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Public release date: 31-Jan-2012

Contact: Annmarie Christensen
annmarie.christensen@dartmouth.edu
603-653-0897
Dartmouth-Hitchcock Medical Center 

Quality medical journal news releases can help newspapers do a better job informing public

LEBANON, N.H. -- Medical journal press releases are the most direct way that journals communicate with the news media about new research. According to a study in the British Medical Journal, press release quality appears to have an important effect on the quality of subsequent newspaper stories. With high quality press releases, key information –basic study facts, quantification of results, acknowledgment of limitations – is substantially more likely to appear in newspaper stories. Low quality press releases, those omitting such key information, may actually make newspaper stories worse than if there were no press release at all.
"The news media matter: medical reporting not only educates but also influences health beliefs and behaviors," said Steven Woloshin and Lisa Schwartz, principal co-investigators of the study. "Our study shows that press releases are important as well."
The investigators, co-directors of the Center for Medicine and the Media at The Dartmouth Institute of Health Policy and Clinical Practice, reviewed consecutive issues of five major medical journals that frequently receive news coverage but have different editorial practices. Two of the journals (Annals of Internal Medicine, Journal of the National Cancer Institute) include editorial notes highlighting study cautions in the studies, two do not (JAMA, British Medical Journal), and one journal in the group does not issue press releases (New England Journal of Medicine).
The authors reviewed consecutive issues of each medical journal (going backwards from January 2009) to identify 100 original research articles that generated newspaper coverage. A total of 759 newspaper stories (a median of three per journal article) were identified through searches of news article databases, Lexis Nexis and Factiva. The investigators did not examine broadcast, web and social media platforms.
All associated medical journal press releases – a total of 68 – were identified using the press release database http://www.eurekalert.org. Two independent research assistants assessed the quality of journal articles, press releases, and a stratified random sample of associated newspaper stories by using a structured coding scheme for the presence of specific quality measures: basic study facts, quantification of the main result, harms and limitations. In their analyses, the authors took into account whether the quality measures were available in the associated abstract of the medical journal article.
Of the 343 newspaper stories analyzed, 71 percent reported on articles for which medical journals had issued press releases. Some 9 percent of stories quantified the main result with absolute risks when this information was not in the press release, 53 percent did so when it was in the press release, and 20 percent when no press release was issued.
Of the total analyzed, 133 stories reported on research describing beneficial interventions. Some 24 percent mentioned harms (or specifically declared no harms) when harms were not mentioned in the press release; 68 percent when mentioned in the press release; and 36 percent when no press release was issued.
Some 256 stories reported on research with important limitations. Of these, 16 percent reported any limitations when limitations were not mentioned in the press release; 48 percent when mentioned in the press release, and 21 percent if no press release was issued.
The Dartmouth Institute investigators reported several limitations of their own study. They noted that since they did not conduct a randomized trial, it is possible that other factors besides the press release accounted for newspaper story quality. For example, medical journals that issue high quality press releases might take other steps that improve subsequent newspaper coverage (but they found no evidence for this). Other limitations: only newspaper print articles were analyzed even though web-based media is gaining in impact; subjectivity is inherent in any content analysis; and the investigators could have introduced bias in their use of stratified random sampling to select newspaper stories.
"Media coverage of medical research often fails to provide the information needed for the public to understand the findings and to decide whether to believe them. Although it is easy to blame journalists for poor quality reporting, problems with coverage could begin with the journalists' sources."
The investigators concluded that high quality press releases are a simple way for medical journals to increase the chance of newspapers reporting key information.
There is substantial room for improving press releases, the investigators noted. They believe medical journals should make the effort to do better and use press releases not simply to make medical news but to make news reporting better.

