“False Hopes, Unwarranted Fears: The Trouble with Medical News Stories.” If you find the headline alarming, you should read the editorial, published just last week in PLoS Medicine. There, the journal’s editors summarize what the Health News Review has discovered over the past two years while evaluating medical stories about new products and procedures throughout the mainstream media.
“It’s not a pretty picture,” says Gary Schwitzer, the University of Minnesota School of Journalism professor who publishes the online project.
In a video linked to the Health News Review website, Schwitzer points out that “about 65% of the time” major news organization are not telling viewers and readers how “big the potential harms” of new treatments are–or “how small the potential benefits.”
Meanwhile, about three-quarters of the stories about a new product or procedure fail to talk about how much the idea costs. “At a time when the U.S. is spending 16 percent of GDP on healthcare, I find this unfathomable,” says Schwitzer. “No one is asking: ‘How are we going to pay for it?’; ‘Who will have access to these things’?; ‘Who’s to say that we even need some of these things? This is what we need to discuss.”
Ultimately, “these stories are painting a ‘kid in the candy-store’ picture of US health care,” Schwitzer charges, “whereby everything is made to look terrific, risk-free, and without a price tag. Nothing could be further from the truth.”
Health News Review is supported by a grant from the nonprofit Foundation for Informed Decision Making, which was founded in 1989 by Dr. Jack Wennberg and colleagues. Its mission is to assure “that people understand their choices and have the information they need to make sound decisions affecting their health and wellbeing.”
But rather than helping people understand that they have choices, news
stories trumpeting a new product often fail to compare it to existing
alternatives. Schwitzer explains: “We expect that a story would put
the new approach being discussed into the context of alternatives, with
some discussion of the possible advantages or disadvantages of the new
approach compared with” treatments already on the market.
Instead, says Schwitzer, good-news stories about “medical
breakthroughs” are “feeding people” who believe there is “a pill for
every ill, creating unrealistic expectations and undue demand for
unproven ideas. This may help explain why we are spending 16 percent of GDP
on healthcare–and not getting the value for our dollars.”
In addition to the editorial, the May issue of PLoS includes an article
by Schwitzer detailing the shortcomings of the 500 medical stories that
Health News Review has reviewed over the past two years while
evaluating stories published in the top 50 U.S. newspapers, in the
three major newsweeklies, carried on the Associated Press’ wires, and
aired on morning and evening news at ABC, NBC and CBS.
Too often, reporters rely on sources that have an axe to grind: “Of 170
stories that cited an expert or a scientific study” Schwitzer observes
“85 (50%) cited at least one with a financial tie to the manufacturer
of the drug, a tie that was disclosed in only 33 of the 85 stories.”
For example, a story
that ran on ABC World news in April of 2007 heralding a new test for
prostate cancer “did not disclose what was abundantly clear even in a
Johns Hopkins news release: the principal investigator receives a share
of the royalties received on sales of the test. He is also a paid
consultant to the manufacturer of the test. There were no quotes from
anyone expressing skepticism about the development.”
Stores that hype hope can also spread fear. The reviewers, who gave the
ABC piece a “2” on a 10-point scale, criticized it for leading with a
dramatic graphic that stated: "Prostate cancer in the U.S.: 1.6
million men undergo prostate biopsies each year."
“That graphic, setting the stage for the story, can be misleading and
confusing to viewers,” the reviewers noted. "It could easily be
inferred that 1.6 million men each year develop prostate cancer. And
therefore we rate it as disease-mongering. The American Cancer Society
estimates that during 2007 about 218,890 new cases of prostate cancer
will be diagnosed in the United States – a number not provided in the
story… it [also] would have been helpful to simply show the number of
men diagnosed and the number of men who actually die to…help men to
understand that this cancer isn’t always a killer.” Finally, “at the
least, the story could have included one line saying that screening is
controversial regardless of method chosen, because it isn’t yet clear
if treatment saves lives.”
But it isn’t just television news that falls short by relying too
heavily on sources who have a financial interest in the product.
Top-tier newspapers fall into the same trap. A 2006 New York Times story
headlined “Drug Doubles Endurance” also received a “2” from reviewers,
in part because it failed to provide “more sources [expressing]
healthy skepticism to balance the overwhelming enthusiasm from other
sources, several of whom had ties to the drug companies promoting the
substance.” Then too the story failed to note that “there is an
important difference between the results from a few research studies in
animals and demonstration of efficacy in people.” (The old mice vs. men
problem.)
Who Does the Reviews? How Do the Reporters Respond?
Health News Review uses a team of reviewers from around the country.
“Some have a Masters in public health; some are RNs; some are MDs from
places like Duke, UCSF, Harvard and Dartmouth,” Schwitzer explains.
“There are people trained in evidence-based medicine. In a sense we are
trying to promote evidence-based health journalism.”
