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“The Kid in a Candy Store” Approach to Health News Stories

candy storeThe limited coverage of healthcare policy by the news media is a major problem.

The PROBLEM is not the problem; the problem is the COMMUNICATION about the problem. Dianna Booher, Booher Consultants, Inc., booher.com

Let’s be frank: we rely on the media to provide us with balanced information so that we can debate the policies that our government adopts. As lawmakers consider major reforms, the need for healthcare policy information is critical.

Unfortunately, as we showed here, the news media would rather highlight stories about the research of, and treatment for, specific diseases and conditions.

This is not especially surprising, as reporters can give these stories a human-interest spin and/or play up sensational elements that help to sell papers and increase ratings.

And there is a need for such information, especially as the Baby Boomer generation ages and as American longevity increases, which means that more folks face the likelihood of battling a serious illness such as cancer, diabetes, heart disease or stroke.

If the news media would do a better job of balancing such stories with coverage about the healthcare policy debates, that would be a good first step.

But there are other major problems with the media’s coverage of diseases, and their treatments, that should concern the public and healthcare reformers alike.

Check out this excellent, innovative website called the Health News Review. Funded by the Foundation for Informed Medical Decision Making, the website’s creator, Dr. Gary Schwitzer, and his dedicated team of news analysts aim to promote Accuracy, Balance and Completeness in media coverage.

In a report published by the Public Library of Science (PLoS), Mr. Schwitzer and his team found that “journalists usually fail to discuss: costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms,” when it comes to presenting information about newly developed treatments, tests, products and procedures.

The study looked at 500 news stories published in a variety of mediums over two years.

Specifically, the news analysts considered whether the stories:

  • Discussed costs, and compared the newer treatments with existing alternatives. Stories that did not mention whether or not insurance companies were likely to pay for the treatments did not receive a high ranking.
  • Explained and quantified benefits and potential harms.
  • Conducted in-depth research, including seeking out additional sources and examining potential conflicts of interest in sources. Often times, reporters rely exclusively on a news release from a scientist or company, without going to outside sources to verify the claims made. The industry-related parties usually stand to benefit financially from the new test or procedure.
  • In other words, the concern is that the news media is simply giving unwarranted, free publicity to drug manufacturers or drug-industry scientists without really questioning the value and potential costs, (financial or otherwise), of the newly developed products.
  • Reviewed the study methodology, and true novelty of the product: As we have shown before, the FDA often approves drugs for the market that offer no significant benefits over their predecessors. The news media is contributing to the hype over new drugs that may not be much better than those coming before, but that certainly cost consumers, insurers and the government much more.
  • Avoided disease mongering: In discussing new treatments, statistics about the large presence of certain diseases are often blown out of proportion. Journalists also lend support to the idea that normal states, such as baldness, need to be treated as diseases.
    • This leads to public alarm, and to increased support for new products.

The study found that more often than not, U.S. news coverage was lacking when it came to these fair and accurate criterion: 62-77% of the stories examined did not meet the minimum standards.

Schwitzer sums up the media coverage of tests, prescription drugs and procedures as such: “You could call it a “kid in the candy store” portrayal of US health care, whereby everything is made to look terrific, risk-free, and without a price tag.”

The Health News Review website has literally thousands of examples of both excellent and poor reporting. You can find ratings for healthcare stories that appeared in just about every major American newspaper.

Here are two examples that caught our attention:

This USA today article examined research linking prostate cancer with multivitamin use. The article received a 5-star (out of 5) ranking because it was careful not to suggest that taking a large number of multivitamins causes cancer.

  • It instead showed that heavy multivitamin usage may result in a higher risk for advanced types of prostate cancer. The article’s author discussed the implications and flaws of the study’s design, while also consulting outside sources and proposing alternatives to multivitamins.
  • Read the article here and the full analysis here.

And our local newspaper, The Pittsburgh Post-Gazette, published this story about research on the use of growth hormone (GH) to fight the effects of aging.

  • The article did not provide statistically significant data to show that elderly adults who were given growth hormone showed improvement in physical functioning, as the research cited claims.
  • The author is ambiguous when it comes to the legality of taking GH for anti-aging or cosmetic uses. It is illegal under federal law to provide GH for these purposes.
  • The article is accused of disease mongering because it consistently suggests that aging is a disease for which a pill must be taken.
  • The article received a one-star ranking.
  • Read the article here and full analysis here.

The lack of reporting on healthcare policy stifles the reform debates.

Poor or misleading reporting on new treatments, tests, and procedures also has enormous potential for harm.

