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20 Years on the Health and Medical Beat

2007; Wolters Kluwer; Volume: 29; Issue: 11 Linguagem: Inglês

10.1097/01.cot.0000282546.29210.76

1548-4688

Andrew Holtz,

Music Therapy and Health

FigureSo far my columns have focused on the entertainment media, but in a recent issue I promised to address the accuracy of health and medical information in the news media. That's a big topic; so I thought I'd start with a personal perspective. I signed on to the health and medical beat full-time 20 years ago when I moved from general assignment to the medical unit at CNN. During a decade as one of the medical correspondents, I got to be part of all varieties of stories, ranging from documentaries on the ethical implications of genetic research, Alzheimer's, and other topics to off-the-cuff live reports on events of dubious import, such as tendon surgery on then-President Bill Clinton's knee after he stumbled during a party at golfer Greg Norman's Florida estate. I've done stories that probably boosted (at least in the short run) the venture capital profiles of investigational devices and drugs, though of course that result was not my intent. And I have been part of coverage that highlighted the potential harms of drugs, devices, and other medical interventions—everything from acetaminophen to anti-arrhythmia drugs to autologous bone marrow transplantation for advanced breast cancer. All in all, I suspect my view of health and medical news coverage resembles what some experienced physicians think of their profession. I got into this line of work in part because I thought I could do some good (while also getting a chance to do some really cool things.) I try to do the best I can on each story, often within harsh constraints. And I wonder whether on balance I've been able to do more good than harm. There's no question that there's more of all sorts of news coverage now. CNN played a central role in the proliferation of broadcast news. When the network signed on in 1980, cable was stirring from its sleepy decades of CATV (Community Antenna Television) operations that merely delivered broadcasts to places with bad reception. Time Contracted Many of us who were there at the birth of the new cable age believed that the growth of television channels would mean more time to tell stories, particularly medical stories, with context. Time to explain caveats and side effects of new medical treatments, not just the wonders promised in news release headlines; time to spell out the specific strengths and limitations of health studies; time to avoid whipsawing viewers with research snippets that seem to contradict each other simply because key details were left on the cutting room floor. We were right—for a while. Twenty years ago, the typical length of a CNN medical story was almost three minutes—even longer in the weekend wrap-up program. But as cable penetration increased and channels proliferated, a strange thing happened: Time contracted. Between CNN and Headline News, we were transmitting 48 hours of news a day, 14 days a week, but we were told to trim story length to 2:30…then 2:15…then 2 minutes. As we spiraled downward, I bailed out. Quick Snacks Rather than Balanced Meals Cable surrendered to TV's tendency to churn out quick snacks rather than balanced meals. According to an analysis of health reports on almost 3,000 local TV newscasts, half the stories were shorter than 33 seconds. This blizzard of medical snippets doesn't inform; it dazzles. No wonder that some surveys of TV viewers indicate that they are more likely to learn certain important health information from the fictional plots of primetime entertainment shows than from the skeletal blurbs on the local news. The brevity imperative comes from the desire to engage readers and audiences; but it is pushed to a dysfunctional extreme by the soulless application of market research. Efforts to defend quality, including the time to explain context, are complicated by American journalism's constitutional foundation. The First Amendment protection of free speech is both the fundamental strength and a potentially corrupting weakness of the news media. The ability to speak is the best protection against tyrannies big and small, but it also bars any imposition of standards. There will never be a Flexner Report on the news media. Well, there have been many reports calling for improvements in the education and training of journalists, and there will be many more; but none will ever bring sweeping regulation because of the vital constitutional prohibition against infringements on free speech. Initiatives to Improve Health Reporting So we are left with voluntary initiatives. While there will not be a governmental Agency for Healthcare Journalism Research and Quality (even though Ah-jerk would be a marvelous acronym), there is AHCJ, the Association of Health Care Journalists. Among many actions meant to encourage better health beat reporting, the group issued a Statement of Principles (www.healthjournalism.org/resource/principles.htm). As a charter member, past President, and