Venal, misleading, pathetic, dangerous, stupid, and busted

March 21st, 2009 by Ben Goldacre in bad science, evidence, media, screening | 69 Comments »

Ben Goldacre
The Guardian
Saturday 21 March 2009

Science is not difficult to explain. Today we will see how British journalists go out of their way to cherry pick which evidence they cover, and then explain the risks and benefits in what has been shown to be the single most unhelpful way possible.

“Screening all older men for prostate cancer ‘could reduce deaths by a fifth’” said the Mail. “Prostate cancer hope” said the Mirror. Calls for new policies on NHS cancer tests said the Independent. Prostate cancer screening could cut deaths by 20% said the Guardian. Better cancer screening is every man’s right was the editorial in the Scotsman, where they wound themselves into a froth of indignation.

But was this just British journalists finding something to complain about? Because all around the world, people were saying something completely different, on the same day, about the very same academic publication: Prostate Cancer Screening May Not Reduce Deaths said the Washington Post. Studies cast doubt on leading prostate cancer test said USA Today. PSA testing may not save your life, after all said Scientific American. Prostate cancer blood test does little to decrease death rate said the Sydney Morning Herald. And so on.

Why would the American and the Australian journalists say something completely different to the British ones, about the very same evidence?

Firstly, our journalists were simply confused. Not a single newspaper managed to clearly explain the risks and benefits of screening in the trial they were writing about. It’s very simple: the study took over 160,000 men between the ages of 55 and 69 and randomly assigned them either to get PSA screening, or to be left alone. The differences were marginal. Yes, there were 20% fewer deaths in the screening group. What does that mean in terms of real people, in real numbers you can understand, not percentages?

1410 men would need to be screened to prevent one death. For each death prevented, 48 people would need to be treated: and prostate cancer treatment has a high risk of very serious side effects like impotence and incontinence.

These figures are not hard to find: they are in the summary of the research paper.

For complex risk decisions like screening, it has been shown in three separate studies that patients, doctors, and NHS purchasing panels make more rational decisions about treatments and screening programmes when they are given the figures as real numbers, as I did above, instead of percentages. I’m not saying that PSA screening is either good or bad: I am saying that people deserve the figures in the clearest form possible so they can make their own mind up.

Journalists meanwhile – professional communicators no less – all used impenetrable percentages, called “relative risk differences”, or worse. The piece by the Guardian’s health correspondent quoted several entirely meaningless numbers. “214 prostate cancer deaths had occurred in the screening group and 326 in the “control” group.” Without explaining the other numbers in each group, these digits are hardly more than decorative. It went on: “The rate of overdiagnosis – defined as diagnosis in men who would not have clinical symptoms during their lifetime – was as high as 50% among those who were screened.” I cannot see how this number helps me understand the risks.

image But it gets worse. British journalists also deliberately ignored one whole half of the research, and I’ll confess I’ve slightly lost my sense of humour over this. There were in fact two large studies on PSA testing published in the New England Journal on the 18th of March 2009, not one. They were both published on the same day, in the same journal, they are side by side on the same contents page. British journalists discussed only one of them: the one that said PSA screening does reduce deaths.

The study they ignored was huge too: it took over 75,000 men and randomly assigned them to either a screening programme, or no screening. It found no difference in death rates between the two groups at all, and in case you think it was a close thing, in fact, there was a non-significant trend towards more deaths in the screening group. Not one UK newspaper mentioned this trial.

So newspapers ignore one half of the evidence, and they fail to explain the other half properly. In the past, nobody could catch them, and nobody could compete with them. That has now changed. Anyone can write, and publish online, and appear in Google news alerts: the NHS, medical research charities, individual academics, journals’ press offices.

These people are intelligent, informed, and they can explain things clearly, without worrying about eyecatching hysteria, or space, or hyperbole. Some will be silly, some won’t be. If they ignore half the evidence, they will be busted in the comments, mocked, and sensible visitors will never come back. They can also link directly and transparently to scientific papers, which mainstream media still refuses to do. Journalists insist that we need professionals to mediate and explain science. From today’s story, their self belief seems truly laughable.

References:

Andriole, G.L. et al. Mortality Results from a Randomized Prostate-Cancer Screening Trial. N Engl J Med NEJMoa0810696(2009).doi:10.1056/NEJMoa0810696

Schroder, F.H. et al. Screening and Prostate-Cancer Mortality in a Randomized European Study. N Engl J Med NEJMoa0810084(2009).doi:10.1056/NEJMoa0810084


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69 Responses



  1. GrahamJackman said,

    March 21, 2009 at 1:31 am

    Maybe it’s all the exposure to medical scientists, who try to make their results seem more impressive than they really are! We justify it to ourselves as a way to improve clarity but I always try to apply the “bleeding obvious” test, or ask myself that if a correlation is so good, can I accurately predict one variable from another and most importantly, it may be significant statistically but has it any clinical utility?

  2. Ben Goldacre said,

    March 21, 2009 at 1:39 am

    can you show me some evidence that the NEJM misrepresented or overstated the more positive one of these two trials? their accompanying editorial was titled “Screening for Prostate Cancer — The Controversy That Refuses to Die”. i’ve not seen the press release from NEJM, but even if it did mention only one of the two studies, which seems very unlikely, and overstated its findings, there is still no excuse for failing to read the abstract of the academic paper, and the contents page featuring both papers is the first thing you find on the NEJM home page.

    i have no idea wtf british journalists thought they were doing or why. i am all ears for an explanation. normally i think this stuff is funny but i’ve really lost my sense of humour this time, this was just too extreme.

  3. The Biologista said,

    March 21, 2009 at 2:21 am

    It does seem rather baffling. Trying to give the morons the best possible benefit of the doubt here by assuming they must just never have picked up the journal in question. That still makes them total morons. Surely this must all have been based on some single news source, fed to the UK papers, that focused on the one study and not the other? Otherwise this is an astounding coincidence.

  4. The Biologista said,

    March 21, 2009 at 2:28 am

    Can I just say though Ben, please don’t lose your sense of humour on this. It’s undoubtedly your best weapon. If you want someone who can use blind rage as a weapon, perhaps mention this to your colleague Mr. Brooker!

