Friday, January 20, 2012

When the Medium Was the Message

Bill Weir of ABC-News
Let's get this straight:  I like Bill Weir. He co-anchors NIGHTLINE and his tongue-in-cheek features often leave me laughing.
         But Tuesday night Bill Weir inadvertently went from writing about to becoming the subject of the latest, hot-off-the-press celebrity doctor book to hit The New York Times bestseller list in 7:06 minutes, the length of the story.
        For the entire week in fact, ABC-News has provided David Agus, MD, a media platform unrivaled by the introduction of any other medical book that I can remember. Is it ratings week? Publicists must be soaking in champagne. While Weir called the Agus book “the most anticipated medical book of the year,” what I heard was a well-respected physician telling an old story in a new way that is a lot more expensive.
         Ask any doctor or advocate: making prevention sexy is the hardest job in town.
         In Weir's case, the calamity prevented was a potentially fatal heart attack. The diagnostic testing he underwent as part of his assignment (at the request of Dr. Agus) revealed a "calcification in the largest artery leading to the heart." That’s a walking time bomb. I'm not knocking the prevention message. Neither are the hundreds and thousands of other internists, family practitioners, and other professionals who find themselves saying the same thing, in different ways, day in and day out. For years. Maybe the ABC story will reach the ears of other 40-year old men who, like Weir, considered yearly check-ups a great idea for anyone but them.
         But I'm not convinced. His story, compelling from an emotional standpoint but low on fact, had an amazing infomercial quality. The prevention aspect really wasn't about prevention at all. It was about the early detection of disease using "cutting-edge" (read expensive) technology. This is not the kind of health reporting we need.  Here's why:

The Celebrity Factor - the "rock star of science" physician.
Both Diane Sawyer and Bill Weir both were quick to point out that Dr. Agus had consulted with Lance Armstrong and Ted Kennedy and as Weir stated, “… kept Steve Jobs alive years beyond what anyone thought was possible."
           Stop right there. Lance, Ted and Steve. Not your everyday individuals. Not your everyday, readily preventable cancers, either. As far as I know there is NO prevention, not to mention early detection, for glioblastoma, the lethal form of brain cancer that claimed Senator Kennedy's life.  Perhaps there’s some combination of blood markers that’s detailed in the book but this small and obviously intentional mention of the three famous patients propagates existing disparities in our medical system.
           One of the secret fears of any person with a life-threatening illness is that somehow, somewhere, there's some treatment that's better than what they can access or afford. To this end too many troll the internet, buying vitamins, supplements, treatments and other 'cures' from quack doctors and companies. Thousands of people who are perfectly healthy do the same thing in the hope of slowing aging or enhancing athletic performance. There are too many people who think that anyone who puts up a professional-looking web page with the MD tagging along after their name is a "rock star doctor." Do you think I’m exaggerating?  Hang around Twitter for a day and watch what people are buying, thinking and doing as part of a ‘healthy’ lifestyle.
           The best doctors are those who partner with you. That’s the new health equation. The NIGHTLINE piece mistakenly leaves the impression that big doctor, big technology leads to big health when in fact, the opposite is just as true. The accretion of everyday choices, how much we move, what we eat, what we do and do not do, even how we think combined yes, with good technology and medical guidance can lead to good health for many.
          Ultimately, the real ‘rock star doctors’ don't have time for television interviews. That doesn't make them any less than those on the best seller lists. They are the ones, who, often late at night, answer emails from patients who aren't even theirs just to set someone straight.

What Didn't Meet the Eye
Anytime you hear the phrase "cutting edge technology" in health care stories take a deep breath. Cutting edge usually means procedures your insurance carrier is bound to deny -- unless Medicare decides to cover it first. Then your carrier will eventually follow suit.
           "The unfortunate truth is that you do have some heart disease now," Dr. Agus tells Bill Weir early on in the piece. That's the pivotal moment. The reporter’s face freezes. All of us with cancer have had the same deer-in-the-headlights moment. It's awful. Your stomach curls. That's also the moment when the reporter’s fact-finding questions vaporize. Once the reporter is the story perspective is gone. Now we’re sharing Bill Weir’s encounter with mortality. We feel badly for him. We feel badly that his father died and truly, we DON'T want his daughter to become an orphan.  In a rapid flash we’ve seen photos of all of them.
         That's television. You become so involved in story that logical questions fade. Just a few of those questions are:
  • would a large calcification in a major artery been detected in a routine annual exam?  
  • Was/is there a history of heart disease in Bill Weir’s family? Doesn't ABC-News require - or encourage - its employees and key players to undergo wellness tests?  Better yet, does yours? Or do you have your own wellness plan in place?
  • And finally, what can you do when people feel they are invincible?  Very few are reporters who were asked (and allowed) by their network to undergo tests totaling thousands of dollars as part of a week-long feature called, The End of Illness. Amazingly, this also happens to be the title of David Agus’s book. 
The Elephant in the Room
The elephant, which I should have seen coming before she walked right over me, was the DNA testing company founded by Dr. Agus in 2006 that provided some of Weir’s testing. Whether or not the DNA analysis led to the CT scan or not wasn’t clear. Whether the DNA analysis indicated anything else to prevent other than the big blob in Bill’s artery wasn’t clear. The price of the combined tests, not to mention the entire topic of DNA analysis, certainly wasn’t clear. It was ‘good television’ but certainly not good reporting.
         People deserve better. They deserve reporters and producers who read between the lines. I can point out hundreds of cancer survivors who did everything right and were diagnosed with cancer anyway. Their perspectives on “the new this” or “the new that” is occasionally and understandably jaded.  What needs to be evaluated is of what use this information be to them now. We need to focus on preventing the next cancer, which may or may not be something subject to our control.  And there’s the ultimate illusion: that technology can help us control everything.
Maybe.  Maybe not. Can NAVIGENICS’s cutting edge DNA analysis tell me, or anyone else, if there’s an errant genetic blip just waiting kick off cancer again? Would the good measures I already have in place change a genetic reality one iota?
         Stay tuned.  I downloaded The End to Illness faster than you can say jack rabbit.  I’m about to go see for myself.
          In the meantime, I’ll repeat what Dr. Agus told Bill Weir, “Real food, regular schedule, live healthy.”
          And Happy New Year.



