In the late 1970s, I covered the National Institutes of Health as a reporter for a weekly newsletter called The Blue Sheet. I was one of only two reporters who went out to NIH every day. I shared a press office with the other reporter, who was from Medical World News, and with an NIH information officer named Jane. Jane's job was to walk the halls of the laboratory buildings on the NIH campus and find out what interesting research was being done. She shuffled around in her comfortable shoes, spent hours talking to scientists about their work, and wrote up long descriptions to send out to the media as press releases. Many of these press releases suggested fascinating feature stories for some entrepreneurial reporter. Yet I can't remember ever seeing a single one of them turned into a newspaper or magazine article.
I think about Jane's job, which I believe has since been eliminated at NIH, whenever I log on to an Internet users' group I subscribe to. The group is called ProMED, an acronym for Program to Monitor Emerging Diseases, and every day I get 20 or more messages describing outbreaks of weird new diseases infecting humans or animals around the world. In the last month alone, I've read about ornithosis in birds and humans in Australia, diphtheria in the former Soviet Union, trypanosomiasis in Zaire, psittacosis in Belgium among custom officers inspecting illegally imported Indian parakeets, and a disease in Ethiopia that killed so many hundreds of camels that at least five camel herders committed suicide.
Any one of these is a potentially interesting story, certainly from the point of view of the people involved and the public health officials called in to investigate. But you're not going to hear about them on the evening news or read about them in any but the most passing way.
Public health issues are defined tautologically: the stories that are thought to be newsworthy are the ones you hear about in the news. But many factors enter into the decision about what is worth writing or broadcasting about: Does it make a compelling tale? Is there a clear bad guy? Is the science easy to understand? Are there good pictures? And, perhaps most important, is everyone else covering it?
Now, when I first started out in this business nearly 20 years ago, I would have said that if everyone else is covering it, then no one would want me to write about it. But that turns out to be the exact opposite of what is the case. In my experience as a freelancer, I have found that the only stories editors are really interested in are the ones they've already heard about. If I want to convince a magazine editor to assign a public health story to me, I better be sure the editor has already heard so much about the story that she can recite the details in her sleep.
I think this herd mentality is what accounts for the enormous difference in the way two different outbreaks were covered in the press in mid-1995: the Ebola outbreak in Zaire, and the dengue fever outbreak in Central and South America. Everyone covered Ebola because everyone else was covering Ebola; no one covered dengue because no one else was.
Last May, you could barely open a newspaper or turn on a TV without hearing about the Ebola outbreak in Africa. It was an interesting story, but it got the kind of attention it did for one reason only: because the goriness of Ebola had already captured the public imagination, including the imagination of news editors, because of Richard Preston's book and Dustin Hoffman's movie. A few months after the Zaire outbreak was over, the reporter Malcolm Gladwell analyzed the media frenzy for The New Republic magazine. This is what he wrote: "It is safe to say that it is because of the success of The Hot Zone that [the movie] Outbreak was made, that the Ebola outbreak in Zaire was covered as feverishly as it was, that the idea of killer viruses has achieved such sudden prominence. In the epidemic of virus paranoia, The Hot Zone is patient zero."
I myself got caught in the tailwinds of the epidemic. An article I had written on emerging viruses for Mademoiselle was suddenly dusted off after nearly a year in inventory and rushed into print. Two days later, I got a call from an editor at First for Women asking me to write an article on emerging viruses. When I told him that Mademoiselle was about to run a similar story, he said he didn't mind; he'd like one too. While I was on the phone with the guy from First for Women, my answering machine was taking a message from an editor at McCalls who had had exactly the same idea. I called her back and told her I had already accepted the assignment from First, so she didn't assign the article to me--but you can bet she assigned it to somebody. I did a computer search last week on emerging diseases, and found that almost every major women's magazine, including Self, Ladies' Home Journal, and Cosmo, had an article on the subject between June and August. And because I had a book on this topic that came out in 1993, before the public's attention was directed to it, I know that this kind of interest did not exist as recently as three years ago.
