Volume 46, Number 1, Spring/Summer 1998

Spinning The News In War On Cancer Has Long History

by Victor Cohn

On December 4, 1970, with ritual summons of the Washington press, a lame duck Texas senator named Ralph Yarborough -- an old fashioned liberal who had just been defeated in a Democratic primary by Lloyd Bentsen--introduced the historic "Conquest of Cancer Act" that launched what was called a "crusade" against this ubiquitous disease.

The media's coverage of that crusade and health and medicine were generally examined one weekend last winter [February 27 to March 1] at Long Island's Cold Spring Harbor Laboratory. In the view of most of the participants, that coverage earned what one participant--this writer--would call a gentleman's C. The occasion was a conference sponsored by the NCI-Designated Cancer Centers Public Affairs Network and that biological laboratory.

Senator Yarborough, back in `70, sought to implement what members of a select panel--notably including Mrs. Mary Lasker, the Fairy Godmother of the National Institutes of Health--were calling a "moonshot" against cancer, patterned after our landing on the moon 21 months earlier. "We are so close" to conquering cancer, said one panel member, that pioneer of chemotherapy, Dr. Sidney Farber. Some panel members even spoke of conquering cancer by 1976 to celebrate the nation's 200th birthday.

I was present for The Washington Post as Sen. Yarborough spoke. I left alongside a colleague from The New York Times. He shrugged. Most of the cancer scientists are put off by this, he said--accurately. They know there wasn't the basic knowledge yet to start promising the end of cancer, this wasn't going to go any place. He wrote an unenthusiastic story that the Times printed on page 22.

I said, Hell, he's enlisted Ted Kennedy and Jacob Javits, two powerhouses. Nobody's going to vote against cancer. I emphasized that kind of support, and the Post ran the story on page one. For once I was right. President Nixon, who initially opposed the idea as a budget buster, embraced it in his January 1971 State of the Union address. He was not about to let Teddy Kennedy get credit for conquering cancer. And after some months of maneuvering over how to absorb the new crusade into NIH, Mr. Nixon signed the Conquest of Cancer Act the following December. Despite progress, cancer of course was not conquered by 1976. Or 1986. Or 1996. It's a tough fight.

What role did the media play in the overwhelming acceptance of this crusade? I heard no argument at Cold Spring Harbor with the fact that, in effect, we were mainly cheerleaders. The positive far outweighed the negative in our stories. There was too little examination of the relative costs or importance of various ways to improve America's health, or whether researchers were ready for a "moonshot" against cancer.

This is not to say that more questions would or should have shot down the effort. But there was not much real discussion, and much dangerous hoopla and hyperbole. Dangerous because over-promise leads to disillusionment and has helped lead to today's massive lack of confidence in mainstream medicine.

In one of the conference's first presentations, Dr. Vincent DeVita, former head of the National Cancer Institute, now director of the Yale Cancer Center, himself an author of some of chemotherapy's triumphs, said the public has been "led to believe" that the war on cancer is a failure, though it is a growing success.

Blame that original and continuing over-promise, said some respondents. "We've been losing the war on cancer in the minds of the public because of over-promise," maintained Eric Rosenthal, public affairs director at Philadelphia's Fox Chase Cancer Center." Cristine Russell, special correspondent for The Washington Post, complained that: "We're still using the language, 'the war on cancer,'" which implies "to the public that it can be won if enough money is spent." There is exaggeration, she said, both in the news and in scientists' reports and statements that feed the news, with journal articles more or less conquering cancer every week, and "scientists and institutions vying for attention ... with their own PR fixes."

Indeed, agreed Dr. Zack Hall of the University of California at San Francisco, former director of NIH's National Institute of Neurological Diseases and Stroke, "The very act of raising the money leads to distortion....In order to mount a campaign it's necessary to believe that the end is near....Another hundred million and we can make it." This is accompanied, he said, by a battle between disease groups in which "each has its own statistics," often exaggerated, "which emphasize that it doesn't get as much money as the others."

What it all leads to, said Russell, is hype. Abandoning hype of course is the cure, though not an easy one. We want to get that story on Page One or the Evening News, and sometimes passion overcomes judgment. We are also human. We too want cures of the diseases we fear, so we too want to believe. And then--a dilemma for all who want to conquer disease--the nation's entire research establishment, including that jewel of research, NIH, was built in large part by public crusades, including generous hype.

"Can you sell what you believe if you're honest?" asked Andrew Holtz, a Portland writer. "Or do you have to sell a cure?"
"We have to find a way," said Dr. Frank Rauscher III of the Wistar Institute Cancer Center, whose own father, a director of the National Cancer Institute, said during that battle for a cancer crusade, "We're so close to curing cancer, you can taste it."