Mary Knudson said...

Nicely written, Jody. @ejwillingham, you may be interested for your discussion of journalism vs advocacy at #scio12. ABC went overboard with this story. Cost of the test, the downside of testing, screening, what portion of people tested actually benefitted from the test, and the profits made by the doctor's DNA company should all be a part of such a story.

Jody said...

Absolutely, Mary. I wasn't quite sure that I could believe what I was watching the other night. My concern is for the thousands who don't watch with a critical eye - or even the simplest of questions.

Overboard is right! Where is Ted Koppell when we need him? Health issues are complex. We need more questions and less hype to help people wade through the information.

Thanks for reading,

The Accidental Amazon said...

Sigh. Medical hype. Again. You know, and I know, Jody, that the really worthwhile information and medical journalism out there is not 'sexy,' and often even a little geeky and boring. But most folks don't know enough to wade through the sound bytes & headlines & pass on the dross.

I love my PCP, who is a rock star in my book, who is a team player, who happens to have a lot of healthcare clinicians as patients, because he doesn't ACT like a star and treats us all like we have working grey cells. I remember once going in for a visit after my back surgery. During the several months since my surgery, I'd managed to lose about 14 pounds. 'Good for you,' he said. 'What did you do?'

'It was amazing,' I told him, with my usual irony. 'I ate less and exercised more! Who'dah thunk it? That old saw really works!'

We both had a good laugh.

Beth L. Gainer said...


I love this posting. Lots of medical hype, for sure. Yeah, the whole docs who are rockstars hype gets to me, too.

My doctors are rock stars, and they are not even famous. Rather than touting this miracle drug or that one or having their own TV shows, my doctors care about me and work so hard to save people's lives. My oncologist is wonderful, will return calls the same day I call him, sometimes within minutes, and I guarantee he won't be on a talk show touting the latest techniques.

Thanks for such an excellent posting.

Dee said...

Excellent ! You made some good points especially regarding "cutting-edge". The part of the episode I watched left me with lots of questions ( I'm a cancer survivor). What is the cost of the test? Does he really want the general population to have this test ? Is he concerned about things that might show up that are benign? Will the test cause unnecessary surgeries? What does the medical community think about his book? Did ABC pick up the story because of a press release about his book? Did the reporter read the book and say "We need to report this?" or was there already a connection between the reporter and the Doctor.

Matt Katz, MD said...

Very well written, Jody. I do not think that celebrity physicians necessarily are better. Having other celebrities as patients is news, not a marker of quality. I don't know much about Dr. Agus, but clearly ABC doesn't seem to reflect on the potential conflict of interest involved in allowing Weir to talk him up.

Unknown said...

I really enjoyed this post--terrific analysis of the bias in the report. A DNA testing company--what an elephant in the room! I also appreciate your comments about celebrity doctors--and how "real people" are made to feel when watching this type of reporting.
I'm at

Renn said...

Thank you for the objective reporting on what ultimately was a not-so-objective piece of TV journalism!

Despite ABC's icing of a prefabricated cake, the show likely got a few people off their butts and to their doctors, and I suspect a few lives were saved in the process.

Kinda like the "pink" movement: Piles of pink icing on a prefabricated cake. But still, cancer is detected; some lives are saved.

I have a sudden hankering for homemade cake, no icing!

Julie Goodale said...

Great post, Jody! Sadly, this kind of reporting is all too common on TV & in print. You & I, and probably most of your readers are the kind of people who will look critically at a medical story. We'll download the report, look at the charts, and try to understand. We'll also be very skeptical of any book or study that appears to simply be a promotion. Unfortunately, way too many people will take it all at face value. They'll go looking for the next great test/cure/fix, and ignore the best things they can do for their health - don't smoke, exercise, & eat better.

Jody said...

You all may be interested in the piece @GarySchwitzer that he posted on the same series, "This is nothing but promotion." I had not seen this when I wrote mine. Here is Gary's excellent piece:

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