Reporters struggle to translate medspeak

Pauline Dakin and other health reporters influence the way people think about their health. This is a tricky responsibility. Take for example the reporting of MS liberation.

By Michelle Hampson

Pauline Dakin and other reporters influence the way people think about their health. This is a tricky responsibility. Take for example the reporting of MS liberation.

Pauline Dakin in her CBC office next to the Halifax Infirmary (Michelle Hampson photo)

By Michelle Hampson

How appropriate that Pauline Dakin’s cubicle overlooks the Halifax Infirmary. The orange-brown brick building contains hundreds of patients awaiting news about their health. Dakin, the national health reporter for CBC Radio, is reminded of the importance of her reporting by merely glancing out the window.

Dakin’s tiny corner cubicle, about nine feet square, is overflowing with paper, stacks of videotapes, notebooks and binders. Over the years she has developed a solid list of contacts. “Being on a beat allows you to develop expertise and knowledge that you can apply to most of your stories.”

Through ten years as a health reporter she has won more than 15 journalism awards. Many were for in-depth stories. Most mainstream media, however, offer a different kind of coverage. “One day I’m reading in the paper that I should be taking vitamin E to prevent whatever and then two weeks later it’s all of a sudden causing cancer,” said Dakin. “There is this kind of ridiculousness around health reporting. It’s because (reporters) are just pulling these little bits of research out that are not ready for prime time.”

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This is a problem. Health stories are one of the top three areas of audience interest and 58 percent of people reported changing their behaviour based on a health story in the media, according to a 1997 survey of 2,256 adults by the U.S. National Health Council.

Only a rare type of reporter reports scientific stories accurately, knows how to manage time constraints, and has accumulated background knowledge: health beat reporters.

A study examining articles on health topics produced by health reporters compared with general assignment reporters was released in September. The study analyzed 1,337 health articles published in Australian media between 2004 and 2009. Media Doctor Australia, a project aimed at analyzing the quality of health stories and providing journalists and readers with feedback, conducted the study. It is funded by the Hunter Medical Research Institute and the University of Newcastle.

Each article was rated according to ten criteria, including reported harms or if the reporter consulted independent expert sources. General journalists scored an average satisfactory of 44.8, compared to health reporters at 56.2. Specialized health reporters scored the highest: 59.6.

Dakin remembers her first solemn warning about the importance of quality health reporting. In 2002 she attended a weeklong health reporting conference in Maryland. While fairly new to the health beat, she joined 25 other reporters, most of whom worked for journals or specialized publications. Dr. Barry Kramer, of the U.S. National Cancer Institute, was lecturing the group. In an offhand comment he made clear just how costly a health reporting mistake can be. It still resonates in Dakin’s mind. “If I screw up,” she says now, “people can die.”

Reporters fail in health coverage

Andre Picard, a Globe and Mail health beat reporter, has been on the job for more than 10 years, and covered hundreds of stories. Still, he is not sure he is comfortable yet in the health beat, or if anyone ever is. “The comfort I have now is having background,” he says. “I think I know how to find information better than before. When you don’t have the background, you can get… led astray a lot more easily.”

Take the multiple sclerosis liberation treatment, for example.

Italian vascular surgeon Dr. Paolo Zamboni, of the University of Ferrara, conducted a study that found almost all MS patients had narrowed veins draining blood from the brain. His solution? Open the veins with balloons. The media focused on MS patients who report improved symptoms after traveling to faraway countries to receive Zamboni’s unproven treatment.

A collection of Chronicle Herald clippings from Sept. 2010 (Photo: Michelle Hampson)

Dalhousie University Professor Emeritus Dr. Jock Murray, who has studied MS for more than 25 years and has written books on the disease, says reporters did not look at Zamboni’s published study, which found that certain types of MS patients did not get better. Media, he says, “they encouraged a lot of people with advanced MS to go seeking the liberation therapy, when [Zamboni’s] published paper indicates that those patients didn’t get any better.”

Since CTV first broke the story in November 2009, Murray says he has been contacted by 35 to 40 journalists about the liberation treatment. Not one, he says, read Zamboni’s paper.

Murray asked these journalists why. They said they did not feel qualified to do the kind of background research necessary. Really, they only wanted the human interest aspect, not the medical aspect. Time constraints were another reason.

Dr. Stan Kutcher does not specialize in MS, but noticed basic scientific context was missing from media reports about liberation therapy. In September 2010, media reported that patients were demanding the treatment be available in Canada and that government immediately fund clinical trials, instead of waiting for results from ongoing studies.

Kutcher, who holds a chair in Adolescent Mental Health at Dalhousie University and the IWK Health Centre, said, “people were speaking with a lot of emotion and trying to make decisions about complicated things, without seeming to understand much about what they were trying to make decisions about.”

He wrote an opinion piece in The Chronicle-Herald to provide readers with context. He explained how clinical trials are the last step of gathering scientific evidence, not the first step. Before any treatment goes on to clinical trial, research already evaluating potential risks and benefits is required. Seven studies already underway are now making that evaluation.

