, I'm less sanguine about the fate of health care reporting, the field I gravitated to about five years ago when I took up writing about pharmaceuticals. So much of what appears in the media is so bad that it fails the basic test of providing the blogosphere with raw material for commentary. When was the last time you read a single online post about a Time magazine cover story about the "new brain chemistry"? Most medical "news" competes for readers attention with the mountains of self-promoting advertorials masquerading as "objective" health care information that already appears on the web. (One of the reasons I grit my teeth every time I hear the phrase "consumer driven health care" is that I know that most of the information consumers get about health care these days comes from the web, and much of that information has the integrity of a late night huckster selling erectile dysfunction supplements.)

A perfect example came at the top of the fold in this morning's Washington Post. Reporter Rob Stein in breathless prose reported a National Cancer Institute study showing that regular use of Eli Lilly's osteoporosis drug Evista (generic name raloxifene) gave postmenopausal women "a powerful way to protect themselves against breast cancer." "Terrific" and "good news" said the above-the-fold quoted experts, including one from NCI. While a few commentators, including one from the National Breast Cancer Coalition, urge caution, our reporter immediately switches back to the data to report that it cuts the risk "by about half."

It isn't until the 15th paragraph that readers learn that of the nearly 20,000 postmenopausal women in the study, only about 320 or 1.6 percent were expected to get breast cancer in the first place. By taking Evista, the number was reduced to 167 or 0.8 percent. In other words, 193 women will have to take this drug for five years to eliminate one case of breast cancer, which is fatal in one in five cases. The cost of preventing this case, by the way, would be about $864,000 ($75 per month for the drug for five years for all 193 women). While the data to make the above analysis was in Stein's story, none of it was clearly spelled out.

There are some objective reasons for failures like this. Health care reporters who are on daily or even weekly deadlines are usually being thrown at topics they know very little about. Yet with a few hours reporting, they are expected to sound authoritative. That may work in covering politics or business, but it fails miserably when confronted by the complexities of science and health.

Given that kind of pressure, the best most can do is come up with the conventional wisdom. They rely on sources who have been elevated into positions of authority by organizations (corporate, institutional, professional) that have a vested interest in one treatment or another. The most depressing phone calls I take each day are the ones from reporters looking for a quick quote to "balance" a story that has already been weighted to the point of view of the drug company that sponsored the study or the regulatory official whose decision reflected some special interest.

Sadly, most of these reporters are not even very good at gathering lots of information quickly and putting it into a coherent story. I've talked about these issues before but they bear repeating: how many times do you read a story that gives the absolute risk of the disease in question instead of relative risk (if a new drug cuts deaths from a disease by 50 percent, how significant is it if the number of people who died from it fell from 2 in 100 who took the drug to 1 in 100?). How does this new technology compare to older, cheaper technologies already deployed? How serious is this problem? Is this horrible condition (restless legs syndrome?) nothing more than "disease mongering" by researchers on a drug company's payroll?

In that sense, most health care reporters lag well behind their peers on the political or business pages, where a healthy skepticism is the order of the day and the knowledgeable reader at least gets enough information to form their own opinion about what's going on. Most consumers of health care news simply don't know enough to know when critical parts of the story have been left out; or when the facts have been arranged in such a way that getting real insight is virtually impossible. Health care news -- like pills -- is almost always swallowed whole.

That's why I'm hoping a new effort by journalism professor Gary Schwitzer of the University of Minnesota has some impact on the profession. Using funding from the Foundation for Informed Medical Decision Making (which insists on its website that it takes no money from any corporation that sells health care or health care technologies like drugs or medical devices), Schwitzer has set up a new website called HealthNewsReview.org to monitor and grade health care coverage in the mainstream media.

He's deployed several graduate students to monitor stories in dozens of newspapers and broadcasts and grade them with one to five stars -- just like the movies! By hacking around his website for a few minutes, I quickly discovered that the grades were based on solid, objective evaluation criteria. Any reporter looking to see why their work earned a poor rating could learn a lot by delving into the details of the critique.

Schwitzer, a former journalist who works closely with the Association of Health Care Journalists, goes to great lengths to explain that he isn't trying to belittle the reporters whose work is highlighted (I saw at least one got five stars). "We hope that U.S. journalists find our reviews helpful and accept the constructive criticism," he writes. "This project is intended to support excellence in health and medical journalism."

I wish him well in his efforts. Health care journalism has to get off the dead end track of reporting the latest study du jour, which is a one-way ticket to flacking for the drug industry. If there are any reporters reading this blog, I encourage you to check out his site. It will be interesting to see how they grade Stein's story.

