How the Media Covers Health Care

Sometimes health care reporters remind me of the financial journalists who helped hype the bull market of the 1980s and 1990s. I began my career as a journalist at Money magazine, and I remember sitting in an editorial meeting where we talked about an upcoming cover story: “The Ten Best Mutual Funds NOW.”  One intrepid reporter asked: “What if there aren’t ten great mutual funds that you really should invest in right now?”

“Let the fact-checker worry about that,” someone else quipped, referring to the person who would be double-checking the details of the story just before it went to press. Almost everyone sitting around the table laughed.

And Money was generally a pretty responsible magazine that tried to warn investors against the risks of the market. Still, “good news” cover stories sold magazines—just as “breakthrough” medical stories on the local evening news keep viewers from changing the channel.

Gary Schwitzer, an associate professor in the School of Journalism and Mass Communication at the University of Minnesota, recently published a provocative piece about how the media covers health care in the American Editor. Schwitzer begins his piece by asking his reader to “Imagine a reporter filing a story from the Detroit Auto Show. She writes about one car maker’s hot new model as if it is the best thing since the ’57 Corvette. But in the excitement over the chrome and style, she doesn’t mention the cost of the new model, doesn’t compare it with other manufacturers’ offerings in the same class, and doesn’t mention anything about performance (fuel efficiency, handling, braking, safety issues, etc.)

“An editor would certainly raise questions about this kind of puffery.

“But over on the health care beat,” Schwitzer observes, “the majority of stories on new products, procedures, treatments and tests are published without including comparable information. Claims that would never be accepted unchallenged from a politician are accepted unquestioningly from physicians and researchers and company spokespersons.”

Schwitzer, who publishes HealthNewsReview.org, a website that grades health care news stories for accuracy, balance, and completeness, has evidence to back up his claim.  Below I’ve re-posted some of his data on some 400 stories from almost 60 major news organizations (available at his website) to demonstrate how many health care stories “provide a kid-in-the-candy-store portrayal of the health care system that leaves readers with the impression that most products or procedures in health care are amazing, harmless and without a price tag”:

Percentage satisfactory for 10 criteria for 400 stories:

Did the story adequately discuss costs?     22%
Did the story quantify the potential benefits?     27%
Did the story quantify the potential harms?     32%
Did the story evaluate the quality of the evidence?     33%
Did the story compare the new idea with existing alternatives?     37%
Did the story have more than one source and look for potential conflicts of interest in sources?     55%
Did the story appear to rely on a news release?     63%
Did the story establish the availability of the test or treatment?     68%
Did the story commit “disease-mongering” – exaggerating the condition or medicalizing a normal state of health?     70%
Did the story establish the true novelty of the idea?     86%

Why aren’t journalists more skeptical when reporting on medical
news? Because so many Americans want to believe that there is a cure
for everything—and that every new drug, device, or surgical procedure
that comes down the pike must be the product of sound scientific
evidence.  Otherwise, why would doctors recommend it? (Does anyone
remember when half of the nation’s children had their tonsils removed?)

Dartmouth’s Dr. Jack Wennberg, who has spent nearly three decades
researching waste in our medical system, calls this the theory of
“Manifest Efficacy: everything we do is effective. And it’s not just
doctors–patients want to believe in manifest efficacy, Wennberg adds,
because “it places medicine closer to a religion than a science.”

Nevertheless, in recent years, medical reporting in some publications
has become increasingly sophisticated. Take a look at Schwitzer’s personal
website, Schwitzer health news blog,  and you’ll find him spotlighting stories like these:


—CANCER RISK FROM OVERUSE OF CT SCANS


The Wall Street Journal reports on an article in this week’s New England Journal of Medicine…
"Doctors are ordering too many unnecessary diagnostic CT scans,
exposing their patients to potentially dangerous levels of radiation
that could increase their risk of cancer, according to Columbia
University researchers . . .


–DEBATE OVER VALUE AND MARKETING OF FERTILITY THERAPIES
The Wall Street Journal reports on questions being raised about genetic
screening, egg freezing and other high-tech fertility therapies.
Excerpt:  "As medical science continues to churn out
ever-more-sophisticated methods to treat infertility — from egg
freezing to genetic screening of embryos — desperate would-be parents
rush to embrace the latest techniques. But some fertility experts worry
that procedures of limited benefit are unfairly raising patients’ hopes.


–TROUBLING PATTERN OF BEHAVIOR BY PHARMACEUTICAL EXECUTIVES"


The Wall Street Journal reports:


"Over a period of several years, drug maker GlaxoSmithKline PLC was so
concerned about a prominent physician’s negative views of its diabetes
drug that it engaged in a concerted effort to intimidate him and stifle
his opinion, a report by the U.S. Senate Finance Committee found…"

What’s impressive is that the Wall Street Journal has been
particularly brave about exposing what’s going on in our for-profit
health care industry. One might expect a financial paper to praise
health care companies that are making a killing—but instead, its
reporters have honed in on how sometimes, the health care industry’s
most touted products may be killing us. 

