Dr. Nancy Snyderman is NBC’s chief medical editor. She went on The Today Show and irresponsibly spouted off cancer screening suggestions that did not follow any accepted guidelines (emphasis mine):
In discussing colon cancer screening, Snyderman explained that because she has a family history, she started having colonoscopies at age 40 in two to three year intervals. She says now that she’s over 50 she gets one every year. “And I get one more than my doctors really recommend because I just get a little nervous about it,” Snyderman said.
Contrast this to the USPSTF’s recommendations which states that a colonoscopy is routinely recommended every 10 years or a sigmoidoscopy/FOBT every 5 years.
Here’s what she says about prostate cancer screening:
“You turn 50, you just have to have a rectal exam to feel that prostate. And you get a prostate-specific antigen, a PSA test.”
Again, look at the USPSTF and you will find zero data supporting that approach. Most guidelines suggest a shared decision with the patient after discussing the risks and benefits of PSA screening for prostate cancer:
Routine PSA measurement without a frank discussion of the issues involved is inappropriate. Patients who elect to be screened, either by digital rectal examination or PSA measurement, should provide verbal informed consent.
If physicians themselves can’t follow the evidence-based guidelines, how can they expect the public to?
This is shoddy medical advice, and irresponsible journalism to present this as the accepted standard of care. (via Schwitzer)
Update:
Dr. Snyderman is an ENT physician according to her profile. I suggest that she brushes up on some of her primary care recommendations.
Related posts:
- Will patients accept the new, evidence-based, breast cancer screening guidelines?
- Has Nancy Snyderman redeemed herself?
- Should doctors who follow evidence-based guidelines be offered liability protection?
- The media vs evidence-based medicine
- Prostate cancer screening in men over 75
- Beware who’s behind the guidelines
- Who monitors clinical guidelines?
{ 13 comments }
Dr. Snyderman is an otolaryngologist. She doesn’t know jack about these topics upon which she expounds publicly. I assume she’s an intelligent individual, so hopefully it’s slovenliness not stupidity which is at work here. Either way, inexcusable.
Media coverage like these, from persons with MD or DO after their names, or DR. as a title, contribute much to the escalation of expense in healthcare [too much unnecessary testing!].
This is majority a marketing ploy [for the shows] and should be looked at by the medical boards, AMA, and CONGRESS – if anyone among these august bodies is truly interested in bringing down the cost of healthcare.
I studied economics before heading to med school, so allow me to make one small observation:
USPSTF, ARHQ and other guidelines are generally written from a societal perspective. Without denigrating that approach (I really do think it is appropriate), I think we ought to acknowledge that patients don’t have a societal perspective.
Specifically, with respect to cost, insurance means that many patients face much lower (direct financial) costs for procedures like colonoscopy or breast screening than society as a whole does. The calculus of screening for patients is pretty close to price-ignorant and rather weighted heavily towards procedural complications. Unless you can convince a patient that a particular screening procedure has the potential to cause serious harm or that the procedure is time consuming, painful or very annoying the over riding concern will be detection, false positives be damned.
We, as clinicians, will never carry the day as long as we continue to refuse to speak in language our patients will listen to.
As irresponsible as Dr. Snyderman’s babble is, she’s using the buzz words patients want to hear and so she’s the one people will listen to.
The public forms its opinions based on what they see and hear. An MD or a professor talking on TV is presented as an expert. These “experts” have been repeating the mantra “just catch it early” for many years.
Yes, public may not care about cost. But I think the reasons they don’t worry about false positives are a) they don’t quite understand the risks of potentially invasive tests b) they don’t know how high is the probability of having a false positive after years of testing c) they don’t understand that a small risk of harm from a test becomes much larger after years of testing d) they overestimate the benefit. The former is rarely mentioned in the media, the latter is always made seem larger. How often do we see a word “overdiagnosis” mentioned in the media, by the way?
Ever seen Fox Sunday Housecall? The doctor there is a professor at Cornell (at least according to the credentials they mention), apparently he also published a bunch of books. So naturally he is viewed as an expert. Yet some time ago he listed PSA as a must-have for men (I doubt he was afraid of lawsuits as I am sure media disclaimers take care of this, so what is his excuse?) as well as CT scan for smokers. A couple of weeks ago, a woman called saying how her own ObGyn recommended stopping pap smears because she had a hysterectomy for benign condition. After some disclaimers about being a cardiologist and her putting him in bad position of contradicting her doctor, he mentioned that he talked with a few of his ObGyn friends and they told him they continue it because of a small risk of vaginal cancer (he forgot to mention, no evidence of benefit or D recommendation from USPSTF). All the while a host talking to him was sitting right there, nodding and saying how it is better to be safe. So, now this woman is going to think her own doctor gave her bad advice, even though her own doctor tried to follow the evidence. Mind you, I thought it was rather stupid of her to call a cardiologist to question her own ObGyn, but it shows how much influence these TV shows have.