How the Media Helps Make People Sick

An article with the above subhead caught my eye. You can find it in the current issue of PLoS Medicine, which is devoted to disease mongering. You won't find that affliction in the Physician's Desk Reference. But it ought to be there, because it is dangerous to your psychic health.

One article in the special issue focused on the media's role in disease mongering. Two Dartmouth Medical School physicians analyzed journalism coverage of restless legs syndrome between 2003 and 2005, a period when GlaxoSmithKline was marketing a Parkinson's disease drug for the disease. They found that virtually every article about the disease uncritically accepted its definition and its widespread incidence in the general population (would you believe one in ten people have it?).

After debunking those claims, they offered this advice for unwary journalists covering the latest medical epidemic that had previously gone unreported:

"If a disease is common and very bothersome, it is hard to believe that no one would have noticed it before. Prevalence estimates are easy to exaggerate by broadening the definition of disease. Journalists need to ask exactly how the disease is being defined, whether the diagnostic criteria were used appropriately, and whether the study sample truly represents the general population."

There's plenty to chew on in this issue of PLoS Medicine. I recommend it highly, and, unlike most leading medical journals, it's available free online.

NEJM: Op-ed Against Open Access Publishing

This week's New England Journal of Medicine contained a provocative article attacking open access publishers like PLoS Medicine. After pointing out the tremendous sunk costs by for-profit publishers and non-profit professional societies that have enabled fast internet access to journal articles in the first place, Martin Frank, executive director of the American Physiological Society, asks who will pick up the estimated $3,000 cost of publishing in a first-tier journal like NEJM?

One obvious possibility is the government that funds much of the research in the first place. After all, most science and research grants range in the tens of thousands if not hundreds of thousands of dollars. How costly would it be to increase that by $3,000 IF something worthy of publishing comes out of the grant? NIH has already amended its policy to require researchers to deposit full text copies of articles in the PubMed database at the Library of Medicine (www.pubmed.org) one year after publication in the original journal (this was amended from six months after protests from journal publishers).

Frank estimates it would cost $200 million per year to move from a subscription and advertiser-driven model of science publishing to one that provided free internet access. He then goes on to ask: "Spending some $200 million in support of open access should give Congress pause, particularly since the NIH budget has been cut this year for the first time in 36 years. At a time of shrinking budgets for biomedical research, does it make sense to spend scarce dollars on publication costs instead of on research to develop treatments and cures for disease?"

Frankly, the answer to his question is an unequivocal YES. Disseminating knowledge widely will hasten the development of cures for disease.

Support Middle Eastern Journalists at Michigan

In 1995 upon returning from four-year stint in Asia, I was privileged to spend a year as a Michigan Journalism Fellow at the Univesity of Michigan in Ann Arbor. Tonight, I learned by reading Juan Cole's essential Informed Comment blog (no one on the Internet covers the war in Iraq better) that my alma mater has launched a fundraising drive to bring Middle Eastern journalists to the U.S. for a fellowship year. Way to go, Charles! (Charles Eisendrath, who long ago was a Time Magazine correspondent, runs the program.)

I know this is not my usual m.o., but if anyone out there has a little extra cash and wants to support a worthy cause, I can't think of a better way than giving to this effort. You can learn more about what is now called the Knight-Wallace Fellowship Program by clicking here.

Death Knell of the Media Barons?

With Knight-Ridder no more and major city newspapers on the block, is the era of the internet finally at hand? No less an authority than Rupert Murdoch thinks so. Today's Guardian has the media baron "comparing today's internet pioneers with explorers such as Christopher Columbus and John Cabot."

"Power is moving away from the old elite in our industry - the editors, the chief executives and, let's face it, the proprietors," Murdoch said.

Now that makes me, plugging along here in obscurity, feel much bertter. As the old saying goes, from his lips to God's ear.

Washington Post Health Section: News or Advertorial?

You've seen them. They're among the cheesiest ads in print. On the left is faded (sometimes black-and-white) "before" photo of a frowning woman -- sometimes obese, sometimes wrinkled like a prune, sometimes both. On the right is the smiling "after" shot -- slim, smiling and smooth.

Even the people who buy the products being peddled must understand that the photos were deliberately chosen to show each condition (before and after) in its worst and best light, respectively. After all, it's just cheesy advertising.

But what was I to think this morning when the Washington Post Health section ran one of those cheesy before-and-after shots. Well, they're in business to make a profit, too. It's just advertising, right?

However, this before-and-after shot wasn't in a quarter-page ad at the bottom of page three of the section. It was on page one. It was at the top of the fold. And it wasn't an ad. It was an illustration for a news article.

