health news coverage: just how bad it is, why it matters, and what doctors can do about it
TRANSCRIPT
Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Can Do About It
Ivan Oransky, MDExecutive Editor, Reuters Health
Clinical Asst. Professor of Medicine, New York UniversityAdjunct Asst. Professor,
New York University Science, Health, and Environmental Reporting Program
Grand RoundsUniversity of Wisconsin School of Medicine and Public Health,
Department of MedicineNovember 5, 2010
Disclosures
I’m a full-time employee of Thomson Reuters, a provider of news about health and other subjects
My wife is a full-time employee of CNN, a provider of news about health and other subjects
Dedication
Stanley Oransky, MDMay 16, 1941 – August 27, 2010
Just how bad is some health care journalism?
Front page story, May 3, 1998
"Judah is going to cure cancer in two years,'' said Dr. James D. Watson, a Nobel laureate who directs the Cold Spring Harbor Laboratory, a cancer research center on Long Island.
Just how bad … ?
Schwitzer G. How do U.S. journalists cover treatments, tests, products, and procedures? An evaluation of 500 stories. PLoS Medicine 2008 doi:10.1371/journal.pmed.0050095
Just how bad … ?
207 stories• 83 (40%) did not report benefits quantitatively
• 124 did, but- 103 (83%) reported relative benefits only, - 3 (2%) absolute benefits only, - 18 (15%) both absolute and relative benefits
• 98 (47%) mentioned potential harm to patients
• 63 (30%) mentioned costs
• 170 stories cited an expert or a scientific study- 85 (50%) cited at least one source with disclosed financial
ties- 33 (39%) disclosed these ties
Moynihan R et al. Coverage by the news media of the benefits and risks of medications. N Engl J Med 2000; 342:1645-1650
Just how bad … ?
193 articles reporting at least one benefit or harm of a drug 100% mentioned at least one benefit 132 (68%) did not mention side effects or harms 119 (62%) did not quantify benefits or harms – Of 510 mentions of benefits and harms, only 120 (24%) gave quantitative
information– In 26% (31/120) the magnitude was presented in relative terms
37 (19%) articles reported only surrogate benefits 7 (4%) mentioned contraindications
61 (32%) mentioned drug costs, 89 (46%) mentioned drug alternatives30 (16%) mentioned nondrug options (such as exercise or diet)
Cassels A. Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ, April 29, 2003; 168 (9)
Just how bad … ?
193 articles reporting at least one benefit or harm of a drug 120 (62%) quoted at least one interviewee.
After exclusion of industry and government spokespeople, potential financial conflicts of interest were reported for only 5 of 164 interviewees (3%)
Of 57 articles covering studies, only 15 (26%) included information on study funding
Cassels A. Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ, April 29, 2003; 168 (9)
Just how bad … ?
Wells: “Newspapers over-represent support for screening mammography for ages 40 to 49”
Reports would have been improved by • Identification of all sources for information cited • Less reliance on relatively few sources • Discussion of benefits in absolute terms
Medical journalism may need standards similar to those used for reporting medical research
Wells J. Newspaper reporting of screening mammography. Ann Intern Med 2001;35:1029-1037.
Just how bad … ?
FDA message: Use of pediatric antidepressants is linked to a risk of suicidality (as opposed to suicide itself)
• Reported correctly in the vast majority of news stories, BUT• Other key health messages in FDA warning often missing• News stories more likely to include anecdotes of children harmed
versus children helped by antidepressants• Quoted experts more likely to emphasize benefits over risks
Coverage grew increasingly neutral over time, conveying neither the impression that the risks outweighed the benefits nor that benefits
outweighed the risks
Barry CL, Busch SH. News coverage of FDA warnings on pediatric antidepressant use and suicidality. Pediatrics 2010; 125:88-95.
Just how bad … ?
Why It Matters: Where do people find health information?
National Health Interview Survey: Among blacks, Hispanics, and whites, doctors and print media were consistently the two most frequent sources of information
Meissner HI et al. How sources of health information relate to knowledge and use of cancer screening exams. J Comm Health 1992;17(3):153–165.
Why It Matters: Where do people find health information?
Woodall ED et al. Sources of health information Among Vietnamese American Men,” Journal of Immigrant and Minority Health July 2006
Survey of U.S. Latino adults by the Pew Hispanic Center and the RWJ Foundation
• More than 25% lack a usual health care provider
• A similar proportion report obtaining no health care information from medical personnel in the past year
• More than 80% report receiving health info from the media
• 79% say they are acting on media information
• “…the survey findings clearly demonstrate the power and potential of these alternative outlets to disseminate health information to the disparate segments of the Latino population.”
