A Medical Breakthrough   

Once the province of correspondents without a clue, network medical reporting now showcases specialists who use their expertise to sort through the confusing welter of reports, studies, developments and "cures."

It's the morning after his "CBS Evening News" report on the frustration many Americans feel about seemingly contradictory health studies. And Dr. Bob Arnot, M.D., the network's medical correspondent, points to it as an example of how things have changed in network coverage of health and medical issues.

His report dissected conflicting research into the benefits of margarine versus butter, and contradictory studies about the benefits of vitamin E in treating heart disease. He told viewers why different doses, varied test groups or misinterpreted statistics could breed contradictory results.

Arnot did the report because he was concerned about the "tremendous retaliatory wave of patients who say 'Forget it – we don't trust you anymore. We are going to have our steaks and we are going to have our french fries.' Red meat consumption is at a 50-year high. It is just through the roof. People are absolutely fed up with phony food news."

There is a new edge to health and medical coverage provided by ABC, CBS, NBC and CNN. It reflects the evolution of the health and medical beat from a haphazard collection of unconnected stories a few decades ago to a prime network assignment now handled by seasoned medical journalists like Arnot, who know as much, if not more, than the researchers and physicians they cover. And they're not afraid to challenge them.

For Dr. Sidney Wolfe, director of the Public Citizen Health Research Group, a Washington, D.C., research and health advocacy group that has spearheaded efforts toward health reforms, the reporting of Arnot and his counterparts at the other networks represents a major turnaround.

When Wolfe left his research post at the National Institutes of Health in 1971 to create Public Citizen he found an "appalling lack" of journalists with expertise covering health. There were exceptions in print, such as Victor Cohn at the Washington Post and Lawrence Altman at the New York Times, he says, but "there wasn't very much going on in the networks."

Today, there is CBS' Arnot and Dr. Timothy Johnson, medical editor at ABC News, both former physicians; Robert Bazell, science correspondent of NBC News who did doctoral studies in immunology; and George Strait, ABC medical correspondent, who did his undergraduate work in biology and his graduate studies in biochemical genetics.

"It is much better. There is no comparison," says Wolfe, who is interviewed frequently on national newscasts as well as programs such as "Nightline." He attributes the improved coverage to hard-edged, critical questioning, and the expertise of the correspondents.

But there is room for improvement, says Julia Moore, who was the executive director of Physicians for Social Responsibility until August. "The good news is networks do try to take complicated issues and make them accessible to the public," she says. "The bad news is that they do it superficially and in itty-bitty pieces here and there and don't give larger, big-picture reporting."

Others are concerned that easy access to medical journals and studies can lead to less skeptical reporting, particularly at smaller news organizations. Says Dan Rutz, managing editor of CNN's health/medical news and senior medical correspondent, "People are more willing to take stuff that is spoon fed them and put it on without question. That's not good."

Wolfe recalls a time when health reporting was a "circus scene" because reporters lacked the background, time or training to dig out the true story and to distinguish between valid and faulty research. At cancer conferences in the 1970s, he says, "you would get a lot of very uncritical reporting of the new cures for cancer or breakthroughs in causes of cancer, and most of it was just junk.

"Most of it, if you looked at the data that was being presented and asked reasonable questions, you would say, 'Why is somebody writing about this?' "

But today's network health reporters bring more background and experience to the job. ABC's George Strait believes his science education makes it "more difficult for scientists to obfuscate." Researchers, he says, "are no more immune to putting a spin on things than politicians..and it is easier for me to get through the spin and figure out what the data really does mean."

In 1982 when ABC News sought to distinguish itself from its competitors, it introduced "Special Assignment" segments and Strait, then a general assignment correspondent, did several on the medical field. Roone Arledge, head of the news division, named Strait as ABC's full time health/medical specialist.

"It just exploded. There was a great appetite to do these stories, and it was a topic that local news organizations had begun to put a specialist on," Strait recalls. Until then, nobody at the network was tracking the key medical and science journals for the kind of news coverage that has since become a staple.

In the 1980s a string of major medical stories including the artificial heart experiments, the outbreak of the herpes epidemic and then the AIDS pandemic, firmly anchored the medical beat as a network necessity. Strait was the first American network journalist to report on AIDS from Zaire (the crew had to smuggle out the videotape when the Zairians changed their minds about open coverage). A few years later, Strait did special segments on health topics from the Soviet Union when Mikhail Gorbachev's glasnost opened the door. Since that time the international health scene has grown rapidly, and it is not unusual to see CBS' Arnot reporting overseas on the medical angles of the Persian Gulf War, or on refugee famine and disease in the Sudan and Somalia, or to see NBC's Bazell tracking AIDS developments in Europe, Africa, South America and the Caribbean.

