Why Reporters and Editors Get Health Coverage Wrong

In 1997, I left behind 26 years of reporting at The Des Moines Register to pursue a master’s degree in public health. The switch proved great fun. I devoured courses in epidemiology and biostatistics, health policy and health behavior theories, research methods and program evaluation, among others. Invariably, however, in class, professors criticized—or, to my chagrin—ridiculed some ineptly done news story about health and medicine. Adding to my dismay were various studies I came across that criticized journalists for careless, unscientific, inadequate or unfair coverage of AIDS, women’s health issues, chronic fatigue syndrome, health reform, and medical research.

Often, I have felt hard pressed to defend the news industry. Having been a reporter, I knew all too well how little preparation and on-the-job training journalists typically receive for covering such complex issues as fetal brain cell implants, HIV/AIDS and, as we have witnessed recently, bioterrorist threats.

I am not alone with my concerns. A recent article in the Journal of the American Medical Association (JAMA) pointed to the frequency of exaggerated reporting about preliminary medical studies. Dr. Lisa Schwartz of the Department of Veterans Affairs Medical Center in White River Junction, Vermont reviewed a year’s worth of health-related research that resulted in news coverage. Her review of 147 research presentations at five major scientific meetings in 1998 found more than one-quarter of the studies generated front-page news stories in at least one major newspaper. Yet more than one-third of those reported-on presentations either involved small numbers of human subjects or were based on animal or laboratory studies. Three years later, only half those research papers generating general news coverage were published in a leading peerreviewed medical journal, with smaller numbers appearing in lesser journals and others going unpublished altogether.

“The current press coverage of scientific meetings may be characterized as ‘too much, too soon,’” Schwartz wrote. “Results are frequently presented to the public as scientifically sound evidence rather than as preliminary findings with still uncertain validity. Press coverage at this early stage may leave the public with the false impression that the data are in fact mature, the methods valid, and the findings widely accepted.”

Health Journalists Need Training

How can this be? The simple answer is that many journalists who cover health and medicine have had no specialized training. In fact, a 1999 survey I did showed that nearly 83 percent of 115 Midwestern health reporters who responded said they had no training, besides on-the-job experience, that specifically helped them cover health issues. And more than two-thirds of the respondents identified four skills—understanding key health issues, putting health news in context, producing balanced stories on deadline, and interpreting statistics—as troublesome. The survey also found that the health reporters (all of whom were at daily newspapers) know they lack proficiency and want help. Only 31 percent felt “very confident” reporting health news and only 9.7 percent felt “very confident” interpreting statistics.

Though these results didn’t surprise me, I find it shocking even now that the news industry pays so little attention to preparation and training for reporters and editors, particularly if they are being asked to report on complex issues involving health and medicine. Indeed, the idea of providing on-the-job training holds so little sway in the journalism industry that no one knows how much is spent on professional development. The best estimate comes from a recent study by Northwestern University’s Media Management Center, which used the standard benchmark—percentage of payroll spent on training—to track spending in the newspaper industry. On average, newspapers spend seven-tenths of one percent of payroll on professional development, Northwestern’s researchers found. The national average of all industries was two percent in 2000, according to the American Society of Training and Development.

Though specialized training should be available for reporters on any beat, it is essential for reporters who cover health and medicine, the business of health care, consumer health issues, or health policy. For one thing, health journalists—unlike education or city hall reporters—need skills and knowledge not easily acquired on the job. They should know, for example, the strengths and weaknesses of clinical trials vs. case control studies, the difference between relative risk and absolute risk, and how to interpret a statistical significance or correlation score, just to name a few. Without such knowledge, journalists can wreak havoc or, at the very least, confusion.

Causing Confusion in Readers’ Minds

Consider last summer’s blockbuster story about the decision to halt the large federally funded hormone replacement therapy (HRT) trial because the drugs increased the risk of heart attacks, although slightly. Surely, many of the six million women taking these drugs wondered how could this be when the press had reported numerous previous studies showing those drugs lowered the risk of heart attack and Alzheimer’s disease.

My theory is that few stories during the last decade put information about HRT in its proper context. Specifically, many reporters routinely failed to inform readers that nearly all previous studies were observational studies. Observational studies, as a well-educated health journalist knows, are a considerably weaker way to assess a treatment’s risks and benefits. That’s why the HRT trial, a well-designed clinical trial with a large number of participants, offered strong enough evidence for doctors and scientists to halt the study in midstream.

But let’s not blame reporters here. Editors should be catching errors and omissions—and demanding context. The problem is that editors typically aren’t any better at doing this than untrained reporters. This situation became apparent to me in 2001 when I analyzed news coverage of a clinical trial involving a new treatment for Parkinson’s disease patients. The Washington Post published a news brief about a study that mistakenly confused stem cells with fetal brain cells. A knowledgeable editor would have prevented such a silly mistake from appearing in the newspaper.

