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Is health journalism evidence-based?


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Is health journalism evidence-based?

  1. 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. 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. 3. Summary • How Reuters Health chooses and covers stories • How others do the same • Why health care coverage matters • Intervention targets for research
  4. 4. How Reuters Health Chooses Stories • Impact factor • Likelihood of changing behavior/clinical practice • Strength of evidence • Novelty
  5. 5. What Do We Miss?
  6. 6. How Do We Cover Stories? Hewing close to the criteria
  7. 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. 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. 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. 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. 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. 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. 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. 14. Why It Matters: How Ethnic Groups May Be Poorly Served
  15. 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. 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. 17. Why Is It So Bad?
  18. 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. 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. 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. 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. 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. 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. 24. Let’s Work to Avoid This
  25. 25. Acknowledgements/Follow-Up • Thanks to Nancy Lapid of Reuters Health • My contact info: