Is health journalism evidence-based?

Is Health Journalism Evidence-Based? Ivan Oransky, MD Executive Editor, Reuters HealthReuters Institute, Dept. of Politics and International Relations Green Templeton College, Oxford University October 31, 2011

What is Reuters Health THREE WIRES COVERING 110 STUDIES EACH WEEK Reuters Medical News Keeps physicians, researchers and other medicalprofessionals informed of developments in their field Reuters Health eLine Wellness and health care for the general public Reuters Health Industry BriefingBusiness information for the healthcare community

Summary• How Reuters Health chooses and covers stories• How others do the same• Why health care coverage matters• Intervention targets for research

How Reuters Health Chooses Stories • Impact factor • Likelihood of changing behavior/clinical practice • Strength of evidence • Novelty

What Do We Miss?

How Do We Cover Stories?Hewing close to the HealthNewsReview.org criteria

How Do Others Cover Stories? 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

How Do Others Cover Stories? 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

How Do Others Cover Stories?193 articles reporting at least one benefit or harm of a drug 100% mentioned at least one benefit 132 (68%) did not mention side 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 exercise or diet) Cassels A. Drugs in the news: an analysis of Canadian newspaper coverage of new prescription drugs. CMAJ, April 29, 2003; 168 (9)

How Do Others Cover Stories?193 articles reporting at least one benefit or harm of a drug 120 (62%) quoted at least one interviewee. After exclusion of industry and government spokespeople, potential financial conflicts of interest were reported for only 5 of 164 interviewees (3%) Of 57 articles covering studies, only 15 (26%) included information 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)

How Do Others Cover Stories?Wells: “Newspapers over-represent support for screeningmammography 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 termsMedical journalism may need standards similar to those used forreporting medical research Wells J. Newspaper reporting of screening mammography. Ann Intern Med 2001;35:1029-1037.

How Do Others Cover Stories? FDA message: Use of pediatric antidepressants is linked to a risk of suicidality (as opposed to suicide itself) • Reported correctly in the vast majority of news stories, BUT • Other key health messages in FDA warning often missing • News stories more likely to include anecdotes of children harmed versus children helped by antidepressants • Quoted experts more likely to emphasize benefits over risksCoverage grew increasingly neutral over time, conveying neither theimpression 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 printmedia were consistently the two most frequent sourcesof 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:How Ethnic Groups May Be Poorly Served

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 adultsby 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 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.

Are Reporters Interested in Improving?Many health reporters feel it’s hard to find independentexperts willing to assist journalistsThey think editors need education in critical appraisal ofmedical newsNearly all want short, reliable, up-to-date backgroundinformation on various topics available on the InternetMost (79%) were interested in participating in a trial toevaluate 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.

Intervention Target: StaffingFewer reporters are doing more stories, broadcasts, andblog posts • Sites chasing a smaller number of advertising dollars • Pressure to cover more and more, which places heavy reliance on journals and meetings

Will It Help?Maybe. As Rob discussed, Caburnay, Kreuter et. al.suggest cancer coverage with a local lead targetedfor black community newspapers provides a modest(but comparatively significant) impact on anaudiences willingness to seek medical care andscreening.Among the lessons: cancer coverage targeted towardminority audiences has a modest potential toenhance community health.

Intervention Target: KnowledgeBarriers 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.

Intervention Target: Press Releases 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

Let’s Work to Avoid This

Acknowledgements/Follow-Up• Thanks to Nancy Lapid of Reuters Health• My contact info: ivan-oransky@erols.com

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Is health journalism evidence-based?

by Ivan Oransky

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