How far has the Post sunk in this latest example of advertorial behavior on the part of American journalism? The photo on the left of a 54-year-old woman before her "thread lift" (an increasingly popular alternative to face lifts, the caption informs us) has her in a tight-lipped frown with deathly pale skin, unkempt hair, no make-up and bags under her eyes large enough for a weekend getaway. The picture was provided by Dr. Ricardo Rodriguez, the Baltimore physician who performed the procedure described in the first paragraph.

And how did Ms. 54-year-old look afterwards? The picture on the right, taken by a Post photographer, shows a smiling woman with attractively groomed hair, eyeliner and eyebrow setting off her gleaming blue eyes, and a smile so wide you could see seven -- count 'em -- seven top teeth.

How long will the look last? "May Take Some Time to Tell," the subhead informs us. Unbelievable. The hoariest cliche in journalism.

The only question for the Post in the wake of this mini-fiasco is not whether the editor should be fired, but whether the section has a journalistic reason for continuing.

Arlo Guthrie Sings For New Orleans

I read this incredibly wonderful story from the UK Independent this morning, describing Arlo Guthrie's tour along the "City of New Orleans" train route to raise money for musicians in that devastated city. Just thought I'd share.

Republican War on Science Breakout

Congrats to Chris Mooney, whose "Republican War on Science" was optioned Friday by moviemaker Morgan Spurlock ("Supersize Me") and will be reviewed on the front page of the New York Times book review on Sunday. I was especially pleased that Times reviewer John Horgan gave greater weight to the corporate influence side of the Republican war on science equation.

Much of the debate over science politicization has focused on the religious right's influence over the Bush administration on issues like Plan B, evolution, stem cell research and sex education (a typical example was a column in today's Post, which carried a small item about the Spurlock movie-in-the-making). Hopefully, Spurlock will focus on the corporate takeover of science, which has taken place not just in global warming, but in food, environment and energy policymaking as well as in the medical arena, an area not covered in Mooney's book but where I spend most of my time. It's in these arenas -- not whether teenagers can gain access to morning after pills or the latter day Scopes trial in Pennsylvania -- where corporate debasing of science truly threatens the long-term health and safety of the American people.

The Post on the Army Corps -- again

Got to give the devil his due. Michael Grunwald and the Washington Post headline writers weighed in with a decent analysis this morning of the Army Corps' failure to shore up the New Orleans levees. I had criticized Grunwald a few days ago for his previous series on Army Corps pork, my argument being essentially that his award-winning series of a few years ago failed to separate the wheat from chaff when discussing infrastructure projects.

Today's headline, "Money Flowed to Questionable Projects: State Leads in Army Corps Spending, but Millions Had Nothing to Do With Floods," summed up the situation.

When Congress sits down to apportion the Army Corps pie, they think up all kinds of phony justifications for dubious projects that have little to do with improving the nation's economy. Using specious cost benefit analysis, they are able to justify an Alaskan bridge to a virtually uninhabited island, or, in the case of New Orleans, a series of expanded locks for grain barges that never come.

But this is only half an analysis. The press is still remiss in failing to hammer at what needs to be done to begin correcting the collapsing infrastructure in the U.S., from levees in New Orleans to bridges falling down on Connecticut interstates. Our infrastructure is falling apart after decades of neglect. The billions that do get spent go to projects that pad the bottom lines of special interests who either benefit from building a project or benefit from its completion.

Even with these misplaced priorities, we shouldn't be surprised that Louisiana leads the nation in scoring Army Corps projects. The Mississippi Delta drains the water system for nearly two-thirds of the U.S. land mass. We are just beginning to hear about the havoc the destruction in New Orleans will play with U.S. farm exports. The Gulf region produces two-thirds of our domestic oil and natural gas.

Yet protecting the infrastructure for these crucial industries depends first and foremost on protecting the city and region they called home. But instead of insisting on that basic maintenance, the oil and ag-barge lobbies connived with local politicians to spend the money on their own narrow interests. Low-income neighborhoods in New Orleans were the last things on their minds.

I'm sure they'd all agree now that theirs was a rather short-sighted view.

Swept Away

The media, like President Bush and the government, were slow to respond to the devastation caused by Hurricane Katrina. But once the press mobilized, they've done a remarkable job bringing us news about the human cost and insight about the neglect that led up to the tragedy. Moreover, as media critic Tim Rutten outlined in today’s Los Angeles Times, the press in hindsight also did a fine job in sounding early warnings about the potential crisis.

“Three years ago, New Orleans' leading local newspaper, the Times-Picayune, National Public Radio's signature nightly news program, "All Things Considered," and the New York Times each methodically and compellingly reported that the very existence of south Louisiana's leading city was at risk and hundreds of thousands of lives imperiled by exactly the sequence of events that occurred this week,” Rutten wrote. “All three news organizations also made clear that the danger was growing because of a series of public policy decisions and failure to allocate government funds to alleviate the danger.”

