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

1. Health News Coverage:
Just How Bad It Is, Why It Matters,
and What Doctors Can Do About It
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
Grand Rounds
University of Wisconsin School of Medicine and Public Health,
Department of Medicine
November 5, 2010

2. 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

3. Dedication
Stanley Oransky, MD
May 16, 1941 – August 27, 2010

4. 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.

5. Just how bad … ?

6. 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 … ?

7. 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 … ?

8. 193 articles reporting at least one 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 … ?

9. 193 articles reporting at least one benefit or harm of a drug
120 (62%) quotedat 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)
Just how bad … ?

10. 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 … ?

11. 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, conveyingneither 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.
Just how bad … ?

12. 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.

13. 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

14. 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?

15. 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?

16. 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:
Where do people find health information?

17. 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."

18. Why is it so bad?

19. 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?

20. 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?

21. 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?

22. 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?

23. • 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
Why is it so bad?

24. 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

25. • 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

26. What You Can Do

27. Acknowledgements
My Twitter followers, especially Susannah Fox
(@SusannahFox) for references on media usage
Nancy Lapid of Reuters Health, for formatting my slides