Media Doctor Australia Blog

MEDIA DOCTOR INACTIVE FOR NOW

Like all enterprises Media Doctor needs both financial and human resources and after 8 years of operation these have run out. We are very grateful to a number of supporters, including the University of Newcastle, Hunter Medical Research Institute and New South Wales Health who have helped us over the years. We greatly regret thiat we have to stop work and hope this is temporary. For now we are not able to post new stories and respond to comments and the site will be in 'read only' mode. But there is a need for Media Doctor. In an era when readers receive much of their health news from the mainstream media, and coverage in many outlets remains inadequate or even misleading, someone needs to provide feedback. But for now that will not be us. We will do our best to get back online in the future. So we are signing off for now. Thank you for your support.

Some tips for covering genetic testing and treatment technologies

Breakthrough Diagnosis; Genetic Screen; Rare Disorder; New Hope: great words to capture attention and entice audiences into reading stories on new technologies for diagnosis and treatment of genetic disorders.
However, Media Doctor Australia has seen vast differences in the quality and potential impact of these stories, reflecting the varying strategies employed to sustain a reader's interest.

Some stories work elegantly to educate and entertain readers, as in The Australian's 'Tiny vectors carry hopes of a cure', (subscription only). This story used an informative and balanced approach to discussing progress and future directions for the use of viral vectors in the treatment of genetic diseases. While the emotive strategy of an affected family was used to add human interest, this did not come at the cost of accuracy.

Other stories, like the Sunday Telegraph's 'Scientists want kids with three parents to help eradicate genetic disease', appear to be written for the sole purpose of polarising their audience and creating controversy.

This story opened with the line "SYDNEY scientists want to create designer babies with the DNA of three parents to prevent children inheriting life-threatening diseases" hitting the strobe light straight on the ethical arguments surrounding this type of technology. This science functions like an "organelle transplant" so that defective mitochondria are not passed from mother to child.

While the technology is still very much in its infancy, the story gave the impression that IVF clinics wanted it implemented right now, in Sydney. It's hard to believe this type of story isn't deliberately stirring up dissent especially when you read the emotional feedback in the online comments section.

Then there are the stories that border on promotion of new diagnostic procedures. An example of this can be seen in the Sydney Morning Herald's "Hair test for breast cancer on the horizon".

What wasn't made clear in this story is that it's very early work and much more research is needed to validate this diagnostic procedure to see how accurate it is. False diagnosis of something like breast cancer can lead to unnecessary, invasive and potentially harmful testing and the fear and anxiety that go along with that.

To improve this type of story, journalists should consider key points such as:
*�false negative rates (eg, a cancer test comes back negative, even though the person has cancer)
*�false positive rates (eg, a cancer test comes back positive, even though the person does not have cancer)
*�the evidence behind company's claims
*�how the test performs compared to existing tests
*�when and where will it be available
*�how much it will cost
*�who will pay for it, and
*�get a second opinion - an expert who doesn't have a conflict of interest.

Tests, and especially genetic tests and therapies can be challenging to report on. Most medical professionals have difficulty understanding the science and statistics in this area. The increase in stories discussing diagnostic advances and new treatments of genetic disorders is a positive sign for the health of our society.

But there is also pressure for companies to sell their products and researchers to publish their research, and journalists should remain sceptical and consider ways to make stories interesting without sacrificing quality of content.

Weigh up benefits and risks

With any story about adverse events or side-effects with a drug, there is the potential to scare people enough to make them stop taking the medication without talking to their doctor about it – never a good idea.

The NPS have put together an accessible response to this story. It basically says people need to weigh up the risks and benefits of taking statins in consultation with their doctor. The available evidence shows that risks are relatively low and the benefits of the drug are good.

People who have had cardiovascular events previously have much more to gain in the way of benefit from statins than any potential risk of diabetes or dementia. People who are at low risk (no history of heart or vascular disease) should discuss the benefits/risk balance with their GP.

Another aspect to consider is that the FDA makes more recommendations about adverse event warnings than Australia does.

