Scientists blame this problem on the press, claiming that reporters are careless about how they present medical research [6-8]. Reporters, in turn, accuse the medical community of obstructing, misguiding, or failing to alert the press [5, 9]. Media critics suggest that the difficulty lies with the audience: People must be more attentive and more skeptical when they interpret news about health [2, 3, 10].

Medical scientists alone cannot correct the deficiencies of medical news coverage, but neither can journalists. In many areas of health news reporting, the underlying problem is an interactive dynamic to which both parties contribute. We examine the roots of the problem and suggest that journalists and scientists share the responsibility for accurate communication to the public. We focus on four problem areas: sensationalism, biases and conflicts of interest, lack of follow-up, and stories that are not covered. In each area, we recommend specific strategies for physicians and scientists who are concerned about coverage of medicine in the media.

Problems

Sensationalism

Too often, journalists pursue medical news as if they are reporting on a hostage crisis. Information is delivered rapidly, but little time is taken to provide a context for the story. Instead, the reporting is sensationalized: The journalist overstates a scientific finding and, as a result, the public is misled about the implications of that finding. This sort of reporting has its roots in newsroom pressures to dramatize stories by sounding alarms [4] or touting cures [5], but scientists and scientific institutions occasionally contribute to sensationalism.

Scientists have understandable desires for publicity: It may help them get funding [8], is valued by institutions [11], and increases awareness of their research. The efforts of scientists to attract media attention, however, can result in flawed coverage. For example, press releases are issued that are inaccurate or incomplete [12] and press conferences are held even though the data being discussed are preliminary [13]. Scientific organizations invite the media to their presentations without providing explanations of epidemiologic and statistical concepts or access to scientists who can critique a given research effort.

The Hazards of Calcium Channel Blockers

In the spring of 1995, news wire services reported that 6 million persons in the United States who were receiving calcium channel blockers for hypertension might be increasing their risk for a heart attack by 60% [14]. Persons who were being treated for hypertension became frightened; in some cases, they stopped taking prescribed medication [15]. Physicians' offices were flooded with calls [16]. Was the reaction to the media coverage out of proportion with the findings [17]? Some believed it was and blamed the media for wreaking havoc [14, 18, 19]. However, journalists were not solely responsible for the sensationalism.

In fact, journalists had been invited to the presentation by the American Heart Association and had been given a press release on the study [20]. The press release has been described as incomplete [14]. No other written materials were given out, and reporters who covered the story had little access to scientists other than the presenter. Reporters would have benefited from a more thorough written report of the study and access to persons with the ability to criticize the work.

Sensationalized Hope

Just as the incentive to sound alarms can push the media toward overstatement, journalists' desire to offer hope can lead to a false portrayal of new treatments. Many examples of this effect have been seen: An unusual and invasive treatment for Alzheimer disease was widely publicized after a small, unblinded pilot study [13]; fluoxetine hydrochloride (Prozac, Dista Products and Eli Lilly and Company, Indianapolis, Indiana) was hailed as a certain cure for depression when it was introduced [21]; and melatonin recently received excessively positive media treatment as a "cure" for aging [22, 23]. Journalists who publicize false claims can be faulted for not being skeptical, but the scientists who provide the information must share the blame.

Sensational Health Risks and the Tendency To Ignore Negative Studies

The negative story about potential health hazards is another sensationalistic tactic. Such stories often acknowledge only the extremes, that is, only two sides of the story: the side of the person who has been harmed and the side of the party that seems to be responsible. For example, news reports about the hazards of breast implants described a battleground on which women who feared that their implants were harming them were pitted against the manufacturers of implants [3]. Little attempt was made to enable the public to understand how scientific studies could shed light on the controversy. Instead, the journalistic drive to present a conflict [21] combined with the journalist's need for balance (equal representation of both sides) resulted in superficial reporting.

Journalists argue that scientists contribute to sensational stories about health risks when they prevent the public dissemination of information [24]. In the case of breast implants, the existence of "secret" corporate documents that described potential hazards of implants inspired heightened press coverage and public attention [3]. Similarly, when reports of research fraud in the National Surgical Adjuvant Breast and Bowel Project emerged in 1994 [25], a key aspect of the story was the claim that researchers had failed to be honest with the public and the press [24, 26].

Inaccurate reporting about health risks is furthered by bias in the media and the medical community against negative studies. The media do not mention negative studies [27], perhaps because they seem to be inconsequential. This omission is then compounded because medical journals are less likely to publish studies that have negative results [28] and scientists are less likely to submit them for publication [29].

