What's your assessment of the health news and information produced by the media these days? Is it accurate? Useful? Interesting? Improving or worse than five years ago?
Last week I received a list of inaccurate beliefs about cancer held by large percentages the American public*. Here are a few of them. Americans tend to:
- Believe U.S. cancer care is superior to the care in other countries.
- Have little knowledge of the price of an individual's cancer care or the rapid growth in cancer care costs to the nation.
- Hope that they will be the exception to the high odds against surviving a particular diagnosis.
- Have a heightened – and probably unrealistic – fear of a cancer diagnosis.
When asked whether health journalists have a responsibility to correct them, I replied "Well, of course they should report as precisely as possible based on the available evidence." But the prospects of this happening aren't looking good.
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, formats and content are tweaked by editors to optimize these metrics. Reporters succeed and fail based far more on their ability to write articles that attract eyeballs, not win Pulitzer prizes.
In the health domain, the effects of these demands were described in a series of interviews the Center for Advancing Health conducted in 2011 with journalists who subscribe to our Health Behavior News Service. The themes that emerged were that health 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 we want versus providing citizens with the accurate and reliable information we need to function in a free society. The responses we received merely indicate that technology now allows for sharper calibration of content to increase the former.
Concerned? Yes. These interviews suggest that journalists are under pressure to excise from their coverage the uncertainty inherent in scientific inquiry and medical practice. Learning about the uncertainty is what we need, but not what many of us get or want.
Most of us prefer yes-or-no answers to questions about our health: Should I stop smoking? Yes. Will antibiotics cure 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 prefer that our health news confirms that simple answers to our problems are readily available.
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 omits any mention of price, or when it stretches the conclusions of a study to satisfy our appetite for certainty about the effectiveness of a treatment.
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, our choices of both can be based on convenience alone. If questions about the risks of a drug 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 price. For example, if 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 the journalists we interviewed 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 or hear.
Of course, this trend is not completely pervasive – yet. It's still possible to find thoughtful, 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 the quality of their health care coverage.
But the money is increasingly on the side of giving us what we want, not what we need – providing incentives for journalists to cover health science news as definite and the solutions to our health as similarly certain.
* This post was inspired by the National Coalition for Cancer Survivorship's (NCCS) annual Rays of Hope gala on September 26 at the Newseum in Washington, DC. Jessie participated in the evening's panel, Media and the Cancer Experience, and was presented with the Excellence in Media Award by NCCS.