Changing the Drumbeat of Typical Health Reporting
4
21st Century Muckrakers about these conflicts, an important step in improving reporting hut in no way sufficient to protect readers (including doctors) from the commercial bias that remains hidden in the details. With great respect for an excellent journalist, Carey appears now to be looking at the results of the JUPITER trial through the windshield, not the rearview mirror. Not surprising, per- haps, since it is almost impossible to get the story right when the funda- mentally commercial goals for which the study has been done are covered up with so much industry-sponsored expertise. My advice to medical jour- nalists charged with reporting devel- opments in clinical medicine includes these guiding principles: Understand that the fundamental mission of commercially sponsored clinical trials is commercial. Search for the ways in which the commercial objective might have trumped dispassionate science—in the study design, analysis and pre- sentation. Realizethatidentifjingthe financial ties isn't enough. Readers won't understand the extent to which the fundamental nature of the results can he spun, as in JUPITER. Recognize that presenting the com- ments of one ortwoex-perts who don't havefinancialties to interested drug makers isn't enough. The majority of the refiection on the import of the findings should be from nonfinan- cially conflicted experts. For better or worse, good medical reporting now requires an investiga- tive approach. Given the strained circumstances under which journalists need to report today, this approach can sound like "mission impossible," and it might be. But readers need to know that, too. • John Abramson, trained as a primary care physician., is a clinical instructor at Ha iva rd Medical School, author of "Overdosed America: The Broken Promise of American Medicine," and setx^'s as an exjjert consultant to plaintiffs'attomeys in litigation in- volving the pharmaceutical industry. Changing the Drumbeat of Typical Health Reporting At HealthNewsReview.org '...we are on the lookout for those stories that include unsubstantiated claims made in the course of reporting about health.' Bv GARY SCUWITZEH level ofhealth care inves- tigative reporting has never been better in this countiy even in small- and medium-sized neivspapers. But the once- or twice- or three-times-a-year stories don't make upfor the daily drumbeat of stories. Health care reporting in this country is a disgrace day in and day out The daily drum,- beat is a disgrace, 'There are no breakthroughs'—that should be the next paragraph in the story lohen anyone makes such a claÍ7n" —Bon Barlett T his was the message Don Barlett, a Pulitzer Prize-winning investi- gative reporter, delivered to an attentive gathering at the Association of Health Care Journalists conference in 2005. Well received as his words might have been with this crowd, the "dmmbeat" of news reporting of claims of breakthroughs, cures and progress in medical research and clinical care has not gone away. In fact, such reporting—notable for its lack of any investigative muscle—abounds in what is published and broadcast daily in U.S. journalism. In "Selling Sickness: How the Worlds Biggest Pharmaceutical Companies Are Turning Us All Into Patients," authors Ray Moynihan and Alan Cassels described the reporting on one such story as "sycophantic ... flaccid." Still, some terrific in-depth health care stories, investigating key ques- tions, do appear, though less frequently than is necessary and possible. The dissonance between what health coverage Americans receive and what they deserve is, in part, related to the direction in which those deciding on what the news is choose to go. When news reporting is seen as trumpeting new treatments, tests, products or procedures, and it is done without ap- plying watchdog oversight, then what the news consumers get will be along the lines of what Barlett described. When reporting about health is seen, instead, as the exploration of e\idence, cost-eft'ectiveness, comparative treat- ments, medical technology assessment, access to medical care and disparities in care, then the news we read, see and hear will he very different. Because I believe in the value gained when reporters take the road of ex- ploring evidence, I've led a three-year effort at HealthNewsReview.org that demonstrates to journalists and the puhlic how coverage of health care and reporting on the claims of researchers should be scrutinized. Our project is grounded in the premise that news 44 Nieman Reports | Spring 2009
description
vv
Transcript of Changing the Drumbeat of Typical Health Reporting
-
21st Century Muckrakers
about these conflicts, an important stepin improving reporting hut in no waysufficient to protect readers (includingdoctors) from the commercial bias thatremains hidden in the details.
