New research (Am J Manag Care 2006;12:170–176) indicates that local television news coverage of health and medicine often does not provide viewers with useful information and sometimes contains inaccuracies. Oncologists interviewed for this article generally agreed with the study findings and noted that news coverage can affect patient perceptions about disease.
“I wasn't surprised by the lack of useful information reported by local TV news,” said the study's lead author, James Pribble, MD, a lecturer in the Department of Emergency Medicine at the University of Michigan Medical School. “I was surprised by the egregious errors reported in major markets.”
The problem may extend beyond local TV broadcasts, though, says Larry Norton, MD, Deputy Physician-in-Chief for Breast Cancer Programs at Memorial Sloan-Kettering Cancer Center. “Flawed reporting is not only a problem in local television reports, but also in national news outlets,” he said in an interview about the study. “Even in newspapers, even the good ones, it's a very big problem.”
Because the majority of Americans get their information from local television newscasts, according to survey data cited in the study, the researchers wanted to evaluate the reporting characteristics of health stories from this medium.
Dr. Pribble and his coauthors analyzed and categorized thousands of hours of local TV broadcasts from October 2002. Health and medical stories were found to make up 11% of the news portion of late-evening newscasts, with 1,799 such stories carried on 2,795 broadcasts captured from the representative sample of 122 stations in the nation's top 50 media markets.
The average story was 33 seconds long, and most did not give specifics about the source of the information presented, the study found. Twenty-six percent of health stories on local television gave specific recommendations, 12% reported prevalence of disease, and 27% included interviews with health professionals.
Drawbacks of the Study
One drawback of the study, said Graciela Rogerio, a medical producer at WABC-TV Eyewitness News in New York City, is that is did not take into account the large variation between the number one market of New York and smaller markets.
In addition, the research evaluated only 11 pm newscasts, for which show producers, rather than medical reporters or producers, may make decisions about coverage. There are generally five other hours of daily TV news, and segments aired at the end of the day may be more limited than what is contained in an hour newscast, she explained.
Lemon Juice Study as an Example of Problems
The study also found that a small minority of stories contained errors. For example, a segment on several stations reported on the effect of lemon juice on sperm and speculated about, or presented as fact, lemon juice's use as an effective contraceptive and its potential effect on preventing sexual transmission of HIV.
Although that particular study was done in a research lab, nearly all the stories failed to mention that it had not involved humans. One of the stations misinterpreted the study altogether and stated that lemon juice may be a substitute for costly HIV medications.
That some stories contained errors, “was a huge criticism and something that shouldn't happen,” Ms. Rogerio said. Only 4 stations out of nearly 2000 aired the HIV and lemon juice story, she noted. “It should have never been reported,” she said. “And [for the researchers] to use this as an example is patently unfair.”
“Obviously, there are shortcomings with this kind of media coverage,” said Mark Pegram, MD, Director of the Women's Cancers Program at UCLA's Jonsson Cancer Center. However, the study did lack a control group, he added, saying that research comparing medical coverage with that of international affairs as a control group during the same time period might be informative.
“This way you could see whether they were doing a good job on any front,” he said.
Reporting about Cancer
Dr. Pribble and his colleagues also found that one of the two most common topics for health stories was breast cancer. October, the time that the data were collected, is Breast Cancer Awareness Month. West Nile Virus was the other most popular news story, and many areas of the country were experiencing an ongoing outbreak of infections at the time. Such temporal specificity was one of the main study limitations, the authors acknowledged.
Almost 76% of the 259 cancer stories were about gender-specific diseases such as breast, cervical, testicular, and prostate cancers. Only five cancer stories discussed lung cancer, the leading cause of cancer death in the United States.
Lung cancer may not be featured in a newscast because major journals such as the New England Journal of Medicine or the Journal of the National Cancer Institute didn't contain any studies at that particular time, Ms. Rogerio said. “This area of research tends to filter more slowly.”
