1. What does it mean for a debate to be “media driven” or a battle to be “lost by the media”? In my last post, I noted that until a few weeks ago, I’d never heard of a “power morcellator.” Nor had I heard of the AAGL–The American Association of Gynecologic Laparoscopists. In an article “Battle over morcellation lost ‘in the media’”(Nov 26, 2014) Susan London reports on a recent meeting of the AAGL[i]
The media played a major role in determining the fate of uterine morcellation, suggested a study reported at a meeting sponsored by AAGL.
“How did we lose this battle of uterine morcellation? We lost it in the media,” asserted lead investigator Dr. Adrian C. Balica, director of the minimally invasive gynecologic surgery program at the Robert Wood Johnson Medical School in New Brunswick, N.J.
The “investigation” Balica led consisted of collecting Internet search data using something called the Google Adwords Keyword Planner:
Results showed that the average monthly number of Google searches for the term ‘morcellation’ held steady throughout most of 2013 at about 250 per month, reported Dr. Balica. There was, however, a sharp uptick in December 2013 to more than 2,000 per month, and the number continued to rise to a peak of about 18,000 per month in July 2014. A similar pattern was seen for the terms ‘morcellator,’ ‘fibroids in uterus,’ and ‘morcellation of uterine fibroid.’
The “vitals” of the study are summarized at the start of the article:
Key clinical point: Relevant Google searches rose sharply as the debate unfolded.
Major finding: The mean monthly number of searches for “morcellation” rose from about 250 in July 2013 to 18,000 in July 2014.
Data source: An analysis of Google searches for terms related to the power morcellator debate.
Disclosures: Dr. Balica disclosed that he had no relevant conflicts of interest.
2. Here’s my question: Does a high correlation between Google searches and debate-related terms signify that the debate is “media driven”? I suppose you could call it that, but Dr. Balica is clearly suggesting that something not quite kosher, or not fully factual was responsible for losing “this battle of uterine morcellation”, downplaying the substantial data and real events that drove people (like me) to search the terms upon hearing the FDA announcement in November.
This interval spanned events that included the first report of the issue in the mainstream media (December 2013), the Food and Drug Administration’s initial statement discouraging use of power morcellation for uterine fibroids (April 2014), and the issuance of analyses and rebuttals by several medical professional associations (May 2104 and thereafter).
Subsequent to the AAGL meeting, the FDA issued a new warning on Nov. 24, 2014, not to use power morcellation in the majority of women undergoing hysterectomy or myomectomy for uterine fibroids because “there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma” that morcellation could spread. The agency estimated that about 1 in 350 fibroid patients actually have an occult sarcoma.”
So it isn’t as if there was some mass PR campaign without substance. It could have been so charged if, say, the statistics were vastly off.
3.Let’s define “media driven” policies. I suggest that a legitimate and useful sense of an issue or decision being “media driven” would be that people’s positions and actions in relation to it were unduly influenced by an exaggerated or pervasive media onslaught, marked by heavily pushing one side of a debate to the exclusion of other reasonable, alternative positions. So let’s define a decision being “media driven” that way. Certainly I can think of a number of media-driven issues and actions as of late, going by this definition. Finding an issue or decision to be “media-driven”, then, is a basis for disparaging the evidential basis for the decision, as when we say they were just caught up in a “media frenzy”.
I find it interesting that the ability to track word look-ups has suddenly given a new basis for disparaging evidence. My criticism of Balica’s use of search data as a test of a “mere media-driven” effect is that one would fully expect such a correlation in cases where genuine evidence was driving both the search and positions reached about the issue. Thus, it is not a severe, and is in fact a lousy test for showing “media driven” effects. What would need to be shown in this case is that the people making the policy decisions, the FDA, Johnson & Johnson, various hospitals, etc. were unduly influenced by an exaggeration of the facts, out of proportion to the real situation.
“Medical and surgical practice is going to be changed by the media,” he predicted. Thus, studying how the morcellator controversy unfolded in this venue can help inform strategies for addressing public perceptions”.
“This is just the battle. Hopefully, we aren’t going to lose the war,” he concluded.
I guess they’ll be ready next time with their own PR. What do you think?
[i] You can read the full article at
I just came across an excellent and complete discussion of the case at least up to its date. I wanted to record it here:
I think Balica needs to be challenged to spell out what this battle and war is that he thinks is lost. What is his vested interest in morcellators? As always, we need to follow the money. This is why sound public health policy is needed, because business interests should not be the deciding factor in reasoning out our health care delivery policies.
This issue would be a good one for review at the Institute of Medicine or similar review body.
The increased searches through Google are an encouraging sign that people have and will use valuable information tools available via the internet to enable themselves to be better informed when they have discussions with their health care providers, so doctors aren’t just foisting treatments on patients.