How the Mainstream Media Hype Health Care

Personal Health
This article originally appeared on Health Beat.

"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 percent 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 U.S. healthcare," 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 well-being."

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 and 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 percent) 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 master's 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 toward 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.

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