Recommendations

1. Researchers who present papers at meetings or publish them in journals should be available to the press to clarify and explain their findings.

2. Closed discussion of research may provoke sensationalism that open discussion could prevent.

3. Journals should make efforts to interest the press equally in negative and positive studies.

Biases and Conflicts of Interest

To avoid inaccurate stories, reporters need to examine the credibility and biases of scientific sources. Such examination is often not done, however, possibly because reporters are misled when the public relations efforts of scientists, institutions, or the pharmaceutical industry turn into blatant boosterism. Scientists or institutions are not wrong to invite the press to cover their research or findings; on the contrary, the media should be stimulated to provide coverage of certain issues. For example, the Centers for Disease Control and Prevention has been criticized for not doing more to interest the media in early reports on the acquired immunodeficiency syndrome (AIDS) [5]. At the same time, however, public relations efforts should be accurate.

The Press Release

Competition between research institutions for press coverage, combined with similar efforts by drug and device manufacturers, has resulted in medical news reporters being barraged by press kits and other materials from corporate sources, academic institutions, medical journals, and professional organizations [12, 30]. These materials can be misleading and even deceptive [31], sometimes amounting to nothing more than sensationalism [12]. Researchers can prevent inaccuracies by disallowing press conferences held to discuss preliminary data [13] and demanding final review and approval of news releases.

Access to Scientists

The major sources for a reporter's story on a research article or presentation are generally the authors or presenters themselves. Reporters who wish to verify such stories, however, should also speak to persons who can criticize the work. To increase reporters' access to critical sources, medical journals could release the names of peer reviewers who are willing to speak with them. When the press is invited to meetings at which peer-reviewed abstracts are presented, sponsoring organizations could also provide reviewers' names (if reviewers agree to this practice). Alternatively, journals could provide the names of experts who have published widely in the relevant field. Journals sometimes pair editorials that criticize a study with the study itself, but few studies are currently accompanied by such editorials.

Disclosing Conflicts of Interest

A journalist's audience should be told explicitly whether the journalist's source of information could benefit financially from the media attention or whether the source is funded or employed by an institution that will benefit. However, such conflicts of interest are often not apparent to reporters or their audiences. One example comes from a recent article about melatonin [22]. Among sources who were quoted about the anti-aging properties of melatonin was Dr. Russel Reiter, author of a popular book on melatonin [32]. Because of the book, Reiter stood to gain personally from press attention to melatonin, but the article described him only as a "scientist."

Reporters have become more aware of conflicts of interest because of policies of medical journals that require conflicts to be revealed [33, 34]. For example, some reporters who covered a recent study of drug treatment for the premenstrual syndrome noted that the study had been funded by the maker of the drug in question [35]. Reporting potential conflicts of interest is crucial because this enables the readers to judge the validity of a claim for themselves. The medical community could do even more; for example, more journals could require authors to reveal conflicts of interest [34].

Public Relations Disguises

Several recent incidents raise concern about the extent to which the press is misled by industry-sponsored comments that are disguised as the objective views of a physician or scientist. In one case, a "Dear Doctor" letter that was sent to physicians and viewed by reporters seemed to offer a cardiologist's independent perspective about the safety of calcium channel blockers. It was later discovered that the cardiologist's comments had been solicited and the letter had been sponsored by Bayer Corporation (West Haven, Connecticut), a manufacturer of nifedipine [36]. In Europe, a press conference on calcium channel blockers was held during a scientific meeting. It turned out that one of the persons speaking to the press was not a scientific presenter but a guest whose invitation had been suggested by Bayer. Reporters, however, were not told of the company's involvement [15]. In some instances, editorials that seem to have been written by independent physicians have instead been commissioned, paid for, and partly written by public relations firms that represent the pharmaceutical industry [37-39]. Industry-sponsored letters, editorials, and speakers should be identified as such; this information should not be kept from reporters.

Recommendations

1. Scientists should check all institutional press releases for accuracy and clarity.

2. Medical journals and sponsors of medical meetings should provide access to experts who can assist journalists to place new information in the proper context. Persons ideally suited to this task are those who have peer reviewed a given article or abstract before its publication or presentation.

3. When financial interest or research sponsorship raises a potential conflict of interest, journalists should be told of the conflict by scientists, journal staff, or members of professional organizations.

4. Industry sponsorship of research and of persons who speak or write about a research effort should be identified as such.