  • For one, overly optimistic stories about new cures can create unrealistic expectations amongst patients, and healthy consumers alike.
    • Folks are more likely to demand a new product or test from their doctors upon hearing such a story on the news.
    • This costs us more in both public and private healthcare dollars, and may even cause physical harm to the patient.
    • Not surprisingly, direct-to-consumer (DTC) pharmaceutical ads tend to have the same effect.
  • Second, we spent 16.6% of our Gross Domestic Product (GDP) on healthcare in 2008 and that percentage is expected to grow.
    • As consumers, taxpayers and citizens, we need fair and accurate information about the true costs and benefits of products.
    • That way, we can collectively make an informed decision about how many new tests, prescriptions and procedures we actually need (and are willing to pay for).

The folks at the Health News Review have great hopes for changing reporters’ behavior through training and increased awareness.

Despite the fact that the majority of newspapers do not provide healthcare-related training opportunities, many organizations including the Center for Disease Control (CDC), the National Institutes of Health (NIH) and the Knight Foundation now offer programs to train reporters in the basics of health care coverage and analysis.

There are also a number of online resources for journalists who are new to the health beat. The Health News Review site has a section called “The Things You Should Know about Medical Research Stories,” which advises reporters to avoid the following 7 words when writing or talking about healthcare and disease:

  • Cure
  • Miracle
  • Breakthrough
  • Promising
  • Dramatic
  • Hope
  • Victim

And The New America Foundation offers this online guide.

{ 2 comments… add one }
  • Dan February 28, 2009, 4:17 pm

    This Makes Me Sick

    When I heard the word ‘warmonger’, I had to find out its definition, as I had no idea what that meant so long ago. I knew others could be labeled this word, so I wanted to find out what it meant. Finally, I found the answer: a warmonger is one who promotes something that is undesirable or discreditable. In this case, one labeled this would promote war.

    Mongering still exists, yet instead of war,, it is medical disorders and disease states that are being promoted in this way.

    There appears to be those who question the existence of what is called disease mongering. Disease-mongering is when typically a large pharmaceutical corporation implements various illegal activities in order to sell more of their products.

    They do this by creating more of those who may be candidates for their drugs and what they treat more than what really exist. One method pharmaceutical companies implement is a determined goal to extend the range of what is truly abnormal regarding the health of others. If this is done, the market for the treatment its products are used for is to the benefit of the pharmaceutical company.

    The intentional creation of front groups is one method masked as advocacy or support groups for a particular disease state or medial disorder. Embellished data shared primarily with health care providers as it relates to the efficacy of the pharmaceutical company’s medications is another way. There are many other tactics utilized by this industry that ultimately is nothing less than clear disease mongering.

    How such pharmaceutical corporations do this in these other ways will be explained soon- and you will read how and why they want the needs for their drugs to be unmet throughout the patent life of the drug of a pharmaceutical company. The companies want to let the public know constantly about the progressive increase for the disease states for which their products treat, and the symptoms expressed by others that indicate such disease. Often, the disease increases as well as the symptoms that conclude specific disease states relevant to the pharmaceutical company are far from authentic.

    This disease mongering in fact does occur often to widen the diagnostic boundaries of an illness, disorder, or syndrome by primarily creating awareness of such medical conditions that often is far from what is really accurate. The drug makers share such information that is flawed both to the public as well as the health care providers, but in different ways as they present in a convincing way what may be overall more fiction than fact..

    First, let’s take a look at this label of disease mongering: It is an inaccurate phrase in that it is an incomplete phrase. Unlike diseases and illnesses, mongering activities also occur with medical disorders and syndromes as well by large pharmaceutical corporations. It is accurate and factual, however, that what is called disease mongering does occur, and occurs often so the promoted drugs of the pharmaceutical companies will increase the market share of their source of revenue.

    Mongering, by definition, is the process of a dealer who promotes something overall void of credit or desire by others in order to create need by establishing credit and desire that does not exist.

    There was a book written by Ray Moynihan and Allan Cassels called, “Selling Sickness” in 2005. The book thoroughly described how big pharmaceutical corporations are turning all of us into patients due to the activities of pharmaceutical corporations misleading the public in this manner.

    Disease mongering progressively continues to transform healthy people into patients with illnesses that they more perceive than possess. Big pharmaceutical corporations engage in creating such misperceptions in a number of ways: Further disturbing is that these drugs that are being used more often than need to be are not always safe, and at times are quitee toxic to one who is taking such a drug.

