Health reporting and regulation – the case for change

This post is a recreation of a post at Demsoc.org. They are working on a project to explore media regulation in light of the Leveson inquiry and the Carnegie Plan for Better Journalism. I was asked to write something to highlight the relationship between regulation and healthcare reporting. Here is my first draft. 

 

I am going to write about the representation of healthcare and the science that underpins it in the media, the potentially dangerous effects this can have, and highlight some of the key discussion points around regulation. There are a number of passionate journalists who are very quick to pick up on particular misleading health stories – with amateur and professional ‘skeptics’ leading the way – much better than I could, so I will stick to the systemic issues, borrowing illustrative examples. What I hope to do is demonstrate that there is a case for change to the regulation of health reporting.

As I see it, health reporting suffers from a number of key issues. Stories tend to be simplified and sensationalised, use advertorials unchallenged and are vulnerable to political agenda. At the heart of healthcare reporting there are a set of crucial, perhaps irresolvable, central conflicts which I will try to draw out.

Mainstream media outlets have minimal direct motivation to report healthcare science stories well. The primary motivation for a media organisation is to drive revenue, and healthcare reporting is a tool by which to do that. Whatever the chosen market, this tends toward creating an internal culture that values output over quality and accuracy, often to a particular template. This actively prevents even the best intentioned journalists being more thorough than the minimum required to meet the standard for their organisation.

The reality of the science that informs and underpins healthcare, and the sort of story that best sells papers, drives clicks or otherwise gets the public attention, are wildly different.

On one hand, medical science progresses by small steps, with each new result acting as just another data point in an array that should be considered as a whole. Single facts, experiments or case studies that radically alter the way we view healthcare are rare at best. The key advances in any science are complex, and there is a necessary technical language built around any given area.

On the other hand, magazines write stories weekly, newspapers create new headlines every day, and websites can’t stand still for an hour. This leads to a tendency to inflate the claims of healthcare stories in the search for something new to grab attention, to distinguish the information in this particular story from the general background understanding. Additionaly, the language and concepts must be simplified to fit the audience.

However, we often see the essence of a story damaged in this simplification process. Nuance is lost around the causality of relationships, the confidence in conclusions and the distinction between relative and absolute risks. One example of both oversimplification and sensationalism, explained by Ben Goldacre, is the use of red wine to prevent breast cancer. Red wine contains resveratrol, a chemical that could indirectly reduce damage to DNA, and therefore cancers. But this is an isolated reaction between two chemicals in a lab, ignoring the complexities of the human body and the wine. The other ingredients in red wine, particularly alcohol, cause cancer. The evidence Ben cites suggest that red wine is known to cause cancer, yet because of oversimplification, people are encouraged to drink it as a cancer preventative. It is worth noting that while Ben was writing in 2008, a quick search shows equivalent ‘red wine prevents cancer’ stories still run regularly, and I am not aware of a dramatic change in the evidence base.

Due largely to the sort of output pressures described above, there is also a tendency for journalists and media sources to accept stories at face value. A well written press release by an organisation with an interest in promoting a particular idea will very quickly do the rounds at all the major news outlets, not just unchallenged, but largely unchanged. This process of converting a press release into a story without challenge relieves the pressure on a journalist, as they have effectively outsourced their job. It also means that the public is subjected to advertorial masquerading as editorial, no journalistic investigation applied to the representation the company would like you to see.

Particularly in the special case of publicly funded media, although not exclusively, there is the additional problem of false balance, whereby all views are given equal time and space to be expressed. This is done in the name of fairness, although it presents a false picture, as if the homeopath and the GP view on treatment of particular conditions are of equal value. It feels to me like this is changing, following the recent ‘BBC Trust – Review of impartiality and accuracy of the BBCs coverage of science‘ recommendations, although I would need to see a further study to see how well this has been enacted.

Finally, there is the potential for an agenda to intrude. Here there is a risk that editorial positions can be imposed on ostensibly science reporting in such a way as to mislead. A moral position can lead to particular views on, for example, birth control, and so affect the reporting of sexual health stories. A prior view on the effectiveness and appropriateness of the free market, for example, can lead to misrepresentation of healthcare outcomes under different healthcare delivery systems.

These factors, and more, mean that the healthcare reporting we see in mainstream media is regularly inaccurate. We hope that the inaccuracies are trivial and understandable, in that a process is simplified without loss of meaning. More commonly, there is exaggeration and sensationalism such that the media representation is potentially dangerous. Much has been written on the persistent misleading reporting in the Wakefield and MMR case, largely uncovered by Brian Deer, and there have been outbreaks of measles in recent years, likely as a result. There is also an ongoing controversy around the clinic of Dr. Burzynski in the USA, where unevidenced claims were supported in the national press, prompting charitable donations for children to be sent at great expense to America for treatment that has not been shown to work.

It is important to note that these sorts of reporting problems are found in all mainstream media channels I am acquainted with. There is a tendency to mock the onoing ‘ontological oncological’ project of the Daily Mail, to divide every item into something that causes cancer, cures cancer, or both. The Daily Mail is indeed a regular for poor health science reporting, but is by no means alone – above Ben Goldacre is talking about an article in The Telegraph, and The Observer was involved in the Burzynski controversy. Basically every media outlet was guilty of dangerous misinformation during the MMR crisis. Every mainstream media outlet suffers these problems to a degree.

We have identified some of the main concerns in health reporting, and it is clear that each of these can lead to harm to the public. However, little has been done to rectify these innacurate stories, and those those dangerous reports go largely unchecked. The PCC as it has been is an inappropriate body to take on this role for a number of reasons that become clear when we think of what a regulator should look like.

The key discussion should be around which of these interests we should expect a regulatory system to serve, and how we would expect those to be served. The interests of the public are in having media coverage that is accurate, accessible, complete and relevant. It is through this sort of coverage that people decide to make the best evidence based lifestyle and healthcare decisions.

Given these aims I think a few of the key considerations for the formation of a regulatory body should be:

  • Degree of empowerment to impose sanctions that decrease likelihood of inappropriate activity, including financial penalties
  • Degree of empowerment to impose sanctions that rectify damage – corrections and clarifications in at least as obvious a manner as the original misguiding information
  • Independance from the media sector to reduce conflict of interests
  • Transparency in and public accountability for decision making
  • Magnitude and impact of misrepresentation required for action
  • Simplicity of and mechanism for reporting (perhaps a browser plugin that reports abuses like Fishbarrel does to the ASA)

I don’t pretend to have the answers to the above, but with due consideration, I think a body could be designed that is considerably more effective at protecting the public from harm and promoting quality healthcare science reporting than the current PCC. If this isn’t done, people will continue to be harmed by poor health reporting.

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  1. March 30th, 2012
  2. March 30th, 2012

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