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Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Can Do About It

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Grand Rounds, University of Wisconsin School of Medicine & Public Health, November 5, 2010

Grand Rounds, University of Wisconsin School of Medicine & Public Health, November 5, 2010

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    Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Can Do About It Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Can Do About It Presentation Transcript

    • Health News Coverage: Just How Bad It Is, Why It Matters, and What Doctors Can Do About It
      Grand RoundsUniversity of Wisconsin School of Medicine and Public Health, Department of Medicine
      November 5, 2010
      Ivan Oransky, MD
      Executive Editor, Reuters Health
      Clinical Asst. Professor of Medicine, New York University
      Adjunct Asst. Professor,
      New York University Science, Health, and Environmental Reporting Program
    • Disclosures
      I’m a full-time employee of Thomson Reuters, a provider of news about health and other subjects
      My wife is a full-time employee of CNN, a provider of news about health and other subjects
    • Dedication
      Stanley Oransky, MD
      May 16, 1941 – August 27, 2010
    • Just how bad is some health care journalism?
      Front page story, May 3, 1998
      "Judah is going to cure cancer in two years,'' said Dr. James D. Watson, a Nobel laureate who directs the Cold Spring Harbor Laboratory, a cancer research center on Long Island.
    • Just how bad … ?
    • Just how bad … ?
      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
    • Just how bad … ?
      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
    • Just how bad … ?
      193 articles reporting at leastone benefit or harm of a drug
      100% mentioned at least one benefit
      132 (68%) did not mentionside 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 exerciseor diet)
      Cassels A. Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ, April 29, 2003; 168 (9)
    • Just how bad … ?
      193 articles reporting at leastone benefit or harm of a drug
      120 (62%) quotedat least one interviewee.
      After exclusion of industry and governmentspokespeople, potential financial conflicts of interest were reported for only 5 of 164 interviewees (3%)
      Of 57 articles covering studies, only 15 (26%) includedinformation 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)
    • Just how bad … ?
      Wells: “Newspapers over-represent support for screening mammography for ages 40 to 49”
      Reports would have been improved by
      • Identification of all sources for information cited
      • Less reliance on relatively few sources
      • Discussion of benefits in absolute terms
      Medical journalism may need standards similar to those used for reporting medical research
      Wells J. Newspaper reporting of screening mammography. Ann Intern Med 2001;35:1029-1037.
    • Just how bad … ?
      FDA message: Use of pediatric antidepressants is linked to a risk of suicidality (as opposed to suicide itself)
      • Reported correctly in the vast majorityof news stories, BUT
      • Other key health messages in FDA warningoften missing
      • News stories morelikely to include anecdotes of children harmed versus childrenhelped by antidepressants
      • Quoted experts more likely to emphasize benefits over risks
      Coverage grew increasingly neutralover time, conveyingneither the impression that the risks outweighed the benefits nor that benefitsoutweighed the risks
      Barry CL, Busch SH. News coverage of FDA warnings on pediatric antidepressant use and suicidality. Pediatrics 2010; 125:88-95.
    • Why It Matters: Where do people find health information?
      National Health Interview Survey:
      Among blacks, Hispanics, and whites, doctors and print media were consistently the two most frequent sources of information
      Meissner HI et al. How sources of health information relate to knowledge and use of cancer screening exams. J Comm Health 1992;17(3):153–165.
    • Why It Matters: Where do people find health information?
      Woodall ED et al. Sources of health information Among Vietnamese American Men,” Journal of Immigrant and Minority Health July 2006
    • Why It Matters: Where do people find health information?
      Survey of U.S. Latino adults
      by the Pew Hispanic Center and the RWJ Foundation
      • More than 25% lack a usual health care provider
      • A similar proportion report obtaining no health care information from medical personnel in the past year
      • More than 80% report receiving health info from the media
      • 79% say they are acting on media information
      • “…the survey findings clearly demonstrate the power and potential of these alternative outlets to disseminate health information to the disparate segments of the Latino population.”
      Pew Hispanic Center, 2008: Hispanics and Health Care in the United States: Access, Information and Knowledge.
    • Why It Matters: Where do people find health information?
      2010 Harris Poll
      88% of adults have looked for health info online
      81% of “Cyberchondriacs” looked online in last 30 days (mean, 6x/mo)
      • 17% looked for health info online ≥10 times in the last month
      Most are satisfied with their ability to find what they want online
      • Only 9% say they were somewhat (6%) or very (3%) unsuccessful
      • Only 8% think the info they found was unreliable
      53% say they discussed online info with their doctors
      51% looked for info online based on discussions with their doctors
    • Why It Matters: Where do people find health information?
      In 1997 the South Wales Evening Post ran a “protracted campaign” on the supposed dangers of measles-mumps-rubella (MMR) vaccinations
      • 5 front-page stories,
      • 3 opinion pieces
      • at least 18 other stories
      Immunization rates fell by 13.6% in the paper's circulation area, and 2.4% in the rest of Wales.
      Mason BW, Donnelly PD. Impact of a local newspaper campaign on the uptake of the measles mumps and rubella vaccine. J Epidemiol Community Health. 2000;54:473-74
    • Why It Matters: Does media coverage make a difference?
      (The $64,000 question)
      Are medical experts like pots calling the kettle black?
      "The reaction of the medical profession to evidence of damage to children was to claim coincidence," Edwards said.
      "We might as well say it was a coincidence that the take-up for MMR fell after we published our series of stories."
    • Why is it so bad?
    • 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?
      Fewer 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
    • Why is it so bad?
      Barriers 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.
    • Why is it so bad?
      Many 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
      Nearly all want short, reliable, up-to-date background information on various topics available on the Internet
      Most (79%) were interested in participating in a trial to evaluate strategies to overcome identified constraints
      Larrson A. Medical messages in the media--barriers and solutions to improving medical journalism. Health Expectations 2003;6:323-31.
    • Why is it so bad?
      Academic 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
    • What You Can Do
      Journals should make efforts to interest the press equally in negative and positive studies
      Scientists should check all institutional press releases for accuracy and clarity
      The health science community should promote contact with the media when confirmatory or non-confirmatory studies emerge in an area that has already been in the news
      Medical journals should revise their policies so that scientists who explain a study to reporters do not jeopardize their chances of publishing their work
      Schuchman M. Medical scientists and health news reporting: a case of miscommunication. Ann Intern Med 1997;126:976-982
    • What You Can Do
      • Develop relationships
      Answer calls
      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
      Start your own blog
      Don’t hype
    • What You Can Do
    • Acknowledgements
      My Twitter followers, especially Susannah Fox (@SusannahFox) for references on media usage
      Nancy Lapid of Reuters Health, for formatting my slides