The annual lifecycle of the medical researcher as told through health news stories

A quick analysis of stories rated and posted on Media Doctor Australiathis years shows a rather nice curve in the number of stories per month. The average number of stories per month is 9 but this peaks to a high of 21 in July. It could be seen as correlating with the annual activity of the average academic researcher. The early months of the researcher’s year are dedicated to grant writing, usually due in March/April. Any previous funding gained is channelled into getting research started so it’s a busy time with not much output. The middle of the year is when people have time to write papers, publish and put their hard earned research money into practice. It’s also the time when grant applications are being shuffled through and sorted into piles of possible, probably and not a chance in hell. It’s a good season to be seen and have your research talked about and the media stories reflect this.By August, it’s probably too late to have much impact on grant examiners so the research press releases drop off, instead researchers are busy writing grant rejoinders in a last desperate bid to stay viable. September and October bring news which in many cases makes or breaks a researcher’s work. It’s a cut-throat business and more than one rising research star will crash in a burning heap and face a bleak future when the funding rounds are announced. Universities close down over Christmas so November is the time for researchers to wind up studies for the year and brace themselves for the 2012 funding round. For the health media this means a sparse diet of cheap, cheerful and imported Christmas health stories.

What the news about health often leaves out

We've noticed lots of missing information in stories recently evaluated by Media Doctor Australia, including mention of whether the intervention or treatment being described is even available.

Over the years we've had lots of comments from health professionals, particularly GPs, about the number of people coming through their doors hoping to try a new therapy they've heard about in the media. The majority of these are disappointed to learn what they're looking for isn't available, either because it's not commercially available (early phase research) or because it's not approved for sale in Australia.

The Media Doctor rating instrument defines 'availability' as accurate information about the accessibility of an intervention. If it's a drug, registration and PBS status should be included (although we usually let this go through to the keeper, it does score extra points when provided). Where relevant, we like to see any reimbursements available - for example, is this test covered under Medicare? But the most important aspect is whether it is widely available in Australia - and this is often left for the audience to find out for themselves.

One story from last month, "Young patients abuzz at the end of pain", was about a device involving an ice pack with vibrating wings that claimed to make injections 'pain free' for kids. While the story read like the device was still undergoing testing, it is in fact commercially available. However, that didn't stop the article sounding like a pretty solid promotion.

Another story, "Asthma pregnancy treatment hope", reported on a highly novel approach to managing asthma during pregnancy. The problem is that at this stage, the intervention is only available from the Newcastle hospital where it has been developed, but the story didn't reveal this. '

A Cochrane review on music therapy for people with cancer, Music 'may help cancer patients', was well covered, but didn't provide any Australian comment or define what is needed for music to be therapy, or the what qualifications are needed to be an authorised therapist. So while music therapy is available in Australia (although the story didn't state this), it's hard to tell if it's the same kind as that used in the research.

One of the reasons for not mentioning availability is because the stories are bought from overseas news agencies and printed verbatim. It would do the media outlets big favours with their audiences if they took a little time to place the stories in a local context. Talking to an Australian expert in the field would not only provide a local comment on the research or intervention but also shine a light on whether Australians have access to it. This would increase production time a little, but it's a good method of getting the edge on rival publications, which have access to the same stories.

Why don't journalists routinely include availability? Maybe they don't want to be seen to be pushing a product and think if someone is interested they will track it down. We think they should ask if an intervention is available in Australia and whether it's on the PBS or covered by Medicare. If it's not widely available, they should ask why and when it will become available.

Telling it like it is: US health reporting guidelines reveal Australian media quirks

This article was published in The Conversation this week(http://theconversation.edu.au/telling-it-like-it-is-us-health-reporting-guidelines-reveal-australian-media-quirks-2548)

A new set of guidelines produced in the United States for reporting deaths, epidemics and emerging diseases has relevance for Australian media. It shows the differences in the way news organisations in the two countries approach coverage of serious health issues as well as the importance of sensible health reporting.

Improving public access to reliable information about health crises has obvious benefits: poor reporting can dramatically change public behaviour, cause anxiety and lead to inappropriate, expensive and sometimes detrimental interventions.