How to do better? Many reporters are doing better, others worse. The coverage of mammography, of cloning, of alternative or "complementary" medicine--"complementary," the latest euphemism--were also examined, with praise and with criticism.

The goal, many of us would say, is to apply some of the rules of science itself--the laws of statistics and probability--to separate the probable truth from the probable trash in what we report, and to place the "ifs" and "buts" high in our stories, not in the umpteenth paragraph, too common in print, or with a throwaway phrase at the end of a glowing report, too common on the tube.

For the hype continues. On January 29, Vice President Gore, advocating an increase in cancer funds, said, "We want to be the first generation that finally wins the war against cancer. For the first time, the enemy is outmatched."

Ouch.

Cohn's Remarks at "Breakthrough" Conference

[Following is a digest of Cohn's own remarks at the Cold Spring Harbor Conference on the dangers of exaggeration and disillusionment.]

As we continue to report on the "crusade against cancer"--and on all health and medical news--the danger of exaggeration followed by disillusionment is a lesson to be remembered. Hoopla and hyperbole still exist.

There is a great deal of good science and medical reporting today, far more than when I wrote my first science story 51 years ago. There is also plenty of bad reporting, and much mediocre reporting that could easily be better.

I think there remain three main sins or problems with our reporting. I know because I have been guilty of all of them.

First, we tend to "believe" everything we hear--IF it's a good story. If it's a good story, we go with it. OK, not always. And in some media more than others--on the TV news more than in print, though often enough in print.

Far too often, however, editors and news directors and reporters fail to apply--hell, they don't even think about some of the very simple rules of science and statistics that can help us separate the probable truth from the probable trash.

One such statistical concept is called "power," simply meaning the power of large numbers to help confer believability. Here's the lead of an AP story--"Technique May Aid Acceptance of Transplants"--that appeared in The Washington Post and that I also saw played hard on the ABC Evening News: "A four-week series of protein injections, done in monkeys, appears to teach the immune system not to reject transplanted organs." Etc.

Well, that would be wonderful. But in how many monkeys was this accomplished? Read way down in the story and you learn that all of eight got the magic shots, of whom six ultimately rejected the transplants. At the time of this report, only TWO were still "alive and well." There's an old saying--"For instance is not proof."

At the time that I joined The Washington Post in 1968, there was an old-time medical reporter on the Post named Nate Haseltine who would not have written that story, or many like it. Nate said, "Mice are not men." We see a lot of animal stories today that ain't going to pan out in men. Or women.

Second, there is a lot of hype. Take some recent headlines. A Newsweek cover asked "The End of AIDS?" Okay, it added "Not Yet"--but the overall impression was "New Hope." Yes, there has been a dramatic stride against AIDS. Some patients may at least stave off the ravages of the disease by a daunting and expensive combination of drugs taken several times daily. Yes, they seem like a miracle to some. But they don't work for everyone. They don't always keep working. They are so expensive that many patients can't get them. And they are already failing in some patients in whom they seemed to work. No one knows yet how long they will keep working, when they work.

Third, a lot of stories suffer from what I'd call lack of context or wholeness. They are either incomplete when it comes to what viewers or readers or any of us would want to know, especially for intelligent decision-making. Or fail to put the story in context, to report a whole picture. Here's a Time magazine special issue on a number of today's "Heroes of Medicine." Deploying many of medicine's new tools, many of them expensive and adding mightily to the high medical costs that are preventing our bestowing their wonders on large parts of our population. In the entire issue, only one brief mention of cost--about the high cost of heart surgery, of bone marrow transplants or anything else. No mention of anyone trying to bring these wonders to the poor and uninsured.

Our stories are often incomplete. Researchers wrote in The New England Journal of Medicine (December 16, 1993) that "one to three drinks" a day may help protect against heart attacks. They defined a drink as 13.2 grams of alcohol on average. But with whiskey, wine and beer all at various "proofs" or alcohol content, neither the NEJM article--nor any news reports I read or saw told how much daily booze, wine or beer contained the prescribed grams. A freely pouring drinker could pour far more.

A sharp magazine editor once told me, "Don't leave any unanswered questions." He didn't mean every possible question, but the questions that will pop into people's heads.

Let me conclude with a cautionary comment about health news by that wonderful critic, Mark Twain. In his time, he was talking about "health books," but the meaning is the same. He said, "Be careful about reading health books. You may die of a misprint."