1.
Is Health Journalism
Evidence-Based?
Ivan Oransky, MD
Executive Editor, Reuters Health
Reuters Institute, Dept. of Politics and International Relations
Green Templeton College, Oxford University
October 31, 2011

2.
What is Reuters Health
THREE WIRES COVERING 110 STUDIES EACH WEEK
Reuters Medical News
Keeps physicians, researchers and other medical
professionals informed of developments in their field
Reuters Health eLine
Wellness and health care for the general public
Reuters Health Industry Briefing
Business information for the healthcare community

3.
Summary
• How Reuters Health chooses and covers stories
• How others do the same
• Why health care coverage matters
• Intervention targets for research

4.
How Reuters Health Chooses Stories
• Impact factor
• Likelihood of changing behavior/clinical practice
• Strength of evidence
• Novelty

5.
What Do We Miss?

6.
How Do We Cover Stories?
Hewing close to the HealthNewsReview.org criteria

7.
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

8.
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

9.
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)

10.
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)

11.
How Do Others Cover Stories?
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.

12.
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 risks
Coverage grew increasingly neutral over time, conveying neither the
impression that the risks outweighed the benefits nor that benefits
outweighed the risks
Barry CL, Busch SH. News coverage of FDA warnings
on pediatric antidepressant use and suicidality.
Pediatrics 2010; 125:88-95.

13.
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.

14.
Why It Matters:
How Ethnic Groups May Be Poorly Served

15.
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

16.
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.

17.
Why Is It So Bad?

18.
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.

19.
Are Reporters Interested in Improving?
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.

20.
Intervention Target: Staffing
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

21.
Will It Help?
Maybe. As Rob discussed, Caburnay, Kreuter et. al.
suggest cancer coverage with a local lead targeted
for black community newspapers provides a modest
(but comparatively significant) impact on an
audience's willingness to seek medical care and
screening.
Among the lessons: cancer coverage targeted toward
minority audiences has a modest potential to
enhance community health.

22.
Intervention Target: Knowledge
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.

23.
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

24.
Let’s Work to Avoid This

25.
Acknowledgements/Follow-Up
• Thanks to Nancy Lapid of Reuters Health
• My contact info: ivan-oransky@erols.com