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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?
This web page has the following sub-sections:
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.”
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.”
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.
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.1103), that a fictional book about terrorists, and poisoned Canadian pills “was commissioned as part of an effort to cause US citizens to worry about the safety of Canadian drugs.”
The US has long had a ban on importing Canadian drugs and this combined with the exorbitant prices of US drugs means that many patients resort to Internet purchases from Canada and elsewhere, the BMJ explained. Apparently, the Vice President of PhRMA and a consultant for that pharmaceutical lobby group had been involved in the deal for the book. The BMJ did not report that the VP denied her own own involvement, only that PhRMA did not “directly” commission the book.
More generally, however, fear is exploited more subtly and the media strategies that health related industries (pharmaceutical, alternative, nutrition, food, etc) have invested in appears to pay off for them as the title from another BMJ article reveals: Who needs health care—the well or the sick14? (Volume 330, April 23, 2005, p.954).
That article makes an interesting observation whereby “the rates of self reported illness are paradoxical: low in Bihar [the poorest state in India], where the low expectations of health are disturbing, and enormously high in the United States, which is equally disturbing but for different reasons.” In summary, it seemed that “the more people are exposed to contemporary health care, the sicker they feel.” A key reason for this appears to be related to the industrialization of health: “more money can be made from selling healthcare interventions for the healthy majority than for the sick minority.”
The radio/TV show, Democracy Now!, adds to this with their January 19, 2007 broadcast, noting that pharmaceutical companies have gone to excessive lengths to portray common ailments and problems as diseases15, and have even highlighted obscure problems as common diseases. Through the use of uncertainty and fear in advertising campaigns people are therefore encouraged to purchase drugs as solutions. As Democracy Now! found out when looking at a documentary called Big Bucks, Big Pharma: Marketing Disease & Pushing Drugs16, there are many examples, including drugs for “restless leg syndrome”, for your “restless mind”, “generalized anxiety disorder” and more.
A striking example is how Paxil was revitalized as a treatment for Social Anxiety Disorder. Its company hired a public relations firm to frame this condition as a major and common medical problem, and the firm launched a multifaceted campaign that moved beyond advertising to get stories about Social Anxiety Disorder placed in print media and on television.
This morning, we begin a special two-part series on Social Anxiety Disorder. Many of us have suffered from shyness or fear of social situations at some point in our lives, but for millions of Americans, their anxiety could be debilitating.
Paxil’s award-winning product director was quoted as saying, “Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with Social Anxiety Disorder.”
— Big Bucks, Big Pharma: Marketing Disease & Pushing Drugs17, Democracy Now!, January 19, 2007
In other words, many health news items appear to be repackaged press releases, or at least have that feel about them (which is not unique to the health industries unfortunately as explained further on this site’s section on media manipulation18).
Sensational headlines sell, of course. That’s why an online vote in a doctor’s chat web site can result in headlines such as “Doctors Say No to Abortions in their Surgeries” (Daily Telegraph, 2007) because 4 out of 5 family doctors voted no to the question “‘GPs should carry out abortions in their surgeries’ strongly agree, agree, don't know, disagree, strongly disagree.”
The question is overloaded because there is no context (what type of abortion, surgical or oral pill? Under what circumstances, with extra training, time and money? And so on. So much so that many doctors complained about the question. Ben Goldacre’s Bad Science has the shocking details, pp.267 – 269. His favorite quote from the chat site was “I think that the question is poorly worded and I hope [the doctors’ web site] do not release the results of this poll to the Daily Telegraph”!)
So, the media itself also bears responsibility for many of these issues, and the next example shows this even more.
The MMR Vaccine Scare — Media Irresponsibility
The MMR vaccine is a triple jab given to children for immunization purposes. In 1998 in Britain, a doctor published an article saying there was a link with this vaccine and autism. The media were all over this and it caused a huge outcry for almost a decade as many parents started to stop immunizing children, fearful of autism.
It turned out that the doctor in question had produced a paper of dubious quality and later it emerged he had a conflict of interest due to his involvement in a patent for a new vaccine, withholding where recruits for the study came from, for not disclosing negative findings and more. The doctor was recently struck off the General Medical Council in Britain meaning he can’t practice medicine. That’s how serious his errors were.
The angst and distress this episode would have caused to parents — some worried that their child had autism possibly because they gave them the MMR vaccine, or the luckier parents whose children do not have autism but were now confused as to what to do — is hard to understate.
