AJN REPORTS
The Reporting of Health Information in the Media Nurses need to be aware of the pitfalls.
T
he American Cancer Society didn’t mince words when it ran this ad in the 1970s: “If you’re a woman over 35, be sure to schedule a mammogram. Unless you’re still not convinced of its importance. In which case, you may need more than your breasts examined.” This attempt at trying to convince women to get screened for breast cancer relied on powerful tools of persuasion—fear, guilt, and one’s own sense of personal responsibility. Although health information can greatly benefit consumers, some reporting by the news media, drug and device advertisers, and even health care systems or individual facilities can be confusing, biased, contradictory, or misleading. It’s the quality of the message that’s important, according to Steven Woloshin, MD, professor of medicine and of community and family medicine and codirector of the Medicine in the Media Program at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire. People aren’t able to make an informed decision if the information is limited or biased. “Ads should help people make a decision, not just push them to do what you want them to do,” Woloshin told AJN.
INTERPRETING THE MESSAGES
Health-related messages in general can be difficult to interpret. The public is often left confused by reports about how well a drug works or whether products, such as electronic cigarettes, are dangerous or benign, frequently while debate among manufacturers, advertisers, regulators, and researchers rages behind the scenes. Woloshin said the problem is often two pronged. First, the messages or reporting may be incomplete, misleading, overstated, or just unclear. Second, there can be issues with how these messages are received by the target audience because many consumers don’t know how to critically read health- related messages and may be unaware that key data are missing or unable to understand the evidence behind certain claims. [email protected]
Referring to a Memorial Sloan Kettering Cancer Center ad in the New York Times Magazine that read, “The early warning signs of colon cancer: You feel great. You have a healthy appetite. You’re only 50,” Woloshin and several coauthors pointed out in the November 1, 2012, New England Journal of Medicine that many men and women in that age range who were frightened by this message would be “surprised (and relieved) to learn that most 50-year-olds who feel great and have a healthy appetite do not have—and will not soon develop—colon cancer.”
GETTING THE RIGHT INFORMATION
Gary Schwitzer, adjunct associate professor in the School of Public Health at the University of Minnesota, Minneapolis, agrees but takes it a step further. He thinks that in addition to improving health care communication, improving the public dialogue about interventions is a major health care policy and reform issue. “Whenever you hear a claim about an intervention, you should not be hearing just about potential benefits,” he said. “We should be getting information AJN ▼ October 2014
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Vol. 114, No. 10
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AJN REPORTS
about cost and about the scope of harms and benefits.” HealthNewsReview.org, a Web site run by Schwitzer, evaluates health care journalism, advertising, marketing, public relations, and other messaging that can influence consumers, and provides criteria that consumers can use to evaluate such messaging themselves. According to Schwitzer, the country’s overall report card isn’t very promising. Of almost 2,000 stories gleaned from a wide variety of news organizations, the majority received a grade of “unsatisfactory” because they didn’t address important factors, such as cost, the quality of the evidence, harms and benefits, or alternatives that are already available. Sometimes public health communications can actually have an effect that’s the opposite of what’s intended. Nyhan and colleagues, writing in April’s Pediatrics, surveyed 1,759 parents and found that the promotion of vaccines actually decreased some parents’ intention to get their children vaccinated. Although misperceptions that vaccines cause autism were reduced, parents’ intention to vaccinate was also decreased, particularly among those parents who held the least favorable attitudes toward vaccines (for more on the study see In the News, June). “The problem is that many people approach a controversial issue like vaccination with strong preexisting beliefs,” said the lead author of the study, Brendan Nyhan, PhD, assistant professor of government at Dartmouth College. “When they receive information that challenges those beliefs, they may actively resist it and as a result not change their views. “People don’t always respond this way to public health messages, of course,” said Nyhan, “but it’s a risk, particularly with the most contested and emotional issues.” More research is needed, he said, especially on effective vaccine messaging. “At the same time, however, it’s not clear that more or different messaging is the solution to the problem. Dwelling on misinformation risks making the problem worse.”
WHO DOES THE PUBLIC TURN TO FOR INFORMATION?