    Here are some ways pharmaceutical companies engage in disease mongering:

    1. Paying medical journals to publish fabricated clinical trials involving their promoted medications after paying those involved with such a clinical trial to create such fabricated data. That is disease mongering to the health care provider, and takes the mongering to a higher level as it relates to fraud and deception.

    2. Subjective medical screenings for various mood disorders, is one way. These were infrequent until about the mid 1990s. It was also at this time the U.S. was becoming a psychotropically induced nation as a result of activities such as this. These screenings were largely composed of particular questions. The sponsor, of course, was involved the creation of these leading questions conducted by disease state support groups upon instruction of their supporting sponsor. When this occurs, the support groups are converted into front groups after being funded by those big pharmaceutical companies who produce drugs for these mood disorders of various kinds and degrees.

    3. Disease creation-1, such as social anxiety disorder, or social phobia: This disorder is in the DSM IV which was published in 1994, and some were forced to delete the statement regarding this disorder that said, “Social Anxiety Disorder is not well-established, and requires further study.” The DSM, by the way, is the Psychiatrist’s handbook for diagnosing and treating those with mental concerns.

    Aside from what may be simply amplified introversion, social phobias are likely due to societal dysfunctions or malfunctions, and certainly should not be labeled as a pathological condition requiring pharmacological treatment as it presently is, in my opinion.

    4. Disease creation 2- what is defined as premenstrual dysphoric disorder. I call this a mid-life crisis, yet it was entered by instruction from the APA into the DSM in 1993. Possible anxiety about the inevitable does not require pharmacological treatment. The APA, by the way, is the American Psychiatric Association.

    5. Direct to Consumer Advertising- a vexing component of our lives more so in the past 10 years or so.

    With such advertising, perhaps most memorable were those commercials for erectile dysfunction. Their absurdness in creating these commercials was possibly psychotic. The typical setting for such a commercial is as follows:

    A healthy man who could probably run a marathon is having a decent time with his wife at some upper middle class location. He is smiling all the time. Because now, his marriage is secure due to copulation that now occurs with his wife that was apparently void before this wonder drug entered him, and his restoration of his life. Of course, it is not possible to have a strong marriage without intercourse, according to others, apparently

    Then there are other conditions, entirely natural in the human lifespan, that have been determined to be diseases by those who can profit off of these age-related conditions. Examples include osteoporosis and menopause, as well as erectile dysfunction. It’s insane the FDA approve pharmaceuticals for such natural events in a human being.

    Finally, there are the required medical guidelines frequently revised for various disease states, such as dyslipidemia, for example.

    There are also publications with such titles that address the disease state of dyslipidemia, as “The Lipid Letter”, or, “Lipid Management.” Both medical publications of any type, as well as the disease state guidelines, offer progressively more aggressive management of the lipid profiles of the patients of the readers, who are normally health care providers. And both guidelines as well as medical publications are typically funded by those big pharmaceutical companies that promote a class of medications called statins- the class of drugs that is almost entirely used as therapy for dyslipidemia.

    A myth is something unproven. A false premise. A story of fiction.

    Disease Mongering is not a myth. Large pharmaceutical corporations promote if not encourage illness and disease occur as often as possible for their own benefit. Illnesses and diseases certainly not desired by anyone and discredited by many. The pharmaceutical corporations do this for potential profit from others who prescribe their promoted drugs.

    Why this behavior of these large pharmaceutical companies continues to be allowed is a mystery to me and others. Their strategies with what they implement are not entirely tacit if one is aware that such activities occur.

    Investigations would be appropriate, and should occur to ensure the health of others. The others are United States Citizens- this is the health of the public. Protests are not out of the question.

    Perhaps if we as citizens protest, and make each other aware of tactics such as these from pharmaceutical companies in larger numbers, there may be a change that will occur that needs to happen for our own well-being and safety.,

    Dan Abshear

    .

