Issues Magazine

Health News in the Media: A Dose of Critical Thinking Is the Best Treatment

By Amanda Wilson (1) and Jane Robertson (2)

Health information is everywhere – in newspapers, television, magazines, online, streaming and blogs. Access is quick, cheap and easy, but not all reporting is good quality. A few simple questions can help people take a more critical view of this information and make better choices about treatments and health behaviours.

Health news is literally at the fingertips of most adults in developed countries, 24 hours a day from every corner of the globe. It might be a 20-second “grab” on the television news, a 10-second radio news update, a 3-minute “in-depth” breakthrough on a current affairs program or a two-page feature in a broadsheet newspaper. Or it might be from the internet: transcripts of broadcasts, online news sites, blogs, streaming, e-news or interactive news. But despite this proliferation of online news services, most internet sites re-use or “aggregate” material taken from the traditional news media.

Alongside the rapid growth in technological communication is an increasing human preoccupation with health. Possibly as a result of the ease of access to information, we have developed a greater awareness of, interest in and demand for new health products. Our fixation with new drugs, tests and interventions comes on top of a lack of rigorous debate about how well the new compares with existing therapies. Ironically, existing treatments often work just as well (sometimes better), are cheaper, and have more safety information than for the new ones.

In making personal health decisions, it’s important to know about the harms and benefits of new interventions, but this also impacts on the way the country’s healthcare system works. Resource allocation decisions depend on rigorous and balanced information, so how the media deals with and presents health news can have important ramifications for individuals and communities alike.

Improving public access to reliable health information has many benefits. For example, news relating to product withdrawals or safety concerns can be quickly disseminated. On the other hand, reports of risks can also have a negative side, generating anxiety and changing individual behaviours in ways that can lead to inappropriate, expensive and even detrimental use of alternative interventions. The aim of the story may be to alert people to potential danger but the media can unintentionally contribute to widespread fear or panic through a high concentration of similar stories, inappropriate information or headlines, and the misinterpretation of clinical information. This perceived media influence is referred to as “moral panic”, where concerns regarding a lifestyle or health practice are associated with threatening or negative consequences.

A good example of this effect was when Australian singer Kylie Minogue’s diagnosis of breast cancer hit the headlines in 2005. Minogue’s illness created a wave of intensive international news media coverage, and this news in turn generated a 100% increase in the number of never-screened young women booking mammograms. This rise in breast scans peaked within a few months, but did not return to normal levels until almost a year later. Despite the increased number of scans performed, no extra breast cancers were diagnosed when compared with projected estimates. Simply, there was no benefit; instead, these women were unnecessarily exposed to radiation, anxiety and “cancer phobia”. The concentrated reporting of Minogue’s illness resulted in a massive and potentially detrimental change in health behaviour.

Currently, routine breast screening is not recommended for asymptomatic young women (those under 40 years). While most of the news stories at the time stressed this fact and discussed other forms of breast checks, young women were still sufficiently concerned by the news to seek reassurance in the form of a relatively invasive, uncomfortable and potentially harmful intervention.

While wide news coverage of especially threatening or fear-inspiring stories can change health behaviours, sometimes substantially, these changes tend to be short-lived, peaking within weeks of the stories hitting the press, and returning to pre-media levels within months. Although this suggests that media-induced “moral panic” is a temporary phenomenon, little is known about how individuals digest this information, apply it in their own lives and how it might affect their healthcare decisions.

“Health literacy” is the ability to understand and usefully apply health information, and is considered important for maintaining and improving public health. Poor health literacy can lead to under-use, misuse or overuse of health resources, leading to inadequate outcomes and inefficient use of healthcare resources.

It follows that good quality health news stories can improve public understanding, contributing to informed decisions and better use of healthcare funds. The global movement in increasing health literacy is underpinned by the technological revolution that makes access to information quick, easy and relatively cheap. Unfortunately, however, this feast of information is not always of good quality.

