Media hype: good or bad for patients and the health care system?

Abstract

and colleagues 1 demonstrate the expected increase in breast imaging (about 20%) in the months following publicity. Interestingly, the biopsy rate did not change in younger women and declined in older women. The odds of surgical procedures following biopsy also fell markedly. These findings led the investigators to propose that the media furore affected doctors as well as patients, leading to a retraction of usual evidencebased practice in the months after the publicity. Is this a good or a bad thing? Celebrity disease is something that can be used to good public effect— notably Ronald Regan’s Alzheimer’s disease diagnosis contributed to moving dementia syndromes from Cinderella status to high National Institutes of Health funding opportunities in the United States. But what about preventing breast cancer given rising incidence rates (http://info.cancerresearchuk.org/ cancerstats/types/breast/incidence/). Kylie Minogue was young but was at risk due to nulliparity—a powerful risk factor, first recognized in the 1920s by Janet Lane-Clayton. 2 The Million Women study has demonstrated the importance of number of children and breast feeding, among other risk factors, 3 prompting Valerie Beral, its director, to urge greater research on prolactin, a hormone that increases in late pregnancy and regulates lactation, at a recent UK National Cancer Research Institute conference. While there are plenty of ‘orphan’ or neglected diseases craving publicity, AIDS is not one of them. The theme of this issue is human immunodeficiency virus—do we still need upper case to denote its importance? Usually associations of social inequalities and disease are negative—it is the poor that suffer. In an analysis of the Tanzanian HIV/AIDS indicator survey, higher standard of living was associated with increased odds of HIV infection, whereas there was no evidence of association with education. 4 Higher occupational status was associated with HIV in women but unemployed men were at greater risk than working men. These findings indicate that simplistic notions of HIV risk among rich and poor need to be more nuanced in appreciating what is clearly a complex social matrix of risk. Perhaps the greatest success in the last year has been the randomized trial evidence, building on a decade of observational epidemiology, demonstrating the reduction in risk of infection due to male circumcision. Many doubted the original observational evidence, so it is particularly gratifying to see how large robust clinical trials have been implemented and pooled to provide strong, compelling evidence of benefit in terms of