Over the past three decades, the media has bombarded the public with a seemingly endless array of risks, from the familiar to the exotic: hormone replacement therapy, anthrax, mad cow disease, SARS, West Nile virus, radon, vaccine-associated autism, childhood obesity, medical errors, secondhand smoke, lead, asbestos, even HIV in the porn industry. A drumbeat of risks to worry about, big and small, with new studies often contradicting earlier ones and creating further confusion. It's gotten so bad that some people feel like they're taking their lives in their hands just trying to order a meal at a restaurant. “Will it be the mad cow beef, the hormone chicken, or the mercury fish?” asks an imperious waiter in one of my favorite cartoons from the Washington Post. “Urn ... I think I'll go with the vegetarian dish,” the hesitant diner responds. “Pesticide or hepatitis?” the waiter asks. The diner, growing ever more fearful, asks for water. The waiter persists: “Point source, or agricultural runoff?” Perhaps it's time for the media to become part of the solution rather than continuing to be part of the problem. Ideally, science journalists could lead the way toward improved risk coverage that moves beyond case-by-case alarms—and easy hype—to a more consistent, balanced approach that puts the hazard du jour in broader perspective. The challenge is to create stories with chiaroscuro, painting in more subtle shades of gray rather than extremes of black and white. Too often, as my late Washington Post colleague Victor Cohn once said, journalists (and their editors) gravitate toward stories at either extreme, emphasizing either “no hope” or “new hope.” Unfortunately, today's “new hope” often becomes tomorrow's “no hope” (which is a good reason for avoiding words like “breakthrough” or “cure” in the first place). Hormone replacement therapy (HRT) is a classic example of this yo-yo coverage. In the '60s and '70s, the media helped overpromote hormones as wonder drugs for women, promising everlasting youth as well as a cure for hot flashes. Concerns rose, however, with reports of possible links to cancers of the breast and uterus. Later, when the uterine cancer risk was shown to return to normal by adding an additional hormone, the publicity about HRT became mostly positive again, emphasizing its potential to protect against bone loss and heart disease.
Case Report: Invasive Endometrial Cancer in a Trans Man and Risk of Testosterone Therapy