  5. fox_renard said,

    March 21, 2009 at 2:34 am

    If as you are saying ben that journalists deliberately ignored the evidence that was easily available to them. Then why did ALL the major British newspapers cover the story in the same manner. Clearly unless there is an unneccesarily complicated conspiracy between all British science journalists then it must be the result of them all lazily copying one person. Who was that person? because they must solely be responsible for this deliberate misleading of the British people and why did they do this? Purely to present some happy medical news to brighten up people’s day? It seems unfathomable.

  6. Ben Goldacre said,

    March 21, 2009 at 2:45 am

    yup, obviously i’ve been giving this some thought.

    the academic papers came out on the 18th and most UK coverage appeared on the 18th late or on the 19th.

    it is possible that the brit’s interest was triggered by this press association piece:

    www.google.com/hostednews/ukpress/article/ALeqM5jRLmLQ_Ot_bqBzZELDGYbo_LKfsA

    however this does not contain all the figures they used. so they must have dug deeper, and then ignored what they didnt like? i dont know. be nice if some of them came out and said what happened. i’d love to know how they work.

  7. fionn said,

    March 21, 2009 at 2:46 am

    Ben,

    I think I understand why you’ve lost your sense of humour on this. It’s not just stunning incompetence… it’s an otiose lapse in epistemic responsibility for people for whom epistemic responsibility is paramount.

    What bothers me… what really really bothers me… is how utterly unprincipled you and others like you reveal *science journalism* to be, and how correspondingly awful and skewed the other investigative sorts of journalism are likely to be by pessimistic induction.

    I like to be an idealist, and think that the organs of communication in a democracy are integral to its proper functioning. That, as journalists, as people with a wide readership, and with a certain measure of power over the evidence with which people think, they have a responsibility to tell the truth, or as near as they can make it.

    As such an idealist, the rot you adduce in the mainstream media is such a desperately poor omen for the state of our Western democracies.

    I think you are doing something important… something far more important (although that is important enough!) than defending the public understanding of science.

  8. chascoppard said,

    March 21, 2009 at 2:49 am

    Newsnight did report this properly, both studies were mentioned and they did have exponents for both sides. I think the figures were a little more meaningful as well.

  9. The Biologista said,

    March 21, 2009 at 3:04 am

    It’s hard not to start jumping at shadows on this one, but the Prostate Cancer Charity seem to be pushing this agenda. Perhaps they issued a press release in response to one of the studies which then go picked up by The Press Association?

    Perhaps it was this:
    www.prostate-cancer.org.uk/news/news_detail.asp?id=1250

  10. The Biologista said,

    March 21, 2009 at 3:06 am

    Prostate Cancer Charity: “Many men in the UK are unaware of their risk of prostate cancer and their right to make an informed decision about whether to have a PSA test. This is clearly unacceptable and must be changed. Countless men face opposition from their own GPs, who themselves are either not fully aware of the issues surrounding the PSA test or do not support a man’s right to make an educated decision to take the test.”

    I think idealistic activism is meeting science and they don’t get on.

  11. zac said,

    March 21, 2009 at 3:20 am

    Ben, I think you’ve hit it — the UK Prostate Cancer Charity looks like it may have been the flashpoint for the odd reporting over there.

    Scotsman’s editorial may well have been in response to this earlier article about the Scottish wing of that charity:

    news.scotsman.com/health/Call-for-all-over50-men.5078569.jp

    Since the charity came out with their position very early, it’s possible they were only aware of the European study, and of course are probably likely to react energetically to any new results, if only to get as much publicity coverage as they can (as a charity, it’s hard to judge that action too harshly — they depend on publicity to raise support).

    Google news (grouped by topic, sorted by date) is a nice way to drill down to the first few reports.

    Interestingly, one of the better early articles I saw was on the online Wall Street Journal, which I didn’t realize even did medical reporting at all!

    online.wsj.com/article/SB123739138165572031.html

    As long as the major reporting organizations are profit-based competitors, we will continue to see this kind of regional “file a louder report than they did at Paper X” nonsense.

  12. Ben Goldacre said,

    March 21, 2009 at 3:30 am

    yes. i think it’s likely that they were peddling a line from the prostate cancer charity. however there are still those figures in the uk journalists’ pieces that came from the one nejm paper, and werent in the charity press release or the PA piece.

    in which case maybe they were told about the figures in the paper by the prostate cancer charity and didnt bother to read it themselves, which seems possible since they were expressing the figures in the most stupid way possible, and there was an invitingly transparent way to explain it in the abstract of the academic journal article itself which surely any sensible person would have taken.

    i dont know, i’m not going to go asking, but in all honesty i think i would be a little impressed if at least one of the journalists involved in this ricockulous saga could consider stepping up and volunteering an explanation themselves.

  13. The Biologista said,

    March 21, 2009 at 3:38 am

    Ok, so I reckon the Charity press release I posted earlier fed into the Press Association’s article-in-a-can and poked the UK papers. Perhaps the detail came from something like this:

    www.alphagalileo.org/ViewItem.aspx?ItemId=56260&CultureCode=en

    Or similar. Not sure how the timing works on that though. When was the story in print in the UK papers?

  14. sampablokuper said,

    March 21, 2009 at 6:39 am

    Good catch, as ever.

  15. GMcP said,

    March 21, 2009 at 7:45 am

    “i’m not going to go asking”

    Could you not at least have a word with Sarah Boseley, health editor at the Guardian? Perhaps naively, I would have thought the two of you would be in regular contact.

  16. muscleman said,

    March 21, 2009 at 7:49 am

    i suspect the British journalists were campaigning Ben, plain and simple. There are those in the ‘Men’s Movement’ who see the lack of a prostate screening program as a matter of equality with women, who have breast AND cervical cancer screening programs. The issue then is not one of whether or not the test is worthwhile, they simply want a test.

    I’m not yet 50 but for the record if offered a PSA test I will decline on the basis that it does not screen for cancer. There are several promising prostate cancer biomarkers in testing, that’s what we need to focus on. Oh and better therapies as well, it’s a bit of a Hobson’s Choice at the moment.

  17. badblood said,

    March 21, 2009 at 7:55 am

    I’d be willing to get there was a press release involved – journalists are lazy, they don’t have journal access, and it is very unusual to see such a uniform take unless there was a single source. Call up a journo off the record and ask how they first came to learn about the research. In my field it’ll usually be a pharmaceutical company marketing rep.

