Health in the Media

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  • by Anup Shah
  • This Page Last Updated Tuesday, September 28, 2010

Many of us grow up learning from our families and cultural background that there are certain things one can do to prevent certain ailments or improve one’s health (such as eating more of something, or less of something else, and so on).

At the same time, sensational headlines appear regularly along those lines or that some new medical breakthrough promises to offer a magic pill solution to an ailment you often worry about.

Unfortunately, there’s more to it than what the headline or the story may reveal. Concerns include dumbing down the details, using inappropriate headlines and examples, exploiting our fears and anxieties, and a lot more.

In an ideal world, we should trust our mainstream media; there should be enough checks and balances in democratic systems to highlight outright flaws, lies, distortions, etc. But of course, reality is always different and various factors combine to distort reality.

How can the ordinary public know when the stories are sensationalized or twisted to mean something more than what actual studies are finding? How can we evaluate whether what we are reading should be treated cautiously or not?

On this page:

  1. Glossing over the science bit
  2. Effects of drug companies advertising directly to citizens
  3. The power of the anecdote
  4. Using fear or creating anxieties and then offering solutions
  5. The MMR Vaccine Scare — Media Irresponsibility
  6. How to read articles about health issues

Glossing over the science bit

Doctor Ben Goldacre is an award-winning writer and medical doctor. He has a column in the British newspaper, The Guardian called Bad Science1 (plus a book and blog2 by the same name) that looks into scientific claims made by journalists, government reports, pharmaceutical corporations, PR companies etc on various health-related issues.

Goldacre explains in detail how the media promotes the public misunderstanding of science, in his book Bad Science (Harper Perennial, 2009). He covers areas such as

  • The medicalization of everyday life;
  • The fantasies about pills from both mainstream and alternative areas
  • Ludicrous health claims about food, where journalists are every but as guilty as nutritionists (p.224), and
  • How science is perceived and portrayed resulting in a structural misleading of the public.

His examples, he admits, are too many, and will certainly not be possible to list here apart from some generalizations.

On the medicalization of every day life and fantasy promises of pills, Goldacre’s sarcastic title for chapter 8 perhaps sums it all: Pill solves complex social problem.

On the food issues (where we are frequently bombarded with claims like eating this or not eating that will be good for some ailment or condition) he goes into how self-proclaimed nutrition experts have their own mainstream TV programs even if their qualifications are questionable, and how they put forward science-like claims without the strength of real science behind them.

On the science front, Goldacre is equally scathing. He feels that in the media, science is portrayed as groundless, incomprehensible, didactic truth statements from scientists, who themselves are socially powerful, arbitrary, unelected authority figures. And ultimately, and most ridiculously, science is too hard to understand for the general public and therefore all stories involving science must be dumbed down (p.237). So, having created this parody, the commentariat then attack it, as if they were genuinely critiquing what science is all about. (p. 225)

Headlines or articles will sometimes start with Research has shown… but the actual studies do not show what is said. An example he gives is as follows:

Compare the two sentences: Research has shown that black children in America tend to perform less well in IQ tests than white children and Research has shown that black people are less intelligent than white people. The first tells you about what the research found: it is the evidence. The second tells you the hypothesis, somebody’s interpretation of the evidence: somebody who, you will agree, doesn’t know much about the relationship between IQ tests and intelligence.

Ben Goldacre, Bad Science, (Harper Perennial, 2009), p.238)

That is, there are various social, cultural, economic, political and other circumstances that can result in the above result, yet the second sentence has jumped to a simplistic conclusion.

Ben Goldacre has numerous examples of how this keeps happening, often giving false hope to people. The British National Health Service (NHS) has a web site devoted to explaining what news headlines and articles about various medical claims are actually saying, called Behind the Headlines3. In a very informative introduction to the topic, Dr. Alicia White explains the concerns Goldacre details with a useful answer to the question, Did the study actually assess what’s in the headline?:

For example, you might read a headline that claims, Tomatoes reduce the risk of heart attacks. What you need to look for is evidence that the study actually looked at heart attacks. You might instead see that the study found that tomatoes reduce blood pressure. This means that someone has extrapolated that tomatoes must also have some impact on heart attacks, as high blood pressure is a risk factor for heart attacks. Sometimes these extrapolations will prove to be true, but other times they won’t.

Alicia White, How to read health news4, Behind the News, NHS Choices, January 6, 2009

In other words, you’d expect the news story to actually focus on the health outcome examined by the research. Unfortunately, as White adds, somewhat alarmingly, this isn’t always the case.

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Effects of drug companies advertising directly to citizens

Goldacre also describes how Pharmaceuticals ultimately distort things: through advertising. In some countries, such as UK, advertising directly to patients is not allowed. In others, such as the US, it is:

Patients are so much more easily led than doctors by drug company advertising that the budget for direct-to-consumer advertising in America has risen twice as fast as the budget for addressing doctors directly. These adverts have been closely studied by medical academic researchers, and have been repeatedly shown to increase patients’ requests for the advertised drugs, as well as doctors’ prescriptions for them.

… This is why drug companies are keen to sponsor patient groups, or to exploit the media for their campaigns.

