Journalism or advertising? "The Health Show" on NPR

Addendum 11/22/10:

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!

Gossip: an untapped renewable energy source

Just out of curiosity I Googled news on "peak oil" and got 3,397 hits. Then, I Googled "Tiger Woods", and got a staggering 57,134 hits! What does this mean?

I have spoken of peak oil before, so will not belabor the issue right at the moment. On the other hand, this is the first time the name Tiger Woods is appearing on this blog. Why? Because a celebrity's personal life is none of my business, it is none of my children's business, and none of my community's business. I prefer to engage in life itself rather than waste my time on voyeuristic destruction of another life (actually several lives).

But here is my question: how can we harness this endless and renewable resource of gossip to power our post-peak lives? Why is the Department of Energy not exploring this abundant energy source? Oh, yeah, you are right, it is toxic to the environment.

Destruction of lives in the name of cheap entertainment has become a staple of "journalism" in America. If news outlets would only focus as much attention on the real issues that we are facing as a society as they do on meaningless infotainment, we might not be a nation of overgrown adolescents habituated to a steady diet of mindless pablum. That would be pretty subversive, would it not? I wonder what it would be like if we just said "No thanks, not today. Not any longer."

The wheels of corporate journalism are lubricated by oil. What would happen if the truth came out? The bottom would fall out of the market, as all of it is inextricably dependent on oil. You can press your nose to the glass of familiar narrative of someone else's fame, fortune and destruction and be content to live in the fairy tale being sold to you. Or you can demand the truth, so that you can make your own decisions within your community. The choice is yours.  

The lost art of evidence-based debate

When people first find out that I was not born in the US (that's right, there go my presidential aspirations!), their question is about culture shock. They want to know what I perceived to be the biggest differences in cultures in the old vs. the new country. Over the nearly 35 years that I have spent in the US my thinking on this has evolved. Initially I was flabbergasted that teachers in high school tolerated students' putting their feet up on the desks. In my old country such behavior would have been punished corporally.

Today I consider myself to be a more sophisticated judge of cultural differences. I have come to appreciate that the US is not a monoculture, but a conglomeration of many different philosophies. And I do not mean just based on race, ethnicity and other obvious cultural drivers. Take for example politics as a profession: its culture is quite distinct from many others. Social scientists tell us that successful politicians are necessarily narcissistic, which is a blessing and a curse. This makes them not only über confident and decisive, but also prone to philandering and other forms of deception. I am also struck by how well they have perfected the art of not responding to questions by taking every opportunity to drive their talking points. Particularly astonishing is their ability, derived from Karl Rove's playbook, to turn a complete fabrication into what is accepted as reality by some. Just look at the death panels rhetoric.

I have to say that over the years I have cynically come to expect this and other bad behaviors from politicians. What is concerning to me is the pervasiveness of the same Rovian tactics in other sectors. Remember the recent E. coli outbreaks linked variously to Mexican peppers, tomatoes and spinach? Well, keeping this in mind, let's consider the work by the Center for Science in the Public Interest on FDA-regulated foods that have been implicated in E. coli outbreaks. This work, citing such seemingly innocuous and even desirable foods as lettuce, tuna and potatoes, has apparently incensed some of the corporate food lobby. Indeed, the Chicago Tribune reports that

...the Produce Marketing Association disagrees with putting them on the list, saying it is committed to providing safe produce and is working with the FDA and CDC to create "food safety solutions to help safeguard public health" and that "fruits and vegetables are necessary for better health."

All points well taken. But how does this address the issue at hand? Take back your data because we are committed and working on doing better? Why this is like a doctor saying "take this malpractice suit off my record because I am committed and working on doing better". Absurd logic? I think so.

The article further cites objections from the tuna organizations thusly:

But the National Fisheries Institute was even more scathing the study (sic) in their statement, saying "Seafood is a safe and healthy product that is an essential part of the American diet. CSPI has a history of attempting to scare consumers by playing fast and loose with definitions that might lead the casual reader to think people are getting sick left and right from seafood...Consumers should take this report with a grain of salt and a heaping helping of perspective."

Scare? Fast and loose? Have they ever heard of scombroid? No, it is not fatal, just unpleasant, but it happens despite the FDA regulation to gut and stuff the fish with ice immediately upon catching. Instead of addressing the evidence, they are quick to deny the allegation by casting doubt on the source.

