24 September 1998
2,000 words

Can medical reporters get the message out?
Better educated, write a glut, defer to NEJM
"What is a virus anyway?"

NEW YORK--At a panel on medical journalism at Fordham University, the experts' hands-down choice for the for the "most dismaying" medical news story that they've seen recently was Gina Kolata's front-page New York Times story on angiostatin as a cure for cancer.

Jane Brody noted that she was out of the country when that story was printed, she said on 24 September 1998. "Two of our reporters told our editors that this was an inappropriate story," she said. "I wrote about the scientific work in the late 1970s," said Brody, and there was a "sober article" on the same research "with lots of caveats" 6 months earlier. Why the Times printed the story "is beyond me."

Moderator Elizabeth Stone, professor of communication at Fordham, asked the panel of doctors, journalists and a government PR person to select and comment on a news story that was "particularly dismaying," at the communications department's panel, "Is Medical Reporting a Health Hazard." They also disagreed over whether there was too much or too little medical journalism, and how well it was communicating the right health messages. Medical reporting is important, they agreed, because patients can decide to make lifestyle changes, or forgo cancer treatment, based on what they read in the Times. TV, with its sound bites and angry debates, can be a frustrating medium. But it's difficult enough for a journalist to figure out what the truth is, and even reporters like Brody tend to defer to the New England Journal of Medicine (NEJM). They don't trust medical meetings, though, and may not be covering them any more.

Brody also noted that she refused to do a story from the NEJM on a Harvard study that linked coffee to pancreatic cancer, and her editors assigned it to somebody else at the Times. She had written about "umpety-ump" larger studies that showed no relationship, so she wanted to do a second-day story putting it in context. "The first tip" that the conclusion ws wrong was that the study was designed to examine pancreatic cancer and alcohol consumption; coffee was a secondary endpoint.

Larry Norton, Chief of Medical Oncology at Memorial Sloan-Kettering Cancer Center, also went along with the angiostatin story. "I'm still getting telephone calls," he said, from people who say things like, "Why should I get any treatment when the cure is right around the corner. It was on the front page of the New York Times. Jim Watson said so."

But while other panelists saw a glut of medical news, Norton complained about all the important stories that didn't get covered. For example, at the American Society for Clinical Oncology meeting last May, there was a "feeding frenzy" about Herceptin, the Her2 antibody treatment, while most of the press ignored the more important story that taxol can be used effectively to treat breast cancer starting from the time of diagnosis. (The Washington Post and the Wall Street Journal covered it well, he acknowledged.) "The percentage of people that can be helped by taxol is hugely more" than for Herceptin, he said. "Does radiation after surgery improve survival for breast cancer?" he quizzed a reporter.

Medical news should get at least as much coverage as sports, or the President's sex life, said Norton.

No video PRs from NEJM

NEJM New England Journal of Medicine editor-in-chief Jerome Kassirer, MD, was most dismayed by the New York Times Magazine article about his journal and JAMA, which said that the NEJM was trying to capitalize on its advertising, and described him as "fleshy and arrogant," and a "brilliant manipulator of the press." The corpulent Kassirer said that he was only guilty of "one of those two" personal attributes, and that if he could manipulate the press, the story never would have run. The NEJM published the coffee and pancreatic story before he got there, he added.

The Magazine is a different department, that nobody in the science department has anything to do with, said Brody.

Kassirer was also dismayed by a story in the Boston Globe a few days ago which reported that potassium reduced the chance of stroke, based on "a simple epidemiologic study of which there are many." The problem with those studies is that it's so hard to separate the confounding variables, he said. People who get potassium from fruits and vegetables are also likely to have other healthy habits, and to have a higher socioeconomic status.

"We send journalists a copy of the journal a week before," said Kassirer. "But no news releases or video clips." Public relations is "not our job," he said. If they think a paper is important, they publish an accompanying editorial, which explains the paper and its significance. "We publish for physicians, and health policy analysts," and medical professionals, he said. "We don't publish for the lay public."

But the editorials and selected contents are free to the public on the NEJM's web site.

Can the media educate?

"Can the mass media get the message out?" asked Anne Thomas, Associate Director for Communications at the National Institutes of Health. She expressed her frustration at the media treatment of the NIH revised obesity guidelines. The important message they were trying to get across was that "being overweight is a health risk and there is something the public can do about it," she said. But, she said, the news media tended to trivialize obesity and make jokes about it. With a video clip, she showed a story that led with critics who said that defining people as obese tended to stigmatize them for a condition that was beyond their control. she asked. Fortunately, she said, Brody's syndicated column went out around the country.

