From AJR, April 2000 issue
Curing Health and Medical Coverage
Journalists need to be more skeptical and place developments in context to avoid confusing the public.
By Bryant Stamford
Bryant Stamford is a professor and director of the Health Promotion Center at the University of Louisville. He writes a syndicated column for Gannett called "The Body Shop."
I WAS YOUNG AND NERVOUS. The line was moving, and up ahead stood the nurse who gives the polio shots. Our third-grade teacher tried to ease anxieties by telling us the story of Dr. Jonas Salk. As I recall, it went something like this:
Salk hated polio and wanted more than anything to rid the world of its terrible effects. Relentlessly, like Dr. Frankenstein locked in his watchtower, Salk worked, neither eating nor sleeping, slavishly researching a cure. Then, one day, near death from exhaustion, he awoke with a brilliant idea, shouted "eureka!," dashed downstairs to his lab, fired up the Bunsen burner, clanked a few test tubes, and, bingo! Out popped the vaccine that would save mankind.
This made a pretty exciting story, and it served the purpose of taking our minds, for the moment at least, off the dreaded needle that grew larger and more menacing with each advancing step. In looking back, I doubt I would have given the teacher much attention if we were told a more accurate version of the Salk discovery--that many research teams from around the scientific world had worked years, and their work had paved the way for the ultimate breakthrough by providing tiny building blocks published in obscure scientific journals.
I held onto the fantasized version of the Salk discovery for many years and was happy in my naiveté. I admire heroic efforts, and I love heroes. It wasn't until much later, when I became a graduate student, that I dared to question.
Ultimately, my career path led to a professorship at a university where I engaged in research and became a producer of knowledge. Along the way, I also became a member of the media, writing a syndicated newspaper column, contributing articles to lay and professional publications, serving on a number of magazine editorial boards, and appearing weekly on local radio and TV programs to report on developments in health and medicine. For many years I have worn two hats: as a producer of knowledge and a reporter-commentator.
In this dual role, I have come to appreciate the subtle complexities involved when combining the media, which thrive on what's hot today, with the medical research establishment, which by its very nature must be careful and meticulously calculating. Often the outcome is less than desirable, if not downright confusing.
In the earlier years of my two-hat role, I thought of myself as a uniquely qualified go-between, able to discuss a number of esoteric topics, distilling them to a commonly understood denominator without oversimplifying and distorting, acting, or so I thought, as the champion of relevance and accuracy. I also became highly critical of my media colleagues who never seemed able to get it right.
Along the way, it was inevitable that I would fall from my self-perceived lofty perch. I have, in fact, eaten carloads of humble pie, learning firsthand how easily and readily I can misinterpret issues to fit my own zealous goal of saving the world from itself. I found myself doing exactly the things I have criticized in others: I have latched onto premature, weakly tested and peripheral findings--blowing them out of proportion, slanting them to bolster my stance. And I have wrapped the likes of Jonas Salk in a cape--blue with a big red "S" on it--when it suited my purpose. I've never done these things knowingly or intentionally, and my purpose was honorable. But ignorance is no excuse, and I am guilty as charged.
I've concluded that those of us who report on this sort of stuff need to work harder and be a little more critical of ourselves and our information in an effort to get it right--or at least to get it as right as possible.
D ESPITE THE PROLIFERATION of information available to us, especially over the past two decades, much of our society is desperately ill-informed and confused when it comes to health issues. How is that possible?
Perhaps we have too much information--too many angles, viewpoints and interpretations. And health and medical issues often do not lend themselves to straightforward translation.
Consider the issue of choosing margarine or butter. A no-brainer, right? Butter is loaded with lethal saturated fat and is bad for you. Margarine, with less saturated fat, is better. End of discussion, or so it seemed. Then, we learned about transfatty acids in margarine, which may be worse than saturated fat. This resulted in a warning about margarine and the implication that butter may be better after all. But butter is harmful, which caused follow-up reports telling us to stay away from butter. It's easy to see why there would be widespread confusion and increasing frustration surrounding what is healthy and what isn't.
