Monday, December 16, 2013

Just Missing the Mark Again, Katie Couric Airs HPV Followup Segment

Back on December 4, award-winning journalist Katie Couric aired a mindnumbingly bad episode of her show Katie. Throwing her credibility and journalistic ethics to the wind, she made her show a platform for the anti-vaccine organization SaneVax, which promotes the erroneous belief that Gardasil, among others, is horribly dangerous and is killing our kids, going so far as to make available a guide on how to blame the vaccine if anything bad happens to your child at some point after they receive it. The episode featured two women, one (Emily Tarsell, National Vaccine Information Center's Director of Gardasil Network Development) who blamed Gardasil for the death of her daughter, and one (Rosemary Mathis, Founder and Director of SaneVax) who blamed a wide range of non-specific maladies that her daughter experienced. Both guests have a vested interest in scaring people away from the vaccine. In addition, one of the primary investigators of the Gardasil (Merck) and Cervarix (GlaxoSmithKline) clinical trials, Dr. Diane Harper, appeared on the show to downplay the effectiveness of the vaccines, stating they only lasted 5 years, while overselling pap smears in such a way that it made the vaccine seem pointless. For the science and reality side of the "conversation", Couric included Dr. Mallika Marshall. Dr. Marshall did her best to point out the facts of the vaccines, but when the entire show was framed to generate fear and mistrust of the vaccine, she had a very difficult time of it.

While others focused on the myriad flaws and errors in the episode, I focused on the ethics, though I did include links to a number of other articles lambasting the show. As a journalist, Couric had a number of responsibilities to her viewers to seek out the truth and report it. Unfortunately, she and her producers opted for ratings. The Friday after the episode aired, someone at the show put up a lukewarm justification for how they opted to do the show. It did not offer any apologies, nor did it correct any of the misinformation from the episode. More criticism popped up, and Couric herself penned a "mea culpa" of sorts on the Huffington Post. It was a step in the right direction, but Couric still didn't go far enough to correct the errors and damage done by her December 4 show. She addressed some, but not all, of the problems the others pointed out, but she skipped over some very important points. To make matters worse, she did it in the wrong venue. Rather than devoting time on her show to the corrections, which would have been seen by the same audience as her original episode, she opted to address a completely different audience: the ones who were criticizing her and already knew what the problems were.

Well, it seems that the well-earned criticism has finally filtered through...kind of. This past Friday, December 13, Couric devoted her "Follow Up Friday" segment to HPV and the vaccines that prevent it.

There are several things that Couric got right in this video, which features Dr. Anne Schuchat, Assistant Surgeon General and Director of the CDC's National Center for Immunization and Respiratory Diseases:
  • the impact of HPV as a significant cause of cancer
  • we have a tool that can prevent many HPV-caused cancers by preventing infection in the first place
  • the vaccines target the two strains of virus responsible for ~70% of cervical cancers
  • the vaccines are adjuncts to cancer screening, since they don't target every strain of the virus
  • immunity from the vaccines appears to be long-lasting; so far antibodies persist for at least 8 years
That information filled the 6½ minutes of the clip. Like the HuffPo article, this was step in the right direction. Couric finally picked the right audience and included good, science-based information. But again, it falls short of what should have been done. Although the brief clip addressed some of the problems that were raised about the original episode, it was far too brief and missed some key topics.

Pap smears or other cervical screening tests are all well and good, and they are important, but one of the benefits of HPV vaccination is that it can help prevent cancer-causing infections for which there are no good screening tools, such as anal or penile cancers and head and neck cancers. Pap smears are very effective at catching the precursors of cervical cancer, and if HPV only caused those types of cancers, then there might be a better argument that the vaccine is unnecessary. Might, not would. Because even if that were the case, there is still the issue of the emotional and physical strains involved with the followup of abnormal screening results. The pap test may show that there are some cells that are not normal and require followup examination. This includes procedures like colposcopy, loop electrosurgical excision procedure (LEEP), or conization or cone biopsy. Each of these carry risks of their own that may necessitate followup care, even when the cells are not cancerous.

I came across a very educational video about what to expect following an abnormal pap test, produced in partnership with the Society of Obstetricians and Gynaecologists of Canada and the Society of Canadian Colposcopists. Although a bit dry, it explains what to expect during followup visits after an abnormal test (warning, one of the animations may not be appropriate for work, and the video discusses sex and sexual organs in a very frank manner):

In any discussion of HPV and the vaccines that prevent the virus, this is crucial information to include, particularly when discussing the risks and benefits of the vaccine and the disease. Neither Couric's original episode, nor her Huffington Post piece addressed these issues. The vaccine can reduce the risk of having an abnormal test and all of the consequent procedures (with their own risks, however minor) that may result, along with the worry that it might be cancer.

Another aspect of Couric's segment that I found lacking was the subject of claims that people were injured or killed by the vaccines. Dr. Schuchat didn't really answer the question, beyond stating how many doses of the vaccines have been given, that the vaccine is safe and saying that "it's really important for parents to get accurate information". I would like to have seen more discussion of the fact that no deaths have been found to be caused by either vaccine and that the often widely publicized reports of injury similarly have no evidence of a connection to the vaccine, other than the fact that they occurred at some point after immunization. That is not to say that the vaccine is without risk. Everything in life does have some risk to it, but thus far, the evidence gathered to date on these vaccines suggest that the risk of adverse reactions is very, very low and is certainly outweighed by the benefits.

There was also opportunity for Couric to talk with women and men (e.g., Michael Douglas) who have survived cancers caused by HPV, to hear what they have gone through and what these vaccines can help to prevent. Talk to the parents whose children have been killed by an HPV-caused cancer. In all of this, from the original episode through every iteration of "my bad" that Couric and her producers have put out, those personal, emotional stories speaking to the benefits of the vaccine have been missing.

Finally, while, again, the followup segment included good, science-based information, Couric did not appear to take any responsibility for the inaccuracies of her reporting in the original episode. To me, it seemed like the only thing she and her producers got from all the criticism was "you need to provide the science behind HPV and the vaccines". They don't seem to have really grasped how much of a misstep they made by giving a platform to highly motivated anti-vaccine activists. I did not get the sense that anyone involved with the program understands just how much damage the original episode may have caused, instilling unreasonable fear and confusion in their viewers.

As with the Huffington Post article, Couric's followup segment was a step in the right direction but still just wasn't enough. I doubt, though, that we'll see anything further from her or her producers.

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