Researchers also found that skin cancer, the most common form of cancer, was reported on five times, and only one story discussed colon cancer. Two health stories erroneously reported that exercise may cause cancer.
The most pervasive cancer story discussed a study (JNCI 2002;94:1445–1457) evaluating the effectiveness of teaching breast self-examinations. This story was reported 40 times and aired in more than half the media markets in the study sample.
The story was typically introduced by a statement that “self-breast exams are a waste of time,” and then often contained an interview with a woman who said she found her cancer with this type of exam, Dr. Pribble said. Sixty-five percent of these stories gave recommendations, and almost 90% of the recommendations encouraged women to continue performing breast self-examinations, despite the negative story introductions.
Moreover, there were differences of opinion among health professionals interviewed. For example, a health professional on one local television channel on the East Coast stated, “This is the best-done study on this subject,” while another health professional at a station in a Western state commented that the study was really terrible.
“This type of reporting does little to inform women and may confuse the issue,” Dr. Pribble said.
“What we are reporting is in medical journals,” Ms. Rogerio said about the media's general coverage of self-breast exam research. That data came from the Journal of the National Cancer Institute and was a big story because it went against conventional knowledge, she said.
Ms. Rogerio said that overall she did not think the researchers make the case for their conclusions, especially their assertion that television newscasts don't provide useful information.
“I don't know how they determine that,” she said, adding that the study was mostly statistical and that quantifying what is useful to viewers is difficult. In addition, the study didn't take any perspective or information from television media professionals into account or on how medical news is gathered, she said.
In addition to the cancer coverage addressed in the Pribble et al study, the oncologists interviewed for this article have found other local, as well as some national news coverage, to be problematic for patients, the public, and practitioners.
Women's Health Initiative Study
Dr. Norton said that one of the more recent examples of reporting that did not take into account all of the nuances of the research is coverage of the Women's Health Initiative study on dietary fat and its impact on invasive breast cancer risk (JAMA 2006;295:629–642).
“This was a very large trial in which the control group ate more fat than they was supposed to and the experimental group did not fully comply with dietary guidelines,” he explained. The 9% reduction in invasive breast cancer risk barely missed statistical significance, but media widely reported that the study definitively showed that dietary fat has no impact on breast cancer.
Researchers calculated the observed decrease in breast cancer risk to be expected only 7% of the time if diet did not make a difference, Dr. Norton explained. Investigators noted that this was very close to the conventional 5% level of statistical significance.
They called for further follow-up of the patients on trial, saying that the results did not prove that dietary fat makes a difference, but did not disprove it either. However, this was not widely reported or explained in lay terms in the media, Dr. Norton said.
“If you read the fine print, what the investigators were saying was not totally negative,” agreed Deborah Axelrod, MD, a surgeon and Director of Clinical Breast Services at the New York University Cancer Institute and Associate Professor at the NYU School of Medicine.
“Some of the negative association had to do with problems inherent in the study such as getting people to conform to a low-fat diet,” she said. Additionally, the fact that women who significantly reduced fat intake from high to low saw more of a benefit than other patients was not pointed out in the media.
The Wall Street Journal is one publication that did an excellent review of the study, Dr. Axelrod said. “But 30-second TV spots led people to believe that it doesn't matter what they eat. I had patients calling to ask if they could resume eating French fries and thick shakes.”
Some people's beliefs about what kind of treatment or lifestyle is beneficial may not be shaken by media reports, said Maurie Markman, MD, Vice President for Clinical Research and Professor and Chair of the Department of Gynecological Medical Oncology at the University of Texas M. D. Anderson Cancer Center. Despite how the Women's Health Initiative data were reported in the media, many people will still follow a low-fat diet, he said.
Negative Reports about Mammography
Dr. Norton also commented about news about mammography. Negative reports in the media a couple of years ago about the screening technique led some patients to skip their scheduled exam, he said.
“When they did come in, I was seeing 2.5 to 3 cm tumors as opposed to the smaller tumors that I might have seen in these patients had I diagnosed them the year before. This potentially is a life-and-death issue.”