current board member of AHCJ, my bias is obvious; yet I think there is evidence to support optimism about the results of this initiative. Founded less than a decade ago, AHCJ now has more than 1,000 members. The most recent annual conference attracted almost a third of the membership to engage in several days of dawn-to-dusk hard study and active discussion of our craft. The turnout looks even more impressive in light of the fact that most of the attendees had to pay their own travel and registration, and many had to take vacation, because their employers rarely support professional education. A lot of reporters and editors care about the quality of their work and want to improve. At one of the conference sessions, the former head of the CNN Medical Unit, Gary Schwitzer, who was also the principal author of AHCJ's Statement of Principles, presented a progress report on an effort to use public praise and shaming to promote better quality coverage of health. Now an associate professor at the University of Minnesota School of Journalism & Mass Communication, Schwitzer is publisher of HealthNewsReview.org. The Web site posts grades for health reports from major print and TV outlets, thus helping to set quality standards. The criteria include discussion of potential harms of treatments, the costs, the alternatives, the absolute (not just relative) effects, and the quality of the evidence. After reviewing their reviews of news stories, Schwitzer and his colleagues saw much room for improvement. The overwhelming majority of stories left out key information. Reporters will retort, “If I had more space or time, I could include all that information.” But there were many 5-star stories that could fit on one single-spaced page of letter paper. Nevertheless, there does appear to be a brevity threshold at about 500 words. Anything less and it seems almost impossible to do a decent job telling a medical story. The HealthNewsReview.org experience jibes with my attitude toward medical news briefs: If a story isn't worth doing well and fully, it isn't worth doing at all. Of course that's a position I rarely defended successfully at CNN. Frenetic managers pushed for faster pacing, sometimes referring to market research indicating viewers want shorter stories. But I suspect the market researchers are essentially asking kids if they like candy, instead of asking whether people want to be offered a balanced diet. I have no doubt that if you ask focus group members whether they prefer long stories on a single topic to quick hits on multiple topics, the news roundups will win out. I would ask the question differently: “Do you like short pieces that skip over key information or do you want fewer, longer stories that include enough context to help you make decisions affecting your health?” It's notable that, with the exception of the Knight Foundation, very little of the support for AHCJ or other efforts to improve the quality of health and medical reporting comes from the world of journalism. The major supporters are foundations familiar to health care researchers, such as the Robert Wood Johnson Foundation, the Kaiser Family Foundation, the California HealthCare Foundation, the Commonwealth Fund, and others. In addition to foundation sponsorship, AHCJ's recent conference in Los Angeles was hosted by USC Health Sciences, UCLA Health Sciences, City of Hope, and the University of California, Irvine. One reason for the tilt in support sources is that there's just a lot more money sloshing around health care than journalism. But it's also a fact that the news business invests much less into quality improvement than other industries. And many news organization managers are only beginning to understand that covering the health beat well requires some specific skills, like knowing the difference between absolute and relative risk comparisons, understanding confidence intervals, and having at least a rudimentary awareness of how the health care system is organized. For the time being, it seems that the tangible support for improvements in health news coverage will come from those with an interest in population health, rather than those connected with the news business. It would be better if the journalism profession could provide for its own, but I don't see it happening anytime soon. Oh, I should mention here that AHCJ does not accept any support from the health care industry or providers (other than academic medical centers.) No educational grants. Not even advertising in the association newsletter or on the AHCJ Web site. We have to forgo some easy funding, but we sleep better. I have absolutely no doubt the freedom that allows anyone to declare himself or herself a journalist, without licensing or mandatory credentials, is essential to protecting all our other freedoms. But that tenet does not mean we must passively accept news coverage of health and medicine that is inept or even nefarious; it simply means that, like motivating patients to comply with difficult therapies or change their habits, promoting good quality journalism requires relentless and comprehensive efforts.