Timothy Johnson of ABC was a physician at Massachusetts General Hospital in Boston when a colleague who invested in a local ABC-TV affiliate hired him to do a weekly medical talk show. This led to appearances on "Good Morning America" beginning in 1975, and eventually to a full time spot at ABC News in 1984.

Arnot was medical director of the National Emergency Service, which oversees emergency rooms and emergency response services performed by 2,500 physicians in 116 hospitals nationwide. He later was a physician for the Olympic Winter Games in Lake Placid, New York, where he ran a sports medicine clinic. He did occasional television reports, and in 1982 CBS offered him a full time spot.

Like ABC's Johnson, who encouraged him to try TV reporting, Arnot has given up his medical practice. He has since reported for the CBS morning news and "48 Hours," but now focuses primarily on the "CBS Evening News with Dan Rather."

After doing doctoral studies in immunology, Robert Bazell wrote for Science magazine and then for the New York Post before joining NBC in 1976. The science correspondent for NBC News, he also reports for "Today" and "Dateline NBC."

With their specialists on board, the networks are also devoting more time to health and science issues. CNN, for example, is making a major commitment to health coverage. Rutz, managing editor of the network's health and medical unit, oversees a 24-member team of producers and on-air correspondents based in Atlanta and Washington that also includes units on nutrition and parenting. Rutz is also a correspondent for CNN's "News from Medicine," which airs several times daily, and coanchor of the weekly "Your Health."

"Any time we have had research done on audience interests, health news always figures prominently," says Rutz, who has been with CNN for 14 years. Other networks and health associations report high viewership, which contributes to keeping health coverage a front-burner issue.

At the commercial broadcast networks, breaking health stories often lead the evening news shows. And weekly special segments, such as Bazell's "Health Watch" on NBC, have become a staple of network newscasts. Collectively, the networks help frame the medical agenda for a nation absorbed with the subject.

Interviews with correspondents and health professionals cite a number of reasons for high viewer interest. A population of aging baby boomers increasingly facing life-threatening diseases, such as breast and prostate cancer, environmental health threats ýnd a frayed, potentially bankrupt health care system, have increased the appetite for health news coverage. Add to that the fact that health care involves hundreds of billions of dollars, a gargantuan chunk of annual federal expenditures and high political stakes.

Many point to the explosion of consumer activism during the 1980s as the impetus that drives people to demand more information in order to make health and lifestyle decisions. ABC's Johnson says this development occurred simultaneously with "obvious changes in medicine when physicians became less distant, less God-like, sort of more human, more available, more approachable." The increase in shared decisionmaking between patients and physicians also bolsters interest in health coverage.

On a typical day at his office at Rockefeller Center in New York City, Bazell fielded a sitdown interview while also handling phone calls about a new tick outbreak, the dangers of hormone replacement and yet another new gene discovery.

Bazell says it's critical for medical reporters to approach their specialty with a healthy dose of skepticism so they don't become conduits for incorrect information. "There are a lot of times that people make statements that are outright stupid and foolish, and lie, and they need to be exposed for that," says Bazell.

ABC's Johnson is based in Boston but is all over the network doing long-form pieces for "20/20" or "Nightline," as well as evening news spots and "Good Morning America." He believes health reporting has taken on "more production values, less talking heads" and is more investigative and "biting edge in how it looks at things."

He mentions a recent piece he did for "20/20" on "how certain heart drugs were approved in the 1980s before they were really studied," and another report on a breast cancer study in which data were falsified.

Johnson, like his colleagues, struggles to make sense of constantly changing research data. "Science tends to discover ongoing truth. It's never got the final truth." He says it's crucial to remind viewers that factors such as varying doses given to test populations can affect the outcome of research.

At CBS, Arnot says the seemingly endless parade of often conflicting studies leaves viewers "bombarded and confused." As a result, he says, it is better for journalists to avoid giving consumer advice. His approach is to help viewers understand "we are building data" and to encourage them to talk with support groups or a personal physician before making a health decision.

"At The New England Journal of Medicine, the editor once took me through their back archives and he said, 'You know what? Almost every single thing that was published in the year 1959 is now a lie. All we are trying to do is to figure out how to publish the best lies,' " Arnot says, explaining how "truth" can change as scientists retest and revise their theories.