Good quality news stories can improve public understanding, allay fears and inform good use of health resources.

Health authorities are pivotal in providing reliable information at the right time, especially during emergencies or potential crises.

Internationally, there are any number of guidelines for health news reporting developed usually by health or media authorities and adopted voluntarily by journalist associations. Most of these associations acknowledge responsibility in creating public opinion, while juggling the competing needs of respecting state institutions and employer loyalty, and protecting journalistic integrity.

The new framework

The US Guidelines released last month are more detailed than anything described by the Press Council of Australia. They are sensibly set out, with separate sections for journalists and health officials, whose outlooks are often, by necessity, opposed.

The authors say the collaborative guidelines were prompted by a “wide variation in information” released by different officials during the 2009 H1N1 pandemic.

They note the “disparate approaches” of information released by state and county health officials became the subject of media attention during the crisis, “distracting from health messages” and inadvertently “undermining public trust”.

The guidelines recognise a need to balance the public’s desire to know – and the media’s role in making this happen – with legitimate requirements public health officials may have in restricting detailed information in the name of privacy.

The authors note “nothing deepens anxiety and erodes trust more than the perception that government officials are hiding information from the public”, observing “in media parlance, the cover up can become a bigger story than the actual event”.

With this in mind, the section aimed at health officials sets out information media organisations will want to know in reporting a typical health story – the “who, what, why, where, when and how” of an event.

Bureaucrats are told that “openness is paramount” and that they should “strive to release as much information as possible, within the limits of the law.”

Information should be withheld “only when there is a clearly justified reason” to do so, the guidelines say, and the reason should be explained in detail.

This is the main departure from what happens in Australia.

Cultural differences

In practice, Australian public sector spokespeople across the board rarely explain a refusal to provide information with anything more detailed than “it would breach privacy concerns” or it’s “commercial in confidence” or “before the courts”.

Interestingly, these explanations are usually accepted by mainstream Australian media. By way of contrast, the US guidelines go so far as to say that if advice is being withheld on “advice by local counsel” – that is on advice from a lawyer or barrister – then that advice should be explained.

The recommendations for reporters in the US guidelines emphasise journalists' responsibility to maintain accuracy and remain fair while acting as a conduit for information from health officials in times of crisis.

One of the main concerns of the guidelines is the way in which information imparted by health officials – and transmitted by journalists – is used to reveal, or to protect, the identity of individuals involved in such health-related events as epidemics.

These concerns are irrelevant, of course, if an individual or their family consents to be identified. But the identification is another area that appears to depart dramatically from Australian practice.

In the past 20 years, Australian laws have increasingly strengthened the restrictions on media identification of people under the age of 18, but the US guidelines appear to go in the opposite direction, saying journalists are likely to “choose to identify an individual when the person’s identity has already become widely known, as often happens when a child is involved… .”.

These small departures aside, these US guidelines have something to offer Australian journalists and officials – especially those working in health.

The guidelines suggest health officials can best serve the public by providing as much information as possible and that journalists need to file complete and accurate stories, while respecting privacy concerns.

And that’s something that translates in its entirety into the Australian context.

Media Doctor - You're Not Perfect

I have learned a lot from reading Media Doctor from time to time, when the demands of daily journalism allow me. I agree with many things, particularly the importance of distinguishing absolute from relative risk. I have learned from it and I thank you for that.

But I also have major issues.

I was appalled to read Ray Moynihan's piece on a 2010 article in my own paper which has been up on the Media Doctor website for some time. It wasn't written by me, I might add, and it was not sighted by me before it went to print. I did not know about the article before it was run in the paper, so I feel I can comment about it. The story was written by a graduate journalist. She'd been in journalism for less than a year which is neither here, nor there. But she wasn't a dedicated health journalist. The Courier-Mail has only one and that happens to be me.

