In the Preamble to its Code of Ethics, the Society of Professional Journalism declares:
... public enlightenment is the forerunner of justice and the foundation of democracy ... Conscientious journalists from all media and specialties strive to serve the public with thoroughness and honesty.
There are examples, many in the 20th century, when print and broadcast journalists lived up to this standard with the support of editors, producers and publishers who seemed to know no other way. As is true of many professions, journalists have been called upon to develop special expertise in order to provide insights on complex issues. It follows that the special expertise defines the purview of their journalism going forward.
Medical journalism is a specialty in journalism with its own peer review and professional organization. The Association of Health Care Journalists was founded in 1997, is based at the School of Journalism of the University of Missouri and has more than 1,000 members. In their Statement of Principles, the association did not shy away from recognizing the moral hazards inherent in translating "health" news to the public:
We should strive to be independent from the agendas and timetables of journals, advocates, and industry and government agencies. We should nourish and encourage original and analytical reporting that provides audiences/readers with context. Given that thousands of journal articles and conference presentations appear each year, and that relatively few are immediately relevant to our audiences/readers, health journalists have a responsibility to be selective so that significant news is not overwhelmed by a blizzard of trivial reports. We are the eyes and ears of our audiences/readers; we must not be mere mouthpieces for industry, government agencies, researchers or health care provider ... Health care journalists should remember that their loyalties reside with the truth and with the needs of the community.
Another Reporting Specialty at Stake: Health Journalism
Living up to these principles is a challenge that is met unevenly. But the ethical standard is understood and shortcomings met with disdain in the profession.
Programs in Health and Medical Journalism have been developed at a number of the leading schools of journalism. The program at the University of North Carolina at Chapel Hill was founded about a decade ago. I have been privileged to participate on the Advisory Board for several years. This capacity coupled with my own activities as a physician and clinical educator has offered me a front-row seat in a dialectic that needs wider appreciation, if not reproach.
The consensus, at a recent Board meeting, was that health journalism is more beleaguered than most other specialties by the financial crunch that faces the entire Fourth Estate. One fallback available to editors in such a circumstance is to purchase the coverage from leading journalists in the employ of other outlets. We have grown accustomed to this when it comes to finance, politics, sports and international coverage. This compromise applies to health reporting as well. But health reporting has access to another source, one that is particularly appealing given its packaging and the cost. This source hides behind the euphemism, Health Communications.
We are all aware of direct-to-consumer advertising by pharmaceutical firms. We are bombarded daily. Billions of dollars are expended with a return on investment that is as predictable as the consequent ethical and regulatory concerns. If there is any "news" to report relating to this effort, it is appropriate for the financial pages only.
However, we are also bombarded by announcements and pronouncements from medical centers and even medical practices. Many tout the opening of a new building, or the offering of a new procedure, or claim world class expertise that outshines all others. These announcements and pronouncements are the work product of a formal department in the institution that often bears the moniker "Public Affairs" or even the "Public Affairs and Marketing Office" as is the case for my own UNC Hospitals. The departmental budget is often liberal and always part of the "overhead" of health care in our country. We all pay for these activities as part of our health care premiums.
Staffing these departments are people highly skilled in communicating to the public with backgrounds in marketing, public relations or, increasingly, health journalism. Working in institutional "health communications" is all too often the soft landing for unemployed health journalists. Hence, the pronouncements and announcements are often put forth in the glossiest of multimedia formats as well as the more standard press announcements.
Medical Press Releases Undermine Independent Research; Public 'Poorly Served'
A recent analysis of the press releases by academic medical centers casts all this activity in an unflattering light (Annals of Internal Medicine 2009;150:613-8). This analysis was a demanding exercise undertaken by investigators funded by the National Cancer Institute. Academic medical centers issue an average of nearly 50 press releases annually. Nearly half pertain to research in animals, which are almost always cast as relevant to human health.
Of the releases about primary human research, very few were describing studies that would pass muster as high quality; far more described findings that were preliminary at best. Most neglected to emphasize cautions regarding interpreting such studies. Clearly, academic medical centers are wont to promote research that has uncertain relevance to human health.
It is for this reason that I am so concerned about the decimation of the ranks of health journalists. I understand the appeal of "press releases" and the greater appeal of such that accumulate on Web sites; convenience can unburden the journalists assigned to cover more than is possible and cost-effectiveness can unburden the publisher whose cash flow is so tenuous.
However, the public is not just poorly served. The public is likely lead astray. At the very least, media must state whether the reportage is based on primary sources that take personal responsibility for the validity of the pronouncement. Better yet, independent sources should be queried as to the validity, reproducibility and relevance of the claims. But neither should pass unfiltered by health journalists who are appropriately trained and willing to assume responsibility for the quality of the input.
If the pronouncement is simply lifted from a marketing Web site, that should be disclosed. But journalism should be as outraged by a dialectic that makes this commonplace as I am about the drums to which American medicine is forced to march.
Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of "Worried Sick: A Prescription for Health in an Overtreated America" and "The Last Well Person."