Are medical reporters recommending vitamin D screening?

Are medical reporters putting themselves in the position of recommending vitamin D screening?

Gary Schwitzer worries about that in a post on his blog at HealthNewsReview.org. “Whom you interview, and how you end a story can have a powerful framing effect on the takeaway message for readers.  It is one clear way that stories become biased,” he writes. “I’ve pointed to an apparent media bias in favor of screening.  Sometimes it’s overt.  Sometimes it’s subtle.  But it happens a lot.”

Let’s stipulate that medical writers, no matter how much they’ve written about vitamin D or screening, are in no position to make recommendations. And I trust that most of them would say they do no such thing. But does carelessness with their copy put them in that position?

Schwitzer dissects a post on the Well blog at The New York Times, which reports the following:

A government health panel on Monday chose not to endorse widespread screening for vitamin D levels in healthy adults, despite research suggesting that a majority of Americans may be deficient in the vitamin.

The United States Preventive Services Task Force, an independent group of health experts, decided not to recommend routine testing for vitamin D levels in part because it was not clear whether otherwise healthy adults with low levels would actually benefit from taking supplements of the vitamin.

The panel concluded that “there was not enough evidence to either endorse or advise against regular vitamin D screening in most adults, and they suggested that testing is something that should be considered case by case,” Anahad O’Connor reported.

O’Connor is weak on backing up the idea that a majority of Americans may be deficient in vitamin D, writing that “some studies estimate that more than two-thirds of Americans are deficient in it.” Which studies? And “some studies” suggests there were others that didn’t find that. Where are they?

The story quotes two people: A member of the task force, who elaborates on the findings, and a doctor at the Cleveland Clinic who told O’Connor, “They’re saying that if doctors decide to do it, that we should tell the patient that we’re not positive whether it will make a difference and we’re not sure if more good will come from it or more harm.”

That’s what drove Schwitzer–and others who contributed comments on O’Connor’s post–into orbit. If it’s unclear whether it makes a difference, they asked, why do it? Why does the story lean so heavily–and conclude–with the opinions of one individual, when the panel, with its organized study of the question, would seem to be far more authoritative? Is O’Connor unintentionally sending readers a message that vitamin D screening is O.K., despite the views of the panel?

And note that word “despite,” which O’Connor uses in her lede. As one commenter points out, “Use of ‘despite’ in the first sentence suggests that the author disagrees with the task force’s conclusion, or (wrongly) that the decision was questionable, inappropriate, or controversial.” (See Schwitzer’s post for the details.)

The story didn’t get a lot of coverage–Google news displayed about two dozen links. One of them went to a story by Kim Painter at USA Today, who was clearer about the unknowns. There “simply isn’t enough evidence” that screening healthy people will improve their health, she writes. Where O’Connor wrote that “a majority of Americans may be deficient” in vitamin D, Painter wrote that while low levels of vitamin D have been linked to illness, studies “have not shown” that vitamin D supplements will help. She doesn’t specify what studies those are, but it appears she got that from the panel’s report.

She does a better job of balance, quoting two people outside the panel–one who favors screening, and one who doesn’t. She ends by noting that the Endocrine Society recommends vitamin D testing for those who are “obese, pregnant, or dark-skinned” and a few others with medical problems. But she doesn’t write that it’s useful for healthy people.

Max Gomez at the CBS affiliate in New York City leads off by suggesting that we don’t get enough vitamin D, before he interviews a member of the panel. He interviews a patient with rheumatoid arthritis who tells him she needs it for her arthritis, and he says there are studies showing it could be an immune-system booster–a claim that isn’t backed up, and one I’d approach with a good deal of skepticism until shown otherwise. Gomez’s piece is, however, a reasonably balanced report–and it does not come out in favor of screening.

Still, Schwitzer is right to worry about a pro-screening bias on the part of reporters. I think I can understand that; we’d all prefer to be screened rather than diagnosed. Screening offers the hope of preventing disease, in addition to treating it. We want to write the story about screening that, say, can be used to prevent rheumatoid arthritis, or other serious conditions.

But we shouldn’t write that story before its time.

-Paul Raeburn

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