For a start, neither Ray, nor Media Doctor, has given the journalist a right of reply which I think is unfair, given he describes the article as an abomination. Secondly, what he doesn't state in the article is that the Courier-Mail journalist did, in fact, quote a dermatologist, Michael Freeman, clearly stating that twenty-somethings don't need Botox because their skin is elastic. A simple Google search would attest to this but don't let the facts get in the way of a good story, Media Doctor! The paper also ran a story the next day quoting a sociologist stating how sad it was that young women were resorting to Botox at such a young age.

I would argue that the story wasn't actually written as a health story, that it could be viewed as an article simply outlining what is a sad reflection on the 21st Century that young women feel they need to do this.

As a health reporter, I would probably have written it differently. But give the young journalist a break. To describe it as an abomination is offensive.

What really is an abomination is that doctors actually offer Botox to young women, but as many of the people behind the Media Doctor websites are clinicians, we wouldn't want to mention that would we?

While Media Doctor does have a place, I think it can be unrealistic and sometimes unfair.

While journalists can strive, and I assure you I do, to be responsible when they're reporting on health, it is often unrealistic to expect reporters to be able to tick off all the criteria you say makes a good health story. It's not uncommon for a 500-word story to be cut down to 100 words. That is not something we dictate. It's dictated by editors and sub-editors. But in all the years of reading Media Doctor, I have never seen an attempt to embrace editors. It always seems to be about picking on journalists.

We are also not writing a piece for a scientific journal. We do have to try to write in an interesting way. Filling an article with too many figures can be confusing for the reader.

Given the Media Doctor criteria, what I sometimes try to do is write two or more articles on the one topic to run over a few days or weeks so that if I can't put everything in one story I try to spread it over more than one story. That, unfortunately, is not always possible, given the demands of the job.

Journalists are under massive time pressures, and it's getting worse. I don't just write for the newspaper. I have to file for on-line and for the iPad edition, often straight from a news conference.

Apart from filing stories about medical research, I report on political matters relating to health, including industrial issues, and health-related human interest stories.

During the past two weeks, I have worked 11-12 hours a day. (Today's my day off) I have been writing constant updates about the Hendra virus outbreaks, as well as trying to keep up with the latest research news. It's exhausting, but that doesn't mean I don't try to be responsible. Foremost in my mind has been trying to get out messages about how people can avoid their horses catching Hendra, and therefore, protect themselves and their families.

When I read articles such as Ray Moynihan's piece on how the public are so poorly informed about health, all I can think of is give us a break. Some of us are trying and if you all think you can do so much better, why don't you? Get a job on a newspaper and give it a go.

If you have in the past, be warned. It's changed. We now file photos for on-line and also audio grabs. It's time consuming.

I guess what I'm saying, Media Doctor, is you're not perfect.

Constructive criticism is good. Unfair and often unbalanced criticism isn't.

What do Journalists Think About Media Doctor?

A common question asked about Media Doctor is What do journalists think about the website? Here are some of the responses we’ve received over the years:

“I started looking at the website a few years ago when I first started writing health and my initial response was ‘Oh my God, hope they never review my stuff’. It’s a bit intimidating but I do think it’s useful. I like to see what the comments are on the web site, wanting people to write about costs, benefit and that kind of thing. It’s probably made me more conscious of what to include and not to include. One criticism is that it doesn’t take into consideration the fact that we’ve got time constraints and can’t always locate the right people to get that information.”

“I actually do think it (Media Dr web site) is quite useful. I’d like to see it expanded and cover features.”

“I was at a medical writers’ conference and there was a girl there who’d had one of her articles just rated and she was pretty devastated. She’d only been reporting for a month and didn’t know how to do background, that kind of thing. It would be interesting to talk to people like that and see whether it changed the way that they report.”

“When I discovered it (the Media Doctor website) about a year or two ago, I was like, how cool is this - I mean my stuff gets put up there!”

“(Media Doctor is) glacially slow, usually taking weeks to post critiques of stories that would often have had to be written within an hour — which is a way of saying that most deficiencies are a result of the time constraints. It’s erratic, and occasionally gets so caught up with its own pet causes that it ends up being quite unfair...”