Arnot blames a triad comprised of the medical industry, researchers and journalists making unwarranted claims or reaching premature conclusions about medical research for conditioning the public to expect black-and-white answers, and making them impatient with gray, tentative data.

Arnot cites a highly publicized medical journal study with a huge base of participants that showed possible connections between breast cancer and the use of estrogen in birth control pills or hormone replacement therapy after menopause. A subsequent study from a competing journal used a far smaller sample and seemed to refute the larger study. Result: more confusion for the viewer.

"What we have really been trying to do is to educate the viewers and say, 'Look, there hasn't been that blind, placebo-controlled, enormous study that is really going to give the answers. So until that is done hedge your bets. You really don't know,' " Arnot says.

CNN's Rutz says the news media, both print and broadcast, must resist a tendency to overdramatize stories with exaggerated "breakthrough" reports, especially in cancer and AIDS coverage. He blames slip-ups on journalists with insufficient background "who sometimes are not knowledgeable enough in the field to realize that a story isn't what it appears."

But Rutz insists blame must also go to the science newsmakers who "face a great deal of pressure now for research grants..and others who hire public relations representatives to pitch their work. They can package things in a pretty slick way and suck you in if you are not careful." He finds an increase in PR efforts by medical establishments and universities that tout clients whose work will appear in upcoming reports of scholarly research studies.

Some of the pitches can be bizarre. Rutz once received a mailing containing a cassette player that said: "Hi, this is your heart talking" when he lifted the lid. It was sent by a firm pushing a heart remedy. He has received a pig's umbilical cord in formaldehyde from a firm promoting animal fetal tissue for surgical repairs. Once he even received a fake bullet with a message attached to "bite the bullet" – a grab for attention by a hospital touting its outpatient surgery services.

Bazell also sees a situation "where hospitals, in particular, and research institutions are being massively threatened with cuts, and there is a lot of pressure from institutions to publicize themselves." Government institutions facing the congressional budget ax also urgently seek publicity.

Another concern raised by TV medical correspondents is about the best way to handle reports on the results of studies from research journals. The New England Journal of Medicine and the Journal of the American Medical Association (JAMA), for example, provide weekly reports to the news media that often get heavy play.

Such reports are sent out several days in advance and are embargoed with a strict release date timed to favor the evening news broadcasts. JAMA even has its own regular video news releases (VNRs), available free to networks and local television stations via satellite.

Arnot of CBS dislikes the journal publicity blitz: "There is no question that the journals load up so they attract press attention." He said a journal might cluster a series of articles and an editorial for maximum attention. This, in addition to a carefully timed press conference, many times makes the story "inescapable."

Coverage of the dangers of cholesterol, for example, is fueled by a barrage of studies in scholarly journals, and advertising and public relations campaigns from the food industry and other segments of the health industry, Arnot says. There are so many cholesterol stories, he adds, because someone is spending a lot of money promoting the idea.

Arnot says CBS is "shying away from the journals because they trap you..into doing a story that has been around and you sort of build on it." It makes the journal editors the agenda-setters, he says, and "the people are fed up with the journals." While heýsays he values the fact that the journals are peer-reviewed – their articles are screened by scientists before publication to ensure scientific validity – and report on properly controlled test results, he believes the news media should make less of studies in their early stages and spend more time on enterprise reporting.

Daniel Maier, director of news and information for the Chicago-based American Medical Association and its journal, defends the way his organization, one of the more aggressive publicity seekers, disseminates information. The journals, he says, perform a valuable service by supplying the media with quality-controlled medical research data that are closely scrutinized by research experts, information they might not have otherwise. Maier also cites data the AMA has provided through its publications in the ongoing debate over smoking and the dangers of cancer that counter claims made by the tobacco industry.

Dr. Jerome Kassirer, editor in chief of the New England Journal of Medicine, says his organization doesn't do any self-promotion. "We don't think that's our responsibility. Our journal is written for physicians and our subscribers," he says. "We think it's appropriate for them to interpret data for themselves."

At the Annals of Internal Medicine, editor Frank Davidoff says only on rare occasions does his publication send out press releases or hold press conferences. He says one example is an upcoming series of five articles on how physicians can deal with issues of domestic violence as one in which the magazine had "some material of unique and special importance."