Over the years, I have learned that when it comes to health topics, there are four major areas in which the overall quality and clarity of reporting can be improved. These areas generally are not purposely ignored. Rather, they are products of the mismatch that naturally exists between the media and medical research, and a naiveté arising from inadequate preparation.
#1. It ain't over till the fat lady sings.
Many health stories are unfolding events, rather than packaged products. A while ago it was thought that gulping vitamin pills gave you everything you needed and, therefore, you didn't have to worry about eating fruits and vegetables as long as you took your pills. Then, we discovered the value of fiber. Oops! Still later, we discovered phytochemicals--chemicals found in plants that are helpful to body function. Oops again! Tomorrow? Who knows?
Regarding butter vs. margarine, there was, in reality, no conflict. Instead, there was the unfolding of events, as would occur when reporting the half-time score of a football game. That score provides some information, but don't be surprised if the final score reveals a different outcome. This is expected in the sporting arena but overlooked when it comes to health topics. It would be helpful if folks understood that much of what they are reading and hearing is early in the ballgame and that circumstances can change abruptly.
Does this mean a health reporter should wait until the game is over before offering information to the public? Of course not. There is no way of knowing whether the game is ongoing or if it is over. Regardless, it's the duty of the reporter to keep this in mind, to be cautious when interpreting and to massage the message so that readers are encouraged to keep their eyes and ears open for future, and possibly conflicting, developments.
#2. Significance vs. newsworthiness
A common problem is the reporting of medical and health issues that are not significant, but seem newsworthy. Here's an example: Suppose that over a year's time three dozen scientific studies are reported in various medical journals, all concluding too much saturated fat in your diet is bad for your health. Is this significant? Yes. Newsworthy? Of course not. Hundreds of studies have reported the same thing over the years. But along comes a study that claims a high-saturated fat diet is good for your health. That seems newsworthy, because it differs from everything that has been shown to be true to date.
Why do the results of this study differ? Perhaps it's bad science. Perhaps the study was conducted on a group of unusual subjects. Perhaps the study is true, and if so, will be replicated with additional follow-up research. But, as one single piece of evidence, this maverick study does not deserve the status of challenging, on equal footing, everything that is scientifically established about this topic. Indeed, if the scientific community operated this way, there would be chaos.
Unfortunately, the media cannot wait for corroborative evidence to emerge, because that may take years. In an attempt to balance the story, they may interview members of the mainstream medical establishment to get their opinions of the latest unusual findings. But their statements often are buried and are certainly overshadowed by screaming headlines: "High-Saturated Fat Diets Improve Health." Moreover, the need to report both sides implies a controversy exists when there is none. Things get worse when you move from print media to television, with its sound-bite reporting.
#3. Too many medical breakthroughs
Medical breakthroughs typically don't blossom overnight. In fact, it takes years of effort to produce one bona fide piece of solid medical evidence. How, then, can there be so many newsworthy medical breakthroughs?
The answer is obvious.
There can't be.
#4. Medicine vs. health
Medicine and health are two entirely different concepts: One relates to treating illness once it has occurred, the other to preventing it. But most folks don't see it this way, and medical issues often are reported as health issues, and vice versa.
The media should try to draw distinctions.
Do we have a health care system in this country? No. We have a disease care system that treats illness, but isn't preoccupied with preventing it. Because there is no emphasis on preventive health care, it is common for our health to break down. When it does, we turn to disease care representatives, hoping they will restore us. Sometimes they can, but often things have gone too far. In fact, odds overwhelmingly favor the latter, because when it comes to chronic diseases, symptoms typically are absent until the process becomes very advanced. Chest pain, for example, is a symptom of heart disease that occurs when blood vessels, which feed the heart, are severely clogged with cholesterol. There is no indication along the way that this process is progressing, and by the time you experience chest pain, the disease is so advanced many folks die without warning. But a better diet--a preventive measure--could have slowed down the clogging process.
Still, even in the face of this, we cling to the belief that we are not responsible for our health. We desperately want someone else to be in charge, to relieve us of the need to make prudent choices. Elsewhere in life we see the disastrous outcome of such thinking. The person who turns over his estate completely to a financial manager may find someday that he is in financial ruin. When having a house built, if you ignore the process entirely until the day you move in, you are likely to encounter a slew of problems.