For the Journal understands—perhaps better than other
papers—that the health care industry’s for-profit corporations have one
goal: to boost earnings.  These companies don’t want to hurt their
customers, and they certainly don’t want to wind up in court.  But
making sure that Americans receive the best care possible at the lowest
possible price is not their job. That’s why somebody needs to be
looking over their shoulder and asking questions. Ideally, that
somebody would be the FDA. But if that isn’t happening, skeptical
journalists can help.  I just hope that new ownership won’t affect how The Wall Street Journal covers medical news.

11 thoughts on “How the Media Covers Health Care

  1. Not to go easy on reporters, but where are they to get the answers to some of these questions?
    When a new drug is approved or a favorable paper is published there are only two possible sources, a research paper or a press release. Neither is likely to discuss cost or comparative efficacy.
    Drug companies make a point of not comparing their drug to the competition except for those aspect where it is “better”.
    As for cost, that is one of the great mysteries of life. There is the listed price, which may or may not bear any relation to what an insurance company pays.
    For all the discussion of how allowing Medicare to negotiate prices would lower costs, do we actually know if this is true? Don’t most insurance plans that use a formulary already negotiate prices? Isn’t UNC or Blue Cross big enough to get a good price, why would Medicare necessarily be able to do better?
    Are there any studies which show how the actual and stated prices for drugs and other supplies really compare?

  2. I think the WSJ also deserves congratulations for its story earlier this week on the poor man who maxed out his health insurance policy ($1 million of lifetime benefits) and, after a lengthy hospitalization, was presented with a bill for $1.2 million, which, of course, he and his family could not possibly pay. The charges, at full list price, were wildly in excess of costs and vastly higher than what hospitals routinely accept as full payment from Medicare, Medicaid and private insurers. And these are NON-PROFIT hospitals!
    I wonder how the executives of these hospitals would feel if they, a relative or family member were on the receiving end of these bills and attempts at collection knowing full well that the charges are grossly excessive compared to what insurers pay. The hospital sector is where the explosive costs are, and those costs continue to rise faster than physician fees and prescription drug costs. Yet, 85% of U.S. hospital beds are part of non-profit institutions. It’s well past time that we changed these crazy hospital billing practices. Thanks to the WSJ for another great story that should make a positive contribution toward hospital accountability in their billing and business practices.

  3. Thanks Maggie- My latest piece on my blog states that irresponsible health reporting has the potential to actually “do harm”. The four area I cover are-
    1)”Confusing and Conflicting Information”
    2)”Disease Mongering”
    3)”Fear Mongering”
    4)”Medical Breakthroughs”
    I each case the reader/listener can be harmed by the media. It might be time to demand some real accountability?
    As long as most health journalists are paid by large for profit media companies, responsible reporting will be hard to achieve.
    Dr. Rick Lippin
    Southampton, Pa