NBC's Bazell says he values the quality of the journals' work, but is troubled by embargoes. He points to the way one embargo was enforced at The New England Journal of Medicine by a former editor who Bazell said "was the most draconian about this – the authors were not allowed to discuss their results until it was published in the journal. I think that is a bad situation."

Bazell attended a conference in the 1980s at the National Institutes of Health "to deal with this because there were real horror stories of things that had public health implications but were kept from the public for months because people wanted their publication in a prestigious medical journal."

In one case, he recalls, results of a steroid injection that relieved spinal cord injuries were the subject of a major trial. "It was held up for several months because the editor of the [journal] did not want people to talk about it and the scientists went along with it." The editors of the science journals would counter that the fragmented release of study results can cause confusion and harm if the news media report the results prematurely. But a truce seems to prevail today between the journals and health correspondents. Now, Bazell says, "if there is a major finding about treatment of some disease, the results are announced immediately and the person can later publish in the journal and it is not withdrawn."

News organizations also receive numerous VNRs, sent by medical associations, pharmaceutical companies and other organizations with an interest in health coverage. But while these VNRs can make a health reporter's job easy, they must also be viewed with a dose of healthy skepticism (see "Video News Releases: Proceed With Caution," page 33).

To make coverage more accessible, producers and correspondents are abandoning technical, jargon-laden reports in favor of segments that engage viewers in more human terms. Rutz of CNN sees a greater use of anecdotes, more focus on people, a more conversational style and more emphasis on editing, graphics and technical values in the future of medical journalism.

"I think it is healthy as long as we don't cross the line and just abandon our principles entirely in favor of production techniques," Rutz says. "We've got to keep our priorities straight, but our goal is to first of all to impart better information."

Rhonda Rowland, a CNN medical correspondent and former senior producer who now covers breaking medical and health news, appears on "Your Health," a weekly show, in addition to producing in-depth features. She, too, cites a growing tendency to humanize stories, to be more consumer oriented and to provide news and information people can use "to live their lives in a healthy way."

As CNN's only female medical correspondent, she believes it's important for her to not only do general coverage but also to examine health from a woman's perspective. She has done a show on breast cancer, as well as special reports on drug abuse, alcoho>ism, depression, menopause and estrogen replacement therapy.

"Women have different stresses in life – combining work with family, those sorts of things," Rowland says. "With issues like menopause, there are still a lot of social factors associated with that, and men can't always – because they are not there, they are not living it – they are not able to understand it quite as well."

She says that while network TV health coverage has improved over the past several years, it could be better. This feeling is echoed by Julia Moore, former executive director of Physicians for Social Responsibility in Washington, D.C., a group with about 20,000 members that focuses on environmental health threats. Moore praises network coverage but says it tends to overpersonalize stories. "What we generally have are stories that deal with one individual's confrontation of a disease or medical challenge," she says. "We don't have much of an effort to talk about the bigger picture: What are the implications? Why is one person's experience typical or atypical as a whole? Viewers find that confusing and draw their own conclusions, which may or may not be accurate." She also criticizes the networks for lack of follow-up on important stories.

Dr. Michael Jacobson, who directs the Center for Science in the Public Interest in Washington, D.C., says he is grateful for the extensive TV coverage of his organization's studies, such as those on the nutritional pitfalls of Mexican and Chinese food, fast food restaurants and movie popcorn drenched in fats. But when Center reports noted the positive qualities of seafood, or reported on a highly successful campaign to introduce low fat milk into an entire community's diet, they were virtually ignored, Jacobson says. "Television likes to cover controversy and problems. When we have good news or praise one thing or another, there is typically no coverage of that," he says.

Both the national health correspondents who cover the field and the public interest groups concerned with better health news see remarkable changes for the better, but there's still a long way to go in terms of informing viewers about complex issues.

Strait and others believe health care reform remains an issue that merits close attention, despite the perception by some that viewers tuned out past coverage. Strait emphasizes a special need to cover the human side of the story: people with inadequate coverage or no health insurance at all.

Others, like Arnot, believe that new technologies such as the Internet and the whole new panoply of multimedia technology will substantially alter the way health and medical information is delivered. Arnot predicts that computer-based information and satellite delivery will bring health news to the most remote African villages just as it does to the most cosmopolitan cities in North America.

He envisions health information being shared worldwide through broadcasting, cable, computers and the information superhighway. "It will become this magnificent tool because television is going to be everywhere," Arnot says exuberantly. "To slide on the back of that with this tremendous export we have, which is this engineered medical knowledge, I just think it is a magnificent future." l