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.