Media fails to cover harms of early diagnostic testing: study

Anastasia Tsirtsakis

7/04/2021 4:21:57 PM

Researchers fear a lack of risk–benefit analysis may be contributing to overdiagnosis.

Man reading a newspaper.
Just 37% of news stories covering new early diagnostic tests mentioned any potential harms.

The study, published in JAMA Internal Medicine, has found media often fails to provide balanced coverage of new early diagnostic tests by amplifying benefits rather than potential harms.
Researchers analysed 1173 English-language news stories from around the world, published between 2016 and 2019, about five new early detection tests. They include liquid blood biopsies to detect cancers, a watch by Apple to detect atrial fibrillation, a 3D mammography for breast cancer, and blood tests and artificial intelligence tests for dementia.
They found that while 97% of all stories reported on the potential benefits of these tests, only 37% mentioned any potential harms, and just 34% reported on both benefits and harms. Additionally, 27% of stories that mentioned harms also de-emphasised the risks.
Lead author Dr Mary O’Keeffe from the School of Public Health at the University of Sydney says the findings raise concerns for overdiagnosis among healthy people.
‘While these tests sound appealing, and can bring benefits, whenever we test healthy people there’s a danger that some people will be wrongly classified as sick,’ she said.
‘This can cause overdiagnosis and overtreatment.’
An example is cancer, with around 29,000 cases estimated to be over diagnosed in Australia in a single year. The prostate-specific antigen (PSA) test is one particularly controversial screening tool, with evidence suggesting 41% of prostate cancer may be over diagnosed.
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP there are a host of harms that can arise from over-testing and that overdiagnosis is the most important downside, but the least understood.
‘One of the great examples might be the early detection of a slow-growing thyroid cancer,’ he said.
‘On first thought you’d think “Oh yeah, pick it up early, that’s going to be a good idea”. But actually, if it leads to further invasive confirmatory tests, unnecessary treatments, lots of additional anxiety, increased insurance premiums or inability to get insurance – and that diagnosis was never going to cause any trouble for the rest of your life, then that’s an overdiagnosis.’
Despite the potential risks and harms of overdiagnosis, the study found only 5% of news stories mentioned it.
Beyond that, Professor Morgan says the potential for false-positives and -negatives also have downsides.
‘Where a test falsely reassures somebody, that could lead to a delayed diagnosis and symptoms that are dangerous being ignored, or a change towards more risky behaviour because of a false-negative test,’ he said.  
Queensland GP Dr Evan Ackermann says it is vital that patients be made aware of the risk–benefit of any test they are undertaking.
‘You want to make sure these tests or this new technology actually provides a patient benefit,’ he told newsGP.
‘The problem with Australia and most of the world is they don’t have a big public health budget to drive the agenda. So that’s why a lot of industry is often driving this agenda to develop these tests [and]
a lot of them aren’t driven by the need of the population, they’re driven by, basically, businesses that see a cost-benefit for them.’
Meanwhile, more than half (55%) of the news stories analysed as part of the research featured commentators with financial conflicts of interest that were only acknowledged in 12% of stories.
One example cited is coverage of the Apple watch’s ability to detect atrial fibrillation. Out of 22 authors for a key trial examining the watch’s ability, 19 disclosed taking grants or personal fees from the company, yet the information was rarely reported.
‘If people have a conflict and if something’s an infomercial, it needs to be clearly labelled as such,’ Professor Morgan said.
‘I get frustrated to see people with a product to sell having things published that look like they’re reporting a news story, when in fact it’s a sales pitch. That’s a fundamental issue of honesty and making sure that media reporting is delivering what it says it’s delivering.’
Professor Morgan says the misrepresentation in the media has significant implications for GPs and the health system as a whole.
‘If we start doing lots of ad hoc screening … we don’t have the infrastructure to back that up with appropriate follow up,’ he said.
‘And if those tests are not very good tests, and they have a lot of false-negatives and false-positives, then a lot of resources are diverted towards inappropriate screening programs, when it’d be much better to concentrate on the screening programs, such as bowel cancer screening, that have good evidence and really do save lives.’
The study concluded that strategies are ‘urgently needed’ to improve media reporting so that professionals, patients and the public receive more balanced information about early detection tests.
To assist, Dr O’Keeffe together with Dr Ray Moynihan, Assistant Professor at Bond University and senior author on the study, are working on a pilot study of new training interventions for journalists.
‘Higher quality medical reporting is more complete medical reporting – covering benefits, harms, and conflicts of interest,’ Dr Moynihan said.
Dr Ackermann believes there should be standards set for health journalism.
‘Just like you have standards for when there’s a mass killing or a suicide, the media have immediate standards by which they report on those, most of that’s been dictated by law,’ he said.
‘So instead of just promoting the benefits, the goal is actually to promote the risk–benefits, so there is some analysis of risk because it really can be misleading. People take their health seriously, and there are a proportion who believe the media and will go to any lengths to get these tests done, by anyone.’
With the coronavirus pandemic having demonstrated just how extensive the reach of social media can be in the dissemination of misinformation, Professor Morgan says GPs have a vital role to play in addressing any patient concerns. 
‘It’s really important to talk to the person with the information that they brought to your attention; it’s not appropriate just to dismiss the concerns out of hand,’ he said.
‘It’s much better to explain that there are both positives and negatives of doing tests and to use a shared decision-making framework for discussing whether or not a test should be done.
‘It’s also important for GPs to of course follow any regulation and rules about appropriate use of taxpayers’ money and only order rebated tests appropriately.’
There are a number of resources to guide GPs to respond to patient requests for tests not considered clinically appropriate on the RACGP website, including the Red Book: ‘Guidelines for preventive activities in general practice’.
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