The Pap smear is no panacea, Katie Couric

Regular readers keeping up on infectious disease issues might have seen Seth Mnookin’s post yesterday, warning of an upcoming episode of the Katie Couric show  focusing on the HPV vaccine. Even though Mnookin previously spoke with a producer at length regarding this topic, the promo for the show certainly did not look promising:

“The HPV vaccine is considered a life-saving cancer preventer … but is it a potentially deadly dose for girls? Meet a mom who claims her daughter died after getting the HPV vaccine, and hear all sides of the HPV vaccine controversy.”

And indeed, reviews thus far show that unfortunately, Couric pretty much  mangled the issue and allowed heart-wrenching anecdotes to trump science (reminiscent of Jenny McCarthy’s appearance on Oprah). I won’t cover it all (you can view it here), but basically Couric allows stories about illness and death in the weeks following administration of the vaccine to go unchallenged, and brings on Dr. Diane Harper as her HPV expert (featured prominently in the anti-vaccine documentary “The Greater Good“). Dr. Harper believes the HPV vaccine is over-hyped, and that Pap screening is “100% accurate” so no HPV vaccine is really needed. This, frankly, is hogwash. Even with emphasis on screening, here in the U.S. we have 12,000 cases and 4,000 deaths from cervical cancer alone each year. (And in Mnookin’s post and in Matthew Herper’s Forbes post, both note that head and neck cancers can also be caused by HPV as well–but have no good screening process).

Even when HPV cervical infections are caught via screening, the treatment ain’t pretty. I’ve written before mentioning one such remedy–the LEEP procedure.  I had this done several years ago, after a Pap smear came back with abnormal cells and positive for HPV DNA:

“Next, a woman with abnormal cells can expect to undergo a LEEP procedure, where portions of your cervix are removed with a burning electric wire under local anesthetic, and the foul smoking remains of your cells are sucked up into the smoke shark, “a sleek, powerful, smoke-eating machine.” [And one gets to look forward to “coffee ground-like discharge” for up to several days following the procedure, due to the materials they use to stem the bleeding cervix]. After LEEP, side effects may include infection, hemorrhage and possibly cervical incompetence.  These are rare, but if we’re talking vaccine side effects versus possible outcomes from HPV infection, these types of outcomes need to be considered as well–not just death from cervical cancer.”

Being currently pregnant following such a procedure, cervical incompetence was something I was carefully monitored for. Nevertheless, it’s still been a huge source of stress throughout this pregnancy, as this is a significant cause of second-trimester miscarriage and there aren’t great, foolproof ways to detect it, or remedy it if it does occur. Harper acts as if finding HPV via Pap smears is like rainbows and unicorns, but it too has a risk-benefit equation, and I’d so much rather have received a vaccination than to have gone through that. And, some women’s treatments for HPV infections and cervical abnormalities are even more extreme than mine was.

This is why I had my now-almost-14-year-old daughter vaccinated for HPV, and why my pre-teen son will soon be getting his as well. There are multiple ways to prevent HPV-induced cancers, but the vaccine (in combination with routine Pap smears) is by far the least invasive and safest route, as multiple studies have confirmed.

Finally, the show was doubly disappointing because Couric has been such an outspoken advocate of colon cancer prevention, which was the cause of her husband’s death in 1998. While realizing this is a fluff talk show and not the kind of harder journalism she’s apparently now abandoned, she still failed to ask even the most basic of questions to the supposed HPV vaccine “victims” she featured on her show, nor to note during their segments that other possibilities may exist for the girls’ illnesses and death besides the HPV vaccine. In the second segment, Rosemary Mathis even admits blatantly doctor-shopping until one would “listen to her” about her daughter–in other words, give her a new diagnosis (vaccine injury). Why isn’t this even questioned? What did her previous doctors tell her about her daughter’s condition? Couric allowed ratings and anecdotes to trump actual science, potentially causing real harm to the public health. How disappointing that this is now part of her legacy.

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Skeptical science and medical reporting (#Scio13 wrap-up)

Ivan Oransky and I moderated a session last week at ScienceOnline, the yearly conference covering all things at the intersection of science and the internets. We discussed the topic ““How to make sure you’re being appropriately skeptical when covering scientific and medical studies.”

We started out discussing some of the resources we’d put up at the Wiki link. Ivan teaches medical journalism at NYU, and noted that he recommends these criteria when evaluating medical studies. I noted I use similar guidelines, and as a scientist, think about papers in a journal club format before I cover them on the blog, considering their strengths and weaknesses (especially in study design and analysis). Ivan also mentioned the need sometimes to consult a real statistician if you don’t understand some of the analyses–suggesting to “keep a biostatistician in your backpocket” or, failing that, to reach out to those at you local university, as “they tend to be lonely people anyway.” (Just kidding, biostats friends and colleagues!) A number of stats references for journalists were also mentioned (see the Storify for specific links). From here, we handed the discussion over to the audience.

One of the first topics we reviewed was just what is meant by being “appropriately skeptical,” which was a theme of the session that we kept coming back to. How does one do that without being an asshole? The importance of criticizing the study’s limitations and weaknesses–and not necessarily being a jerk to the authors–was noted. No study is going to be perfect, after all. It was also pointed out that anyone reporting on the study should go beyond the press release, and not to do so is in fact “journalistic malpractice.” Bora also started an interesting tangent–are medical studies more likely to be fake (or more deserving of skepticism about results) than more basic science reports? Also, is it worth reporting on bad studies? Sometimes this can help to point out the bad science (like that recent mouse-GMO study, which was reported on–negatively–in many venues). This recent study on “out” versus “closeted” homosexuals in Montreal was also brought up by Annalee Newitz–a small study that was widely reported, but was it designed and powered correctly to examine the questions it supposedly answered? (I haven’t read it, but just looking over the article, looks like “no”.)

Audience members also asked how to find sources to comment on studies. Ivan has previously written a post on this, and others in the audience recommended looking at other references in the story itself, or looking at reviews or meta-analyses on the topic to see who else may have expertise in these particular areas. However, SciCurious also noted that you need to be somewhat skeptical of those as well, and examine if the authors of these reviews or analyses have their own biases that may skew the information being presented.

The idea of “Glamour Mags” was also introduced. How should those reporting on a story know whether the results were published in a “good” journal or not? Several pointed out that just because a study is in a lower impact-factor journal doesn’t necessarily mean it’s not to be trusted. Eli elaborated, noting that fraud is actually higher in the big, fancy journals, and that many studies that end up in lower-tier journals actually go through *more* peer review in some cases, as they have been rejected from higher impact publications.

Unfortunately as I was moderating, I wasn’t taking notes, and I can’t recall what we ended the session on (but it was a great comment and general agreement that it nicely tied things up). I’ve also tried to Storify the session based on the #medskep hashtag, but I’m new to Storify and it doesn’t want to embed for me. If you were there, please feel free to add to the discussion in the comments below.