  18. thepoisongarden said,

    March 21, 2009 at 8:23 am

    I’m not sure the Prostate Cancer Charity are to blame. As well as the link The Biologista gave they issued two other releases on their website;

    www.prostate-cancer.org.uk/news/news_detail.asp?id=1252

    www.prostate-cancer.org.uk/news/news_detail.asp?id=1249

    They both mention ‘two major studies’ in the opening sentence.

    The New England Journal of Medicine has the US study above the European one on its site contents page content.nejm.org/

    And if journalists wanted to be lazy they need only go to the NHS Choices ‘Behind the Headlines’ page www.nhs.uk/news/2009/03March/Pages/Reviewofprostatescreening.aspx to get all they needed for a proper report.

    I wonder if there’s a ‘Daily Mail’ effect. As a journalist you know the Mail will report any cancer story as miracle cure or certain death so if you write a story which says ‘interesting but not significant’ you’ll probably get a kicking for not helping sales.

  19. thepoisongarden said,

    March 21, 2009 at 8:31 am

    I think I’ve found it. The European Randomized Study of Screening for Prostate Cancer (ERSPC) issued its own press release at the time of online publication in the NEJM.

    www.erspc-media.org/release090318.php

    This led to

    news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/03-18-2009/0004990803&EDATE=

    which suggests the journalists didn’t even look at NEJM and didn’t know about the other study.

  20. gregpye said,

    March 21, 2009 at 9:50 am

    The piece that made your blood boil does feel an irritating, but was it really that lazy? I’m not normally in the habit of supporting journalists on this sort of stuff (far, far from it). But, many news feed services, such as that shown in comment 13, do a deep link directly to the paper, not to the NEJM homepage. And, whilst it might have been nice if the journalists had done a wider search for evidence, there doesn’t feel like a specific reason to look on the NEJM homepage to see if there happened to be another paper of relevance there. There could have been one in another journal, or one published some while back. So, I get much more irritated by the lack of deep enough knowledge in the domain by the journalists who are ‘educating’ their readership, and the dreadfully poor grasp of statistics, than I do by the failure to have chanced across the second paper.

  21. thepoisongarden said,

    March 21, 2009 at 9:59 am

    gregpye

    ‘the failure to have chanced across the second paper.’

    But, surely, these are supposed to be specialist journalists who just might be expected to understand than one study may not tell the whole story and might be expected to do a quick search to see if there was anything else on the topic which they could include in their report?

    I’m not sure we should be satisified with any journalist just waiting until they happen to have ‘chanced across’ a story.

  22. Bob Ward said,

    March 21, 2009 at 10:31 am

    Ben, not for the first time you are shooting at the wrong target. As others here have pointed out, the Uk media coverage was generated by the media release that was distributed by the host institutions of the European authors of the PSA study. The reason, I suspect, that the other study wasn’t reported in the UK media was that the authors were Us-based and their host institutions did not distribute the release to UK journalists. Indeed, UK journalists tend to rely on the AlphaGalileo service for media releases, mostly posted by Europeans, whereas US media use EurekAlert, mostly used by US insitutions.

    I’ve pointed out before that journalists working on the daily newspapers do not have the luxury of an entire week to write one piece (unlike your column) and so rely heavily on media releases, rather than wading through medical journals when they need to write an article over just a couple of hours.

    So, Ben, if you want to improve the quality of reporting, you should investigate a bit more about the role of media releases and start aiming at those that are misleading and inaccurate, rather than automatically blaming journalists.

  23. Dr Jim said,

    March 21, 2009 at 10:34 am

    Even if journalists don’t always have access to online scientific journals, they certainly do have access to phone and emails that they might use to glean a greater understanding directly from the scientists involved, or from the university press officers (who should be consulting with the scientists).

    Then again, it is another argument for Open Access academic journals, rather than to continue burying the much of the evidence we so often quote behind layers of expensive subscriptions or $30 articles.

  24. gimpyblog said,

    March 21, 2009 at 10:43 am

    Bob Ward

    I’ve pointed out before that journalists working on the daily newspapers do not have the luxury of an entire week to write one piece (unlike your column) and so rely heavily on media releases, rather than wading through medical journals when they need to write an article over just a couple of hours.

    Fair point that press releases should be more accurate, but are you really justifying the fact that journalists aren’t checking their sources? A trained monkey can rewrite a press release, I thought journalists were meant to check facts?

    It really doesn’t take more than 15-20 mins to scan a paper to see if the press release matches the data. You will probably not see the complex arguments or any awkward data and results the authors are trying to hide in the body of the text but the general gist will be clear.

  25. biggerpills said,

    March 21, 2009 at 10:44 am

    “it is possible that the brit’s interest was triggered by this press association piece:

    www.google.com/hostednews/ukpress/article/ALeqM5jRLmLQ_Ot_bqBzZELDGYbo_LKfsA

    I’m very interested in that piece too Ben. About a year ago I worked in the press office of another cancer research organisation and we took a completely different approach:

    Last year one of our teams got some very promising results from Phase I clinical trials of a new treatment. As promising as the results were, the treatment was in a very early stage of development and its availability on the NHS was a long way off.

    It was my job to write the press release and I was told- repeatedly and in no uncertain terms- to play it down and avoid giving anyone false hope. We were even planning a press conference to try and keep this thing under control, because we knew there was a risk of journalists getting carried away with their coverage.

    I’ve just dug out the press release and see the copy I have here is the sixth draft. I’ve also looked it up on the organisation’s website and I can see it went through even more rewrites after I left. I’ve also looked up some of the coverage the story got and can see we managed to control it pretty effectively, with no-one getting hysterical about the findings.

    …so, with the NEJM paper, somewhere along the line someone has been irresponsible, but when, and who? It really is hard to tell with this one.

    @muscleman #16: Good points, and here is an earlier Mail article on PSA screening:

    tinyurl.com/dmxdf7

    “Some experts, including many doctors in America, dismiss the value of a PSA test because it can alarm men unnecessarily.” See how those “doctors in America” are dismissed while Uncle Max (one of the 1 in 48 it seems) is allowed to have his say. Now with this: content.nejm.org/cgi/content/full/NEJMoa0810696 those pesky doctors in America are being ignored again. Looks like there is definitely some campaigning going on here, by journalists, PRs *and* charities.

  26. sophiedb said,

    March 21, 2009 at 10:45 am

    They may not have the luxury of a week, but 5 minutes with Google can’t be that big an ask, surely? If the papers don’t have time to get their facts straight, editors should start thinking about hiring more journos rather than giving people (in this case) an unjustified sense of hope.