Lack of Follow-up

The public is generally unaware of the scientific process and is therefore likely to give more importance than scientists would to the results of a single study [40]. The public might be more aware of how medical research works if news reporters spent more time following ongoing stories and returning to subjects that were first covered when only preliminary findings were available. This follow-up is generally not done, partly because editors and producers are not interested in such stories and partly because journalists themselves may not appreciate how the scientific process works. That preliminary findings must be tested in large-scale clinical trials or that an unblinded or nonrandomized study does not carry the weight of a blinded or randomized one is not easily understood by the public or by journalists [4, 40, 41].

Even reporters who are experienced at writing about medicine have difficulty following the medical literature. Two writers who won a Pulitzer Prize for a series of articles on gene therapy later described their attempts to read scientific journals [42]:

"We ... found them incomprehensible; utter gobbledygook. It took us months to understand the jargon so that we could discern the important papers from the inconsequential."

Certain terms are likely to be misinterpreted. The term negative study, for example, may be misunderstood by a reporter as referring to a study with a bad outcome [4] when, in fact, the result of the study was simply inconclusive or no effect was detected. The term meta-analysis is scientific jargon that may sound like metaphysics to the layperson.

No Follow-up on the Need for Carotid Endarterectomies

If adequate follow-up stories are not presented by the media, the public may be deceived. In the early years of the AIDS epidemic, network news coverage of potential cures for the syndrome was misleading. Patients with AIDS often heard that a certain drug trial had seemed to be successful, but they did not learn about the drug's eventual failure [5]. Institutions sometimes contribute to a lack of follow-up by presenting research outcomes as the final word. In 1994, the National Institutes of Health held a press conference to announce the findings of a study on the use of carotid endarterectomy to prevent stroke. Speakers at the conference suggested that the procedure should be more widely used [43]. It later became apparent that the implications of the study were controversial at best and could not necessarily be applied to all patients who had significant carotid obstruction [44]. The public did not learn this information, however, because the National Institutes of Health did not hold a follow-up press conference to correct the initial misimpressions and reporters did not continue to track the story. Public understanding of a supposed association between coffee drinking and pancreatic cancer was hampered by a similar lack of follow-up. The press covered the article that suggested the association [45] but not the subsequent research that failed to confirm it [2]. This sort of lapse in coverage allows preliminary findings to assume the status of a public myth [5].

The potential for good follow-up reporting on science is unfortunately diminished by a cycle involving both journalists and scientists. The media is disinterested in follow-up stories; the scientific community takes this disinterest to mean that it should not seek coverage of follow-up research. In turn, journalists do not hear about confirmatory studies, and the cycle continues.

Recommendation

The health science community should promote contact with the media when confirmatory or nonconfirmatory studies emerge in an area that has already received attention from the press.

Stories That Are Not Covered

Not long ago, medical news stories were typically written by general assignment reporters. Reporters who specifically cover medicine are now commonly found at many major news organizations [46, 47]. Although such specialized reporters are now available to cover medical news, important issues that are recognized by physicians and scientists continue to be ignored by the press. One explanation for this is that journalists focus too narrowly on certain areas; another is that journalists who investigate medical science often cannot obtain answers to their questions. Again, the responsibility for this problem is shared by the media and the medical science community.

Narrow Focus on Politics and Journals

Journalists have been criticized for having a limited focus. For example, many reporters stopped covering the rising costs of medical care when the health care reform effort died in Washington; this was because the story was no longer considered political news [21]. Journalists also narrow their scope by giving disproportionate attention to individual journal articles. Each week, medical reporters feel obliged to glance at the lead articles or press releases from five or six particular peer-reviewed journals [30, 46]. This sense of obligation to cover particular articles can discourage reporters from following an area of research, a process that might involve contacting scientists, scanning specialty journals, or reading papers other than lead articles [48].

Medical journals promote media overemphasis on single articles through the embargo system. Under this system, journals provide news organizations with advance issues and press releases that cannot be made public until a specified date and time. Embargoes are sometimes represented as a way to encourage accurate reporting, and reporters have said that they appreciate having time to research a story without the fear of being "scooped" [49]. The embargo system, however, increases the perceived newsworthiness of a journal article, thereby encouraging an overreliance on journals as a source of scientific news [12, 50].

Information That Is Withheld or Not Explained

Issues sometimes go unreported in the media because the medical community does not want to discuss problems publicly or fears that journalists will not understand the issues. An example involves the incompetency of clinical laboratories that was documented during the 1970s and 1980s. At the time, some physicians knew that the high error rate in Papanicolaou test readings was partly attributable to poor laboratory conditions [51]. When media coverage brought heightened attention to the problem, guidelines were established and error rates declined [52]. Another example concerns data gathered by New York State comparing the performance of physicians and hospitals with regard to coronary artery bypass graft surgery [53]. In this case, a New York newspaper used a freedom of information request to elicit greater disclosure of the data.