Health news, like other news, is increasingly presented in so-called “electronic” tabloid style: punchy, simplistic and often sensationalised or inaccurate. Worse still, from an accuracy point of view, is the internet-driven trend of “churnalism”, in which news stories are “churned out” using information from press agencies and media releases in the race to trump the opposition’s news outlet, with little or no effort put in by the media organisations to check the accuracy of the content. While more established media outlets tended to stand or fall on their reputation for accuracy, giving readers some expectation of this accuracy, this proviso seems less clear in the internet age, making it harder for consumers to know whether the information is reliable.

Well-conducted research published in quality journals is a good basis for a news story. However, many news stories discuss research from animal studies, laboratory investigations or early phase trials, and extrapolate these findings to suggest potential treatments for people suffering often severe illness. Sometimes it is unclear when, or even if, a treatment will be available.

To counter such situations there have been calls from the research community to restrict media reports based on early research so only studies published in peer-reviewed journals, or about interventions close to or available for common use, can be reported. While this would limit misrepresentation of the relevance of research findings that may sound promising but are years away (if ever) from being used in a human population, it would also be extremely restrictive, probably counterproductive and almost impossible to enforce.

A better approach would be to educate journalists, and readers alike, about the differences between various types of research and trials, and to encourage researchers to be honest about the relevance of findings from early research.

Other common problems in the reporting of health and medical issues include:

• unnecessary sensationalism: exaggerated claims of the benefits or risks, such as overblown headlines, use of hyperbole and dramatic descriptions like “miracles”, “ground-breaking research” or “life-saving drugs” that may generate false hope;

• not considering the quality of the evidence: How good was the study? What kind of trial was it? How many people took part? How long did it run? Have the results been published in a good quality journal?

• reporting benefits or harm using a relative frame: results can seem more impressive than if presented in absolute terms (see “Different Ways to Tell the Same Story”);

• forgetting about stories: a revolutionary intervention is reported on but then disappears from the public eye forever; there is a need to revisit the research and tell the reader what happened;

• ignoring the public health dimensions: where the impact of the disease or cost of the intervention is not put into context;

• glossing over costs: this is not advertising, especially if the costs of the new drug are compared with the existing one. Is the benefit worth the price? If it is very small or the side-effects worse, then maybe not; and

• not getting a second opinion – it is a cardinal rule of journalism to tell both sides of a story. A good story includes comment from an expert who didn’t have anything to do with the research.

Media authorities and peak medical societies recognise the importance of good quality health reporting, as illustrated by the various guidelines developed for journalists. The Australian Press Council Guidelines for journalists provide explicit warnings stating that the “dangers of exciting unreasonable fears or hopes are far too great for anything but the most careful treatment”. The guidelines stress the need to consult an independent source even if the information provided comes from the “most eminent authority”. They say claims of cures and miracles should be treated with caution and any interest in the intervention should be made clear (e.g. the doctor who conducted the trial has a vested interest, as does the company who makes the drug). Personal experience or anecdotal evidence should be clearly identified as such. It is also ethically necessary to keep medical news distinct from medical marketing.

In Australia, as in most developed countries, there are media outlets recognised for their higher standards of reporting. These outlets aim for audiences wanting more probing stories and include the broadsheet newspapers (e.g. The Age, The Australian, The Sydney Morning Herald), the Australian Broadcasting Corporation (ABC) outlets, and Special Broadcasting Service (SBS). The tabloid newspapers and commercial television generally have a higher number of “easy reading” stories: human interest, celebrity, entertainment and sports news (e.g. The Daily Telegraph, The Herald Sun, Today Tonight, A Current Affair).

The news websites of the ABC and ninemsn reflect their television counterparts – the government-funded ABC and the commercial Nine Network. Online ABC provides serious, in-depth, local, national and global news as well as specialised areas of reporting including health. Ninemsn specialises in entertainment news along with specific news services. The health section provides serious and, in many cases, high quality stories, but these are scattered among low quality stories on beauty, cosmetics enhancement and diet. This type of “health” reporting promoting “cosmeceutical” stories as health news has become a trend internationally.