Ah, the lessons to be learned from the MS liberation story. Most reporters did not read the relevant medical literature. They did not have the time to cover the story properly. They felt they did not have adequate knowledge to deal with the information available.

Even lack of understanding about what a clinical trial entails can lead to poor reporting and confusion. Kutcher points out that most journalists’ lack of scientific understanding and critical thinking is “super compounded” by the public’s similar lack of scientific literacy.

One aspect of health reporting where journalists often err is statistics. People may be told about a drug, for example, that offers a 50 percent risk reduction in a certain illness. This sounds impressive, but the data may be presented in a biased way.

Chemistry major Brendan Peters working at a Dalhousie University lab (Photo: Michelle Hampson)

Alan Cassels, a drug policy researcher at the University of Victoria, explains that a person’s overall risk of susceptibility to an illness may be two percent, but if they take the drug their risk is one percent. That’s a 50 percent drop in relative risk. Reporting these numbers in relative terms can make the drug sound great, while in absolute terms the impact of the drug is very small.

Cassels, who is the lead researcher of Media Doctor Canada, the Canadian version of Media Doctor Australia, said, “Journalists get this wrong, not because they’re bad or not because they’re dumb. It’s because the scientific publications of the study will often be misleading.” Drug company PR releases, he says, often present benefits in relative terms, but state risks in absolute terms.

Full-time health reporters do better

Health reporting is a broad topic, and includes health policy, access, treatments, research and of course, the human interest aspect. Dan Leger, director of news content at The Chronicle-Herald, says in a perfect world he would have many reporters covering health. The Herald’s current health reporter has been on the beat for about a year, and is also the environmental reporter.

A survey of 256 members of the Association of Health Care Journalists, conducted in 2008, found that 94 percent of respondents say the bottom line pressure in news organizations is seriously hurting the quality of health news. Forty percent said the number of health reporters at their organization has gone down since they’ve been there, while 16 percent reported an increase. The top three challenges to health reporting were newsroom cutbacks, insufficient time and space for in-depth coverage, and lack of experienced, trained and knowledgeable reporters.

Another problem might be the way in which some general assignment reporters are accustomed to reporting. The Globe and Mail’s Picard does not think health should be covered in terms of conflict. He describes health as gray, rather than black and white.

“The stuff that’s coming down the pipe is going to be increasingly difficult for people to understand.”
–Pauline Dakin

Take cholesterol pills, for example.

“The reality is they’re good for some people, they’re bad for some people. They work well in some contexts, they don`t work well in other contexts. There’s a lot more subtleties in health than say in a court story (when) somebody’s guilty or not guilty.”

Health is not easy to cover, but full-time health reporters have an advantage. Dakin, Picard and Canadian Press health and lifestyles editor Anne-Marie Tobin say one advantage of health reporting is that they may hear of a study before its released, which allows time to prepare for it. However, there have been changes in the beat over recent years – a shift toward lifestyle stories and an increase in science complexity.

A CBC radio health show, Health Matters, was dropped in 2005. Health gets less play on national airwaves now. “We used to have a very big focus on covering the journals, the latest research, and a fair bit of investigative stuff,” said national health reporter Pauline Dakin. “We don’t do any of that anymore and I think it’s largely a function that we’re a very small unit now.”

“There are very few reporters anywhere in Canada who are really qualified to read or review in the Canadian Medical Association Journal…”
–Dan Leger

She also noted a shift in what the network aims for. “They got very interested in more water-cooler health news in the last few years, which is not very ‘sciency.’ It’s more about nutrition, or fitness or its more lifestyle stuff, and that seemed to be more what the appetite was for.”

About four years ago, both CP and The Globe and Mail experienced a similar shift to lifestyle reporting. At CP, the Entertainment and Lifestyles section was changed to the Health and Lifestyles section. Picard says that The Globe and Mail created a Life section to attract more women readers. He also points out that baby boomers are getting older, so interest in health news may increase.

To determine what could be a medical story , and not just hype check out these questions.

Some changes at CBC, including a new VP of English Services, and organizational changes in Toronto, make Dakin hopeful there will be a shift back to more investigative journalism.

Still, the number of reporters who can understand scientific publications is problematic. The Chronicle-Herald ‘s Leger, former producer of Health Matters at CBC, said, “It’s a huge challenge because there are very few reporters anywhere in Canada who are really qualified to read or review in the Canadian Medical Association Journal or any of the specialty journals, and really understand what it is.”

And studies are getting even more complex.

“It makes me very afraid about my ability to be a good health reporter when I look at what’s ahead in medicine,” said Dakin. She jokes that, even with her training and experience, she sometimes reads whole science publications only to understand the word “and.”

Science gets increasingly more complex

Whole new fields of science are emerging. “Holy smokes,” Dakin said, “the stuff that’s coming down the pike is going to be increasingly difficult for people to understand.”

The CBC reporter is back at her crammed desk now, having just returned from a weeklong AIDS vaccination conference in Atlanta. Stacks of notebooks and loose paper surround her computer. Just above her desk is a shelf full of binders, all of them dark and unlabeled. One lonely white binder sticks out in the middle, letters running up its spine. It reads: “Investigative.”

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