Testing in Mouse Models
News reports highlighting outcomes in mouse models can also be misleading for patients.
For example, Dr. Markman often sees patients who have heard about a new ovarian cancer treatment on the news. However, more often than not, the drug was tested in a mouse model rather than in humans, information that patients missed hearing or didn't understand, he explained.
In these situations, the most harm that is done is that the patient has spent the last 72 hours thinking about how wonderful a treatment may be that is not available. “I'm the one to burst their bubble,” Dr. Markman said.
“Although the media need to pay attention to ratings, early preclinical studies reported in journals are not applicable to the patient who will see me on Monday morning, said Nevena Damjanov, MD, of Fox Chase Cancer Center and Assistant Professor of Medicine at Temple University Hospital. “Physicians may be perceived as withholding therapy from people if they come in asking about a particular drug that is not ready for the clinic.
Not All Therapies Applicable to Patients' Diagnosis
Dr. Pegram said he has had the repeated experience of patients calling to discuss TV reports about specific therapies and asking if the treatments can be used for their cancer, even if the drug was not developed for their tumor type. For example, when the news of Gleevec being effective in chronic myeloid leukemia first hit the airwaves, his patients called to see if they could take it for breast, ovarian, and other types of cancer.
Every targeted therapy that has been approved has been associated with a flurry of phone calls, he said. “I spend hours every clinic undoing information that patients have acquired from various media outlets, especially the Internet. I spend an awful lot of time correcting information.”
There is an upside, though. Naturally, news coverage of health and medicine can play an important role in public awareness of cancer and patient care.
For example, while celebrity health news stories often seem to attract the spotlight, they can be informative, Dr. Axelrod said. Because of Dana Reeve's death from lung cancer, the disease was brought to the forefront of the media, which in this case, was good. News stories addressed that people who don't smoke can get lung cancer and that high-risk individuals should be screened.
New Drug Approvals And Off-Label Use
Some of the studies that have a clinical impact are reported correctly, such as when a new cancer drug is approved or has a new indication, Dr. Damjanov noted, adding that news about FDA-approved drugs can be life changing.
Study data about drugs for uses other than what is FDA-indicated can also have an important impact. Dr. Damjanov said that the most beneficial reports in cases like these are those that give viewers the information, that state that the therapy may or may not be appropriate on an individual basis, and then encourage people to talk with their doctors.
Physicians may not have read the latest journal that contains such study data, so news reports that initiate a conversation between doctor and patient can be useful, Dr. Damjanov added.
What Oncologists Can Do to Improve Media Coverage
To help improve news coverage, physicians and scientists could be proactive in providing briefings and summaries about data to the media, Dr. Markman suggested. They can also help journalists by responding to their request for interviews and outside comments.
Public health authorities, clinical experts, and researchers must give reporters information, interviews, and pretaped video that meet the demands of TV newscasts, which must tell stories quickly, visually, and in language that's understandable to non-experts, Dr. Pribble said. Information from journals and researchers needs to be simple and in a format that is useful for journalists.
Health professionals and organizations need to take the lead in conveying complicated medical information to the public in a comprehensive manner, Ms. Rogerio emphasized. “I think there should be more of a dialog between health professionals and the media.” Workshops and seminars for medical journalists sponsored by health organizations are useful, she said.
Some media outlets take the initiative to have medical experts on staff to help with reporting, Ms. Rogerio said, pointing to ABC television, which employs medical experts with MDs and PhDs who review journal studies and vet information. This unit sends a daily listing and analysis and when appropriate, comments from experts around the country, to the medical reporters and producers at the local stations. Additionally, at WABC-TV, Ms. Rogerio partners with a physician to ensure that news is accurate and that stories contain expert opinions on study data.
Overall, both journalists and health care professionals have a role to play, according to Dr. Markman. “We need to think about how everyone can do things better,” he concluded.