  • Dan February 28, 2009, 4:18 pm

    Those who design and create releases for the press, which is the print media, is designed to contain information of sufficient importance or interest to the public, historically speaking.
    Instead, those who design and release written information to the press are often sponsors of the print media who will issue the press release. Such sponsors often instruct such media outlets with mandated authoritarian nuances, such as the press release that they created will not be altered in any way by the print media that agrees to release the press created by the sponsor of the media outlet.
    Of course, the sponsor and creator of such a press release creates such written words in order to promote the sponsor itself, as well as its products. By doing so, they are allowed the freedom to embellish if not fabricate what may be annotated on the release they issue to the press that has now been bought by them, the corporate sponsor.
    These well- constructed statements are meticulously composed and customized before they are issued to targeted editors and contacts at mass media publication locations.
    The sponsor also has been known to direct the location and time of the release of their press creation that, upon direction from the sponsor, is completely un-reviewed by such a media source.
    As this is done, the mass media outlets are again instructed on how to present their completed statements, as well as are given instructions once again not to alter these press releases in any way, as part of the agreement between the print media source and their sponsor.
    As a result of this collusion, press releases are presently a form of public relations often utilized for those companies who create what is supposed to be an attempt to express their products as being newsworthy.
    Press releases, historically, have been created and released to inform the readers by adding insight and related information for them regarding a particular topic that was typically complete and balanced.
    Today, they seem to be more or less an annotative commercial with press compositions generated by corporations in particular, so it seems.
    Unfortunately, and presently, press releases are often embellished, biased, and incomplete with deliberate intent in order to benefit the creator of these documents, who again develop them solely to increase awareness and usage of their products that they promote with their business, which they want to be viewed as favorable and with a positive image to the public.
    One could suggest that the mass media who receives these press statements from certain corporations are transformed into mass front groups who perhaps coercively offer third party legitimacy for the content of the press release as they release this information to their readers.

    The often notable if not intentional flaws at times are numerous within such press releases that reflect reckless disregard with informing readers in such a way, who are the American public. Citizens typically believe that what they are reading from a respected media source is both honest and complete.
    An example is an anonymous press release posted on the Medical News Today website (www.medicalnewstoday.com) that is dated in March of 2006. The title: “Cymbalta Safely and Effectively Treats core anxiety symptoms associated with generalized anxiety disorder.”
    Cymbalta, by the way, is a psychoactive drug often utilized for human affective disorders.
    Clearly, this title itself includes words associated with relief or elation, which are subjective and not objective elements which would clearly be more appropriate- with a health care press release in particular.
    The first paragraph of this press release repeats the results mentioned in the title of this article, but also states Cymbalta offers relief of painful symptoms associated with anxiety, as well as improved functional impairment- also claimed to be associated with anxiety in this press release.
    These conclusions are speculative at best, as these inferences appear to be unexamined by others regarding the benefits claimed to exist with Cymbalta as illustrated in this press release.
    Cymbalta was not approved by the FDA for anxiety or any of the symptoms associated with this condition at the time of this press release. In fact, Cymbalta was not filed with the FDA for this speculated new indication for anxiety that was desired by Eli Lilly until May of 2006.
    By definition, this press release may possibly be off-label promotion as well as misbranding of Cymbalta that was performed overtly in this manner of the press release, one may speculate.
    As one continues to read this press release, testimonials were intentionally created and inserted into this press release that illustrated results they hope are impactful to the reader regarding Cymbalta.
    This testimonial was from the lead author, who expanded the claims made initially with utilizing various medical terms, which was followed by this person’s passionate optimism about the great potential of Cymbalta based on this remarkable study.
    This study, by the way, was to be addressed in further detail at a National Anxiety meeting some weeks after this press release was announced to the public on this website.
    The second testimonial was Eli Lilly’s Medical Advisor expressing his elation about what the lead author just stated, followed by how much he was encouraged by these results that will benefit so many others that have these debilitating medical conditions.
    Of course, profit forecasts and desired market growth and expansion regarding Cymbalta remarkably were not stated in this press release.
    What is not included in this particular press release were any clear statements regarding the disadvantages and adverse if not toxic events associated those who take Cymbalta.
    Reactions from Cymbalta users include discontinuation syndrome at times, when the user stops taking this medication, which I understand can be quite devastating for the one experiencing this syndrome.
    Furthermore acts of suicide and suicidal ideation have been frequently associated with those who take Cymbalta as well. There have been apparent lack of efficacy suggestions by others who have taken Cymbalta.
    Basically, anything that may be considered negative aspects about this drug were not annotated in this particular press release as it should have been for fair balance that is or should be a primary standard in the pharmaceutical industry and health care journalism.
    The staff involved with the release and publication of such press releases as this one was annotated and described should perhaps be more informed on what not to accept and what to present regarding these issues addressed.
    As with any reporting by the media, objectivity and thorough completeness of the topic discussed in a press release is a necessary requirement with any publishing that is potentially exposed to so many other readers- with issues related to the restoration of their health in particular:
    “The public has a lot at stake, and the media has a responsibility always to be aware of the source of information and the conflicts those sources might have when they report the results of clinical research. People who have financial stake in the results of clinical research can well be biased in the way research is conducted, in the way they report it, and what they say about it when interviewed by the media.”
    – Arnold Relman, former editor in chief of the New England Journal of Medicine

    Dan Abshear

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