Just the Facts: Effective Medical & Health Reporting Made Easy
The Do's and Don't of Medical/Health Reporting

By Guenther Krueger

Communicating health information is a specialized and complicated task, whether the audience is the public or the professional. Information comes from a variety of sources and is reported in many ways. How the information is presented and which aspects are highlighted become important determinants of the story's interpretation.

Media stories tend to have a feeling of authority and permanence to them, making people react negatively, even with hostility, when there are errors. This is particularly the case for health-care professionals who view sloppy reporting with disdain. When the Globe and Mail has as its headline, "Fatal viruses return with a vengeance," we might forgive the hackneyed combative style. However, the first line which states, "They're back. Cholera, malaria, tuberculosis..." is misleading, since not one of these three diseases is caused by a bacterium.What else is incorrect in the story to come?

Learning to report in as accurate and responsible a manner as possible is an ongoing process. Here are some tips and tricks I've learned that can help you get it right.

Keep your audience in mind
If you are writing for professionals, you can assume a general level of knowledge and background. However, if the story is for the public, aim for clarity and an explanation of terminology that is necessary towards understanding the key issues. Photographs, charts, diagrams, pull-outs and sidebars can often go a long way towards helping people interpret complex theories.

Ask the right person the right questions
If at all possible, ask your questions of the researcher who has conducted the study, or presented the findings. Frequently these days, PR people will handle the media giving the story an instant spin or veneer. My experience is that while scientists may be objective and more cautious about extrapolating the results, PR people are much less so and may try to place an inappropriate "breakthrough" or "breaking news" slant on the story.

Key questions include the following:
"Why was this area chosen for study?" "Why now?" "What did you find and what does that mean for clinical practice?" "What does it mean in terms of implications for further research?" "How does this fit into the overall scheme of research in this area?" "Who funded the work?"

When you are out of your depth...
In an ideal world we would all understand exactly what experts tell us, we would formulate the right questions and probe appropriately in order to shape the story into a model of clarity and thoughtfulness. In reality of course, we sometimes drown in technical jargon and the strange intricacies of basic science research findings.

Keep in mind that often the best person to synthesize the results of studies is the person that conducted the study. Research and peer-reviewed journals demand a certain level of jargon. You on the other hand can aim for clarity and even simplicity. Some appropriate questions to ask of researchers include:

"What is the take-home message here?" "What are the implications for busy family physicians?" "Where does this fit into the existing treatment arsenal?" "Does it replace conventional treatments?" "Augment them?" "Or is it all too preliminary to tell?"

Aim for a logical flow and above all, clarity
If you don't understand it, neither will the reader. If it's fuzzy to you, it will be unclear for your audience. If there is a break in logic, others will have difficulty following your argument. Attempt to be clear without being patronizing, explain without being pedantic, and logical without being tedious.

Always keep in mind that disease causation is complex
How people become ill is not nearly as well understood as people generally believe. Someone sneezing in a room will release millions and millions of disease-causing organisms and only one person will become ill. Why?

Disease is caused by a range of factors. These include:
Genetic predisposition or heredity; Socio-economic factors; Strength of the immune system; Diet; Lifestyle factors such as drinking, smoking, getting enough rest; Exposure to viruses, bacteria, parasites; Age, sex; Psychological variables.

These and many other factors come together to make you ill or well, healthy or unhealthy. Simple, single causes are unusual but rather fit into a larger whole. Healthy people don't do one thing right, they do many things correctly. Unhealthy people often practice a wide variety of inappropriate things that contribute to their disease.

Be careful with extrapolation
It seems that everything these days is groundbreaking and innovative. Some of it may be, but the vast majority of research moves knowledge forward incrementally. The "Salk vaccine" days- when one important discovery could literally wipe out a disease entity - are long gone. Because new knowledge and understanding happens slowly and unevenly, the projected path of actual clinical application is also bumpy and somewhat unpredictable. So, even though editors and the public may demand simple solutions, the journalist should resist giving them unless there is very clear evidence for them.

Many times, research findings will alter the "risk balance" of health in certain individuals. Lowering your cholesterol won't necessarily make you live longer (although it's possible). What it will do is lower your risk for cardiovascular complications, causing you to stay healthy longer and thereby increasing your chances of longer life. Continuing to smoke won't kill you (although again, it's possible), but it will greatly increase your chances of all kinds of harmful effects which will increase your chances of contracting a range of diseases.

