Headline: Big Study Finds No Clear Benefit of Calcium Pills,
The New York Times
Headline: Study: Calcium Supplements Provide 'Modest'
Benefits, USA Today
Headline: Does Calcium Really Help Women Prevent Bone
Loss, Fractures, Wall Street Journal
Jay Winsten (l) and Meir Stampfer
Attempting to untangle these issues and to suggest ways to improve health news coverage, a distinguished panel convened in Snyder Auditorium on May 9 to discuss "Media Coverage of Health: Murky Findings, Mixed Messages, Public Angst." The panel included correspondents for The New York Times and ABC News, the deputy editor of the Journal of the American Medical Association (JAMA), communications experts, and investigators on two of the country's best-known health studies.
The colloquium was sponsored by the HSPH Center for Health Communication, Division of Public Health Practice, and Office of Communications. A webcast is available.
A Damaging Drumbeat
Timothy Johnson
Winsten provided a 10-point plan to improve such coverage, including fewer breaking-news health articles on page one and more in-depth, trend stories. For more on these points, see sidebar below.
The panel was moderated by Dr. Tim Johnson, who is a medical editor at ABC News and an HSPH alumnus. "In my lifetime in this business I have seen, obviously as we all have experienced, the sea change in the way in which these two worlds [of media and medical science] function," he said. "They have become very competitive, very fractionated, very much driven by financial and public relations concern."
Moreover, he worries that the public is becoming cynical about health researchers' motives. He suspects that the public thinks medical scientists love to do studies without caring "about finding answers, at least answers that make sense or that are final or that are definite in any way," Johnson said.
Keeping these kinds of concerns in mind when first hired by ABC News, Johnson insisted that he would not be required to rush coverage of breaking stories. Instead, he opted to be a commentator and an analyst, which allows him to probe the issues. When breaking news requires attention, ABC has lined up more than 12,000 experts in an array of fields (not just health) who can be emailed for quick comment.
"And it's been an absolutely not only helpful experience, but fascinating experience, for me personally to have a topic come out, have a news item break, and to send out hopefully perceptive and pertinent questions to these experts, and get back a wide range of insight and answers," he said.
Lessons from the Women's Health Initiative
JoAnn Manson
"At times, the problem is that the interests of the researchers and the media may be almost too well aligned in terms of having impact and making a splash with a media report," noted Manson. "And that's really not the proper focus of reporting health information. The proper focus should be having responsible and reliable information presented to the public."
Manson described how news about three major WHI studies was handled, drawing lessons from each example. One study examined hormone replacement therapy (HRT) and was halted three years early when risks seemed to outweigh benefits in using HRT to prevent chronic diseases among older women. What investigators did not emphasize and what journalists did not seem to understand was an important distinction between absolute and relative risk. The study suggested that younger women and women who had recently entered menopause who used HRT had a low absolute risk for developing conditions such as heart attacks or breast cancer, meaning these women faced a low chance of experiencing these outcomes during this part of their lives. They just appeared to face higher risks when compared to other groups-which represents their "relative" risk. But this distinction got lost in media coverage.
"So a lot of the problems that arose from the hormone therapy trial could have been preempted by the investigators first by anticipating what were the likely issues and concerns and misinterpretations of the study results," said Manson.
Another WHI study of low-fat diets was criticized in the media for paying too little attention to so-called "bad" fats and for seeming to lump good and bad fats together. The message portrayed by media was that reducing total fat in diets didn't seem to matter in fighting illnesses such as colorectal cancer and heart disease. What wasn't conveyed, said Manson, was the rationale of the study's trials-to test if reducing total fat to 20 percent of calories or less may help prevent breast and colorectal cancers because both good and bad fats are implicated in these illnesses. "The media didn't fully understand what the rationale of that part of the study was, and the investigators should have made that clearer," said Manson.
A similar problem emerged when the results of a WHI clinical trial on calcium and vitamin D supplements were released this February (triggering the three headlines at the beginning of this article). Media reports suggested that calcium and the supplements only modestly improve bone strength and have no benefit in fighting colorectal cancer. What factor was lost in this coverage? The trial's participants already were replete with calcium and vitamin D, explained Manson. The goal of the study was to see if any additional benefits could be derived from taking the mineral and vitamin,
"Science doesn't lend itself readily to the 30-second sound bite, but it is important for investigators to be thinking that through in their own mind and help the media with the public health message," said Manson. "And I think if we're more preemptive in trying to avoid these misunderstandings that we can get much more responsible messages out to the public."
Manson suggested that web sites could review the reliability of media reports and of the press releases that help fuel them. Such a site has gone online: HealthNewsReview.org rates health care news stories for accuracy, balance, and completeness, using a multidisciplinary group of experts to assign numerical scores. Even more recently, the MIT-based Knight Science Journalism Tracker evaluates science and medical news stories, lists top "picks" of the day, and encourages comments.
The Role of Peer Review
Lawrence Altman (l) and Drummond Rennie
"By making so much of peer review, doctors and scientists, intentionally or not, have created the impression that publication in a peer-review journal is the scientific equivalent of the Good Housekeeping seal of approval," said Altman. "That's what I find in my spot checks with people when I go around and ask. Relatively few doctors and scientists and members of the public have a satisfactory understanding of the definition of peer review and how the system works. That's not surprising, because there is no dictionary definition of peer review, and no uniform way journals apply peer review in reviewing manuscripts."
Drummond Rennie, deputy editor of JAMA, retorted that Altman's accusations were "nonsense" and "old-fashioned."
"If editors contend that peer review is a good idea, it is [because] the experience of journals that have dropped peer review or that have never taken it up has been catastrophic," said Rennie.
The pair also sparred over the degree to which journal editors should more aggressively investigate the validity of study data. Altman argued that medical journal editors, like journalists, should take a much greater role in exploring the claims presented in papers before publishing them. Rennie responded that, "There are reasons we don't call ourselves journalists, because we haven't trained in journalism. We're scientists. We're medical folk. It would be like calling a reporter a physician scientist. They're different folk. And it's nonsense to pretend they're not."
Meir Stampfer, chair of the HSPH Department of Epidemiology and an investigator with the oft-cited Nurses' Health Study, offered some concluding observations.
"The real problem is that things are complicated. They aren't simple. And public angst and murky findings, well, that's what we have-professional angst and professional murky findings," said Stampfer. "Often there is a lot of disagreement within the scientific community about the meaning of research findings."
He added, "I think if there is one thing the media and the people who talk to the media could do to help improve the situation would be to try to convey the degree of uncertainty: this we know for sure, this we think we know, this might be, further research is necessary, this is a possibility, and we'll see how it plays out."
Copyright, 2007, President and Fellows of Harvard College
