We reviewed four stories on the Swedish mammography study that appeared in the journal Cancer last week. Three of the four stories gave a pretty clear indication that there were methodological concerns about the Swedish research (of the four reviewed, only HealthDay offered no such hint):
• 4th paragraph of AP story: “The new study has major limitations and cannot account for possibly big differences in the groups of women it compares.”
• 1st paragraph of LA Times blog story: “Critics charged that the study was poorly designed and potentially vastly misleading.”
• 2nd sentence of NY Times story: “Results were greeted with skepticism by some experts who say they may have overestimated the benefit.”
But none of the stories did a very complete job of explaining those potential limitations. Because of the confusion that must be occurring in the minds of women — especially those in their 40s — this is a time in which journalism must rise to the need and do a better job of evaluating evidence and helping readers make sense of what appear to be conflicting findings.
I was in Chapel Hill, North Carolina, when the study was published and had the chance to talk about it with former U.S. Preventive Services Task Force member, and a recognized thought leader on issues of prevention and especially of screening tests, Dr. Russell Harris, Professor and Director of the Health Care and Prevention Concentration of the University of North Carolina (UNC) School of Public Health. Read more »
Peter Orszag wants doctors to work weekends. The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.
And he’s right, to a point.
I’ve pointed to studies showing that mortality rises on the weekends, in part due to skeleton staffs that hospitals employ on Saturday and Sunday. And, since Mr. Orszag is an economist, the cost factor is noted. Tests that get pushed off until Monday cost the health system serious dollars. The problem I have is that Mr. Orszag, like most health reformers, offers doctors little incentive in return. Read more »
*This blog post was originally published at KevinMD.com*
The implication was obvious. Simple tool determines an individual’s risk for heart attack or death from heart attack. It over estimates risk. Patients treated unnecessarily. To be also clear, the program did underestimate risk as well.
Unfortunately, the article missed an important point. While the simplified calculator may not be as accurate as the more complex algorithm used by the National Cholesterol Education Program, the truth is doctors are likely to be overtreating patients not because the former program is presented by the pharmaceutical roundtable, but for another reason. Read more »
Texas is at the center of a heated national battle over the training emergency physicians need in order to advertise themselves as “board certified.” Via the Houston Chronicle:
At stake is the welfare of patients requiring immediate medical attention. Leaders of the traditional board say allowing physicians without proper training to advertise themselves as board-certified would mislead the public. Leaders of the alternative board say the proposed rule change will undermine the ability of Texas’ rural hospitals to staff their emergency departments with board-certified ER physicians.
A final verdict may only come, given one board’s already delivered threat, in a court of law.
At stake also are the careers of a lot of practicing Emergency Physicians, many of whom I’m proud to call friends and colleagues. (And it’s not just docs at rural hospitals, they’re in nearly every ED in Texas, and your lesser state). They practice high quality Emergency Medicine, and I have no qualms about the practice of those who are alternately boarded. Read more »
*This blog post was originally published at GruntDoc*
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