However, Ben Goldacre says that despite the doctor’s errors, the other real scandal was the media failings that allowed the scare to be blown out of proportion and sustain headlines for years:
The responsibility for the MMR scare cannot be laid at the door of a single man, however much the media may not be trying to argue that it should.
The blame lies instead with the hundreds of journalists, columnists, editors and executives who drove this story cynically, irrationally, and willfully onto the front pages for nine solid years.… They overextrapolated from one study into absurdity, while studiously ignoring all reassuring data, and all subsequent refutations. They quoted “experts” as authorities instead of explaining the science, they ignored the historical context, they set idiots [sic] to cover the facts, they pitched emotive stories from parents against bland academics (who they smeared), and most bizarrely of all, in some cases they simply made stuff up.
Now they claim [the original research] has been “debunked” (it was never anything compelling in the first place) and you will be able to watch this year as they try to pin the whole scare onto one man.
— Ben Goldacre, Bad Science, (Harper Perennial, 2009), p.291)
(Goldacre titled his chapter on this issue as “The media’s MMR Hoax”.)
As well as effects on individual families, this has an impact on the wider community:
Since the MMR scare, the percentage of people being vaccinated has dropped to the extent that there is not sufficient “herd immunity” (where you need enough people in a population to be vaccinated for it to be effective across society so that those who are not vaccinated are less likely to get it because so many others are vaccinated).
As a result, the number of cases of measles in Britain has risen, and we mustn’t forget that measles carries its own complications including male infertility and cerebral complications.
How to read articles about health issues
Ben Goldacre’s book goes at length to explain why evidence-based medicine with proper peer-reviewed and transparent science is better than so-called alternatives. Some 200 pages of his book goes through flaws in popular alternative medicines and therapies and also highlights how some popular television programs on nutrition involve people who appear legitimate but in various ways are not.
But he also gives a cautionary note about the reaction we have to one of the partners in the evidence-based medicine approach: the pharmaceutical industry, accusing, both drugs companies and the alternative industries of using the same “tricks of the trade” to manipulate citizens:
We all feel nervous about profit taking any role in the caring professions, but that feeling has nowhere to go. Big pharma is evil: I would agree with that premise. But because people don’t understand exactly how big pharma is evil, their anger and indignation get diverted away from valid criticisms — its role in distorting data, for example, or withholding life-saving AIDS drugs from the development world — and channeled into infantile fantasies. “Big pharma is evil,” goes the line of reasoning, “therefore homeopathy works and the MMR vaccine causes autism.” This is probably not helpful.
— Ben Goldacre, Bad Science, (Harper Perennial, 2009), p.201)
(This web site’s page on pharmaceutical companies19 looks at some of those above concerns in further detail, including issues such as withholding life-saving AIDS drugs that Goldacre mentions.)
So, given the myriad of problems with health coverage and news, how do we read health articles without getting so cynical about everything that we distrust even good coverage and label everything as wrong, and ironically, as “bad science”?
Here are some reputable sources that explain how to interpret and read articles about health in the media:
- From the British NHS web site:
- From the charity, Cancer Research UK Science fact or fiction?22 section:
- Ben Goldacre’s book, Bad Science is written more for the general audience than as a scholarly text, so is highly accessible and provides detailed insights into the above issues (and a lot more). His Bad Science25 blog has a lot more articles.
- Sense about science26 is a charity that attempts to respond to the misrepresentation of science and scientific evidence on issues that matter to society.
(Note that listed here are only those hyperlinks to other articles from other web sites or elsewhere on this web site. Other sources such as journal, books and magazines, are mentioned above in the original text. Please also note that links to external sites are beyond my control. They might become unavailable temporarily or permanently since you read this, depending on the policies of those sites, which I cannot unfortunately do anything about.)
- Global Issues: “Global Financial Crisis”, Last updated: Sunday, March 24, 2013, http://www.globalissues.org/article/768/global-financial-crisis
- Global Issues: “Media Manipulation”, Last updated: Monday, April 17, 2006, http://www.globalissues.org/article/532/media-manipulation
- Global Issues: “Pharmaceutical Corporations and Medical Research”, Last updated: Saturday, October 02, 2010, http://www.globalissues.org/article/52/pharmaceutical-corporations-and-medical-research