It often seems that the public is more likely to listen to celebrities than to advice from health care experts or organizations. Jenny McCarthy, for example, has emerged as one of the most visible and outspoken opponents of vaccination, and many blame her for rising numbers of unvaccinated children. “Celebrities can be important, but also detrimental,” said Woloshin. Celebrities can also have a positive effect, however. Actor Michael J. Fox has raised more than $350 million for Parkinson’s disease research, and singer and songwriter Elton John has raised $300 million for research on HIV and AIDS, according to a study in the December 21, 2013, issue of BMJ. 20
AJN ▼ October 2014
▼
Vol. 114, No. 10
Nyhan suggests that trusted health care providers may be more effective at promoting vaccination than media reporting. This is true in other areas of health care, such as cancer screening and drugs, where the messaging (from ads in particular) may be unclear, misleading, or missing essential information. But even providers are sometimes confused or aren’t up to date on the information being disseminated in the media. This is particularly true about direct-to-consumer drug advertising, Woloshin said. “The drug ads are required to list potential harms, and they comply—but not in a way that is really absorbed by consumers,” he said. “People tune it out. What [the ads] often don’t do is actually tell you how well the drug works,” leaving it to the consumer to fill that information in. “We need to create clear drug information and disseminate it, but right now there is asymmetry in advertising,” said Woloshin. “Unfortunately, consumers and even clinicians may have difficulty deciphering the relevant information. To make an informed decision, they need to weigh the risks and benefits, and you’re not going to find that in the drug ads.”
WHAT CAN NURSES DO?
Schwitzer believes that nurses need to become more familiar with the elements of good reporting and be better prepared to answer questions and educate their patients. One recent example of irresponsible reporting was sparked by a report in the New England Journal of Medicine about a “bionic” pancreas. The device received a great deal of coverage in the popular media—much of it sensational and misleading, according to Schwitzer. “It was being treated like it was the Holy Grail,” he said. “There were stories calling it a cure, that it was the final solution for diabetes, the next best treatment, and so on.” Very few media reports included context or mentioned that the device was only tested in 52 people for five days, Schwitzer pointed out. “So I wonder how many patients or families were demanding access to this technology based on misleading media stories. We’re constantly seeing examples like this, and they do harm.” Schwitzer said that because nurses provide so much of the health care education delivered in the clinical setting, they’re in an ideal position to help consumers understand information that comes from the media. “Nurses play an important role as communicators,” he said. “I invite nurses to come to our site, which can help them better understand what to look for in a media report and how to more easily see red flags. And then they’re better equipped to discuss these issues with patients.”—Roxanne Nelson ▼ ajnonline.com
The Reporting of Health Information in the Media Nurses need to be aware of the pitfalls.
T
he American Cancer Society didn’t mince words when it ran this ad in the 1970s: “If you’re a woman over 35, be sure to schedule a mammogram. Unless you’re still not convinced of its importance. In which case, you may need more than your breasts examined.” This attempt at trying to convince women to get screened for breast cancer relied on powerful tools of persuasion—fear, guilt, and one’s own sense of personal responsibility. Although health information can greatly benefit consumers, some reporting by the news media, drug and device advertisers, and even health care systems or individual facilities can be confusing, biased, contradictory, or misleading. It’s the quality of the message that’s important, according to Steven Woloshin, MD, professor of medicine and of community and family medicine and codirector of the Medicine in the Media Program at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire. People aren’t able to make an informed decision if the information is limited or biased. “Ads should help people make a decision, not just push them to do what you want them to do,” Woloshin told AJN.
INTERPRETING THE MESSAGES
Health-related messages in general can be difficult to interpret. The public is often left confused by reports about how well a drug works or whether products, such as electronic cigarettes, are dangerous or benign, frequently while debate among manufacturers, advertisers, regulators, and researchers rages behind the scenes. Woloshin said the problem is often two pronged. First, the messages or reporting may be incomplete, misleading, overstated, or just unclear. Second, there can be issues with how these messages are received by the target audience because many consumers don’t know how to critically read health- related messages and may be unaware that key data are missing or unable to understand the evidence behind certain claims. [email protected]
Referring to a Memorial Sloan Kettering Cancer Center ad in the New York Times Magazine that read, “The early warning signs of colon cancer: You feel great. You have a healthy appetite. You’re only 50,” Woloshin and several coauthors pointed out in the November 1, 2012, New England Journal of Medicine that many men and women in that age range who were frightened by this message would be “surprised (and relieved) to learn that most 50-year-olds who feel great and have a healthy appetite do not have—and will not soon develop—colon cancer.”