Pew Hispanic Center, 2008: Hispanics and Health Care in the United States: Access, Information and Knowledge.
Why It Matters: Where do people find health information?
2010 Harris Poll88% of adults have looked for health info online
81% of “Cyberchondriacs” looked online in last 30 days (mean, 6x/mo)• 17% looked for health info online ≥10 times in the last month
Most are satisfied with their ability to find what they want online • Only 9% say they were somewhat (6%) or very (3%) unsuccessful• Only 8% think the info they found was unreliable
53% say they discussed online info with their doctors
51% looked for info online based on discussions with their doctors
Why It Matters: Where do people find health information?
In 1997 the South Wales Evening Post ran a “protracted campaign” on the supposed dangers of measles-mumps-rubella (MMR) vaccinations • 5 front-page stories, • 3 opinion pieces • at least 18 other stories
Immunization rates fell by 13.6% in the paper's circulation area, and 2.4% in the rest of Wales.
Mason BW, Donnelly PD. Impact of a local newspaper campaign on the uptake of the measles mumps and rubella vaccine. J Epidemiol Community Health. 2000;54:473-74
Why It Matters: Where do people find health information?
Why It Matters: Does media coverage make a difference?
(The $64,000 question)
Are medical experts like pots calling the kettle black?
"The reaction of the medical profession to evidence of damage to children was to claim coincidence," Edwards said. "We might as well say it was a coincidence that the take-up for MMR fell after we published our series of stories."
Why is it so bad?
In a national survey of U.S. health and medical journalists: • Nearly 70% had at least a bachelor’s degree• 19% reported having a master’s degree; • 4.5% had a doctorate; about 3% were M.D.s • Almost half had a degree in journalism• 13% had a degree in communications • 8% were ‘‘life sciences’’ majors
Viswanath K et al: Occupational practices and the making of health news: A national survey of U.S. health and medical science journalists. Journal of Health Communication 2008; 13:759–777.
Why is it so bad?
Fewer reporters are doing more stories, broadcasts, and blog posts
• Sites chasing a smaller number of advertising dollars
• Pressure to cover more and more, which places heavy reliance on journals and meetings
Why is it so bad?
Barriers to improving medical journalism
• Lack of time, space and knowledge (the most common obstacles)
• Competition for space and audience• Difficulties with terminology• Problems finding and using sources• Problems with editors and commercialism
Larrson A. Medical messages in the media--barriers and solutions to improving medical journalism. Health Expectations 2003;6:323-31.
Why is it so bad?
Many health reporters feel it’s hard to find independent experts willing to assist journalists
They think editors need education in critical appraisal of medical news
Nearly all want short, reliable, up-to-date background information on various topics available on the Internet
Most (79%) were interested in participating in a trial to evaluate strategies to overcome identified constraints
Larrson A. Medical messages in the media--barriers and solutions to improving medical journalism. Health Expectations 2003;6:323-31.
Why is it so bad?
• Academic medical centers issue a mean of 49 press releases/year• Among 200 randomly selected releases
– 87 (44%) promoted animal or laboratory research, of which 64 (74%) explicitly claimed relevance to human health
– Among 95 releases about clinical research, 22 (23%) omitted study size and 32 (34%) failed to quantify results
– 113 releases promoted human research• 17% promoted randomized trials or meta-analyses • 40% reported on uncontrolled interventions, small samples (<30
participants), surrogate primary outcomes, or unpublished data—yet 58% lacked the relevant cautions
Woloshin S et al. Press releases by academic medical centers: not so academic? Ann Intern Med 2009;150:613-618
Why is it so bad?
What You Can Do
• Journals should make efforts to interest the press equally in negative and positive studies
• Scientists should check all institutional press releases for accuracy and clarity
• The health science community should promote contact with the media when confirmatory or non-confirmatory studies emerge in an area that has already been in the news
• Medical journals should revise their policies so that scientists who explain a study to reporters do not jeopardize their chances of publishing their work
Schuchman M. Medical scientists and health news reporting: a case of miscommunication. Ann Intern Med 1997;126:976-982
• Develop relationships– Answer calls– Don’t just call when you have a paper published– Send newsworthy items and ideas from other groups– Be an reporter’s back pocket expert
• Help news offices write better press releases
• Start your own blog
• Don’t hype
What You Can Do
What You Can Do
Acknowledgements
My Twitter followers, especially Susannah Fox (@SusannahFox) for references on media usage
Nancy Lapid of Reuters Health, for formatting my slides