Is society becoming over-medicalized? Are medical technologies doing more harm than good? Who better to comment on some of these questions than the Executive Editor of Reuters Health? Dr. Ivan Oransky (yes, Dr. – he is an MD-turned-journalist) reads over 100 clinical papers each week and manages half-a-dozen full –time staff and many more freelancers in order to “shine a spotlight” on good, and bad, medical research findings. In his “spare time” he runs the blogs Embargo Watch and Retraction Watch, which have both helped change policy concerning medical journalism and scientific publication.
This past April, Dr. Oransky gave a thought-provoking talk at TEDMED (see below) about the proliferation of “pre-conditions” and associated screenings, and whether they are all necessary. Since then we’ve corresponded with him and asked him a couple of questions, which he gladly answered:
Shiv Gaglani, Medgadget: We first heard you at TEDMED, where you spoke about the over medicalization of society. What has been the reception to your talk since then?
Dr. Ivan Oransky: The most important result of the talk is that it has engendered lots of conversations. It received a good amount of coverage when I gave the talk, and then when it went live on the TEDMED and TED sites, where it received over 150,000 views. TED has a tremendous audience, many of whom commented on the video.
The ideas expressed in the talk have prompted a lot of people to have vigorous conversations about whether we’re doing more harm than good by being worried about this pre-condition or that pre-condition. Some people don’t necessarily think I’m right, and I welcome that. Obviously I feel strongly about this topic having seen a lot of evidence about the cost-effectiveness, and more importantly the health benefits, of certain screening procedures. The talk is going to hit people where they live since it’s a challenging idea both to individuals who believe that early detection is always a good idea, which is simply not the case, and in terms of their careers and how they make money. There was one group who objected to how I characterized a term that they created, and we had a pretty robust discussion about that on my blog. Certainly the goal of a talk is not necessarily to persuade, but to motivate people to engage with the content and have thoughtful discussion so we as a society can make changes.
Medgadget: Was there ever concern about “crossing a line” of neutrality when you gave the TEDMED talk, based on your position as a journalist and editor?
Oransky: That’s a good question. The whole notion of objectivity and neutrality in all journalists is somewhat misplaced. What we really want in our reporters is honesty, fairness, open-mindedness, and the ability to synthesize and present relevant information. Journalism is really about showing where the evidence lies, and if all of the evidence points towards one side, one need not devote half the article to the other side to make appearances of being balanced. Jay Rosen, a colleague of mine at the school of journalism at NYU, has written great stuff about this.
For example, take the over-medicalization issue which has many economic and health ramifications. There’s a joke about what the first biopsy you get when you walk into the ER is: a wallet biopsy. The evidence shows that we need to think not only about the economics of ubiquitous screenings; it’s also not clear if it’s doing more harm than good by testing every man over 50 for a PSA each year. These are serious things to think about and questions to ask. Some people may come up with completely different answers. What we as journalists cannot do is spoon-feed our public with answers and expect them to trust us. Our audience needs to have the ability to think critically about the medical evidence.
Medgadget: What motivated you to devote much of your career to shining a spotlight on medical evidence?
Oransky: I’ll give you an example from the realm of conflict of interest when I was a psychiatry resident at Yale. New Haven is known for its pizza, so drug reps at a certain pharmaceutical company invited us to come by a restaurant and enjoy some pizza. Many of my colleagues wanted to get back home to their families after a long day, so they said that we could come in, order, and they’d talk to us only during the time it took to cook the pizza. I found out later that the reps had previously talked to the owners of the restaurant and had them turn down the cooking temperature of the oven, so the pizzas would take longer to cook, and thus they’d have our ears for longer.
Though this is sort of an innocuous occurrence, it speaks to the conflicts of interest that often arise in the healthcare industry. Another example: In terms of scientific publishing, very few journals actually make public retractions of work they published, which is why we’ve used Retraction Watch to make people aware of incorrect or false results from clinical trials. We need more transparency in healthcare.
Medgadget: TEDMED also featured a number of other talks on topics that we cover daily, such as artificial organs and flexible electronics. What do you view as the most exciting trends in medicine or medical technology?
Oransky: The most exciting developments for me are where people are starting to realize that maybe less is more. Not to sound like a broken record, but we need to be able to figure out who will actually benefit from some of our treatments. It’s not the most cutting-edge (most expensive) technologies or treatments that excite me the most. It’s the technology of databases, computing, etc. that will help us enter the realm of personalized medicine, where not every person gets screened for everything, but we can target our treatments to those who will actually benefit.
Medgadget: What do you think about the rise in consumer-based health monitoring devices?
Oransky: The jury is still out on whether a lot of these consumer-based devices work. For example, here at Reuters we cover studies about electronic medical records each week, and many of these show that EMRs don’t necessarily do anything for quality of care. There are other reasons to use EMRs, of course, but when you study some of these consumer apps and devices carefully you actually may not see much of an effect, positive or negative. We need to figure out what actually works in this sea of information.
For more information about Dr. Oransky, read this article & interview at the OtherDoctors.com.
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