Because the media report health issues from a medical point of view, they perpetuate the notion that we are not responsible for the diseases plaguing us: Doctors are heralded as saviors, the techniques employed as Godsent, and patients are embraced as innocent victims. This slant inspires us to jump on every medical discovery as a potential "breakthrough" destined to save us. In so doing, we ignore the fact that the epidemic of chronic diseases we face is largely self-imposed and can be turned around with a little effort and self-discipline.
W HAT CAN THE MEDIA do to make things better?
Develop the skills to determine if a medical report is significant and founded on broad-based, scientifically sound facts. If there is substance, there will be a stream of scientific information on this topic that accumulates and gains momentum. Seeking the flow and determining momentum take time, of course, and run contrary to the innate desire to get the scoop. But, unless we are careful, we find ourselves latched onto flashy stories that lack substance and quickly fade. Remember cold fusion? The story was huge, because we all wanted to believe cold fusion could produce an endless supply of energy, solving our energy problems. But the public was exposed to this supposed breakthrough far too early, before it had a chance to develop and withstand scientific scrutiny. In the same manner, we desperately want to believe we have found miracle cures for heart disease and cancer. And, certainly, as medical reporters, we want to break the news. But how often have we been exposed to stories of wonderful discoveries that pack great promise as the punch that will knock out these chronic diseases, that, once published, are never heard of again?
Understand that, unlike mankind, not all new knowledge is created equal. Some scientific journals are more demanding than others, which means they have more scientific integrity and will not print anything unless it meets the highest research standards. Other journals are less sophisticated and may print flawed research results. This often explains how conflicting reports come to light. The naive medical reporter who is unaware of this hierarchy may push the importance of a finding that is unproven and probably untrue.
Develop an understanding of the distinction between medicine and health. It's subtle but immensely important. If one of our purposes is to enhance the quality of living by accurately informing the public, we are falling down on the job, interchanging medicine and health. Heart disease; cancers of the breast, colon and prostate; stroke; maturity onset diabetes; and other chronic diseases get worse with time--time that could be spent fighting them, overcoming them. Instead, the nature of much of our reporting encourages the public to do nothing, to wait for the magic fix. Understanding the difference between medicine and health also will provide a meaningful backdrop to developments. When, for example, a new gene is discovered that is touted as wiping out obesity, take a closer look. Is this real? Or is it the view of a medical scientist closeted in an ivy-covered lab who fails to understand the human side of obesity and who believes all problems will be solved by genetic engineering? Don't get me wrong. Discovery of a particular gene responsible for a particular function is important. In this case, perhaps the gene is responsible for satiety. But is feeling full the key to obesity prevention in this country? Obesity is typically not closely aligned with overeating at one sitting. On the contrary, it is often associated with snacking and "auto-matic" eating--consuming food simply because it's there.
Be prepared. I firmly believe the reporting of health and medical issues is more effective when adequate educational material is used as background to put the issues into perspective. When reporting on the potential effects of salt on blood pressure, for example, it's important to provide sufficient background on how blood pressure is regulated in the body in general. When this is included, it's easier to see and appreciate how the role of salt may contribute. I make it a point to do this in my writings, and I'm often told they have clarified issues that had seemed mysterious and unfathomable, but in reality were not all that difficult to digest. The only thing missing was instructive background and some meaningful reference points.
I regularly receive phone calls from writers seeking input on a wide range of health topics. At times I am impressed by callers with great skills and deep backgrounds, who ask probing and insightful questions. At other times I am amazed at how poorly prepared a caller is, and I find myself taking lots of time, trying to steer and educate the writer, hoping to avoid another splash of misinformation. If you are not prepared to write a meaningful article, you should pass the assignment along to someone who is.
My final advice: Apply a little common sense. It's hard, especially when the news story is a "grabber," telling us something we know our readers want to hear: "Meat-eating couch potatoes are healthier than vegetarian joggers." When exposed to such garbage we must take a hard look and allow common sense and intuition to lead us in the right direction.
We must be skeptical of news that is too encouraging, too sensational--too good to be true.