Heathcare in the news? Treat it with a grain of salt.

The US Journal of the American Medical Association has recently published A Guide to Reading Health Care News Stories.

The author, Gary Schwitzer, details how a team of reviewers from HealthNewsReview.org evaluated the reporting by US news organisations on new medical treatments, tests, products, and procedures. Over a more than 12-year period, 1,889 stories from a variety of different types of media outlets were reviewed. Ten review criteria were used to assess each news story reviewed. The review criteria addressed whether the story (1) adequately discussed the costs of the intervention; (2) adequately quantified the benefits of the intervention; (3) adequately quantified the harms of the intervention; (4) evaluated the quality of the evidence; (5) widened the diagnostic boundaries of illness and promoted public awareness of these widened boundaries, which may expand the market for treatments, a practice that has been termed disease mongering; (6) quoted independent sources and identified the conflicts of interest of sources; (7) compared the new approach with existing alternatives; (8) established the availability of the intervention; (9) established whether the approach was truly novel; and (10) appeared to rely solely or largely on a news release as the source of information.

The reviewers graded most stories unsatisfactory on 5 of 10 review criteria: costs, benefits, harms, quality of the evidence, and comparison of the new approach with alternatives. Drugs, new tests, medical devices, and other interventions were usually portrayed positively; potential harms were minimised, and costs were ignored. These findings would likely be replicated if the same analysis was done on Australian media coverage of health interventions.

Common problem areas in reporting include stating risk reduction in relative, rather than absolute, terms. For example a news item may saw that intervention X reduces the rate of disease Y by 30%. However if the rate of disease Y is already very low this may be not worth spending money or effort to achieve. Journalist also often fail to explain the limits of observational studies. The article lists more than a dozen flawed stories about observational studies involving coffee appearing in major US media outlets. These stories typically used language that suggested cause and effect had been established, although it had not. Examples of such language are as follows: “coffee can kill you,” “2 cups of coffee lowers uterine cancer risk,” “one or more cups a day reduces stroke risk,” coffee “radically reduces the risk of colon and rectal cancer,” and “coffee fights skin cancer.”

Another problem area that we often see in popular media such as magazines in Australia is the use of anecdote where the experience of just one person is hailed as a “breakthrough” in medicine. While it may be fortunate for the person involved one example does not prove anything. Another problem identified was that half of all stories reviewed relied on a single source or failed to disclose the conflicts of interest of sources. An example cited is ABC’s Good Morning America asking, “Could a cure for obesity be just a pill away?” The reporter asserted that because the physician he was interviewing was a consultant to the pill manufacturer he was “the right man to talk to.” Clearly this person is not the right man to talk to because he has a strong incentive to talk up the possible benefit of such a pill.

Journalists were often affected by the gee-whizz factor when reporting on new technologies. Very expensive and technologically advanced items such as proton beam radiation machines for cancer treatment and robotic surgical systems were often reported in positive terms with no consideration of whether they had been shown to provide any benefit over current treatment modalities at all, let alone cost-effective benefits.

Of particular interest to us at Lab Tests Online are stories about screening tests that do not explain the trade-offs between benefits and harms. A number of previous news items on this site have looked at just this problem in various types of cancer screening. The review found many stories that lacked balance about screening for cardiovascular disease and screening for breast, lung, ovary, and prostate cancer. One example given was the NBC Today Show showing two of its anchors being screened for prostate cancer on the air and featuring a urologist who said there were no harms from screening for prostate cancer. Anyone who has read the information on prostate cancer screening on this and other reputable health information sites will know that this is false.

The conclusions of the study were: “For 7 years, our media watchdog project has established that health care news stories often emphasize or exaggerate potential benefits, minimise or ignore potential harms, and ignore cost issues. Our findings can help journalists improve their news stories and help physicians and the public better understand the strengths and weaknesses of news media coverage of medical and health topics.”

While most of us know that the internet is a minefield full of both good and bad information about every subject including healthcare, we should also be careful about what we take from mainstream media reporting. Most reporters have little medical or scientific training and can fall into any of the traps identified above when they write their stories.


Further reading
A Guide to Reading Health Care News Stories. Journal of the American Medical Association, online May 5, 2014.

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