Ben Goldacre, Bad Science, (Harper Perennial, 2009), p. 222

He goes on to describe a case where Britain’s NHS was pressured to approve a drug for Alzheimer’s even though the evidence for its efficacy was weak and because drug companies had failed to subject their medications to sufficiently rigorous testing on real-world outcomes … that would be much less guaranteed to produce a positive result.

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The power of the anecdote

Goldacre wrote his example of pressuring the NHS over an Alzheimer’s drug a while back. Such examples to approve a drug that has weak evidence for effectiveness — followed by shock and horror in the media — is commonplace.

Even as of writing the initial version of this page (end of August 2010), the UK body responsible for drug guidance (NICE — National Institute for Health and Clinical Excellence) was being criticized for another drug seemingly being denied to people on the British NHS. This caused news headlines on the main television news channels in UK as well as most of the press.

The drug in question that would not be funded on the NHS was Avastin, a bowel cancer drug that costs £21,000 per patient. This drug had been studied in a large randomized trial of 1401 patients receiving either chemotherapy with Avastin, or chemotherapy with placebo. As Goldacre summarized, overall, the study shows that Avastin extends survival from 19.9 months to 21.3 months (about 6 weeks).

How the press (from a ranging of political stances) dealt with it is interesting, as Goldacre notes:

The Daily Mail5, the Express6, Sky News7, the Press Association8 and the Guardian9 all described these figures, and then illustrated their stories about Avastin with an anecdote: the case of Barbara Moss. She was diagnosed with bowel cancer in 2006, had all the normal treatment, but also paid out of her own pocket to have Avastin on top of that. She is alive today, four years later.

Ben Goldacre, The power of anecdotes10, Bad Science/The Guardian, August 28, 2010

Reading the above (and the referenced news articles), we’d naturally wonder how NICE can be so callous and inhumane to deny this drug to people. And that is how the press reacted, interviewing many campaigners and patient organizations disappointed at NICE’s decision. But Goldacre explained:

Avastin extends survival [by] about 6 weeks. Some people might benefit more, some less. For some, Avastin might even shorten their life, and they would have been better off without it (and without its additional side effects, on top of their other chemotherapy).

Barbara Moss is very lucky indeed, but her anecdote is in no sense whatsoever representative of what happens when you take Avastin, nor is it informative. She is useful journalistically, in the sense that people help to tell stories, but her anecdotal experience is actively misleading, because it doesn’t tell the story of what happens to people on Avastin: instead, it tells a completely different story, and arguably a more memorable one – now embedded in the minds of millions of people – that Roche’s £21,000 product Avastin makes you survive for half a decade.

Ben Goldacre, The power of anecdotes11, Bad Science/The Guardian, August 28, 2010

So why are these nuances and complexities not explained?

Rationing healthcare resources is a soul-destroying and unavoidable horror, in which some people who are dearly loved will always die, and this makes it an irresistible magnet for questionable behaviour from people who are happy to release themselves from the burden of being realistic about difficult decisions.

Journalists can exploit these impossible decisions for outrage, and the pleasure of leading a popular campaign, but so can politicians.

… Whoever draws that line, wherever it falls, is always going to be pilloried and despised. When you’re writing about such an incredibly easy and emotive target, it might be fair to at least use a representative anecdote for illustration, instead of Barbara Moss.

Ben Goldacre, The power of anecdotes12, Bad Science/The Guardian, August 28, 2010

As an aside, the Daily Mail, one of the papers that Goldacre mentioned above, instead continued the shock and outrage angle by continuing to criticize NICE and its chief executive. NICE was criticized for spending more on spin and communications (£4.5 million) than on assessing new medicines (£3.4 million). The chief executive was criticized for having seen his salary increase 44% in the last 5 years to £180,000.

The salary attack is commonplace, especially in a time of financial crisis13, subtly exploiting the understandable anger people have at the high salaries and bonuses awarded to many many in the finance industry (who were part of the cause for the massive financial crisis, which health services and others now pay the price for). But maybe it could be argued that a high paid doctor/nurse/teacher/emergency services person etc is more justifiable than a high paid finance executive — in an ideal world…!

Media headlines then make it look like the death panels that have been conjured up in some recent US health reform debates, ignoring these more, seemingly boring, details.

And the point of Goldacre and others’ critique for years seems to have by-passed the Daily Mail: maybe those organizations would not need to spend so much on spin and communications if the news outlets reporting health issues did not themselves spin the topics to such levels of distortion as Goldacre and others have shown in so much detail.

As another aside, from a media perspective, it is almost astonishing to notice how all the above stories (including television reports on this) feel almost exactly the same: they mention the drug, its cost, and how NICE did not approve it for the NHS and how Barbara Moss survived and how she feels NICE is immoral and how it works because she is alive, etc. There seemed to be no discussion of the challenge NICE face let alone what Goldacre has raised, even though these papers are supposed to be from a broad spectrum of public debate.

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Using fear or creating anxieties and then offering solutions

People’s personal health concerns can unfortunately be exploited and is all too common.

Perhaps a bizarre and extreme example is the following: The British Medical Journal reported in November 2005 (Volume 331, p.11