  27. chatsubo said,

    March 21, 2009 at 11:01 am

    I had the dubious honour of writing the prostate cancer article on the NHS Choices website, and as you would expect, I am a second rate humanities graduate with little previous medical or clinical training.

    But after 60 minutes reading the clinical guidelines and relevant Cochrane Reports on screening it was obvious even to a layman like me that screening carried some pretty large disadvanatges.

    You would expect science journalists to do the same sort of minimal research – logging onto the NEJM website isn’t much of an ask, is it as sophiedb said.

    Though personally I think the misinterpretation was deliberate not a sin of omission – plays into the rolling news need for a state of permanent public outrage at the NHS, New Labour, the weather etc

    As an aside – even though I shouldn’t – have become addicted to the Daily Mail messageboards, and found a new gem

    ‘This is another HALF BAKED idea of this oivernment
    It should be VOLUNTARY not Compulsary
    A person Body is their responsiblity NOT this load of MUPPETS
    Again this lot are POKING their noses into people’s private affairs ‘
    Time that they STOPPED

  28. Bob Ward said,

    March 21, 2009 at 12:15 pm

    I am willing to bet that the authors of the European study approved the press release that was distributed by the European Association of Urology. And frankly, if journalists had to assume that all parts of a press release were wrong until proven otherwise, then it would defeat the object of using the release in the first place. And why stop there? Why not assume that the journal papers are also wrong until verified by a second source? The answer to both is that it would be unworkable, reducing both the quality and quantity of coverage of science and medicine in the general news media.

    It may not be desirable that journalists have such ridiculously short deadlines (even shorter these days with online news, 24-broadcast news and shrinking incomes) but it is a fact. Newspapers could of course employ two or three times more journalists, but then readers would need to stump up five or six times more money each day to buy the newspaper.

    How about this? Ben persuades The Guardian to try an experiment, by letting him work for a week as a health reporter and see how he copes? It would probably benefit both Ben and his colleagues in the newsroom.

  29. cenderis said,

    March 21, 2009 at 12:15 pm

    Isn’t this just normal journalist behaviour: report something controversial? For the UK press that means reporting that screening saves lives (because screening isn’t normal in the UK), and for the US press it means reporting that screening probably isn’t worth it (because PSA screening is normal there).

    It looks like the UK journalists had to be more creative with the actual story involved, but otherwise it’s not really surprising, is it? I mean what’s the news value (in the sense of selling newspapers, rather than any deeper sense) in “PSA screening quite likely not worth it, so current government policy is just fine.”?

  30. Henry said,

    March 21, 2009 at 12:48 pm

    You might find answers if you look at the bigger picture – the Sun is currently campaigning to have the cervical screening age lowered;
    www.thesun.co.uk/sol/homepage/news/article2274203.ece

    there’s a rumbling controversy over informed consent in breast screening;

    www.bmj.com/cgi/eletters/338/jan27_2/b86

    and we’ve hit the ‘Government bashing’ part of the electoral cycle.

    Seems natural to me that screening’s going to be used to score political points for a while… and the evidence will likely be bent to fit…

    way of the world innit.

  31. DrFred said,

    March 21, 2009 at 12:57 pm

    Not sure what position this supports, but the New York Times seems to have gotten it right;

    www.nytimes.com/2009/03/19/health/19cancer.html?_r=1&em

    Are they better science journalists, or, as cenderis points out, PSA is more available here – (if you have the third party insurance to cover it).

  32. jodyaberdein said,

    March 21, 2009 at 1:31 pm

    Re Bod Ward, Dr Jim

    Yeah I can see how a major news organisation would struggle to stump up for an athens subscription, and how if your a health journalist then the friggin New England Journal of Medicine would be deemed just a bit too specialised to read each week.

  33. Ben Goldacre said,

    March 21, 2009 at 2:03 pm

    Bob Ward:

    “Ben, not for the first time you are shooting at the wrong target…I’ve pointed out before that journalists working on the daily newspapers do not have the luxury of an entire week to write one piece (unlike your column) and so rely heavily on media releases, rather than wading through medical journals when they need to write an article over just a couple of hours.”

    hi bob, misleading press releases are something i’ve written about many times before.

    i’ll admit i’m a bit reluctant to spend any time engaging with you on this after the bizarre episode recently when you repeatedly and bafflingly claimed that the key misunderstanding of a telegraph piece was caused a misrepresentation in the press release, when it very simply and obviously wasn’t.

    www.badscience.net/2009/01/the-telegraph-misrepresent-a-scientists-work-on-climate-and-then-refuse-to-correct-it-when-he-writes-to-them/

    however since you spend a good deal of your time commentating on science and the media and are clearly regarded as something of an expert in the science communication community, i’d like to clear up a couple of things.

    there is a misunderstanding you seem to have made a few times: i am very familiar with the time pressures on journalists, but i obviously dont spend a week on my column, i have a day job, writing this column is a hobby.

    i wrote this particular piece over about four hours on thursday night. in fact it should be obvious that i couldn’t possibly have had any longer to write it: the media coverage on prostate screening came out on thursday, my deadline is friday morning.

    i dont see how a lack of time is a legitimate excuse for expressing the risk in the single most unhelpful way possible, when the best and most comprehensible means of expressing the risk is in the abstract, you wouldnt even have had to read the whole paper.

    equally importantly, when you write an entire piece about one study it seems very reasonable to look at the evidence context with a quick pubmed search, or a scan of the most up to date systematic review. this wld take a few minutes. people do it millions of times a day.

  34. Ben Goldacre said,

    March 21, 2009 at 2:04 pm

    oh, for those who are suggesting the NEJM stuff was hard to get hold of, and behind a paywall, i think that’s incorrect. as far as i can see, they’re coming up for me from home, without logging in, so the articles must be free to access. do let me know if that’s not the case and i’ll get on to the NEJM press office and campaign for them to make them free to access, i think that’s really important always (natch) but especially when an article becomes a big story and cause of concern for the public.

  35. Dr* T said,

    March 21, 2009 at 2:41 pm

    I have full unfettered access to both articles in NEJM. Definately not paywalled.

  36. thepoisongarden said,

    March 21, 2009 at 2:57 pm

    chatsubo

    Just to say thanks. I read all the ‘Behind the Headlines’ stories. It helps to know there is still some sanity in the world.

