Katie Hobson of US News & World Report tweeted, “RIP, CRP?”

See the Times story.

The Wall Street Journal added to the discussion about cost-effectiveness of cancer drugs reflecting on a commentary in the Journal of the National Cancer Institute estimating that “it would cost $440 billion to extend life by one year for the 550,000 Americans who die annually of cancer.”

Important topic. I’m glad the WSJ addressed it.

But one line bothered me. It read:

“Some countries, like the United Kingdom, agree to pay for expensive drugs only if they meet a certain threshold of efficacy, but no such rationing exists in the U.S.”

A news story that comes right out and labels a demand for proof of efficacy as rationing?

A semantics purist may say that the term applies in this discussion – like restricting or rationing consumption of meat or electricity during war.

But given that any newsroom must realize how the term is used as a heavy-handed piece of rhetoric by those who oppose evidence-based medicine and who oppose health care reform that calls for such evidence, this seems like editorializing.

Good story – but that one word in that one sentence left a bad taste for me. Semantics, word choice and framing matter if you care about public understanding of complex health policy issues.

Despite my red marks on that one section, read the rest of the article (if it’s still available online), which was important enough to be on page one of at least the D section of the printed WSJ, not way back on D4.

It’s great to be first. But it’s better to be complete, balanced, and helpful with your news.

CBS claimed an “exclusive” with a report on the “first person ever to get an infusion of his own heart stem cells” to try to avoid future problems after a heart attack.

OK, they had the exclusive report that the procedure was done.

But they didn’t make clear that:

• There is currently nothing known about the benefits of this approach in people. That simply wasn’t emphasized in the story.
• Instead, it was referred to as a “cutting edge” clinical trial. Are there non-cutting-edge clinical trials?
• It was called a “major advance.”
• It was called a “trailblazing procedure.”
• But the onscreen graphic continuously trumpeted it as a “CBS Evening News Exclusive.”

The segment was clear that this treatment is experimental, but the failure to discuss potential risks, potential harms, costs involved, and current treatment options available to patients were huge omissions.

For anyone who really wants to learn about this area of research, the National Institutes of Health has a website describing the current state of the art. It contains questions we wish the CBS segment had explored, such as (excerpt follows):

“What are the implications for extending the research on differentiated growth of replacement tissues for damaged hearts? There are some practical aspects of producing a sufficient number of cells for clinical application. The repair of one damaged human heart would likely require millions of cells. The unique capacity for embryonic stem cells to replicate in culture may give them an advantage over adult stem cells by providing large numbers of replacement cells in tissue culture for transplantation purposes. Given the current state of the science, it is unclear how adult stem cells could be used to generate sufficient heart muscle outside the body to meet patients’ demand.

Although there is much excitement because researchers now know that adult and embryonic stem cells can repair damaged heart tissue, many questions remain to be answered before clinical applications can be made. For example, how long will the replacement cells continue to function? Do the rodent research models accurately reflect human heart conditions and transplantation responses? Do these new replacement cardiomyocytes derived from stem cells have the electrical-signal-conducting capabilities of native cardiac muscle cells?”

An interesting story on a condition called FMD, or fibromuscular dysplasia, soon tumbled into an exercise in disease-mongering. Excerpts:

“I believe that a large number of Americans have FMD,” says Jeffrey W. Olin, director of vascular medicine and a professor at the Mt. Sinai School of Medicine in New York City. “It’s reasonable to say that many thousands could be saved from complications like heart attack, stroke, ruptured aneurysm and even death, by screening patients.”

…Dr. Olin has prepared a top-10 list of doctors’ misconceptions and missteps. They include, “Telling patients that the symptoms are all in their head. Telling patients that FMD is a rare disease. Telling patients with severe headaches with FMD that there is nothing that you can do for them.”

…”Three to five percent would be a very reasonable estimate in the general population for FMD,” says Thom W. Rooke, vascular medicine professor at the Mayo Clinic. That works out to there being possibly 10 million Americans who have FMD, he says. By comparison, an estimated 3 million Americans have epilepsy, 2.5 million have breast cancer, more than 2 million have schizophrenia and 725,000 have melanoma.