  4. Robert Feinman, Barry and Rick–
    Thanks for your comments.
    Robert-You raise good questions.
    As a reporter, when I read about a new product or procedure I check for other viewpoints by Googling the name of the product or prcedure and “skeptics” and the name of the product or procedure and “critics.”
    As someone who writes about healthcare I also have a fairly long list of doctors who are sources and I’ll e-mail anyone in the appropriate specialty and ask what they know about the product or procedure. If I don’t know anyone in the appropriate specialty, I’ll e-mail doctors asking for suggestions.
    I also read medical journals like Health Affairs, BMJ, NEJM and JAMA which often write about controversies within medicine.
    Finally–and this is enormously useful– I go to http://www.FDA.gov and serach the name of the drug or device and look for the minutes of the hearing where it was approved. There, I find the questions that one or two people on the panel asked that the manufacturer never answered, the reservations that some doctors on the panel expressed before having their arms twisted into voting “yes” (the FDA likes consensus and so if one person holds out he is seen as standing in the way of progress and may not be invited back to serve on another panel . . .)
    On the question of whether Medicare would have more clout than the insurance companies –without question yes. First, both Medicare and the VA (which negotiates very successfully) are much bigger than any private insurer.
    Secondly, private insurers really don’t care how much they pay for drugs as long as they can pass the cost along in the form of higher premiums and/or higher co-pays. And for the last seven years, that is exactly what they have been doing.
    Finally pharamcy benefit managers–for-profit companies that supposedly negotiate better rates on drugs for managed care plans–take rebates from the drug companies in exchange for putting the companies’ most expensive drugs in the managed care plans’ formularies.
    The fact that PBMs (legally) take rebates from the drug companies that they are negotiating with creates an enormous conflict of interest.
    Medicare needs to negotiate with drug-makers directly, without a PBM middle-man.
    Barry–
    Hospitals are not the major driver of health care inflation or waste in the system. As I explain in the book, there is no single villain.
    Hospitals, drug-makers, device-makers, some doctors and patients all play a role.
    Hospital bills are so high in large part because the cost of the technology they purchase has skyrocketed– in medicine “technology” includes cutting-edge drugs and devices as well as equipment like MRI units, neonatal intensive care units etc.
    This isn’t to say that some non-profits aren’t running surpluses and plowing the money into unncessary expansions that emphasize amenities (waterfalls, atriums) over medically necessary improvments (electronic medical records, systems to reduce errors . . .)
    But very few hospitals have significant surpluses. Most of the money that they are using for the unncessary building boom that I have
    talked about in past posts (“Can We Afford the Waterfalls?) is borrowed money. They’ve been building in large part because money is cheap (low interest rates.) Rather than borrowing in order to build (because their community needs more beds), they are building in order to borrow (because money is cheap and so the trustees think its the “smart” thing to do.)
    Of course, in the future, as they pay off this debt, they’ll have to do more unncessary procedures to generate the income stream necessary to service the debt.
    Finally, on why hospitals charge some patients–and some insurers–more than others: This is all about cost-shifting in order to cover the money they lose on Medicaid patients, the uninsured, etc.
    Hospitals wouldn’t have to “cost-shift” if we were all willing to pay the higher state or federal taxes we would need to pay to fund Medicaid so that it could pay hospitals what it cost to provide a service, and if we were all willing to buy insurance and so share in the cost of providing care for those who cannot afford insurance.
    See my Nov. 28 response to your comment on “What Americans Want . . .”
    Rick– I agree that there should be accountability.
    And the fact that so much of our media is owned by large for-profit corporations has had a chilling effect on what editors will let reporters write.
    On the other hand, I’m impressed by the work the WSJ medical reporters have done in recent years; Bloomberg News also has some excellent reporters as does the NYT. Though at the Times, one week you’ll see a very good story, then the next week they’ll run a story saying “New Evidence Suggests Coated Stents May Be Safer than Reserachers Feared.”
    It feels as if someone got a phone call saying “Hey, why are you knocking coated stents . . ”
    Often while bending over backwards to present “both sides of the story” (and to satisfy critics who say that the Times is too liberal, standing in the way of progress, capitalism, etc.) the Times winds up waffling in a way that distorts the truth.

    • Oh pseale James, pseale leave the standard Democrat class warfare tactics out of it. The upper class already pays a majority of the taxes-the top 10 percent of earners pays 70 percent of the taxes. To the writer, apparently the Congress didn’t bother to read much of the bill either. Pelosi: We need to pass the bill so people can know what’s in it. The whole process was a joke and history tells us that Gov’t programs rarely, if ever, become defecit-neutral. The Massachusetts universal healthcare plan passed in 2006 was slated to cost 88 billion, but is now over budget at 190 billion. This bill needs to be repealed for the fiscal sake of our future.

      • Tan–

        The upper class pays a majority of taxes becuase they have the majority of the money.
        Over the past 30 years, their income has continued to soar, while the middle-class and working class has
        watched their wages flatten.

        Over the same 30 years, the upper class also has made a great deal of money on real estate, stocks and bonds.
        It takes money to make money, and so the rich become richer–unless we tax them to pay for the education, health care and other services that the middle-class and working class need.

        Because we’re not taxing the upper class appropriately, ours is no longer an upwardly mobile society. If you’re born into a middle-class family, your chances of winding up upper-middle class are much, much lower than they were in the 70s or 60s. (We began cutting taxes for the rich, and paying CEOs multi-million-dollar salaries in the 1980s.

  5. Maggie:
    I continue to be pleased with the way you take time to answer those of us who post comments. Too many blogs are just pontificating while allowing the unwashed to debate among themselves.
    I think it would be valuable if you took this latest posting of yours and added your replies and reposted it on TMPcafe. Such discussions need a wide exposure and this means going to where the audience is.
    I do have one remark on your reply, however.
    Your investigative skills (including look at the FDA minutes) just reinforce my point that there is no other objective source of information besides the drug company. Objections raised at a hearing aren’t evidence. Contacting your experts also is a poor substitute for real data. Why should these people have any information that is not available to others?
    If they do then why wasn’t it presented at the hearings?
    As many recent cases have shown (Vioxx, etc) the entire testing, approval and tracking system is seriously compromised. Thinking that a reporter can, singlehandedly, outsmart it doesn’t seem credible.