With great respect for an excellentjournalist, Carey appears now to belooking at the results of the JUPITERtrial through the windshield, not therearview mirror. Not surprising, per-haps, since it is almost impossible toget the story right when the funda-mentally commercial goals for whichthe study has been done are coveredup with so much industry-sponsoredexpertise. My advice to medical jour-nalists charged with reporting devel-opments in clinical medicine includesthese guiding principles:
Understand that the fundamentalmission of commercially sponsoredclinical trials is commercial.Search for the ways in which thecommercial objective might havetrumped dispassionate scienceinthe study design, analysis and pre-sentation.Realizethatidentifjingthe financialties isn't enough. Readers won'tunderstand the extent to which thefundamental nature of the resultscan he spun, as in JUPITER.Recognize that presenting the com-ments of one ortwoex-perts who don'thave financial ties to interested drugmakers isn't enough. The majority ofthe refiection on the import of thefindings should be from nonfinan-
cially conflicted experts.
For better or worse, good medicalreporting now requires an investiga-tive approach. Given the strainedcircumstances under which journalistsneed to report today, this approachcan sound like "mission impossible,"and it might be. But readers need toknow that, too.
John Abramson, trained as a primarycare physician., is a clinical instructorat Ha iva rd Medical School, authorof "Overdosed America: The BrokenPromise of American Medicine," andsetx^'s as an exjjert consultant toplaintiffs'attomeys in litigation in-volving the pharmaceutical industry.
Changing the Drumbeat of Typical Health ReportingAt HealthNewsReview.org '...we are on the lookout for those stories thatinclude unsubstantiated claims made in the course of reporting about health.'
Bv GARY SCUWITZEH
level of health care inves-tigative reporting has neverbeen better in this countiy evenin small- and medium-sizedneivspapers. But the once- ortwice- or three-times-a-yearstories don't make up for thedaily drumbeat of stories.Health care reporting in thiscountry is a disgrace day inand day out The daily drum,-beat is a disgrace, 'There are nobreakthroughs'that should bethe next paragraph in the storylohen anyone makes such acla7n" Bon Barlett
This was the message Don Barlett,a Pulitzer Prize-winning investi-gative reporter, delivered to anattentive gathering at the Associationof Health Care Journalists conferencein 2005. Well received as his wordsmight have been with this crowd, the"dmmbeat" of news reporting of claimsof breakthroughs, cures and progressin medical research and clinical carehas not gone away. In fact, suchreportingnotable for its lack of anyinvestigative muscleabounds in whatis published and broadcast daily in U.S.journalism. In "Selling Sickness: Howthe Worlds Biggest PharmaceuticalCompanies Are Turning Us All IntoPatients," authors Ray Moynihan andAlan Cassels described the reportingon one such story as "sycophantic ...flaccid."
Still, some terrific in-depth healthcare stories, investigating key ques-tions, do appear, though less frequentlythan is necessary and possible. Thedissonance between what health
coverage Americans receive and whatthey deserve is, in part, related to thedirection in which those deciding onwhat the news is choose to go. Whennews reporting is seen as trumpetingnew treatments, tests, products orprocedures, and it is done without ap-plying watchdog oversight, then whatthe news consumers get will be alongthe lines of what Barlett described.When reporting about health is seen,instead, as the exploration of e\idence,cost-eft'ectiveness, comparative treat-ments, medical technology assessment,access to medical care and disparitiesin care, then the news we read, seeand hear will he very different.
Because I believe in the value gainedwhen reporters take the road of ex-ploring evidence, I've led a three-yeareffort at HealthNewsReview.org thatdemonstrates to journalists and thepuhlic how coverage of health care andreporting on the claims of researchersshould be scrutinized. Our project isgrounded in the premise that news
44 Nieman Reports | Spring 2009
-
Medical and Health Reporting
HEALTH N E W S R E V I E W O R GFINDREViEWS i SIGN UP FOR EXTRAS <
LATEST STORY REVIEWS
tS8|in;f| II Tie nviews)Today's Matters al the Heart:Dr. Nancy'i Persona! WaKe-iJpCall
A 6-minuEe egmeiE almostcomoletely dv
-
21st Century Muckrakers
some difference as reporters absorbthese observationsand awareness isleading to positive change.