    Ben,

    Like Dr* T, I’ve just opened not only both papers in full but also the editorial which does a compare and contrast of the two.

    I’m sure with a bit of cut and paste combined with some thesaurus work to cover the plagarism, I could write a piece on this in less time than the poor, hard-pressed journos Bob Ward is so worried about had for their pieces.

  37. lyndon666 said,

    March 21, 2009 at 3:01 pm

    As a lowly NHS labrat, I have the contents of Nature, Science and NEJM e-mailed to me every week. Is it too much to ask for bloody science journalists to do the same, they can probably even afford a subscription?

    As others have said, both the articles and the editorial were open access when I read them on Thursday.

  38. gimpyblog said,

    March 21, 2009 at 4:27 pm

    Bob Ward

    And frankly, if journalists had to assume that all parts of a press release were wrong until proven otherwise, then it would defeat the object of using the release in the first place. And why stop there? Why not assume that the journal papers are also wrong until verified by a second source? The answer to both is that it would be unworkable, reducing both the quality and quantity of coverage of science and medicine in the general news media.

    Your initial argument used the fact that press releases were often inaccurate as justification for this misreporting. I don’t see how your latest argument, that it is unreasonable for journalists to assume a press release is inaccurate, is in anyway consistent with your first?

    As press releases are largely hearsay I think it is not unreasonable to demand that journalists read the research they are writing about. I would also like to see them provide direct references to the original paper in the form of correct citations to make it easier for those who are interested to read the original source (and to check the story is correct).

  39. wilsontown said,

    March 21, 2009 at 4:44 pm

    “I would also like to see them provide direct references to the original paper in the form of correct citations to make it easier for those who are interested to read the original source (and to check the story is correct).”

    I can’t see what possible reason the press can have for not routinely doing this. You could have the reference in small print at the bottom of the piece. It would take up scarcely any room, cost nothing, and allow people to easily look up research they’re interested in.

  40. Liloldlady said,

    March 21, 2009 at 6:07 pm

    The commentator on the papers in the NEJM got it about right when the author said that both PSA sceptics, and supporters, would behold beauty in the results. (Not a direct quote. More of an ‘impressionic re-imagining’. I can’t find my reading glasses to check…) I’m worn out by the issue, having been submerged in it for years up until recently, working for a prostate cancer charity. The PSA test is a 20th century technology whose meaning can be spun from ‘the only thing available’ to ‘the best thing available’ in a heart beat. Neither suffices. But men’ll be stuck with it a while longer. … . We’re 21st century now and should junk it. We need a ‘built for purpose’ test not an ‘it’ll do’ test.

    It seems that if the UK went PSA mad, for every one of the 2,000 lives projected to be saved, there will be 100,000 men who think their’s was one of them and will tell everyone else.

    The ‘I’m Spartacus’ effect.

    We won’t know who’s life was saved but sheer numbers, with a straightforward message, pro test, will. The personal story of a cancer patient is a powerful thing. Medicine by public acclamation.

    Can EBM be subject to majority overthrow? Discuss.

    My personal experience re the PSA test is of having a middle aged, sedentary brother who smokes and could meanly but accurately be described as a ‘bit fat’. This means I won’t be drawing his attention the PSA test any time soon. We ponder on walking more and smoking less. We have discussed Abdominal Aortic Aneurysms (which did for our Dad) and bowel cancer (which did for our Mum)though. Both, incidently, screen detectable. And I still prefer EVIDENCE. For screening, and against it. I don’t have a general sentimental attachment to it. But I do to my big bro’.

  41. RS said,

    March 21, 2009 at 6:22 pm

    If they linked to the paper then the plebs could read it and their ‘expertise’ would be worth nothing.

    Take Sarah Boseley in the Guardian, notorious in the medical profession for a string of crap articles, in one of her latest pieces she tells us about the Million Women study (blog pimp) “[it] cannot easily be dismissed…even a small glass of wine a day increases a woman’s risk of breast cancer…women who want to minimise their cancer (and heart disease) risks…Ideally, don’t drink at all…Almost all of the criticism of the study has been from the HRT lobby – usually gynaecologists and GPs who prescribe the drugs…It can nail down how many women will die because they are obese or they drink every night…”

    The amount of misrepresentation and outright falsehood in that article is breathtaking (consider, for example, that the Million Women study certainly does not show that women who drink no alcohol are healthier than those who drink some alcohol) yet this woman, with no formal qualifications in this area, feels she is a suitable person to be telling the public what they should and should not be doing to minimise their cancer risk and to judge what conclusions can be drawn from epidemiological studies.

  42. Rich said,

    March 21, 2009 at 7:08 pm

    It’s interesting that the paper that gives the “20% deaths prevented” conclusion also says, immediately below the abstract: “Another randomized screening trial in the United States, the Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial, was initiated around the same time, and interim results are also reported in this issue of the Journal”. In fact, the two papers reference each other.

    Just saying.

  43. woodchopper said,

    March 21, 2009 at 10:20 pm

    Ian Sample over at the comments section of the Guardian version of this article suggested that:

    “The one press release I can find referring to work on prostate cancer in that issue of NEJM is from the European Association of Urology. Its title is: “PSA screening cuts deaths by 20%”. I suspect many people who covered the story only saw that too, and I think I’m right in saying that actual copies of the journal don’t land until today, so leafing through to find other studies that aren’t press released is sadly unlikely. This wasn’t a press release from one researcher at one lab. The content and headline were endorsed by an entire medical association. I’m pointing this out only for people’s information in case its helps, nothing more.”

    The EAU press releases are available here:www.uroweb.org/press/press-releases/

    The link is down there, but a copy is available across the web,, for example here: www.physorg.com/news156618899.html

    And indeed, the press release just mentions the European study and the first sentence starts “Screening for prostate cancer can reduce deaths by 20%, according to the results of the European Randomized Study of Screening for Prostate Cancer …”

    At no point is the other study mentioned.

    The press release also links directly to the European paper in the NEJM.

    I agree that the journalism mentioned in Ben’s article was at best slipshod – they could and should have found the other paper and reported the risk etc properly. But we should also admit that the journalists were aided and abetted by a professional association that claims to represent some 12 000 doctors, scientists and other personnel.

    The contact details for the European Association of Urology can be found here: www.uroweb.org/eau-organisation-governance-structure/contact-us/

    Should anyone wish to complain about their misrepresentation of the research.