Risk is tricky to understand and interpret. While people want the shortest possible distance between cause and effect, responsible journalism will attempt to explain it more in terms of risk/benefit.

Improve your knowledge and your tools of the trade
There are certain things with which you should be familiar, if you're going to do any health-care reporting at all.

You should be familiar with the scientific approach by which a problem is defined, a hypothesis or question is raised, deductive reasoning is applied, the hypothesis is tested through collection and analysis of data, and finally, the hypothesis is confirmed or rejected.

You should understand the clinical trial process, the scientific way in which agents or procedures are tested to ensure safety and effectiveness. Methods are compared, often using a placebo or sham treatment that makes objective measurements possible. There is also a phase process where, for example, pharmaceuticals move from the laboratory, into animals, then into selected individuals, and finally into widespread use.

The more you understand about research design, the more comfortable you will be in looking at scientific studies and analyzing where potential problems might arise. Of course, few of us have the background and expertise to determine whether appropriate statistical inferences were made and whether the general study design is robust and well-constructed. Even professional hire statisticians to do the number crunching.

However, you should be familiar with two terms: validity and reliability. Validity refers to the extent to which the study measured what it was supposed to. Reliability refers to whether the measuring device is consistent in measuring whatever it measures.

There are many interesting and informative Internet sites that explore all of the above-mentioned processes and concepts. As a good journalist, you shouldn't have any trouble finding them.

A working knowledge of the principles of medical genetics, a field that is rapidly becoming a common denominator in many diverse areas, is useful.

Avoid the blame game
Every disease and condition usually has some sort of organizational umbrella or funding mechanism, and every single one of them will tell you that they are underfunded. While money is of concern to everyone, statements comparing resource allocation in terms of some arbitrary numbers or comparing one disease to another, is inflammatory and counterproductive.

The pharmaceutical industry
Drug companies go to a great deal of trouble to get the word out about their products. Their influence is pervasive and it's useful for journalists to have little warning flags pop up when the information comes from a pharmaceutical company. While the information need not be invalid, it only stands to reason that there is an agenda and a spin that will favour the product or the company.

How companies promote their products and influence consumer and physician decision-making is a complex and controversial area. The more you understand about the process the better you will be able to navigate through the minefields of company-sponsored bumf.

Pharmaceutical companies are masters of the advertorial. Selected scientific studies, presented by high-ranking researchers in professional forums with carefully-invited and selected participants can provide a very subjective environment for a product.

All that said, few advances have had such an impact on the quality of life in Western culture as the introduction of pharmaceutical agents. And of course, they are costly to produce and require a free-market economy in which to thrive.

Alternative therapies and products
The area of complementary medicine usually has a built-in polarization that can be troublesome or provocative depending on your point of view. Often the differences in approach and opinion are related to the scientific methods and the way in which anecdotal evidence takes the place of rigorous research.

None of this is good or bad, but it does require special challenges. My advice is to avoid those topics you consider flaky altogether.

Build up your personal reference library
Of course there is a great deal of useful information on the Internet. But it still can't take the place of some good reference books. To get you started:

Stedman's Medical Dictionary, 26th Edition A great overall book that I use almost daily.

Medical English Usage and Abusage by Edith Schwager Published by Oryx Press, this reference is guaranteed to improve your grammar and terminology.

A medical spell-checker is very useful for your word processor. Several are available
Anatomy and physiology CD ROMs may be useful to brush up on these areas

The American Medical Association Encyclopedia of Medicine A good reference presented in lay terms. Not particularly comprehensive, but sometimes a good starting point when you know nothing about a disease or problem.

Pharmaceutical reference books. There are many, and many people have a copy of CPS. However, I recommend going through the nursing section at the health sciences bookshop and browsing through several before you choose. Often these texts have useful patient teaching information that can be useful when writing a story.

Feel free to contact me if you have further questions: Guenther Krueger, E-mail: gkrueger@istar.ca

Published in Sources, Number 45, Winter 2000.

See also:
Science Writing for Daily Newspapers

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