Dr. Rooke says many FMD patients might never have symptoms, and only a few are likely to experience severe problems. But, he says, many “vascular catastrophes,” such as heart-rhythm deaths and strokes in young people, may stem from FMD.

The screening assertion is never clarified nor challenged. It is just left hanging out there: maybe 10 million Americans with this silent problem. If only we screened for it!

Whom would you screen?

When would you start?

What’s the number needed to screen in order to prevent one event?

What evidence is there for effectivness of such screening?

The WSJ reporter in question has done this kind of story before – pro-vascular-screening advocacy without the perspectives of anyone who might challenge the prudence of such screening recommendations.

Dartmouth’s Dr. Gil Welch, in response to that previous pro-screening story, wrote me: “Screen many, to find the few — while many others get labeled at risk in the process. And thus many will be treated “wrong.” “

Why isn’t that important perspective included in this kind of story?

The BBC reports that experts have discovered the first case of swine flu that is resistant to tamiflu, an antiviral drug being used to fight h1n1.

Roche Holding AG confirmed a patient with H1N1 influenza in Denmark showed resistance to the antiviral drug.



David Reddy, company executive, said it was not unexpected given that common seasonal flu could do the same.



The news comes as a nine-year-old girl has become the third to die in the UK with swine flu.

Virologist Professor John Oxford told the BBC, “I’m not surprised about this finding. The question is whether it is going to spread. We will soon know the answer.”



The CDC has categorized swine flu as a Category 2 outbreak, with the possibility of 90,000 to 450,000 deaths in the U.S. There were are record 6,300 new cases in the U.S. last week.



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That quote comes from a Minnesota physician in a Pioneer Press article that includes many good elements:

• Info on disparities in Medicare spending;
• Dartmouth Atlas data and graphic;
• Local angle on Atul Gawande’s New Yorker piece .

Kudos to reporter Jeremy Olson.

“This is so ridiculous, it may not be worth blogging on,” Marilyn Mann wrote to me.

I thrive on the ridiculous.

Whenever and wherever I see something this absurd, this non-evidence-based, this unhelpful and potentially harmful to health care consumers, I’m going to comment.

The columnist, a certified personal trainer, says she adapted her column from the July/August issue of Men’s Health magazine.

She advises men to think about getting

• Cardiac CT angiography

• Bone density scan – She writes: “Uh, oh, fellows. Did you think osteoporosis was just for women? Nope.”

• VO2 Max Test. She writes: “For this one, you get on a treadmill or stationary bike and pump up your cardiovascular volume to maximum effort while wearing a mask that measures your every breath.

The VO2 Max Test is the master cardiovascular test that will let you know what you’re made of. It’s the most accurate measure of your cardiovascular and overall health.”

You won’t find one evidence-based recommendation that supports any of those recommendations.

This kind of junk journalism feeds the “test, test, test” mentality that fuels the worried well and drives up health care costs.

I hope Philly Daily News readers either didn’t read this column or didn’t pay any attention to it. But for those that did, now you know the rest of the story.

Michael Jackson suffered from a cardiac arrest and died. CNN’s Elizabeth Cohen explains what a cardiac arrest is and how it is different than a heart attack. A cardiac arrest is when a heart stops functioning. Rescu usually only works when someone gets it within ten minutes but the outcome is usually not good if the person is not helped within three to five minutes.

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The Wall Street Journal educates us about “medical science liaisons.” Excerpt:

“Pharmaceutical companies are barred by the Food and Drug Administration from promoting unapproved drug uses, called off-label use, but they are using employees called “medical science liaisons,” who are often physicians and pharmacists, as a legal way to discuss those uses.

Medical science liaisons (MSLs), who are considered medical rather than sales staff, have greater freedom than salespeople as they visit doctors offices to discuss the science behind a medicine, including unapproved uses.”

USA Today reports:

“The type of advertising war that helped doom the last effort to overhaul the nation’s health care system is heating up.”