A Morning Edition report on Monday with the headline "Congress May Be Forced To Intervene Again On Mammogram Recommendations" drew some sharp rebukes, many of them from physicians who expressed deep concern over missing context.
The story, from political reporter Juana Summers, looked at the latest development in the ongoing tug of war between the U.S. Preventive Services Task Force, which in 2009 recommended that women under 50 may not need to get routine mammograms, and Congress, which passed legislation to override that guidance. As the task force moves forward with an update of the guidelines, a repeat showdown is brewing, Summers reported. Her story was centered around an anecdote from Debbie Wasserman Schultz, the Florida Congressional Democrat and chair of the Democratic National Committee, who herself was treated for breast cancer.
"While stories of potential missed diagnoses are powerful, there was no attempt to investigate or explain the reasoning behind the recommendations," wrote Marika Russell of San Francisco, Calif. "A physician myself, I know firsthand how we are often faced with the challenge of balancing the greater good against individual patient needs or concerns, and would have appreciated a more nuanced look into this issue."
Jane Drummond, a primary care internist from Portland, Ore., laid out what she saw as the missing piece:
"Studies do not support screening for breast cancer in asymptomatic women without a family history of breast cancer. Mammography in this population has not been shown to decrease mortality from breast cancer and screening is associated with a significantly higher number of false positive tests leading to unnecessary biopsies and anxiety in the vast majority of women As physicians, we try to follow evidence based guidelines and especially avoid interventions that may lead to harm and unnecessary worry. A balanced discussion of this issue would include discussion of the USPSTF's rationale for their recommendations and the processes by which the evidence is reviewed."
The criticism was also taken up by HealthNewsReview.org's Gary Schwitzer. That website says it "evaluates health care journalism, advertising, marketing, public relations and other messages that may influence consumers and provides criteria that consumers can use to evaluate these messages themselves."
Schwitzer wrote that while the NPR story quoted three current or former politicians, all of whom were opposed to the guidelines, "the four-minute piece had no interview with anyone with the Task Force. Not a quote. Not a word. That's imbalance. You can talk about bipartisan opposition all you want. But on a scientific controversy, citing bipartisan opposition doesn't equate to balanced or sound journalism."
I agree. Even as a piece about politics, not science, it needed at least a summary of the task force recommendations. The online headline is also skewed toward the Congressional critics, making it sound as though Congress has no choice but to intervene in the issue.
Ron Elving, an NPR senior editor and correspondent who stepped in to the edit the piece on a day when the staff was short-handed, told me by email that his understanding was that the piece was to be focused on the background for the expected Congressional action, and Summers had not been assigned to seek a task force interview.
"I did not expect [the piece] to be a fuller explanation of the issues or a rundown on the recommendations, which I understood had been reported on earlier," he wrote. Summers, he said, "tried to find a congressperson willing to speak up for the task force recommendations but was not able to find one. We should have made that clear."
Moreover, he wrote, lacking a Congressional voice in defense of the recommendations;
"NPR should have devoted more time in the piece to explaining why the task force has made its recommendations against these tests for younger women — and done so twice now. That would have made it clearer that these were science-based recommendations, concerned with public resources, but also concerned about the negative health effects and about false positives, etc. This would have been a better service to our listeners. We could have done a better job."
While this piece fell short of NPR's journalistic standards, NPR listeners can find more detailed information about the complicated mammogram issue elsewhere on NPR.org. Since April 13, NPR's radio newsmagazines have discussed the issue four times (including Summers' piece) and an additional two online-only stories have been posted. The pieces have examined in some depth the conflicting perspectives in the medical community, and an online story by Katherine Hobson looked in an intensely personal way at the internal debates the varying viewpoints have caused for patients. Kevin Lomangino, of HealthNewsReview.org called that piece "an insightful approach, bringing a much-needed patient perspective to the clinical weighting of benefits and harms." (He also had some quibbles with it, which you can read here.)
For those who come across Summers' story online, it might be helpful if NPR would add links on the page to a discussion of the other side of the argument.
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