So how does the average reader/viewer know when health news stories are worth paying attention to? How can you critically appraise the content?

There are no courses in critical thinking for assessing health information presented in the news media. However, you don’t need a medical background to get a general idea of the value of most health stories. Patients are encouraged to develop a question prompt list to take to their doctors. This form of critical thinking helps people become active in their health care rather than passively accepting advice and information.

The same concept can be applied to the media. A handful of basic questions can be applied to most health stories to guide peoples’ thinking and help reach a more informed decision on whether it is worth buying the drug, having the test or pursuing the treatment.

One approach is to divide interventions into four basic categories. Every therapeutic intervention will fall into one of these (in the case of diagnostic procedures substitute “effective” with “accurate”):

1. It’s effective and safe.

2. It’s effective but with side-effects.

3. It’s ineffective but safe.

4. It’s ineffective and has side-effects.

Surely no medicines or interventions in Australia would fall into the last two categories? In the case of prescription medicines and many over-the-counter medicines, we have rigorous evaluation procedures that try to ensure that only products that are effective and safe are available in the marketplace.

Surprisingly, relatively few drugs fall into the first category of being truly “effective and safe”. More often, a treatment that offers a cure or symptom relief will have side-effects as a trade-off for the benefits of therapy, but the balance of benefits and harms favours the use of the drug.

Perhaps more troubling is that substantial numbers of health interventions are accepted in the marketplace despite little or no evidence to show they work. Patient testimonials are no substitute for rigorous evaluation.

Similar provisos apply to diagnostic testing. Very few tests are 100% accurate and the risk of a false-positive result (suggesting that disease is present when it is not) or false-negative result (misses the disease when it is present) can have devastating consequences.

In 2009, Issues published a story about Media Doctor Australia (www.mediadoctor.org.au), a website developed to assess the quality of health news stories published in the Australian media. Media Doctor Australia (MDA) is the first of six similar international websites, including Media Doctor Canada, Germany, Japan, Hong Kong and HealthNewsReview in the USA. The Media Doctor websites use rating instruments to assess news stories and assign them a star-rating on the quality of the content (5 stars being the highest quality rating). Over the 7 years MDA has been operating, the general quality of health news has come up short. At least some of the reason behind this is the poor quality of information that is provided to the media by researchers wanting to promote their research (see Examples of Stories on page 23).

Media Doctor Australia uses an evidence-based medicine approach and applies rigorous scientific methods of enquiry in its critical thinking. The MDA website is freely available and provides detailed ratings and comments on many health news stories appearing in the Australian media. This is a good place to start if you want to follow up a story, although there is generally a lag time of around a week between the stories going live and being posted on the site, and not all health stories are included.

Health consumers can also use their own critical thinking when assessing news reports by applying a simple framework (see Critical Thinking: What Can I Be Sure Of?), based on four questions:

• How well does the drug/intervention/diagnostic test work?

• What are the harms or side-effects?

• Is it available?

• How much does it cost?

The media plays a central role in informing the public about health and medical care, and in doing so influence health behaviours and choices. However, the general quality of this information is poor. Researchers, health professionals, journalists and news outlets all have a role to play in providing more accurate and balanced communication. Researchers can make more balanced claims about their work and be more widely available to journalists to interpret and provide context for research findings. Journalists need to do more than reproduce information provided in press releases from research institutions and industry; they need to ask the questions about efficacy, safety and cost that matter to readers. Time and commercial pressures can compromise the best of intentions, whether it’s a health story published in print, put to air or posted on the web.

There are steps people can take to help them judge the quality of health stories in the media. Take a minute to consider what the article is really telling you. Look for evidence in the form of a research trial or study that involves humans (this indicates a more advanced phase of testing), think about what it says regarding efficacy and safety. Does an independent expert put the claims into context? Is it available in Australia? See what others have to say: websites such as Media Doctor may have reviewed the story.

And, of course, talk to your doctor to see whether it might work for you.