Kassirer, Norton, and Thomas thought the media did a pretty good job. Brody, and Timothy Johnson, MD, Medical Editor, ABC News, reminisced about how much better-educated medical journalists have become since the days, decades ago, when reporters were pulled off the police beat to cover a medical story.

Thomas began to appreciate how good medical reporters were in 1981, when the AIDS crisis started, and she got calls from general reporters who would ask, "What is a virus anyway?"

"We've expanded our research operation," said Johnson. ABC has 3 people in Boston alone, and an e-mail list of close to 1,000 experts to call upon for guidance. But Brody wasn't as fortunate. "I have no secretary, no private office," she said. "The disadvantages of that is that I don't get to see everything. The advantages of that is that I personally see the raw material."

Sound bites and quacks

Kassirer complained about the TV programs that send a camera crew out to interview someone, anyone, connected with a study, because they need a sound bite of someone saying something that has often been better expressed in the original paper. "They cut out a little snippet" of 13 seconds, he complained. Or they put you on a stage with someone who disagrees with you, "and they scream at you."

A debate would not be too bad, said Kassirer, if they have a moderator who would "allow someone to get a full sentence out, a full thought." But that wasn't his experience on Nightline, after he wrote his editorial arguing that patients should be allowed to use medical marijuana. He was sitting in a darkened room in Florida, looking into a camera, with someone else in Washington, DC, that he couldn't see, rebutting him.

Brody had a similar experience on Nightline, debating Harvey and Marilyn Diamond, author of the book, "Fit for Life," which is "gobbledygook and total nonsense," she said. Brody researched their claims, and the institution Harvey Diamond got his a degree from, which was a mail order university that became a religious school to avoid being shut down by the state, said Brody. As she laid out fact after damning fact, "the Diamonds sat there grinning from ear to ear," she said. "They had learned the PR trick" that, if you look pleased, the audience will assume that people are saying favorable things about you, said Brody.

When is the evidence good enough to write a story? Stone recalled how, a few years ago when Prozac had just been released to the market, she went to a meeting of the American Psychiatric Association. At one session, a speaker said, "Have any of you noticed that a lot of these women who are on antidepressants are getting pregnant?" and asked for a show of hands. Several hands went up. Is that something you should report? Not according to Thomas. "Reporters help the public understand and weigh the data," said Thomas.

"We received a report from the Mayo Clinic," said Kassirer, on albumin differences in patients who were taking fen-phen. They reported on 6 cases, which, out of 18 million prescriptions, "plus or minus 2," is hard to evaluate. The NEJM reviewed the report internally, and sent it back to consider it as a letter to the editor. By that time Mayo had 25 cases, and that made the decision easier. "That's hypothesis generation," he said.

When the NEJM decides to print a study, they are very sensitive to the likely play it will get in the media, Kassirer said. They always worry about how good the data are. "If the study is about some lifestyle thing like sex or eating, we are particularly careful, because we know that the media are likely to pick it up."

The public gets annoyed because scientists change their minds, said Brody. One week they say broccoli is bad for you, and the next week that broccoli is good for you. The fundamental problem, she said, is that the lay public looks to medical research for a quick fix, while the most important preventives are lifestyle changes. "Nutrition and physical exercise are the hardest things we have to sell," she said.

"Why can't people be aware that science is a process," said Norton.

Deferring to NEJM

Stone was struck by how much influence the NEJM had on media coverage. "In my other areas of reporting the newspaper is the gatekeeper," she said, "but in medicine, the New England Journal is the gatekeeper." As a result, some important developments might not become visible on the horizon.

"Why shouldn't that be the case?" said Brody. "They are a peer-reviewed journal. I cannot pretend to evaluate a research paper," she said, "with all the wheeling and dealing" that is required to evaluate validity. "The statistics are getting more and more complicated," she said. "They keep inventing these relative risks and odds ratios." The NEJM, added Kassirer, has 3 statisticians and 1 molecular biologist to review papers.

No more meeting stories?

"We no longer cover medical meetings as a source," said Brody, "because the reports are not peer reviewed." The abstracts are peer reviewed, but a researcher can get an abstract in the program, and go on to say anything in the presentation. "We were burned many years ago," when Summerlin at Memorial Sloan-Kettering claimed to have transplanted skin from a black mouse to an unrelated white mouse. The black spots turned out to be black ink, and Summerlin was disgraced.

On the other hand, with fax machines, "we can now send [a paper] in an instant all over the world for experts to read," said Brody.

ABC is also "rethinking" their coverage of medical meetings, said Johnson. They were once places where researchers could discuss their ideas confidentially, but they've turned into a "media show."

(For upcoming events, see the Center for Communication.

--Norman Bauman