And this brings me to my central point. Do these tactics of killing the messenger originate in relentless pursuit of market share even at the expense of public's health? Or is this just ignorance of how to debate a legitimate point? Is it possible that these executives and lobbyists do not have the skills to structure a logical evidence-based argument? Perhaps our educational institutions have lost sight of this critical skill as well. My guess is that it is a little bit of the latter and a lot of the former. Seems like public debate continues to deteriorate into voyeuristic entertainment, aided by shallow reporting.

But it does not have to be this way. The public needs to be empowered to make their own decisions based on a critical look at the evidence presented by both sides. If we can vet this evidence ourselves, there will be no room for corporate deception. Their antics will take their rightful place in the comics section of the paper.  

Whores, psychopaths and newsmen

Prostitution is legal in Las Vegas. Before antibiotics, people with tertiary (or neuro-) syphilis were considered to be pleasantly demented. Fitting neither of these criteria, fringe politics today is nevertheless mercenary and surreal. And loud. What we have is malicious fabrication rammed down the public's throat by a bunch of whores and psychopaths.

Consider Rush. A tool of the extremist right, he spews hatred day in and day out. Take Beck. With an actor's flair he incites his adoring public to the heights of fanatic hatred worthy of an Orwell novel. Taken together, their sociopathic rhetoric is validating and mainstreaming the psychotic margin that has always existed in our nation. And people listen, get worked up into lather and start Facebook discussions about presidential assassination. They are actors in well financed sinister entertainment masquerading as political commentary.

Some politicians seem to follow. Take Bachmann and Wilson and Franks. Bachmann, who advocates a hunger strike to make sure that we fail to reform and provide access to healthcare for all citizens. A Christian stance? I do not think so. Then, the illustrious Wilson calling the President a liar? In the Congressional chamber? Absurd! Finally, Franks referring to the leader of the free world as "the enemy of humanity". Is this not madness?

David Brooks in an editorial in the NYT today reminds us of the impotence of these "spittle-flecked" Quasimodos. Much like I said before, he contends that their claims of vast followings of Republican armies are simple delusions. I hope so. Nevertheless, their noise is giving me a headache. Let's use the power button. Off.

Is our political discourse suffering from a psychiatric disorder?

When I was a kid in Odessa my Dad and I went to see The Sound of Music at least 17 times in the span of 3 months. Remember that song sung by the nuns when Maria is late for the vespers, "How do you solve the problem like Maria?" One nun says "She's an angel", another one counters "She's a demon", when the voice of reason from Mother Superior repositions the whole argument with "She's a girl!" I always saw this as a bit of splitting nipped effectively in the bud by the Mother Superior -- good for her!

The press are doing exactly this to President Obama: the right makes him out to be a demon promoting a big government take-over within the US while ruining our reputation abroad, and the left canonizes him as the do-no-wrong president. I am struck by how effective this borderline personality approach has been at overtaking our political discourse. A borderline personality is a psychiatric diagnosis highlighted by a black-and-white view of the world, resulting in splitting behaviors. Sound familiar? Right: Obama bad, we good! Left: Obama good, them bad! I learned in medical school that a borderline personality disorder is a psychosis. Therefore, conservative and liberal alike, in lemming-like fashion we are following a psychotic analysis of reality.

In this grey world, neither the black nor the white bent seems intellectually honest. Granted, everything I understand about politics I learned from the "West Wing", so I am by no means an expert pundit. But I have also learned some valuable lessons from my own life, including that life is all about compromises whenever possible. This, I believe, is what Obama is after, which makes him neither evil nor a saint, but a reasonable leader and diplomat.

Let's take his approach to the Middle East. Yes, he is making an effort with the Iranians, the nation perceived to carry a substantial threat to the US security. Does it not make sense to establish constructive relationships with their leaders so as to avoid a potential nuclear confrontation? You know that expression about "an eye for an eye" and being blind -- this seems like the perfect application for it: time to turn around our eight-year bully posturing on Iran and start exploring real long-term solutions.

Domestically, the biggest sticky wicket is the healthcare reform. And even here Obama is showing himself to be a compromiser. This is not appreciated by the extreme right or left (myself included), but the realist in me understands that this is a chess match with far-reaching implications. And while I would like to see quality single payer healthcare for all Americans in my lifetime, I appreciate that mine is considered to be an extreme point of view.

More important to me than getting my own way is to see our country brought together. We need to get away form the psychotic hegemony and end the divisiveness of the deliberately polarizing rhetoric. We must engage in an honest intellectual exercise and effect changes that are best for all people.