  44. clobbered said,

    March 21, 2009 at 10:30 pm

    Can we defer worrying about fixing worldwide journalism for a moment and focus on the Guardian?

    I am very disappointed to see the Guardian fall into the same traps as the tabloids (who after all, can be seen to have an obvious agenda).

    Ben – you really ought to try and approach the Guardian main desk on this. Offer to teach a workshop or something to their reporters. This story forms a good basis with which to approach the relevant editors.

  45. Dr Jim said,

    March 22, 2009 at 12:14 am

    Ahem, Yes, well, aside from that fact that the journal content will be over the head of most journalists, the NEJM is only (generally) free after six months.

    However, it is true that Andriole et al. was funded by an Open Access funding agency (as you would expect of the NIC at the NIH) and pays for the article to be free to all.

    NEJM does at least make all its content free to low income countries.

  46. Robert Carnegie said,

    March 22, 2009 at 4:40 am

    I thought that before now it was in the American system that the PSA test was a product widely offered to paying customers despite not providing much useful information, and work was already being undertaken on effective alternatives. The new reports should revise that, but somehow it doesn’t feel like it yet.

  47. kerledan said,

    March 22, 2009 at 6:41 am

    clobbered wrote:

    “I am very disappointed to see the Guardian fall into the same traps as the tabloids (who after all, can be seen to have an obvious agenda).”

    But the Guardian *is* to some extent a tabloid (albeit one with longish articles sprinkled around with long words).

  48. T said,

    March 22, 2009 at 8:29 am

    Its Sunday morning and when my papers arrive I’m going to sit in bed and peruse the weeks events at my leisure…..however thanks to this column I’m now thinking what is the ruddy point….its all guff. I was in the process of sending my husband off for one of these tests as he is 50 this year; again I have read the papers seen celebrities on the TV promote this as a life saver (Max Clifford has just survived this cancer). I find this alarming

  49. thepoisongarden said,

    March 22, 2009 at 8:50 am

    #45 Dr Jim

    ‘the journal content will be over the head of most journalists’

    So, journalists who are writing about science or health, some of whom have job titles like ‘health editor’ or ‘science editor’, shouldn’t be expected to be able to read scientific papers.

    I was going to use the analogy of theatre critics not needing to go and see the play but there have been instances of that happening which shows that the problem goes beyond the confines of science and health reporting.

  50. Craig said,

    March 22, 2009 at 9:12 am

    @Bob Ward

    And frankly, if journalists had to assume that all parts of a press release were wrong until proven otherwise, then it would defeat the object of using the release in the first place.

    Sounds fair to me. Press releases have a largely toxic effect on journalism; seeing them treated with due scepticism strikes me as a win.

    It’s a safe bet that anyone issuing a press release, even if technically honest, is going to be consciously or unconsciously slanting the information towards their particular viewpoint. Accepting a press release at face value is exactly as stupid as acccepting an advertisement at face value.

    And why stop there? Why not assume that the journal papers are also wrong until verified by a second source?

    There is a second source; it’s called peer review. It ain’t perfect, but it is usually good enough to catch blatant deception. And when even peer review fails, there’s still that handy “cited by” link on Google Scholar…

  51. The Biologista said,

    March 22, 2009 at 2:35 pm

    @45 “Ahem, Yes, well, aside from that fact that the journal content will be over the head of most journalists, the NEJM is only (generally) free after six months.”

    If academic institutions can provide full Pubmed access, then surely enormous multinational media conglomerates can pull it off too. As thepoisongarden points out, arts critics are expected to fully understand their medium. Sports journalists must understand the rules of most sports. If a science or health journalist cannot read the primary literature, he or she is in the wrong job.

  52. DrJG said,

    March 22, 2009 at 2:40 pm

    It is not just the 47 other diagnosees per life saved who worry me.
    With a PSA cutoff of 3.0 (necessary as using the common “upper limit of normal” of 4.0 will miss a significant proportion of still-potentially-treatable cancers), there will be many with nothing but benign prostatic hyperplasia. To prove this, they would need further investigation, likely to be an ultrasound-guided rectal-route prostate biopsy, or, to be at all reliable, multiple biopsies, sometimes repeated at a later date. Perhaps we should be asking these journalists how many such biopsies they would be prepared to undergo to save one man’s life, or what odds they would demand that it was going to be Their life which would be saved?

    I would imagine that these false positives would outweigh even the 47 who still die of the disease or, as is most often the case, die With the disease Of something completely different. I note the claimed figures that 35000 men a year are diagnosed with prostatic carcinoma, and “one an hour” (ie between 8 and 9000) die of it annually. Well, I know that very few of the rest are ever actually cured of the disease, which suggests that maybe around 25000 sufferers a year die of something else.

    The Prostate Cancer Charity, from the press releases referenced, clearly believe that GPs are not taking the matter seriously (like many other single-issue health-related organisations seem to think, we should obviously be putting Their agenda higher than the agendas of every other issue, maybe).
    Perhaps if they had had to deal with many years of patients being sent to us after some private medical with a marginally raised PSA, they might understand it better: “Ah, yes, we’ve done your prostate cancer test, and it is a bit high, aren’t you lucky you came our way? Now, be a good fellow and just pop along to your GP and get them to sort it all out for you.”
    Thankfully, that seldom happens now, but there is no doubt that dealing with the fall-out from such thoughtless testing will tend to colour a GP’s view.

    And the last time, admittedly before this latest round of research, that I went to a clinical debate on the subject, the Urologist arguing the case for screening freely admitted during the discussion afterwards that he was firmly anti other than for the sake of the meeting.

  53. Andrew Clegg said,

    March 22, 2009 at 5:22 pm

    The issue of journalists not routinely reading, or having access to, full texts of journal articles is a complete red herring here.

    Not just because the full text of the ignored article is open access, as others have pointed out already, but more importantly because the abstract — which takes about 20 seconds to read — spells out the key point in no uncertain terms.

    “Conclusions: After 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.”

    I don’t see how you could spoon-feed lazy journalists a message any more effectively than that!

  54. Dr Jim said,

    March 22, 2009 at 6:00 pm

    #49 / #51: I agree, and absolutely expect that science correspondents should be capable of reading the primary literature. But, as Ben has described in his book:

    “Nobody dumbs down the finance pages. I can barely understand most of the sports section. In the literature pull-out, there are five-page-long essays which I find completely impenetrable, where the more Russian novelists you can rope in the cleverer everybody thinks you are. I do not complain about this: I envy it.”