Screening Tests: A ParticularConcern
Our review process has picked up,however, a troubling trend. In manynews reportsincluding some done bymajornews organizationsa crusadingadvocacy seems to exist when it coniesto promoting screening tests. And thishappens even when such guidance con-flicts with the best medical evidence.(WeVe written several articles aboutthis topic, including one on our Website, wwvt'.healthnewsreview.org, thatoffers a good summary of the evidenceand our argument.) While the intentof such stories might be good, manyreporters don't seem to realize thatin promoting screening tests outsidethe boundaries of evidence there is agood chance they canse more harmthan good.
Not only does such reporting shedthe journalistic pursuit of providinginformation that has been verified.
as much as it is possible to do so, inmost cases it is just plain wrong. Asthe saying goes, "It ain't what peopledon't know that bothers me; it's whatthey know that jnst ain't so." The be-
One thing we've noticedis how easy it is for
journalists to becomemarketing arms of
industry.
lief underpinning these stories is thatscreening of (nearly) any kind makessense for everyone. But that "just ain'tso."These pro-screening crusades oftenpromote costly approaches, such as CTscans of the heart or of the lungs orof the full body, which convince manynew "worried well" people to enter thehealth care system, costing them and
all of us dearly.If even the most rudimentary inves-
tigative effort was made with storiesabout screening testsexaminingthem along the lines posed by our10 questionsthen the informationthat gets out to the public via newsorganizations would be very differ-ent than is happening today. Onething we've noticed is how easy it isfor journalists to become marketingarms of industry. But our experi-ence also tells us that this doesn'thave to happen when journalismasbest practicedremains foremost inthe mind of reporters. An ounce ofinvestigation, it turns out, can yielda pound of pride in news coveragewhen the story a reporter writes doesnot sound like an echo chamber forthe industry's message.
Gaiy Schwitzer, the publisher ofHealthNewsReview.org, is an associateprofessor at the University of Min-nesota School of Joumalism ^ MassCommunication. He also tantes a blogabout these topics at http://hlog.lib.umn.edu/schwitz/healthnews.
Examining Water Supplies in Search ofPharmaceutical Drugs'Secrecy, it turned out, was our biggest enemy, but not for the reasonsinvestigative reporters typically encounter .,..'
BY RICHARD T. PIENCAK
An investigative reporting proj-ect sometimes begins with awhispered tip from an informedinsider or a stack of leaked documentsfrom someone with an ax to grind. Fre-quent topics include corruption, faultyregulations, laws that aren't enforcedproperly, or the failure to protect therights of the downtrodden. How aboutone where the key is sitting in plainsight, even if it is invisible to the hu-man eye, waiting to be discoveredasubject like pharmaceuticals in our
drinking water?The genesis of The Associated Press
CAP) project, "PharmaWater," can betraced to reporting our national writerMartha Mendoza did in 2005 aboutdangers associated with birth controlpatches. She'd noticed that in Europespecial disposal packets are requiredto prevent estrogen from seeping intothe environment. When Mendozamentioned this to one of her journalistfriends, she was informed about severalstudies involving traces of pharma-
ceuticals being detected in water. Awhile later this friend, who wrote fora small community newspaper, retiredand urged Mendoza to keep lookinginto this troubling topic.
In the fall of 2007, I rejoined theAP in the newly created position ofnational investigative editor. Againsta landscape of tighter budgets andshrinking investigative-enterpriseunits at newspapers and other mediaoutlets, AP executives had formulateda plan to expand the news agency's
46 Nieman Reports | Spring 2009