  6. Robert–
    What’s surprising–and shocking–is that things come out in a FDA hearing that provide pretty clear evidence that the drug should Not be approved.
    And then, as you read on in the transcript, you see (hear)the skeptics who objected beginning to feel uncomforable, group pressure takes over, and the vote is unanimous, without ever resolving the questions the skeptics raised.
    It’s much like watching a movie which focuses on the jurors making their decison. Except that in the movies the two or three honest skeptics tend to persuade the others. In real life, it doesn’t always work that way.
    Not many people read these transcripts becuase they are quite long (the hearing can go on for six hours or longer) and most of the transcript is boring.
    Except for the parts that are not. You also need to know some medical and technical language to follow everything–though with a medical dictionary at your side, this is not a problem.
    The evidence comes out because the FDA panel discusses the trials that the company conducted in some detail. So, for example, you find out that when they tested Gardasil, Merck’s vaccine for cervical cancer, they discovered that the children of young women who were pregnant when they took it were more likely to suffer from a variety of birth defects.
    Merck’s solution– young women who are pregant or plan to become pregnant shouldn’t take Gardasil. But the drug is designed to be taken by girls 12, 13, 14, and 15 years old.
    How many are plannning to become pregant? How many would be willing to tell their doctor (in front of their mother) if they suspected they might possibly be pregnant (because they are having unprotected sex with a boyfriend).
    In the FDA minutes, you also find out that Gardasil was tested on very few young girls and for a relatively short period of time. This tells you that we don’t know much about risks.
    In terms of how much my sources know: acamdeic doctors in a particular specialty attend conferences, read papers describing the manufacturers’ trials and draw conclusions as to whether those trials were well-designed and whether we know enough about risks and benefits to put the product on the market . ..
    What’s shocking is that, years before a drug like Vioxx is finally withdrawn from the market, a fair number of people who are knowledgable about the drug know that it is ineffective, too risky, whatever.
    For example,in the case of Vioxx, the Mayo Clinic, Kaiser Permanente and the VA all decided not to use it for most patients (unless they absolutely could not tolerate other painkillers) a couple of years before the news about risks became public.
    So I’m not singlehandedly discovering the truth. Far from it. It’s out there. Just as, during the late 1990s, many, many people on Wall Street realized that many stocks were overpriced. These professionals were not buying U.S. stocks for their children’s college tuition fund. . .
    But even if a financial journalist talked to these people–and many did–your editor might not want you to publish this information. This is not the news people wanted to hear. This wouldn’t sell newspapers.
    Finally, thanks for the suggestion that I post this on tpmcafe. Sometimes I do post things there that I also post here. But tpm also prefers to have posts that haven’t been posted elsewhere. And they also prefer shorter pieces (800 words or less).
    On this blog, I’m building a niche (I think) for readers who are willing to read longer essays.
    And the readers who respond tend to come back with substantive comments.They don’t just write: “nice post.”
    And in addressing other readers’ comments, there are very, very few personal attacks. I like that.
    At the same time, I like my readers on tpmcafe and appreciate the larger readership that tpm provides. And by and large, it too, atracts a thoughtful audience because TPM has many excellent contributors. That’s why I continue to write for tpm too.
    At the same time, the audience here is building at a rate I find astounding–given the fact that it’s a single-subject blog and that Niko and I write these relatively long posts . . .

  7. As an aside, and this has nothing to do with the topic at hand, and more to do with the community that is active here.
    I come back daily for the reasons you cite. There is no flaming, people tend to reveal themselves (I think a highly predictive indicator of a good blog), and the dialog is at a sophisticated level. I know that if I post, I will learn from whomever chooses to respond. I hope that does not change as I view this site as a solid resource, as well as an enriching source of new knowledge.
    Brad
    Posted

  8. I could not agree with you more. I am a Washington Post reader and the quality of their health reporting dismays me.
    My thought is that health news bring readers so anything that comes across the wires gets published. Most reporters are not very statistical and they don’t know about all the different diseases so they don’t approach them analytically.
    Journalists being journalists the “I found the system and won” story is always popular. So a woman appealing for a breast MRI gets a long story. In the case of the article in the Post, she finally got the MRI — and whatever they were looking at was what the original Radiologist who didn’t recommend an MRI said it was!
    Since the article was consumer-oriented the focus was not on the fact that this kind of activity clogs up the system for those with genuine problems and adds to costs.

  9. Brad and Ginger–
    Thanks very much for you kind comments.
    Ginger–I agree with you –many of those “I fought the system and won” stories ignores whether the patient actually needed what they were fighting for!
    In fact, as you say, if these fights are based simply on emotion “I want what I want” rather than medical evidence, these fights actually hurt other patients by “clogging up the system for those with genuine problems and adding to costs.”