    The financial and literature review sections of broadsheet newspapers can be well over the head of most readers, the same expectations are not made of science.

    Not sure whether we could ever expect them to rise to the challenge, but I guess we can encourage the media to seek appropriate consultants.

  55. Jeesh42 said,

    March 22, 2009 at 9:41 pm

    Bob Ward,

    Surely journalists should (in theory) be doing something more than regurgitating the press release. Otherwise why don’t newspapers just give us the press releases and fire the lot of you?

    The fact that nurses work under a lot of pressure doesn’t give them free reign to neglect all their patients.

  56. adamcgf said,

    March 23, 2009 at 8:25 am

    I understand that it might slow the news down but surely journalists should operate under the kind of ‘strict liability’ that athletes do – if it’s under your name then it’s your responsibility. I imagine this kind of thing can work itself out in responsible journalists in time – if you’re fed information from a source that proves unreliable you will come to question it at some point – but it should always be the case that if you are ‘publishing’ it it’s up to you to make sure it’ right.

  57. Jessicathejourno said,

    March 23, 2009 at 10:51 am

    If you wanted replies from the actual journalists involved, you should have included their full names in the article so they catch it whilst vanity googling. Because sadly that’s something most of us can be relied on to research thoroughly.

    Anyways, Bob Ward’s arguments piss me off. I write (and far, far more than one article a week) for a B2B concern and if I just copied out a press release without looking into it and adding detail I’d get slapped, and rightfully so. My readers pay about 700 pounds a year for this crap and they deserve value. I don’t think Ward would argue with that.

    So his position annoys me, because while I doubt anyone would argue I shouldn’t do background checking into the releases that cross my desk for my kajillion articles a week because people pay so much for what I write, he seems to be arguing that the public, who pay much less than 700 pounds a year for their news, don’t deserve value – that the system of journalists regurgitating press releases for pop markets is a functional way for things to work because it gets the most information out the fastest.

    The information angle is nonsense, obviously. Press releases aren’t information, they’re ads. That’s their job. That should be obvious to the meanest of intelligences – even to all the non-humanities grads out there.

    But the suggestion that pop audiences don’t deserve the same checking into the material for lifestyle articles, especially the ones about health regimens, is what really gets my goat. They might not be paying however many hundreds of pounds a year but they’re certainly making the business in question however many hundreds of pounds a year. It’s exploitative and gross.

    Oh, and it’s not that damn hard to check a damn press release. It really isn’t. You call the contact people, you look at the company or organization, you have a few quick searches to see if anything else is being done along the same lines somewhere else or by someone else; I mean, the whole damn thing takes 45 minutes at the topmost. Stop being such a big bunch of sucks. Stop playing solitaire or dropping overly-long comments like this one on Bad Science and pick up the damn phone. Damn it.

  58. The Biologista said,

    March 23, 2009 at 3:15 pm

    @54

    Perhaps a distinction needs to be made between “front page” scientific coverage and some sort of “science section” coverage. I wonder if the front page coverage of the economic crisis reflected the accuracy (if not the depth) of the financial pages of most papers? If the second aids the first then perhaps what we really need is hardcore scientific coverage in papers which will then pull up the socks of the flashy front page stuff.

  59. Thegoodhack said,

    March 24, 2009 at 3:25 pm

    It’s a pack thing. After a press conference, the boys and girls from the nationals, popular and unpopular, gather together to agree what the angle is. The last thing they want is to write one story and to see a better angle in another paper, that will invite a bollocking from the news editor. The same thing happens virtually.
    It’s not necessarily venal etc etc, it is the nearest thing to being collegiate in the dog eat dog world of national news reporting.
    The NEJM, uniquely among the big general medical journals, doesn’t issue press releases, but sometimes other people (universities, charities) do, based on early sight of a paper. I suspect (but I don’t know) that this is what happened here, and that the Prostate Cancer Charity issued a release based on one of the papers that supported their activist interventionist agenda.
    Journalists tend to believe charities over the NHS/department of health/government. They just do. It’s genetic. And normally not a bad rule of thumb.
    Except, obviously in cases like this.
    It is possible, indeed likely, that the writers wrote longer more balanced pieces, including stuff from boith studies and they were cut and edited because news editors want simple narratives where there is a villain: in this case the government.
    Important stories on the front page will be honed and honed by various sub-editors and editors to achieve that simple compelling narrative. When it goes right it is a brilliant way of communicating complex information and ideas to millions of people with varying levels of literacy/health literacy.
    And it’s a hard job to do in the few hours available to the average reporter competing for space against celebrinews, murder and the rest of the news agenda. Try it some time. I’m amazed how often they do a good job in reporting complex science in 350 words.
    I prefer newspapers to be energetic vital popular (and sometimes wrong) to dreary, dead, unread, bankrupt and gone (as they increasingly are in the US outside a few metropolitan hotspots).
    Not a popular view among the BAd Science possee, I suspect

  60. Isoelectric said,

    March 24, 2009 at 3:46 pm

    Some of the hubris above sounds like dogs that have treed a raccoon rather than going after the bear they were supposed to be chasing (Ken Kesey: Sometimes a Great Notion). The impact of inaccuracies and inconsistencies of popular press reporting is tiny compared to the systematic abuse of overdiagnosis and ruination of patients due to unnecessary surgery and treatment. Such nonchalant abuse and collateral damage continues because a large number of narcissistic agencies benefit from indolence and disinformation despite years of evidence. A day of reckoning similar to that being experienced in another field of human endeavour may be nigh. But I doubt it.

  61. Jessicathejourno said,

    March 24, 2009 at 4:16 pm

    “I prefer newspapers to be energetic vital popular (and sometimes wrong) to dreary, dead, unread, bankrupt and gone (as they increasingly are in the US outside a few metropolitan hotspots).”

    You’re welcome to your preferences, but it’s a false comparison: many newspapers have gone and will presently be gone that were/are also energetic, vital, and popular.

    Dry troubled newspaper or wet troubled newspaper, their ownership structure has tended to be share-based. So when a bunch of shareholding morons start panicking about the Internet and everything else stealing advertisers and readers away, their knee-jerk reaction is:

    -To cut costs to boost (often already healthy, in the sense a privately-owned enterprise would be happy with them) margins, thereby screwing their quality in a way that is very obvious to readers and advertisers, who then move on, and kill the margins

    -To dumb everything down, chasing what they believe is the lowest common denominator, who they think cares more about reading something entertaining than being informed, and who they nonetheless think advertisers are interested in reaching

    But the problems start right away: this stereotype of the lowest-common-denominator reader isn’t going to be the sort of stereotype high-disposable income stereotype advertisers want to chase.