Three reviewers analyze each article. (All reviewers are listed online).
As the publisher of the project, Schwitzer is always the third reviewer
of each story. “I’ll mediate any disagreements between the first two
reviewers,” he explains, “gaining consensus before publishing the final
review.”
The rating instrument
used includes ten criteria used by similar websites in Australia and
Canada. All of the criteria—which range from “Adequately explains and
quantifies potential harms” to “Compares the new idea with existing
alternatives” are addressed in the Association of Health Care
Journalists’ “Statement of Principles.” For each of the 10 criterion,
the story is given a rating of “satisfactory,” “unsatisfactory,” or
“not applicable.”
The goal of the exercise is “not media-bashing” says Schwitzer. “It’s
outreach. When we evaluate a health news story, we e-mail the
evaluation to the journalist who wrote that story. We’re saying: ‘Come
see how we have reviewed your story; learn from it, engage us—and the
public –in a discussion of where things could be done better.’”
“And their responses have been overwhelmingly positive,” he reports.
“It’s quite sobering to read the reviews,” wrote one journalist. “I
imagine you’ve heard all the laments from reporters, but the lack of
both space and research time is enormously frustrating (and will
probably drive me out of journalism in the end).”
Cutbacks at many newspapers plus a lack of training also make it
difficult for journalists to do the job that they would like to do. One
week they’re reporting on crime; the next week they’re covering cancer.
Yet the public does not understand that, even at our leading
newspapers, a reporter may be writing about something that he or she
does not fully understand.
Editors and publishers also can get in the way of telling the true
story. As Schwitzer observes: “Reporters and writers have been
receptive to the feedback; editors and managers must be reached if
change is to occur.”
As the PLoS editorial points out: “There is also a broader
context in which medical stories get exaggerated—the 24-hour news cycle
means that media organizations are battling for audience share, which
in turn means that the press has moved towards sensationalism,
entertainment, and opinion. Headlines are often written by news
editors, rather than the article’s reporter, and are particularly prone
to exaggeration. All of this sensationalism strays far from the reality
of biomedical research, a slow process that yields small, incremental
results based on long-term studies that always have weaknesses.”
I know, from experience, that publishers and editors are sometimes more
concerned about ratings and circulation that they are about the facts.
While working as a journalist, I was told on more than one occasion:
“Our readers don’t like negative stories. They want to hear good news.”
Headlines about medical miracles sell newspapers. Articles that
explain that the breakthrough fizzled do not. Unless the bad news is
truly sensational (“400 women felled by Botox treatments in L.A.”)
readers and viewers may not be terribly interested in tales of
side-effects, risks, and complications. Nevertheless, while some
editors worry about what their customers “want to hear” good
journalists know that it’s their job to inform people—to tell them what
they “need to know.”
Schwitzer’s project should open up some much-needed dialogue about the difference—especially when the topic is so important.
Thanks Maggie-
My last post on my own blog at http://medicalcrises.blogspot.com was entitled “Health Journalists-You Too- First Do No Harm” and is relevant to your piece here.
I believe medical journalists desperately want to be more professional but they are mostly “trapped” in a media dominated by corporate interests.
Dr. Rick Lippin
WHOOPS- CORRECTION
It is my next to last piece in my blog from last November.See http://medicalcrises.blogspot.com for my piece on Medical Journalism.
Sorry,
Dr. Rick Lippin
The influence of advertising revenue on the treatment of stories seems not to be mentioned. For example, the Sunday NY Times Magazine frequently features 20-30 page inserts with nothing but medical ads and meaningless puff pieces.
If the newspaper ran critical stories about some of these advertisers it seems unlikely they would continue to buy space. I’m sure the same dynamic exists in the broadcast media.
The government has done more than enable this type of misinformation, it has explicitly promoted it by allowing patent medicines, “dietary supplements”, to advertise even when there is no objective data on benefits. We have a pretty low standard of honesty when snake oil is exempted from FDA and FTC oversight.
This was a timely post. The Oncologists have been meeting in Chicago this week and there have been a number of cancer research stories released.
While the results of the studies are interesting, they aren’t all earth shattering, but you wouldn’t realize that if you read the media coverage.
Hey Maggie,
when i was in school they made us study a series of articles called “how to read the medical literature” (in JAMA) It should be required reading for medical journalists. I’ve had many friends that did something new, got a capital investment, then went to conferences giving the same tired presentation of “original” research over and over. Journals are pretty good at sorting out the wheat from the chaff so before they interview these people they should go back and read the original research. Ian.
http://www.waittimes.blogspot.com
About 10 years ago, I was editor of a community weekly in a small town of about 18,000 people. I had an opening for a news reporter, and hired a young woman who had grown up in the town, but her first two jobs out of college were as a TV news reporter in small markets out of state.
