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Some well-informed critique of media coverage of health matters

As the previous post suggests, Gary Schwitzer is an influential figure in health journalism, and not only in his home country of the US.

If you’re interested in media coverage of health matters, particularly of tests, treatments and other interventions, then you really should be following Schwitzer on Twitter or reading HealthNewsReview.org, where he leads a team of more than two dozen people who grade health news reporting by major US news organisations (many of the reports also pop up in Australian media, in some form or another).

Schwitzer understands the constraints that journalists work under – he was a television medical news reporter for 14 years, including with CNN where he headed the medical news unit.

His industry experience may help explain why I noticed so little defensiveness when he presented at an Association of Health Care Journalists workshop in Philadelphia a few months ago, giving his diagnosis of the quality of health reporting.

He said that the review of 1,500 stories over five years found that:

  • 72% fail to adequately discuss costs.
  • 68% fail to quantify benefit – often how small is potential benefit
  • 66% fail to quantify harm – often how large is potential harm
  • 65% fail to evaluate the quality of the evidence
  • 58% fail to compare new idea with existing options

Recurring themes of the analyses included:

  • Failure to explain limitations of observational studies. Stories that conflate association and causation.
  • Surprising number of stories that rely solely on news releases – examples of “churnalism” – of stenography, not journalism
  • There is a wide spectrum of quality “from Pulitzers to putrid”.

As Schwitzer pointed out, this is not some dry, theoretical concern. Stories about health matter, he said, because they  whip “the worried well” into a frenzy; raise unrealistic expectations of health care; and promote undue demand of costly, unproven technologies that may produce more harm than good.

Schwitzer was particularly critical of journalists’ failure to convey the message that “all screening tests cause harm; some may do good.” Even in 300 words journalists should be able to explain that more is not always better, newer is not always better, and screening doesn’t always make sense, he said.

As Schwitzer acknowledges, HealthNewsReview is based upon the pioneering Australian site, Media Doctor Australia.

I’m delighted to report that Media Doctor Australia has recently joined Twitter (so it’s very easy for you to follow its analyses of current health stories), and has also agreed to provide a regular update of its findings for Croakey readers.

But first Dr Amanda Wilson explains below some of the background to Media Doctor Australia and how it works….

***

We’re a resource for journalists, the public and health professionals

Amanda Wilson writes:

Media Doctor Australia (MDA) is a web site that critiques health news stories on how well they cover certain aspects, such as the benefits, harms and costs, of new medical interventions.

The impetus for MDA was concern about how health news, particularly new medical interventions, is presented in the mainstream media. Research undertaken in the US highlighted an uncomfortable level of drug company influence in the form of ‘info-advertisements’ masquerading as news clips and stories being used in the media with little or no changes.

It was unclear whether the same things were happening in Australia. In conjunction with these concerns was the emergence of the patient as consumer. With easy access to health information from newspapers TV, magazines and the internet, patients were using newly acquired knowledge to request these new treatments from their doctors.

We saw MDA as operating at several levels. First, by providing a form of ‘critical appraisal’ of a news report, there was opportunity to influence and raise the overall quality of health reporting in Australia.

MDA also had potential as a tool for busy practitioners, providing summaries of recent health stories and an assessment of the quality of information they contain.

A third aim was to improve overall health literacy in the general public, in the media and even among health professionals – health industry workers also rely on mainstream media for much of their information about new medical interventions. What’s more, there is good evidence to show that this information influences health practice, behaviour and choices.

One example of the power of the media, highlighted by Professor Simon Chapman, came when entertainer Kylie Minogue was diagnosed with breast cancer.

News of her illness flashed around the globe, resulting in a doubling in the number of previously unscreened young women booking mammograms.  Despite the dramatic increase in screening, the rate of malignancies detected did not rise.  Instead of more cancers being detected, healthy young women were unnecessarily exposed to anxiety, radiation and ‘cancer phobia’.

Our starting point with MDA was to develop and validate a number of rating tools to assess the quality of news stories.

Funding for the work of MDA has been patchy and inconsistent; these funding limitations (we have one part-time employee and our reviewers donate their time and expertise) have restricted the types of health stories we can review.

We generally limit stories to new human health interventions that fit under the broad categories of  pharmaceutical, surgical, diagnostic tests, and ‘other’ stories, the latter including reports on diet, physiotherapy, ‘cosmeceuticals’, stem cell therapy, and complementary and alternative medicines (CAM). Two reviewers independently rate every story, with their results on 10 assessment items combined to produce a consensus score.

Each story is checked to see whether it provides information about the availability of the test or treatment, treatment options, evidence of disease mongering, evidence and quantification of benefits and harms, costs and the use of independent sources to provide an objective view and context for the new health intervention for the reader. Many of these items reflect the Australia Press Council Guidelines for Health Reporting.

Each item is assessed as Satisfactory, Not Satisfactory or Not Applicable. The overall rating is converted to a percentage score and then a star rating (out of five), which appears on the website along with a short comment highlighting strengths or weaknesses of the story. Our reviewers include journalists, researchers, doctors, nurses, physiotherapists, optometrists and pharmacists. More detailed information is available on the website.

Soon after MDA went live, a sister site was started in Canada.  In 2006,  Health News Review came online in the US. Since then Media Doctor sites have appeared in Hong Kong, Japan and Germany, with another soon to be launched in Sweden.  Although independently run, all use the same rating instruments and procedures as MDA.

During the almost seven years of operation of MDA, we’ve achieved some of our aims.

We’ve conducted analyses of the quality of health reporting in Australia, looking at the differences between media outlets and comparing scores based on the experience of the reporters involved. We have changes in ratings over time and concentrated on specific areas including cancer and CAM (read more about these findings on the website).

And, in the process of assessing news reports, we have engendered some strong reactions from journalists, both negative and positive. We regularly refine our rating tools to include suggestions made to us by journalists and are expanding our capacity to include other media including lifestyle magazines.

As MDA seeks to become more active in the debate on media coverage of health, we welcome all comments about our work.

We invite contributions to our blog “Second Opinion” and suggestions for improvement and modification of our procedures. If you’d like to join our intrepid team of unpaid reviewers, please drop us an email, tweet or phone, our contact details are on the website.

Croakey has invited Media Doctor to give a monthly summary of our best, worst or most interesting stories so we’ll give you our first run-down shortly.