    And even if they did, it’s obvious to anybody besides panic-stricken shareholding morons that there are a MILLION things more entertaining than an ‘entertaining’ newspaper. It’s just not the right format for lowest-common-denominator entertainment. Why go to all the trouble of READING pablum when you can watch just about any idiocy roll out on gossip sites, reality shows, scaremongering current affairs programmes with presenters with nice tits, etc.?

    Is any news group more ‘entertaining’ and less concerned with dry facts than the Daily Mail group? They’ve just slashed the costs to hell; the only problem is they can’t dumb down anymore. Predictably enough, they’re losing ad revenue and will almost certainly lose a great deal more.

    I don’t disagree with your explanation of why science reporting can get so crappy and homogenous, but I really doubt competing with celebrinews and murder splats is the best route forward for science reporting or other news reporting in the papers . . . either for the papers or the readers. The ‘lowest common denominator’ has better things to do than be condescended to in print, and the newspaper medium has too many other possibilities.

  62. 10channel said,

    March 24, 2009 at 10:47 pm

    In something as important as health and medicine, one would think that at least that caution is the best method of reporting the facts – but no, most British newspapers seem to have no restraint in writing laudatory tracts for this or that related to health. If this is what sells, and if this is what the people want, then it is also a fault of the people. Do the people in the U.K. just fail to be sceptical about health and medicine or what?

  63. SimonCox said,

    March 25, 2009 at 12:22 pm

    @BobWard

    “It may not be desirable that journalists have such ridiculously short deadlines (even shorter these days with online news, 24-broadcast news and shrinking incomes) but it is a fact. Newspapers could of course employ two or three times more journalists, but then readers would need to stump up five or six times more money each day to buy the newspaper.”

    This is a straw man – you assume that research results must be reported as soon as possible. Why must they?

    The scientific research being discussed takes months or years to carry out, and the results, when published, generally take weeks, months or years to filter into any kind of technology or policy that will actually have an effect our lives. Given this, there is no credible reason that I can think of for newspapers to report scientific research findings on the day that the relevant press release is issued.

    Put it like this: if you were given the choice between reading a misleading, error-strewn science article on Monday and reading a meaningful, factually correct science article on Tuesday, which one would you choose?

  64. NeilHoskins said,

    March 27, 2009 at 3:29 pm

    Silly me: I thought that headline was referring to the pope and his views on condoms making the HIV/AIDS epidemic worse. You’re oddly silent on that one, Ben: is it OK to talk scientific bollocks if you wear a pointy hat?

  65. heavens said,

    March 27, 2009 at 4:24 pm

    @Bob Ward, who said, “And frankly, if journalists had to assume that all parts of a press release were wrong until proven otherwise, then…”

    Then they would be doing their jobs properly.

    I’ve been on both sides of a press release. What’s included in the press release is usually technically accurate, but what’s left out is often much more important. The level of “honesty” is often the level that you get from asking a young boy whether he got his clothes muddy.

    The boy might look at the mud caked on his shoes, the filth on his hands, and the streaks in his hair, but note that from collar to socks there’s not a speck of mud, and “honestly” tell you that he didn’t get any mud on his clothes.

    If I were writing for a pro-PSA group, I’d never tell you that you have to screen 1400 men to save one life. I’d never tell you that saving one life requires putting 47 other men through useless treatment. You might not make the “right” choice if I did that.

    It’s not just prostate cancer; we could use any number of examples:

    If I were writing for a pro-HIV testing center, I’d never tell you that testing people (in the developed world) with no identifiable risk factors (e.g., no anal sex) is going to produce an enormous proportion of false positives.

    If I were writing for a pro-choice group, I’d never tell you that the reason abortion isn’t associated with breast cancer is because they compare the risk of a woman that has an early abortion at age 20 and her sole full-term pregnancy at age 30 to a woman that never got pregnant until she was 30 — instead of to a woman that had two children, the first at age 20 and the second at age 30. We all know that “age at first full-term pregnancy” and “number of children” have a significant impact on breast cancer risk, but they set up the studies to compare the risk to someone that never got pregnant in the first place, instead of comparing it to a woman who got pregnant and gave birth instead of getting an abortion (i.e., the two actual choices facing the woman in question, given that time travel has not yet been perfected).

    Similarly, I’d never tell you that young women who refuse abortions typically do better in life (including income, education, housing, staying out of criminal justice, and more) than the ones that have an abortion. The facts are real, and every person whose grandfather said, “I realized when your uncle was born, in the bad old pre-abortion days, that I needed to grow up in a hurry” knows that it’s not entirely a matter of already-successful women choosing to give birth while losers get abortions.

    If I were writing for a Chronic Fatigue Syndrome charity, I’d never tell you that 90%+ of CFS patients actually have undiagnosed orthostatic hypotension. Who wants to give up 90%+ of their support base?!? Most “CFS” patients need a tilt-table test and three litres of water every day, not a poor-mysterious-us group, but you won’t get that information from the charity.

    All rare diseases are underdiagnosed — if you believe the press releases.

    I could go on, but I think you get the picture. It’s irresponsible to trust in the completeness of a press release. It’s unprofessional to assume that the press release is the best method of presenting the information.

  66. mikewhit said,

    April 1, 2009 at 12:37 pm

    but they set up the studies to compare the risk to someone that never got pregnant in the first place, instead of comparing it to a woman who got pregnant and gave birth instead of getting an abortion

    Surely they should be comparing like with like – the woman who had the abortion did not have a full-term baby. Otherwise you have two factors instead of one: a) having an abortion b) having a full-term pregnancy

    They should instead perhaps compare with someone who had a miscarriage at the same (st)age.

    Or, the study you propose should include miscarriages as well as abortions.

  67. mikewhit said,

    April 2, 2009 at 9:03 am

    But in any case I don’t think anyone desperate enough to consider having an abortion is going to be swayed in their decision by some marginal difference in long-term breast cancer statistics !

  68. ivy said,

    April 5, 2009 at 4:28 am

    How do I track my posts? I remember posting somwehere on this board but I cannot find it.

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