“I think a tip sheet explaining things about absolute/ relative risk, that kind of terminology, would be really good. Also, how to interpret data because ... a lot of people think if something doubles it’s an increase of 100% but it’s not, its 50% - very easy to get that stuff wrong.”

“I think a lot of researchers don’t comprehend that other people don’t have their degree of understanding of things like stats. They put out press releases - we’ve seen certainly examples of press releases that are just wrong. But that’s what goes out and that’s what gets printed. I think that’s something you should cover (on the website).”

Broadsheets have a really different style (to other media outlets) and really different variety (of stories). If you can differentiate (between the different media) because we report on different stuff.”

“When it’s been mine (the rated story) ... I’ve tried to take on the criticisms.”

“I think that sometimes it (the website) is not really comparing apples with apples. You’re never going to be able to put that much detail in what is effectively just a transcript of radio compared to a Routers or AAP story which is very detailed and thorough.”

“We would never put the cost in a story unless it is very, very expensive. Otherwise it would seem like an ad. It’s not something that you routinely would put in unless it’s newsworthy and it’s usually not.

“... I can’t possibly list all the side effects cause it would take a minute and a half just to list all the side effects so you’d normally just pick some significant ones - you might list a couple. But you just don’t have the time and the space to list all of them.”

What are your thoughts about Media Doctor – good or bad? If you’d like to write about your thoughts or experiences for our monthly blog, contact amanda.wilson@newcastle.edu.au

Uncertain prognosis for media reporting of medicine

Everyone will have their own favourite example of unhealthy medical reporting, but mine comes from the daily tabloid in my home town, Brisbane, Australia.

One dry autumn morning last year, the front page of Rupert Murdoch’s Courier Mail carried an enormous close-up photo of a smiling and attractive woman, with the accompany headline, “Wrinkle-wary twenty-somethings turn to Botox.”

The newspaper article – if it can be called that – quoted a cosmetic surgery “king” urging women to “look after themselves from a younger age – and that included using Botox.” Furthermore, readers were told injectables and cosmetic enhancements were “going to become a part of life.”

The story was an abomination: a crude and misleading medical advertisement disguised as a piece of reporting and an insult to the readers of Brisbane. Sadly it’s also an extreme example of the much wider problem Media Doctor has been helping to reveal for a large part of the past decade: too many medical stories look more like promotion than journalism.

Having analysed more than 1300 media stories about new medical treatments, this website has built up a rare and invaluable body of published evidence about how the public is too often poorly informed in such a critically important area as healthcare.

In general the findings are that too many stories overplay benefits and fail to report the costs and harms of treatments, while too few stories contain independent comments to balance the enthusiasm of advocates for new treatments.

Importantly, Media Doctor has found statistically significant differences when it compares the quality of reports across different media – print is better than on-line, and television current affairs sits squarely at the bottom of the ladder.

Interestingly, an analysis of media reports on complementary and alternative medicines found similar problems to the general medical coverage: most stories failed to cover costs and potential harms; two-thirds failed to get comment from an independent expert; and most stories that quantified the benefits of treatments did so in “relative” terms, an approach that tends to exaggerate.

Last year the Media Doctor team reported on stories about cancer, finding lots of unhelpful emotional language and hyperbole– coming though directly from the researchers quoted, rather than the journalists or world-weary sub-editors, a finding reminding us that the over enthusiastic promotion of new treatments is a much deeper problem that the culture of the newsroom.

Encouragingly, tracking changes over the past decade, Media Doctor is starting to pick up small but significant improvements in coverage: more journalists seem to be mentioning side effects and more accurately reporting the benefits of new treatments.

Frankly though, so much medical reporting is so unhealthy, I’m not sure whether its better to try and keep the patient alive, or turn off the life support now, bypass the mindless botox-promoters in the media and look elsewhere for our health information.

Ray Moynihan is an author and journalist who has been writing about the business of medicine for more than a decade. He is a regular columnist and contributor to the British Medical Journal, where is also a Visiting Editor. His 2005 work, “Selling Sickness” was translated into twelve languages, and his most recent book, “Sex Lies and Pharmaceuticals” was released globally in 2010.

More at: www.raymoynihan.net