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Evidence-Based Journalism

The power of the press and other media to influence opinion is well understood. It can be used for purposes of which many of us would approve, but when, inevitably, it gets something wrong it can drive us to distraction. For instance, an episode of "The Chief" recently perpetrated the myth that radioactivity at nuclear power plants causes childhood leukaemia - disappointing when many years of painstaking research has investigated this and shown it be a population mixing phenomenon found in many non-nuclear projects.

It is more of a concern when a medical journalist writes to propose actions which are not based on evidence and which are, at best, controversial. The Times of May 16 carried an article by Dr Thomas Stuttaford on the health checks than every man and woman needs each year. Dr Stuttaford is an influential medical journalist, but we would take issue with the 18 checks he advocates shown in the box.

The following letter was not printed in The Times.

Sir,

The dose of Dr Thomas Stuttaford's customary common sense is lower than usual in his article on screening, which is written with evangelical zeal.

Screening is, of course, a deliciously attractive idea. A stitch in time is said to save nine and forms the basis of the enthusiasm for screening. However, for 18 of the tests recommended by Dr Stuttaford there is insufficient evidence to support their recommendation. There is, for example, no good evidence that women under 50 benefit from mammography.

Because a disease is found early it does not mean that survival is improved. In some cases the only result is that the individual knows they have a disease for a longer period of time.

Ineffective screening is not only inefficient, it is also harmful, causing anxiety and exposing people who have false positive tests to further tests and treatment, each of which carries its own risks. Screening has an important part to play in health care, but it is not so extensive as indicated by Dr Stuttaford.

In health care decisions are increasingly evidence-based - namely backed by good scientific evidence. Perhaps The Times should follow this example and give references to support the assertions made by correspondents where evidence is available. Evidence-based journalism has a vitally important part to play in public education, but unsubstantiated assertions, with recommendations to attend clinics offering ineffective tests at high cost are more likely to do harm than good.

Yours faithfully,

J A Muir Gray



Is there evidence for effectiveness for these screening tests recommended by The Times of May 19 1995?

The Bandolier screening blacklist:
  1. Chest X-ray in older patients, smokers and travellers.
  2. Haemoglobin for anaemia.
  3. ESR for inflammatory infective or malignant disease.
  4. Liver function tests in blood.
  5. Renal function tests.
  6. Calcium in blood.
  7. Uric acid in blood.
  8. Glucose in blood.
  9. Cholesterol.
  10. HDL/LDL ratio.
  11. Mammography in women over 40 years.
  12. Ultrasound examination of the ovaries.
  13. Bone density in women.
  14. Resting ECG.
  15. Exercise ECG on a treadmill.
  16. Ultrasound examination of the aorta in men over 55 years.
  17. PSA in men over 50 years.
  18. Helicobacter pylori.
Some of these, like cholesterol screening, have been examined and found wanting. Others, like PSA testing in men, are the subject of active research. Bandolier would like to know from any reader who is aware of evidence of effectiveness for the use of these tests as screening tests.

We would also like other examples of tests of unproven efficacy or of proven ineffectiveness to extend the Bandolier Screening Blacklist. We were tempted to offer prizes - first prize one private health check, second prize two etc. - but decided to depend on the public spiritedness of our readers.



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