Thursday, October 1, 2009

A tough week for health reporting

Two news stories this week in Britain have stirred up some old controversies about the quality and merits of popular reporting on medical matters.

The tragic death of a 14-year-old girl after receiving the new cervical cancer vaccine stirred up all sorts of issues.

So it wasn't long before the critics emerged from the woodwork and accused the media of getting everything wrong or pursuing private agendas (yes, sometimes some newspapers do have their own agendas). Here is a report from The Guardian criticising the reporting of the death of a 14-year-old girl after receiving the HPV vaccine.

A second story has also upset quite a few people - because it implied that households with parents who work full time weren't looking after their children properly. We tucked the report away as four paragraphs in the middle of a round up of child health here. Instinctively, we felt it raised all sorts of social issues rather than establishing any direct health links between parents working and their children's lifestyles. Some British newspapers made a big thing of it and upset many of their readers. Here is blogger Jayne Howarth, (who occasionally writes for Englemed)  letting rip at the research.

The problem with these controversies is it begins to sound as if  some people think these stories should not be reported. For when they are reported, there is always scope for misunderstanding and distortion of facts, on the part of headline writers and editors as well as readers.

I'm not sure that the critics of the reporting of the cervical cancer vaccine story really get the problem. It appears, according to statements released yesterday, that the teenager had an underlying and hidden medical condition - it emerges today it was a cancer in the area of the heart.  Nobody yet knows whether the vaccine - or the shock of vaccination - triggered her collapse. The vaccine is being offered to every teenage girl in the country - so if it is going to cause fatal reactions to hidden "underlying medical conditions", that surely seems a legitimate question of public policy.  And it is a real concern for parents, unless they can be reassured their child does not have "hidden" conditions that won't also cause a big reaction.

The story about working parents is more problematic. Instinctively, it seemed a story that needed treating with caution. Usually in these instances, you can spot the flaw quickly - not many people in the study, other factors, eg smoking, not properly accounted for, dodgy source.  In this instance the number of children involved was quite large, about 12,500 and the source reputable - but it felt as if the phrase "working parents" stood for a load of other issues. Instead we focused on a story from Sweden, published in the same journal, the Journal of Epidemiology and Community Health, about pecking order in the playground. And we took pains the highlight the main query about that particular study - it was from Sweden, which may well not be like other countries.

The NHS Choices analysis of the working parents story was particularly interesting and detailed. It seems to boil down to how the findings are interpreted.

Sometime ago I blogged about some guidelines for assessing medical stories. Dr Alicia White apparently provides analysis for NHS Choices and has published her own guidelines for "reading" medical news, which expand on the theme, stressing, for instance, the difference between studies involving humans and those involving laboratory animals.

In our last posting, about the new world of news reporting on the web, we suggested that writers start learning to show greater respect for the intelligence and education level of their readers.

The problem with debunking all medical reports and all scary headlines is that it gives out a rather old-fashioned and patronising message - that only the experts can make sense of the evidence. That's not the world we live in now - the public is thirsty for information and doesn't always trust 'experts', knowing they are not always right. Sometimes it is true people flit - or tweet - from headline to headline. But if they are interested in a topic, they will dig deep, checking sources and challenging conclusions.

Both readers and writers need to understand one simple thing about medical news: it is that very, very few individual pieces of research change understanding of health and medicine.

Those that do, tend to involve very large numbers of people  - hundreds of thousands. Good doctors and the public health specialists who assess evidence pull together and assess large numbers of pieces of research. Sometimes they are slow to do so and sometimes they get it wrong. Look how long it took for all the problems with hormone replacement therapy to emerge. And how long it took for British government scientists to put a stop to cattle being fed the brains of other cattle. And I'm still not convinced (and here) that British medicine isn't over-reliant on drugs to treat blood pressure when overwhelming evidence from the USA and elsewhere suggests that fitness and good diet can be effective.

So it's no wonder that the public want faster information and they want a chance to decide for themselves. From a reporting point of view, the most helpful medical organisations are those that get in fast with response and explanation. Full praise here to the British Heart Foundation who were quick to challenge a study that could have been read as disputing that eating fish is good for the heart. Report here. But it didn't happen in the case of the Coventry death - and public statements continue to be erratic and poorly sourced.

Another study involved 39,000 people in 29 Asian countries and we blogged on it a few months ago. And it reached the curious and surprising conclusion that those who "trust" the media are the healthiest. A rogue study? Perhaps.Or perhaps an argument for more rather than less health reporting.

1 comment:

  1. Jon,

    The points you raise are really important - not surprising since you come across these kinds of research stories more than most of us.

    With regard to my rant, to which you kindly linked, I acknowledge in an answer to a commentator that it is often the editor/reporter who misconstrues the information to get a headline or at least a hook to get the reader interested in the piece.

    Of course, it is important that research is reported upon (more often than not)and commented upon. What is more important, though, as you point out, is that the headline-grabber isn't distorted to reach a popular audience.

    It's a tricky one to balance and the media are culpable, with its "never mind the width, feel the quality" approach to reporting and the need to get the story - any story - in the public domain.