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Ill Informed

September 28, 2010
by David Tuller
photograph of someone looking at medical masks on a computer screen

Health care reporting requires years of experience to get right. Can we afford to wait?

In March, the National Sleep Foundation, a nonprofit based in Washington, D.C., released the results of its annual poll, Sleep in America. The survey reported some worrisome statistics: More than half of adults have in the past year driven at least once while drowsy. And 20 percent—up from 13 percent in 2001—report sleeping less than six hours a night. The foundation’s motto, according to its website, is “Waking America to the Importance of Sleep.” And who could argue with that? As it does every year, the foundation’s survey led to widespread news reports about how the modern American lifestyle leads to levels of sleep deprivation and insomnia that are harmful to our health.

I’m extremely pro-sleep and I’d very much like more of it in my life. So I think it’s great that these dedicated folks are advocating on its behalf. But if an organization sponsoring a poll about the dangers of disordered sleep has also received extensive backing from the makers of sleeping pills, I’d like to be told—by the journalists who tell me about the poll itself. It certainly doesn’t mean the results are wrong or the poll is methodologically flawed. But let’s be clear: The findings of the Sleep in America survey will not hurt the prospects of the many corporations that have donated to the National Sleep Foundation—such as Sepracor and Sanofi-Aventis, makers of the blockbuster sleeping medications Lunesta and Ambien.

This reportorial slip is fairly typical in health journalism. The story that overlooks quiet corporate support for organizations whose purportedly disinterested research generates evidence that—surprise!—bolsters the financial interests of the sponsors. And this kind of unquestioning, gee-whiz method of health reporting is all too common these days. News stories routinely tout the latest advances in medical technology and drugs without also informing us of the costs, the possibility of unpleasant side effects, or whether the company selling the product is funding the research.

It’s a problem whenever reporters fail to ask the kinds of probing questions that few bothered to pose to the National Sleep Foundation. But it’s particularly troubling right now, when health care reform—and after that, the multi-year process of implementing that reform—looms so large on the national agenda.

The last time we experienced the elusive possibility of reform, at the start of the Clinton era, everyone flubbed it. Hillary alienated the political universe with her Kremlin-esque approach to policy making. And her 1,400-page, take-it-or-leave-it master plan confused journalists as much as everyone else. So the public debate was dominated by the plight of Harry and Louise (the middle-class couple who fretted in a series of TV ads that Hillary’s approach would rob them of free choice in decisions about health care), which doomed the effort. It didn’t matter that Harry and Louise were fictional characters created by the insurance industry opposing Hillary’s efforts, or that the couple’s concerns were based on lies and distortions.

A recent survey sponsored by the Kaiser Family Foundation and the Association of Health Care Journalists, a 10-year-old organization, details the current challenges facing health journalism—and its practitioners—in the United States. More than 90 percent of the 256 association members who responded to the survey reported that financial pressures at media outlets were undermining the quality of health news coverage. Only 16 percent said that the number of reporters specializing in health had increased at their organization during their employment, compared with 40 percent who said the number had declined. And almost 40 percent predicted that their job would be axed within a few years.

For an accompanying report, Gary Schwitzer, a professor of health journalism at the University of Minnesota who is founding editor of and publisher of, which analyzes and grades health-related news stories, interviewed health journalists at media outlets across the country. He found that cutbacks in the ranks of health and science reporters at many traditional news organizations have placed enormous pressures on those who remain.

Too often, Mr. Schwitzer said in a recent interview, reporters are required to focus on consumer medical advice and flavor-of-the-month wonder drugs. That leaves them much less time to engage in the more time-consuming and resource-intensive digging often needed to report about structural problems in the larger health-care system, about conflicts of interest in medical research, and about the socioeconomic factors—such as lack of health insurance, poor access to preventive and prenatal care, and inability to afford the most nutritious foods—that constrain individual health choices. These “social determinants of health,” as they are called in the growing field of social epidemiology, help ensure that some groups benefit far more than others from advances in medical care. This disproportionate distribution of health care goods and services is a major reason, for example, that infant mortality remains significantly higher among African-Americans than for white babies.