GETTING THE RIGHT INFORMATION
Gary Schwitzer, adjunct associate professor in the School of Public Health at the University of Minnesota, Minneapolis, agrees but takes it a step further. He thinks that in addition to improving health care communication, improving the public dialogue about interventions is a major health care policy and reform issue. “Whenever you hear a claim about an intervention, you should not be hearing just about potential benefits,” he said. “We should be getting information AJN ▼ October 2014
▼
Vol. 114, No. 10
19
AJN REPORTS
about cost and about the scope of harms and benefits.” HealthNewsReview.org, a Web site run by Schwitzer, evaluates health care journalism, advertising, marketing, public relations, and other messaging that can influence consumers, and provides criteria that consumers can use to evaluate such messaging themselves. According to Schwitzer, the country’s overall report card isn’t very promising. Of almost 2,000 stories gleaned from a wide variety of news organizations, the majority received a grade of “unsatisfactory” because they didn’t address important factors, such as cost, the quality of the evidence, harms and benefits, or alternatives that are already available. Sometimes public health communications can actually have an effect that’s the opposite of what’s intended. Nyhan and colleagues, writing in April’s Pediatrics, surveyed 1,759 parents and found that the promotion of vaccines actually decreased some parents’ intention to get their children vaccinated. Although misperceptions that vaccines cause autism were reduced, parents’ intention to vaccinate was also decreased, particularly among those parents who held the least favorable attitudes toward vaccines (for more on the study see In the News, June). “The problem is that many people approach a controversial issue like vaccination with strong preexisting beliefs,” said the lead author of the study, Brendan Nyhan, PhD, assistant professor of government at Dartmouth College. “When they receive information that challenges those beliefs, they may actively resist it and as a result not change their views. “People don’t always respond this way to public health messages, of course,” said Nyhan, “but it’s a risk, particularly with the most contested and emotional issues.” More research is needed, he said, especially on effective vaccine messaging. “At the same time, however, it’s not clear that more or different messaging is the solution to the problem. Dwelling on misinformation risks making the problem worse.”
WHO DOES THE PUBLIC TURN TO FOR INFORMATION?
It often seems that the public is more likely to listen to celebrities than to advice from health care experts or organizations. Jenny McCarthy, for example, has emerged as one of the most visible and outspoken opponents of vaccination, and many blame her for rising numbers of unvaccinated children. “Celebrities can be important, but also detrimental,” said Woloshin. Celebrities can also have a positive effect, however. Actor Michael J. Fox has raised more than $350 million for Parkinson’s disease research, and singer and songwriter Elton John has raised $300 million for research on HIV and AIDS, according to a study in the December 21, 2013, issue of BMJ. 20
AJN ▼ October 2014
▼
Vol. 114, No. 10
Nyhan suggests that trusted health care providers may be more effective at promoting vaccination than media reporting. This is true in other areas of health care, such as cancer screening and drugs, where the messaging (from ads in particular) may be unclear, misleading, or missing essential information. But even providers are sometimes confused or aren’t up to date on the information being disseminated in the media. This is particularly true about direct-to-consumer drug advertising, Woloshin said. “The drug ads are required to list potential harms, and they comply—but not in a way that is really absorbed by consumers,” he said. “People tune it out. What [the ads] often don’t do is actually tell you how well the drug works,” leaving it to the consumer to fill that information in. “We need to create clear drug information and disseminate it, but right now there is asymmetry in advertising,” said Woloshin. “Unfortunately, consumers and even clinicians may have difficulty deciphering the relevant information. To make an informed decision, they need to weigh the risks and benefits, and you’re not going to find that in the drug ads.”
WHAT CAN NURSES DO?
Schwitzer believes that nurses need to become more familiar with the elements of good reporting and be better prepared to answer questions and educate their patients. One recent example of irresponsible reporting was sparked by a report in the New England Journal of Medicine about a “bionic” pancreas. The device received a great deal of coverage in the popular media—much of it sensational and misleading, according to Schwitzer. “It was being treated like it was the Holy Grail,” he said. “There were stories calling it a cure, that it was the final solution for diabetes, the next best treatment, and so on.” Very few media reports included context or mentioned that the device was only tested in 52 people for five days, Schwitzer pointed out. “So I wonder how many patients or families were demanding access to this technology based on misleading media stories. We’re constantly seeing examples like this, and they do harm.” Schwitzer said that because nurses provide so much of the health care education delivered in the clinical setting, they’re in an ideal position to help consumers understand information that comes from the media. “Nurses play an important role as communicators,” he said. “I invite nurses to come to our site, which can help them better understand what to look for in a media report and how to more easily see red flags. And then they’re better equipped to discuss these issues with patients.”—Roxanne Nelson ▼ ajnonline.com
