The media-medicine mix: quality concerns in medical reporting.

Many people hear about medical discoveries for the first time through popular media. Newspapers, magazines, television and the Internet play an increasingly crucial role in communicating information about health issues and informing the public about research findings and new treatments.1, 2 Good medical journalism provides accurate, balanced reports and important contextual information, helps to set appropriate expectations on the part of consumers, informs the larger medical community, and thus arguably provides a vital public service. By the same token, poor medical journalism can exaggerate or oversimplify an issue, unnecessarily inflating expectations of patients and providers and putting increasing strain on the physician–patient relationship.

The importance of the role played by health journalism is reflected in the findings of a 1999 survey of Canadian general practitioners; of the 250 physicians surveyed, 75% thought that health-related news reporting is beneficial because it prompts patients to ask important questions and otherwise learn more about their health.3 However, almost two thirds of survey respondents stated that journalists should do better job of reporting on health issues. This concern with the quality of medical reporting stemmed from many documented problems, such as stories that lacked complete information, especially concerning the quality of evidence, and that selectively reported benefits, harms and costs of treatment. Other problems are evident; for example, studies in several countries have found that media stories often do not mention the financial ties between study groups or experts and the manufacturers of the treatment in question, although this information provides vital context to a new study.4, 5 Such concerns have led to recent calls for more direct and honest reporting of trial results.6

Quality and comprehensiveness of health technology coverage by the lay media are important for individual patients and society as a whole.7 Preliminary reports can set the tone for subsequent news stories; because media coverage influences perceptions of both consumers and health care professionals, it can affect demand (positively or negatively) for particular health treatments, which in turn can have an impact on public decision-making, shaping public debate around access to new therapies through drug licensing, subsidized payments and other means.

For example, in 2005 new studies of trastuzumab (Herceptin) announced a breakthrough in treatment for women with breast cancers that expressed the HER2 gene.8 Initial reporting in Canada focused on perceived benefits of the treatment. This was soon followed by stories about patient access to the treatment, the cost of Herceptin (estimated at CDN$35,000 to CDN$45,000) and the dilemmas faced by physicians and patients who were not able to access it. Despite some media attention to the limited benefits offered by trastuzumab compared with existing treatment,9 dozens of media stories over the next 6 months created further controversy and put pressure on provincial health plans and cancer agencies to speed up access to the drug, without waiting for more robust scientific review. In July 2005 British Columbia relented, announcing that it would pay for trastuzumab therapy. Ironically, this occurred one month before the drug's maker, Genentech, issued a warning of significant cardiac toxicity related to its use.10

Some of the hype related to new treatments is driven by organizations, companies, universities and research groups promoting their research and attempting to get favourable coverage from major media outlets. This leads to a general tendency to over-promote new treatments. For example, a 2003 study analyzing the content of 1,203 American newspapers found that 20% of all examined newspaper articles about common neurologic conditions contained medical errors or exaggerated the treatment's effectiveness.11

This may also lead to reports giving inadequate attention to negative findings of studies. Some colleagues and I looked at the coverage in North American newspapers of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial and found that while 98% (47 of 48) accurately captured a single key message – that diuretics, calcium-channel blockers and ACE inhibitors are equivalent in preventing death from heart failure and non-fatal heart attacks – only half reported the increased risk of stroke with ACE-inhibitors, and only half conveyed the increased risk of heart failure with calcium-channel blockers (both compared to diuretics).12 The implications for public health and the health care system of failing to disclose these health outcomes is potentially very significant, given the widespread use of these drugs and the fact that ACE-inhibitors and calcium-channel blockers are up to 20 times more expensive than diuretics.

News coverage of drug treatments can also overemphasize negative aspects of a study's findings, at the risk of engendering further irrational drug use. A recent example was the reporting and subsequent market withdrawal of phenylpropanolamine, an additive in cough preparations and appetite suppressants. A news article in BMJ reported that the "risk of haemorrhagic stroke was found to be as much as 15 times higher in those who had taken appetite suppressants in the three days before the stroke."13 What this article and subsequent media follow-up failed to report was that the absolute risk of stroke in those women remained extremely rare: between one in 3.26 million and 1 in 107,000.14

Many of those working within medical journalism are aware of these concerns. André Picard, a leading medical reporter at the Toronto Globe and Mail, elucidates some key problems with quality medical reporting: a lack of reporter skepticism, weak evidence to support health claims, the influence of commercialism and the use of single sources. He also points to a factors such as the lack of full-time health journalists within news organizations, the failure to devote sufficient space to cover an issue properly and the use of untrained journalists.15

A major and sustained improvement in reporting standards needs to start with improving the education of journalists and the public on what qualities to look for in news reports about new treatments. Recent initiatives in researching, monitoring and evaluating medical coverage aim to start this education process. In the last 3 years Media Doctor Australia, Media Doctor Canada and Health News Reviews in the United States have used teams of experts to scan, review and post ratings of hundreds of health treatment stories according to similar criteria for quality. Recognizing the need to build better capacity in science journalism and biomedical communications, the Canadian Institute for Health Research (CIHR), the leading government funder of health research in Canada, recently announced a Health Research Communications Award to support Canadian journalism or communications students who are pursuing a career in health research communications.

These initiatives can start none too soon. Consumer awareness of medical technologies and treatments is a significant policy concern for drug plan managers and provincial health ministries, as a (mis)informed public places pressure on government for the rapid uptake of often expensive and sometimes inadequately studied medical technologies and drugs. Although better medical journalism will no doubt also require changes to the culture of media companies and the behaviour of companies and researchers with a vested interest in generating positive coverage, the public, researchers, and health care professionals should welcome current efforts to improve the quality of health news reporting.