News of the World wasn't read by 15 percent of the British public because it told people what they should know. It got there by giving them what they wanted: stories about the peccadilloes of the rich and famous, accounts of the gross incompetence of government and of course, pictures of naked ladies.
Setting aside the fact that News of the World is no more, its publishers and editors knew how to sell the news. As free online news replaces print, every click, every page view, every second of viewing per page is tracked in the fierce competition for ad dollars, and so the selling of news increasingly influences its reporting. Titles, format and content are tweaked by editors to optimize the metrics. Reporters succeed and fail based on their ability to write articles that attract eyeballs, not Pulitzer prizes.
In the health domain, the effects of these demands were described in a series of conversations the Center for Advancing Health hosted with health care journalists over the past month.* The themes that emerged were that journalists are often encouraged to:
Avoid ambiguity. Write short, definite pieces. Don't qualify the findings or describe limitations of studies. Stay away from We don't know what works and More research is needed.
Make things simple. Present 'The Top Five Things You Need to Know (or Do) About X.
Write to get clicks. 'We are successful based on how many people open our articles. I write articles based on questions readers submit.
Shocked? Nah. The news business has historically maintained a delicate balance between offering stories people want versus providing 'citizens with the accurate and reliable information they need to function in a free society. These comments merely indicate that technology now allows for sharper calibration of content to increase the former.
Concerned? Yes. These observations suggest that health care journalists are under pressure to excise the uncertainty inherent in scientific inquiry and medical practice from their coverage. Learning about the uncertainty is what we need but not what many of us want.
Most of us prefer yes-or-no answers to questions about our health: Should I stop smoking? Yes. Should I take antibiotics for a viral infection? No. Ambiguity about health matters makes us uncomfortable. We don't fully understand how to apply information about the risks and benefits of treatment options. We are not confident about our ability to master the technical language and complicated concepts some health decisions now require. And many of us don't have the time or the interest -- or we are too sick -- to do so. We want to believe that there is a single solution to our problem: a cure for our illness, relief from our suffering. We just want our clinician to recommend or prescribe or refer or schedule whatever it will takes to make us feel better.
And so, of course, we want our health news to confirm that this is true.
But we need accurate health news. And coverage is inaccurate when it omits discussion of the limitations of a finding, for example, or when it stretches to personalize the conclusions of a study in the interest of satisfying our appetite for certainty about the effectiveness of a drug.
Further, as increased responsibilities fall to us to make decisions about our health care, the illusion of certainty supports our passivity. If there is no difference in the quality of care delivered by different doctors or in different hospitals, my choices of both can be based on convenience alone. If questions about the risks of a drug I take are glossed over, why should I inquire about alternatives? The illusion of certainty in health care also perpetuates public attitudes that skew against policies to improve the quality of care and contain its costs. For example, if the news stories of women who have successfully taken expensive but unproven cancer drugs are not accompanied by discussion of the limitations of their effectiveness and their dangerous side effects, why shouldn't I expect that such a drug would be available to me if I needed it?
The observations of these journalists make sense: The business model of online news organizations supplies strong incentives for reporters to present scientific findings both as simpler and more definite than the research supports because that's what most of us prefer to read. Of course, this trend is not completely pervasive -- yet.
It is still possible to find thoughtful and lengthy discussions of evidence on specific questions in mainstream publications. The lively Association of Health Care Journalists provides a range of services and activities to uphold the quality of reporting. Gary Schwitzer and his cadre of fellow critics at HealthNewsReview.org publicly ding the most egregious laggards. And there is considerable interest among journalists in improving, not weakening, the quality of their health care coverage.
But the money is on the side of giving people what they want, not what they need, providing incentives for journalists to cover health science news as certain'and of course, naked ladies.
* CFAH is the home of the Health Behavior News Service, which since 1994 has identified new findings relevant to people making decisions about their health and health care, written news stories about them and disseminated them pre-embargo to journalists around the world at no cost. HBNS focuses particularly on Cochrane Collaboration systematic reviews and large randomized controlled trials that meet this criterion. The aim is to ensure that the public has easy access to well-written, accurate accounts of new, useful findings. CFAH periodically interviews journalists who subscribe to HBNS and a few who do not in an effort to improve the service and the product.