If news coverage of health and medicine didn’t matter so much, maybe I wouldn’t care. The fact is that news reports about health and health care affect the well being of many Americans. And there’s plenty of evidence to prove it:

• A 1997 National Health Council survey showed that more than half of Americans (58 percent) claim a medical or health news story led them to consider changing their behavior or to take a specific action, such as seeing their doctor, changing their eating patterns, modifying their exercise habits, or getting some kind of medical treatment.
• A January 2000 poll conducted for the American Dietetic Association found 48 percent of respondents who cited television as a leading source of nutrition information, while 47 percent said they get information from magazines and 18 percent from newspapers. Physicians were cited as a leading source by only 11 percent of respondents.
• A March 2002 Harris poll showed that about 110 million American adults—nearly 80 percent of all American adults who use the Internet—spend at least part of their time online searching for health care information. On average, they search for health information three times a month.

In short, misleading reporting can be dangerous. As Schwartz noted, “Patients may experience undue hope or anxiety or may seek unproven, useless or even dangerous tests and treatments.”

Encouraging Professional Development

So, what’s to be done? The first thing is to encourage the news industry to do its duty: Provide the proper training for its reporters and editors. There is no question that journalists want help. A study, “Newsroom Training: Where’s the Investment?,” done for the Council of Presidents of National Journalism Organizations and funded by the Knight Foundation, showed that the number one complaint among journalists is lack of training. Luckily, some movers and shakers within the journalism industry are working to transform attitudes so professional development becomes an indispensable part of a newsroom operation. Last summer, the American Society of Newspaper Editors drew together representatives from about 25 journalists groups to develop a plan to remedy this situation.

An analysis the Association of Health Care Journalists (AHCJ) did about a year ago found many wonderful professional development opportunities out there. But they reach relatively few health and health care journalists. All told, each year these workshops and seminars attract no more than 200 to 400 of an estimated 3,500 to 5,000 journalists who report on these issues.

Training also seems to reach mostly experienced reporters at large media outlets. Small news outlets often do not allow staffers to attend workshops and seminars. This means that young and inexperienced journalists at smalland mid-sized news outlets—the very journalists who need training the most—are less likely to receive it.

Another conclusion: Most workshops and seminars deal with one subject, such as cancer or genetics. Some programs, such as the Knight Fellowships at Stanford, do not focus on health care, but journalists can use the fellowship year to study health topics. However, almost no program offers training in such journalism fundamentals as how to interview health and medical researchers or how to report medical research. The only systematic health education typically requires 12 months to two years in a graduate program, and this is often too costly and timeconsuming for journalists.

Those training programs that do exist also need to be better assessed. Few, if any, of these programs have been evaluated by outside parties to determine if they improve the knowledge and skills of participants—or, what’s more important—if they actually raise the quality of news reports. This is where groups such as the AHCJ can provide leadership. We are working to RELATED ARTICLE
“Covering the Quality of Health Care: A Resource Guide for Journalists”
– Melinda Vossdevelop the framework for a comprehensive curriculum that will be readily available to large numbers of journalists who cover health and health care and will be properly evaluated. As part of this effort, AHCJ produced a 220-page resource guide for reporters on covering quality issues in health care.

In devising such a curriculum, we will avoid reinventing the wheel. We want to include existing programs such as those offered by the Kaiser Family Foundation, the Knight Science Journalism Fellowships at the Massachusetts Institute of Technology, the Knight Center for Specialized Journalism at the University of Maryland, and at workshops and seminars put on by such groups as the National Press Foundation, the Foundation for American Communications, the American Press Institute, and the Poynter Institute for Media Studies.

This new curriculum and approach might not be fully up and running for a decade, but I believe it will provide a workable and credible way to systematically provide the skills and knowledge health journalists need to do their jobs well, without requiring them to leave their jobs for a year. It’s certainly something I wish had been available when I was reporting on health and medicine. With the knowledge I acquired earning a master’s degree in public health, I blush to think of the mistakes and omissions I undoubtedly made. Perhaps this is why I’ve made it my life’s mission to do what I can to improve the quality of news reports about health and medicine.

Melinda Voss earned a master’s degree in public health after 26 years as a reporter at The Des Moines Register. She is cofounder and executive director of the Association of Health Care Journalists (www.ahcj.umn.edu). In addition, she is the coordinator of the Health Journalism Masters Program at the University of Minnesota and vicechair of the Council of Presidents of National Journalism Organizations, an umbrella group of 44 journalism organizations.