Measuring Health Care Coverage

As many of you know, I spent a quarter century in the ink-on-paper news business, mostly covering business and economic issues, before being relegated to minor league status on the Internet. Unlike many bloggers, I try to do my own reporting before I go on at length about one thing or another, a trait that is sadly lacking in most of cyberspace. That's why I am more sanguine about the fate of so-called mainstream media than many of my former colleagues in the press (not to mention the know-it-alls on the web). Hard-working reporters cannot be replaced by opinion-mongers who think reporting is reading the headlines in the morning paper and starting to type before they get to the jump page.

That said, I'm less sanguine about the fate of health care reporting, the field I gravitated to about five years ago when I took up writing about pharmaceuticals. So much of what appears in the media is so bad that it fails the basic test of providing the blogosphere with raw material for commentary. When was the last time you read a single online post about a Time magazine cover story about the "new brain chemistry"? Most medical "news" competes for readers attention with the mountains of self-promoting advertorials masquerading as "objective" health care information that already appears on the web. (One of the reasons I grit my teeth every time I hear the phrase "consumer driven health care" is that I know that most of the information consumers get about health care these days comes from the web, and much of that information has the integrity of a late night huckster selling erectile dysfunction supplements.)

A perfect example came at the top of the fold in this morning's Washington Post. Reporter Rob Stein in breathless prose reported a National Cancer Institute study showing that regular use of Eli Lilly's osteoporosis drug Evista (generic name raloxifene) gave postmenopausal women "a powerful way to protect themselves against breast cancer." "Terrific" and "good news" said the above-the-fold quoted experts, including one from NCI. While a few commentators, including one from the National Breast Cancer Coalition, urge caution, our reporter immediately switches back to the data to report that it cuts the risk "by about half."

It isn't until the 15th paragraph that readers learn that of the nearly 20,000 postmenopausal women in the study, only about 320 or 1.6 percent were expected to get breast cancer in the first place. By taking Evista, the number was reduced to 167 or 0.8 percent. In other words, 193 women will have to take this drug for five years to eliminate one case of breast cancer, which is fatal in one in five cases. The cost of preventing this case, by the way, would be about $864,000 ($75 per month for the drug for five years for all 193 women). While the data to make the above analysis was in Stein's story, none of it was clearly spelled out.

There are some objective reasons for failures like this. Health care reporters who are on daily or even weekly deadlines are usually being thrown at topics they know very little about. Yet with a few hours reporting, they are expected to sound authoritative. That may work in covering politics or business, but it fails miserably when confronted by the complexities of science and health.

Given that kind of pressure, the best most can do is come up with the conventional wisdom. They rely on sources who have been elevated into positions of authority by organizations (corporate, institutional, professional) that have a vested interest in one treatment or another. The most depressing phone calls I take each day are the ones from reporters looking for a quick quote to "balance" a story that has already been weighted to the point of view of the drug company that sponsored the study or the regulatory official whose decision reflected some special interest.

Sadly, most of these reporters are not even very good at gathering lots of information quickly and putting it into a coherent story. I've talked about these issues before but they bear repeating: how many times do you read a story that gives the absolute risk of the disease in question instead of relative risk (if a new drug cuts deaths from a disease by 50 percent, how significant is it if the number of people who died from it fell from 2 in 100 who took the drug to 1 in 100?). How does this new technology compare to older, cheaper technologies already deployed? How serious is this problem? Is this horrible condition (restless legs syndrome?) nothing more than "disease mongering" by researchers on a drug company's payroll?

In that sense, most health care reporters lag well behind their peers on the political or business pages, where a healthy skepticism is the order of the day and the knowledgeable reader at least gets enough information to form their own opinion about what's going on. Most consumers of health care news simply don't know enough to know when critical parts of the story have been left out; or when the facts have been arranged in such a way that getting real insight is virtually impossible. Health care news -- like pills -- is almost always swallowed whole.

That's why I'm hoping a new effort by journalism professor Gary Schwitzer of the University of Minnesota has some impact on the profession. Using funding from the Foundation for Informed Medical Decision Making (which insists on its website that it takes no money from any corporation that sells health care or health care technologies like drugs or medical devices), Schwitzer has set up a new website called HealthNewsReview.org to monitor and grade health care coverage in the mainstream media.

He's deployed several graduate students to monitor stories in dozens of newspapers and broadcasts and grade them with one to five stars -- just like the movies! By hacking around his website for a few minutes, I quickly discovered that the grades were based on solid, objective evaluation criteria. Any reporter looking to see why their work earned a poor rating could learn a lot by delving into the details of the critique.

Schwitzer, a former journalist who works closely with the Association of Health Care Journalists, goes to great lengths to explain that he isn't trying to belittle the reporters whose work is highlighted (I saw at least one got five stars). "We hope that U.S. journalists find our reviews helpful and accept the constructive criticism," he writes. "This project is intended to support excellence in health and medical journalism."

I wish him well in his efforts. Health care journalism has to get off the dead end track of reporting the latest study du jour, which is a one-way ticket to flacking for the drug industry. If there are any reporters reading this blog, I encourage you to check out his site. It will be interesting to see how they grade Stein's story.

Posted by gooznews at April 17, 2006 10:58 PM