28 March 2018

Medicine and the media – an uneasy partnership

Communication Research Social Media

A few months ago, a journalist asked if I could write a piece on pregnancy “curing” endometriosis. After informing her this was, in fact, an old-wives tale, I suggested, instead, an article on the myths and misconceptions surrounding endometriosis.

She never got back to me. Several weeks later the article did appear, authored by a non-clinician, but with the message that Australian doctors were still advising their patients with endometriosis to fall pregnant in the hope of a cure.

End result? A much more provocative article, which was followed by contentious and often angry commentary from the readers.

For me, this encapsulated the uneasy relationship between medicine and the media. The 24-hour media beast has an insatiable hunger for copy but moves quickly on to the next tasty morsel without too much insistence on accuracy.

As the numbers of journalists fall, there are now not only crippling deadlines, but an increasing pressure for many online hits as possible – thus the rise of “clickbait”.

There are fewer health and science specialist writers these days and wading through evidence and counter-evidence is not only tedious, but impossibly time-consuming.

Journalists are right to be sceptical of claims being made by government, industry and those with possible conflicts of interest. Yet when dealing with academic experts, they often blithely ignore an identical potential for bias and agenda in the quest for academic metrics.

“Hype” in science is on the rise because many academics know that the more controversial the findings the higher the rate of citations, interest factors and media attention.

There is no doubt that the internet and social media has changed forever the way we access and use health information, but there are acknowledged problems. Constant review and curation is required if the quality and reliability of information is to be maintained.

For clinicians, social media is a two-edged sword. It enables the formation of worldwide clinical communities in which paradigms can be challenged and information shared, but it also means that traditional guidelines around privacy and boundaries for patient care can become blurred. We need to ask ourselves whether we are really willing to make the transition from clinician to “patient influencer”.

In 2010, more than half those surveyed in the United States identified the media as an important source of healthcare information, 1 so getting it wrong has important implications. Misinformation may drive some consumers to unnecessary consultations and unproven therapies while others may be wary of treatments that could benefit them.

The bottom line is that it is so much easier to scare people than to “unscare” them.

We are also seeing an increasing influence of social networking platforms on health behaviour, with 2015 data suggesting that nearly 90% of subscribed older adults are using them to find and share health information.2

Such platforms play an important role in linking those with similar conditions as well as providing powerful personal validation and the opportunity for advocacy. Yet as evidence-based medicine has moved away from case-report and anecdote, social media relies on such individual stories to synthesise a collective knowledge and shared experience.3

Unfortunately, negative health experiences seem to motivate more involvement, anger and frustration than do positive. The media is aware that social media sites provide a ready source of patients willing to share their stories. The selection of which exemplars to use is guided by the subjective sentiment of the journalist, who is only too aware that such testimony increases audience engagement, cultivates emotional investment and makes research-based information palatable.

Bad news has high impact and the mere suggestion of a clinical cover-up, plus or minus a
Big Pharma scandal, is pure catnip for journalists.  Accountability, balance and accuracy may become secondary considerations.

So what can clinicians do to improve the standard of health reporting?

We should advocate for better training for health journalists in research analysis and insist that our academic colleagues disseminate their research evidence responsibly. Absolute and relative risks should be documented in any discussion of quantitative research, since both are essential for any understanding of the true impact of the findings.

Responsible researchers and clinicians must take the time to hold media outlets to account when they ignore accepted evidence or fail to put new findings into context. And there is plenty of scope here, with one United States website rating 70% of independently reviewed health stories as unsatisfactory.

We already have some heroes in this endeavour. In 2013 Japanese media carried anecdotal reports of serious adverse events attributed to the HPV vaccine. As vaccination rates plummeted from 70% to 1%, Dr Riko Muranaka from Kyoto University challenged what she believed was irresponsible reporting. She battled personal threats, litigation and accusations that she was in the pay of Big Pharma.

In 2017, she was awarded the John Maddox prize for those who promote science and evidence on matters of public interest.5 In accepting the award Dr Muranaka said, “I really hope it will help people speak the truth and to take the side of science …”

Surely an important lesson for us all.

Dr Terri Foran is a sexual health physician and lecturer at the University of New South Wales in the School of Women’s and Children’s Health

References:

1. Henry J, Kaiser Family Foundation: Kaiser health tracking poll—May 2010. http://www.kff.org/kaiserpolls/8075.cfm

2. Tennant B, Stellefson M, Dodd V et al. eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. J Med Internet Res. 2015;17(3):e70. doi: 10.2196/jmir.3992

3. Grindrod K, Forgione A, Tsuyuki RT et al.  Pharmacy 2.0: A scoping review of social media use in pharmacy. Res Social Admin Pharm 2014; 10(1): 256-270

4. Schwitzer G. Addressing tensions when popular media and evidence-based care collide. BMC Med Inform Decis Mak 2013; 13(Suppl 3): S3 doi: 10.1186/1472-6947-13-S3-S3 PMCID: PMC4029196

5. For Dr Muranaka’s full address see: https://note.mu/rikomuranaka/n/nd26c1eaacb3e