She had moved back home to get married, and I considered myself lucky to get someone smart, seasoned and energetic who knew the area.
She didn’t stay with us long. Clearly it was a transitional job for her as she got another TV job within a few months.
But I’ll never forget the first staff brainstorming meeting for feature ideas that she sat in on. Part of the way through it, she pipes up with words along the lines of, “Why don’t you guys do some medical features? We did them at the TV stations I worked at and they’re real easy. You just call the PR department and they give you everything you need.”
This is the thinking you are contending with among TV “journalists” regarding health reporting. Maggie correctly points out: lack of training, lack of understanding and a need to fill airtime or column-inches — all of which boils down to resources — exacerbated in some cases by seeking the path of least resistance.
In my case, I let the reporter down gently, encouraging her to poke around the local schools some more. I guess I had the good sense to know what the strengths and limitations of a community newspaper were. Which was why they paid me the big bucks (Heh!).
The idea that publishers want good news is rubbish. Good news doesn’t sell — sensationalism, panic, crisis and fear sells (both with readers and advertisers). To report that the evidence shows that there is nothing to worry about or that the latest scare (or cure) is bogus and unneeded, guarantees that you will go unpublished.
The media sell hype and fear, but especially fear. In times like these especially, stories tend to focus on how awful things are by showing a few unfortunate people in a few unfortunate circumstances.
You can find stories like this even in a booming economy, but you can’t sell fear into a booming economy.
So now we hear stories about once-affluent people now homeless (seems like there was a lack of financial planning there).
And in health care, despite most people being insured, watching news reports you’d think that’s not the case.
On Media Coverage of Health
Over at the incomparable Health Beat Blog, Maggie Mahar does an excellent job summarizing the implications of several new articles published in PLoS Medicine on the woeful state of media coverage of health care and biomedical research. We’ve noted our
Health reporting
Maggie Mahar: “I know, from experience, that publishers and editors are sometimes more concerned about ratings and circulation that they are about the facts. While working as a journalist, I was told on more than one occasion: ‘Our readers don’t like ne
Everyone–
Thanks very much for your comments.
Dr. Rick–I agree that most medical jouranlists do want to do a good job. (If they didn’t, they wouldn’t volunteer to cover such a difficult topic.)
And thanks for the link–” “Health Journalists-You Too- First Do No Harm” is spot-on.
Robert–You’re right. It’s not just about selling papers–it’s about advertising. And the NYT magazine inserts definitely are telling.
Ginger–yes, cancer attracts some of the most senational healthcare reporting because people are so terrified of the disease.
Meanwhile, the truth is that progress in the war on cancer has been very slow. In some areas, we’ve made progress, but it’s a very complicated set of diseases. And the fact that the researchers who are trying to figure it out are competing with each other, rather than collaborating, has slowed progress.
Ian– I agree, medical journalists definitely need to get their information from medical journals–and not from medical journal press releases which someitmes exaggerate the “break-through “good news.
Rick–thank you for an wonderful story. It does an great job of illustrating how things in journalism are changing.
Rene–
I hear what you are saying.
You are right that sensationalism, panic and fear sell–but that is more liklely in the tabloids and on the local TV news. There, the story about the babies born with terrible defects and the 12-car pile-up on the local highway draw viewers and readers.
But you are less likely to see those stories on the front page of the top-tier newspapers, on the cover of TIME magazine, or on the national network news.
If the disaster is big enough it will make the top of the news on those outlets.
But on the whole, these papers and network shows are aimed at people who are looking for “serious” stories that they can believe–and that won’t be too disrubing. They want ot hear that the econony is doing better, that medicine is making breaktrhoughs.
Particularly, when it comes to healthcare, you are more likely to find good news stories in these outlets.
At the same time, you and Tim are right– by adn alrge, these days, fear seems to sell better than hope. . .
Tim–
See what I said to Rene above. When I was working as a journalist and told “Our readers don’t like negative stories” , it was before 9/11.
Unfortunately 9/11 gave the fear-mongers great leverage.
MedBlog Power 8
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Hi Maggie
Apologies for going kinda off topic, but if you feel it… I was wondering if you had any thoughts about Obama and how he should approach health care in the general election?
Nascar Daughter–
I really don’t know what Obama is going to do about healthcare.
He’ll have many things on his plate. My suspicion is that we are not going to have real national health reform that provides healthcare for everyone in the next four years. We could have legislation that provides some sort of health insurance for everyone, but that’s not healthcare.
My great fear is that Congress will compromise on something that gives a lot of people health insurance in name only.
But I’m hopeful we’ll have Medicare reform because we don’t have a choice–it’s running out of money. And some people have some very good ideas about how to reform Medicare that could then be translated into national health reform in a two-step process.
MedBlog Power 8
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Thanks very much