Shoot The Messengers?Challenges in Medical Journalism

Ivan Oransky, MDGlobal Editorial Director, MedPage Today

Vice President, Association of Health Care JournalistsAdjunct Associate Professor (Journalism), New York University

@ivanoransky

SGIMSan Diego

April 25, 2014

Disclosures

I am an employee of MedPage Today, LLC, which is not a commercial entity, but is wholly owned by Everyday Health, Inc.,

a commercial entity in which I own stock options. I am not discussing or referencing any product Everyday Health sells, but

because I am discussing medical journalism and that is what MedPage Today does, I wanted to err on the side of disclosure

How Are The Media Doing?

How Are The Media Doing?

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

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

How Are The Media Doing?

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 alternatives

30 (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)

How Are The Media Doing?

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)

How Are The Media Doing?

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?

The ProblemFewer 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

• Doubles down on natural tendency to favor what’s shiny and new

“He Said, She Said” Alive And Well

The ProblemMany 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

Larrson A. Medical messages in the media--barriers and solutions to improving medical journalism. Health Expectations 2003;6:323-31.

The ProblemBarriers 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.

The Tyranny of the Anecdote• Make sure anecdotes are appropriately chosen to

serve the interests of fairness and balance. Avoid the "tyranny of the anecdote." Personal stories used as examples must be consistent with the larger body of evidence. Whenever possible, individuals who had both positive and negative outcomes should be included.

Statement of Principles of the Association of Health Care Journalists http://healthjournalism.org/secondarypage-details.php?id=56

Poor Risk Perception• The same risk perception factors that trigger fear in

those who consume the news trigger interest in the people who report it. For reporters, these “fear factors” are characteristics of a story that has a better chance of making the front page or the top of a news broadcast. For editors and producers hungry to increase the number of readers or viewers, these factors identify stories that might grab more attention.

David Ropeik, Neiman Reports

http://www.nieman.harvard.edu/reports/article/101383/Journalists-Can-Be-Seduced-By-Aspects-of-Risk.aspx

But It’s Not Just JournalistsAcademic 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

• Develop relationships

– Answer calls

– Don’t hype

– 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

What You Can Do

Pitch Less, Tip More

Use Twitter

• Follow reporters to see what they’re interested in

• Don’t use it to send the same thing to 30 reporters

Avoid Jargon

• Talk to me like I’m your smart 14-year-old nephew

Get to Know AHCJ

Get to Know AHCJ

• >1,500 members in 49 U.S. states, >25 countries

• Strict membership guidelines: Journalists only

• Annual conference with workshops, newsmakers, more

• Website http://www.healthjournalism.org has reporting guides, blog, tipsheets, other resources

Start Your Own Blog

► University of Pennsylvania Perelman School of Medicine

– Peer reviewed content

– Providing free online CME

► Strategic partnerships with

– American Heart Association

– American College of Cardiology

– American Thoracic Society

– American Academy of Neurology

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– The Endocrine Society

THE #1 MEDICAL NEWS SITE FOR HEALTH CARE PROVIDERS

Credible Authoritative

► Vice President, Editor-in-Chief: Peggy Peck

– 25 Medical news correspondents, journalists and multi-media specialists

► Vice President, Global Editorial Director: Ivan Oransky

► Sanjay Gupta, MD, Editor, Gupta Guide

► #1 Physician Blog: Kevin MD

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PRODUCT OVERVIEW“Putting Breaking Medical News Into Practice”

► 35 Therapeutic categories

– 400 subcategories

– 100+ medical conference coverage worldwide

► Non-therapeutic coverage includes:

– Practice Management

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► Over 9,000 articles published in 2012

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Let’s Work to Avoid This