I want to be very clear that I very much appreciate excellent health reporting by Julie Rovner, JoAnne Silberner, Scott Hensley and other NPR healthcare reporters. What concerns me about this show is that it is popularized coverage, and, as such, may reach a broad audience who does not have the tools to recognize critical gaps in the story.
I love NPR! We are lucky enough to have 2 local NPR stations to choose from, WFCR and WAMC. I love everything about them -- their critical approach to politics, their intellectual curiosity and their local flavor. What I sometimes do not love is their coverage of health news.
Case in point is tonight's broadcast of "The Health Show". I was driving on one of our particularly windy roads while listening to the first story of the show covering the NCI's NLST, and almost drove off the road! I was glad that it was dark, so no one could see the crazy lady behind the wheel yelling back at the radio. Why was I yelling? Here is why.
The story was of course about the staggering success of NLST. The guest interviewed was Dr. Regina Vidaver, the Executive Director of the National Lung Cancer Partnership, a group focused on understanding gender differences in lung cancer. The initial conversation focused on the NLST cancer mortality data, where the enthusiastic host threw a give-away to the equally enthusiastic guest about the main finding. The guest ran with it, breathlessly citing the 20% reduction in cancer deaths. In all fairness, she did not fall into the host's trap of inference as to the cause of this reduction, assumed by him to be due to early detection, as she responded that these data have not been analyzed yet or reported in peer-reviewed literature. Dr. Vidaver further intimated that this is a very promising break-through, sure to change the outcomes of lung cancer among heavy smokers. She even compared it to breast cancer mortality reduction due to mammography screening. What rock has she been living under?
Throughout the interview, I kept waiting for the host to ask some critical questions, like what was the actual (absolute) reduction in mortality? Or how many patients would need to be screened annually and for how long to prevent one death? Or how much will it cost to prevent one death? Or what is the risk and what are the implications of a false positive result (these data have been reported, and it looks like 1 out of 4 screened patients may have a false positive test)? And what about how this testing compares to the costs and effectiveness of smoking prevention and cessation efforts? These are pretty elementary concepts which I discussed at great length here and here. No, none of these issues was explored, just the awe-struck host feeding soft questions to the guest. I swear, I thought I was listening to an infomercial! This is journalism? And on NPR? Come on!
But the most peculiar part of the interview came later. Here the host and the guest emphasized that other potential causes of lung CA exist and cannot be ignored, like radon and second-hand smoke. Strangely, there was no mention of asbestos or other occupational or chemical exposures. Don't take me wrong, these are important causes. But what do they have to do with the NLST data? Were they implying that everyone should undergo screening and not just those with heavy smoking history, since we do not know always what exposures other than smoking may be present? Furthermore, the big elephant in this interview was the lack of mention that 85% of all lung cancer is caused by smoking -- why not cite this startling statistic? Not compelling enough? Is it not amazing that, if every smoker quit, we could avoid about 190,000 new cases of lung CA in the US annually? Not to mention all the other disease caused by this poison.
But instead of pointing out the potential advantages of public health interventions aimed at smoking cessation, NPR decided to give easy air time to a shiny new technology, holding great promise for the uninformed masses and for the market, but fraught with untold expense and complications. Is this responsible journalism? NPR and WAMC, you can and should do better than this!