Prescription for More Reliable Health News Reporting

In February, experienced journalists at major media outlets described the same set of facts in very different ways. Results from a trial of calcium and vitamin D supplements in postmenopausal women enrolled in the Women’s Health Initiative (WHI) were either the definitive last word or a cliffhanger chapter in an ongoing story, depending on who wrote the article and whom the reporter interviewed. The benefits of the supplements for strengthening bones and preventing fractures were negligible or modest or significant, and for warding off colorectal cancer, the supplements were ineffective or it was too soon to tell.

Photo by Suzanne Camarata

To improve media coverage of health news, researchers need to anticipate misinterpretations, prepare clear messages about what their findings do and do not mean, and present their studies in the larger context of their results, said (left to right) Jay Winsten, Meir Stampfer, and JoAnn Manson.

Over the past few years, news from the WHI about hormone therapy, dietary fat, and calcium supplements may have established a new benchmark for issues in communication of complex science. But these are not alone among dubious headlines that researchers worry may be undermining public confidence, trust, and support of research. Often, initial confusing news reports about major science stories generate a second round of articles to clarify the messages and correct widespread misinterpretations.

Locally, this scenario played out in late April when state public health officials warned about possible cancer risks for Ashland residents who swam or waded in water polluted by the now-closed Nyanza dye manufacturing plant. Journalists scrambled for the next few hours to make sense of the inch-thick study by deadline. Two weeks after the first front-page story reported the health warning, The Boston Globe ran a second front-page story with more nuances, caveats, and cautions.

“A steady drumbeat of front-page controversies, surprises, and scandals over the past two years—ranging from Vioxx, obesity-related mortality rates, estrogen, calcium, low fat, stem cell research fraud, among others—threatens to seriously damage the credibility of health research, creating a risk that the public will turn away from public health pronouncements,” said Jay Winsten, the founding director of the Center for Health Communication at HSPH.

He and his colleagues became so concerned that they staged a special colloquium at the School to examine practical steps that journalists, health researchers, journal editors, and communication specialists can take to strengthen news coverage of health research. The live webcast of the May 9 event has been archived.

Flight from Facts
Winsten’s interest in the topic dates back to a paper he wrote for the spring 1985 Health Affairs. “The quality of individual and policy decisions which rely on scientific information depends on the fidelity with which that information is transmitted from scientists to decision-makers through the media,” he wrote. In-depth interviews with 27 science reporters, editors, and television producers at leading news organizations convinced him that competitive forces in journalism and in science create a synergistic distorting influence in media coverage of health research.

The competitive pressures have become more pronounced. Last year, Winsten said in an interview, “it seemed as if we had reached a tipping point in the public acceptance of the credibility of health research.”

Just as some biologists are adopting a systems approach to elucidate the molecular and cellular processes underlying health and disease, the symposium speakers discussed how scientists, reporters, journal editors, meeting organizers, and research institutions all inadvertently conspire to create the confusion, and steps each party can take to improve the quality of information reaching the public (see sidebar).

“There is no ready solution to this problem of murky findings, public angst, and mixed messages,” said Meir Stampfer, chairman of the Department of Epidemiology at HSPH. “Just about every player has a role that enhances that effect—all well-meaning, of course, or mostly.”

The researchers, for example, not only want to find the truth, they want to be doing something important to save the world. “It’s very easy to talk yourself into believing that your finding truly is important and therefore needs to be heard by everyone as loudly as possible,” Stampfer said.

Institutions that employ the researchers, journals that publish their findings, and professional associations that host scientific meetings all have media relations people whose job is to get the message out, in part to enhance the reputation of their organizations. “There’s a natural tendency to exaggerate the findings to some extent, or at least aggrandize them,” Stampfer said.

“Finally, the individual reporters want to be writing about something that’s very important and momentous and get themselves on the front page and above the fold with their byline,” he said.

Fleshing out the Message
The WHI has provided “a lifetime of lessons and experiences,” said JoAnn Manson, HMS professor of medicine, HSPH professor of epidemiology, and one of the WHI principal investigators. “Researchers and reporters need to work together closely to provide reliable information to the public. It’s the responsibility of all researchers talking to media to emphasize the limitations, put the findings into the context of the totality of evidence, clarify the public health messages, and make it clear what results mean and what they don’t mean.”

Researchers and institutional communications professionals need to anticipate and preempt misinterpretation of the results, she said. For example, the WHI had “a tremendously important public health message for older women that the risks of hormone therapy outweighed the benefits,” she said. “You should not be starting hormone therapy in your 60s and 70s for the purpose of preventing cardiovascular disease and osteoporosis.” The same risk-to-benefit profile did not extrapolate to younger women taking hormones for symptomatic relief of hot flashes, in part because of their lower absolute risks.

Despite the pressures to overstate the importance of a story while aiming for the front page, Gideon Gil, Boston Globe health and science editor, thinks major newspapers are doing a better job of putting research studies into the proper context compared to 20 years ago. “The public has an insatiable appetite,” Gil said, “and the places where the public is increasingly getting information [web and television] are places that, so far by and large, don’t do a great job of giving caveats and nuances of medical study results.” In the case of the Ashland study and unpublished preliminary results of a breast cancer prevention study of tamoxifen and raloxifene released in April by the National Cancer Institute, Gil said, government agencies have contributed to miscommunication by not providing the complex studies in advance to journalists.

Elsewhere, journalism training programs at two universities have launched websites devoted to evaluating and improving the quality of health, medicine, and science news. Health News Review, published by the health journalism graduate program at the University of Minnesota, provides a kind of scientific peer review to improve the accuracy of news stories about medical treatments, tests, and procedures and to help consumers evaluate the evidence for and against new ideas in health care. The KSJ Tracker, created and funded by the Knight Science Journalism Fellowship Program at MIT, aims to help science reporters and editors evaluate the work of their peers and improve their own performance.

—Carol Cruzan Morton

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