Note that one important media outlet didn’t make it onto that list. Unfortunately, it was the one that most politicians in Washington read to gauge what’s really important. That outlet is the Washington Post.

Where has the Washington Post been on the question of crucial water control projects? Over the past several years, the paper has run story after story attacking the Army Corps of Engineers for wasteful government spending, often to the cheers of public interest and environmental groups.

Reporter Michael Grunwald took the lead with a June 2002 attack on the Everglades restoration project, which was portrayed as a gift to Gov. Jeb Bush and nothing more than a pro-development project to deliver more fresh water to greedy housing developers.

There are plenty of reasons to oppose the way most shoreline and inland water projects are handled – from how they treat the environment to how they wind up benefiting wealthy property owners and developers. But when reporters go after these aspects of the projects, they often wind up painting the entire concept as a boondoggle. There's no room for nuanced coverage -- ugh, how boring -- in the press.

Here’s how Grunwald described the Everglades project in his "nut graf" (news-speak for the paragraph that signals what the story says and why it's important): “Most of the plan's ecological benefits for the Everglades are riddled with uncertainties and delayed for decades, though it delivers swift and sure economic benefits to Florida homeowners, agribusinesses and developers.”

And here’s how he introduced that nut graf: “The plan is already the national model for future restorations, from a $ 15 billion proposal for Louisiana coastal wetlands to a $ 20 billion plan for California rivers and deltas.”

Yes, politicians ignored warnings in the media about what could happen to New Orleans after a direct hit by a major hurricane. But the capital’s paper of record was sending them a very different message, one that was music to the ears of the Republicans in power. That message said: All government spending on infrastructure is wasteful.

Medical Reporting Beyond Hype and Hope

When I broke into the news business, the financial desk's primary source of breaking news was a Dow Jones wire clack-clack-clacking in the corner of the room. A bell rang whenever a major story broke. Sometimes two bells would go off, signaling a really big story. The day the stock market crashed in 1987, the newsroom sounded like St. Peters Square on Easter.

I imagine something comparable occurs these days when the advance copies of leading medical journals cross science editors' computer screens. Stories from the frontiers of medical research can make it onto page one—the most coveted real estate in daily journalism. News magazines have bolstered their sagging bottom lines with an endless stream of cover stories touting the latest breakthroughs in medicine.

But is this news all that it is cracked up to be? Have the reporters properly weighed the importance of the studies they're touting? Have they asked the tough questions of the researchers and their sponsors to figure out the significance of the results? Have they presented the data in a fashion that is meaningful to health-care consumers? And in an age when most clinical trials are sponsored by private companies, have they fully informed their readers of the researchers' conflicts of interest?

Too often, the answer to these questions is no. Take recent reports from the American Society of Clinical Oncology, which met in mid-May in Orlando. One leading paper reported on a Veterans Administration review of the experience of over 40,000 women in the south central U.S. “The women taking statins were half as likely to have breast cancer as women who were not taking the drugs,” the paper reported. Put that way, it sounds like a dramatic reduction. But elsewhere in the story, it was reported that 12 percent of the women were taking the cholesterol-lowering medications and that only 1.4 percent of the total group contracted breast cancer. Only by massaging the numbers could one figure out that physicians would need to put 700 women on statins to eliminate one cancer case (in medical parlance, this is called number needed to treat). It sounds a lot less impressive that way. But the number needed to treat would be a lot more meaningful to women, especially those on tight budgets wondering if it is worth $1,000 a year for a prescription.

Reporting of surrogate endpoints instead of primary endpoints is another way that readers get misled. Reports on cancer drug trials often fall into this trap. A “lifesaving” drug that shrinks tumors by 50 percent sounds a lot better than a chemotherapy agent that prolongs life by two months. The same can be said for bone density and fractures, blood pressure and strokes, and cholesterol levels and heart attacks. While there may be a minor yet statistically significant reduction in the primary endpoint, the trial sponsors prefer to promote the more dramatic-sounding secondary endpoint. Too many reporters prominently feature the less meaningful number, while leaving out or delaying until late in the story the real bottom line.

Sadly, the media have only lately come around to taking seriously the issue of conflicts of interest in medical science. Last July, the National Heart, Lung, and Blood Institute's National Cholesterol Education Project updated its guidelines for cholesterol management. The update, touted in the front page of every major U.S. paper, called for a dramatic reduction in the cholesterol levels now considered optimal for people who have never had heart disease but are considered moderately at risk. Prescribing physicians using these guidelines will likely put millions more Americans on these drugs in the next few years.

Yet three days after the report came out, reporters at Newsday broke the story that eight of nine physicians on the National Cholesterol Education Project panel had financial ties to statin manufacturers