How can journalists become motivated to investigate areas in which they lack expertise, and how can scientists and physicians be encouraged to share information about problems on which they are the experts? It has been argued that one task of public health professionals is to work with the media proactively to prevent distortions and to make health news more comprehensive. These efforts, termed media advocacy, can be effective [54]. For example, the New York State Health Department, believing that the press did not understand the limitations of its data comparing cardiac surgical performance, instituted a program to educate journalists about the data. The program apparently reduced the number of misleading news stories [53].

Corporate Pressures To Remain Quiet

It would be naive not to recognize the many reasons that scientists have for being reluctant to speak with reporters. The competitive nature of science and its increasing interdependence with the corporate world have left scientists fearful that if the press (or even a colleague) learns about research prematurely, the news could adversely affect a company's investment or the stock market's response to that investment [55]. Some scientists say that this sort of thinking promotes a degree of secrecy that is unnecessary and immoral [56]; others argue that temporary secrecy may be necessary to generate research funds [57].

In some cases, information is withheld from the public because of concern that vested interests may do battle on researchers. The tobacco, pharmaceutical, and medical device industries have been accused of using intimidation and lawsuits (so-called SLAP suits, the primary purpose of which is to intimidate) to prevent or delay the publication of research [20, 58, 59]. In one case, RJR Nabisco, the manufacturer of Camel cigarettes, brought legal action against scientists whose studies demonstrated the appeal of "Joe Camel" to young people [58]. The company demanded the names of study participants who had been promised anonymity when they consented to participate in the research. Several other such cases have been described [20]. It is understandable that scientists who work in such an environment might not want to speak openly with reporters. However, the resulting silence lessens the potential for effective media coverage.

In a case that recently received attention, Knoll Pharmaceutical Company (Mount Olive, New Jersey) threatened to bring legal action against the University of California, San Francisco, if a certain research manuscript was published [59, 60]. Individuals at the university approached a reporter for the Wall Street Journal about the suppression of peer-reviewed research findings (King RT Jr. Personal communication). That reporter subsequently described the episode in a front-page article [59]. One year later, the manuscript was published [61]. The company claimed that it had agreed to the publication partly because of "intense media speculation about the study's findings and conclusions" [62]. It seems likely that the company would have prevented publication if the media had not become involved.

Journal Pressures To Remain Quiet

Medical journals further discourage openness by refusing to publish research that has already been presented to the public [63, 64]. Although the advantages and disadvantages of such a policy can be debated [65, 66], it has had a strong negative effect on the access that reporters have to working scientists [67]. Researchers who are aware of the policy regularly refuse to discuss their findings with the press; journalists who have heard of a certain study then find themselves unable to interview its authors [66, 67].

Recommendations

1. The purposes served by the embargo system of medical journals should be evaluated by the journals and members of the press.

2. Concerns that research data will be misinterpreted by the media are best addressed by providing members of the media with easily understood explanations; withholding the information may promote even greater misunderstanding.

3. Those who understand the complexities of newsworthy issues in medicine and public health should work with the media proactively to prevent distortions and to make news coverage more comprehensive.

4. The academic medical community should act to protect its members from intimidation by industry. These actions may include alerting members of the media to the intimidation of scientists.

5. Medical journals should revise their policies so that scientists who explain a study to reporters do not necessarily jeopardize their chances of publishing their work.

Conclusions

Examining the media's coverage of medicine seems to show that medical news reporting is less than ideal. Medical scientists and journalists share the responsibility for this problem. Although this paper has focused on the medical science community and the ways in which it can encourage accurate medical reporting, we recognize that journalists will also have to take active measures to improve the situation.

For scientists, the process of contacting or answering the media should be a well-thought-out process. Reporters should be able to assume that press releases are accurate, findings are not overstated, and conflicts of interest are acknowledged. Scientists deserve similar considerations from the media. Scientists should not be quoted out of context, and care should be taken to explain the implications of their research. It is precisely because of experiences in which such minimal expectations were not met that some physicians and health scientists view reporters as their worst enemies. It often seems that the best route is simply not to speak with the media.

However, ignoring the media overlooks the profound effect that health news reporting has on patients. In almost all examples of journalists' failures to be accurate, to identify vested interests, to follow up on stories, and to cover important health issues, patients are the ones who stand to suffer the most. It is the public that ultimately benefits from medical scientists' contributions to improved media coverage.