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Editor's Note: Please see the article http://www.bmj.com/content/344/bmj.d8164 for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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No Mortality Benefit Seen from PSA Screening By Charles Bankhead, Staff Writer, MedPage Today Published: January 06, 2012 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. Prostate cancer screening with prostate-specific antigen (PSA) afforded no obvious prostate cancer mortality benefit during 13 years of follow-up in a large randomized trial. In fact, screened patients had a slightly higher prostate cancer mortality: 3.7 per 10,000 person-years, versus 3.4 for unscreened men. The results emphasize the need to find some means to identify patients who are most likely to benefit from PSA screening, said the first author of a report in the January issue of the Journal of the National Cancer Institute. "Routine mass screening of the population, purely on the basis of a man's age, is not going to be an effective way of reducing his chance of dying of prostate cancer," Gerald Andriole, MD, of Washington University in St. Louis, told MedPage Today. Action Points   Prostate cancer screening with prostate-specific antigen (PSA) afforded no obvious prostate cancer mortality benefit during 13 years of follow-up in a large randomized trial. The study found that screened patients had a slightly higher prostate cancer mortality: 3.7 per 10,000 person-years, versus 3.4 for unscreened men. "Having said that, that's not to say that no man should get PSA testing," he continued. "There are subsets of men in the population at large who do seem to stand a good chance of benefiting from PSA testing. "Those are men who are young, with no comorbidities, and generally very healthy. These are men with the longest life expectancy overall. They are men who, even if they harbor a nonaggressive, slow-growing cancer, are nonetheless expected to live long enough to die of prostate cancer in the absence of it being identified and treated." Screening also is reasonable for men who have an above-average risk of prostate cancer, such as African Americans and men with a strong family history of the disease, Andriole added. The data 0ffered nothing to change the conclusions of an earlier analysis of data from the same study, the National Institutes of Health-sponsored Prostate, Lung, Colorectal, and Ovarian (PLCO) screening program. After a median follow-up of seven years (up to as long as 10 years) the screened and unscreened groups had a similar prostate cancer mortality. The prostate cancer portion of PLCO involved 76,685 men who were ages 55 to 74 and cancer-free at enrollment. Study participants were randomized to annual PSA screening for six years or to usual care, which sometimes included "opportunistic" PSA screening. The initial report from the study showed a prostate cancer rate of 116 per 10,000 in the screened group compared with 95 per 10,000 in the control group. Prostate cancer mortality was 2 per 10,000 with screening and 1.7 per 10,000 in the control group. The current report showed that after a median follow-up of 13 years, cancer incidence was 108.4 and 97.1 per 10,000 in the screened and unscreened groups, respectively. The difference represented a statistically significant 12% increase in cancer incidence in the screened group (RR 1.12, 95% CI 1.07 to 1.17). Mortality was 3.7 and 3.4 per 10,000 with and without screening, respectively, a nonsignificant difference. "This article updates with more person-years of follow-up our previously reported finding of no reduction in mortality from prostate cancer in the intervention arm compared with the control arm to 10 years, with no indication of a reduction in prostate cancer mortality to 13 years," the authors wrote of their findings. Responding to the study, Otis W. Brawley, MD, chief medical officer of the American Cancer Society, acknowledged that the results are consistent with other studies that have pointed to a potential harm from overscreening and unnecessary treatment of indolent prostate cancer. "This trial does suggest that if there is truly an advantage to mass [PSA] screening it is small," Brawley said in a statement. Even so, the results do not rule out the possibility of a benefit in some high-risk men or the value of PSA screening in men who want the test, he added. "I truly believe that a man who is concerned about prostate cancer and understands that experts are not certain that screening saves lives, but it definitely causes anxiety and needless treatment, can reasonably choose to be screened," said Brawley. "A man who is more concerned with unnecessary diagnosis and treatment might reasonably choose not to be screened. It is an area that needs to be left to an informed patient." The PLCO trial is sponsored by the National Institutes of Health. Andriole disclosed relationships with Amgen, Augmenix, Bayer, Cambridge Endo, Caris, France Foundation, GenProbe, GlaxoSmithKline, Myriad Genetics, Steba Biotech, Ortho Clinical Diagnostics, and Viking Medical. Co-authors disclosed relationships with GlaxoSmithKline and Human Genome Sciences. Primary source: Journal of the National Cancer Institute Source reference: Andriole GL, et al "Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian cancer screening trial: Mortality results after 13 years of follow-up" J Natl Cancer Inst. 2012; 104: 125-132.

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