Researchers are concerned that a lack of risk–benefit consideration is due to overdiagnosis.
As per the report, which was reported in JAMA Internal Medicine, the media often struggles to have unbiased analysis of experimental early diagnostic tests by exaggerating advantages rather than possible harms.
Researchers examined 1173 English-language news reports written between 2016 and 2019 regarding five recent early warning experiments from across the globe. These provide liquid blood biopsies for cancer detection, an Apple Watch for atrial fibrillation detection, 3D mammography for breast cancer detection, and blood checks and artificial intelligence tests for dementia.
They discovered that, while 97 percent of all stories discussed the possible advantages of these experiments, only 37 percent discussed any potential drawbacks, and only 34 percent discussed all benefits and harms. Furthermore, 27 percent of stories that listed harms often downplayed the threats.
The results, according to lead author Dr. Mary O'Keeffe of the University of Sydney's School of Public Health, pose questions about overdiagnosis in safe people.
She says while these assessments sound enticing and have potential advantages, there is a risk that any good individuals may be misclassified as sick.
This has the potential to lead to overdiagnosis and overtreatment.
Cancer is one example, with almost 29,000 cases expected to be overdiagnosed in Australia in a single year. The prostate-specific antigen (PSA) test is a highly contentious screening instrument, with data indicating that 41 percent of prostate cancer cases could be overdiagnosed.
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that over-testing may have a number of negative consequences, the most serious of which is overdiagnosis.
One of the great cases may be the early diagnosis of slow-growing thyroid cancer.
However, if it contributes to additional intrusive confirmatory testing, needless surgeries, higher insurance costs, or failure to get insurance – and the condition was never going to trigger many problems for the remainder of your life – then it is an overdiagnosis.
Despite the possible dangers and harms of overdiagnosis, just 5% of news reports discussed it, according to the report.
Professor Morgan adds that the possibility of false positives and false negatives has drawbacks.
He said that where a test incorrectly reassures someone, this may lead to a delayed evaluation and unsafe signs being missed, or a transition towards more hazardous behavior as a result of a false-negative test.
Dr. Evan Ackermann, a Queensland GP, believes it is important that patients understand the risk–benefit ratio to every procedure they are undergoing.
The trouble with Australia like much of the rest of the world is that they lack a large public health fund to push the agenda. So that is why a lot of industry is also behind this agenda to create these experiments [and] a lot of them aren't motivated by population need, they're driven by, really, companies that see a cost-benefit for them.
Meanwhile, more than half (55%) of the news reports examined as part of the study had analysts with financial conflicts of interest, which were only acknowledged in 14% of the stories.
Coverage of the Apple Watch's potential to predict atrial fibrillation is one indication. Despite the fact that 19 of the 22 writers for a crucial trial testing the watch's potential admitted receiving grants or personal payments from the firm, the detail was barely published.
When there is a conflict, and if this is an infomercial, it must be explicitly labeled as such,' says the author
It irritates me when individuals with a commodity to offer to get items written that seem to be news stories but are really sales pitches. That is a critical question of fairness and ensuring that media reporting does what it promises.
According to Professor Morgan, public misrepresentation has serious consequences for GPs and the healthcare sector as a whole.
He said if we start doing lots of ad hoc screening, we don’t have the infrastructure to back that up with an appropriate follow-up.
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.
Dr. Moynihan said higher quality medical reporting is more complete medical reporting – covering benefits, harms, and conflicts of interest.
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 which’s been dictated by law.
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 is 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.
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 the appropriate use of taxpayers’ money and only order rebated tests appropriately.
