summer-2003-Part 2-live - Nieman Foundation - Harvard University

Medical Reportingexample, a study showing that a treatmentreduces tumor size in cancer patientsdoes not necessarily mean it alsosaves lives. It might, in fact, do moreharm than good.Judging whether or not the evidenceis relevant to alarger group ofpatients involvesasking who hasbeen studied andwho is affected bythe condition.Therefore, thebasic questionsinclude: Do theseresults really applyto other patients?How do you know?When looking for clues about whatis weak scientific evidence for treatments,what follows is a list of familarcharacteristics:• Preliminary results (often presentedat conferences and said to be “basedon my experience”)• No control group (only before andafter measurements)• No randomization (often resultingin systematic errors)• Few observations (often making itimpossible to draw conclusions)• Biased samples (particularly sick/healthy or old/young, or narrow subgroups)• Major dropout (resulting in systematicerror)• No use of blinding (allowing expectationsto influence the results andhow they are interpreted)• Short follow-up (leading to prematurejudgments of treatment successor failure)• Lab values only (rather than symptoms,quality of life, and survival,which matter the most to patients).How Can the News BeReported Fairly andAccurately?Balance is often considered a hallmarkof fair reporting. In the medical beat,this means, for example, reporting theeffects and the side effects, as well asSeasoned medical reporters are distinguishedfrom gullible ones by their ability to remainskeptical toward unproven claims—whether ininterviews, in press releases, at conferences, injournal supplements, and on the Internet.the benefits and harm. Thus, when anexpert discusses treatment from a singlepoint of view, a good medical reporterwill inquire about the other side of theissue and ask for such evidence.Balance also means conveying importantambiguity and controversy.Both sides of an argument should bepresented. More specifically, exposinga lack of scientific support for eitherside of an argument is equally important.In fair medical reporting, it is alsoimportant to learn how to choose typicalexamples. At times, medicine offersexamples of odd phenomena—incurablediseases that mysteriously disappearafter a treatment that has beenshown to be ineffective or perfectlyhealthy people who die suddenly froma chemical that has been proven quiteharmless. Given their rarity, these casesattract journalistic attention. But whenreporting such events, journalists mustmake it clear that these are exceptionsto the rule. And when interviewing apatient with a particular disease, thepublic needs to know whether the patientis a typical or an exceptional case.Accurate reporting also entails helpingthe audience distinguish betweencorrelation and cause. When two eventsoccur at the same time—for example, apatient’s symptoms improve when anew treatment is started—this doesnot necessarily imply that one causesthe other. Correlation is not causation.In reporting about a particular healthrisk, it may be helpful to give the odds,but to also compare them with theodds of other risks to allow the publicto have information by which to compare.For example, the risk of acquiringcancer from a particular food canbe compared to the risk of acquiringcancer from smoking. Finally, goodmedical reporters return to importanttopics and follow-up their reports. Theymight reevaluate claims by approachingthe subject from new angles.Seasoned medical reporters are distinguishedfromgullible ones bytheir ability to remainskeptical towardunprovenclaims—whether ininterviews, in pressreleases, at conferences,in journalsupplements, andon the Internet.While doing researchfor my textbook on medicaljournalism, I interviewed many excellentmedical journalists. The lessonthey had learned was clear: It does nottake a medical degree to be a goodmedical reporter. What it requires isbasic knowledge of a few scientificground rules (many of which I describein my book) and, above all, commonsense and a whole lot of healthyskepticism.As psychiatrist Thomas Szasz said,“Formerly, when religion was strongand science weak, men mistook magicfor medicine; now, when science isstrong and religion weak, men mistakemedicine for magic.” Let us not add tothe confusion, but try to help the audienceby sorting the wheat from thechaff. ■Ragnar Levi, M.D., is an awardwinningmedical editor with abackground in both medicine andjournalism. Since 1992, Levi hasbeen the executive editor of “Science& Practice,” published by SBU, Sweden.He has written “Medical Journalism—ExposingFact, Fiction,Fraud” (Iowa State Press, 2001) andalso authored a monograph onevidence-based medicine.levi@pi.seNieman Reports / Summer 2003 63