I think many of the criticisms here are out-of-line and based on incmplete information.
My father died of colon cancer in his 30’s. His brother contracted colon cancer in his early 40’s. This was 30 years ago, but there is reason to believe this represents HNPCC, the screening recommendations for which are much more stringent than the routine guidelines referenced by the original blogger. The recommendations include ANNUAL colonoscopy starting at age 40.
I don’t know the specifics of Dr. Snyderman’s situation, but it is entirely possible she is correct in her colonoscopy screening regimen.
Everyone is free to have their opinion, but responsible people keep it to themselves when they do not have adequate knowledge in the area upon which an opinion is being requested.
Guidelines are not the measure of what is appropriate for any given patient, which is worked out in context of the patient’s own life philosophy, discomfort avoidance orientation, disease anxiety, and the doctor-patient relationship.
Financial considerations are also an appropriate factor for the patient. If people paid for their healthcare at the time of service rather than collectivize the cost, then the difference in finacial cost for the patient vs society would not be a consideration. But the real cost of a $1000 screening procedure varies from patient to patient because the value of the$1000 varies in proportion to how hard the person had to work to get it and what competing demands are extant for that money. Insurance, in mitigating that inequality, creates other inequalities in which people spend other’s money with abandon on themselves for things that they would not consider worthwhile if it were their money.
These are not decisions that should be made collectively, they should be made individually, but our collectivization of payment is driving us ever closer to a lose of individual liberty in healthcare.
Anon at 11:33, Nancy Snyderman is free to do what she wants and pay for it. But when she recommends her own course of action to everyone else is when she crosses the line. Not to mention that her article went way beyond colonoscopies for people at high risk.
What does her family history has to do with recommending PSA?
I have written many criticisms on the Daily Nightly (NBC Nightly News blog) specifically pointing out Snyderman’s clinical errors and wrong advice (she has stated that women no longer need to perform breast self-exams, and she gave wrong information about managing the care of someone contemplating assisted living and end of life treatment deicisions, to name a few recent atrocities). The Daily Nightly gets read by the NBC news producers and managing editor (Brian Williams), and they occasionally respond to readers. I would advice a blog swarm to convey the healthcare blogopshere’s dissatisfaction with Snyderman.
Oops – sorry for the typos!
There has been data published by the National Cancer Institute showing a fall in prostate cancer deaths since the eary 2000’s as a result of PSA screening. The American Urologic Association, the American Cancer Society and the National Cancer Institute all recommend some form of screening.
The USPSTF is working with 20 year old data.
How would you feel if YOUR CANCER could have been detected earlier and saved your life?
Contrary to popular belief, doctors are not out to get you. If you think yours is doing the wrong thing, get another one.
How can someone be a volunteer for this study? Will they be recruiting people soon? How do I get sign up?
Nancy Snyderman, again today, April 1, 2008. April Fools Day, began again her blatant promotion of drug company studies as the gospel. In this case a company ( Novartus )
NBC Today Show Link as follows, http://today.msnbc.msn.com/id/21134540/vp/23897327#23897327 who stands to benefit financially, as the sole supplier of this drug. It is generally accepted that there is nothing more despicable, and unconscionable than media manipulation, where the advertisement of drugs is being masked as urgent, and then portrayed as Breaking News! The Interview process of presenting this information is also known to be a deceptive way of presenting false and misleading information, where the interviewer plays the role of asking leading, and non specific questions.
Snyderman continues to extol the benefits of studies done by and for the exclusive financial benefit of the drug companies VS the more rational, and typically more in-depth independent studies. Her ”’Big Profits for Deep Pockets”’ approach to the promotion of a “drugged up America” is in stark contrast to general health advise and typical precautions she should be providing the viewers.
Regarding some of the above comments. Read Dr. Snyderman’s book, “Necessary Journeys” as it explains her medical philosophy. Her father, brother, and she are physicians. She has established her credibility in medicine far more so than most of the posters on this blog.
Comments on this entry are closed.