Pulse
The Whole Story
A local website helps journalists understand whether they’re on the mark when reporting risks and benefits in medicine.
Hours before being interviewed for this story, Michael Bierer, M.D., an assistant professor of medicine at Harvard Medical School in Boston, witnessed the effects television news can have on patients. Bierer had met with a patient who wanted to quit smoking. When he mentioned the smoking-cessation drug varenicline, the patient told him he didn’t want it because he had heard on the news that it caused hallucinations and may have contributed to the death of a Texas musician, Carter Albrecht.
Last September, Albrecht was shot by a neighbor who thought the musician was trying to break into his home. In an interview on Good Morning America, Albrecht’s girlfriend mentioned that after Albrecht started taking the drug, he began having nightmarish dreams and exhibiting bizarre behavior. Although the segment did mention that Albrecht had been drinking the night of his death, “the culprit in the story was a pill,” Bierer says. “To demonize or lionize a pill without a good foundation isn’t serving the public well,” he says of the media report.
Bierer is probably more interested than the average doctor in what his patients read or hear on the news. In addition to teaching and seeing patients, he is one of 17 physicians who review medical articles for HealthNewsReview.org, a website published by University of Minnesota associate professor of journalism Gary Schwitzer.
The site, which was launched in April of 2006, critiques medical stories that make safety or efficacy claims about a product, procedure, treatment, or test. The stories often rely on reporters to interpret research findings and translate what the numbers mean for their readers and viewers. They’re also the type of stories that most journalists aren’t trained to cover. “I don’t think more than a relative handful of people covering this beat on a regular basis have been afforded the opportunity to go to workshops to learn about reporting on research,” Schwitzer says.
Kids in the Candy Store
Schwitzer certainly wasn’t. In 1974, fresh out of Marquette University in Milwaukee, he was writing copy and editing film at WTMJ, the NBC affiliate in Milwaukee. One day, the news director offered him a new beat—medicine. “No one else wanted to deal with doctors full time,” he says of why he got the job.
Having no medical or scientific training to fall back on, he bought a copy of Dorland’s Medical Dictionary and subscribed to the Journal of the American Medical Association and the New England Journal of Medicine. He recalls struggling to understand the abstracts of the articles, much less put the authors’ findings into context for his audience. “Sadly, I think that’s the way too many people are either thrown into this beat or thrown into general assignment and given responsibility for covering one of these stories,” he says. “To a large degree, the lack of training and lack of investment that news organizations are making in this beat explain why we get what we’re getting.”
And those are stories that are creating what he calls a “kid in a candy store portrayal of U.S. health care.” “Almost everything seems terrific. Almost everything seems to be risk-free, and there’s no price tag associated with it,” he explains.
Schwitzer, who as editor-in-chief helped launch MayoClinic.com before helping to create the health journalism master’s program at the university in 2003, got the idea for HealthNewsReview.org from similar sites in Australia and Canada. “I saw it as a clear opportunity to offer some constructive outreach,” he says. Schwitzer’s goal is to educate journalists about how to better cover medical stories and, ultimately, help consumers make more informed decisions about their health care.
Schwitzer’s research assistants scan the Associated Press newswire, 10 of the 50 largest U.S. newspapers by circulation, and the three major networks’ morning and evening news programs each day as well as Time, Newsweek, and U.S. News and World Report for stories that make claims about safety and efficacy. Physicians, scientists, public health experts, and nurses affiliated with the Foundation for Informed Medical Decision Making, for which Schwitzer once worked and which funds HealthNewsReview.org, do the initial critique of selected articles. The stories are then sent to physician reviewers such as Bierer. Schwitzer serves as the final set of eyes.
Reviewers evaluate whether a story discusses the cost and availability and the risks and novelty of a treatment; whether it exaggerates the seriousness of a disease or the benefits of a drug; whether it’s based on a case study, observational study, or more powerful large-scale randomized clinical trial; whether the information sources are credible; and whether the story discusses alternative treatments.
Of the 430-plus stories that have been critiqued since the site launched, Schwitzer says fewer than 25 percent adequately discussed cost; about 25 percent quantified benefits; 30 percent quantified harms; about 33 percent made the quality of the underlying evidence clear; and 37 percent put the new idea into the context of existing treatments.
“Unfortunately, it’s all too easy to get some pretty valuable free publicity because of the way a lot of news organizations cover these topics,” Schwitzer says. Thus far, he says, many journalists have expressed appreciation for the site’s assessment of their work. “Nothing would make me feel better than to put ourselves out of business with this site,” he says, explaining that he would like to see media outlets stop running the type of stories reviewed on his site. “Far too much news coverage is being devoted to preliminary, unproven, costly, and maybe harmful ideas.”
A Checklist for All
For physicians such as Bierer, having patients ask him about stories they’ve read in the newspaper or seen on television has benefits and drawbacks. “Sometimes, they bring something to my attention that I’m not aware of,” he says. On the other hand, he often finds himself spending valuable appointment time countering misinformation or balancing claims such as those alleged in the story about musician Albrecht’s death or proclaimed in headlines about a new drug or procedure holding promise for those suffering from migraines, chronic back pain, or even cancer.
“Depending on the condition, you can well imagine that patients who are suffering without a lot of hope or without a lot of good options are going to want to read that article and have hope,” he says. Bierer adds that such patients are less likely to want to read stories that talk about the possibility of moderate effects or the fact that a study showed preliminary findings in mice and not humans.
Schwitzer, who says he would like to do a more formal analysis of how news reporting affects physicians, says the criteria HealthNewsReview.org uses to rate articles may also be useful for physicians who talk to patients about treatments and procedures. “The same things we’re looking for in news stories should probably be in most communications about these ideas,” he says.—Kim Kiser