“That news-you-can-use category, and the reports on new research and new products, distract many newsrooms from the agenda-setting responsibility of putting health care reform issues, health policy, health disparities and quality, on the table, in the paper, online, or on the air,” said Mr. Schwitzer, who worked for many years as a health and medical reporter and producer at CNN and other news organizations. “There’s this daily drumbeat of the new and the wonderful and the terrific, without asking questions about evidence, cost effectiveness, access.”

Such stories can lead consumers worried about their health to make choices based on insufficient or questionable evidence. For example, reporters have long been cheerleaders for prostate cancer screening, urging millions of older men to seek yearly PSA tests despite significant debate in the medical literature about the effectiveness of this strategy. In March, two large studies found that annual screening did little or nothing to save lives and led to unneeded surgeries with potentially serious consequences, including erectile dysfunction. The study findings, widely discussed in the media, appeared to render moot much of the earlier reporting on the subject.

As old-time newspapers tremble and collapse, or shed experienced reporters in desperate efforts to avoid that dismal fate, they are losing a corps of talented professionals who know how to read epidemiological studies, understand that a correlation between two variables does not mean one caused the other, and recognize that there is more to health coverage than a story on a new “breakthrough” treatment for baldness.

President Obama’s plans for an overhaul of the entire health-care system is not the only health-related issue on the public and media agendas. This season’s swine flu outbreak has recently dominated the news, but the medical needs of Iraq War veterans, the health impacts of climate change, the ongoing battle over reproductive rights, the threat of bioterrorism, the dangers of contaminated food are all critical domains of our national life. Obtaining accurate and actionable information about any of them demands that we have knowledgeable, trained communicators who can keep us informed, guard against undue corporate influence on research and on health policy decisions, clearly interpret the nuances of epidemiologic studies, and generally look out for the public’s interests.

Few journalists come to this profession with any training in how to read a study, much less a general conception of public health. I first started covering health in the early 1990s as a reporter at the San Francisco Chronicle.

I had no notion of a central public-health understanding—viewing health from the perspective of what’s best for the overall population can lead to very different conclusions and policy prescriptions than addressing the issue solely as a matter of individual medical care and choice.

As Americans, we live in a society that fetishizes willpower, grit, and self-reliance. We seek private solutions even when the problems demand a collective and public response. And we even deride these collective responses—such as proposals to ensure that every American has health insurance—as “socialized medicine.”

When people are overweight, for example, we tend to regard it as their own fault for eating fatty foods and not exercising enough. Within this paradigm, the “answer” to obesity is obvious: Stock up on fresh fruit and vegetables and join a gym. We don’t stop to think that poor neighborhoods have far fewer sources of fresh produce, and that folks who must work two jobs to make ends meet don’t have time to go to the gym. This broader perspective demands a different response, one based less on urging individuals to improve their lifestyle than on addressing the social inequities that render it impossible for many people to effect such changes in the first place.

It took me time to learn enough basic public health concepts and vocabulary to sound like I knew what I was writing about. Most of the students in my journalism class on reporting about public health still don’t. Health care is for them what it is for most of us—concern about our personal well-being, not about the often-invisible systemic factors that play as big a role in our state of health as our behavioral choices do.

This is a perilous time for the news industry. No one knows what the media of the future will look like. More than ever, we will need the best information possible in order to address personal as well as societal needs. My job is to broaden my students’ vision and help them bring their reporting skills and insights to bear in dissecting the larger picture. It doesn’t matter all that much what form their storytelling takes—print, online, or some other medium not yet invented. What is crucial is that they understand that we have a very sick health-care system on our hands—and that the system needs treatment as much as any of the individuals it serves.

David Tuller teaches health reporting at the Graduate School of Journalism and is spearheading the creation of a combined master’s program in public health and journalism.
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