So there's a definite me-too aspect to what makes a newsworthy story: If everybody else is covering something, we should be covering it, too. The flip side of this, though, is that when there is an interesting story that is worth writing about, no one is quite ready to make the first move.
That is what happened only a few months after the Ebola outbreak. In the summer and fall of 1995, I began to notice a lot of e-mail messages on my ProMED list relating to thousands of cases of another potentially fatal hemorrhagic viral disease known as dengue hemorrhagic fever. These were occurring in Central and South America, with some patches of cases reported only 10 miles from the U.S. border. Yet no one was writing about it.
In the end, there were more than 200,000 cases of dengue in Latin America, and more than 5,500 cases of the more severe form of the disease, dengue hemorrhagic fever. At least 40 people died. But while Ebola is still a household word--and Nova just aired a one-hour documentary on the outbreak just last Tuesday--not too many people were aware of the dengue epidemic. Nor do they know that the most efficient vectors for transmitting dengue, the Aedes aegypti and Aedes albopictus mosquitoes, both exist in the United States.
I still don't know exactly what accounts for the relative silence with which the dengue epidemic was greeted by the press. Maybe we were all talked out about new viruses after the rash of Ebola stories. Maybe a disease that is carried by mosquitoes doesn't seem sexy enough to report on. Maybe a disease with only a 10 percent death rate doesn't seem scary enough.
It is, in a way, harder to tell the story of dengue hemorrhagic fever than of Ebola. The known agent of dengue transmission, the mosquito, isn't as photogenic as the suspected carriers of Ebola--monkeys and cave bats in particular. And while Ebola remains a medical mystery, the specifics of dengue are depressingly familiar. The symptoms are much the same as symptoms from most other exotic diseases--fever, muscle aches, pain--rather than the graphic liquefying of all internal organs, an image that made its way into just about every Ebola account last spring. The virus responsible is well characterized, as is the mechanism of transmission. And the things you need to do to prevent transmission are also rather mundane: spray insecticides, use window screens and mosquito netting, and eliminate sources of standing water in backyards like in discarded soda cans and old flower pots.
The issues that make it into most magazines tend to be the issues that are of concern to a group of white, literate, upper- middle-class editors in New York City. I've experienced this in writing not only about matters of public health, but in other medical topics as well. I wrote an article about what it's like to be adopted because my editor had an adopted son he was having trouble with. I wrote an article about the perimenopause because my editor was a woman in her forties who wanted to know whether to take estrogen. I wrote an article about infertility because my editor had a niece who was having trouble conceiving.
When these same editors read The Hot Zone or speak to lots of other people who have, they get more attuned to the weird things that can happen when a hemorrhagic virus escapes from the African rain forest and starts infecting humans. Unfortunately, this interest doesn't translate into a more generalized interest in emerging infectious diseases. And because magazine articles must by their nature be narratives, with a beginning, a middle, and an end, they don't really lend themselves to stories that emphasize the process of disease emergence rather than the particulars of one gruesome disease.
Those of you who are experts in your particular fields know how many times a fascinating issue is totally ignored by the mainstream press. My friend Lynne Lamberg is an expert on chronobiology who strongly believes that the sleep deprivation resulting from shift work is an important emerging public health problem, but she has trouble interesting magazines in the topic because it isn't sexy enough. But there is some cause for optimism. In the past month, I've been happy to see some interesting feature writing appear on the front page of The Washington Post that you might not ordinarily expect to find in a major newspaper. John Schwartz wrote an article, based on a report in Nature, about an epidemic of canine distemper virus that had crossed species, moving from dogs in Tanzania to lions in the Serengeti National Park. And just this week Laura Sessions Stepp wrote about a new drug abuse epidemic among suburban teenagers, getting high from the Ritalin that is widely prescribed to treat hyperactivity. But I think the problem will remain with us that most stories don't get printed or aired unless there's an easy way to tell them--which means that most of the most important public health stories of the day will continue to be discussed only among people already in the know.
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Robyn Marantz Henig is a journalist and author in Takoma Park, MD. The text was presented at the AAAS annual meeting, Baltimore, MD, February 9, 1996.