“The realization that the world is often quite different from what is presented in our leading newspapers and magazines is not an easy conclusion for most educated Americans to accept,” writes Ron Unz. He’s right. He provides several examples of the difference between reality and what we are told. In finance, there are Bernie Madoff and Enron. Huge frauds are supposed to be detected. In geopolitics, there is the Iraq War. Saddam Hussein’s Baathists and al-Quada were enemies. Invading Iraq because of 9/11 made as much sense as attacking “China in retaliation for Pearl Harbor” — a point rarely made before the war. In these cases, the national media wasn’t factually wrong. No one said Madoff wasn’t running a Ponzi scheme. The problem is that something important wasn’t said. No one said Madoff was running a Ponzi scheme.
This is how the best journalists (e.g., at The New Yorker and the New York Times) get it wrong — so wrong that “best” may be the wrong word. In the case of health, what is omitted from the usual coverage has great consequences. Health journalists fail to point out the self-serving nature of health research, the way it helps researchers at the expense of the rest of us.
The recent Health issue of the New York Times Magazine has an example. An article by Peggy Orenstein about breast cancer, meant to be critical of current practice, goes on and on about how screening has not had the promised payoff. As has been widely noted. What Orenstein fails to understand is that the total emphasis on screening was a terrible mistake to begin with. Before screening was tried, it was hard to know whether it would fail or succeed; it was worth trying, absolutely. But it was always entirely possible that it would fail — as it has. A better research program would have split the funds 50/50 between screening and lifestyle-focused prevention research.
The United States has the highest breast cancer incidence (age-adjusted) rates in the world — about 120 per 100,000 women, in contrast to 20-30 per 100,000 women in poor countries. This implies that lifestyle changes can produce big improvements. Orenstein doesn’t say this. She fails to ask why the Komen Foundation has totally emphasized cure (“race for the cure”) over prevention due to lifestyle change. In a long piece, here is all she says about lifestyle-focused prevention:
Many [scientists and advocates] brought up the meager funding for work on prevention. In February, for instance, a Congressional panel made up of advocates, scientists and government officials called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities.
Nothing about how the “meager funding” was and is a huge mistake. Xeni Jardin of Boing Boing called Orenstein’s article “a hell of a piece“. Fran Visco, the president of the National Breast Cancer Coalition, praised Orenstein’s piece and wrote about preventing breast research via a vaccine. Jardin and Visco, like Orenstein, failed to see the elephant in the room.
Almost all breast-cancer research money has gone to medical school professors (most of whom are men). They don’t do lifestyle research, which is low-tech. They do high-tech cure research. Breast cancer screening, which is high-tech, agrees with their overall focus. High-tech research wins Nobel Prizes, low-tech research does not. For example, those who discovered that smoking causes lung cancer never got a Nobel Prize. Health journalists, most of whom are women, apparently fail to see and definitely fail to write how they (and all women) are harmed by this allocation of research effort. The allocation helps the careers of the researchers (medical school professors); it hurts anyone who might get breast cancer.